Syllabus · Historical · V4 (2023) · Haematological System
Q2 · Pharmacology of Haematological System
Q2.i · Pharmacology of Haematological System
Understand the pharmacology of anti-coagulants, anti-platelet drugs, thrombolytic drugs, and anti-fibrinolytic drugs.
Written examination
SAQ history
Anticoagulants — Dabigatran vs Warfarin
1 exam appearance
Compare and contrast the mechanism of action, pharmacokinetics, adverse effects and monitoring of effect of dabigatran and warfarin.
29%
Anticoagulants — Heparin vs Enoxaparin
5 exam appearances
Describe the following pharmacology of both unfractionated heparin and bivalirudin: (a) indications for use (10% of marks) (b) mechanism of action (30% of marks) (c) monitoring and reversal (10% of marks) (d) important pharmacokinetic differences and considerations when using in the intensive care unit (ICU) (30% of marks) (e) adverse effects (20% of marks).
35%
Outline the important similarities and differences between unfractionated heparin and enoxaparin using the following headings (20% of marks each): (i) Mechanism of action (ii) Pharmacokinetics (iii) Adverse effects (iv) Dosing (v) Monitoring and reversal
27%
Describe the pharmacology of heparin highlighting important differences between unfractionated and fractionated (low molecular weight) heparin.
71%
Anticoagulants — LMWH & Hirudin
1 exam appearance
Describe the pharmacology of low molecular weight heparin (70% marks). Outline the pharmacology of hirudin (30% marks).
40%
Anticoagulants — Warfarin
3 exam appearances
How does warfarin exert its pharmacological effect (40% marks)? Write brief notes on the pharmacology of the agents that can be used to reverse the effects of warfarin (60% marks).
43%
How does warfarin exert its anti-coagulant effect (50% of marks)? Outline the pharmacology of the agents that can be used to reverse the effects of warfarin, giving examples (50% of marks).
38%
Antiplatelet Drugs — Aspirin vs Clopidogrel
2 exam appearances
Antiplatelet Drugs — Classification & Pharmacology
2 exam appearances
Outline the mechanisms of action of anti-platelet drugs. (50% of marks) Briefly describe the mechanism of action, and pharmacokinetics of aspirin, in relation to its use as an anti-platelet drug. (50% of marks).
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List the antiplatelet agents and outline their mechanisms of action, adverse effects, mode of elimination and duration of action.
67%
Haemostatic Drugs
1 exam appearance
Heparin vs Enoxaparin
1 exam appearance
Outline the differences between heparin and enoxaparin with respect to:
a. Phamacokinetics
b. Monitoring of effect
c. Adverse effects
d. Reversal of effect
33%
Haemostasis — Aspirin & Haemostasis
1 exam appearance
Outline the physiological processes that occur in a blood vessel after venipuncture (80% of marks). How are these altered by the administration of aspirin (20% of marks)?
66%
Haemostasis — Clotting & Thrombolysis
1 exam appearance
Outline the major clotting factors and steps in the haemostasis pathway (70% marks). Outline the mechanism of action of thrombolytics (30% marks).
80%
Haemostasis — Fibrinolysis
1 exam appearance
Describe the fibrinolytic pathway and identify areas of interaction with the coagulation pathway (80% of marks). List two anti-fibrinolytic agents and state their specific mechanism of action (20% of marks).
8%
Haemostasis — Fibrinolysis & Alteplase
1 exam appearance
(a) Outline the process of fibrinolysis including how it interacts with the coagulation system (80% of marks). (b) Describe the mechanism of action and adverse effects of alteplase (20% of marks).
3%
Haemostasis — Fibrinolysis & TXA
1 exam appearance
Outline the process of fibrinolysis (40% marks). Write short notes on the indications, mechanism of action, pharmacokinetics and side effects of tranexamic acid (60% marks).
30%
Haemostasis — Tranexamic Acid
1 exam appearance
Platelets & Clopidogrel
1 exam appearance
Describe the structure and function of platelets (50% marks). Outline the pharmacology of clopidogrel (50% marks).
52%
Oral examination
VIVA history
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2021A · Day 2 · VIVA 7
This viva will explore your knowledge of viscoelastic measures of coagulation and pharmacology of antiplatelet drugs. (Image removed from report.) Explain the principle behind the viscoelastic methods. What information can be obtained from them?
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2020B · Day 1 · VIVA 5
This viva will explore your knowledge of platelets and antiplatelet drugs. Can you outline how platelets are produced?
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2019B · Day 3 · VIVA 4
This viva will explore your understanding of anticoagulation and arterial pressure. Describe the physiology of coagulation after tissue trauma.
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2018A · Day 1 · VIVA 5
This viva will explore your knowledge of the following areas: The pharmacology of common anticoagulants and the physics of arterial lines. What is the mechanism of action of un-fractionated heparin?
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2016B · Day 2 · VIVA 7
This viva tested knowledge of blood grouping and cross match and went on to the events involved in blood clotting and some aspects of anticoagulant pharmacology.
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2016A · Day 2 · VIVA 7
This viva tested knowledge of the coagulation system, including fibrinolysis, tests of coagulation and the pharmacology of heparin.
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2012B · VIVA 7
This Viva will examine knowledge of blood products and blood transfusion. How is blood processed after it is collected? Subsequent discussion focused on other aspects of transfusion such as additives in a bag of blood, blood components, blood groups, storage lesions and haemostatic agents, in particular tranexamic acid.
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2010B · VIVA 6
This viva will test your knowledge on blood coagulation, and the pharmacology of heparin. Candidates had a good knowledge of the coagulation cascade. Heparin pharmacology proved to be an area of weakness, particularly concepts relating to loading dose, and it’s dose-response characteristics.
Sources: objective text from the relevant CICM syllabus; historical SAQ and VIVA wording from CICM examiner reports.