Chapter 14

PharmacyPrep.
Com Cardiovascular Disorders

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it is illegal to reproduce without permission. This manual is being used during review sessions
conducted by PharmacyPrep.
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14
PHARMACY PREP

PERIPHERAL VASCULAR DISEASE

Venous Thromboembolism (VTE)

1. Women get in emergency first time with symptoms- swollen legs, pain. She is taking
warfarin. It happened after a long flight. Which drugs could affect her condition to
worst?
a. Vitamin K
b. Acetyl salicylic acid
c. Acetaminophen
d. Alcohol
Ans: A

2. After measuring her INR =4 (normal 2-3), What to do?
a. Give vitamin K injection
b. Stop taking warfarin
c. Decrease dose of warfarin for 10 to 15%
d. Skip one dose one day and then decrease 10 to 15%
Ans: D

3-For deep vein thrombosis, which is the drug of choice?
A. Low molecular weight heparin
B. Warfarin
C. ASA
D-Clopidogrel
E-Ticlopidine
Ans: A

4. Which of the following statements best describes the mechanism of action of warfarin
in preventing stroke?
A. It prevents clot formation by reducing certain clotting factors in the liver
B. It prevents platelet aggregation by reducing the production of thromboxane A
2

C. It prevents hemorrhagic stroke by reducing bleeding time
D. It prevents prostaglandin synthesis and ultimately platelet aggregation
Ans: A
TIPS: Warfarin act by inhibiting the synthesis of Vit. K depending clotting factors (ii, vii,
ix, and x) and the anticoagulant proteins C and S. Ref (CPS, 2003, Coumadin).
PharmacyPrep.Com Cardiovascular Disorders
14-2

5-Patient is on warfarin and all of a sudden his INR increased. What should be done?
A. Stop medication and wait for INR to come down. Then again starts medicine with
low dose
B. Increase the dose of warfarin
C. Take vitamin K
Ans: A

6-A patient to be commences on oral anticoagulants treatment for DVT will be treated
with:
I-Oral anticoagulant with ASA for a goal of INR 2-5
II-Oral anticoagulant with warfarin for goal of INR 2.5 to 3.5
III- Oral anticoagulant with warfarin for goal of INR 2 to 3 ranges.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-B

7-The following is/are used to monitor antithrombotic treatment:
I-Heparin assay
II-aPTT (activated partial thromboplastin (aPTT)
III-INR
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans -C
Comments: Unfractionated heparin may be monitored either aPTT (0.2-0.4 units/mL or
heparin assays. LMWH can be reliably monitored by heparin assay.

8-Prophylaxis against VTE include:
I-Graduated compress stockings
II-Caval interruptions
III-LMWH and UFH
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans -E

9-True statements about anticoagulation treatment in pregnancy, EXCEPT:
A-UFH is the drug of choice in pregnancy
14-3
B-Woman can breast while on warfarin
C-UFH should be stopped at first sign of labor
D-UFH 5000 units sc Q12H is throughout the preg. Recommended.
E-Green vegetable increase warfarin INR
Ans -E
Comments: dark green vegetable such as (Spinnach, lettuce), cauliflower, milk etc.
contain vitamin K , therefore decreases INR.

10-The most common cause of poor anticoagulant control:
A-Non compliance
B-Intolerance
C-Drug interaction
D-Resistance
E-Side effects
Ans -C

11-How often you measure INR for warfarin treatment:
I-Daily for first 3 -4 days, then every three days for week, then 1 or 2 time weekly, then
every 4 weeks when stable.
II-Daily for 4 weeks
III-Daily for first 3-4 days and for next warfarin treatment
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans -A

12-The following will increase INR:
A-Chronic smoker
B-Coffee
C-Chronic alcoholic
D-Heparin treatment
E-Chronic ASA use
Ans -C
Ref: TC p 362

13-Which of the following are contraindication for fondaparinux:
I- Geriatic patient
II- Patient with sever renal impairments
III-Patient weighs less than 50 kg
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
14-4
Ans -D

14-If patient has INR greater than 20 and active bleeding that is clinically significant is
hematuria, what would be your response as pharmacist?
I-Administer plasma
II-administer vitamin K
III-stop the drug therapy.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans -E
Tips: Pharmacist may be called on to offer advice on reversal of warfarin therapy: must
consider most appropriate dose and route of vitamin K delivery, administer freshly frozen
plasma and stop warfarin treatment when INR is >20.

15. Several months late, LM is put on ticlopidine. What must she be aware of to optimize
her therapy with this agent?
A. She must ensure that she has her blood tested every week for the first three months of
therapy
B. She must take it on an empty stomach to maximize absorption and minimize adverse
effects
C. She should report fever and sore throat to her physician
D. She should continue to take ASA with ticlopidine with added benefits
E. She should be aware that constipation is common but it is a transient effect
Ans: C
Tips: Ticlopidine Causes sever neutropenia during the first 3 to 12 weeks its symptoms
are (fever, chills, sore throat, and ulceration in oral cavity). The patients should be
advised to stop the medication and consult their physician immidiatly. Ref. (CPS, 2003,
Ticlid)

16. Which of the following statements is true regarding clopidogrel?
A. It is an antiplatelet agent with a different mechanism of action from ticlopidine
B. It appears to be more effective than ASA in preventing ischemic stroke
C. It is more effective than warfarin in preventing stroke in atrial fibrillation
D. The incidence of neutropenia is two percent with clopidogrel
Ans:B
Tips: Clopidogril indicated for (MI, Ischemic stroke, cardiovascular death, and/or
refractory ischemia). These benefits are occurred when these patients are treated with
ASA. Ref (CPS, 2003, Plavix).

Case
Physician asks pharmacist to commence a LMWH therapy for patient complaining of
pain and swelling for his right lower extremities. His medical history he ejection fraction
15% and he has previous MI.
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17-When choosing LMWH to treat the patient you would administer which of the
following?
I-Tinazaprin 175 IU/kg/dose SQ q24 h
II-Enoxaprin 1 mg/kg/dose SQ q12h
III-Enoxaprim 1.5 mg/kg/dose SQ q12 hr
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-C

18-Which of the following tests are used to monitor antithrombolytic treatment?
I-Heparin assay
II-aPTT
III-INR
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-D

19-A patient on oral anticoagulant therapy is commenced on cotrimoxazole double
strength twice daily. How would that effect on INR:
I-No change
II-Decrease
III-Increase
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-B

20-A pharmacist notice a patient has INR greater than 2.0 and active bleeding that
clinically significant hematuria: Pharmacist should:
I-administer fresh frozen plasma
II-administer vitamin K
III-Stop the drug therapy.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
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Ans-E

21-Which of the following drug should not be given to a pregnant hypertensive patient:
A-Hydrochlorothiazide
B-Propranolol
C-Verapamil
D-Lisinopril
E-alpha methyl dopa
Ans-D

22-Which of the following antihypertensive drug that reduce most blood sugar?
A-Hydralazine
B-Acebutalol
C-Propranolol
D-Captopril
E-Simvastatin
Ans-C

23-Which of the following patients is most suited for primary therapy with
hydrochlorothiazide?
A-Patient with impaired renal function
B-Patient with gout
C-Elderly patient
D-Young hypertensive patient with rapid resting heart rate
E-Patient with hyperlipidemia
Ans-C

24-In Addisonian patient, all of the following agents would have diuretic actions
EXCEPT;
A-Furosemide
B-Bumetanide
C-Sprianolactone
D-Chlorothiazide
E-Hydrochlorothiazide
Ans-C
Tips: Spiranolactone competes with aldosterone and drug would have no effect in the
absence of endogenous hormone in Addison disease patients.

25-All of the following will increase VTE:
A-Pregnancy
B-Age
C-Active cancer
D-High dose estrogen therapy
E-Immobility (bed rest more than 4 days)
F-Protein C or protein s deficiency
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26-In DVT:
A-Elevate limbs (reduce edema, and pain)
B-Immobilize (reduces pain, and swelling)
C-Avoid pressure on swelling
D-Use acetaminophen

27-Which of the following are correct counseling tips for warfarin:
A-Avoid OTC products such aspirin and other anticoagulants
B-Do not substantially alter food containing vitamin K (avacado, lettuce, spinach, turnip
greens, broccoli, cabage)
C-Inform all health care providers (including dentist) use of warfarin.
D-Store drug in light resistant container at 15-30
o
C
E-After reconstitution warfarin injection is stable for 4 hours at controlled room temp.
F-Warfarin contra indicated in pregnancy
G-All of the above
Ans-G

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Com Cardiovascular Disorders

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