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  • Exam Code: DES-3612
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Answer: D

For this question, decide whether the action makes it likely or unlikely that an instructor will achieve the goal. Select the BEST statement that explains why the action is likely or unlikely to accomplish the goal.
GOAL: To employ instructional techniques appropriate to methods and instructional situations prescribed
ACTION: At the completion of each of the courseware's modules, the instructor lists additional reference materials and suggests additional exercises for the students.
A. Unlikely, because the offering of additional material would be of little relevance to the students.
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C. Likely, because the offering of additional learning exercises extends the learning concepts detailed in the courseware
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Your company has an Active Directory domain that has an organizational unit named
Sales. The Sales organizational unit contains two global security groups named sales
managers and sales executives.
You need to apply desktop restrictions to the sales managers group. You must not apply these desktop restrictions to the sales executive group.
You create a GPO named DesktopLockdown and link it to the Sales organizational unit.
What should you do next?
A. Configure the Deny Apply Group Policy permission for the sales executives on the DesktopLockdown GPO.
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C. Configure the Deny Apply Group Policy permission for the sales managers on the DesktopLockdown GPO.
D. Configure the Deny Apply Group Policy permission for Authenticated Users on the DesktopLockdown GPO.
Answer: A

Your patient is a 58-year-old male who presents with onset of severe substernal chest pain and shortness of breath. An ECG reveals an acute STEMI, and he is on his way to the cardiac catheterization suite for percutaneous coronary intervention.
Which of the following drugs used in acute coronary syndromes treated with PCI must undergo oxidation by hepatic P450 enzymes to an active form?
A. Eptifibatide
B. Clopidogrel
C. Aspirin
D. Warfarin
E. Ticlopidine
Answer: B
Clopidogrel and ticlopidine are ADP receptor pathway inhibitors. The irreversible inhibition of the ADP- dependent pathway of platelet activation is thought to be the result of covalent modification and inactivation of the platelet P2Y ADP receptor. This receptor is coupled to the inhibition of adenylyl cyclase. Both drugs are prodrugs and undergo conversion to active metabolites in the liver. However, clopidogrel must undergo oxidation by hepatic P450 enzymes to its active form. This is significant because many drugs are metabolized the hepatic P450 enzymes, including statins, and clopidogrel may interact with these medications. Clopidogrel is a second-generation thienopyridine and ticlopidine is a first-generation thienopyridine. Both drugs are indicated in combination with aspirin to prevent stent thrombosis. Eptifibatide is a GPIIb-IIIa receptor antagonist that is used to treat unstable angina and non-ST segment elevation myocardial infarction.
Eptifibatide is also used to reduce ischemic events in patients who are undergoing percutaneous coronary intervention. The drug is a synthetic peptide that directly antagonizes the GPIIb-IIIa receptor on the platelet.
Aspirin is an antiplatelet drug that works by inhibition of synthesis of prostaglandins. Prostaglandin G2 is the result of a synthesis pathway that is activated by platelets and endothelial cells, and results in localized vasoconstriction and induction of platelet aggregation, as well as causing release of platelet granules. Warfarin is an anticoagulant that acts on vitamin K-dependent reactions in the coagulation pathway. Vitamin K is necessary for hepatic synthesis of coagulation factors II, VII, IX and X, protein C and protein S.
Vitamin K- dependent carboxylation is necessary for induction of enzymatic activity of these coagulation factors. Take- home message: Clopidogrel, a second-generation thienopyridine ADP receptor pathway inhibitor, is indicated in combination with aspirin to prevent stent thrombosis in patients who undergo percutaneous coronary intervention after myocardial infarction. Clopidogrel is a prodrug that must undergo oxidation by hepatic P450 enzymes, and therefore may affect the activity of statins and other drugs dependent on the hepatic P450 enzymes.


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