Quiz 4 Blood/GIT Flashcards
(38 cards)
A 58 year old business executive is brought to the emergency room 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes cnfirm the diagnosis of myocardial infaraction. The decision is made to attempt to open her occluded artery. Conversion of plasminogen to plasmin is brought about by
a. Heparin
b. Warfarin
c. Reteplase
d. Aminocaproic acid
e. Lepirudin
c. Reteplase
Only tPa
***A 62 year old white man complains of left thigh and leg pain and swelling that are exacerbated by walking. One week earlier, the patient underwent cardiac catheterization. The patient is currently vacationing and has spent the past 28 hours in a car. Which of the following drugs, which might be prescribed in this instance, works by inhibiting the enzyme epoxide reductase?
A. Tissue-type plasminogen activator (tPa) B. Dipyridamole C. Heparin D. Streptokinase E. Acetylsalicylic acid F. Warfarin
F. Warfarin
Warfarin affects INR in blood
If a patient undergoes a percutaneous coronary procedure and placement of a stent in a coronary blood vessel, she may be given EPTIFIBATIDE. The mechanism of EPTIFIBATIDE’s anticlotting action is
A. Reversible inhibition of glycoprotein IIb/IIIa receptors
B. Blockade of posttranslational modification of clotting factors
C. Inhibition of thromboxane production
D. Activation of antithrombin III
E. Irreversible inhibition of platelet ADP receptors
A. Reversible inhibition of glycoprotein IIb/IIIa receptors
A 20 year old varsity hockey player is referred to you by his coach. The young athlete has excessive bruising after a very physical match 2 days before. His knee had been bothering him, so he took two 325-mg aspirin tablets several hours before the contest. He got checked hard into the boards. 10 times during the game, but denies any excessive or unusual trauma. As you ponder the etiology you order several blood tests. Which test or finding do you most likely expect to be abnormal as a result of the prior aspirin use?
A. Platelet count B. Bleeding time C. INR (International normalized ratio) D. Activated partial thromboplastin time (APTT) E. Prothrombin time
B. Bleeding time (prolonged)
A patient develops severe thrombocytopenia in response to treatment with unfractionated heparin and still requires parenteral anti coagulation. The patient is most likely to be treated with
A. Abciximab B. Lepuridin C. Streptokinase D. Urokinase E. Plasminogen
B. Lepuridin
***A 22 year old woman who experienced pain and swilling in her right leg presented at the emergency room. An ultrasound study showed thrombosis in the popliteal vein. The patient, who was in her second trimester of pregnancy, was treated for seven days with intravenous unfractionated heparin. The pain resolved during the course of therapy, and the patient was discharged on day eight. Which one of the following drugs would be most appropriate outpatient follow-up therapy for this patient, who lives 100 miles from the nearest hospital?
A. Streptokinase B. Warfarin C. LMWH D. Unfractionated heparin E. Alteplase
C. LMWH
Low molecular weight heparin
A 67 year old woman with a history of venous thromboembolism is placed on warfarin (Coumadin) prophylactically. The blood concentration of Coumadin becomes too high and bleeding occurs. This bleeding can best be treated by the administration of which of the following?
A. Fibrinogen B. Thrombin C. Platelets D. Protein C E. Vitamin K
E. Vitamin K
A patient who has been a high-dose alcohol abuser for many years presents with hepatic portal-sytsemic encephalopathy. Which of the following drugs, give in relatively high doses, would be most suitable for the relief of signs and symptoms of this condition, and the likely underlying biochemical anomalies?
A. Lactulose B. Esomeprazole C. Diphenoxylate D. Ondansetron E. Loperamide
A. Lactulose
Binds to ammonia ion and excretes it
A 68 year old woman with a history of coronary insufficiency suffers a heart attack and begins taking anticoagulant. One year later, her physician prescribes colestyramine to treat her hypercholesterolemia. A few months after the patient begins colestyramine treatment, she develops gastrointestinal bleeding and is found to have hypothrombinemia. Which of the following mechanisms accounts for how colestyramine causes hypoprothrombinemia?
A. Distribution B. Absorption C. competes with plasma proteins D. Metabolism E. Pharmacodynamics
B. Absorption
What is the most likely mechanism by which losartan lowers blood pressure?
Prevents the cardiovascular effects of angiotensin II mediated by AT-1 receptors
We treat a patient with a drug that affects the clotting-thrombolytic systems for a time sufficient to let the drug’s effects and blood levels stabi- lize at a therapeutic level. We then isolate platelets from a blood sample and test their in vitro aggregatory responses to ADP, collagen, PAF, and throm- boxane A2. Aggregatory responses to ADP are inhibited; responses to the other platelet proaggregatory agonists are unaffected. Which drug did we most likely administer to this patient?
a. Aspirin
b. Bivalirudin
c. Clopidogrel
d. Heparin
e. Warfarin
c. Clopidogrel
It is generally acceptable and common to administer unfractionated heparin along with other classes of drugs that affect some aspect of the coagulation or thrombolytic processes. The proviso, of course, is to moni- tor closely all drug dosages, the appropriate blood tests, and the patient’s responses overall, since the main risk is uncontrolled or excessive bleeding, if not frank hemorrhage.
There is one main exception. With which one of the following drugs is concomitant administration of heparin contraindicated because of an extremely high risk of excessive bleeding or frank hemorrhage?
a. Alteplase (t-PA)
b. Aspirin
c. Clopidogrel
d. Streptokinase
e. Warfarin
d. Streptokinase
SK not clot specific
A 45-year-old man postmyocardial infarction (MI) is being treated with several drugs, including intravenous unfractionated heparin. Stool guaiac on admission was negative, but is now four, and he has had an episode of hematemesis. Which of the following would be the best drug to administer to counteract the effects of excessive heparin remaining in the circulation?
a. Aminocaproic acid
b. Dipyridamole
c. Factor IX
d. Protamine sulfate
e. Vitamin K
d. Protamine sulfate
A 20-year-old varsity hockey player is referred to you by his coach. The young athlete has excessive bruising after a very physical match 2 days before. His knee had been bothering him, so he took two 325-mg aspirin tablets several hours before the contest. He got checked hard into the boards 10 times during the game, but denies any excessive or unusual trauma. As you ponder the etiology you order several blood tests. Which test or finding do you most likely expect to be abnormal as a result of the prior aspirin use?
a. Activated partial thromboplastin time (APTT)
b. Bleeding time
c. INR (International Normalized Ratio)
d. Platelet count
e. Prothrombin time
b. Bleeding time
A 60-year-old man, hospitalized for an acute myocardial infarction, is treated with warfarin (among other drugs). What is the main mechanism by which warfarin is causing the effects for which it is given?
a. Increase in the plasma level of Factor IX
b. Inhibition of thrombin and early coagulation steps
c. Inhibition of synthesis of prothrombin and coagulation Factors VII, IX, and X
d. Inhibition of platelet aggregation in vitro
e. Activation of plasminogen
f. Binding of Ca2+ ion cofactor in some coagulation steps
c. Inhibition of synthesis of prothrombin and coagulation Factors VII, IX, and X
A 30-year-old pregnant woman requires heparin for prophylaxis of thromboembolism. Which of the following best summarizes heparin’s main mechanism of action?
a. Activates plasminogen
b. Increases the plasma level of Factor IX
c. Inhibits platelet aggregation in vitro
d. Inhibits synthesis of prothrombin and coagulation Factors VII, IX, and X
e. Inhibits thrombin and early coagulation steps
f. Lyses platelets
e. Inhibits thrombin and early coagulation steps
A 42-year-old man with an acute MI is treated with alteplase. Which of the following most accurately describes how this drug exerts its intended effect?
a. Blocks platelet ADP receptors
b. Inhibits platelet thromboxane production
c. Inhibits synthesis of vitamin K-dependent coagulation factors
d. Prevents aggregation of adjacent platelets by blocking Glycoprotein IIb/IIIa receptors
e. Promotes conversion of plasminogen to plasmin
e. Promotes conversion of plasminogen to plasmin
A 64-year-old woman has had several episodes of transient ischemic attacks (TIAs). Aspirin would be a preferred treatment, but she has a his- tory of severe “aspirin sensitivity” manifest as intense bronchoconstriction and urticaria. Which of the following would you consider to be the best alternative to the aspirin?
a. Acetaminophen
b. Aminocaproic acid
c. Clopidogrel
d. Dipyridamole
e. Streptokinase
c. Clopidogrel
A 60-year-old woman with deep-vein thrombosis (DVT) is given a bolus of heparin, and a heparin drip is also started. Thirty minutes later she is bleeding profusely from the intravenous site. The heparin is stopped, but the excessive bleeding continues. You decide to give protamine sulfate to reverse the adverse effect of heparin. Which statement best describes the mechanism of action of this antidote?
a. Activates the coagulation cascade, overriding the action of heparin
b. Causes hydrolytic inactivation of heparin
c. Causes platelet aggregation, thereby providing a natural hemostatic effect
d. Changes the conformation of antithrombin III to prevent binding to heparin
e. Combines with heparin as an ion pair, thus neutralizing it
e. Combines with heparin as an ion pair, thus neutralizing it
A patient has been receiving otherwise “proper” doses of a drug for 5 days straight. Dosing was done correctly, starting with usual maintenance doses; no loading dose strategy was used. Then, and rather precipitously, they develop signs and symptoms of widespread thrombotic events; platelet counts decline significantly concomitant with the thrombosis. The patient dies within 24 h of the onset of signs and symptoms. Which is the most likely cause?
a. Abciximab
b. Clopidogrel
c. Heparin (unfractionated)
d. Nifedipine
e. Warfarin
c. Heparin (unfractionated)
heparin-induced thrombocytopenia - HIT - It is an immune-mediated thrombocytopenia
- **A patient on long-term warfarin therapy arrives at the clinic for her weekly prothrombin time measurement. Her INR is dangerously pro- longed, and the physical exam reveals petechial hemorrhages. She’s had episodes of epistaxis over the last 2 days. We are going to stop the warfarin until the INR becomes acceptable (and perhaps admit the patient for follow-up). However, we are concerned with her ongoing bleeding. Which of the following drugs would you most likely administer to counteract the warfarin’s excessive effects?
a. Aminocaproic acid
b. Epoetin alfa
c. Ferrous sulfate
d. Phytonadione (vitamin K)
e. Protamine sulfate
d. Phytonadione (vitamin K)
A 58-year-old man presents with a myocardial infarction—his first episode of ACS. Angioplasty and stenting are not possible because the car- diac cath lab is busy with other high-priority patients, so administration of a thrombolytic drug is the only option. Which one of the following is the most important determinant, overall, of the success of thrombolytic ther- apy in terms of salvaging viable cardiac muscle?
a. Choosing a “human” (cloned) plasminogen activator (e.g., t-PA), rather than one that is bacterial-derived
b. Infarct location (i.e., anterior wall of left ventricular vs. another site/wall)
c. Presence of collateral blood vessels to the infarct-related coronary artery
d. Systolic blood pressure at the time the MI is diagnosed
e. Time from onset of infarction to administration of the thrombolytic agent
e. Time from onset of infarction to administration of the thrombolytic agent
patient is started on therapy with abciximab. Which one of the following best describes how this drug causes its desired effects?
a. Blocks thrombin receptors selectively
b. Blocks ADP receptors
c. Blocks glycoprotein IIb/IIIa receptor
d. Inhibits cyclooxygenase
e. Inhibits prostacyclin production
c. Blocks glycoprotein IIb/IIIa receptor
Many clinical studies have been conducted to investigate the benefits of daily aspirin use in the primary prevention of coronary heart disease and sudden death in adults. The results have been somewhat inconsistent, in part because different dosages were studied, and there were important dif- ferences in the populations that were studied. Nonetheless, many (if not most) of the studies have revealed that for some at-risk patients, aspirin increased the incidence of a particularly unwanted adverse response, even when dosages were kept within the range of dosages typically recom- mended for cardioprotection (81 mg/day). Which of the following is the most likely adverse response associated with the drug?
a. Centrolobular hepatic necrosis
b. Hemorrhagic stroke
c. Nephropathy
d. Tachycardia and hypotension leading to acute myocardial ischemia
e. Vasospastic angina
b. Hemorrhagic stroke
