Final Exam Pcol2 Mw 8:30-10am

1. Can Heparin be used for pregnant patients?

Yes

No

Option 3

Option 4

2. This drug inhibits vitamin K epoxide reductase.

Warfarin

Heparin

Xarelto

Eliquis

3. Which statement is TRUE on the diagnosis of MI?

Diagnosis of MI is confirmed with detection of rise and/or fall of cardiac biomarkers, mainly Troponin T or I.

Checking patient symptoms, PMH and ECG.

STE, ST-segment depression and T-wave inversion.

All of the answers

4. What are the standard secondary prevention treatment drugs to be initiated following an acute MI?

Beta blockers

Statins

ACE inhibitors

All of the answers

5. It is a monoclonal antibody

Abciximab

Clopidogrel

Xarelto

Warfarin

6. Clinical uses of Heparin

DVT

Pulmonary embolism

Acute MI

All of the answers

7. Antidote for Heparin toxicity or overdose

Protamine for unfractionated heparin

Vitamin K

Plasma

Prothrombin complex concentrates

8. The following are glycoprotein IIb/IIIa receptor inhibitors EXCEPT:

Abciximab

Tirofiban

Eptifibatide

Clopidogrel

9. The following are ADP receptor antagonists EXCEPT:

Aspirin

Clopidogrel

Plavix

Ticlopidine

10. If a fibrinolytic drug is used for treatment of this woman's acute myocardial infarction, which of the following adverse drug effects is most likely to occur?

Acute renal failure

Development of antiplatelet antibodies

Encephalitis secondary to liver dysfunction

Hemorrhagic stroke

Neutropenia

11. Fractionated preparations of heparin of molecular weight 2000-6000

Heparin-induced Thrombocytopenia

Antithrombin III

Glycoprotein IIb/IIIa

LMW heparins

12. A protein complex on the surface of platelets

Clotting cascade

LMW heparins

Heparin-induced Thrombocytopenia

Glycoprotein IIb/IIIa

13. MOA of Heparin

Activates antithrombin III

Impairs post-translational modification factors II, VII, IX and X

Both

None of the answers

14. Laboratory test used to monitor the anticoagulant effect of warfarin which is prolonged when drug effect is adequate.

Activated Partial Thromboplastin time (aPTT) test

Antithrombin III

Prothrombin time (PT) test

Glycoprotein IIb/IIIa

15. Unfractionated heparin has a molecular weight range of 5000-30000

Glycoprotein IIb/IIIa

Clotting cascade

Prothrombin time (PT) test

LMW heparins

16. Which clotting factor/s is/are inhibited by Oral Anticoagulant drugs?

XIa

VIIIa

X

Va

17. Which of the following drugs accelerates the conversion of plasminogen to plasmin?

Aminocaproic acid

Heparin

Lepirudin

Reteplase

Warfarin

18. System of serine proteases and substrates in the blood that provides rapid generation of clotting factors in response to blood vessel damage

Clotting cascade

Heparin-induced Thrombocytopenia

LMW heparins

Prothrombin time (PT) test

19. Site of Action for Heparin

Small Intestines

Skin

Blood

Liver

20. Choose the correct statement about ADP receptor antagonists

21. It is a phosphodiesterase-3 inhibitor

Cilostazol

Clopidogrel

Aspirin

None of the answers

22. A hypercoagulable state plus thrombocytopenia that occurs in a small number of individuals treated with unfractionated heparin

Prothrombin time (PT) test

Glycoprotein IIb/IIIa

Heparin-induced Thrombocytopenia

LMW heparins

23. If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent in a coronary blood vessel, she may be given eptifibatide. Which of the following most accurately describes the mechanism of eptifibatide anticlotting action?

Activation of antithrombin III

Blockade of post-translational modification of clotting factors

Inhibition of thromboxane production

Irreversible inhibition of platelet ADP receptors

Reversible inhibition of glycoprotein IIb/IIIa receptors

24. An endogenous anticlotting protein that irreversibly inactivates thrombin and factor Xa.

Heparin-induced Thrombocytopenia

Antithrombin III

Clotting cascade

LMW heparins

25. When activated, it aggregates platelets primarily by binding to fibrin

LMW heparins

Heparin-induced Thrombocytopenia

Glycoprotein IIb/IIIa

Clotting cascade

26. Which statement is TRUE on the clinical use of Thrombolytics?

Cerebral hemorrhage must be positively ruled out before each use.

It is not indicated for sever pulmonary embolism.

Under ideal conditions such as treatment within 24hrs, these agents can promptly recanalize the occluded coronary vessel.

27. Choose the correct statement on Inhibitors of Phosphodiesterase 3.

28. Its enzymatic action is markedly accelerated by the heparins

Clotting cascade

Glycoprotein IIb/IIIa

Antithrombin III

Heparin-induced Thrombocytopenia

29. Laboratory test used to monitor the anticoagulant effect of unfractionated heparin and direct thrombin inhibitors which is prolonged when drug effect is adequate

Clotting cascade

Activated Partial Thromboplastin time (aPTT) test

Prothrombin time (PT) test

FTIR

30. CASE JR is an 87-year-old man with a chief complaint of shortness of breath, productive cough, and fever. This is his second admission to the hospital in the last month for a similar complaint. His past medical history includes BPH, congestive heart failure (CHF), and hypertension. His home medications are fluconazole, citalopram, furosemide, metoprolol, aspirin, and lisinopril. JR is admitted with nasal cannula oxygen. His diagnosis is pneumonia. Labs are pertinent for creatinine clearance of 41 mL/min and sputum culture positive for Pseudomonas aeruginosa. Bacterial sensitivities are not back yet. JR is ready for discharge from the hospital when he develops multiple episodes of diarrhea. Stool culture is positive for Clostridium difficile. The optimal initial treatment of choice is

Vancomycin

Clofazimine

Clindamycin

Metronidazole

Moxifloxacin

31. Site of Action for Warfarin

Small Intestines

Blood

Skin

Liver

32. Which statement is TRUE? (You can tick more than once)

Heparin is the drug of choice when an anticoagulant must be used in pregnancy.

Heparin does not cross the placental barrier.

The action of Heparin is monitored by PT.

Option 4

Submit

33. Substances that increase intracellular cyclic adenosine monophosphate –cAMP- inhibit ______.

Platelet dissolution

Platelet lysis

Platelet aggregation

All of the answers

34. A cell surface protein involved in platelet cross-linking.

Alpha receptors

5HT receptors

Glycoprotein IIb/IIIa receptor

All of the answers

35. It is activated by endogenous factors such as thromboxane A₂, ADP and serotonin which initiates a signaling cascade

Glycoprotein IIb/IIIa

Antithrombin III

LMW heparins

Glycoprotein IIb/IVa

36. Which drug may be a problem given that the patient has DM?

Atenolol

Atorvastatin

Amlodipine

Captopril

37. Case: A 65-year-old man is brought to the emergency department 30 min after the onset of right-sided weakness and aphasia (difficulty speaking). Imaging studies ruled out cerebral hemorrhage as the cause of his acute symptoms of stroke. Over the next 2 d, the patient's symptoms resolved completely. To prevent a recurrence of this disease, the patient is most likely to be treated indefinitely with which of the following?

Aminocaproic acid

Aspirin

Lepirudin

Warfarin

38. Which clotting factor/s is/are inhibited by Heparin?

IX

XIa

II

X

39. Case: A 65-year-old man is brought to the emergency department 30 min after the onset of right-sided weakness and aphasia (difficulty speaking). Imaging studies ruled out cerebral hemorrhage as the cause of his acute symptoms of stroke. Prompt administration of which of the following drugs is most likely to improve this patient's clinical outcome?

Abciximab

Alteplase

Factor VIII

Streptokinase

Vitamin K

40. Which statement is true about Warfarin?

Has a narrow therapeutic window

Antidote is Protamine

Can inhibit Xa Factors

The effect of warfarin is monitored by aPTT test

41. CASE JR is an 87-year-old man with a chief complaint of shortness of breath, productive cough, and fever. This is his second admission to the hospital in the last month for a similar complaint. His past medical history includes BPH, congestive heart failure (CHF), and hypertension. His home medications are fluconazole, citalopram, furosemide, metoprolol, aspirin, and lisinopril. JR is admitted with nasal cannula oxygen. His diagnosis is pneumonia. Labs are pertinent for creatinine clearance of 41 mL/min and sputum culture positive for Pseudomonas aeruginosa. Bacterial sensitivities are not back yet. JR is not responding to your choice of antibiotics and the physician adds tobramycin to the regimen. Using the ODA method, his tobramycin peak at steady state is 17.2 ug/mL and trough of 1.4 ug/mL. Based on these levels, the best recommendation would be to

Hold tobramycin and restart at a lower dose/ frequency.

Increase tobramycin frequency but keep dose the same.

Continue tobramycin at the same dose and frequency.

Discontinue tobramycin and start amikacin.

Discontinue tobramycin and start ciprofloxacin

42. Goals of Treatment for MI (you can tick more than once)

Early restoration of blood flow to infarct-related artery to prevent infarct expansion.

Prevention of death and other complications

Prevention of coronary artery reocclusion

Relief of ischemic chest discomfort

Resolution of ST-segment and T-wave changes on ECG

Control of Cardiovascular risk factors

Prevention of additional CV events and Improvement in quality of life.

Submit

43. The following are Antiplatelet drugs EXCEPT:

Aspirin

NSAIDs

Abciximab

Warfarin

44. CASE JR is an 87-year-old man with a chief complaint of shortness of breath, productive cough, and fever. This is his second admission to the hospital in the last month for a similar complaint. His past medical history includes BPH, congestive heart failure (CHF), and hypertension. His home medications are fluconazole, citalopram, furosemide, metoprolol, aspirin, and lisinopril. JR is admitted with nasal cannula oxygen. His diagnosis is pneumonia. Labs are pertinent for creatinine clearance of 41 mL/min and sputum culture positive for Pseudomonas aeruginosa. Bacterial sensitivities are not back yet. The optimal choice of antibiotic(s) for the treatment of JR's pneumonia is (are)

Cefuroxime

Sulfamethoxazole

Ceftaroline

Doxycycline

Doripenem

45. CASE JR is an 87-year-old man with a chief complaint of shortness of breath, productive cough, and fever. This is his second admission to the hospital in the last month for a similar complaint. His past medical history includes BPH, congestive heart failure (CHF), and hypertension. His home medications are fluconazole, citalopram, furosemide, metoprolol, aspirin, and lisinopril. JR is admitted with nasal cannula oxygen. His diagnosis is pneumonia. Labs are pertinent for creatinine clearance of 41 mL/min and sputum culture positive for Pseudomonas aeruginosa. Bacterial sensitivities are not back yet. After 2 days on his new antibiotic, JR has developed a major drug interaction. Which of the following is the major sign/symptom of this drug interaction?

Thrombocytopenia

Serotonin syndrome

Torsades de pointe

Hypertensive crisis

Jaundice

46. CASE JR is an 87-year-old man with a chief complaint of shortness of breath, productive cough, and fever. This is his second admission to the hospital in the last month for a similar complaint. His past medical history includes BPH, congestive heart failure (CHF), and hypertension. His home medications are fluconazole, citalopram, furosemide, metoprolol, aspirin, and lisinopril. JR is admitted with nasal cannula oxygen. His diagnosis is pneumonia. Labs are pertinent for creatinine clearance of 41 mL/min and sputum culture positive for Pseudomonas aeruginosa. Bacterial sensitivities are not back yet. Five days later, JR complains of flank pain and pain on urination. His urine culture is positive for Enterococcus faecium. The best choice to treat his urinary tract infection is

Cefepime

Azithromycin

Piperacillin/tazobactam

Linezolid

47. Which statement/s is/are TRUE about Rivaroxaban and Apixaban? (you can tick more than once)

They are oral Xa Inhibitors

Have a rapid onset of action and shorter half-lives than warfarin

They require monitoring

They undergo cytochrome P450-dependent and cytochrome P450-independent elimination.

Submit

48. Choose the General Approaches in the treatment and management of MI? (you can tick more than once)

CBC

APTT and INR

CT Scan and MRI

Submit

49. Which statement/s is/are TRUE about Thrombolytic Agents? (you can tick more than once)

It either comes in the form of tPA or a protein synthesized by streptococci.

All are given in IV

TPA is an enzyme that directly converts plasmin to plasminogen

Submit

50. Which statement/s is/are TRUE? (you can tick more than once)

Aspirin is used extensively to prevent transient ischemic attacks (TIAs), ischemic stroke and other thrombotic events.

Abciximab, Tirofiban and Eptifibatide are indicated for unstable angina and non-Q-wave acute MI

Clopidogrel and Ticlopidine are effective in preventing TIAs and ischemic strokes, especially in patients who cannot tolerate aspirin.

Clopidogrel is routinely used to prevent Thrombosis in patients who have not received a coronary artery stent.

Dipyridamole is approved as an adjunct to heparin in the prevention of thrombosis in those with cardiac valve replacement.

Submit

Final Exam Pcol2 Mw 8:30-10am

1. Can Heparin be used for pregnant patients?

2.

What first name or nickname would you like us to use?

2. This drug inhibits vitamin K epoxide reductase.

3. Which statement is TRUE on the diagnosis of MI?

4. What are the standard secondary prevention treatment drugs to be initiated following an acute MI?

5. It is a monoclonal antibody

6. Clinical uses of Heparin

7. Antidote for Heparin toxicity or overdose

8. The following are glycoprotein IIb/IIIa receptor inhibitors EXCEPT:

9. The following are ADP receptor antagonists EXCEPT:

10. If a fibrinolytic drug is used for treatment of this woman's acute myocardial infarction, which of the following adverse drug effects is most likely to occur?

11. Fractionated preparations of heparin of molecular weight 2000-6000

12. A protein complex on the surface of platelets

13. MOA of Heparin

14. Laboratory test used to monitor the anticoagulant effect of warfarin which is prolonged when drug effect is adequate.

15. Unfractionated heparin has a molecular weight range of 5000-30000

16. Which clotting factor/s is/are inhibited by Oral Anticoagulant drugs?

17. Which of the following drugs accelerates the conversion of plasminogen to plasmin?

18. System of serine proteases and substrates in the blood that provides rapid generation of clotting factors in response to blood vessel damage

19. Site of Action for Heparin

20. Choose the correct statement about ADP receptor antagonists

21. It is a phosphodiesterase-3 inhibitor

22. A hypercoagulable state plus thrombocytopenia that occurs in a small number of individuals treated with unfractionated heparin

23. If this patient undergoes a percutaneous coronary angiography procedure and placement of a stent in a coronary blood vessel, she may be given eptifibatide. Which of the following most accurately describes the mechanism of eptifibatide anticlotting action?

24. An endogenous anticlotting protein that irreversibly inactivates thrombin and factor Xa.

25. When activated, it aggregates platelets primarily by binding to fibrin

26. Which statement is TRUE on the clinical use of Thrombolytics?

27. Choose the correct statement on Inhibitors of Phosphodiesterase 3.

28. Its enzymatic action is markedly accelerated by the heparins

29. Laboratory test used to monitor the anticoagulant effect of unfractionated heparin and direct thrombin inhibitors which is prolonged when drug effect is adequate

31. Site of Action for Warfarin

32. Which statement is TRUE? (You can tick more than once)

33. Substances that increase intracellular cyclic adenosine monophosphate –cAMP- inhibit ______.

34. A cell surface protein involved in platelet cross-linking.

35. It is activated by endogenous factors such as thromboxane A2, ADP and serotonin which initiates a signaling cascade

36. Which drug may be a problem given that the patient has DM?

38. Which clotting factor/s is/are inhibited by Heparin?

40. Which statement is true about Warfarin?

42. Goals of Treatment for MI (you can tick more than once)

43. The following are Antiplatelet drugs EXCEPT:

47. Which statement/s is/are TRUE about Rivaroxaban and Apixaban? (you can tick more than once)

48. Choose the General Approaches in the treatment and management of MI? (you can tick more than once)

49. Which statement/s is/are TRUE about Thrombolytic Agents? (you can tick more than once)

50. Which statement/s is/are TRUE? (you can tick more than once)

35. It is activated by endogenous factors such as thromboxane A₂, ADP and serotonin which initiates a signaling cascade