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 (D)</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 (B)</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 (C)</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 (C)</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 (C)</p> Signup and view all the answers

Where is endogenous heparin found most abundantly in the body?

<p>Lungs (D)</p> Signup and view all the answers

What is the recommended antidote for heparin overdose?

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

How does heparin primarily get excreted from the body?

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

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

<p>Immediately (D)</p> Signup and view all the answers

Which is NOT a shortcoming of clopidogrel?

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

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

<p>CYP2C19 (B)</p> Signup and view all the answers

When does platelet inhibition typically occur after taking clopidogrel?

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

What is the approximate half-life of clopidogrel?

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

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

<p>Inhibition of the ADP receptor (B)</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 (A)</p> Signup and view all the answers

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

<p>Measuring fibrinogen level (D)</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 (D)</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 (D)</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 (D)</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 (A)</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 (A)</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 (C)</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 (D)</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 (A)</p> Signup and view all the answers

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

<p>Never (B)</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 (B)</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 (C)</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 (A)</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 (D)</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 (D)</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 (C)</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 (B)</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 (B)</p> Signup and view all the answers

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

<p>Kidneys (C)</p> Signup and view all the answers

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

<p>98% (A)</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 (C)</p> Signup and view all the answers

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

<p>Preventing vitamin K synthesis (C)</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 (C)</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 (A)</p> Signup and view all the answers

What is the mechanism of action of alteplase?

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

Why is caution advised when using alteplase in older patients?

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

Where does metabolism predominantly occur for alteplase?

<p>Liver (A)</p> Signup and view all the answers

Which route of administration is used for alteplase?

<p>Intravenous (A)</p> Signup and view all the answers

What is the main adverse effect of alteplase?

<p>Bleeding (C)</p> Signup and view all the answers

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

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

What is one of the three noted shortcomings of clopidogrel?

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

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

<p>CYP2C19 (C)</p> Signup and view all the answers

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

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

What is the approximate half-life of clopidogrel?

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

How is clopidogrel primarily excreted from the body?

<p>Intestines (A)</p> Signup and view all the answers

What is the main action of clopidogrel on platelet cells?

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

What is the primary adverse effect associated with warfarin therapy?

<p>Hemorrhage (B)</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 (B)</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 (D)</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 (B)</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 (B)</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 (B)</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 (C)</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 (C)</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 (C)</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 (D)</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 (A)</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 (C)</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 (D)</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 (B)</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 (C)</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 (A)</p> Signup and view all the answers

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

<p>To improve patient outcomes (C)</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 (B)</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 (B)</p> Signup and view all the answers

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

<p>Requires dosage reduction (A)</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 (C)</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 (C)</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 (D)</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 (A)</p> Signup and view all the answers

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

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

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

<p>Tylenol (D)</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 (C)</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 (A)</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 (A)</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 (C)</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 (B)</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 (B)</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 (B)</p> Signup and view all the answers

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

<p>Kidneys (B)</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 (B)</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 (B)</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 (C)</p> Signup and view all the answers

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

<p>Liver (D)</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 (B)</p> Signup and view all the answers

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

<p>Patients with renal impairment (A)</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 (A)</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 (A)</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 (D)</p> Signup and view all the answers

How does this medication primarily prevent organ rejection following transplants?

<p>By inhibiting DNA synthesis (B)</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 (C)</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 (C)</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 (D)</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 (A)</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 (A)</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 (A)</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 (A)</p> Signup and view all the answers

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