NBME 20 Cilostazol (NBME Answers)

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nbme20/Block 3/Question#43 (reveal difficulty score)
A 71-year-old man comes to the physician ...
Cilostazol 🔍 / 📺 / 🌳 / 📖
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submitted by ∗neonem(629)

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Cilostazol is a phosphodiesterase inhibitor; leads to increased cAMP which inhibits platelet degranulation/activation while also causing vasodilation. All of the other options work on either vasculature or platelets but not both.

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kernicterusthefrog Just to add: cAMP activates protein kinase A (PKA), which is the more direct mediator of platelet aggregation inhibition, and of myosin light-chain kinase inhibition (which causes inhibition of smooth muscle contraction and thus vasodilation). Just in case there's a question that gets more specific than this one! +14

brbwhat wasn’t dypirdamole an option? +

fataldose I believe they also cause vasodilation by decreasing the cellular reuptake of adenosine by endothelial cells and the adenosine causes vasodilation. +

+2 upvote downvote
submitted by ∗isaacmed2020(2)

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-Page 429- First Aid 2019 Edition. Antiplatelet phosphodiesterase inhibitors

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+0 upvote downvote
submitted by ∗fatboyslim(118)

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I chose Aspirin. So aspirin is a non-reversible inhibitor of COX-1 and 2 which should decrease TXA2 levels, and according to FA 2020 page 485, TXA2 causes platelet aggregation and increases vascular tone...I'm guessing the overall combined effect of COX 1 & 2 inhibition will cause a net effect of either vasoconstriction or no change to vascular tone?

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spaceboy98 Me too. i thought aspirin blocking off the TXA2 production would allow for vasodialation. +1

kevin This was a UWorld question. I originally thought the same, it's just cilostazol does the vasodilation and inhibition of platelet activation most directly +1

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