Anticoagulant, Antiplatelet, and Fibrinolytic Agents
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Questions and Answers

What is the specific portion of heparin that binds to Antithrombin (AT) forming the AT/Heparin complex?

  • Pentasaccharide sequence (correct)
  • Disaccharide sequence
  • Monosaccharide sequence
  • Oligosaccharide sequence

    • Which coagulation factors are irreversibly inhibited by the AT/Heparin complex?

  • IIa and IXa
  • Xa and XIa
  • IIa, IXa, Xa, XIa, and XIIa (correct)
  • IXa and XIa

    • What is the anti-factor Xa to anti-factor IIa inactivated ratio for unfractionated heparin (UFH)?

  • 1:2
  • 2:2
  • 1:1 (correct)
  • 2:1

    • Apart from Antithrombin, what other plasma proteins or cells does unfractionated heparin (UFH) bind to?

    <p>Endothelial cells</p> Signup and view all the answers

    Which factors are the most sensitive to inhibition by the AT/Heparin complex?

    <p>Factor IIa and Xa</p> Signup and view all the answers

    What is the percentage of the heparin molecule that contains the high-affinity pentasaccharide sequence required for anticoagulant activity?

    <p>1/3</p> Signup and view all the answers

    What is the most common serious adverse effect of Unfractionated Heparin?

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

    In which condition are heparin requirements reduced and elimination half-life prolonged?

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

    For which condition are the doses of Unfractionated Heparin recommended to be LOWER compared to VTE treatment?

    <p>Acute Coronary Syndrome</p> Signup and view all the answers

    What is the most common site of bleeding associated with heparin use?

    <p>GI System</p> Signup and view all the answers

    Which reaction is NOT an adverse effect associated with Unfractionated Heparin?

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

    In which condition are heparin requirements increased according to the text?

    <p>Pulmonary embolic disease</p> Signup and view all the answers

    What is the primary route of excretion for Dabigatran and its metabolites?

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

    Which test is NOT recommended for routine monitoring of Pradaxa®'s anticoagulant effect?

    <p>Activated partial thromboplastin time (aPTT)</p> Signup and view all the answers

    What is the most sensitive test to perform if the anticoagulant effect of Pradaxa® is to be assessed?

    <p>Ecarin clotting time (ECT)</p> Signup and view all the answers

    Which medication is specifically mentioned to increase the risk of bleeding when used concomitantly with Pradaxa®?

    <p>Aspirin (ASA)</p> Signup and view all the answers

    What is the reversal agent for Dabigatran (Pradaxa®) called?

    <p>Praxbind® (Idarucizumab)</p> Signup and view all the answers

    Which of the following is NOT an Oral Direct Factor Xa Inhibitor?

    <p>Warfarin (Coumadin)</p> Signup and view all the answers

    'LP' in medical context stands for:

    <p>Lumbar Puncture</p> Signup and view all the answers

    'Fab' in Idarucizumab refers to:

    <p>Fragment Antigen Binding</p> Signup and view all the answers

    'Hemodialysis can be used to remove _______ in an overdose situation.'

    <p>Excess Drug</p> Signup and view all the answers

    Which of the following can influence the risk of bleeding when using Pradaxa®?

    <p>Concomitant use with NSAIDs</p> Signup and view all the answers

    What is the mechanism of action of streptokinase?

    <p>Forms a complex with plasminogen to generate plasmin</p> Signup and view all the answers

    What is the primary concern associated with the use of streptokinase?

    <p>Formation of anti-streptokinase antibodies</p> Signup and view all the answers

    Which type of thrombolytic agent preferentially binds to fibrin within a thrombus?

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

    What is the plasma half-life of streptokinase?

    <p>20 minutes</p> Signup and view all the answers

    Which adverse effect is most commonly associated with streptokinase use?

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

    What initiates local fibrinolysis in the mechanism of action of fibrin-specific thrombolytics?

    <p>Plasminogen conversion to plasmin on fibrin</p> Signup and view all the answers

    What is the primary route of elimination for ticagrelor?

    <p>Hepatic metabolism</p> Signup and view all the answers

    Which antiplatelet agent is considered a more potent inhibitor of platelet aggregation than clopidogrel but less than prasugrel?

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

    What is the mechanism of action of ticagrelor and its active metabolite?

    <p>Reversible binding to P2Y12 receptors</p> Signup and view all the answers

    Which medication should ticagrelor be discontinued at least 5 days prior to?

    <p>Any surgery</p> Signup and view all the answers

    In patients with ACS managed with PCI, which antiplatelet agent is indicated to reduce the rate of thrombotic cardiovascular events?

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

    Which drug class does ticagrelor belong to?

    <p>Cyclopentyl-triazolo-pyrimidine</p> Signup and view all the answers

    What is a reported adverse effect of ticagrelor?

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

    What condition is a contraindication for the use of prasugrel?

    <p>Previous transient ischemic attack (TIA) or stroke</p> Signup and view all the answers

    Which antiplatelet agent requires metabolic activation before becoming active?

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

    What enzyme is mainly responsible for the metabolism of ticagrelor?

    <p>CYP3A4</p> Signup and view all the answers

    What is the most appropriate recommendation for managing patients with a concern for protamine allergy?

    <p>Provide antihistamines and corticosteroids as prophylaxis</p> Signup and view all the answers

    In patients receiving insulin containing protamine, what group is more likely to experience allergic reactions to protamine?

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

    What is the recommended time interval to delay heparin administration after needle placement for neuraxial blockade?

    <p>1 hour</p> Signup and view all the answers

    For subcutaneous prophylaxis, when can neuraxial blocks occur after heparin administration?

    <p>4 to 6 hours after heparin administration</p> Signup and view all the answers

    What is the recommended action regarding heparin infusion and coagulation status before neuraxial blockade?

    <p>Verify normal coagulation status before heparin infusion</p> Signup and view all the answers

    When should low-dose heparin be delayed for one hour after needle placement?

    <p>&gt;12 hours after needle placement</p> Signup and view all the answers

    What is the mechanism of action of Iprivask® (Desirudin)?

    <p>Forms a complex with thrombin and causes irreversible inhibition</p> Signup and view all the answers

    How is Lepirudin (Refludan®) primarily administered?

    <p>Continuous IV infusion</p> Signup and view all the answers

    Which direct thrombin inhibitor has been discontinued by the manufacturer?

    <p>Refludan® (Lepirudin)</p> Signup and view all the answers

    What is the primary route of excretion for Iprivask® (Desirudin)?

    <p>Renal excretion</p> Signup and view all the answers

    Which laboratory test should be monitored for Lepirudin use?

    <p>Activated clotting time (ACT)</p> Signup and view all the answers

    What is the key difference between Desirudin and Lepirudin?

    <p>Route of administration</p> Signup and view all the answers

    Which direct thrombin inhibitor requires dose adjustments in patients with liver impairment?

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

    What is the mechanism of action of Bivalirudin in inhibiting thrombin function?

    <p>Prevents fibrin formation</p> Signup and view all the answers

    Which direct thrombin inhibitor can be safely used in patients with varying degrees of renal dysfunction without requiring dosage adjustments?

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

    What is the primary route of excretion for Argatroban?

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

    Which laboratory test is used to monitor the anticoagulant effect of Argatroban in HIT patients?

    <p>APTT (activated partial thromboplastin time)</p> Signup and view all the answers

    What is the primary adverse effect associated with Bivalirudin use?

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

    Which direct thrombin inhibitor is an alternative to heparin for anticoagulation in patients requiring coronary artery bypass grafting (CABG)?

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

    'Argatroban can be used safely in patients with varying degrees of renal dysfunction' - This statement is true because:

    <p>'Dose adjustments are required in patients with renal impairment'</p> Signup and view all the answers

    'Used as an alternative to heparin in patients undergoing cardiopulmonary bypass surgery' - Which direct thrombin inhibitor does this refer to?

    <p>'Angiomax (Bivalirudin)'</p> Signup and view all the answers

    What initiates local fibrinolysis in the mechanism of action of fibrin-specific thrombolytics?

    <p>Conversion of entrapped plasminogen to plasmin</p> Signup and view all the answers

    Which agent is known to be antigenic and may lead to the formation of circulating anti-streptokinase antibodies?

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

    What is the primary concern associated with the use of streptokinase?

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

    Which property makes alteplase, reteplase, and tenectaplase different from streptokinase in their mechanism of action?

    <p>Preferential binding to fibrin</p> Signup and view all the answers

    Which effect is unique to streptokinase among the mentioned thrombolytics?

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

    What indicates the mode of action for alteplase, reteplase, and tenectaplase once introduced into the systemic circulation?

    <p>Systemic proteolysis</p> Signup and view all the answers

    Which factor Xa inhibitor has the longest half-life among the listed options?

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

    Which Factor Xa inhibitor has the highest protein binding affinity?

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

    Which laboratory test is considered the most useful to check the anticoagulant effect of these Factor Xa inhibitors?

    <p>Chromogenic anti-Xa assay</p> Signup and view all the answers

    Which Factor Xa inhibitor does not have an available assay at this time for monitoring its anticoagulant effect?

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

    Which reversal agent is specifically indicated for patients treated with rivaroxaban and apixaban?

    <p>Andexxa®</p> Signup and view all the answers

    What is the most common adverse effect associated with Factor Xa inhibitors?

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

    Which Factor Xa inhibitor has the shortest half-life among the listed options?

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

    "Andexxa®" exerts its procoagulant effect by binding to and sequestering which compound?

    <p>Factor Xa inhibitors</p> Signup and view all the answers

    Which route of excretion is common among these Factor Xa inhibitors?

    <p>Kidney &amp; feces</p> Signup and view all the answers

    What is the primary mechanism by which heparin prevents fibrin formation?

    <p>Inhibiting thrombin-induced activation of factor VIII</p> Signup and view all the answers

    Which coagulation factor is NOT irreversibly inhibited by the AT/Heparin complex?

    <p>Factor Xa</p> Signup and view all the answers

    What is the anti-factor Xa to anti-factor IIa inactivated ratio of Heparin?

    <p>1:1</p> Signup and view all the answers

    Which plasma protein or cell does Unfractionated Heparin NOT bind to?

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

    What is the specific portion of heparin that binds to Antithrombin, forming the AT/Heparin complex?

    <p>Pentasaccharide sequence</p> Signup and view all the answers

    What is the required cofactor for Unfractionated Heparin's anticoagulant effects?

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

    What is the expected therapeutic range for the Heparin anti-factor Xa assay?

    <p>0.3-0.7 anti-Xa units/mL</p> Signup and view all the answers

    For what clinical indication is the heparin dosing adjusted based on either the aPTT, ACT, or heparin anti-factor Xa assay?

    <p>Acute Coronary Syndrome (ACS)</p> Signup and view all the answers

    When monitoring higher heparin doses for PCI or CABG procedures, what is the target goal for the Activated Clotting Time (ACT)?

    <p>300-450 seconds</p> Signup and view all the answers

    Which test assesses the intrinsic and final common pathways and is used to monitor higher heparin doses in patients undergoing PCI or CABG procedures?

    <p>Activated Clotting Time (ACT)</p> Signup and view all the answers

    Which complication is associated with an increased risk of bleeding when using unfractionated heparin along with thrombolytics or glycoprotein IIb/IIIa inhibitors?

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

    In VTE treatment and prophylaxis, which monitoring test is considered the most accurate for UFH therapy?

    <p>Heparin anti-factor Xa assay</p> Signup and view all the answers

    What is the primary mechanism of action by which protamine sulfate reverses the anticoagulation effect of unfractionated heparin?

    <p>Neutralization reaction with heparin molecules</p> Signup and view all the answers

    What is the approximate half-life of protamine sulfate?

    <p>7 minutes</p> Signup and view all the answers

    What phenomenon might explain the rebound effect seen with heparin administration when comparing the clearance rates of heparin and protamine?

    <p>Rapid clearance of heparin</p> Signup and view all the answers

    What happens if protamine is administered intravenously in the absence of heparin or is given in excess?

    <p>Enhances the anticoagulant activity of heparin</p> Signup and view all the answers

    How is the dose of protamine sulfate calculated for reversing the effects of heparin?

    <p>$1.3 mg/kg for every 100 USP units of heparin</p> Signup and view all the answers

    Which system is responsible for removing the heparin-protamine complexes following their interaction?

    <p>Reticuloendothelial system</p> Signup and view all the answers

    What enzyme mainly inhibits the vitamin K oxide reductase in the conversion of vitamin K1 to vitamin KH2?

    <p>CYP2C9</p> Signup and view all the answers

    What percentage of warfarin is protein bound to albumin?

    <p>90%</p> Signup and view all the answers

    Which factor enhances the anticoagulant effect of warfarin in the presence of liver disease?

    <p>Increased metabolism</p> Signup and view all the answers

    What is the primary route of elimination for warfarin?

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

    What delays the time to onset and offset of the anticoagulant effect of warfarin?

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

    Which enzyme metabolizes S-warfarin?

    <p>CYP2C9</p> Signup and view all the answers

    Which thrombolytic agent has the highest degree of fibrin specificity and binding?

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

    What is the primary route of clearance for Reteplase?

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

    Which thrombolytic agent permits double bolus dosing of 10 units 30 minutes apart?

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

    Which thrombolytic agent is non-glycosylated and rarely causes allergic reactions?

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

    What is the major adverse effect associated with Tenecteplase use?

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

    Which thrombolytic agent has a longer plasma half-life than Alteplase?

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

    How does fondaparinux inhibit the coagulation cascade?

    <p>By forming a complex with AT and Factor Xa</p> Signup and view all the answers

    What is the primary pharmacokinetic advantage of fondaparinux over UFH and LMWHs?

    <p>Prolonged half-life in renal dysfunction</p> Signup and view all the answers

    Why is routine lab monitoring NOT required for fondaparinux?

    <p>It has a predictable anticoagulant response</p> Signup and view all the answers

    What is a contraindication for the use of fondaparinux?

    <p>Severe renal dysfunction (CrCl &lt; 30 mL/min)</p> Signup and view all the answers

    How does fondaparinux's effect on coagulation differ from heparin and LMWHs?

    <p>Fondaparinux does not bind to plasma proteins</p> Signup and view all the answers

    What is the most common adverse effect associated with Arixtra® (fondaparinux)?

    <p>Injection site reactions</p> Signup and view all the answers

    What is the primary mechanism of action of aspirin in inhibiting platelet aggregation?

    <p>Direct inhibition of thromboxane A2 synthesis</p> Signup and view all the answers

    What is the pharmacokinetic effect of high-dose aspirin on platelet cyclooxygenase enzymes?

    <p>Inhibition of both COX-1 and COX-2</p> Signup and view all the answers

    What is the primary adverse event associated with aspirin use?

    <p>Gastrointestinal bleeding</p> Signup and view all the answers

    What is the effect of enteric coating on the pharmacokinetics of aspirin?

    <p>Increases plasma levels peak time</p> Signup and view all the answers

    Which statement accurately reflects the appropriate management of aspirin therapy before surgery?

    <p>Aspirin should be continued up to surgery based on most evidence-based guidelines</p> Signup and view all the answers

    What is the primary mechanism by which Dipyridamole inhibits platelet function?

    <p>Increase in cAMP platelet concentrations</p> Signup and view all the answers

    Which laboratory test is most useful to monitor the anticoagulant effect of unfractionated heparin in patients?

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

    What is the primary mechanism of action for Ticagrelor (Brilinta®) among the listed antiplatelet agents?

    <p>Adenosine diphosphate (ADP) P2Y12 receptor antagonism</p> Signup and view all the answers

    Which Glycoprotein IIb/IIIa Receptor Inhibitor has the longest plasma half-life?

    <p>Abciximab (Reopro®)</p> Signup and view all the answers

    Which drug is recommended to be discontinued at least 5 days prior to surgery due to its antiplatelet effects?

    <p>Prasugrel (Effient®)</p> Signup and view all the answers

    Which anticoagulant is often used as an alternative to heparin in patients undergoing cardiopulmonary bypass surgery?

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

    Which medication exerts its main procoagulant effect by binding and sequestering a specific compound?

    <p>Andexxa®</p> Signup and view all the answers

    What makes Streptokinase different from other plasminogen activators in terms of its mechanism of action?

    <p>Non-enzymatic in its fibrinolytic action</p> Signup and view all the answers

    Which of the following conditions is an absolute contraindication for the administration of Fibrinolytic/Thrombolytic Agents?

    <p>Severe hypertension</p> Signup and view all the answers

    Which agent is classified as a non-fibrin-specific Fibrinolytic/Thrombolytic Agent?

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

    What is the primary clinical concern associated with the use of Streptokinase as a fibrinolytic agent?

    <p>Risk of allergic reactions</p> Signup and view all the answers

    Which thrombolytic agent is produced by recombinant DNA technology and is commercially available in the United States?

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

    In the context of Fibrinolytic/Thrombolytic Agents, what condition would be considered a relative contraindication?

    <p>&gt; 75 years of age</p> Signup and view all the answers

    Which thrombolytic agent acts preferentially on plasminogen molecules located within a fibrin clot?

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

    Which antiplatelet agent does NOT require metabolic activation and is considered a direct-acting agent?

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

    Which antiplatelet agent has been incorrectly labeled as a thienopyridine agent, but is actually a cyclopentyl-triazolo-pyrimidine drug class (CPTP)?

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

    Which antiplatelet agent is FDA approved for use only via IV administration and is a reversible P2Y12 platelet receptor antagonist?

    <p>Kengreal®</p> Signup and view all the answers

    Which antiplatelet agent is a non-thienopyridine class drug that binds reversibly to P2Y12 receptors to inhibit ADP-induced platelet aggregation?

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

    Which antiplatelet agent has the greatest risk of bleeding among the listed options?

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

    Which antiplatelet agent is considered to be approximately equipotent to its active metabolite in inhibiting platelet aggregation?

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

    Which antiplatelet agent reduces the rate of stent thrombosis in patients treated with percutaneous coronary intervention?

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

    Which of the following is a potential adverse reaction associated with rapid IV injection of protamine?

    <p>Facial flushing</p> Signup and view all the answers

    What is a possible complication of anaphylactoid reactions to protamine?

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

    In what way does rapid IV administration of protamine affect the risk of adverse reactions?

    <p>Increases the likelihood of allergic reactions</p> Signup and view all the answers

    Which of the following is a symptom associated with noncardiogenic pulmonary edema caused by protamine adverse reactions?

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

    What action can help minimize the risk of severe hypotension when administering protamine?

    <p>Extended infusion time</p> Signup and view all the answers

    How does heparin inactivate thrombin?

    <p>By forming a Ternary Heparin/AT/Thrombin Complex</p> Signup and view all the answers

    Which pathway does heparin primarily block in the coagulation cascade?

    <p>Intrinsic Pathway</p> Signup and view all the answers

    Why is intramuscular administration of unfractionated heparin not recommended?

    <p>Due to potential for hematoma formation</p> Signup and view all the answers

    What is the primary mechanism of physiological clearance for unfractionated heparin?

    <p>Reticuloendothelial system clearance</p> Signup and view all the answers

    In what way does the biologic half-life of heparin vary?

    <p>Based on the dose administered</p> Signup and view all the answers

    How can the anticoagulant activity of heparin be monitored?

    <p>Anti-Xa Assay</p> Signup and view all the answers

    What is the primary route of excretion for fondaparinux?

    <p>Renal excretion</p> Signup and view all the answers

    What is the main pharmacokinetic advantage of fondaparinux over unfractionated heparin and low molecular weight heparins?

    <p>Longer half-life</p> Signup and view all the answers

    Which laboratory test is recommended for monitoring the anticoagulant activity of fondaparinux when necessary?

    <p>Fondaparinux-specific anti-Xa assay</p> Signup and view all the answers

    What is the mode of action for fondaparinux in inhibiting the coagulation cascade?

    <p>Indirect inhibition of factor Xa through antithrombin</p> Signup and view all the answers

    What is a common adverse effect associated with the use of fondaparinux?

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

    In which population is fondaparinux contraindicated based on its excretion characteristics?

    <p>Patients with severe renal dysfunction (CrCl &lt; 30 mL/min)</p> Signup and view all the answers

    What property of direct thrombin inhibitors makes them different from unfractionated heparin?

    <p>They do not cause Heparin Induced Thrombocytopenia (HIT)</p> Signup and view all the answers

    In what aspect do direct thrombin inhibitors differ according to the text?

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

    What is the primary reason why there is currently no antidote available for parenteral direct thrombin inhibitors?

    <p>Direct binding to thrombin</p> Signup and view all the answers

    Which of the following statements is true regarding the anticoagulant response of direct thrombin inhibitors?

    <p>They require Antithrombin as a cofactor</p> Signup and view all the answers

    What distinguishes direct thrombin inhibitors from unfractionated heparin in terms of side effects?

    <p>Ability to cause Heparin Induced Thrombocytopenia (HIT)</p> Signup and view all the answers

    What is a potential reason for a higher incidence of allergic reactions to protamine in patients allergic to fish?

    <p>Cross-reactivity between fish allergens and protamine</p> Signup and view all the answers

    In the context of neuraxial anesthesia implications, when should heparin administration be delayed after needle placement?

    <p>1 hour</p> Signup and view all the answers

    What is the suggested timing to discontinue heparin infusion and ensure normal coagulation status before neuraxial blockade in the case of intravenous heparin?

    <p>4 to 6 hours</p> Signup and view all the answers

    What is an appropriate approach for prophylactic low-dose heparin administration based on the text?

    <p>Administration after 1-hour delay post-needle placement</p> Signup and view all the answers

    Which statement represents the correct approach for managing patients with a concern for protamine allergy?

    <p>Pre-treat with antihistamines and corticosteroids</p> Signup and view all the answers

    What is the recommended action regarding heparin administration when considering neuraxial blockade in patients?

    <p>Delay administration for 1 hour post-needle placement</p> Signup and view all the answers

    What is the fundamental clinical complication from the development of Heparin-Induced Thrombocytopenia (HIT)?

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

    In the diagnosis of Heparin-Induced Thrombocytopenia (HIT), what platelet count drop is considered indicative of the condition?

    <p>Platelet count drop &lt; 150,000 mm3</p> Signup and view all the answers

    Which of the following is NOT a serological finding used in the diagnosis of Heparin-Induced Thrombocytopenia (HIT)?

    <p>Platelet count drop &lt; 150,000 mm3</p> Signup and view all the answers

    What is the first line of anticoagulants used in the treatment of Heparin-Induced Thrombocytopenia (HIT)?

    <p>Injectable direct thrombin inhibitors</p> Signup and view all the answers

    What is a critical step in the treatment protocol for Heparin-Induced Thrombocytopenia (HIT)?

    <p>Discontinue ALL heparin products IMMEDIATELY</p> Signup and view all the answers

    Which condition must be ruled out to diagnose Heparin-Induced Thrombocytopenia (HIT)?

    <p>Other causes of thrombocytopenia</p> Signup and view all the answers

    What is the primary mechanism of action of aspirin in inhibiting platelet aggregation?

    <p>Inhibition of thromboxane A2 synthesis</p> Signup and view all the answers

    How does low-dose aspirin differ from high-dose aspirin in terms of cyclooxygenase inhibition?

    <p>Low-dose inhibits only COX-1, whereas high-dose inhibits both COX-1 and COX-2</p> Signup and view all the answers

    What is the approximate peak time for plasma levels of aspirin after non-enteric coated administration?

    <p>30 to 40 minutes</p> Signup and view all the answers

    Which of the following is NOT a common indication for using aspirin?

    <p>Anticoagulant treatment for DVT</p> Signup and view all the answers

    Which adverse event is most commonly associated with aspirin use according to the text?

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

    How does dipyridamole inhibit platelet function according to the text?

    <p>By increasing platelet cAMP concentrations via 2 different mechanisms</p> Signup and view all the answers

    When determining when to stop a patient's warfarin prior to surgery, what is the determining factor?

    <p>Patient's thrombotic risks and type of surgical procedure</p> Signup and view all the answers

    What is the general practice for patients at greatest thrombotic risks when it comes to stopping warfarin prior to a procedure?

    <p>Warfarin stopped 5 days before the procedure</p> Signup and view all the answers

    What is the primary target of antiplatelet agents like Ticlopidine, Clopidogrel, and Prasugrel?

    <p>P2Y12 ADP receptors</p> Signup and view all the answers

    Which group of agents is considered as Non-Thienopyridine P2Y12 ADP-Receptor Antagonists?

    <p>Ticagrelor, Cangrelor</p> Signup and view all the answers

    What do Antiplatelet Agents like Ticlopidine, Clopidogrel, and Prasugrel inhibit?

    <p>P2Y12 ADP-Receptor signaling</p> Signup and view all the answers

    Which agent can be administered for urgent reversal of warfarin prior to surgery?

    <p>Kcentra®</p> Signup and view all the answers

    How does Fondaparinux exert its anticoagulant effect?

    <p>By binding to Factor Xa and inhibiting its activity</p> Signup and view all the answers

    What is the primary method of excretion of Fondaparinux?

    <p>Excreted unchanged via the kidneys</p> Signup and view all the answers

    Why is routine lab monitoring NOT required to monitor the anticoagulant effects of Fondaparinux?

    <p>Lack of specific antidote for reversal</p> Signup and view all the answers

    Which adverse effect is MOST commonly associated with Fondaparinux use?

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

    What is the recommended action when using Fondaparinux in patients with a concern for protamine allergy?

    <p>Avoid using Fondaparinux in these patients</p> Signup and view all the answers

    What is the main clinical use of Fondaparinux in patients with non-valvular atrial fibrillation?

    <p>Anticoagulation in bridging with warfarin</p> Signup and view all the answers

    What enzyme does Dipyridamole inhibit to increase platelet cAMP levels?

    <p>Cyclic nucleotide phosphodiesterases</p> Signup and view all the answers

    How does Dipyridamole increase local adenosine concentrations in platelets and endothelial cells?

    <p>Inhibits adenosine uptake</p> Signup and view all the answers

    Which enzyme is responsible for converting Prasugrel into its active metabolite?

    <p>Cytochrome P450 enzymes</p> Signup and view all the answers

    What is the primary mechanism of action for Ticlopidine (Ticlid®)?

    <p>Inhibits ADP-induced platelet aggregation</p> Signup and view all the answers

    Which antiplatelet agent is metabolized in the liver via CYP-450 enzymes?

    <p>Clopidogrel (Plavix®)</p> Signup and view all the answers

    What is the half-life of cilostazol and its active metabolites?

    <p>~20 hours</p> Signup and view all the answers

    Which antiplatelet agent requires a two-step metabolic conversion in the liver to become active?

    <p>(Plavix®)</p> Signup and view all the answers

    Why has the clinical use of Ticlopidine (Ticlid®) decreased significantly?

    <p>Increased risk of neutropenia and TTP</p> Signup and view all the answers

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