Master the Basics of Anticoagulant Drugs

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Questions and Answers

Which of the following is the mechanism of action for heparin?

  • Interfering with the synthesis of coagulation factors
  • Inhibiting the action of coagulation factors
  • Binding to thrombin and factor Xa
  • Binding to antithrombin III and rapid inactivation of coagulation factors (correct)

What is the source of unfractionated heparin used for commercial purposes?

  • Dalteparin
  • Porcine intestinal mucosa (correct)
  • Histamine in mast cells
  • Enzymatic depolymerization

Which of the following is a low molecular weight form of heparin?

  • Heparin
  • Warfarin
  • Tinzaparin
  • Enoxaparin (correct)

Which of the following is NOT a therapeutic use of heparin and LMWHs?

<p>Treatment of chronic venous insufficiency (C)</p> Signup and view all the answers

Which of the following is true about LMWHs?

<p>They do not cross the placenta (C)</p> Signup and view all the answers

Which of the following is a potential adverse effect of heparin and LMWH therapy?

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

What is the mechanism of action of LMWHs?

<p>Inactivation of factor Xa (D)</p> Signup and view all the answers

Which of the following is the primary therapeutic use of urokinase?

<p>Treatment of arterial thromboembolism (B)</p> Signup and view all the answers

What is the source of therapeutic urokinase?

<p>Isolation from cultures of human kidney cells (C)</p> Signup and view all the answers

What is the mechanism of action of urokinase?

<p>Directly cleaves the arginine–valine bond of plasminogen (A)</p> Signup and view all the answers

Which of the following is the standard measure used to monitor the anticoagulant activity of warfarin therapy?

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

What is the goal range for the INR during warfarin therapy for most indications?

<p>2 to 3 (A)</p> Signup and view all the answers

What is the mechanism of action of warfarin?

<p>Antagonism of vitamin K cofactor functions (C)</p> Signup and view all the answers

Which thrombolytic agent has the longest half-life and the greatest binding affinity for fibrin?

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

Which thrombolytic agent is NOT approved for the treatment of acute ischemic stroke?

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

Which thrombolytic agent is contraindicated in patients with a history of intracranial bleeding?

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

Which thrombolytic agent is derived from culture broths of group C β-hemolytic streptococci?

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

Which of the following is the most accurate statement about the anticoagulant effects of warfarin?

<p>The anticoagulant effects of warfarin may be delayed for 72 to 96 hours after drug administration. (D)</p> Signup and view all the answers

Which of the following is NOT a therapeutic use of warfarin?

<p>Treatment of protein C and S deficiency. (C)</p> Signup and view all the answers

Which of the following is true about the pharmacokinetics of warfarin?

<p>The mean half-life of warfarin is approximately 24 hours. (C)</p> Signup and view all the answers

Which of the following is an adverse effect of warfarin therapy?

<p>Purple toe syndrome (D)</p> Signup and view all the answers

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Study Notes

Heparin

  • Mechanism of action: binds to antithrombin, enhancing its ability to inactivate thrombin and factor Xa
  • Source of unfractionated heparin for commercial purposes: pig intestine or cow lung tissue
  • Low molecular weight form of heparin: enoxaparin
  • NOT a therapeutic use of heparin and LMWHs: cancer treatment

Low Molecular Weight Heparins (LMWHs)

  • Mechanism of action: inhibit factor Xa, preventing thrombin formation
  • True about LMWHs: they have a more predictable dosing and pharmacokinetics compared to unfractionated heparin
  • Potential adverse effect of heparin and LMWH therapy: bleeding

Urokinase

  • Primary therapeutic use: treatment of pulmonary embolism
  • Source of therapeutic urokinase: human kidney cell culture
  • Mechanism of action: converts plasminogen to plasmin, breaking down fibrin clots

Warfarin

  • Mechanism of action: inhibits vitamin K-dependent clotting factors II, VII, IX, and X
  • Standard measure used to monitor anticoagulant activity: international normalized ratio (INR)
  • Goal range for INR during warfarin therapy for most indications: 2-3

Thrombolytic Agents

  • Thrombolytic agent with the longest half-life and greatest binding affinity for fibrin: tenecteplase
  • Thrombolytic agent NOT approved for the treatment of acute ischemic stroke: urokinase
  • Thrombolytic agent contraindicated in patients with a history of intracranial bleeding: streptokinase
  • Thrombolytic agent derived from culture broths of group C β-hemolytic streptococci: streptokinase

Warfarin Pharmacology

  • Most accurate statement about the anticoagulant effects of warfarin: it takes several days to reach maximum effect
  • NOT a therapeutic use of warfarin: acute coronary syndrome
  • True about the pharmacokinetics of warfarin: it has a narrow therapeutic index
  • Adverse effect of warfarin therapy: bleeding

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