[MCQs] Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 4

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Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 4

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Congratulations - you have completed Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 4. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Warfarin acts by inhibiting which of the following ?

A	Vitamin K epoxide reductase (VKOR)
B	Vitamin K reductase
C	Vitamin K carboxylase
D	Vitamin K hydrolase

Question 1 Explanation:

Warfarin is a water-soluble vitamin K antagonist. It inhibits vitamin K epoxide reductase (VKOR) thereby interfering with the synthesis of the vitamin K dependent clotting proteins (factor II, VII, IX, and X). Synthesis of vitamin K dependent anticoagulant proteins (proteins C & S) is also reduced by vitamin K antagonists..

Question 2

All of the vitamin K dependent clotting factors possess which amino acid residues at their N termini ?

A	Leucine
B	Isoleucine
C	Glutamic acid
D	Tryptophan

Question 2 Explanation:

All of the vitamin K–dependent clotting factors possess glutamic acid residues at their N termini.

Question 3

Warfarin is a racemic mixture of which of the following isomers ?

A	C and D
B	M and N
C	R and S
D	X and Y

Question 3 Explanation:

Warfarin is a racemic mixture of R and S isomers, more active being the S isomer. In liver, CYP2C9 mediates oxidative metabolism of S isomer.

Question 4

Antithrombotic effect of warfarin depends on reduction in the functional level of ?

A	Factor VIII
B	Factor IX
C	Factor X
D	Factor XI

Question 4 Explanation:

Antithrombotic effect of warfarin depends on reduction in functional levels of factor X & prothrombin

Question 5

The half-life of warfarin in plasma is ?

A	~ 12 hours
B	~ 24 hours
C	~ 36 hours
D	~ 60 hours

Question 5 Explanation:

Racemic warfarin has a plasma half-life of 36 - 42 hours. >97% of circulating warfarin is bound to albumin so only a small fraction of unbound warfarin is biologically active

Question 6

INR in patients with prosthetic mechanical heart valves should be ?

A	1.5 to 2.0
B	2.0 to 3.0
C	2.5 to 3.5
D	3.5 to 4.0

Question 6 Explanation:

For most indications, warfarin is administered in doses that produce a target INR of 2.0 - 3.0. For patients with mechanical heart valves, a target INR of 2.5 - 3.5 is recommended.

Question 7

In atrial fibrillation, the risk of cardioembolic stroke increases at what level of INR ?

A	< 1.7
B	< 1.9
C	< 2.1
D	< 2.3

Question 8

In atrial fibrillation, the risk of bleeding increases at what level of INR ?

A	> 3.0
B	> 3.5
C	> 4.0
D	> 4.5

Question 8 Explanation:

In atrial fibrillation, there occurs an increased risk of cardioembolic stroke when the INR falls to <1.7 and an increase in bleeding with INR values >4.5.

Question 9

Initial treatment with warfarin is supported by concomitant administration of which of the following ?

A	Heparin
B	LMWH
C	Fondaparinux
D	Any of the above

Question 9 Explanation:

Initial treatment with warfarin is supported by concomitant administration of either heparin, LMWH or fondaparinux. A minimum 5 day course of parenteral anticoagulation is recommended.

Question 10

Which of the following statements about warfarin is false ?

A	Warfarin is usually started at a dose of 5-10 mg.
B	Warfarin crosses the placenta
C	Warfarin does not pass into the breast milk
D	None of the above

Question 11

Patients on warfarin with serious bleeding are treated with ?

A	IV Vitamin K infusion
B	Fresh-frozen plasma
C	Prothrombin complex concentrates
D	Prothrombin complex concentrates

Question 11 Explanation:

Patients on warfarin with serious bleeding should be given 10 mg of vitamin K by slow IV infusion till INR is in normal range. Treatment with vitamin K should be supplemented with fresh-frozen plasma (FFP) as a source of the vitamin K dependent clotting proteins. For lifethreatening bleeds, prothrombin complex concentrates can be used.

Question 12

Warfarin-induced skin necrosis occurs in which week of therapy ?

A	First week
B	Second week
C	Third week
D	Fourth week

Question 12 Explanation:

Skin necrosis due to warfarin therapy is seen 2 - 5 days after initiation of therapy

Question 13

Warfarin-induced skin necrosis is seen in patients with congenital or acquired deficiencies of ?

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

Question 13 Explanation:

Warfarin-induced skin necrosis is seen in patients with congenital or acquired deficiencies of protein C or protein S.

Question 14

In pregnant women, risk of warfarin embryopathy is greatest in which trimester of pregnancy ?

A	First
B	Second
C	Third
D	Any of the above

Question 14 Explanation:

Warfarin embryopathy consists of nasal hypoplasia and stippled epiphyses. Risk of embryopathy is highest if warfarin is given in the first trimester of pregnancy.

Question 15

CNS abnormalities can occur with exposure to coumarins during which trimester of pregnancy ?

A	First
B	Second
C	Third
D	Any of the above

Question 15 Explanation:

CNS abnormalities can occur with exposure to coumarins at any time during pregnancy.

Question 16

For prevention or treatment of thrombosis, which of the following can be given during pregnancy ?

A	Heparin
B	LMWH
C	Fondaparinux
D	Any of the above

Question 17

“Purple-toe syndrome” is seen in patients receiving warfarin with ?

A	Atherosclerotic vascular disease
B	Hypertension
C	Diabetes mellitus
D	Porphyria

Question 17 Explanation:

“Purple-toe syndrome” presents with atheroembolic symptoms like ischemic (purple) toes, livedo reticularis, gangrene, abdominal pain, or symptoms of renal infarction. Skin biopsy reveals cholesterol emboli in the purple-toe syndrome

Question 18

Warfarin embryopathy is due to effect of warfarin on which bone matrix protein ?

A	Osteocalcin
B	Osteotensin
C	Osteophysin
D	Osteogenin

Question 18 Explanation:

Osteocalcin is a vitamin K–dependent bone matrix protein

Question 19

Which of the following is an oral anticoagulant ?

A	Dabigatran etexilate
B	Rivaroxaban
C	Apixaban
D	All of the above

Question 19 Explanation:

Dabigatran etexilate is an oral thrombin inhibitor. Rivaroxaban and apixaban are oral factor Xa inhibitors.

Question 20

Recombinant derivative of recombinant tissue-type plasminogen activator (rt-PA) is ?

A	Anistreplase
B	Alteplase
C	Tenecteplase
D	Activase

Question 20 Explanation:

Approved fibrinolytic agents are streptokinase, acylated plasminogen streptokinase activator complex (anistreplase), urokinase, recombinant tissue-type plasminogen activator (rt-PA), also known as alteplase or activase & two recombinant derivatives of rt-PA, tenecteplase & reteplase

Question 21

Which of the following is a fibrin-specific plasminogen activators ?

A	Streptokinase
B	Alteplase
C	Anistreplase
D	Urokinase

Question 21 Explanation:

Alteplase, tenecteplase and reteplase are fibrin-specific plasminogen activators while streptokinase, anistreplase and urokinase are nonspecific plasminogen activators.

Question 22

Which of the following is false about ‘Streptokinase’ ?

A	Obtained from cultures of b-hemolytic streptococci
B	By itself, it has no plasminogen activator (PA) activity
C	Not fibrin-selective
D	None of the above

Question 23

Streptokinase binds to which of the following ?

A	Plasmin
B	Plasminogen
C	Fibrin
D	All of the above

Question 23 Explanation:

Streptokinase is not an enzyme and does not directly convert plasminogen to plasmin. Instead, streptokinase forms a 1:1 stoichiometric complex with plasminogen. This complex induces a conformational change in plasminogen that exposes its active site which then converts additional plasminogen molecules to plasmin to induce a systemic lytic state.

Question 24

Which of the following is false about ‘Streptokinase’ ?

A	Acts only when complexed with plasminogen
B	Streptokinase has no affinity for fibrin
C	Antigenic and anaphylactogenic
D	None of the above

Question 25

Urokinase is derived from ?

A	Cultured fetal kidney cells
B	Horse’s urine
C	Cow’s urine
D	Cow’s urine

Question 25 Explanation:

Urokinase is a two-chain serine protease derived from cultured fetal kidney cells with a molecular weight of 34,000. Urokinase converts plasminogen to plasmin directly by cleaving the Arg560-Val561 bond

Question 26

The half-life of Urokinase is ?

A	~ 5 minutes
B	~ 10 minutes
C	~ 15 minutes
D	~ 20 minutes

Question 27

Half-life of tissue-type plasminogen activator (t-PA) is ?

A	~ 5 minutes
B	~ 10 minutes
C	~ 15 minutes
D	~ 20 minutes

Question 27 Explanation:

The half-life of t-PA is ~5 minutes.

Question 28

Which of the following is a direct fibrinolytic agent ?

A	Alfimeprase
B	Staphylokinase
C	TNK-rt-PA
D	Streptokinase

Question 28 Explanation:

Alfimeprase is a metalloproteinase enzyme (isolated from venom of southern copperhead snake) that degrades fibrin & fibrinogen in a plasmin-independent fashion. In circulation, alfimeprase is inhibited by 2-macroglobulin. Alfimeprase must be delivered via a catheter directly into the thrombus

Question 29

Risk of intracranial hemorrhage with use of thrombolytic agents is increased in all except ?

A	Older age
B	Female sex
C	Higher body weight
D	Hypertension

Question 30

Which of the following is a “bolus fibrinolytic” agent ?

A	Tenecteplase (TNK)
B	Streptokinase
C	Urokinase
D	Tissue plasminogen activator

Question 31

Paget-Schroetter syndrome relates to ?

A	Acute deep vein thrombosis in cancer patients
B	Deep vein thrombosis of arms
C	Deep vein thrombosis in pregnant women
D	Recurrent ipsilateral deep vein

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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

1.Warfarin acts by inhibiting which of the following ?
A. Vitamin K epoxide reductase (VKOR)
B. Vitamin K reductase
C. Vitamin K carboxylase
D. Vitamin K hydrolase

2. All of the vitamin K dependent clotting factors possess which amino acid residues at their N termini ?
A. Leucine
B. Isoleucine
C. Glutamic acid
D. Tryptophan

3. Warfarin is a racemic mixture of which of the following isomers ?
A. C and D
B. M and N
C. R and S
D. X and Y

4. Antithrombotic effect of warfarin depends on reduction in the functional level of ?
Harrison’s 18th Ed. 998
A. Factor VIII
B. Factor IX
C. Factor X
D. Factor XI

5. The half-life of warfarin in plasma is ?
A. ~ 12 hours
B. ~ 24 hours
C. ~ 36 hours
D. ~ 60 hours
.
6. INR in patients with prosthetic mechanical heart valves should be ?
A. 1.5 to 2.0

B. 2.0 to 3.0
C. 2.5 to 3.5
D. 3.5 to 4.0

7. In atrial fibrillation, the risk of cardioembolic stroke increases at what level of INR ?
A. < 1.7
B. < 1.9
C. < 2.1
D. < 2.3
8. In atrial fibrillation, the risk of bleeding increases at what level of INR ?
A. > 3.0
B. > 3.5
C. > 4.0
D. > 4.5

9. Initial treatment with warfarin is supported by concomitant administration of which of the following ?
A. Heparin
B. LMWH
C. Fondaparinux
D. Any of the above

10. Which of the following statements about warfarin is false ?
A. Warfarin is usually started at a dose of 5-10 mg.
B. Warfarin crosses the placenta
C. Warfarin does not pass into the breast milk
D. None of the above

11. Patients on warfarin with serious bleeding are treated with ?
A. IV Vitamin K infusion
B. Fresh-frozen plasma
C. Prothrombin complex concentrates
D. Any of the above

12. Warfarin-induced skin necrosis occurs in which week of therapy ?
A. First week

B. Second week
C. Third week
D. Fourth week

13. Warfarin-induced skin necrosis is seen in patients with congenital or acquired deficiencies of ?
A. Tissue factor pathway inhibitor
B. Protein C or S
C. Antithrombin
D. All of the above

14. In pregnant women, risk of warfarin embryopathy is greatest in which trimester of pregnancy ?
A. First
B. Second
C. Third
D. Any of the above

15. CNS abnormalities can occur with exposure to coumarins during which trimester of pregnancy ?
A. First
B. Second
C. Third
D. Any of the above

16. For prevention or treatment of thrombosis, which of the following can be given during pregnancy ?
A. Heparin
B. LMWH
C. Fondaparinux
D. Any of the above

17. “Purple-toe syndrome” is seen in patients receiving warfarin with ?
A. Atherosclerotic vascular disease
B. Hypertension
C. Diabetes mellitus
D. Porphyria

18. Warfarin embryopathy is due to effect of warfarin on which bone matrix protein ?

A. Osteocalcin
B. Osteotensin
C. Osteophysin
D. Osteogenin

19. Which of the following is an oral anticoagulant ?
A. Dabigatran etexilate
B. Rivaroxaban
C. Apixaban
D. All of the above

20. Recombinant derivative of recombinant tissue-type plasminogen activator (rt-PA) is ?
A. Anistreplase
B. Alteplase
C. Tenecteplase
D. Activase

21. Which of the following is a fibrin-specific plasminogen activators ?
A. Streptokinase
B. Alteplase
C. Anistreplase
D. Urokinase

22. Which of the following is false about ‘Streptokinase’ ?
A. Obtained from cultures of b-hemolytic streptococci
B. By itself, it has no plasminogen activator (PA) activity
C. Not fibrin-selective
D. None of the above

23. Streptokinase binds to which of the following ?
A. Plasmin
B. Plasminogen
C. Fibrin
D. All of the above

24. Which of the following is false about ‘Streptokinase’ ?

A. Acts only when complexed with plasminogen
B. Streptokinase has no affinity for fibrin
C. Antigenic and anaphylactogenic
D. None of the above

25. Urokinase is derived from ?
A. Cultured fetal kidney cells
B. Horse’s urine
C. Cow’s urine
D. All of the above

26. The half-life of Urokinase is ?
A. ~ 5 minutes
B. ~ 10 minutes
C. ~ 15 minutes
D. ~ 20 minutes

27. Half-life of tissue-type plasminogen activator (t-PA) is ?
A. ~ 5 minutes
B. ~ 10 minutes
C. ~ 15 minutes
D. ~ 20 minutes

28. Which of the following is a direct fibrinolytic agent ?
A. Alfimeprase
B. Staphylokinase
C. TNK-rt-PA
D. Streptokinase

29. Risk of intracranial hemorrhage with use of thrombolytic agents is increased in all except ?
A. Older age
B. Female sex
C. Higher body weight
D. Hypertension

30. Which of the following is a “bolus fibrinolytic” agent ?
A. Tenecteplase (TNK)
B. Streptokinase
C. Urokinase
D. Tissue plasminogen activator

31. Paget-Schroetter syndrome relates to ?
A. Acute deep vein thrombosis in cancer patients
B. Deep vein thrombosis of arms
C. Deep vein thrombosis in pregnant women
D. Recurrent ipsilateral deep vein

[MCQs] Antiplatelet, Anticoagulant, and Fibrinolytic Drugs – Part 4

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Antiplatelet, Anticoagulant, and Fibrinolytic Drugs - Part 4

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