4 6G Haem Anticoagulant & Antiplatelet Gab

Front 1

Which is not ture for heparin?
a) blinds antithrombin and inhibited of thrombin and factor Xa
b) prolong INR by inhibite the extrinisic pathway
c) can induce thrombocytopenia
d) can cause alopecia and osteoporosis
e) aim APTT between 60-90sec in infusion

Back 1

b) inhibit intrinsic pathway (dunn957)

Front 2

Advantage of LMWH over unfractionated heparin

Back 2

- more predictable pharmacokinetic
- high bioavailability
- long plasma half life
- easy means of administration
- no need to monitor APTT
(Dunn 958)
- less antiplatelet activity
- less adverse bleeding (half the incidence of unfractional heparin 4% VS 8%)
- greater prevention of thrombus growth

Front 3

Disadvantageof LMWH over unfractionated heparin

Back 3

- Slower reversal follow cessation
- dose adjustment required in renal disease
(Dunn 958)

Front 4

Which is not true with LMWH?
a) does not cross placenta
b) protamine does not completely reverse the effect
c) Do not cause thrombocytopenia
d) Bioavailability is 90% from SC injection
e) APTT is usually unaffected

Back 4

c) can cause thrombocytopenia (2%) like heparin (3%) (Dunn 958)

Front 5

Which is not true for Warfarin?
a) Inhibit of vit K dependent clotting factors II VII IX X
b) inhibit protein S and protein C
c) Factor IX X first become inhibited
d) elimination half life between 15-40 hours
e) does not excreted in breast milk

Back 5

c) Factor VII is the first to be inhibited ( T half 5 hours), than Factor IX X at 50hours. Theoretical increase thrombosis from early reduction of factor VII with decrease in protein C (before factor II acitivity is reduce)
(Dunn 959)

Front 6

Which is not ture for laboratory test for monitoring warfarin dose?
a) Initial inhibition only extrinsic pathway (INR & PT)
b) Chronic therapy leads to ingibition of intrinsic pathway (APTT)
c) Target INR <2 before joint aspiration or pleura tap
d) INR aim 1.5-2.5 in DVT
e) INR aim 2.5-3.5 in AF

Back 6

e) AF: INR 2-3 (Dunn 959)

Front 7

Which is not true in over anticoagulation with warfarin?
a) 1-2mg of Vitamin K and warfarin is withhold if INR 5-9 and no haemorrhage:
b) 5mg of Vitamine K should be give to INR >9 with no haemorrhage
c) 1 unit of FFP for any major beeding with elevated INR
d) Prothrombinex 25-50 U / kg if makor bleed with elevated INR
e) FFP does not completely normalise level of factor VII

Back 7

e) FFP does not normalisied factor IX , Ptohorombinex had II IX X but not VII, always use both to reverse warfarin.

Front 8

Drugs decrease metabolism of warfarin?

Back 8

Phenytoin
Chloramphenicol
cimetidine
erythromycin
TCA
Omeprazole

Front 9

Things that increase metabolism of warfarin?

Back 9

Chronic ETOH
Carbamazepine
cholestyramine
Rifampicin
antithyroid drugs