[PCOL] Part 4.1 - Hematologic Drugs - Drugs for Coagulation Disorders

f. All

Drugs for coagulation disorders.

a. Antithrombotics

b. Fibrinolytics

c. Pro-thrombotics

d. a and b

e. b and c

f. All

c. Both

Antithrombotics

a. Anticoagulants

b. Antiplatelets

c. Both

d. None

f. All

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

d. a and b

Clotting factors inhibited by anticoagulants.

a. IIa

b. Xa

c. VIIa

d. a and b

e. b and c

f. All

b. Direct thrombin inhibitors

Blocks IIa directly.

a. Indirect thrombin inhibitors

b. Direct thrombin inhibitors

HBAD

Hirudin, Lepirudin

Bivalirudin

Argatroban

Dabigatran

Direct thrombin inhibitors.

e. Dabigatran

Parenteral direct thrombin inhibitors except:

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

f. None

d. Hirudin

Natural from Hirudo medicinalis.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

b. Lepirudin

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

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

a. Bivalirudin

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

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

c. Argatroban

Alternative for HIT.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

Dabigatran

Oral direct thrombin inhibitor.

e. Dabigatran

Mgt of thrombo embolism usually as an alternative to warfarin.

a. Bivalirudin

b. Lepirudin

c. Argatroban

d. Hirudin

e. Dabigatran

b. Prothrombin

Clotting factor II.

a. Fibrinogen

b. Prothrombin

c. Tissue thromboplastin or tissue factor)

d. Ionized calcium

e. Labile factor or proaccelerin

f. All

coumarin derivatives → warfarin

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

Parenteral indirect anticoagulant/thrombin inhibitors.

a. Unfractionated Heparin

b. LMW Heparin

c. Coumarin derivatives

d. a and b

e. b and c

f. All

e. None

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

a. Regular Heparin

Unfractionated heparin.

a. Regular Heparin

b. Enoxaparin

c. Dalteparin

d. Tinzaparin

e. a and b

f. b, c, and d

f. All

LMW Heparins.

a. Enoxaparin

b. Dalteparin

c. Tinzaparin

d. a and b

e. b and c

f. All

a. Regular Heparin

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

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

LMWH target

a. IIa

b. Xa

c. Both

d. None

e. None

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

f. All

Contraindications of heparin:

a. Bleeding

b. Aspirin (ASA) therapy

c. Thrombocytopenia

d. a and b

e. b and c

f. All

c. Coumarin derivatives

Oral 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

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

c. VIII

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. Both

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

e. None

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

d. Warfarin

Causes purple toe syndrome.

a. UF Heparin

b. Enoxaparin

c. Dabigatran

d. Warfarin

b. 2-3

Normal PT-INR.

a. 1-2

b. 2-3

c. 3-4

d. 4-5

e. a and c

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

f. b and d

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. All

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

d. a and b

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

f. None

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

c. Both

Newer anticoagulant agents:

a. Apixaban

b. Rivaroxaban

c. Both

d. None

a. Heparin

Inhibitor of action of clotting factors.

a. Heparin

b. Warfarin

b. Warfarin

Inhibitor of the synthesis of clotting factors.

a. Heparin

b. Warfarin

e. None

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

a. Inhibition of COX

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

c. Inhibition of Phosphodiesterase enzyme (PDE)

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

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

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

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

c. II, III

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

d. IV, V

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

e. VI, VII, VIII

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

f. All

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

a. True

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

a. True

b. False

f. None

Fibrinolytics except:

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

f. None

e. Urokinase

Produce in the kidneys; activates plasminogen.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

d. Streptokinase

Bacterial glycoprotein: activates plasminogen.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

c. Duteplase

Recombinant human tPA with a single amino acid change.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

b. Reteplase

Recombinant fragment of human tPA.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

a. Alteplase

Recombinant natural human tPA.

a. Alteplase

b. Reteplase

c. Duteplase

d. Streptokinase

e. Urokinase

d. Urokinase

Recombinant fibrinolytics except:

a. Alteplase

b. Reteplase

c. Duteplase

d. Urokinase

e. None

f. All

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

d. a and b - Vitamin K

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

c. Tranexamic acid

Inhibitor of plasminogen activation.

a. Phytonadione

b. Menaquinone

c. Tranexamic acid

d. a and b

e. b and c

f. All

a. Phytonadione

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

b. Menaquinone

Vitamin K:

Vitamin K2

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

a. Phytonadione

b. Menaquinone

c. Both

d. None

e. None

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

c. Aminocaproic acid

Tranexamic acid is potent analogue of

a. Nitrocaproic acid

b. Nitrocaprylic acid

c. Aminocaproic acid

d. Aminocaprylic acid

c. Tranexamic 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

A. Endothelin release inducing reflex vasoconstriction

What immediate vascular reaction follows Step 1 endothelial injury in primary hemostasis?

A. Endothelin release inducing reflex vasoconstriction

B. Nitric oxide release inducing rapid vasodilation

C. Histamine release causing vascular permeability

D. Prostacyclin release inhibiting platelet activation

B. Collagen is exposed and binds to von Willebrand Factor

In Step 2 of primary hemostasis, what subendothelial structure is exposed upon injury, and what factor binds to it?

A. Fibrinogen binds directly to endothelial cell membranes

B. Collagen is exposed and binds to von Willebrand Factor

C. Tissue factor is exposed and binds to Factor VIII

D. Antithrombin III binds to exposed smooth muscle cells

B. Glycoprotein Ib

In Step 3 of primary hemostasis, through which surface glycoprotein receptor do platelets adhere to bound von Willebrand Factor?

A. Glycoprotein IIb/IIIa

B. Glycoprotein Ib

C. Glycoprotein VI

D. Glycoprotein Ia/IIa

B. Glycoprotein IIb/IIIa receptor forming a white thrombus primary platelet plug

In Step 5 of primary hemostasis, which receptor mediates interplatelet binding, and what structure is formed?

A. Glycoprotein Ib receptor forming a red thrombus

B. Glycoprotein IIb/IIIa receptor forming a white thrombus primary platelet plug

C. Tissue factor receptor forming a fibrin clot

D. Antithrombin III receptor forming a secondary platelet plug

C. Factors X, V, II, and I

Which clotting factors form the Common Pathway of the coagulation cascade?

A. Factors XII, XI, IX, VIII

B. Factors III and VII

C. Factors X, V, II, and I

D. Factors XIII, Protein C, and Protein S

C. Antithrombin III, Protein C, and Protein S

Which endogenous anticoagulants inhibit active thrombin and coagulation factors in the blood?

A. Tissue Factor and Factor VIIa

B. Thromboxane A2 and ADP

C. Antithrombin III, Protein C, and Protein S

D. Tissue Plasminogen Activator and Plasmin

A. Endothelial injury, Stasis, and Hypercoagulation state

What three pathologic features comprise Virchow's Triad in thrombosis formation?

A. Endothelial injury, Stasis, and Hypercoagulation state

B. Vasoconstriction, Platelet adhesion, and Fibrin degradation

C. Hemophilia, Thrombocytopenia, and Anemia

D. Hypertension, Hyperglycemia, and Hyperlipidemia