Clopidogrel Pharmacokinetics Quiz
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Questions and Answers

Which drug is typically administered with clopidogrel to prevent thrombosis following placement of an intracoronary stent?

  • Aspirin (correct)
  • Heparin
  • Coumadin
  • Warfarin

    • What is the usual loading dose range of clopidogrel when administered for platelet inhibition?

  • 100-200 mg
  • 200-400 mg
  • 300-600 mg (correct)
  • 600-800 mg

    • In what duration is maximum inhibition of platelet aggregation achieved with repeated doses of 75 mg/d of clopidogrel?

  • 3-7 days (correct)
  • 1-3 days
  • 10-14 days
  • 7-10 days

    • For what specific condition is clopidogrel used in conjunction with aspirin to reduce major vascular events?

    <p>Acute coronary syndrome</p> Signup and view all the answers

    Which condition may lead prescribers to order clopidogrel as an alternative antiplatelet drug for patients who cannot tolerate aspirin?

    <p>Allergies</p> Signup and view all the answers

    What is the duration for which platelet inhibition essentially lasts after administration of clopidogrel?

    <p>5-7 days</p> Signup and view all the answers

    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?

    <p>12 months</p> Signup and view all the answers

    How soon does the effect of clopidogrel become apparent after administering a 300-mg loading dose?

    <p>2 hours</p> Signup and view all the answers

    Where is endogenous heparin found most abundantly in the body?

    <p>Lungs</p> Signup and view all the answers

    What is the recommended antidote for heparin overdose?

    <p>Protamine sulfate</p> Signup and view all the answers

    How does heparin primarily get excreted from the body?

    <p>In the urine</p> Signup and view all the answers

    What is the onset of action when heparin is administered intravenously?

    <p>Immediately</p> Signup and view all the answers

    Which is NOT a shortcoming of clopidogrel?

    <p>Fast onset of action</p> Signup and view all the answers

    What is the enzyme responsible for converting clopidogrel to its active form?

    <p>CYP2C19</p> Signup and view all the answers

    When does platelet inhibition typically occur after taking clopidogrel?

    <p>2 hours after ingestion</p> Signup and view all the answers

    What is the approximate half-life of clopidogrel?

    <p>8 hours</p> Signup and view all the answers

    Which aspect of clopidogrel's action makes it similar to aspirin?

    <p>Inhibition of the ADP receptor</p> Signup and view all the answers

    What is a notable difference between clopidogrel and heparin in terms of their mechanism of action?

    <p>Heparin has an antidote while clopidogrel does not</p> Signup and view all the answers

    What is a crucial step before initiating thrombolytic therapy with alteplase?

    <p>Measuring fibrinogen level</p> Signup and view all the answers

    In which patients is alteplase contraindicated due to an increased risk of bleeding?

    <p>Patients with recent intracranial surgery</p> Signup and view all the answers

    What is the role of experienced personnel in administering thrombolytic therapy?

    <p>Having cardiac and other monitoring devices in place</p> Signup and view all the answers

    Why is it necessary to avoid intramuscular injections in patients receiving systemic thrombolytic therapy?

    <p>To minimize the risk of bleeding</p> Signup and view all the answers

    When should the fibrinogen level be measured after starting thrombolytic therapy with alteplase?

    <p>Two or three hours after starting alteplase</p> Signup and view all the answers

    In which patients should alteplase be avoided due to the presence of certain conditions?

    <p>Patients with known coagulopathy</p> Signup and view all the answers

    What are the contraindications for the use of traditional anticoagulants like heparin?

    <p>Peptic ulcer disease and blood dyscrasias</p> Signup and view all the answers

    How should the aPTT be regulated during heparin therapy?

    <p>Maintained at 1.5 to 2.5 times the control value</p> Signup and view all the answers

    When should blood for the aPTT be drawn during intermittent administration of heparin?

    <p>Approximately 1 hour before a dose of heparin</p> Signup and view all the answers

    When is it necessary to monitor aPTT when using low-dose standard heparin subcutaneously?

    <p>Never</p> Signup and view all the answers

    What is the normal control value for aPTT, and what are therapeutic values for adequate anticoagulation?

    <p>$25$ to $35$ seconds and $45 to $70$ seconds</p> Signup and view all the answers

    In which patient populations should heparin therapy be avoided due to contraindications mentioned in the text?

    <p>Critically ill patients with acute thromboembolic disorders</p> Signup and view all the answers

    Which patient population might require concurrent treatment with other anticoagulants along with warfarin due to the delayed onset of its anticoagulant effects?

    <p>Critically ill patients</p> Signup and view all the answers

    In which patient group is a lower dose of warfarin usually required to achieve a therapeutic effect?

    <p>Elderly patients</p> Signup and view all the answers

    Which population might face challenges with warfarin dosage adjustments due to its potential accumulation in their bodies?

    <p>Patients with hepatic impairment</p> Signup and view all the answers

    What is a concern when administering warfarin to children post-cardiac surgery for thromboembolism prevention?

    <p>Established doses and guidelines</p> Signup and view all the answers

    Which patient group would likely need dosage adjustments for warfarin due to decreased synthesis of vitamin K and plasma proteins?

    <p>Critically ill patients</p> Signup and view all the answers

    For which patient group would a clinician need to closely monitor blood coagulation tests while on warfarin therapy?

    <p>Pediatric patients</p> Signup and view all the answers

    What is the primary organ responsible for the excretion of warfarin and its inactive metabolites?

    <p>Kidneys</p> Signup and view all the answers

    What percentage of warfarin is bound to plasma proteins, predominantly albumin?

    <p>98%</p> Signup and view all the answers

    What is the antidote for warfarin in cases where the INR level is 5 or above with signs of bleeding?

    <p>Vitamin K</p> Signup and view all the answers

    How does warfarin prevent blood clotting by acting on hepatic clotting factors?

    <p>Preventing vitamin K synthesis</p> Signup and view all the answers

    When do the anticoagulant effects of warfarin typically start to manifest after initiation?

    <p>Within 3 to 5 days</p> Signup and view all the answers

    Which clotting factors are directly affected by warfarin's competitive antagonism with vitamin K?

    <p>Factors II, VII, IX, and X</p> Signup and view all the answers

    What is the mechanism of action of alteplase?

    <p>Promotes fibrinolysis</p> Signup and view all the answers

    Why is caution advised when using alteplase in older patients?

    <p>Higher risk of bleeding complications</p> Signup and view all the answers

    Where does metabolism predominantly occur for alteplase?

    <p>Liver</p> Signup and view all the answers

    Which route of administration is used for alteplase?

    <p>Intravenous</p> Signup and view all the answers

    What is the main adverse effect of alteplase?

    <p>Bleeding</p> Signup and view all the answers

    Which condition is NOT an indication for the use of alteplase?

    <p>Congestive heart failure</p> Signup and view all the answers

    What is one of the three noted shortcomings of clopidogrel?

    <p>Reversible inhibitory effects on platelets</p> Signup and view all the answers

    Which enzyme is primarily responsible for converting clopidogrel to its active form?

    <p>CYP2C19</p> Signup and view all the answers

    How does platelet inhibition typically occur after a single dose of clopidogrel?

    <p>2 hours after administration</p> Signup and view all the answers

    What is the approximate half-life of clopidogrel?

    <p>8 hours</p> Signup and view all the answers

    How is clopidogrel primarily excreted from the body?

    <p>Intestines</p> Signup and view all the answers

    What is the main action of clopidogrel on platelet cells?

    <p>Blocks the ADP receptor</p> Signup and view all the answers

    What is the primary adverse effect associated with warfarin therapy?

    <p>Hemorrhage</p> Signup and view all the answers

    Why is a lower dose of warfarin usually required with increasing patient age?

    <p>Decreased synthesis of vitamin K</p> Signup and view all the answers

    What is the main reason that warfarin dosage adjustments may be necessary in people with hepatic impairment?

    <p>Accumulation in hepatic tissues</p> Signup and view all the answers

    Why might critically ill patients need concurrent treatment with other anticoagulants while on warfarin?

    <p>Due to the delayed onset of warfarin's effects</p> Signup and view all the answers

    What is the main reason that heparin is continued until the international normalized ratio (INR) is in the therapeutic range?

    <p>To maintain consistent anticoagulation</p> Signup and view all the answers

    Why are children post-cardiac surgery given warfarin for thromboembolism prevention?

    <p>'Safe and effective' established dosages and guidelines are absent for children</p> Signup and view all the answers

    What is the primary goal of heparin therapy in patients with disseminated intravascular coagulation (DIC)?

    <p>To replenish clotting factors quickly</p> Signup and view all the answers

    Why is heparin considered the anticoagulant of choice during pregnancy and lactation?

    <p>It is not secreted in breast milk</p> Signup and view all the answers

    What is the impact of renal or hepatic impairment on heparin dosage?

    <p>The half-life of heparin is unaffected</p> Signup and view all the answers

    Why is it essential to monitor platelet counts regularly during heparin therapy?

    <p>To watch for the development of heparin-induced thrombocytopenia</p> Signup and view all the answers

    In what scenario would it be necessary to discontinue heparin therapy?

    <p>If platelet count falls below 100,000 or less than half the baseline value</p> Signup and view all the answers

    Why is LMWH often preferred for home management of venous thrombosis?

    <p>It is associated with a lower risk of heparin-induced thrombocytopenia</p> Signup and view all the answers

    What is the purpose of having a 'quiet zone' during medication preparation and administration?

    <p>To reduce errors and distractions</p> Signup and view all the answers

    Which aspect is considered while studying medications according to the study guide?

    <p>Purpose and mechanism of action</p> Signup and view all the answers

    Why are drug names classified into generic and brand (trade) names?

    <p>To indicate chemical composition and manufacturer branding</p> Signup and view all the answers

    What is the significance of knowing the side effects/adverse reactions of medications?

    <p>To provide informed patient care</p> Signup and view all the answers

    Why is it crucial to know the classification and prototypes of medications?

    <p>To improve patient outcomes</p> Signup and view all the answers

    Which of the following is a potential adverse effect of ibuprofen related to renal impairment?

    <p>Decreased renal blood flow</p> Signup and view all the answers

    What is the primary purpose of using ibuprofen in children over 6 months of age?

    <p>To reduce fever</p> Signup and view all the answers

    What is the mechanism of action of ibuprofen in relation to hepatic impairment?

    <p>Requires dosage reduction</p> Signup and view all the answers

    Among the listed NSAIDs, which one is a propionic acid derivative and a prototype of its class?

    <p>Ibuprofen</p> Signup and view all the answers

    Which of the following patient groups would need evaluation for potential GI blood loss when prescribed ibuprofen?

    <p>Older adults taking ibuprofen</p> Signup and view all the answers

    What is the primary purpose of Tylenol (Acetaminophen) based on the text?

    <p>Anti-inflammatory and analgesic effects</p> Signup and view all the answers

    Which drug has the mechanism of action to inhibit platelet aggregation and is known to be nephrotoxic?

    <p>Clopidogrel</p> Signup and view all the answers

    What is a common adverse effect associated with Ibuprofen based on the information provided?

    <p>Gastric ulcers</p> Signup and view all the answers

    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?

    <p>Aspirin</p> Signup and view all the answers

    Based on the text, which medication is primarily used for its antipyretic effects?

    <p>Tylenol</p> Signup and view all the answers

    What is the primary purpose of the Drug Enforcement Administration (DEA) enforcing the Controlled Substances Act?

    <p>To prevent any potential abuse of controlled substances</p> Signup and view all the answers

    What is a notable nursing implication when administering strong controlled substances?

    <p>Administering them only to people for whom they are prescribed</p> Signup and view all the answers

    What is a potential adverse effect associated with Schedule III opioid analgesics?

    <p>Development of psychological or physical dependence</p> Signup and view all the answers

    In terms of pharmacokinetics, what does absorption refer to?

    <p>The movement of a drug through the body to reach sites of action</p> Signup and view all the answers

    Which classification of medications is described as having accepted medical use, but still with some potential for abuse?

    <p>Schedule IV</p> Signup and view all the answers

    What is the primary purpose of warfarin in the context of excretion and vitamin K antagonism?

    <p>To prevent the synthesis of vitamin K-dependent clotting factors in the liver</p> Signup and view all the answers

    What is a potential adverse effect of administering vitamin K as an antidote for warfarin overdose?

    <p>Increased risk of blood clots</p> Signup and view all the answers

    Which organ is primarily responsible for the excretion of warfarin and its inactive metabolites?

    <p>Kidneys</p> Signup and view all the answers

    What is the mechanism of action of warfarin that leads to its anticoagulant effects?

    <p>Inhibiting synthesis of vitamin K-dependent clotting factors</p> Signup and view all the answers

    How does renal impairment impact the excretion of warfarin from the body?

    <p>It decreases excretion of the drug from the kidneys</p> Signup and view all the answers

    What is the primary purpose of prescribing the least toxic drug, according to the text?

    <p>To maximize the benefit to the patient</p> Signup and view all the answers

    In terms of Pharmacokinetics, what is the primary site of metabolism for acetaminophen (Tylenol)?

    <p>Liver</p> Signup and view all the answers

    What is the mechanism of excretion for acetaminophen (Tylenol) after metabolism?

    <p>94% in urine as conjugates, 2% unchanged, 4% as a toxic metabolite</p> Signup and view all the answers

    Which patient group should avoid acetaminophen due to possible accumulation in kidneys?

    <p>Patients with renal impairment</p> Signup and view all the answers

    What is a significant implication of alternating acetaminophen and ibuprofen in young children over a 3-day period?

    <p>Effective way to control fever</p> Signup and view all the answers

    What is a potential adverse effect associated with the long-term use of the medication described in the text?

    <p>Fluid and electrolyte imbalance</p> Signup and view all the answers

    Which of the following is an important nursing implication related to the administration of this medication to pediatric patients with renal impairment?

    <p>Monitoring for sources of infection</p> Signup and view all the answers

    How does this medication primarily prevent organ rejection following transplants?

    <p>By inhibiting DNA synthesis</p> Signup and view all the answers

    Which common side effect is particularly concerning due to its potential impact on patients' nutritional status?

    <p>Weight changes</p> Signup and view all the answers

    What is the main therapeutic effect healthcare providers should monitor for in patients receiving this medication?

    <p>Absence of signs/symptoms of rejection reactions</p> Signup and view all the answers

    What is a key contraindication for the use of this medication during pregnancy and lactation?

    <p>Potential fetal malformations</p> Signup and view all the answers

    Which organ's impairment may lead to increased plasma levels of the medication and the need for dose adjustments?

    <p>Liver</p> Signup and view all the answers

    What is a protection precaution for patients prescribed this medication regarding their living environment?

    <p>Ensuring a clean home environment</p> Signup and view all the answers

    Which adverse effect may necessitate close monitoring of fluid and electrolyte balance in patients taking this medication?

    <p>Weight changes</p> Signup and view all the answers

    What should be enforced in women taking this medication to prevent potential fetal loss or malformations?

    <p>Contraception use</p> Signup and view all the answers

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