DNAP 2027 > Summer 25 - Coags - Test > Flashcards

Summer 25 - Coags - Test Flashcards

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1
Q

Q1. What initiates the intrinsic (contact activation) pathway of the coagulation cascade?
A. Cellular injury and tissue factor exposure
B. Contact with negatively charged surfaces (e.g., damaged endothelium)
C. Activation of factor VII by tissue factor
D. Conversion of fibrinogen to fibrin by thrombin

A

Correct answer: Contact with negatively charged surfaces (e.g., damaged endothelium).
Explanation: The intrinsic pathway is triggered when blood contacts negatively charged surfaces, such as damaged endotheliumfile:///home/oai/share/doc_text.txt#:~:text=Initiated%20by%20%20contact%20with,of%20%20VIIIa%20%2C%20leading.

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2
Q

Q2. Which natural anticoagulant system inactivates factors Va and VIIIa?
A. Antithrombin
B. Protein C and Protein S
C. Plasmin and tissue plasminogen activator
D. Warfarin and heparin

A

Correct answer: Protein C and Protein S.
Explanation: Protein C, activated by thrombin binding thrombomodulin, with Protein S as a cofactor inactivates factors Va and VIIIafile:///home/oai/share/doc_text.txt#:~:text=4,by%20thrombomodulin%20on%20endothelial%20cells.

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3
Q

Q3. In the common pathway of coagulation, factor Xa with factor Va converts prothrombin into which of the following?
A. Fibrin
B. Thrombin
C. Plasmin
D. Tissue factor

A

Correct answer: Thrombin.
Explanation: Factor Xa, with cofactor Va, converts prothrombin (II) into thrombin (IIa)file:///home/oai/share/doc_text.txt#:~:text=Factor%20Xa%20%2C%20in%20the,monomers%20%2C%20which%20polymerize%20into.

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4
Q

Q4. Which of these drugs is a vitamin K antagonist?
A. Heparin
B. Warfarin
C. Lepirudin
D. Fondaparinux

A

Correct answer: Warfarin.
Explanation: Warfarin inhibits the regeneration of vitamin K and reduces synthesis of vitamin K-dependent clotting factorsfile:///home/oai/share/doc_text.txt#:~:text=Coumarin%20anticoagulants%20%20%28e,C%20and%20S.

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5
Q

Q5. Which condition is not a typical indication for anticoagulant therapy?
A. Venous thromboembolism
B. Hip surgery
C. Hypertension
D. Atrial fibrillation

A

Correct answer: Hypertension.
Explanation: Anticoagulants are used for arterial and venous thrombotic disorders but not for uncomplicated hypertensionfile:///home/oai/share/doc_text.txt#:~:text=Indications%3A%20Arterial%20thrombosis%20Atrial%20fibrillation,Heart%20valve%20disease%20Venous%20thromboembolism.

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6
Q

Q6. Which fibrinolytic drug is frequently used to treat acute ischemic stroke?
A. Alteplase (tPA)
B. Warfarin
C. Dipyridamole
D. Heparin

A

Correct answer: Alteplase (tPA).
Explanation: Alteplase (tPA) converts plasminogen to plasmin and is used in acute ischemic strokefile:///home/oai/share/doc_text.txt#:~:text=Mechanism%20%3A%20These%20agents%20convert,PE.

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7
Q

Q7. Which platelet aggregation inhibitor irreversibly blocks cyclooxygenase-1, preventing thromboxane A2 synthesis?
A. Dipyridamole
B. Aspirin
C. Clopidogrel
D. Abciximab

A

Correct answer: Aspirin.
Explanation: Aspirin irreversibly inhibits COX-1, blocking thromboxane A2 synthesisfile:///home/oai/share/doc_text.txt#:~:text=Mechanism%20%3A%20Irreversibly%20inhibits%20,doses%2C%20which%20may%20reduce%20anti.

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8
Q

Q8. Which statement accurately describes the mechanism of action of unfractionated heparin?
A. Directly inhibits Factor Xa
B. Binds antithrombin III and enhances inhibition of factors Xa, IIa, IXa, and XIa
C. Inhibits vitamin K–dependent clotting factors
D. Converts plasminogen to plasmin

A

Correct answer: Binds antithrombin III and enhances inhibition of factors Xa, IIa, IXa, and XIa.
Explanation: Heparin binds antithrombin III and accelerates inhibition of multiple clotting factorsfile:///home/oai/share/doc_text.txt#:~:text=Mechanism%20of%20Action%20%3A%20Binds,thrombin%20and%20ultimately%20fibrin%20formation.

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9
Q

Q9. The therapeutic effect of heparin is best monitored by which laboratory test?
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Anti-factor Xa level only

A

Correct answer: Activated partial thromboplastin time (aPTT).
Explanation: aPTT is used to monitor unfractionated heparin therapyfile:///home/oai/share/doc_text.txt#:~:text=Monitoring%20%3A%20Activated%20Partial%20Thromboplastin,therapeutic%20effect%20and%20guide%20dosing.

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10
Q

Q10. A significant adverse effect of heparin when used with epidural catheters is which of the following?
A. Atrial fibrillation
B. Epidural hematoma causing spinal cord compression
C. Pulmonary embolism
D. Nephrotoxicity

A

Correct answer: Epidural hematoma causing spinal cord compression.
Explanation: Heparin increases the risk of epidural hematoma leading to spinal cord compressionfile:///home/oai/share/doc_text.txt#:~:text=Cautions%20%3A%20Use%20with%20,Epidural%20hematoma%20usually%20happens.

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11
Q

Q11. Compared with unfractionated heparin, low molecular weight heparins (LMWHs):
A. Have a shorter half-life
B. Show greater selectivity for factor Xa over thrombin
C. Require routine PT/INR monitoring
D. Have a higher incidence of thrombocytopenia

A

Correct answer: Show greater selectivity for factor Xa over thrombin.
Explanation: LMWHs are derived from heparin, have longer half-life, and more specifically inhibit factor Xafile:///home/oai/share/doc_text.txt#:~:text=Key%20Characteristics%20%3A%20%20,heparin%20which%20inhibits%20both%20effectively.

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12
Q

Q12. Why is bridging therapy with heparin recommended when initiating warfarin?
A. Warfarin has a very short half-life
B. Warfarin initially causes a procoagulant state due to Protein C inhibition
C. Warfarin has an immediate maximal effect
D. Heparin and warfarin share the same mechanism

A

Correct answer: Warfarin initially causes a procoagulant state due to Protein C inhibition.
Explanation: Warfarin initially causes Protein C inhibition, creating a procoagulant state; bridging with heparin prevents thisfile:///home/oai/share/doc_text.txt#:~:text=Onset%20and%20Pharmacokinetics%3A%20Warfarin%20affects,protein%20C%20inhibition.

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13
Q

Q13. Which fibrinolytic agent is now rarely used owing to high immunogenicity and risk of allergic reactions?
A. Alteplase
B. Streptokinase
C. Tenecteplase
D. Urokinase

A

Correct answer: Streptokinase.
Explanation: Streptokinase is rarely used due to high immunogenicity and antibody formationfile:///home/oai/share/doc_text.txt#:~:text=Clinical%20Note%3A%20Streptokinase%20%20is,allergic%20reactions%20and%20antibody%20development.

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14
Q

Q14. Direct thrombin inhibitors such as argatroban are particularly indicated for patients with which condition?
A. Renal failure
B. Heparin-induced thrombocytopenia (HIT)
C. Vitamin K deficiency
D. Hypertension

A

Correct answer: Heparin-induced thrombocytopenia (HIT).
Explanation: Direct thrombin inhibitors are used in patients intolerant to heparin, including those with HITfile:///home/oai/share/doc_text.txt#:~:text=1,induced%20thrombocytopenia%20%28HIT%29.

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15
Q

Q15. Fondaparinux exerts its anticoagulant effect by:
A. Direct inhibition of thrombin
B. Selective inhibition of Factor Xa
C. Activation of protein C
D. Inhibition of platelet P2Y12 receptors

A

Correct answer: Selective inhibition of Factor Xa.
Explanation: Fondaparinux is a selective Factor Xa inhibitor used for DVT prophylaxisfile:///home/oai/share/doc_text.txt#:~:text=2,hip%20fracture%20%20surgery.

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16
Q

Q16. Which statement about platelet activation is correct?
A. Platelets release nitric oxide to promote aggregation
B. Thromboxane A₂ is a potent vasoconstrictor that promotes aggregation
C. ADP release from platelets inhibits aggregation
D. Fibrinogen binding to GPIIb/IIIa receptors is inhibited by aspirin

A

Correct answer: Thromboxane A₂ is a potent vasoconstrictor that promotes aggregation.
Explanation: Thromboxane A₂ released from platelets promotes vasoconstriction and aggregationfile:///home/oai/share/doc_text.txt#:~:text=Upon%20vascular%20injury%2C%20%20platelets,platelet%20aggregation.

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17
Q

Q17. Which antiplatelet agent inhibits phosphodiesterase, increases cAMP in platelets and has vasodilatory effects?
A. Ticlopidine
B. Dipyridamole
C. Aspirin
D. Abciximab

A

Correct answer: Dipyridamole.
Explanation: Dipyridamole inhibits phosphodiesterase and raises cAMP, leading to antiplatelet and vasodilatory effectsfile:///home/oai/share/doc_text.txt#:~:text=Dipyridamole%20Mechanism%20%3A%20Inhibits%20,benefits%20in%20combination%20therapy.

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18
Q

Q18. Which GP IIb/IIIa inhibitor is irreversible and has antiplatelet effects lasting up to 48 hours?
A. Eptifibatide
B. Abciximab
C. Tirofiban
D. Cangrelor

A

Correct answer: Abciximab.
Explanation: Abciximab irreversibly binds the GPIIb/IIIa receptor and its effect can last up to 48 hoursfile:///home/oai/share/doc_text.txt#:~:text=Pharmacology%3A%20Abciximab%20%3A%20Irreversible%20,hours%20Eptifibatide%20%26%20Tirofiban.

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19
Q

Q19. Protamine sulfate is used to reverse the effects of which anticoagulant?
A. Warfarin
B. Heparin
C. Clopidogrel
D. Factor Xa inhibitors

A

Correct answer: Heparin.
Explanation: Protamine sulfate neutralizes unfractionated heparinfile:///home/oai/share/doc_text.txt#:~:text=1,Protamine%20sulfate.

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20
Q

Q20. Which drug is an oral direct thrombin inhibitor with low bioavailability (~7%) and predominantly renal elimination?
A. Dabigatran
B. Rivaroxaban
C. Prasugrel
D. Edoxaban

A

Correct answer: Dabigatran.
Explanation: Dabigatran is an oral direct thrombin inhibitor with ~7% bioavailability and renal eliminationfile:///home/oai/share/doc_text.txt#:~:text=1,12%E2%80%9317%20hours%20Renal%20elimination.

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21
Q

Q21. What distinguishes Prasugrel from Clopidogrel?
A. Prasugrel requires biotransformation to become active
B. Prasugrel is more potent and does not require biotransformation
C. Clopidogrel has faster onset
D. Prasugrel has reversible binding to P2Y12

A

Correct answer: Prasugrel is more potent and does not require biotransformation.
Explanation: Prasugrel does not require activation and produces potent platelet inhibitionfile:///home/oai/share/doc_text.txt#:~:text=2,7%20days.

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22
Q

Q22. Which property makes Ticagrelor advantageous for surgical candidates compared with Prasugrel?
A. It irreversibly binds its receptor
B. It is administered intravenously
C. It has reversible binding
D. It has a longer half-life

A

Correct answer: It has reversible binding.
Explanation: Ticagrelor binds reversibly, allowing a faster offset beneficial for surgical candidatesfile:///home/oai/share/doc_text.txt#:~:text=Ticagrelor%20,advantageous%20for%20surgical%20candidates.

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23
Q

Q23. Which statement about Cangrelor is correct?
A. It is an oral prodrug with slow onset
B. It is an IV agent with a very short half-life and rapid offset
C. It irreversibly binds GPIIb/IIIa receptors
D. It inhibits vitamin K regeneration

A

Correct answer: It is an IV agent with a very short half-life and rapid offset.
Explanation: Cangrelor is administered IV, has a half-life of 3–5 minutes, and a rapid offset (~60 minutes)file:///home/oai/share/doc_text.txt#:~:text=Cangrelor%20,rapid%20on%2Foff%20platelet%20inhibition.

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24
Q

Q24. What is the recommended perioperative hold time for Rivaroxaban before surgery?
A. 6 hours
B. 24 hours
C. 3 days
D. No hold necessary

A

Correct answer: 24 hours.
Explanation: Rivaroxaban is typically held for 24 hours prior to surgery to reduce bleeding riskfile:///home/oai/share/doc_text.txt#:~:text=Rivaroxaban%20,24%20hours%20perioperatively.

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25
Q25. Among the novel factor Xa inhibitors, which agent has a long half-life of 90–100 hours and is not yet commercially available? A. Rivaroxaban B. Apixaban C. Edoxaban D. Idraparinux
Correct answer: Idraparinux. Explanation: Idraparinux has a half-life of 90–100 hours and is not yet marketedfile:///home/oai/share/doc_text.txt#:~:text=Idraparinux%20%20%20,Dosing%20%3A%20%20Once%20weekly.
26
Q26. Which agent is used to treat von Willebrand disease by promoting von Willebrand factor release? A. Protamine sulfate B. Desmopressin (DDAVP) C. Tranexamic acid D. Andexanet alfa
Correct answer: Desmopressin (DDAVP). Explanation: Desmopressin promotes vWF release and is used to treat von Willebrand diseasefile:///home/oai/share/doc_text.txt#:~:text=5,promotes%20%20vWF%20%20release.
27
Q27. Which reversal agent is specifically indicated for dabigatran? A. Andexanet alfa B. Idarucizumab C. Vitamin K D. Platelet transfusion
Correct answer: Idarucizumab. Explanation: Idarucizumab (Praxbind) reverses the anticoagulant effect of dabigatranfile:///home/oai/share/doc_text.txt#:~:text=6,see%20earlier%20slide.
28
Q28. Andexanet alfa acts as a decoy reversal agent for which class of anticoagulants? A. Direct thrombin inhibitors B. Warfarin C. Factor Xa inhibitors D. P2Y12 inhibitors
Correct answer: Factor Xa inhibitors. Explanation: Andexanet alfa is a recombinant Factor Xa decoy reversing rivaroxaban and apixabanfile:///home/oai/share/doc_text.txt#:~:text=PCC%20or%20%20aPCC%20Factor,apixaban%20%3B%20investigational%20for%20othersfile:///home/oai/share/doc_text.txt#:~:text=Reversal%20Options%20%3A%20Andexanet%20alfa,possibly%20effective.
29
Q29. What pharmacokinetic feature of Edoxaban may lead to treatment failure in patients with normal renal function? A. Lack of oral bioavailability B. Faster clearance due to efficient renal elimination C. Irreversible inhibition D. Very long half-life
Correct answer: Faster clearance due to efficient renal elimination. Explanation: Edoxaban is cleared more rapidly in patients with normal renal function, risking subtherapeutic levelsfile:///home/oai/share/doc_text.txt#:~:text=Edoxaban%20%20,risk%20of%20treatment%20failure.
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Q30. Which new compound modifies idraparinux by adding a biotin moiety to allow potential reversibility with avidin? A. Prasugrel B. IdraBIOTAParinux C. Cangrelor D. Apixaban
Correct answer: IdraBIOTAParinux. Explanation: IdraBIOTAParinux modifies idraparinux with a biotin moiety for potential reversal with avidinfile:///home/oai/share/doc_text.txt#:~:text=IdraBIOTAParinux%20%20%20,reversible%20%20with%20%20avidin.
31
Q31. Which cofactor assists in the conversion of factor IX to IXa in the intrinsic pathway? A. Factor VIIa B. High Molecular Weight Kininogen (HMWK) C. Factor VIIIa D. Prekallikrein (PK)
Correct answer: Factor VIIIa. Explanation: Factor VIIIa accelerates the activation of factor IX to IXafile:///home/oai/share/doc_text.txt#:~:text=XII%20%E2%86%92%20XIIa%20%20%E2%86%92,to%20activation%20of%20%20X.
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Q32. Which pathway of the coagulation cascade is primarily regulated by tissue factor pathway inhibitor (TFPI)? A. Common pathway B. Intrinsic pathway C. Extrinsic pathway D. Fibrinolytic pathway
Correct answer: Extrinsic pathway. Explanation: The extrinsic pathway is regulated by TFPIfile:///home/oai/share/doc_text.txt#:~:text=2,TFPI.
33
Q33. Which clotting factor, when crosslinked by factor XIIIa, stabilizes the fibrin mesh? A. Fibrinogen B. Factor V C. Factor X D. Plasminogen
Correct answer: Fibrinogen. Explanation: Factor XIIIa crosslinks fibrin strands derived from fibrinogen to stabilize the clotfile:///home/oai/share/doc_text.txt#:~:text=Factor%20Xa%20%2C%20in%20the,fibrin%20to%20stabilize%20the%20clot.
34
Q34. What is a common clinical use of platelet aggregation inhibitors? A. Treatment of hyperthyroidism B. Prevention of restenosis after cardiac catheterization C. Reversal of anticoagulation D. Treatment of hemophilia
Correct answer: Prevention of restenosis after cardiac catheterization. Explanation: Platelet aggregation inhibitors are used to prevent restenosis post-catheterization and after CABGfile:///home/oai/share/doc_text.txt#:~:text=Clinical%20Uses%20%3A%20Cerebrovascular%20accident,infarction%20%2F%20acute%20coronary%20syndrome.
35
Q35. Which of the following correctly describes the mechanism of plasmin? A. Converts fibrin to fibrinogen B. Breaks down fibrin and fibrinogen into degradation products C. Activates platelets D. Crosslinks fibrin strands
Correct answer: Breaks down fibrin and fibrinogen into degradation products. Explanation: Plasmin degrades fibrin and fibrinogenfile:///home/oai/share/doc_text.txt#:~:text=Mechanism%20of%20Action%3A%20These%20drugs,Fibrinogen%20Factor%20V%20Factor%20VIII.
36
Q36. Which of the following is a prominent clinical use of fibrinolytics? A. Treatment of chronic kidney disease B. Management of acute pulmonary embolism C. Prevention of thrombocytopenia D. Maintenance therapy for atrial fibrillation
Correct answer: Management of acute pulmonary embolism. Explanation: Fibrinolytics are used to manage acute PE, MI, ischemic stroke and DVTfile:///home/oai/share/doc_text.txt#:~:text=Mechanism%20%3A%20These%20agents%20convert,PE.
37
Q37. Which of these heparin derivatives has less frequent dosing due to a longer half-life? A. Unfractionated heparin B. Low molecular weight heparin (LMWH) C. Warfarin D. Fondaparinux
Correct answer: Low molecular weight heparin (LMWH). Explanation: LMWHs have longer half-life than unfractionated heparin, allowing less frequent dosingfile:///home/oai/share/doc_text.txt#:~:text=Derived%20from%20unfractionated%20heparin%3B%20molecular,less%20frequent%20dosing.
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Q38. Which of the following statements about LMWH monitoring is correct? A. Routine PT and INR tests are required B. Routine PTT monitoring is required C. Anti-factor Xa levels may be measured but routine monitoring is usually unnecessary D. Bleeding time is the primary monitoring parameter
Correct answer: Anti-factor Xa levels may be measured but routine monitoring is usually unnecessary. Explanation: Routine monitoring is generally not required; standard PT/PTT/INR tests are unreliablefile:///home/oai/share/doc_text.txt#:~:text=Laboratory%20Monitoring%20%3A%20Routine%20monitoring,used%2C%20but%20not%20widely%20accessible.
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Q39. Which vitamin K-dependent clotting factor has the shortest half-life and thus first declines after initiating warfarin? A. Factor II (prothrombin) B. Factor VII C. Factor IX D. Factor X
Correct answer: Factor VII. Explanation: Factor VII has a short half-life (~5 hours) and declines first when warfarin is initiatedfile:///home/oai/share/doc_text.txt#:~:text=Warfarin%20affects%20%20newly%20synthesized,2%E2%80%933%20days.
40
Q40. Which direct thrombin inhibitor is used intravenously during percutaneous coronary intervention because of its rapid onset and offset? A. Lepirudin B. Argatroban C. Bivalirudin D. Fondaparinux
Correct answer: Bivalirudin. Explanation: Bivalirudin is used IV during PCI due to rapid on-off actionfile:///home/oai/share/doc_text.txt#:~:text=1,%2C%20preventing%20it%20from.
41
Q41. Select the correct statement about fondaparinux: A. It is indicated for prophylaxis of DVT after orthopedic surgery B. It enhances antithrombin’s inhibition of thrombin C. It requires INR monitoring D. It reverses heparin’s anticoagulant effect
Correct answer: It is indicated for prophylaxis of DVT after orthopedic surgery. Explanation: Fondaparinux selectively inhibits Factor Xa and is used for DVT prevention after hip/knee replacementfile:///home/oai/share/doc_text.txt#:~:text=2,hip%20fracture%20%20surgery.
42
Q42. Which molecule released by platelets promotes adhesion of platelets to the endothelium? A. Thrombin B. Prostacyclin C. von Willebrand factor D. Plasminogen
Correct answer: von Willebrand factor. Explanation: von Willebrand factor mediates platelet adhesion to endotheliumfile:///home/oai/share/doc_text.txt#:~:text=Both%20%20ADP%20and%20TXA%E2%82%82,adhesion%20to%20endothelium.
43
Q43. Which of the following mediators increases platelet cAMP and thereby inhibits platelet activation? A. Thromboxane A₂ B. ADP C. Prostacyclin (PGI₂) D. Factor XIIIa
Correct answer: Prostacyclin (PGI₂). Explanation: Prostacyclin raises cAMP in platelets and inhibits activationfile:///home/oai/share/doc_text.txt#:~:text=Increased%20cAMP%20%20within%20platelets,NO.
44
Q44. What is a major gastrointestinal adverse effect associated with aspirin therapy? A. Colonic perforation B. Upper GI ulceration C. Hepatic failure D. Pancreatitis
Correct answer: Upper GI ulceration. Explanation: Aspirin’s COX-1 inhibition increases risk of GI ulcerationfile:///home/oai/share/doc_text.txt#:~:text=Widely%20used%20in%20%20cardiac,GI%20ulceration.
45
Q45. Dipyridamole is primarily used in combination therapy for what purpose? A. Enhancing vitamin K absorption B. Supplementing fibrinolytic agents C. Providing antithrombotic benefits as an adjunct to other antiplatelet agents D. Treating acute coronary thrombosis alone
Correct answer: Providing antithrombotic benefits as an adjunct to other antiplatelet agents. Explanation: Dipyridamole’s antithrombotic benefit is primarily in combination therapyfile:///home/oai/share/doc_text.txt#:~:text=Dipyridamole%20Mechanism%20%3A%20Inhibits%20,benefits%20in%20combination%20therapy.
46
Q46. What is the mechanism of action of clopidogrel? A. Irreversible inhibition of cyclooxygenase-1 B. Blocking P2Y12 ADP receptors on platelets C. Inhibiting phosphodiesterase and increasing cAMP D. Binding GP IIb/IIIa receptors
Correct answer: Blocking P2Y12 ADP receptors on platelets. Explanation: Clopidogrel blocks P2Y12 receptors, preventing ADP-mediated activation of plateletsfile:///home/oai/share/doc_text.txt#:~:text=Ticlopidine%20and%20Clopidogrel%20Mechanism%20%3A,and%20thus%20platelet%20aggregation.
47
Q47. Among GP IIb/IIIa inhibitors, which one is a reversible competitive inhibitor with effects generally reversing within 8–12 hours? A. Abciximab B. Eptifibatide C. Streptokinase D. Idarucizumab
Correct answer: Eptifibatide. Explanation: Eptifibatide is a reversible inhibitor with effects reversing in 8–12 hoursfile:///home/oai/share/doc_text.txt#:~:text=Irreversible%20%20inhibitor%20Antiplatelet%20effect,reversed%20in%208%E2%80%9312%20hours.
48
Q48. Which of these agents reverses excessive fibrinolysis by competitively inhibiting plasmin? A. Idarucizumab B. Andexanet alfa C. Tranexamic acid D. Protamine sulfate
Correct answer: Tranexamic acid. Explanation: Tranexamic acid and aminocaproic acid competitively inhibit plasmin and reverse excessive fibrinolysisfile:///home/oai/share/doc_text.txt#:~:text=Reversal%20%3A%20Aminocaproic%20acid%20Tranexamic,are%20competitive%20inhibitors%20of%20plasmin.
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Q49. Desmopressin (DDAVP) is used therapeutically in: A. Disseminated intravascular coagulation B. Von Willebrand disease to increase vWF release C. Heparin overdose D. Warfarin reversal
Correct answer: Von Willebrand disease to increase vWF release. Explanation: Desmopressin promotes vWF release and treats Von Willebrand diseasefile:///home/oai/share/doc_text.txt#:~:text=5,promotes%20%20vWF%20%20release.
50
Q50. Which reversal strategy is commonly employed for warfarin-associated bleeding? A. Protamine sulfate B. Platelet transfusion C. Vitamin K and prothrombin complex concentrate D. Tranexamic acid
Correct answer: Vitamin K and prothrombin complex concentrate. Explanation: Warfarin reversal uses vitamin K and PCC containing factors II, VII, IX, Xfile:///home/oai/share/doc_text.txt#:~:text=Reversal%20%3A%20Vitamin%20K%20,IX%2C%20X%20Factor%20%20VIIa.
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Q51. Which direct thrombin inhibitor is taken orally and is a prodrug activated by hydrolysis? A. Argatroban B. Dabigatran C. Bivalirudin D. Lepirudin
Correct answer: Dabigatran. Explanation: Dabigatran is an oral prodrug direct thrombin inhibitorfile:///home/oai/share/doc_text.txt#:~:text=1,%28%E2%86%93%20by%20PPIs.
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Q52. Which P2Y12 inhibitor does not require metabolic activation and achieves steady-state inhibition in about five days? A. Clopidogrel B. Ticlopidine C. Prasugrel D. Warfarin
Correct answer: Prasugrel. Explanation: Prasugrel doesn’t need biotransformation and reaches steady-state in five daysfile:///home/oai/share/doc_text.txt#:~:text=2,7%20days.
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Q53. Compared with prasugrel, ticagrelor is preferred for surgical candidates because it: A. Has a longer half-life B. Binds reversibly and thus has a shorter offset C. Requires hepatic bioactivation D. Is available only intravenously
Correct answer: Binds reversibly and thus has a shorter offset. Explanation: Ticagrelor binds reversibly, giving a shorter offset beneficial before surgeryfile:///home/oai/share/doc_text.txt#:~:text=Ticagrelor%20,advantageous%20for%20surgical%20candidates.
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Q54. Which intravenous P2Y12 inhibitor has a plasma half-life of 3–5 minutes and is used when rapid onset and offset are needed? A. Cangrelor B. Idarucizumab C. Ticagrelor D. Warfarin
Correct answer: Cangrelor. Explanation: Cangrelor is an IV P2Y12 inhibitor with a half-life of 3–5 minutes and rapid offsetfile:///home/oai/share/doc_text.txt#:~:text=Cangrelor%20,rapid%20on%2Foff%20platelet%20inhibition.
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Q55. Which statement about rivaroxaban metabolism and elimination is correct? A. It is primarily metabolized by CYP2C9 B. About two-thirds of the drug is eliminated renally and one-third fecally C. It has a negligible interaction with P-glycoprotein D. Its half-life is longer than that of apixaban
Correct answer: About two-thirds of the drug is eliminated renally and one-third fecally. Explanation: Rivaroxaban is metabolized via CYP3A4 and P-glycoprotein with two-thirds renal eliminationfile:///home/oai/share/doc_text.txt#:~:text=Rivaroxaban%20,1%2F3%20fecal%20Metabolism.
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Q56. What is the recommended perioperative hold time for apixaban before elective surgery? A. 8 hours B. 12 hours C. 1–2 days D. 4 days
Correct answer: 1–2 days. Explanation: Apixaban should generally be held for 1–2 days before surgeryfile:///home/oai/share/doc_text.txt#:~:text=Apixaban%20%28Eliquis%29%20Peak%20%3A%20,Hold%20%3A%20%201%E2%80%932%20days.
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Q57. Edoxaban’s risk of treatment failure in patients with normal renal function is due to: A. Increased hepatic metabolism B. Faster clearance leading to lower blood levels C. Irreversibility of factor Xa inhibition D. Accumulation in the liver
Correct answer: Faster clearance leading to lower blood levels. Explanation: Edoxaban is cleared rapidly in normal renal function, leading to subtherapeutic levelsfile:///home/oai/share/doc_text.txt#:~:text=Edoxaban%20%20,risk%20of%20treatment%20failure.
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Q58. Which factor Xa inhibitor has once-weekly dosing because of its long half-life? A. Rivaroxaban B. Apixaban C. Edoxaban D. Idraparinux
Correct answer: Idraparinux. Explanation: Idraparinux has a half-life of 90–100 hours and is dosed once weeklyfile:///home/oai/share/doc_text.txt#:~:text=Idraparinux%20%20%20,Dosing%20%3A%20%20Once%20weekly.
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Q59. Which investigational universal reversal agent is mentioned as under development for multiple anticoagulants? A. Praxbind B. Ariprazine C. Andexanet alfa D. Protamine sulfate
Correct answer: Ariprazine. Explanation: Ariprazine is noted as a universal reversal agent under developmentfile:///home/oai/share/doc_text.txt#:~:text=8,anticoagulant%20and%20antiplatelet%20agents.
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Q60. Which novel variant of idraparinux includes a biotin moiety to allow potential reversibility with avidin? A. Prasugrel B. IdraBIOTAParinux C. Cangrelor D. Apixaban
Correct answer: IdraBIOTAParinux. Explanation: IdraBIOTAParinux modifies idraparinux with a biotin moiety for avidin-mediated reversalfile:///home/oai/share/doc_text.txt#:~:text=IdraBIOTAParinux%20%20%20,reversible%20%20with%20%20avidin.
DNAP 2027
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