IPS2: Pharmacology - Part 4.1 - Hematologic Drugs - Drugs for Coagulation Disorders

Drugs for coagulation disorders.

a. Antithrombotics

b. Fibrinolytics

c. Pro-thrombotics

d. a and b

e. b and c

f. All

f. All

Antithrombotics

a. Anticoagulants

b. Antiplatelets

c. Both

d. None

c. Both

Anticoagulants.

a. Interfere with blood coagulation cascade by acting on different clotting factors such as IIa and Xa

b. Target blood coagulation cascade inhibiting Ia (Fibrin) Formation resulting to bleeding

c. Can be indirect thrombin inhibitors or direct thrombin inhibitors

d. a and b

e. b and c

f. All

f. All

Clotting factors inhibited by anticoagulants.

a. IIa

b. Xa

c. VIIa

d. a and b

e. b and c

f. All

d. a and b

Blocks IIa directly.

a. Indirect thrombin inhibitors

b. Direct thrombin inhibitors

b. Direct thrombin inhibitors

Direct thrombin inhibitors except:

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

f. None

f. None

Parenteral direct thrombin inhibitors except:

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

f. None

e. Dabigatran

Natural from Hirudo medicinalis.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

d. Hirudin

Recombinant; 1st line for Heparin induced thrombocytopenia (HIT).

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

b. Lepirudin

Mgt of post-Percutaneous transluminal coronary angioplasty (PTCA).

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

a. Bivalirudin

Alternative for HIT.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

c. Argatroban

Oral direct thrombin inhibitor.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

f. None

e. Dabigatran

Mgt of thrombo embolism usually as an alternative to warfarin.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

e. Dabigatran

Clotting factor II.

a. Fibrinogen

b. Prothrombin

c. Tissue thromboplastin or tissue factor)

d. Ionized calcium

e. Labile factor or proaccelerin

b. Prothrombin

Indirect anticoagulant/thrombin inhibitors.

a. Unfractionated Heparin

b. LMW Heparin

c. Coumarin derivatives

d. a and b

e. b and c

f. All

f. All

Parenteral indirect anticoagulant/thrombin inhibitors.

a. Unfractionated Heparin

b. LMW Heparin

c. Coumarin derivatives

d. a and b

e. b and c

f. All

d. a and b

True about Heparin except:

a. Polymeric mixture of sulfated mucopolysaccharides indicating that it is a carbohydrate

b. Macromolecule

c. Targets Anti-thrombin forming a active complex

d. Increases the activity of antithrombin by 1000-fold

e. None

e. None

Unfractionated heparin.

a. Regular Heparin

b. Enoxaparin

c. Dalteparin

d. Tinzaparin

e. a and b

f. b, c, and d

a. Regular Heparin

LMW Heparins.

a. Enoxaparin

b. Dalteparin

c. Tinzaparin

d. a and b

e. b and c

f. All

f. All

Target clotting factor II and and Xa.

a. Regular Heparin

b. Enoxaparin

c. Dalteparin

d. Tinzaparin

e. a and b

f. b, c, and d

a. Regular Heparin

LMWH target

a. IIa

b. Xa

c. Both

d. None

b. Xa - LMWHs act mainly via antithrombin to inhibit factor Xa; they have little effect on inhibition of thrombin

Uses of heparins except:

a. Preoperative prophylaxis against Deep Vein Thrombosis (DVT)

b. Administered following acute MI or pulmonary embolism

c. Reduces pulmonary embolism in patients with established thrombosis

d. Prevents clotting in extracorporeal circulation devices

e. None

e. None

Contraindications of heparin:

a. Bleeding

b. Aspirin (ASA) therapy

c. Thrombocytopenia

d. a and b

e. b and c

f. All

f. All

Oral indirect anticoagulant/thrombin inhibitors.

a. Unfractionated Heparin

b. LMW Heparin

c. Coumarin derivatives

d. a and b

e. b and c

f. All

c. Coumarin derivatives

Coumarin Derivatives.

a. Orally administered

b. Derived from 4-hydroxycoumarin

c. Include dicumarol, warfarin sodium, and phenprocoumon

d. a and b

e. b and c

f. All

f. All

Coumarin derivatives.

a. Dicumarol

b. Warfarin sodium

c. Phenprocoumon

d. a and b

e. b and c

f. All

f. All

Warfarin

a. Has the best bioavailability

b. The least severe adverse effects

c. Has narrow therapeutic index thus toxic

d. a and b

e. b and c

f. All

f. All

Warfarin inhibits synthesis of Vitamin K-dependent clotting factors which include the following except:

a. II

b. VII

c. VIII

d. IX

e. X

f. None

c. VIII

Warfarin inhibits synthesis of Vitamin K-dependent clotting factors by inhibiting VKERC (Epoxide Reductase Complex) which results to

a. Reduce Vit K

b. Inhibition of formation Ia (Fibrin)

c. Both

d. None

c. Both

Uses of warfarin except:

a. Treatment and prophylaxis of Ventricular Tachycardia (VT) and Pulmonary embolism (PE)

b. Mgt of Atrial Fibrillation

c. Mgt of thromboembolism in patients with mechanical heart valves

d. Mgt of Rheumatic heart disease (RHD)

e. None

e. None

Causes purple toe syndrome.

a. UF Heparin

b. Enoxaparin

c. Dabigatran

d. Warfarin

d. Warfarin

Normal PT-INR.

a. 1-2

b. 2-3

c. 3-4

d. 4-5

b. 2-3

Above normal PT-INR.

a. Risk of Hemorrhage

b. Thrombosis

c. Overdose of warfarin

d. Underdose of warfarin

e. a and c

f. b and d

e. a and c

Below normal PT-INR.

a. Risk of Hemorrhage

b. Thrombosis

c. Overdose of warfarin

d. Underdose of warfarin

e. a and c

f. b and d

f. b and d

Can increase PT-INR; increase risk of bleeding.

a. Amiodarone and Sulfinpyrazone

b. ASA and Salicylates

c. Antibiotics

d. a and b

e. b and c

f. All

f. All

Can decrease PT-INR; increase risk of thrombosis.

a. Barbiturates and Rifampin

b. OCPs

c. Antibiotics

d. a and b

e. b and c

f. All

d. a and b

True about newer anticoagulant agents except:

a. Xa inhibitors

b. Orally administered

c. No monitoring required

d. Safer than warfarin

e. Include the "-xabans"

f. None

f. None

Newer anticoagulant agents:

a. Apixaban

b. Rivaroxaban

c. Both

d. None

c. Both

Inhibitor of action of clotting factors.

a. Heparin

b. Warfarin

a. Heparin

Inhibitor of the synthesis of clotting factors.

a. Heparin

b. Warfarin

b. Warfarin

Mechanisms of anti-platelets except:

a. Inhibition of COX

b. Inhibition of Adenosine diphosphate (ADP)

c. Inhibition of Phosphodiesterase enzyme (PDE)

d. Inhibition of Glycoprotein IIb/IIIa

e. None

e. None

Results to inhibition of Thromboxane A2 (TXA2) Synthesis.

a. Inhibition of COX

b. Inhibition of Adenosine diphosphate (ADP)

c. Inhibition of Phosphodiesterase enzyme (PDE)

d. Inhibition of Glycoprotein IIb/IIIa

e. None

a. Inhibition of COX

Results to increase cAMP levels in endothelial cell that can cause antiplatelet effect.

a. Inhibition of COX

b. Inhibition of Adenosine diphosphate (ADP)

c. Inhibition of Phosphodiesterase enzyme (PDE)

d. Inhibition of Glycoprotein IIb/IIIa

e. None

c. Inhibition of Phosphodiesterase enzyme (PDE)

Antiplatelet agents.

I. Aspirin

II. Clopidogrel

III. Ticlopidine

IV. Dipyridamole

V. Cilostazol

VI. Eptifibatide

VII. Abciximab

VIII. Tirofiban

a. I, II, III

b. I

c. II, III

d. IV, V

e. VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

COX inhibitor antiplatelet agents.

I. Aspirin

II. Clopidogrel

III. Ticlopidine

IV. Dipyridamole

V. Cilostazol

VI. Eptifibatide

VII. Abciximab

VIII. Tirofiban

a. I, II, III

b. I

c. II, III

d. IV, V

e. VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

b. I

Thienopyridines or ADP inhibitor anntiplatelet agents.

I. Aspirin

II. Clopidogrel

III. Ticlopidine

IV. Dipyridamole

V. Cilostazol

VI. Eptifibatide

VII. Abciximab

VIII. Tirofiban

a. I, II, III

b. I

c. II, III

d. IV, V

e. VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

c. II, III

PDE inhibitors antiplatelet agents.

I. Aspirin

II. Clopidogrel

III. Ticlopidine

IV. Dipyridamole

V. Cilostazol

VI. Eptifibatide

VII. Abciximab

VIII. Tirofiban

a. I, II, III

b. I

c. II, III

d. IV, V

e. VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

d. IV, V

GP IIb/IIIa inhibitor Antiplatelet agents.

I. Aspirin

II. Clopidogrel

III. Ticlopidine

IV. Dipyridamole

V. Cilostazol

VI. Eptifibatide

VII. Abciximab

VIII. Tirofiban

a. I, II, III

b. I

c. II, III

d. IV, V

e. VI, VII, VIII

f. I, II, III, IV, V, VI, VII, VIII

e. VI, VII, VIII

Fibrinolytics.

a. Also known as Plasminogen Activators

b. Target pathway is in the activation of plasminogen

c. Enhance/accelerate plasmin that can destroy the clot

d. a and b

e. b and c

f. All

f. All

Plasminogen is an inactive protein that is activated into plasmin by the tissue plasminogen activator

a. True

b. False

a. True

Fibrinolytics except:

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

f. None

f. None

Produce in the kidneys; activates plasminogen.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

e. Urokinase

Bacterial glycoprotein: activates plasminogen.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

d. Streptokinase

Recombinant human tPA with a single amino acid change.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

c. Duteplase

Recombinant fragment of human tPA.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

b. Reteplase

Recombinant natural human tPA.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

a. Alteplase

Recombinant fibrinolytics except:

a. Alteplase

b. Reteplase

c. Duteplase

d. Urokinase

e. None

d. Urokinase

Prothrombotics.

a. Actions is by causing clot formation

b. Increase Clotting Factors X, IX, VII, II

c. Increase Ia (Fibrin) Formation resulting to clotting

d. a and b

e. b and c

f. All

f. All

Prothrombotics.

a. Vitamin K

b. Tranexamic acid

c. Aprotonin

d. a and b

e. b and c

f. All

f. All

Required for translational modification of clotting factors II, VII, IX, and X.

a. Phytonadione

b. Menaquinone

c. Tranexamic acid

d. a and b

e. b and c

f. All

d. a and b - Vitamin K

Inhibitor of plasminogen activation.

a. Phytonadione

b. Menaquinone

c. Tranexamic acid

d. a and b

e. b and c

f. All

c. Tranexamic acid

Vitamin K:

Vitamin K1

Clinically useful

Found in food and is available for oral or parenteral use

a. Phytonadione

b. Menaquinone

c. Both

d. None

a. Phytonadione

Vitamin K:

Vitamin K2

Found in human tissues and is the form synthesized by intestinal bacteria

a. Phytonadione

b. Menaquinone

c. Both

d. None

b. Menaquinone

Tranexamic acid except:

a. Hemostan

b. A potent analogue of aminocaproic acid

c. Inhibit plasminogen activation; Inhibits fibrinolysis

d. Used in the Mgt of post-procedural bleeding

e. None

e. None

Tranexamic acid is potent analogue of

a. Nitrocaproic acid

b. Nitrocaprylic acid

c. Aminocaproic acid

d. Aminocaprylic acid

c. Aminocaproic acid

Used in the Mgt of post-procedural bleeding.

a. Phytonadione

b. Menaquinone

c. Tranexamic acid

d. a and b

e. b and c

f. All

c. Tranexamic acid