Anticoagulants

1. Warfarin
a. Blocks the gamma-carboxylation of glutamate residues in Protein C <=
b. Has poor oral bioavailability
c. Does not cross the placenta
d. Anticoagulant activity is reduced by amiodarone
e. Inactivates activated factors II, VII, IX, X

2. Which is correct regarding warfarin?

a. Broken down in GIT
b. Added to transfused blood
c. Decreases thromboplastins
d. ?
e. ?

3. Which drug does not interact with warfarin?

a. Phenobarbitone – inducer, thus decrease
b. Loop diuretics – pharmacodynamic decrease
c. Benzodiazepines <=
d. Cephalosporins – 3rd gen, kill vit K producing bacteria so increase
e. ?

4. Regarding fibrinolytics
a. Urokinase is cheap but less selective
b. Streptokinase comes from human cells
c. HIMA says GIT haemorrhage is most common haemorrhagic complication
d. GIT haemorrhage within 12 months is a contraindication
e. Actriylitic acid is a potent fibrinolytic inhibitor

5. Ticlodipine
a. Decreases platelet aggregation by inhibiting ADP pathway of platelets <= also clopidogrel
b. Has no GIT side effects – commonSE, less w/ clopidogrel
c. Inhibits prostaglandin metabolism – unlike aspirin, no effect
d. ?
e. ?

6. Heparin
a. Inhibits antithrombin III
b. Causes alopecia <=
c. Decreases rate of conversion of prothrombin to thrombin – increases the inactivation of 2
(thrombin), 9 and 10 (10 only for LMWH)
d. Decreases rate of conversion of fibrinogen to fibrin
e. Decreases rate of conversion of VII to VIIa

7. Heparin induced mild thrombocytopenia is caused by

a. Release of lipoprotein lipase
b. Aggregation <= ?
c. Thrombosis
d. Antiplatelt antibodies
e. None of the above

8. Which is NOT true of warfarin?

a. It has a half life of 6 hours <= 36
b. It is reversed by FFP
c. It is 99% protein bound
d. It affects vitamin K synthesis
e. It is 100% bioavailable

9. Which drugs increase the INR?

a. Benzodiazepines
b. Barbiturates
c. Rifampin
d. Cholestyramine
e. Amiodarone <=

10. Regarding fibrinolytics

a. All thrombolytics act to convert free plasminogen to plasmin – tPA works on bound
b. Urokinase is a human product <= from kidneys
c. tPA and APSAC lack the streptococcal antigen
d. Reactions to tPA and anistreplase are preparation related
e. tPA does not occur naturally

11. Regarding heparin

a. Does reduction is necessary in the elderly
b. LMW fractions have more effect on thrombin than HMW
c. It may cause alopecia <=
d. It inhibits antithrombin III
e. Protamine is a competitive antagonist of heparin

12. Warfarin
a. Is an orally administered anticoagulant with low bioavailability
b. Blocks the alpha carboxylation of glutamate residues in protein C
c. Has an anticoagulant action which is immediate
d. Does not cross the placenta-blood barrier
e. Causes decreased prothrombin time when given with diuretics <=

13. Heparin
a. Consists of a heterogenous group of glycoprotein’s - mucopolysaccharides
b. Acts by decreasing activity of blood coagulant factor VII
c. Is associated with osteomalacia
d. Increases the reaction rate of antithrombin III on clotting factors <=
e. Is consumed in anticoagulation activity

14. Low molecular weight heparins

a. Have a higher affinity for antithrombin than high molecular weight heparin
b. Are less effective in preventing the development of deep venous thrombosis
c. Have a higher bioavailability from the subcutaneous site of injection than normal heparin <=
d. Require more frequent dosing than normal heparin
e. Level monitoring may be required in liver failure – renal and pregancy

15. regarding streptokinase

a. the GUSTO trial showed a higher risk of haemorrhagic stroke compared to t-PA
b. it is administered intravenously as a single rapid bolus dose
c. it converts plasmin to plasminogen
d. there are no in vivo inhibitors for the streptokinase-proactivation complex <=
e. urokinase is made by bacteria

16. Warfarin
a. Is not bound to plasma proteins
b. Is poorly absorbed orally
c. Is mainly excreted by the kidney
d. Is metabolized by the liver <=
e. Does not cross the placenta

17. With regard to heparin

a. High molecular weight heparin acts primarily by activating antithrombin III <=
b. Protamine fully reverses the effects of low molecular weight heparins
c. Protamine inactivates heparin by enzymatically degrading the heparin molecule
d. Low molecular weight heparin has a high affinity for factor XII - X
e. Heparin is reliably absorbed after oral administration

18. streptokinase
a. is a complex lipopolysaccharide
b. is synthesized by the human kidney
c. binds to the proactivator plasminogen <=
d. activates the plasminogen that is bound to fibrin
e. is more dangerous than tPA in those over 75 years of age

19. all of the following are known to potentiate the effects of oral anticoagulants EXCEPT:
a. cimetidine
b. ceftriaxone
c. rifampicin <=
d. metronidazole
e. trimethoprim

20. Regarding fibrinolytics

a. TIMI trial showed increased incidence of GI bleed as the major side effect of administration
b. Aminocaproic acid inhibits fibrinolysis <=
c. ?
d. ?
e. ?

21. Which of the following drugs can cause alopecia

a. Warfarin
b. Heparin <=
c. Verapamil
d. Ticlodipine
e. Digoxin