BCACP Anticoagulation Management

Question 1

What is the target INR range for a patient with nonvalvular atrial fibrillation on warfarin?

Accepted Answer

2.0–3.0

Answer

The standard therapeutic INR range for nonvalvular atrial fibrillation is 2.0–3.0 to balance stroke prevention with bleeding risk.

Question 2

Which of the following clotting factors is NOT inhibited by warfarin?

Accepted Answer

Factor VIII

Answer

Warfarin inhibits only vitamin K-dependent clotting factors (II, VII, IX, X); Factor VIII is not vitamin K-dependent and is therefore unaffected.

Question 3

A patient on warfarin for atrial fibrillation presents with an INR of 8.5 and no signs of active bleeding. What is the most appropriate management?

Accepted Answer

Hold warfarin, administer oral vitamin K 2.5 mg, and recheck INR in 24–48 hours

Answer

CHEST guidelines recommend holding warfarin and administering low-dose oral vitamin K (2.5 mg) for INR above 5 without active bleeding to safely lower the INR.

Question 4

Which drug is most likely to INCREASE warfarin's anticoagulant effect by inhibiting its primary metabolizing enzyme?

Accepted Answer

Fluconazole

Answer

Fluconazole is a strong CYP2C9 inhibitor, the primary enzyme responsible for warfarin (S-enantiomer) metabolism, leading to increased warfarin levels and elevated INR.

Question 5

A patient with a bileaflet mechanical mitral valve requires long-term anticoagulation. Which agent is most appropriate?

Accepted Answer

Warfarin with target INR 2.5–3.5

Answer

Warfarin is the only anticoagulant approved for mechanical heart valves; all DOACs are contraindicated due to demonstrated increased risk of thromboembolic events in this population.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Anticoagulation Management