[MCQs] Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 3

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Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 3

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Congratulations - you have completed Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 3. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Which of the following is false about immunologic thrombocytopenia ?

A	Platelets coated with immune complexes
B	Usually no splenomegaly
C	Increased number of bone marrow megakaryocytes
D	None of the above

Question 1 Explanation:

Most common causes of immunologic thrombocytopenia are viral or bacterial infections, drugs (heparin) and idiopathic thrombocytopenic purpura (ITP). Such patients usually do not have splenomegaly & show increased number of bone marrow megakaryocytes.

Question 2

“White clot syndrome” is also called ?

A	Heparin-induced thrombosis
B	Warfarin-induced thrombosis
C	Phenytoin-induced thrombosis
D	Thiazide-induced thrombosi

Question 2 Explanation:

Heparin-induced thrombosis is also called “white clot syndrome”.

Question 3

Mechanism of Heparin induced thrombocytopenia type I is ?

A	Idiopathic
B	Directly agglutinating platelets
C	Heparin–PF-4 antibody complexes
D	All of the above

Question 4

Mechanism of Heparin induced thrombocytopenia type II is ?

A	Idiopathic
B	Directly agglutinating platelets
C	Heparin–PF-4 antibody complexes
D	All of the above

Question 4 Explanation:

In Type I HIT, thrombocytopenia is produced by directly agglutinating platelets. In type II HIT, an immune reaction causes thrombocytopenia. Offending antigen is a complex formed between heparin and platelet-derived heparin-neutralizing protein, platelet factor 4.

Question 5

Characteristic of Platelet factor 4 is ?

A	Platelet-derived heparin-aggravating protein
B	Platelet-derived heparin-aggravating protein
C	Platelet-derived heparin-activating protein
D	Platelet-derived heparin-destroying protein

Question 5 Explanation:

Platelet factor 4 is a heparin-neutralizing protein. Severe of Type II HIT is because heparin - PF- 4 antibody complexes bind the platelet Fc receptor to induce platelet activation & secretion.

Question 6

Which of the following drugs does not cause thrombocytopenia ?

A	Unfractionated Heparin
B	Sulfonamides
C	Danazol
D	Thiazide diuretics

Question 7

Which of the following best relates to Heparin-induced thrombocytopenia (HIT) ?

A	Antibodies of the IgM isotype
B	Antibodies against neoantigens on PF4
C	More common in medical than surgical patients
D	More frequent in males than in females

Question 7 Explanation:

HIT is an antibody-mediated process triggered by antibodies directed against neoantigens on PF4 that are exposed when heparin binds to this protein. These antibodies are of the IgG isotype and bind simultaneously to heparin-PF4 complex and to platelet Fc receptors. HIT is more common in surgical patients than in medical patients and, like many autoimmune disorders, occurs more frequently in females than in males

Question 8

HIT occurs how many days after initiation of heparin therapy ?

A	1 to 3 days
B	2 to 5 days
C	5 to 14 days
D	12 to 25 days

Question 8 Explanation:

HIT occurs 5 to 14 days after initiation of heparin therapy

Question 9

The most specific diagnostic test for diagnosis of HIT is ?

A	ELISA for antibodies against heparin-PF4 complexes
B	Platelet activation assays
C	Serotonin release assay
D	None of the above

Question 9 Explanation:

None of the above

Question 10

Which of the following drugs is useful in HIT ?

A	Lepirudin
B	Bivalirudin
C	Fondaparinux
D	All of the above

Question 10 Explanation:

Heparin must be stopped in suspected or documented HIT. Alternative anticoagulant to prevent or treat thrombosis is started like parenteral direct thrombin inhibitors (lepirudin, argatroban, or bivalirudin), or factor Xa inhibitors (fondaparinux)

Question 11

LMWH have a mean molecular mass of ?

A	~5 saccharide units
B	~17 saccharide units
C	~30 saccharide units
D	~45 saccharide units

Question 11 Explanation:

LMWH have a mean molecular weight of 5000 (~ 17 saccharide units)

Question 12

LMWHs have an anti-factor Xa:antithrombin activity ratio of ?

A	0.2 : 1
B	0.5 : 1
C	1:1
D	2:1

Question 12 Explanation:

LMWH accelerates factor Xa inhibition by antithrombin. It has little effect on thrombin inhibition. LMWH have anti-factor Xa to anti-factor IIa ratios ranging from 2:1 - 4:1.

Question 13

Plasma half-life of LMWH is ?

A	4 hour
B	6 hour
C	8 hour
D	12 hour

Question 13 Explanation:

LMWH has a plasma half-life of ~4 hours and is cleared almost exclusively by kidneys.

Question 14

Which of the following statements about LMWH is false ?

A	LMWH cannot be administered IV
B	LMWH is prepared from unfractionated heparin
C	LMWH is cleared by kidneys
D	Resistance to LMWH is rare

Question 14 Explanation:

Usually given SC, LMWH can be administered IV if a rapid anticoagulant response is needed.

Question 15

Coagulation monitoring with LMWH is done by ?

A	PT
B	aPTT
C	Anti-factor Xa levels
D	Any of the above

Question 15 Explanation:

In LMWH therapy, coagulation monitoring is done by anti-factor Xa levels because most LMWH preparations have little effect on aPTT

Question 16

Range of therapeutic anti-factor Xa levels with LMWH is ?

A	0.5 - 1.2 units/mL
B	1.5 - 2.2 units/mL
C	2.5 - 3.2 units/mL
D	3.5 - 4.2 units/mL

Question 16 Explanation:

Therapeutic anti-factor Xa levels with LMWH range from 0.5 - 1.2 units/mL, 3-4 hours later.

Question 17

Peak anti-factor Xa levels required when LMWH is given in prophylactic doses is ?

A	0.1 - 0.3 units/mL
B	0.2 - 0.5 units/mL
C	0.5 - 0.8 units/mL
D	0.8 - 1.0 units/mL

Question 17 Explanation:

When LMWH is given in prophylaxis, peak anti-factor Xa levels of 0.2 - 0.5 units/mL are desirable.

Question 18

Indications for LMWH monitoring include ?

A	Renal insufficiency
B	Obesity
C	Pregnancy
D	All of the above

Question 18 Explanation:

Indications for LMWH monitoring include ren

Question 19

In unstable angina, dose of LMWH is ?

A	30 - 50 units/kg
B	30 - 50 units/kg
C	80 - 100 units/kg
D	100 - 120 units/kg

Question 19 Explanation:

In unstable angina, LMWH is given SC, twice-daily, at a dose of 100 - 120 units/kg.

Question 20

Which of the following statements about LMWH is false ?

A	Major complication of LMWH is bleeding
B	Protamine sulfate completely reverses anti-factor IIa activity of LMWH
C	Patients at high risk for bleeding are more safely treated with continuous IV UFH than with SC LMWH
D	None of the above

Question 21

Fondaparinux has a molecular weight of ?

A	1728
B	2728
C	3728
D	4728

Question 21 Explanation:

Fondaparinux has a molecular weight of 1728. Fondaparinux binds only to antithrombin and is too short to bridge thrombin to antithrombin. Consequently, fondaparinux catalyzes factor Xa inhibition by antithrombin and does not enhance the rate of thrombin inhibition

Question 22

Which of the following about Fondaparinux is false ?

A	Bioavailability of SC Fondaparinux is 100%
B	Plasma half-life of Fondaparinux is 17 hours
C	Fondaparinux does not cause HIT
D	None of the above

Question 22 Explanation:

Fondaparinux does not cause HIT because it does not bind to PF4. Also, there is no crossreactivity of fondaparinux with HIT antibodies, hence can be used for the treatment of HIT

Question 23

Which of the following drugs used for thromboprophylaxis has longest duration of action ?

A	Fondaparinux
B	Idraparinux
C	Ximelagatran
D	Argatroban

Question 23 Explanation:

Argatroban

Question 24

Which of the following is a natural anticoagulant ?

A	Tissue factor pathway inhibitor
B	Protein C and S
C	Antithrombin
D	All of the above

Question 24 Explanation:

Coagulation cascade is regulated by natural anticoagulants like tissue factor pathway inhibitor, protein C & protein S & antithrombin. They restrict formation of hemostatic plug to the site of injury.

Question 25

Which of the following “Direct Thrombin Inhibitors” is cleared by liver ?

A	Melagatran
B	Argatroban
C	Ximelagatran
D	Recombinant Hirudins

Question 25 Explanation:

Argatroban is predominantly cleared by hepatic metabolism and requires dose adju

Question 26

Which of the following statements about Direct Thrombin Inhibitors is false ?

A	Activity of DTIs is independent of antithrombin
B	DTIs can bind to and inhibit the activity of soluble thrombin and also thrombin bound to fibrin
C	DTIs also have an antiplatelet effect
D	None of the above

Question 27

aPTT is used to monitor the anticoagulant effect of all except ?

A	Heparin
B	Lepirudin
C	Low-Molecular-Weight Heparin
D	Argatroban

Question 27 Explanation:

If monitoring is necessary in patients receiving LMWH, anti-factor Xa levels must be measured because most LMWH preparations have little effect on the aPTT.

Question 28

Warfarin was initially developed as a ?

A	Diuretic
B	Antibiotic
C	Sedative
D	Rodenticide

Question 28 Explanation:

Warfarin was initially developed as a rodenticide.

Question 29

Which of the following is a vitamin K - dependent coagulation protein ?

A	Factor VII
B	Factor X
C	Prothrombin
D	All of the above

Question 29 Explanation:

Warfarin interferes with the synthesis of the vitamin K–dependent clotting proteins like prothrombin (factor II) and factors VII, IX, and X. Synthesis of the vitamin K–dependent anticoagulant proteins, proteins C and S, is also reduced by vitamin K antagonists.

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See all quizzes of the Antiplatelet, Anticoagulant, and Fibrinolytic Drugs at here:

Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 1 | Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 2

Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 3 | Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 4

II. Preview all questions below:

1.Which of the following is false about immunologic thrombocytopenia ?
A. Platelets coated with immune complexes
B. Usually no splenomegaly
C. Increased number of bone marrow megakaryocytes
D. None of the above

2. “White clot syndrome” is also called ?
A. Heparin-induced thrombosis
B. Warfarin-induced thrombosis
C. Phenytoin-induced thrombosis
D. Thiazide-induced thrombosis

3. Mechanism of Heparin induced thrombocytopenia type I is ?
A. Idiopathic
B. Directly agglutinating platelets
C. Heparin–PF-4 antibody complexes
D. All of the above

4. Mechanism of Heparin induced thrombocytopenia type II is ?
A. Idiopathic
B. Directly agglutinating platelets
C. Heparin–PF-4 antibody complexes
D. All of the above

5. Characteristic of Platelet factor 4 is ?
A. Platelet-derived heparin-aggravating protein

B. Platelet-derived heparin-neutralizing protein
C. Platelet-derived heparin-activating protein
D. Platelet-derived heparin-destroying protein

6. Which of the following drugs does not cause thrombocytopenia ?
A. Unfractionated Heparin
B. Sulfonamides
C. Danazol
D. Thiazide diuretics

7. Which of the following best relates to Heparin-induced thrombocytopenia (HIT) ?
A. Antibodies of the IgM isotype
B. Antibodies against neoantigens on PF4
C. More common in medical than surgical patients
D. More frequent in males than in females

8. HIT occurs how many days after initiation of heparin therapy ?
A. 1 to 3 days
B. 2 to 5 days
C. 5 to 14 days
D. 12 to 25 days

9. The most specific diagnostic test for diagnosis of HIT is ?
A. ELISA for antibodies against heparin-PF4 complexes
B. Platelet activation assays
C. Serotonin release assay
D. None of the above

10. Which of the following drugs is useful in HIT ?
A. Lepirudin
B. Bivalirudin
C. Fondaparinux
D. All of the above

11. LMWH have a mean molecular mass of ?
A. ~5 saccharide units
B. ~17 saccharide units
C. ~30 saccharide units
D. ~45 saccharide units

12. LMWHs have an anti-factor Xa:antithrombin activity ratio of ?
A. 0.2 : 1
B. 0.5 : 1
C. 1:1
D. 2:1

13. Plasma half-life of LMWH is ?
A. 4 hour
B. 6 hour
C. 8 hour
D. 12 hour

14. Which of the following statements about LMWH is false ?
A. LMWH cannot be administered IV
B. LMWH is prepared from unfractionated heparin
C. LMWH is cleared by kidneys
D. Resistance to LMWH is rare

15. Coagulation monitoring with LMWH is done by ?
A. PT
B. aPTT
C. Anti-factor Xa levels
D. Any of the above

16. Range of therapeutic anti-factor Xa levels with LMWH is ?
A. 0.5 – 1.2 units/mL
B. 1.5 – 2.2 units/mL
C. 2.5 – 3.2 units/mL
D. 3.5 – 4.2 units/mL

17. Peak anti-factor Xa levels required when LMWH is given in prophylactic doses is ?
A. 0.1 – 0.3 units/mL

B. 0.2 – 0.5 units/mL
C. 0.5 – 0.8 units/mL
D. 0.8 – 1.0 units/mL

18. Indications for LMWH monitoring include ?
A. Renal insufficiency
B. Obesity
C. Pregnancy
D. All of the above

19. In unstable angina, dose of LMWH is ?
A. 30 – 50 units/kg
B. 50 – 80 units/kg
C. 80 – 100 units/kg
D. 100 – 120 units/kg

20. Which of the following statements about LMWH is false ?
A. Major complication of LMWH is bleeding
B. Protamine sulfate completely reverses anti-factor IIa activity of LMWH
C. Patients at high risk for bleeding are more safely treated with continuous IV UFH than with SC LMWH
D. None of the above

21. Fondaparinux has a molecular weight of ?

A. 1728
B. 2728
C. 3728
D. 4728

22. Which of the following about Fondaparinux is false ?
A. Bioavailability of SC Fondaparinux is 100%
B. Plasma half-life of Fondaparinux is 17 hours
C. Fondaparinux does not cause HIT
D. None of the above

23. Which of the following drugs used for thromboprophylaxis has longest duration of action ?
A. Fondaparinux
B. Idraparinux

C. Ximelagatran
D. Argatroban

24. Which of the following is a natural anticoagulant ?
A. Tissue factor pathway inhibitor
B. Protein C and S
C. Antithrombin
D. All of the above

25. Which of the following “Direct Thrombin Inhibitors” is cleared by liver ?
A. Melagatran
B. Argatroban
C. Ximelagatran
D. Recombinant Hirudins

26. Which of the following statements about Direct Thrombin Inhibitors is false ?
A. Activity of DTIs is independent of antithrombin
B. DTIs can bind to and inhibit the activity of soluble thrombin and also thrombin bound to fibrin
C. DTIs also have an antiplatelet effect
D. None of the above

27. aPTT is used to monitor the anticoagulant effect of all except ?
A. Heparin
B. Lepirudin
C. Low-Molecular-Weight Heparin
D. Argatroban

28. Warfarin was initially developed as a ?
A. Diuretic
B. Antibiotic
C. Sedative
D. Rodenticide

29. Which of the following is a vitamin K – dependent coagulation protein ?
A. Factor VII
B. Factor X

C. Prothrombin
D. All of the above

[MCQs] Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 3

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Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 3

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