BCACP Anticoagulation Management 5

Question 1

A patient on warfarin has a new prescription for fluconazole for a vaginal infection. What is the expected interaction?

Accepted Answer

Fluconazole increases warfarin effect by inhibiting CYP2C9

Answer

Fluconazole is a potent CYP2C9 inhibitor, reducing warfarin metabolism and significantly increasing INR.

Question 2

When using the HAS-BLED score in a patient with atrial fibrillation, what does a score of ≥3 indicate?

Accepted Answer

High risk of bleeding, warrants caution and closer monitoring

Answer

HAS-BLED ≥3 indicates high bleeding risk, prompting caution and more frequent monitoring, but is not a contraindication to anticoagulation.

Question 3

A patient with a mechanical mitral valve requires anticoagulation. Which regimen is most appropriate?

Accepted Answer

Warfarin with a target INR of 2.5–3.5

Answer

Mechanical mitral valves require warfarin with a higher INR target of 2.5–3.5; DOACs are contraindicated for mechanical valves.

Question 4

A patient receives idarucizumab for dabigatran reversal. Which statement is correct?

Accepted Answer

Idarucizumab is a specific reversal agent for dabigatran

Answer

Idarucizumab (Praxbind) is a humanized monoclonal antibody fragment that specifically and rapidly reverses dabigatran's anticoagulant effect.

Question 5

A patient with antiphospholipid syndrome (APS) and recurrent DVT is on a DOAC. What change should be made?

Accepted Answer

Switch to warfarin with target INR 2.0–3.0

Answer

Guidelines recommend warfarin over DOACs for triple-positive APS due to higher rates of recurrent thrombosis seen with DOACs in clinical trials.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test