106 Questions
Which drug is typically administered with clopidogrel to prevent thrombosis following placement of an intracoronary stent?
Aspirin
What is the usual loading dose range of clopidogrel when administered for platelet inhibition?
300-600 mg
In what duration is maximum inhibition of platelet aggregation achieved with repeated doses of 75 mg/d of clopidogrel?
3-7 days
For what specific condition is clopidogrel used in conjunction with aspirin to reduce major vascular events?
Acute coronary syndrome
Which condition may lead prescribers to order clopidogrel as an alternative antiplatelet drug for patients who cannot tolerate aspirin?
Allergies
What is the duration for which platelet inhibition essentially lasts after administration of clopidogrel?
5-7 days
What is the recommended duration for patients who receive implants with a bare-metal stent or a drug-eluting stent to take dual antiplatelet therapy?
12 months
How soon does the effect of clopidogrel become apparent after administering a 300-mg loading dose?
2 hours
Where is endogenous heparin found most abundantly in the body?
Lungs
What is the recommended antidote for heparin overdose?
Protamine sulfate
How does heparin primarily get excreted from the body?
In the urine
What is the onset of action when heparin is administered intravenously?
Immediately
Which is NOT a shortcoming of clopidogrel?
Fast onset of action
What is the enzyme responsible for converting clopidogrel to its active form?
CYP2C19
When does platelet inhibition typically occur after taking clopidogrel?
2 hours after ingestion
What is the approximate half-life of clopidogrel?
8 hours
Which aspect of clopidogrel's action makes it similar to aspirin?
Inhibition of the ADP receptor
What is a notable difference between clopidogrel and heparin in terms of their mechanism of action?
Heparin has an antidote while clopidogrel does not
What is a crucial step before initiating thrombolytic therapy with alteplase?
Measuring fibrinogen level
In which patients is alteplase contraindicated due to an increased risk of bleeding?
Patients with recent intracranial surgery
What is the role of experienced personnel in administering thrombolytic therapy?
Having cardiac and other monitoring devices in place
Why is it necessary to avoid intramuscular injections in patients receiving systemic thrombolytic therapy?
To minimize the risk of bleeding
When should the fibrinogen level be measured after starting thrombolytic therapy with alteplase?
Two or three hours after starting alteplase
In which patients should alteplase be avoided due to the presence of certain conditions?
Patients with known coagulopathy
What are the contraindications for the use of traditional anticoagulants like heparin?
Peptic ulcer disease and blood dyscrasias
How should the aPTT be regulated during heparin therapy?
Maintained at 1.5 to 2.5 times the control value
When should blood for the aPTT be drawn during intermittent administration of heparin?
Approximately 1 hour before a dose of heparin
When is it necessary to monitor aPTT when using low-dose standard heparin subcutaneously?
Never
What is the normal control value for aPTT, and what are therapeutic values for adequate anticoagulation?
$25$ to $35$ seconds and $45 to $70$ seconds
In which patient populations should heparin therapy be avoided due to contraindications mentioned in the text?
Critically ill patients with acute thromboembolic disorders
Which patient population might require concurrent treatment with other anticoagulants along with warfarin due to the delayed onset of its anticoagulant effects?
Critically ill patients
In which patient group is a lower dose of warfarin usually required to achieve a therapeutic effect?
Elderly patients
Which population might face challenges with warfarin dosage adjustments due to its potential accumulation in their bodies?
Patients with hepatic impairment
What is a concern when administering warfarin to children post-cardiac surgery for thromboembolism prevention?
Established doses and guidelines
Which patient group would likely need dosage adjustments for warfarin due to decreased synthesis of vitamin K and plasma proteins?
Critically ill patients
For which patient group would a clinician need to closely monitor blood coagulation tests while on warfarin therapy?
Pediatric patients
What is the primary organ responsible for the excretion of warfarin and its inactive metabolites?
Kidneys
What percentage of warfarin is bound to plasma proteins, predominantly albumin?
98%
What is the antidote for warfarin in cases where the INR level is 5 or above with signs of bleeding?
Vitamin K
How does warfarin prevent blood clotting by acting on hepatic clotting factors?
Preventing vitamin K synthesis
When do the anticoagulant effects of warfarin typically start to manifest after initiation?
Within 3 to 5 days
Which clotting factors are directly affected by warfarin's competitive antagonism with vitamin K?
Factors II, VII, IX, and X
What is the mechanism of action of alteplase?
Promotes fibrinolysis
Why is caution advised when using alteplase in older patients?
Higher risk of bleeding complications
Where does metabolism predominantly occur for alteplase?
Liver
Which route of administration is used for alteplase?
Intravenous
What is the main adverse effect of alteplase?
Bleeding
Which condition is NOT an indication for the use of alteplase?
Congestive heart failure
What is one of the three noted shortcomings of clopidogrel?
Reversible inhibitory effects on platelets
Which enzyme is primarily responsible for converting clopidogrel to its active form?
CYP2C19
How does platelet inhibition typically occur after a single dose of clopidogrel?
2 hours after administration
What is the approximate half-life of clopidogrel?
8 hours
How is clopidogrel primarily excreted from the body?
Intestines
What is the main action of clopidogrel on platelet cells?
Blocks the ADP receptor
What is the primary adverse effect associated with warfarin therapy?
Hemorrhage
Why is a lower dose of warfarin usually required with increasing patient age?
Decreased synthesis of vitamin K
What is the main reason that warfarin dosage adjustments may be necessary in people with hepatic impairment?
Accumulation in hepatic tissues
Why might critically ill patients need concurrent treatment with other anticoagulants while on warfarin?
Due to the delayed onset of warfarin's effects
What is the main reason that heparin is continued until the international normalized ratio (INR) is in the therapeutic range?
To maintain consistent anticoagulation
Why are children post-cardiac surgery given warfarin for thromboembolism prevention?
'Safe and effective' established dosages and guidelines are absent for children
What is the primary goal of heparin therapy in patients with disseminated intravascular coagulation (DIC)?
To replenish clotting factors quickly
Why is heparin considered the anticoagulant of choice during pregnancy and lactation?
It is not secreted in breast milk
What is the impact of renal or hepatic impairment on heparin dosage?
The half-life of heparin is unaffected
Why is it essential to monitor platelet counts regularly during heparin therapy?
To watch for the development of heparin-induced thrombocytopenia
In what scenario would it be necessary to discontinue heparin therapy?
If platelet count falls below 100,000 or less than half the baseline value
Why is LMWH often preferred for home management of venous thrombosis?
It is associated with a lower risk of heparin-induced thrombocytopenia
What is the purpose of having a 'quiet zone' during medication preparation and administration?
To reduce errors and distractions
Which aspect is considered while studying medications according to the study guide?
Purpose and mechanism of action
Why are drug names classified into generic and brand (trade) names?
To indicate chemical composition and manufacturer branding
What is the significance of knowing the side effects/adverse reactions of medications?
To provide informed patient care
Why is it crucial to know the classification and prototypes of medications?
To improve patient outcomes
Which of the following is a potential adverse effect of ibuprofen related to renal impairment?
Decreased renal blood flow
What is the primary purpose of using ibuprofen in children over 6 months of age?
To reduce fever
What is the mechanism of action of ibuprofen in relation to hepatic impairment?
Requires dosage reduction
Among the listed NSAIDs, which one is a propionic acid derivative and a prototype of its class?
Ibuprofen
Which of the following patient groups would need evaluation for potential GI blood loss when prescribed ibuprofen?
Older adults taking ibuprofen
What is the primary purpose of Tylenol (Acetaminophen) based on the text?
Anti-inflammatory and analgesic effects
Which drug has the mechanism of action to inhibit platelet aggregation and is known to be nephrotoxic?
Clopidogrel
What is a common adverse effect associated with Ibuprofen based on the information provided?
Gastric ulcers
Which drug in the text has a duration of action ranging from 3 to 6 hours and can cross the placenta and enter breast milk?
Aspirin
Based on the text, which medication is primarily used for its antipyretic effects?
Tylenol
What is the primary purpose of the Drug Enforcement Administration (DEA) enforcing the Controlled Substances Act?
To prevent any potential abuse of controlled substances
What is a notable nursing implication when administering strong controlled substances?
Administering them only to people for whom they are prescribed
What is a potential adverse effect associated with Schedule III opioid analgesics?
Development of psychological or physical dependence
In terms of pharmacokinetics, what does absorption refer to?
The movement of a drug through the body to reach sites of action
Which classification of medications is described as having accepted medical use, but still with some potential for abuse?
Schedule IV
What is the primary purpose of warfarin in the context of excretion and vitamin K antagonism?
To prevent the synthesis of vitamin K-dependent clotting factors in the liver
What is a potential adverse effect of administering vitamin K as an antidote for warfarin overdose?
Increased risk of blood clots
Which organ is primarily responsible for the excretion of warfarin and its inactive metabolites?
Kidneys
What is the mechanism of action of warfarin that leads to its anticoagulant effects?
Inhibiting synthesis of vitamin K-dependent clotting factors
How does renal impairment impact the excretion of warfarin from the body?
It decreases excretion of the drug from the kidneys
What is the primary purpose of prescribing the least toxic drug, according to the text?
To maximize the benefit to the patient
In terms of Pharmacokinetics, what is the primary site of metabolism for acetaminophen (Tylenol)?
Liver
What is the mechanism of excretion for acetaminophen (Tylenol) after metabolism?
94% in urine as conjugates, 2% unchanged, 4% as a toxic metabolite
Which patient group should avoid acetaminophen due to possible accumulation in kidneys?
Patients with renal impairment
What is a significant implication of alternating acetaminophen and ibuprofen in young children over a 3-day period?
Effective way to control fever
What is a potential adverse effect associated with the long-term use of the medication described in the text?
Fluid and electrolyte imbalance
Which of the following is an important nursing implication related to the administration of this medication to pediatric patients with renal impairment?
Monitoring for sources of infection
How does this medication primarily prevent organ rejection following transplants?
By inhibiting DNA synthesis
Which common side effect is particularly concerning due to its potential impact on patients' nutritional status?
Weight changes
What is the main therapeutic effect healthcare providers should monitor for in patients receiving this medication?
Absence of signs/symptoms of rejection reactions
What is a key contraindication for the use of this medication during pregnancy and lactation?
Potential fetal malformations
Which organ's impairment may lead to increased plasma levels of the medication and the need for dose adjustments?
Liver
What is a protection precaution for patients prescribed this medication regarding their living environment?
Ensuring a clean home environment
Which adverse effect may necessitate close monitoring of fluid and electrolyte balance in patients taking this medication?
Weight changes
What should be enforced in women taking this medication to prevent potential fetal loss or malformations?
Contraception use
Test your knowledge on the pharmacokinetics of Clopidogrel, including onset of action, duration of platelet inhibition, and dosing regimens. Learn about the effectiveness and timing of platelet aggregation with this quiz.
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