CVS PHARMACOLOGY FINAL EXAM
2025/2026 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS |CURRENTLY TESTING
QUESTIONS AND SOLUTIONS|ALREADY
GRADED A+|NEWEST|BRAND NEW
VERSION!!|GUARANTEED PASS
What is fondaparinux?
Synthetic factor Xa inhibitor
SC administration, 18 hour half-life
When are heparins indicated?
Prophylaxis of VTE
Pregnancy - doesn't cross placenta
Initial DVT and PE treatment
Short term in ACS
What are heparin ADRs?
Bruising and bleeding
Heparin induced thrombocytopenia
Hyperkalaemia
What are heparin contraindications?
Clotting disorders and renal impairment
What are heparin drug interactions?
Other antithrombotic agents, ACEi/ARBs, spironolactone
What is warfarin?
Vitamin K antagonist - inhibits activation of vitamin K dependent clotting factors and inhibits
conversion of vitamin K to its active reduced for - competitively inhibits VKOR
1|Page
,When is warfarin indicated?
VTE, PE, DVT and secondary prevention, superficial vein thrombosis, AF with high risk of stroke,
cardioversion and heart valve replacement (bio prosthetic and some mechanical
What is warfarin pharmacokinetics?
Good bioavailability when taken orally
Inter individual variability due to CYP2C9
Metabolised in liver, crosses placenta - avoided in 1st and 3rd trimesters
What are warfarin ADRs?
Bleeding - epistaxis and spontaneous retroperitoneal bleeding
Most effective antidote is vitamin K and warfarin should also be stopped although it will take a
few days to have effects
What are warfarin DDIs?
Mainly due to inhibition of the hepatic metabolism, especially by inhibiting CYP2C9 -
amiodarone clopidogrel and intoxicating alcohol use, reduction of vitamin K by eliminating gut
bacteria involved in production - cephalosporin antibiotics, displacement from plasma proteins
by NSAIDs
Acceleration of metabolism - barbiturates, phenytoin, rifampicin, St John's Wort
What is INR?
International normalized ratio - when low there is less anticoagulated, when high more
What are the 2 groups of DOACs?
Direct Xa - apixaban, edoxaban and rivaroxaban
Direct IIa - dabigatran
What are ADRs of DOACs?
Bleeding
What are contraindications of DOACs?
Pregnancy and breastfeeding - lack of info
Low creatinine clearance - dabigatran contraindicated
Very low creatinine clearance - direct Xa contraindicated
What are DDIs of DOACs?
2|Page
,[Plasma] is reduced by carbamazepine, phenytoin and barbiturates, with it being increased by
macrolides
What does HDL do?
Acts to carry cholesterol away from the circulation to tissues requiring it and the liver for
disposal - it is 'good cholesterol'
What are statins?
HMG-CoA reductase inhibitors
What is the mechanism of action of statins?
Inhibit HMG-CoA reductase
Upregulation of hepatic LDL receptors
Decreases VLDL secretion
What are other additional benefits of statins?
Improved vascular endothelial function
Stabilisation of atherosclerotic plaque
Improved haemostasis
Anti-inflammatory
Antioxidant
What are side effects of statins?
Include GI disruption, nausea, headaches, myalgia (dose related), rarely rhabdomyolysis and
increased liver enzymes
What are contraindications of statins?
Renal (renal excretion) or hepatic impairment, pregnancy (cholesterol important in fetus
development) and breastfeeding (present in breast milk)
What are important drug interactions of statins?
CYP3A4 is also important so any drugs that inhibit it (amiodarone, diltiazem, macrolides...) lead
to an increased plasma statin concentration
What is Rosuvastatin?
Was used a lot in USA due to a very good efficacy but not so much anymore due to concerns
about side effects, especially linked to diabetes
What is cerivastatin?
3|Page
, Was withdrawn for drug interactions with fibrate
How are statins given for primary prevention?
20mg atorvastatin once daily
How are statins given for secondary prevention?
80mg atorvastatin once daily unless amendment needed - CKD can only have 20mg
What is the target after giving statins?
>40% reduction in non-HDL at 3 months
What is the nocebo effect?
Patient perceives they may have an ADR and so they report it - problem with statins due to
media coverage
What are fibric acid derivatives?
Activate the nuclear transcription factor PPARα which is involved in regulation of gene
expression controlling lipoprotein metabolism
What does fenofibrate do?
Increase in triglycerides from lipoproteins in the plasma, an increased fatty acid uptake by the
liver, increased levels of HDL and increased LDL affinity for receptor
When can fibrates be used?
Rarely used alone but can be co-prescribed in mixed hyperlipidaemia
What are ADRs of fibrates?
Include gall stones, GI upset and (rarely) myositis
What are contraindications of fibrates?
Photosensitivity and gall bladder disease
What are drug interactions of fenofibrate?
Warfarin - leads to increased anticoagulation
What are cholesterol absorption inhibitors?
Inhibit the NPC1L1 transporter at the brush border, reducing cholesterol absorption by the gut
by around 50%
4|Page
2025/2026 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS |CURRENTLY TESTING
QUESTIONS AND SOLUTIONS|ALREADY
GRADED A+|NEWEST|BRAND NEW
VERSION!!|GUARANTEED PASS
What is fondaparinux?
Synthetic factor Xa inhibitor
SC administration, 18 hour half-life
When are heparins indicated?
Prophylaxis of VTE
Pregnancy - doesn't cross placenta
Initial DVT and PE treatment
Short term in ACS
What are heparin ADRs?
Bruising and bleeding
Heparin induced thrombocytopenia
Hyperkalaemia
What are heparin contraindications?
Clotting disorders and renal impairment
What are heparin drug interactions?
Other antithrombotic agents, ACEi/ARBs, spironolactone
What is warfarin?
Vitamin K antagonist - inhibits activation of vitamin K dependent clotting factors and inhibits
conversion of vitamin K to its active reduced for - competitively inhibits VKOR
1|Page
,When is warfarin indicated?
VTE, PE, DVT and secondary prevention, superficial vein thrombosis, AF with high risk of stroke,
cardioversion and heart valve replacement (bio prosthetic and some mechanical
What is warfarin pharmacokinetics?
Good bioavailability when taken orally
Inter individual variability due to CYP2C9
Metabolised in liver, crosses placenta - avoided in 1st and 3rd trimesters
What are warfarin ADRs?
Bleeding - epistaxis and spontaneous retroperitoneal bleeding
Most effective antidote is vitamin K and warfarin should also be stopped although it will take a
few days to have effects
What are warfarin DDIs?
Mainly due to inhibition of the hepatic metabolism, especially by inhibiting CYP2C9 -
amiodarone clopidogrel and intoxicating alcohol use, reduction of vitamin K by eliminating gut
bacteria involved in production - cephalosporin antibiotics, displacement from plasma proteins
by NSAIDs
Acceleration of metabolism - barbiturates, phenytoin, rifampicin, St John's Wort
What is INR?
International normalized ratio - when low there is less anticoagulated, when high more
What are the 2 groups of DOACs?
Direct Xa - apixaban, edoxaban and rivaroxaban
Direct IIa - dabigatran
What are ADRs of DOACs?
Bleeding
What are contraindications of DOACs?
Pregnancy and breastfeeding - lack of info
Low creatinine clearance - dabigatran contraindicated
Very low creatinine clearance - direct Xa contraindicated
What are DDIs of DOACs?
2|Page
,[Plasma] is reduced by carbamazepine, phenytoin and barbiturates, with it being increased by
macrolides
What does HDL do?
Acts to carry cholesterol away from the circulation to tissues requiring it and the liver for
disposal - it is 'good cholesterol'
What are statins?
HMG-CoA reductase inhibitors
What is the mechanism of action of statins?
Inhibit HMG-CoA reductase
Upregulation of hepatic LDL receptors
Decreases VLDL secretion
What are other additional benefits of statins?
Improved vascular endothelial function
Stabilisation of atherosclerotic plaque
Improved haemostasis
Anti-inflammatory
Antioxidant
What are side effects of statins?
Include GI disruption, nausea, headaches, myalgia (dose related), rarely rhabdomyolysis and
increased liver enzymes
What are contraindications of statins?
Renal (renal excretion) or hepatic impairment, pregnancy (cholesterol important in fetus
development) and breastfeeding (present in breast milk)
What are important drug interactions of statins?
CYP3A4 is also important so any drugs that inhibit it (amiodarone, diltiazem, macrolides...) lead
to an increased plasma statin concentration
What is Rosuvastatin?
Was used a lot in USA due to a very good efficacy but not so much anymore due to concerns
about side effects, especially linked to diabetes
What is cerivastatin?
3|Page
, Was withdrawn for drug interactions with fibrate
How are statins given for primary prevention?
20mg atorvastatin once daily
How are statins given for secondary prevention?
80mg atorvastatin once daily unless amendment needed - CKD can only have 20mg
What is the target after giving statins?
>40% reduction in non-HDL at 3 months
What is the nocebo effect?
Patient perceives they may have an ADR and so they report it - problem with statins due to
media coverage
What are fibric acid derivatives?
Activate the nuclear transcription factor PPARα which is involved in regulation of gene
expression controlling lipoprotein metabolism
What does fenofibrate do?
Increase in triglycerides from lipoproteins in the plasma, an increased fatty acid uptake by the
liver, increased levels of HDL and increased LDL affinity for receptor
When can fibrates be used?
Rarely used alone but can be co-prescribed in mixed hyperlipidaemia
What are ADRs of fibrates?
Include gall stones, GI upset and (rarely) myositis
What are contraindications of fibrates?
Photosensitivity and gall bladder disease
What are drug interactions of fenofibrate?
Warfarin - leads to increased anticoagulation
What are cholesterol absorption inhibitors?
Inhibit the NPC1L1 transporter at the brush border, reducing cholesterol absorption by the gut
by around 50%
4|Page
