Examene Joesph: Pharmacokinetis of Antiplatelets & Anticoagulants

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1

Which of the following are symptoms of deep vein thrombosis (DVT)? SATA

A. Chronic lower limb swelling

B. Pain (sharp stabbing)

C. Chest pain

D. Tenderness

E. Skin Discoloration

F. Ulceration (severe cases)

G. Tachycardia

H. Symptoms are present asymmetrically

A. Chronic lower limb swelling

B. Pain (sharp stabbing)

D. Tenderness

E. Skin Discoloration

F. Ulceration (severe cases)

H. Symptoms are present asymmetrically

2

Which of the following are symptoms of pulmonary embolism (PE)? SATA

A. Pain (sharp stabbing)

B. Chest pain

C. SOB

D. Tachypnea

E. Tachycardia

F. Skin discoloration

G. Differentiation from pneumonia: no fever

B. Chest pain

C. SOB

D. Tachypnea

E. Tachycardia

G. Differentiation from pneumonia: no fever

3

In the the Virchow's Triad, what are the 3 teirs of risk factors?

  1. Endotherial damage
  2. Hypercoagulability
  3. Venous Stasis
4

Risk Factors for DVT and PE.

  1. Immobility
  2. Factor V Leiden
  3. Obesity
  4. Surgery
  5. Major Trauma
  6. Cancer
  7. Pregnancy
  8. Estrogen-containing medications (oral contraceptives)
  9. Previous venous thromoboembolism
5

What rates the risk factors for DVT (VTE & PE)?

card image

CHADS2-VASC scoring

6

Risk factors using the Virchow's Triad

card image
  • Estrogen containing medications (contraceptives)
7

Which of the following are used to diagnose a DVT? SATA

A. D-dimer

B. Compression Ultrasound

C. Computed tomography (CT)

D. Wells score

E. Pulmonary angiography (CTPA)

A. D-dimer

D. Wells score

8

What is the D-dimer value of a person with a DVT?

< 500 (normal)

>500 in patients with DVT

9

Which of the following are used to diagnose a PE? SATA

A. D-dimer

B. Compression Ultrasound

C. Computed Tomography (CT)

D. Wells score

E. Pulmonary Angiography (CTPA)

B. Compression Ultrasound

C. Computed Tomography (CT)

E. Pulmonary Angiography (CTPA)

10

Wells score

card image
11

What is the mechanism of action of Heparin? SATA

A. A glycosaminoglycan binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

B. Selectively inhibit factor Xa

C. Prevents the conversion of fibrinogen to fibrin.

D. Inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX and X

A. A glycosaminoglycan binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

C. Prevents the conversion of fibrinogen to fibrin.

12

How is Heparin administered? SATA

A. PO

B. IM

C. IV

D. SubQ

C. IV

D. SubQ

13

What is the prophylactic dose of Heparin?

A. 150 units SubQ

B. 500 units SubQ

C. 1000 units SubQ

D. 5000 units SubQ

D. 5000 units SubQ

14

Which of the following are used to monitor Heparin? SATA

A. aPTT

B. Serum creatinine

C. PT

D. Anti-Xa levels

E. Platelets

F. Hemoglobin

G. Hematocrit

A. aPTT

D. Anti-Xa levels

E. Platelets

F. Hemoglobin

G. Hematocrit

15

Where is Heparin mainly metabolized?

In the liver

16

T/F

Heparin requires renal dosing

False

Heparin does not require renal dosing since it is primarly metabolized in the liver. At therapeutic doses, elimination of Heparin occurs at nonrenal mechanisms.

17

Why is Heparin a preferred treatment in VTE and acute coronary syndrome?

It has a short half-life of 1.5 hours

18

Which of the following are side effects of Heparin? SATA

A. Bleeding/ hemorrhage

B. Thrombocytopenia

C. Hypercalcemia

D. Hyperkalemia

E. Osteoporosis

F. Increased LFTs

G. Hypersensitivity

H. Alopecia

A. Bleeding/ hemorrhage

B. Thrombocytopenia (HIT)

D. Hyperkalemia

E. Osteoporosis

F. Increased LFTs

G. Hypersensitivity

H. Alopecia

19

What 3 anticoagulants can replace Heparin in the case of HIT?

1. Argatroban

2. Bivalirudin

3. Lepirudin

These are non-heparin anticoagulant are the direct thrombin inhibitors (DTIs)

20

What is the reversal agent of Heparin?

Protamine

21

What is the mechanism of action of Low Molecular Weight Heparin (LMWH)?

A. Binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

B. Selectively inhibit factor Xa

C. Prevents the conversion of fibrinogen to fibrin.

D. Inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX and X

A. Binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

22

How is Low Molecular Weight Heparin (LMWH) administered?

A. PO

B. IM

C. IV

D. SubQ

D. SubQ

23

What are 2 Low Molecular Weight Heparins (LMWH)?

  1. Enoxaparin (Lovenox)
  2. Daltaparin (Fragmin)
24

Which of the following are side effects of Enoxaparin (Lovenox) & Daltaparin (Fragmin)? SATA

A. Confusion

B. Thrombocytopenia

C. Diarrhea

D. Increased LFTs

E. Hemorrhage

F. Injection site pain

A. Confusion (Daltaparin (Fragmin))

B. Thrombocytopenia

C. Diarrhea

D. Increased LFTs

E. Hemorrhage

F. Injection site pain

25

Which of the following is the half-life for Enoxaparin (Lovenox)?

A. 4.5 to 7 hours SC

B. 3 to 5 hours SC

C. 2 to 4 hours IV

D. 2.1 to 2.3 hours IV

A. 4.5 to 7 hours SC

C. 2 to 4 hours IV

Note:

LMWH have a half life that is about twice as long as the half lives of heparin and are renally cleared

26

Which of the following is the half-life for Daltaparin (Fragmin)?

A. 4.5 to 7 hours SC

B. 3 to 5 hours SC

C. 2 to 4 hours IV

D. 2.1 to 2.3 hours IV

B. 3 to 5 hours SC

D. 2.1 to 2.3 hours IV

Note:

LMWH have a half life that is about twice as long as the half lives of heparin and are renally cleared

27

Which of the following are drug interactions with LMWH?

  1. Other anticoagulants
  2. Platelets
  3. Herbals
  4. SSRIs
  5. SNRIs
28

Which of the following are used to monitor Low Molecular Weight Heparin (LMWH)? SATA

A. aPTT

B. Serum creatinine

C. PT

D. Anti-Xa levels

E. Platelets

F. Hemoglobin

G. Hematocrit

B. Serum creatinine

D. Anti-Xa levels

E. Platelets

F. Hemoglobin

G. Hematocrit

29

What is the special dosing of Enoxaparin for obese patients (>100 kg)

A. 25 mg SubQ BID

B. 10 mg SubQ BID

C. 30 mg SubQ BID

D. 40 mg SubQ BID

D. 40 mg SubQ BID

30

When treating a patient with Low Molecular Weight Heparin (LMWH), what is the renal adjustment when treating DVT?

A. 25% reduction

B. 50% reduction

C. 75% reduction

D Discontinue use of LMWH

B. 50% reduction

In CrCl <30 mL/min

31

When treating a patient with Low Molecular Weight Heparin (LMWH), what is the renal dosing when treating DVT?

A. 2.5 mg/kg QD

B. 1 mg/kg QD

C. 3 mg/kg QD

D. 4 mg/kg QD

B. 1 mg/kg QD

32

When treating a patient with Low Molecular Weight Heparin (LMWH), what is the renal dosing is prophylaxis treating?

A. 25 mg

B. 10 mg

C. 30 mg

D. 40 mg

C. 30 mg

33

What is the reversal agent of Heparin?

Protamine

34

What is the mechanism of action of the Direct Factor Xa Inhibitors?

A. Binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

B. Selectively inhibit factor Xa

C. Prevents the conversion of fibrinogen to fibrin.

D. Inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX and X

B. Selectively inhibit factor Xa

35

Which of the following are Direct Factor Xa Inhibitors? SATA

A. Enoxaparin (Lovenox)

B. Apixaban (Eliquis)

C. Rivaroxaban (Xarelto)

D. Daltaparin (Fragmin)

E. Edoxaban (Savaysa)

F. Betrixaban (Bevyxxa)

G. Fondaparinux (Arixtra)

B. Apixaban (Eliquis)

C. Rivaroxaban (Xarelto)

E. Edoxaban (Savaysa)

F. Betrixaban (Bevyxxa)

G. Fondaparinux (Arixtra) SubQ

36

Which of the following are administered PO? SATA

A. Apixaban (Eliquis)

B. Rivaroxaban (Xarelto)

C. Fondaparinux (Arixtra)

D. Edoxaban (Savaysa)

E. Betrixaban (Bevyxxa)

A. Apixaban (Eliquis)

B. Rivaroxaban (Xarelto)

D. Edoxaban (Savaysa)

E. Betrixaban (Bevyxxa)

Fondaparinux (Arixtra) is administered SubQ

37

Which Direct Factor Xa Inhibitor indirectly inhibits factor Xa by directly inhibiting anti-thrombin III?

A. Apixaban (Eliquis)

B. Rivaroxaban (Xarelto)

C. Fondaparinux (Arixtra)

D. Edoxaban (Savaysa)

E. Betrixaban (Bevyxxa)

C. Fondaparinux (Arixtra)

Note:

Fondaparinux inhibits the precursor (Anti-thrombin III) from becoming factor Xa; therefore, indirectly inhibiting blocking Xa

38

Which of the following are used to monitor Direct Factor Xa Inhibitors? SATA

A. aPTT

B. Serum creatinine

C. PT

D. Anti-Xa levels

E. Platelets

F. Hemoglobin

G. Hematocrit

B. Serum creatinine

F. Hemoglobin

G. Hematocrit

D. Anti-Xa levels (only for Atrixa)

39

T/F

There are no monitoring of efficacy reequired for Direct Factor Xa Inhibitors

True

40

Which of the following are side effects of the Direct Factor Xa Inhibitors? SATA

A. Bleeding/ hemorrhage

B. Rash

C. Anemia

D. Increased LFTs

A. Bleeding/ hemorrhage

B. Rash (Edoxaban(Savaysa))

C. Anemia (Edoxaban(Savaysa))

D. Increased LFTs

41

Which of the following can be reversed by (Andexxa)? SATA

A. Apixaban (Eliquis)

B. Rivaroxaban (Xarelto)

C. Fondaparinux (Arixtra)

D. Edoxaban (Savaysa)

E. Betrixaban (Bevyxxa)

A. Apixaban (Eliquis)

B. Rivaroxaban (Xarelto)

These CURRENTLY have FDA indications

42

Which DOACS is 60% protein bound and is also a substrate of P-glycoprotein?

A. Eliquis

B. Xarelto

C. Savaysa

D. Bevyxxa

D. Betrixaban (Bevyxxa)

43

Which DOACS is/are substrates of P-glycoprotein?

A. Eliquis

B. Xarelto

C. Savaysa

D. Bevyxxa

C. (Edoxaban) Savaysa

D. Betrixaban (Bevyxxa)

44

What is the mechanism of action of the Warfarin (Coumadin)?

A. Binds to antithrombin, inactivating thrombin (IIa) and Factor Xa

B. Selectively inhibit factor Xa

C. Prevents the conversion of fibrinogen to fibrin.

D. Inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX and X and anticoagulant proteins C and S.

D. Inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX and X and anticoagulant proteins C and S.

45

Which of the following are clotting factors that are inhibited by Warfarin? SATA

A. I

B. II

C. VII

D. X

E. IX

F. anticoagulant protein A

G. anticoagulant protein C

H. anticoagulant protein S

B. II

C. VII

D. X

E. IX

G. anticoagulant protein C

H. anticoagulant protein S

46

Why is Warfarin loved and used widely especially in the outpatient setting?

It inhibits multiple factors

It can be easily reversed

There is ample research

It can be monitored with the INR

47

Which of the following are used to monitor Warfarin (Coumadin)? SATA

A. INR (international Normalized ratio)

B. Hematocrit

C. Serum creatinine

D. Hemoglobin

A. INR (international Normalized ratio)

B. Hematocrit

D. Hemoglobin

48

T/F

Warfarin is highly protein bound.

True

Warfarin is 99% protein bound.

49

Warfarin is dosed at 2-3 for which of the following patients? SATA

A. DVT

B. Afib

C. Bioprosthetic mitral valve

D. Mechanical mitral valve

E. 2 mechanical heart valve

F. antiphospholipid syndrome

A. DVT

B. Afib

C. Bioprosthetic mitral valve

F. antiphospholipid syndrome

50

Warfarin is dosed at 2.5-3.5 for which of the following patients? SATA

A. DVT

B. Afib

C. Bioprosthetic mitral valve

D. Mechanical mitral valve

E. 2 mechanical heart valve

F. antiphospholipid syndrome

D. Mechanical mitral valve

E. 2 mechanical heart valve

51

What is the dosage form of Warfarin?

A. Suspension

B. Tablet

C. Solution

D. Patch

B. Tablet

52

Warfarin is classified as which pregnancy category?

Cat X

Contraindicated in pregnancy except with mechanical heart valves.

53

What are the 2 reversal agents of Warfarin?

  1. Vitamin K
  2. Kcentra
54

What is a prothrombin complex that contains vitamin K-dependent coagulation factors II, VII, IX, X, and antithrombotic protein C and protein S?

Kcentra

55

Lyssa is a 45-year-old female that has been admitted to CRMC with SOB, chest pain, coughing and sweating. She states she coughed up blood on the way to the hospital. She is recovering from a bad fall two days ago after fainting from a ladder but reports no broken bones just a few bruises.

  • Vital signs: BP- 162/105 mmHg, HR-112, Temp- 97.7
  • Past Medical History: Hypertension, Neuropathic pain, Atrial fibrillation, Miscarriage at age 38 & Factor V Leiden Thrombophilia.
  • Medications: Aspirin 325 mg QD, Lyrica ® 75mg BID, HCTZ 25 mg QD, Zoloft ® 25 mg QD, & Climara® 0.025mg QD.
  • MD will be performing a transcatheter aortic valve implantation.

Which of the following are risk factors?

  1. Hypertension
  2. Atrial fibrillation
  3. Factor V Liden Thrombophilia
  4. Oral contraceptive (Climara)
  5. Miscarriage