Hematinics, coagulants, anticoagulants, fibrinolytics and antiplatelet drugs MCQs With Answer

Hematinics, coagulants, anticoagulants, fibrinolytics and antiplatelet drugs constitute a core area in Advanced Pharmacology-I for M.Pharm students, bridging pharmacokinetics, mechanisms and clinical therapeutics. This quiz-focused blog provides targeted multiple-choice questions designed to deepen understanding of drug actions, monitoring parameters (PT/INR, aPTT), adverse effects (HIT, bleeding risks), reversal strategies (vitamin K, PCC, protamine, idarucizumab, andexanet alfa), and clinical indications. Questions emphasize mechanistic details, comparative pharmacology (UFH vs LMWH, DOACs vs warfarin), and practical considerations in patient management. Use these MCQs for revision or self-assessment to reinforce rational drug selection, dosing nuances, drug interactions and safety measures relevant to hematology and vascular medicine.

Q1. Which of the following best describes the primary mechanism of action of warfarin?

• Inhibition of gamma-glutamyl carboxylase, preventing clotting factor activation
• Direct inhibition of factor Xa catalytic site
• Inhibition of vitamin K epoxide reductase, impairing regeneration of reduced vitamin K
• Activation of antithrombin leading to thrombin inactivation

Correct Answer: Inhibition of vitamin K epoxide reductase, impairing regeneration of reduced vitamin K

Q2. The most appropriate laboratory test to monitor warfarin therapy is:

• Activated partial thromboplastin time (aPTT)
• Prothrombin time expressed as INR
• Thrombin time (TT)
• Anti-factor Xa assay

Correct Answer: Prothrombin time expressed as INR

Q3. Compared to unfractionated heparin (UFH), low molecular weight heparin (LMWH) is characterized by:

• Greater inhibition of thrombin (IIa) than factor Xa
• Higher anti-factor Xa to anti-factor IIa activity ratio than unfractionated heparin
• Ability to be reversed completely by vitamin K
• Strong platelet activation leading to increased HIT risk

Correct Answer: Higher anti-factor Xa to anti-factor IIa activity ratio than unfractionated heparin

Q4. For life-threatening bleeding in a patient on chronic warfarin, the fastest and most effective reversal approach is:

• Oral vitamin K alone
• Fresh frozen plasma transfusion only
• Vitamin K plus prothrombin complex concentrate (PCC)
• Protamine sulfate infusion

Correct Answer: Vitamin K plus prothrombin complex concentrate (PCC)

Q5. Which antiplatelet drug irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets, reducing thromboxane A2 synthesis?

• Ticagrelor
• Clopidogrel
• Aspirin (irreversible COX-1 inhibitor)
• Abciximab

Correct Answer: Aspirin (irreversible COX-1 inhibitor)

Q6. Clopidogrel’s antiplatelet effect primarily results from:

• Reversible antagonism of thromboxane receptors
• Irreversible P2Y12 ADP receptor antagonism on platelets
• Inhibition of phosphodiesterase to increase cAMP
• Blocking GP IIb/IIIa receptor

Correct Answer: Irreversible P2Y12 ADP receptor antagonism on platelets

Q7. Heparin-induced thrombocytopenia type II (HIT) is best described as:

• A direct dose-dependent toxic effect of heparin on megakaryocytes
• Antibody-mediated platelet activation against PF4-heparin complexes leading to thrombosis
• Non-immune transient platelet aggregation with minor bleeding
• Vitamin K deficiency secondary to heparin use

Correct Answer: Antibody-mediated platelet activation against PF4-heparin complexes leading to thrombosis

Q8. Which product provides rapid replenishment of vitamin K–dependent clotting factors with lower infusion volume and is preferred for urgent warfarin reversal?

• Fresh frozen plasma (FFP)
• Cryoprecipitate
• Prothrombin complex concentrate (PCC)
• Desmopressin (DDAVP)

Correct Answer: Prothrombin complex concentrate (PCC)

Q9. Which fibrinolytic agent is a recombinant tissue plasminogen activator that preferentially activates plasminogen bound to fibrin?

• Streptokinase
• Alteplase (tissue plasminogen activator)
• Aminocaproic acid
• Protamine sulfate

Correct Answer: Alteplase (tissue plasminogen activator)

Q10. A major absolute contraindication to administering systemic fibrinolytic therapy is:

• History of well-controlled hypertension
• Minor recent surgery within 2 days
• History of intracranial hemorrhage within past 3 months
• Active deep vein thrombosis

Correct Answer: History of intracranial hemorrhage within past 3 months

Q11. Erythropoiesis-stimulating agents (e.g., epoetin alfa) commonly carry which clinically important adverse effect?

• Hypotension and decreased stroke risk
• Hypertension and increased risk of thromboembolic events
• Severe neutropenia
• Glomerular filtration rate reduction

Correct Answer: Hypertension and increased risk of thromboembolic events

Q12. Which oral iron preparation is most commonly recommended for first-line treatment of iron deficiency anemia due to best oral absorption and cost-effectiveness?

• Ferric gluconate IV
• Ferrous sulfate
• Polysaccharide iron complex
• Ferric carboxymaltose oral

Correct Answer: Ferrous sulfate

Q13. The preferred initial therapy for symptomatic pernicious anemia with neurologic involvement is:

• High-dose oral folic acid
• Dietary B12 supplementation only
• Parenteral vitamin B12 (cyanocobalamin) injections
• Oral iron and vitamin C

Correct Answer: Parenteral vitamin B12 (cyanocobalamin) injections

Q14. Administering folic acid to a patient with undiagnosed vitamin B12 deficiency can:

• Correct both hematologic and neurologic deficits
• Mask hematologic signs while allowing neurologic deterioration
• Neutralize B12 deficiency by promoting methylation
• Increase intrinsic factor production

Correct Answer: Mask hematologic signs while allowing neurologic deterioration

Q15. Which direct oral anticoagulant (DOAC) is a direct thrombin (factor IIa) inhibitor?

• Rivaroxaban
• Apixaban
• Dabigatran (direct thrombin inhibitor)
• Edoxaban

Correct Answer: Dabigatran (direct thrombin inhibitor)

Q16. Regarding routine laboratory monitoring for modern direct oral anticoagulants (DOACs), the most accurate statement is:

• Daily INR monitoring is mandatory
• Routine coagulation monitoring is generally not required for most patients
• Anti-factor Xa levels are required weekly for dabigatran
• aPTT is used to dose-adjust rivaroxaban

Correct Answer: Routine coagulation monitoring is generally not required for most patients

Q17. The specific reversal agent for dabigatran in the setting of life-threatening bleeding is:

• Protamine sulfate
• Idarucizumab
• Andexanet alfa
• Vitamin K

Correct Answer: Idarucizumab

Q18. Which antidote is designed to reverse the effect of factor Xa inhibitors such as rivaroxaban and apixaban?

• Protamine sulfate
• Vitamin K1 (phytonadione)
• Andexanet alfa
• Desmopressin (DDAVP)

Correct Answer: Andexanet alfa

Q19. Glycoprotein IIb/IIIa receptor antagonists (e.g., abciximab) exert their antiplatelet effect by:

• Blocking platelet P2Y12 receptors preventing ADP binding
• Irreversibly inhibiting COX-1
• Blocking GP IIb/IIIa receptor preventing fibrinogen-mediated platelet cross-linking
• Increasing cAMP within platelets to inhibit aggregation

Correct Answer: Blocking GP IIb/IIIa receptor preventing fibrinogen-mediated platelet cross-linking

Q20. Aminocaproic acid and tranexamic acid are classified as antifibrinolytics; their primary mechanism is to:

• Enhance plasmin activity to promote clot breakdown
• Inhibit plasminogen activation or binding to fibrin, reducing fibrinolysis
• Directly inhibit thrombin generation
• Bind vitamin K to potentiate clotting factor activity

Correct Answer: Inhibit plasminogen activation or binding to fibrin, reducing fibrinolysis

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