Answer Happy

a. Warfarin is safe in pregnancy (Pregnancy C. Warfarin may be unsafe in pregnancy Category A) (Pregnancy Category C) b. Warfarin may be safe in pregnancy (Pregnancy Category B) d. Warfarin is unsafe in pregnancy and cannot be used (Pregnancy Category X) 7. By what routes of administration can heparin be given? a. Intravenous and buccal administration d. Intravenous, intramuscular and subcutaneous administration e. Intravenous and subcutaneous administration b Intravenous and intramuscular administration c. Intravenous, intramuscular and oral administration 8. Karla Porter is a 58-year-old female who is usually well-controlled on a warfarin regimen of 5 mg daily. She has been sick for the past week but feels better today. She ate little during her illness. Ms. Porter presents to the anticoagulation clinic to have her INR checked. Her INR is elevated today at 5.8. There is no noticeable bleeding and she is a low bleeding risk. Choose the preferred course of action: a. Hold warfarin x 1 and administer phytonadione 1 to 2.5 mg orally b. Omit the next few doses, monitor frequently, and resume therapy at a lower dose when the INR is in the therapeutic range. d. Hold warfarin and administer vitamin K 5 mg orally. e. Hold warfarin and administer phytonadione 2 mg by IM injection c. Hold warfarin and administer phytonadione 2 mg by SC injection. 9. What would be expected to occur if a patient on warfarin with a stable INR is started on amiodarone? a. The INR would decrease, and the patient d. The INR would decrease, and the patient may experience bleeding. may clot. b. The INR would increase, and the patiente. The INR would not change. may clot. c. The INR would increase, and the patient may experience bleeding. 10. The pharmacist will counsel a patient on the correct self-administration technique for enoxaparin. Which of the following are correct counseling statements? (Select ALL that apply.) a. This medication can cause the patient to bruise and/or bleed more easily. d. Store this medication in the refrigerator until just prior to each use
b. Choose an area on the right or left side of e. It is best to rub the injection site after the patient's abdomen, but not within two administration to ensure quick absorption. inches from the belly button. c. Do not expel the air bubble in the syringe prior to injection 11. A female patient who is pregnant has been admitted to the hospital with a DVT. The physician will begin heparin therapy. What is the mechanism of action of heparin? a. Heparin potentiates factor V d. Heparin potentiate antithrombin b. Heparin potentiates factor IXa e. Heparin inhibits clotting factors II, VII, IX, & X 6 c. Heparin potentiate factor Xa stort 12. Select the correct dosing recommendation for dabigatran for a patient with a DVT and a creatinine clearance of 54 mL/min: Take a 150 mg capsule twice daily, with food. d. Take a 75 mg capsule twice daily, with or without food. b. Take a 150 mg capsule twice daily, without e. Take 150 mg capsule once daily, with food. food. a. Take a 150 mg capsule twice daily, with or without food. bolo 13. Which of the following is a possible side effect from the long-term use of heparin therapy? a. Gingival hyperplasia d. Hair growth b. Osteoporosis e. Hypokalemia c. GERD 14. In which of the following scenarios are the intravenous direct thrombin inhibitors considered the drugs of choice? color To provide anticoagulation in patients d. To provide better anticoagulation in ACS who have heparin-induced patients. thrombocytopenia (HIT). a. b. To provide anticoagulation in patients e. For patients who are allergic to latex. who had a recent intracranial hemorrhage. c. To provide anticoagulation in patients who had heparin-induced hyperkalemia. 15. Which of the following statements regarding warfarin are correct? (Select ALL that apply.) The antidote is protamine, d. Warfarin is a vitamin K antagonist. a. b. Warfarin blocks the activation of clotting e. Warfarin generally takes 2 days to become factors II, VII, LX, and X. therapeutic. c. Patients on warfarin should not eat any vitamin K containing foods.
a. 16. Muhammad Al-Hadeen is a 66-year-old male with hypertension, renal disease and degenerative joint disease. In his younger years, Mr. Al-Hadeen was a football player and has lived with the pain of a hip injury for many years. He enters the hospital for elective hip replacement surgery. His creatinine clearance is 25 mL/min. The physician orders enoxaparin 30 mg SC BID for DVT prophylaxis. Choose the correct statement: The dose is correct as ordered. d. The dose should be 45 mg SC daily. b. The dose should be 60 mg SC daily. e. The patient should receive heparin for DVT prophylaxis. The dose should be 45 mg SC daily. 17. Which of the following procedures can help reduce medication errors associated with heparin? (Select ALL that apply.) Do not use the color of the syringe or d. Make sure unit nurses prepare the heparin packaging to verify the dose. doses. c. a e b. Provide in services that review heparin Have the pharmacist verify the heparin safety, including the lower heparin flush concentration for the patient's indication. c. If possible, outsource the preparation of heparin flushes. 18. Patients may use the following non-pharmacological method to reduce the risk of venous thromboembolism: a. Increase their intake of green leafy d. Use intermittent pneumatic compression vegetables. devices. b. Perform several reps of 10 deep squats Consume more olive oil and green tea, daily, if the physician approves this type of exercise. e. c. Consume lots of water 19. Hong Yu is a 58-year-old male with atrial fibrillation. He has been using warfarin for over two years and is normally well-controlled. His cardiologist recently began amiodarone and citalopram therapy with no other medication adjustments. He is admitted to the emergency room with weakness and bleeding gums. The INR is obtained and is 9.5. His hemoglobin is 8.4 g/dL. His pants are stained with blood which is coming from his rectum. Choose the correct course of action: a. Hold warfarin x 1 dose and administer phytonadione 1 to 2.5 mg orally. d. Hold warfarin therapy and give vitamin K 10 mg by slow IV injection along with four-factor prothrombin complex concentrate. e. Hold warfarin therapy and give vitamin K 10 mg by IM injection and fresh frozen plasma. b. Omit the next 1-2 doses, monitor frequently, and resume therapy when the INR is in the therapeutic range. c. Hold warfarin and administer phytonadione 2 mg by SC injection.
20. Michael Gallagher is a 43-year-old male who is usually well-controlled on a warfarin regimen of 7.5 mg five days per week, and 5 mg two days weekly. He presents to the anticoagulation clinic to have his INR checked. He reports that he had an upper respiratory infection and the physician had given him a 10-day course of levofloxacin. He just took his last levofloxacin tablet this morning. His INR is elevated today at 3.5; the target therapeutic INR is 2-3. Choose the preferred course of action: Do not use the color of the syringe or d. Make sure unit nurses prepare the heparin packaging to verify the dose. doses. a e b. Provide in services that review heparin Have the pharmacist verify the heparin safety, including the lower heparin flush concentration for the patient's indication concentrations to the higher treatment doses c. If possible, outsource the preparation of heparin flushes 21. Michael Gallagher is a 43 year-old male who is usually well-controlled on a warfarin regimen of 7.5 mg five days per week, and 5 mg two days weekly. He presents to the anticoagulation clinic to have his INR checked. He reports that he had an upper respiratory infection and the physician had given him a 10-day course of levofloxacin. He just took his last levofloxacin tablet this morning. His INR is elevated today at 3.5; the target therapeutic INR is 2-3. Choose the preferred course of action: a. Hold the warfarin dose today, resume d. Hold warfarin and administer usual dosing regimen when INR is phytonadione 2 mg by IM injection. therapeutic and have the patient monitor Resume warfarin when the INR is for symptoms of bleeding. therapeutic b. Hold warfarin and administer phytonadione 5 mg PO x 1 now. Resume warfarin when the INR is therapeutic. e. Hold warfarin and administer phytonadione 2 mg by IV injection Resume warfarin when the INR is therapeutic. c. Hold warfarin and administer phytonadione 2 mg by SC injection. Resume warfarin when the INR is therapeutic. a 22. What is the purpose of using a heparin "lock-flush, such as Hep Flush? To provide systemic anticoagulation d. To prevent HIT prophylaxis b. To provide systemic anticoagulation e. To dilute other medications going through treatment the same IV line c. To keep IV lines open 23. Select the correct indication for dabigatran: a. To provide anticoagulation in patients with acute coronary syndrome. d. To provide anticoagulation in patients who had bleeding on heparin
e b. To reduce the risk of stroke and blood clots in patients with non-valvular atrial fibrillation. To reduce the risk of a secondary stroke in patients who have a subarachnoid hemorrhage. a c. To reduce the risk of stroke and blood clots in patients with ventricular 24. A 42 year-old female with a heart condition is presenting to the hospital with a DVT. The medical resident wishes to give her a low molecular weight heparin (LMWH), but the older supervising physician insists on using heparin. What are advantages to the use of LMWHs over heparin? (Select ALL that apply.) LMWHs are more efficacious than d. LMWHs do not require monitoring in heparin in treating DVTS. some patients. b. LMWHs are more cost effective than c. LMWHs have a more consistent heparin. anticoagulation response. LMWHs are easier to reverse in patients that experience significant bleeding. 25. Select the correct mechanism of action for Lovenox: a. Oral direct thrombin inhibitor d. Inhibits Factor Xa and Factor Ila via antithrombin b. Injectable direct thrombin inhibitor e. Selectively inhibits Factor Xa c. Vitamin K antagonist c a 26. Henry Wong is receiving a heparin drip. What is the name of the test used to monitor heparin for efficacy? Potentiation factor d. International normalized ratio b. Factors Ila, VIIa, IXa and Xa test e. The activated partial thromboplastin time c. Anti-Xla levels a 27. A pharmacist working in an inpatient medical ward of the local hospital is responsible for monitoring anticoagulation therapy. She routinely obtains laboratory parameters and adjusts the doses of low molecular weight heparins (LMWHs), as needed. In which of the following clinical situations is it appropriate to monitor the level of anticoagulation with LMWH therapy? (Select ALL that apply.) Patients with a myocardial infarction d. Mechanical heart valves b. Significant renal impairment e. Extremes of body weight c. Pregnancy 28. A patient comes to the hospital with a DVT. He has developed HIT with thrombosis in the past. Which of the following agents is considered first-line treatment in this patient? Arixtra d. Fragmin b. Argatroban e. Desirudin c. Xarelto 29. Which of the following medication can NOT significantly interact with warfarin? a. Amiodarone d. Levetiracetam a.
b. Morphine e. Fluconazole c. Rifampin 30. Select the correct statement concerning Pradaxa: It is indicated for patients with valvular d. The effect can be reversed with vitamin K. atrial fibrillation to reduce the risk of stroke. a. b. e. It does not require blood testing to monitor for effectiveness. It has more drug and food interactions than warfarin It causes the same amount of GI bleeding as warfarin. c. 31. A 70 year-old patient has been using warfarin therapy in the hospital. She had a deep vein thrombosis (DVT) in her right lower leg. She is being discharged, and the outpatient pharmacist who is going to dispense her warfarin is checking her medication profile for drug interactions. The pharmacist notes that the patient is using medications which increase the risk of bleeding. She will counsel the patient on increased bleeding risk. Which of the following medications can increase her bleeding risk? (Select ALL that apply.) a. Co-enzyme Q10 d. Ginkgo biloba b. Clopidogrel e. Lithium c. Amiodarone 32. A hospitalized patient developed a pulmonary embolism and was started on enoxaparin therapy. The physician began warfarin therapy Monday and wrote an order to discontinue the enoxaparin therapy the following day. The pharmacist contacted the prescriber to recommend the following action: a. Continue the enoxaparin until the INR d. Continue the enoxaparin for a full 7 days reaches the therapeutic range for one and the patient has been therapeutic for at value. least 2 of those days. b. Continue the enoxaparin until the INR has e. Pulmonary emboli cannot be treated with been therapeutic for at least 24 hours. warfarin; the warfarin should be discontinued. c. Continue the enoxaparin until the INR has been therapeutic for at least 48 hours. 33. When heparin is administered, the following laboratory value must be carefully monitored: a. White blood cells d. Amylase b. Eosinophils e. Sodium Platelets 34. Why is it important for hospitals to get INRs taken at about the same time in the morning? c. a. The INR must be taken before antibiotics d. All labs are taken in the morning per most are administered that day. hospital's policies and procedures.
b. The INR value will be inaccurate if taken e. Warfarin, hence the INR, is affected by later in the day due to the effect of meals. the diurnal rhythm of the body. C. Healthcare providers will have the INR value and be able to adjust that day's warfarin dose. 35. A new patient is using enoxaparin therapy for "bridging" until her INR level is therapeutic. She brings the following over-the-counter medicines to the pharmacy window for payment: DHEA, Women's 50+ multivitamin, Advil Migraine, coenzyme Q10 and a B-Complex vitamin. The pharmacist should offer the following advice: a. Advil Migraine is not safe to use with d. Women's 50+ multivitamin may increase warfarin; acetaminophen is safer. the INR. b. DHEA contains vitamin K and may make e. Willow bark may decrease the the warfarin ineffective. effectiveness of warfarin. c. Vitamin B complexes cannot be used with warfarin. 36. What is the name of the test used to monitor warfarin efficacy and toxicity? a. Potentiation factor d. The international normalized ratio The activated partial thromboplastin time b. Factors II, VII, IX and X e c. Anti-Xa level e 37. Which of the following groups of laboratory parameters need to be monitored during heparin therapy? a. Hematocrit, hemoglobin, platelets, and PT d.Hematocrit, hemoglobin, platelets, and aPTT b. Hematocrit, hemoglobin, platelets, AST, Platelets, aPTT, PT, and SCr and ALT c. SCr, platelets, aPTT, and PT 38. A patient is being started on Pradaxa. Choose the correct statement regarding Pradaxa: Once a bottle of Pradaxa is opened, the d. Once a bottle of Pradaxa is opened, the capsules must be used within 15 days. capsules must be used within 120 days. b. Once a bottle of Pradaxa is opened, the If Pradaxa capsules are transferred to an capsules must be used within 60 days. amber container, they are good up to 2 months. a. e c. Once a bottle of Pradaxa is opened, the capsules must be used within 90 days. 39. A patient has developed a DVT and will be placed on daiteparin. What is the correct brand name for dalteparin?
a. Apixaban c. Arixtra b. Fragmin d. Pradaxa 40. Select the correct mechanism of action for Pradaxa: a. Oral direct Factor Ila inhibitor d. Oral Factor Xa inhibitor b. Injectable direct thrombin inhibitor Inhibits Factor Xa and Factor Ila via antithrombin e. c. Vitamin K antagonist 41. Vitamin K given IV has a risk of the following adverse reaction: a. Acute dystrophy d. Anaphylaxis b. Seizures e. Neuroleptic malignant syndrome c. Peripheral neuropathy 42. Unfractionated heparin binds to antithrombin III and inactivates clotting factor(s) a. Xa d. All of the above b. IXa e. None of the above c. IIa 43. What would be expected to occur if a patient on warfarin with a stable INR is started on fluconazole? a. The INR would increase and the patient d. The INR would decrease and the patient may experience bleeding. may clot. e The INR would not change. b. The INR would increase and the patient may experience bleeding. c. The INR would decrease and the patient may clot. 44. Which of the following is the most likely adverse effect from the use of heparin? a. Leukopenia d. decreased cognitive function b. Hypercalcemia e. Lupus like syndrome C Bleeding 45. A patient has developed heparin-induced thrombocytopenia (HIT). He requires anticoagulation therapy for a pulmonary embolism. Which of the following agents would not pose a risk for HIT in this patient? a. Enoxaparin c. Dalteparin b. Argatroban d. None of the above 46. What would be expected to occur if a patient on warfarin with a stable INR is started on phenobarbital? (Select ALL that apply.)
d. The patient may experience bleeding. The INR would not change. e a. The INR would increase b. The INR would decrease. c. The patient may clot. 47. Terry Lance was admitted to the local hospital for a knee replacement. Orthopedic surgery is considered high risk for venous thromboembolism (VTE) but TL did not receive any VTE prophylaxis. He developed a deep thin and active. How long should he receive warfarin? vain thrombosis and was discharged on warfarin. This was his first incidence of VTE. Normally, Mr. Lance is d. 6 months e. 12 months a. 1 month b. 2 months c. 3 months 48. Judy Keith is a 62-year-old female with chronic urinary tract infections. Several times a year, she receives a prescription for Bactrim. The physician suggested she use the antibiotic daily, but she prefers not to because she feels that she is already using too many medications. Ms. Keith comes to the pharmacy today with a prescription for warfarin. She tells the pharmacist that the heart doctor found her heart was "beating funny." The pharmacist should emphasize the following counseling to Ms. Keith: (Select ALL that apply.) a. If she gets a UTI, the antibiotic Bactrim d. Warfarin can cause the Bactrim to be could make her warfarin level increase. ineffective in treating the UTI. b. When taking the warfarin and Bactrim, e. She should make sure to inform her health separate the doses by 4 hours to decrease care providers that she is using warfarin so the risk of the drug interaction. they can choose alternative medications that do not cause drug-drug interactions. The drug interaction between warfarin and Bactrim for a UTI may lead to significant bleeding. c. 49. A patient has developed a DVT and will be placed on Dalteparin. Choose the correct statements concerning Dalteparin: a. Dalteparin is safe to use if a person has a d. Dalteparin is monitored by anti-Xa levels history of heparin-induced but monitoring is not required in thrombocytopenia. everyone. b. Dalteparin is safe to use in a patient e. Dalteparin cannot be used safely in a receiving concurrent neuraxial anesthesia. patient with a sulfa allergy. C. Dalteparin is administered by intramuscular injection. 50. A hospitalized patient is post-op day #1 after a right hip arthroplasty. The patient has a history of a previous VTE. The doctor has recommended that the patient begin warfarin with Lovenox bridge therapy but the patient responds that he does not wish to take "rat poison". The pharmacy intern wants to explain to the patient the risks associated with not taking an anticoagulant, when indicated. The intern should explain to th patient that he is at higher risk for the following complications if he chooses not to use the warfarin: (Select ALL that apply.) -
a. Deep vein thrombosis d. Pleural effusion b. Pulmonary embolism c. Bleeding e. Cardiac tamponade