Pharm 34 Flashcards

A clinician draws blood for a coagulation assay but wants to prevent clotting in the tube. Which additive is most appropriate?

A. Tissue plasminogen activator
B. Calcium chelator
C. Vitamin K analogue
D. Direct thrombin inhibitor

A patient with persistent postoperative oozing is given aminocaproic acid. The drug most directly decreases formation of which enzyme?

A. Thrombin
B. Factor Xa
C. Plasmin
D. Protein C

Aminocaproic acid is best understood as a structural analogue of which amino acid?

A. Lysine
B. Glycine
C. Serine
D. Arginine

The principal hemostatic process inhibited by aminocaproic acid is:

A. Platelet adhesion
B. Fibrinolysis
C. Vitamin K recycling
D. Fibrin cross-linking

Which heparin preparation has the greater effect on thrombin inhibition?

A. Fondaparinux
B. Low-molecular-weight heparin
C. High-molecular-weight heparin
D. Warfarin

Compared with high-molecular-weight heparin, low-molecular-weight heparin has less effect on:

A. Platelet cyclooxygenase
B. Direct thrombin inhibition
C. Protein C activation
D. Vitamin K epoxide reductase

Heparin begins its anticoagulant action by binding to:

A. Antithrombin III
B. Factor VII
C. Protein S
D. Plasminogen

After binding its target protein, heparin most directly accelerates inactivation of:

A. VIIa and IXa
B. II and Xa
C. XI and XII
D. Va and VIIIa

Which pattern most accurately describes high-molecular-weight heparin?

A. Predominant Xa inhibition
B. Platelet ADP blockade
C. II and Xa inhibition
D. Oral Xa blockade

Which pattern most accurately describes low-molecular-weight heparin?

A. Mainly factor Xa inhibition
B. Mainly factor II inhibition
C. P2Y12 receptor blockade
D. Vitamin K antagonism

Which drug is a low-molecular-weight heparin?

A. Argatroban
B. Enoxaparin
C. Fondaparinux
D. Abciximab

A hospitalized patient on a continuous heparin infusion should be followed primarily with which laboratory study?

A. PT
B. INR
C. Bleeding time
D. PTT

Five days after starting heparin, a patient develops thrombocytopenia and a new painful swollen leg. Which complication is most likely?

A. Disseminated fibrinolysis
B. Heparin-induced thrombocytopenia
C. Warfarin skin necrosis
D. Aspirin resistance

A patient develops heparin-induced thrombocytopenia with new thrombosis. Which alternative is most appropriate?

A. Argatroban
B. Phytonadione
C. Abciximab
D. Enoxaparin

A major long-term adverse effect of prolonged heparin therapy is:

A. Osteoporosis
B. Hemarthrosis
C. Folate deficiency
D. Hemolytic anemia

Another recognized long-term consequence of heparin exposure is:

A. Hyperaldosteronism
B. Mineralocorticoid deficiency
C. Copper deficiency
D. Nephrogenic diabetes insipidus

Which complication pair is classically associated with prolonged heparin therapy?

A. Cataracts and glaucoma
B. Ulcers and perforation
C. Fractures and osteoporosis
D. Neuropathy and myopathy

Heparin is generally contraindicated in a patient who has very recently undergone:

A. Vaccination
B. Surgery
C. Colonoscopy
D. Hemodialysis

Which drug is highly specific for factor Xa and is especially effective for prevention and treatment of venous thromboembolism?

A. Dabigatran
B. Cilostazol
C. Fondaparinux
D. Clopidogrel

Which drug is an oral factor Xa inhibitor?

A. Rivaroxaban
B. Eptifibatide
C. Ticlopidine
D. Hirudin

Which additional drug also belongs to the oral factor Xa inhibitor class?

A. Prasugrel
B. Edoxaban
C. Bivalirudin
D. Abciximab

Which agent is another oral factor Xa inhibitor?

A. Betrixaban
B. Tinzaparin
C. Argatroban
D. Tirofiban

Which drug directly binds the active site of thrombin?

A. Apixaban
B. Clopidogrel
C. Bivalirudin
D. Fondaparinux

Which additional agent is also a direct thrombin inhibitor?

A. Melagatran
B. Cilostazol
C. Prasugrel
D. Tirofiban

A patient requires inhibition of ADP-induced platelet aggregation after arterial thrombosis. Which drug fits best?

A. Abciximab
B. Clopidogrel
C. Rivaroxaban
D. Hirudin

Which additional drug shares that ADP-mediated antiplatelet mechanism?

A. Ticlopidine
B. Eptifibatide
C. Betrixaban
D. Enoxaparin

Which platelet inhibitor works by blocking glycoprotein IIb/IIIa receptors?

A. Prasugrel
B. Dabigatran
C. Tirofiban
D. Warfarin

Which additional drug works by the same glycoprotein IIb/IIIa mechanism?

A. Abciximab
B. Apixaban
C. Cilostazol
D. Ticlopidine

A smoker with exertional calf pain is started on a phosphodiesterase inhibitor to improve symptoms. Which drug was most likely prescribed?

A. Prasugrel
B. Cilostazol
C. Fondaparinux
D. Edoxaban

A patient with warfarin excess develops active bleeding and marked overanticoagulation. Which treatment pair is most appropriate?

A. Menadione and platelets
B. Protamine and cryoprecipitate
C. Phytonadione and fresh frozen plasma
D. Aspirin and plasma

Which vitamin preparation should never be used to treat warfarin overdose?

A. Vitamin K1 (Phytonadione)
B. Vitamin K2
C. Vitamin K3 (Menadione)
D. Folinic acid

Which drug is also an oral factor Xa inhibitor?

A. Argatroban
B. Apixaban
C. Hirudin
D. Abciximab

Which drug directly inhibits thrombin?

A. Tinzaparin
B. Prasugrel
C. Dabigatran
D. Edoxaban

Which additional agent is also a direct thrombin inhibitor?

A. Hirudin
B. Tirofiban
C. Cilostazol
D. Clopidogrel

Which drug inhibits ADP-induced platelet aggregation?

A. Fondaparinux
B. Eptifibatide
C. Prasugrel
D. Warfarin

ticlopidine: which adverse effect is most classically associated with this drug?

A. Hemolysis
B. Leukopenia
C. Polycythemia
D. Eosinophilia

Which drug is another example of a low-molecular-weight heparin?

A. Dalteparin
B. Dabigatran
C. Abciximab
D. Menadione

Which additional drug also belongs to the low-molecular-weight heparin group?

A. Tirofiban
B. Tinzaparin
C. Argatroban
D. Cilostazol

Which factor Xa inhibitor has a heparin-like mechanism yet does not cause HIT?

A. Fondaparinux
B. Rivaroxaban
C. Apixaban
D. Edoxaban

A patient receiving unfractionated heparin develops severe bleeding. Which agent is most appropriate for immediate reversal?

A. Idarucizumab
B. Phytonadione
C. Protamine sulfate
D. Fresh frozen plasma

Warfarin impairs γ-carboxylation of glutamate residues on which coagulation-related factor?

A. Factor VIII
B. Factor VII
C. Factor V
D. Factor XII

Warfarin also decreases γ-carboxylation of which additional factor?

A. Factor XI
B. Factor XIII
C. Factor IX
D. Factor VIII

Warfarin decreases synthesis of functional clotting factors by inhibiting:

A. Thrombin
B. VKORC1
C. Plasmin
D. Antithrombin III

Which endogenous anticoagulant protein is reduced by warfarin and contributes to its initial paradoxical hypercoagulability?

A. Protein C
B. Protein M
C. Protein S
D. Protein H

Which additional endogenous anticoagulant protein undergoes impaired γ-carboxylation with warfarin therapy?

A. Protein A
B. Protein M
C. Protein S
D. Protein H

A patient presents with an acute pulmonary embolism and needs immediate anticoagulation. Is warfarin the best initial monotherapy?

A. Yes, because it is rapid
B. Yes, if INR is high
C. No, use aspirin first
D. No, use heparin first

Warfarin is avoided as sole initial therapy in acute thrombosis because it can transiently produce:

A. Hypercoagulability
B. Fibrinolysis
C. Thrombocytosis
D. Vasodilation

Which statement best describes warfarin use during pregnancy?

A. Safe after first trimester
B. Safe with folate supplementation
C. Contraindicated; crosses placenta
D. Contraindicated; poor absorption

A patient newly started on warfarin develops painful dark skin lesions. Which complication is most likely?

A. Cholesterol embolization
B. Skin necrosis
C. Calciphylaxis
D. Erythema nodosum

Warfarin therapy is followed primarily with which laboratory test?

A. PTT
B. Bleeding time
C. Thrombin time
D. PT

Which cytochrome P450 enzyme is most important in warfarin metabolism?

A. CYP3A4
B. CYP2C9
C. CYP2D6
D. CYP1A2

What INR range is expected for a patient therapeutically anticoagulated with warfarin, based on this material?

A. 1.0–1.5
B. 1.5–2.0
C. 2.0–3.5
D. 3.5–5.0

A patient on warfarin presents with major bleeding and marked overanticoagulation. Which reversal strategy is most appropriate?

A. Vitamin K only
B. Protamine and plasma
C. Idarucizumab and plasma
D. Plasma, vitamin K, factor VII

Which oral anticoagulant directly inhibits factor Xa?

A. Rivaroxaban
B. Dabigatran
C. Warfarin
D. Bivalirudin

Rivaroxaban is primarily metabolized by which enzyme?

A. CYP2C9
B. CYP3A4
C. CYP2E1
D. CYP1A2

A patient wants an oral anticoagulant that usually does not require routine laboratory monitoring. Which class best fits?

A. Direct thrombin inhibitors
B. Vitamin K antagonists
C. Oral direct Xa inhibitors
D. Unfractionated heparins

Which medication suffix most strongly suggests an oral direct factor Xa inhibitor?

A. -parin
B. -gatran
C. -plase
D. -xaban

Direct factor Xa inhibitors are commonly used for which arrhythmia?

A. Ventricular fibrillation
B. Atrial fibrillation
C. Torsades de pointes
D. Sinus bradycardia

Which direct factor Xa inhibitor is specifically noted here as not fitting that atrial fibrillation indication, especially with poor renal function?

A. Rivaroxaban
B. Apixaban
C. Edoxaban
D. Betrixaban

Which feature uniquely distinguishes dabigatran among the direct thrombin inhibitors in this material?

A. Causes HIT
B. Inhibits factor Xa
C. Oral administration
D. Needs PT monitoring

A patient with dabigatran-associated hemorrhage requires urgent reversal. Which agent should be used?

A. Protamine sulfate
B. Idarucizumab
C. Phytonadione
D. Tranexamic acid

what can we call strepokinase and urokinase?

______-busters

Streptokinase and urokinase exert their effects primarily by:

A. Blocking thrombin
B. Chelating calcium
C. Activating plasmin
D. Inhibiting VKORC1

Alteplase and tenecteplase are best classified as:

A. Direct Xa inhibitors
B. Fibrinolytics
C. Platelet antagonists
D. Vitamin K analogues

Which description best distinguishes alteplase and tenecteplase from streptokinase and urokinase?

A. Recombinant t-PAs
B. Oral thrombin blockers
C. Heparin analogues
D. Antiplatelet antibodies

A patient with STEMI receives alteplase. The drug’s immediate therapeutic goal is:

A. Lower factor VII
B. Block platelet ADP
C. Accelerate fibrinolysis
D. Reverse protein C loss

A patient with acute coronary syndrome is given an antiplatelet drug that irreversibly acetylates its target enzyme in platelets. Which drug was most likely administered?

A. Clopidogrel
B. Aspirin
C. Tirofiban
D. Cilostazol

The antiplatelet effect of aspirin is primarily due to inhibition of:

A. COX
B. PDE-3
C. P2Y12
D. Thrombin

By inhibiting cyclooxygenase in platelets, aspirin most directly decreases release of:

A. Prostacyclin
B. Fibrinogen
C. Thromboxane A2
D. Plasminogen

Which pair shares the same principal mechanism of antiplatelet action?

A. Aspirin and abciximab
B. Clopidogrel and ticlopidine
C. Cilostazol and warfarin
D. Alteplase and aspirin

Clopidogrel reduces platelet function primarily by blocking the:

A. GPIIb/IIIa receptor
B. COX enzyme
C. P2Y12 receptor
D. PAR-1 receptor

Inhibition of the platelet P2Y12 receptor most directly reduces platelet:

A. Adhesion
B. Aggregation
C. Degranulation
D. Vasoconstriction

A patient with unstable angina is started on an oral antiplatelet agent that blocks ADP signaling. Which drug best fits?

A. Clopidogrel
B. Eptifibatide
C. Dipyridamole
D. Rivaroxaban

Which acute coronary syndrome is specifically included among the indications for clopidogrel in this material?

A. Stable bradycardia
B. NSTEMI
C. Atrial flutter
D. Mitral stenosis

Which additional condition is listed here as an indication for clopidogrel?

A. STEMI
B. DVT
C. PE
D. AFib

Clopidogrel requires bioactivation predominantly through which enzyme?

A. CYP3A4
B. CYP2D6
C. CYP2C19
D. CYP1A2

A patient started on ticlopidine returns with fever and a low white blood cell count. Which adverse effect is most classically associated with this drug?

A. Hemolysis
B. Leukopenia
C. Polycythemia
D. Eosinophilia

In addition to leukopenia, ticlopidine has also been associated with:

A. DIC
B. TTP
C. HIT
D. ITP

Thrombotic Thrombocytopenic Purpura, a rare, life-threatening blood disorder characterized by ___ ___ forming in small vessels throughout the body, causing low platelets, organ damage, and potential bleeding.

Abciximab, eptifibatide, and tirofiban share which mechanism?

A. P2Y12 blockade
B. COX inhibition
C. GPIIb/IIIa blockade
D. PDE-3 inhibition

The platelet receptor blocked by abciximab is best described as the receptor for:

A. ADP
B. Thromboxane
C. Fibrin
D. Collagen

GPIIb/IIIa signaling is considered the final common pathway for platelet:

A. Production
B. Adhesion
C. Aggregation
D. Activation

A child with lifelong mucocutaneous bleeding has absent platelet GPIIb/IIIa receptors. Which diagnosis is most likely?

A. Bernard-Soulier syndrome
B. von Willebrand disease
C. Glanzmann thrombasthenia
D. Hemophilia B

Dipyridamole and cilostazol inhibit platelet aggregation primarily by inhibiting:

A. PDE-3
B. COX-1
C. VKORC1
D. Plasmin

The platelet-inhibitory effect of dipyridamole and cilostazol is mediated by increased intracellular:

A. cGMP
B. ATP
C. cAMP
D. Calcium

A patient with calf pain during walking is treated with a phosphodiesterase inhibitor that also impairs platelet aggregation. Which drug was most likely used?

A. Ticlopidine
B. Cilostazol
C. Aspirin
D. Abciximab

Hemophilia A results from deficiency of which clotting factor?

A. IX
B. VIII
C. XI
D. XIII

Hemophilia B results from deficiency of which clotting factor?

A. VII
B. VIII
C. IX
D. X

Which treatment is matched correctly with hemophilia A?

A. Alteplase
B. Idelvion
C. Aspirin
D. Eloctate

Which treatment is matched correctly with hemophilia B?

A. Idelvion
B. Abciximab
C. Desmopressin
D. Alteplase

A patient with mild hemophilia A needs a temporary increase in factor VIII activity before a minor procedure. Which drug is most appropriate?

A. Clopidogrel
B. Desmopressin acetate
C. Tirofiban
D. Dipyridamole

Desmopressin acetate is also useful in which bleeding disorder listed here?

A. Glanzmann thrombasthenia
B. von Willebrand disease
C. Hemophilia B
D. DIC

A trauma patient with hyperfibrinolytic bleeding is treated with a synthetic drug that competitively inhibits plasminogen activation. Which drug fits best?

A. Tranexamic acid
B. Alteplase
C. Aspirin
D. Abciximab

Aminocaproic acid and tranexamic acid are best classified as:

A. Fibrinolytics
B. Antiplatelet antibodies
C. Fibrinolysis inhibitors
D. Direct Xa inhibitors

The shared mechanism of aminocaproic acid and tranexamic acid is:

A. Direct plasmin inhibition
B. Competitive plasminogen activation blockade
C. Irreversible COX acetylation
D. GPIIb/IIIa receptor blockade

A patient receiving abciximab still generates thromboxane A2 normally but cannot complete the final common pathway of platelet plug formation. Which step is being blocked?

A. Platelet aggregation
B. Platelet synthesis
C. vWF release
D. Vitamin K recycling

-xaban → direct factor _____ _____

-gatran → direct _____ _____

-plase → _____/_____

-parin → _____