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Anticoagulants, Antiplatelets, and Thrombolytics
By Alaina Darby
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Which of the following factors is not formed by the body under normal circumstances?
von Willebrand factor Fibrinogen Thrombin Thromboplastin c
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Which of the following is a cofactor that is present on the collagen of the basement membrane?
von Willebrand factor Fibrinogen Thrombin Thromboplastin a
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Which of the following binds thrombin to cause activation of fibrinogen at the wound site?
TxA2 PAR4 ADP GPIIb/IIIa b
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Which of the following anchors to fibrinogen to bring it to the wound site and to link platelets together? TxA2 PAR4 ADP GPIIb/IIIa d
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Which of the following is also known as prothrombin? Factor I
Factor II Factor XIII Factor X b
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Which of the following links fibrin strands to form a net? Factor I
Factor II Factor XIII Factor X c
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Which of the following does not increase the speed of response?
High prothrombin concentration High fibrinogen concentration Positive feedback from thrombin b
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Which of the following lyses the clots when it is no longer needed?
Plasminogen Plasmin Fibrinogen Fibrin b
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Which of the following is the last step of clot formation?
Activation of factor X Cleavage of fibrinogen Cleavage of prothrombin Activation of factor V b
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Which of the following is not a necessary aspect of clot formation?
Phospholipid surface Cofactors Sodium Calcium c
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Which of the following cofactors is not affected by warfarin? X IX V
II c
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Which of the following is the action of heparin?
Binds to antithrombin III to decreased clotting factor activation Binds to antithrombin III to increase clotting factor activation Binds to antithrombin III to decreased clotting factor inactivation Binds to antithrombin III to increase clotting factor inactivation d
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Platelet factor 4 binds to heparin
Which of the following occurs only when a patient is on heparin for too long? Platelet factor 4 binds to heparin Hemorrhaging may occur at a higher rate Antibodies are formed against the heparin complex Platelets are inactivated at a higher rate c
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Which of the following is not an action of warfarin?
Inhibits vitamin K epoxide reductase Directly inhibits carboxylation of clotting factors Causes deformation of clotting factors Causes initial increase in clotting b
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Which of the following is not an indication for warfarin?
Deep vein thrombosis Pulmonary embolism Prosthetic heart valves Hemorrhage d
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Predictability of effects Thrombin complexation
Which of the following is not increased by the use of LMWH versus native heparin? Anti-Xa activity Duration of action Predictability of effects Thrombin complexation d
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Which of the following binds to a different site on thrombin than the others?
Fibrinogen Heparin Thrombomodulin Protein C b
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Which of the following binds to the fibrinogen recognition site as well as reversibly at the active site on thrombin? Hirudin Bivalirudin Argatroban Melagatran b
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Which of the following does thrombin not activate? V Platelets VIII X
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Action against clot-bound thrombin Most can be given orally
Which of the following is not a benefit of using direct thrombin inhibitors over heparin? Action against clot-bound thrombin Most can be given orally Not dependent on antithrombin III No induction of thrombocytopenia b
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Which of the following would have the highest bleed risk? Hirudin
Bivalirudin Argatroban Melagatran a
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Which of the following is not a benefit of rivaroxiban?
Oral administration No monitoring required Can be used in kidney disease Few drug interactions c
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Which of the following works by inhibiting COX3? Aspirin Acetaminophen
Coxibs NSAIDs b
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Prevention of thromboxane synthesis through COX1 inhibition
Which of the following actions of aspirin actually serves to increase aggregation? Prevention of thromboxane synthesis through COX1 inhibition Prevention of thromboxane synthesis through COX2 inhibition Prevention of prostacyclin synthesis through COX1 inhibition Prevention of prostacyclin synthesis through COX2 inhibition d
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Which of the following COX inhibitors would have the greatest risk of CHD?
Aspirin Acetaminophen Coxibs NSAIDs c
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For which of the following would aspirin therapy be recommended?
47 year old male with 5% 10 year CHD risk 47 year old female with 5% 10 year CHD risk 67 year old male with 10% 10 year CHD risk 67 year old female with 10% 10 year CHD risk a
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Which of the following does P2Y12 antagonists inhibit? ADP TXA2 5-HT
Fibrinogen a
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Which of the following P2Y12 receptor blockers should not be given to someone who is taking omeprazole? Ticlopidine Prasugrel Clopidogrel Ticagrelor c
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Alterations in which of the following hepatic enzymes will alter activation of clopidogrel but not of other antiplatelet drugs in the same class? CYP3A4 CYP2D6 CYP2C19 CYP2B6 c
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According to the CAPRIE study which of the following would combination therapy with clopidogrel and aspirin be most beneficial? MI PAD Ischemic stroke All patients b
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Non-ST segment elevation myocardial infarction
For which of the following populations would concommittant aspirin therapy with a P2Y12 receptor antagonist not be recommended? Non-ST segment elevation myocardial infarction Percutaneous coronary intervention Unstable angina Stable coronary artery disease d
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To which of the following does the glycoprotein IIB/IIIa receptor bind?
ADP TXA2 5-HT Fibrinogen d
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Glycoprotein IIB/IIIa receptor Vitronectin
Which of the following does eptifibidate directly inhibit in regions of high sheer stress such as coronary arteries? Fibrinogen Von Willibrand factor Glycoprotein IIB/IIIa receptor Vitronectin c
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Glycoprotein IIB/IIIa receptor Vitronectin
Binding to which of the following can cause off target effects in abciximab treatment? Fibrinogen Von Willibrand factor Glycoprotein IIB/IIIa receptor Vitronectin d
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How does dipyridamole inhibit platelet aggregation?
Directly inhibiting adenylate cyclase Directly activating phosphodiesterase Indirectly decreasing calcium availability Indirectly decreasing cAMP levels c
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Which of the following patients would be able to take cilostazol but not Aggrenox?
Renal failure Aspirin allergy Hypotension Hepatic failure b
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Which of the following would be a reason to choose a combination of aspirin and ER dipyridamole as opposed to a combination of aspirin and clopidogrel for stroke prevention? Risk of headache Risk of nausea Risk of hemorrhage Risk of fall c
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Aspirin due to his low risk of embolization
Mark is 65 and has a family history of heart attack, hypertension and diabetes. He wants to be proactive and begin taking something to prevent myocardial infarction in himself. Based on his the CHADS2 score, which of the following regimens should the doctor recommend? Aspirin due to his low risk of embolization Aspirin due to his high risk of embolization Warfarin due to his low risk of embolization Warfarin due to his high risk of embolization a
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Clopidogrel and warfarin Warfarin alone Clopidogrel alone
Johnny recently had a coronary stent placed. Which of the following regimens would be most effective in preventing thrombosis while also carrying the least bleed risk? Clopidogrel and warfarin Warfarin alone Clopidogrel alone Aspirin and warfarin c
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For which of the following would thrombolytic drugs not be indicated?
Ischemic stroke Prophylaxis of myocardial infarction Pulmonary embolism Central venous catheter occlusion b
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Which of the following thrombolytics has no intrinsic protease activity?
Uricase Streptokinase Reteplase Alteplase b
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Mary has just recovered from having strep and is still finishing her course of antibiotics. She presents to the ED with shortness of breath, pain in her left arm and shoulder, and nausea. Tests confirm a myocardial infarction. According to her medical history, which of the following thrombolytics would be the last choice of agents? Streptokinase Alteplase Reteplase Activase a
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Daisy has peripheral artery disease, which has resulted in an emboli traveling to her lung. Which of the following could be administered to treat this condition but also poses the risk of causing a systemic lytic state but not allergic reactions? Uricase Streptokinase Reteplase Alteplase a
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Which of the following is indicated for acute MI, pulmonary embolism, and acute ischemic stroke?
Uricase Streptokinase Reteplase Alteplase d
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Unstable angina (with CABG not being considered)
Fibrinolytic agents should be given to which of the following patients? Unstable angina (with CABG not being considered) NSTEMI (with CABG not being considered) STEMI (door to balloon time <2 hours) STEMI (door to balloon time >2 hours) d
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Multilobar infarctions on CT Platelet count of 50,000/mm3
Which of the following would not exclude the use of alteplase in a patient with ischemic stroke? Multilobar infarctions on CT Platelet count of 50,000/mm3 Blood pressure of 140/90 16 years old c
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Prevent bleeding during dental extraction in patients with hemophelia
For which of the following uses would aminocaproid acid not be indicated? Prevent bleeding during dental extraction in patients with hemophelia Treatment of bleeding in patients with hemorrhagic cystitis Bleeding related to thrombolytic therapy with alteplase Prevention of bleeding with surgery to insert bypass grafts c
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