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WorksheetsCardio Exam 3 - Anticoagulants Austin
Total questions: 78
Worksheet time: 39mins
Name
Class
Date
1.
What is hemostatsis
a)
the balance
b)
pathological state
c)
solid mass of blood components that forms locally and blocks blood flow
d)
substance that travels through blood and causes blockage away from site of origin
e)
thrombus breaks free<br />
2.
What is thrombosis
a)
the balance
b)
pathological state
c)
solid mass of blood components that forms locally and blocks blood flow
d)
substance that travels through blood and causes blockage away from site of origin
e)
thrombus breaks free<br />
3.
What is a thrombus
a)
the balance
b)
pathological state
c)
solid mass of blood components that forms locally and blocks blood flow
d)
substance that travels through blood and causes blockage away from site of origin
e)
thrombus breaks free<br />
4.
What is an embolus
a)
the balance
b)
pathological state
c)
solid mass of blood components that forms locally and blocks blood flow
d)
substance that travels through blood and causes blockage away from site of origin
e)
thrombus breaks free<br />
5.
What is a thromboembolus
a)
the balance
b)
pathological state
c)
solid mass of blood components that forms locally and blocks blood flow
d)
substance that travels through blood and causes blockage away from site of origin
e)
thrombus breaks free<br />
6.
What is the sequence of events associated with hemostasis during coagulation
a)
vasoconstriction, primary hemostasis, secondary hemostasis, resolution
b)
primary hemostasis, secondary hemostasis, vasoconstriction, resolution
c)
secondary hemostasis, primary hemostasis, vasoconstriction, resolution
d)
primary hemostasis, vasoconstriction, secondary hemostasis, resolution
7.
What is released by damaged cells and platelets during coagulation and what does it cause
a)
reflex mechanism
b)
vasoconstriction
c)
vasodilation
d)
primary hemostasis
e)
secondary hemostasis
8.
What step during coagulation do platelets activate and adhere to subendothelial matrix
a)
reflex mechanism
b)
vasoconstriction
c)
resolution
d)
primary hemostasis
e)
secondary hemostasis
9.
What step during coagulation activates the coagulation cascade leads to formation of fibrin matrix by recruiting more platelets
a)
reflex mechanism
b)
vasoconstriction
c)
resolution
d)
primary hemostasis
e)
secondary hemostasis
10.
What step of coagulation forms a stable plug
a)
reflex mechanism
b)
vasoconstriction
c)
resolution
d)
primary hemostasis
e)
secondary hemostasis
11.
Where does the extrinsic pathway occur
a)
"outside of" blood
b)
in vivo
c)
"within" blood
d)
in vitro
12.
Where does the intrinsic pathway occur
a)
"outside of" blood
b)
in vivo
c)
"within" blood
d)
in vitro
13.
What are the key functions of thrombin
a)
induction of platelet recruitment/activation
b)
conversion of soluble fibrinogen to insoluble fibrin
c)
activation of proenzymes
d)
conversion of insoluble fibrin to soluble fibrinogen
14.
Thrombin has what kind of feedback during coagulation<br />
a)
positive feedback
b)
negative feedback
c)
does not cause feedback
15.
What are some limitations of clot formation
a)
pro-coagulant factors are often membrane-bound
b)
anti-coagulant factors are soluble and secreted
c)
localized activity
d)
pro-coagulant factors are often not bound to anything
e)
systemic activity
16.
What substances are important in limiting clot formation
a)
antithrombin III
b)
proteins C and S
c)
tissue-type plasminogen activator (t-PA)<br />
d)
Prostacyclin (PGI2)
e)
Tissue factor pathway inhibitor
17.
What are some characteristics of arterial clots
a)
contain many platelets; treated with antiplatelets
b)
often caused by atherosclorsis
c)
"white clots"
d)
"red clots"
e)
large size
18.
What are some characteristics of venous clots
a)
contain many platelets; treated with antiplatelets
b)
contain mostly fibrin and RBC components; treated with anticoagulants
c)
associated with blood stasis and/or medication
d)
"red clots"
e)
large size
19.
Which thromboembolic conditions are associated with venous clots
a)
deep vein thrombosis (DVT)
b)
pulmonary embolism (PE)
c)
stroke
d)
myocardial infarction (MI)
e)
disseminated intravascular coagulation
20.
Which thromboembolic conditions are associated with arterial clots
a)
deep vein thrombosis (DVT)
b)
pulmonary embolism (PE)
c)
stroke
d)
myocardial infarction (MI)
e)
disseminated intravascular coagulation
21.
What are some bleeding conditions that can occur
a)
vitamin K deficiency
b)
thrombocytopenia
c)
stroke
d)
impaired liver function
e)
hemophilias
22.
What are predisposing factors of Virchow's Triad
a)
endothelial injury
b)
stasis
c)
hypercoaguable state
d)
hyperkalemia
23.
What are some predisposing factors of endothelial injury of Virchow's Triad
a)
arterial thrombosis
b)
inadequate HTN management
c)
inadequate HLD management
d)
uncontrolled DM management
e)
venous thrombosis
24.
What are some predisposing factors of stasis (or abnormal blood flow) of Virchow's Triad
a)
arterial thrombosis
b)
atrial fibrillation, atherosclerotic plaques
c)
increased endothelial cell activation and platelet proximity
d)
activated coagulation factors lingering
e)
venous thrombosis
25.
What are some predisposing factors of hypercoaguable state of Virchow's Triad
a)
arterial thrombosis
b)
may be genetic or acquired (secondary)
c)
malignancy, oral contraceptives
d)
heparin-induced thrombocytopenia (HIT)
e)
venous thrombosis
26.
What are some treatment strategies to prevent or reverse thrombus formation
a)
inhibit platelet activity
b)
dissolve clot
c)
anticoagulants
d)
vitamin K supplements
27.
What is the biggest ADR of anticoagulant drugs
a)
bleeding
b)
clotting
c)
hyperkalemia
d)
decrease platelet formation
28.
What are types of anticlotting drugs
a)
anticoagulants
b)
thrombolytics
c)
antiplatelet drugs
d)
antiarrhythmics
29.
What are some types of anticoagulants
a)
heparins
b)
direct thrombin inhibitors
c)
warfarin
d)
direct factor Xa inhibitors
e)
ADP inhibitors (clopidogrel)
30.
What are some types of thrombolytics
a)
streptokinase
b)
direct thrombin inhibitors
c)
t-PA derivatives
d)
glycoprotein Iib/IIIa inhibitors
e)
PDE/adenosine uptake inhibitors
31.
What are some types of antiplatelet drugs
a)
aspirin
b)
ADP inhibitors (clopidogrel)
c)
t-PA derivatives
d)
glycoprotein Iib/IIIa inhibitors
e)
PDE/adenosine uptake inhibitors
32.
What are some drugs that facilitate clotting
a)
replacement factors
b)
ADP inhibitors (clopidogrel)
c)
vitamin K
d)
glycoprotein Iib/IIIa inhibitors
e)
antiplasmin drugs
33.
Which enantiomer of Coumarin is 2-5 times more potent than the other?
a)
S
b)
R
34.
Which coenzyme metabolizes Coumarin
a)
CYP 2C9
b)
CYP 3A4
c)
CYP 1A1
d)
CYP 1A2
35.
What are some characteristics of coumarin
a)
well absorbed in GI tract
b)
extensive protein binding
c)
duration of action > t1/2 of warfarin
d)
poorly absorbed in GI tract
e)
minimal protein binding
36.
Warfarin is rapidly absorbed following oral administration, absorbed percutaneously, and has a slow onset of action
a)
true
b)
false
37.
Is Warfarin contraindicated in pregnancy?
a)
YES
b)
NO
38.
Warfarin Drug Interactions: What is the R in RATS FAME
a)
Rifampin
b)
Ramipril
c)
Ranitidine
d)
Rifaximin
39.
Warfarin Drug Interactions: What are the A's in RATS FAME
a)
Amiodarone
b)
Alcohol
c)
Acyclovir
d)
Alprazolam
40.
Warfarin Drug Interactions: What is the T in RATS FAME
a)
Thyroid Hormone
b)
Tamoxifen
c)
Telmisartan<br />
d)
Tizanidine<br />
41.
Warfarin Drug Interactions: What is the S in RATS FAME
a)
Sulfa Drugs
b)
Sertaline
c)
Spironolactone
d)
Sildenafil
42.
Warfarin Drug Interactions: What is the F in RATS FAME
a)
Fluconazole
b)
Famotidine
c)
Finasteride
d)
Furosemide
43.
Warfarin Drug Interactions: What is the M in RATS FAME
a)
Metronidazole
b)
Meloxicam
c)
Meclizine
d)
Methotrexate
44.
Warfarin Drug Interactions: What is the E in RATS FAME
a)
Erythromycin
b)
Enalapril
c)
Escitalopram
d)
Esomeprazole
45.
When a patient is on Warfarin, prothrombin time (PT) needs to be monitored using the international normalized ratio (INR). What is the typical range of INR
a)
2.0-3.0
b)
2.5-3.5
c)
3.0-4.0
d)
3.5-4.5
46.
When a patient is on Warfarin, prothrombin time (PT) needs to be monitored using the international normalized ratio (INR). What risk does an increased INR (i.e. 5.0) have
a)
increased bleeding risk
b)
increased clotting risk
c)
increased blood volume
47.
When a patient is on Warfarin, prothrombin time (PT) needs to be monitored using the international normalized ratio (INR). What risk does a decreased INR (i.e. 0.05) have
a)
increased bleeding risk
b)
increased clotting risk
c)
increased blood volume
48.
What is the equation for INR
a)
(PT patient/PT reference plasma)^ISI
b)
(PT reference plasma/PT patient)^ISI
c)
(PT patient/ISI)^PT reference plasma
d)
(ISI/PT patient)^PT reference plasma
49.
What are some ADRs of Warfarin
a)
bleeding
b)
alopecia, dermatitis
c)
GI upset
d)
osteoporosis-related fracture
e)
purple toe syndrome
50.
What are some ways we can reverse bleeding ADRs due to Warfarin
a)
vitamin K
b)
plasma
c)
aspirin
d)
alcohol
e)
rifampin
51.
How many daltons are unfractionated heparin (UFH)
a)
1-30 kDa
b)
5-30 kDa
c)
1-5 kDa
52.
How many daltons are low molecular weight heparins (LMWH)
a)
1-30 kDa
b)
5-30 kDa
c)
1-5 kDa
53.
Unfractionated heparins and low moelcular weight heparins have the same activity
a)
true
b)
false
54.
What are some characterstics of unfractionated heparin (UFH)
a)
high affinity for antithrombin III
b)
enhances inactivation of thrombin
c)
heparin-antithrombin complex also inhibits the activity of factor Xa
d)
has short duration of action (parenterally)
e)
has long duration of action (parenterally)
55.
What reversal agent is used for unfractionated heparin (UFH)
a)
protamine sulfate
b)
vitamin K
c)
plasma
d)
enoxaprin
e)
dalteparin
56.
What are some ADRs of unfractionated heparin (UFH)
a)
increased bleeding risk
b)
alopecia, dermatitis
c)
heparin-induced thrombocytopenia (HIT)
d)
osteoporosis
e)
purple toe syndrome
57.
What are some characteristics of low molecular weight heparin (LMWH)
a)
only terminal pentasaccharide required for binding to antithrombin
b)
does not effectively bind thrombin
c)
shorter polymer effectively binds factor Xa
d)
renal elimination, multiple indications
e)
larger therapeutic index than UFH
58.
What are characteristics of Type 1 Heparin-induced Thrombocytopenia (HIT)
a)
mild-moderate decrease in platelet count
b)
occurs within 5 days
c)
transient effect that is reversed upon D/C
d)
severe decrease and platelet activation
e)
occurs between 5 to 14 days
59.
What are characteristics of Type 2 Heparin-induced Thrombocytopenia (HIT)
a)
mild-moderate decrease in platelet count
b)
occurs within 5 days
c)
aggregation, endothelial injury, paradoxical thrombosis
d)
severe decrease and platelet activation
e)
occurs between 5 to 14 days
60.
Fondaparinux ("tiny heparin") targets
a)
Xa > IIa
b)
Xa only
c)
IIa only
d)
Xa about equal to IIa
61.
What are some characterstics of Fondaparinux ("tiny heparin")
a)
synthetic
b)
sulfonated pentasaccharide
c)
no effect on thrombin
d)
decreased risk of HIT
62.
What are some direct factor Xa inhibitors that inhibit factor Xa and do not require antithrombin III
a)
rivaroxaban
b)
apixaban
c)
protamine sulfate
d)
enoxaprin
63.
Which dose of Rivaroxaban is not affected by food and how often is it dosed
a)
10 mg
b)
15 mg
c)
20 mg
d)
once daily
e)
twice daily
64.
What dose of Rivaroxaban should be taken with food and how often is it dosed
a)
10 mg
b)
15 mg
c)
20 mg
d)
once daily
e)
twice daily
65.
How often is Apixaban dosed
a)
once daily
b)
twice daily
c)
three times a day
66.
What are some drug interactions with Xa inhibitors
a)
CYP 2C9
b)
CYP 3A4
c)
P-glycoprotein inhibitors
d)
P-glycoprotein inducers
67.
What is the reversal agent for Xa inhibitors
a)
protamine sulfate
b)
andexanet alfa
c)
vitamin K
d)
apixaban
68.
What are some characterstics of direct thrombin inhibitors
a)
decreased conversion of fibrinogen to fibrin
b)
decreased endothelial cell/platelet activation
c)
decreased activation of factor XIII
d)
increased conversion of fibrinogen to fibrin
e)
increased endothelial cell/platelet activation
69.
What are some protein-based direct thrombin inhibitors parenteral agents
a)
desirudin
b)
bivalirudin
c)
argatroban
d)
dabigatran
70.
What is the small molecule direct thrombin inhibitor parenteral agents
a)
desirudin
b)
bivalirudin
c)
argatroban
d)
dabigatran
71.
What is the direct thrombin inhibitors oral agent
a)
desirudin
b)
bivalirudin
c)
argatroban
d)
dabigatran
72.
What is the method of action for dabigatran etexilate
a)
direct
b)
reversible inhibitor of thrombin
c)
selective inhibitor of Xa that do not require antithrombin III
73.
What is the reversal agent for Dabigatran Etexilate
a)
pro
b)
andexanet alfa
c)
idarucizumab
d)
apixaban
74.
What are some advantages of Dabigatran Etexilate over Warfarin
a)
fast onset
b)
predictable PK
c)
fixed dosing (monitoring not usually required)
d)
decoy receptor
75.
Based on the properties of an ideal anticoagulant, which of the following is not an advantage of direct acting oral anticoagulants over warfarin
a)
once daily dosing
b)
less monitoring requirements
c)
rapid onset of action
d)
no interactons (with drugs or food)
76.
Which medication has the least effect on the activity of thrombin
a)
enoxaparin
b)
fondaparinux
c)
dabigatran
d)
heparin
77.
Warfarin inhibits cofactors involved in which pathway
a)
intrinsic
b)
extrinsic
c)
common
78.
The onset of action of warfarin depends on which of the following<br />
a)
rate of vitamin K oxidation
b)
reaching steady state warfarin levels
c)
half-life of warfarin in a given individual
d)
half-life of circulating active clotting factors
e)
rate of absorption
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