MTM Anticoagulation Management 4

Question 1

A patient on rivaroxaban needs an elective colonoscopy with polyp removal. What is the recommended periprocedural anticoagulation management?

Accepted Answer

Stop rivaroxaban 24 hours before and restart 24 hours after if hemostasis achieved

Answer

For high-bleeding-risk procedures like polypectomy, rivaroxaban should be held for at least 24 hours (or 48 hours for high-bleed-risk) before the procedure with no bridging required.

Question 2

Which laboratory test is most appropriate to monitor anticoagulant effect when using argatroban in a patient with HIT?

Accepted Answer

Activated partial thromboplastin time (aPTT)

Answer

Argatroban, a direct thrombin inhibitor, is monitored using the aPTT with a target of 1.5–3 times the baseline normal value.

Question 3

A woman with atrial fibrillation on anticoagulation discovers she is pregnant. Which anticoagulant is considered safest during the second trimester?

Accepted Answer

Low molecular weight heparin (LMWH)

Answer

LMWH is preferred throughout pregnancy because it does not cross the placenta, unlike warfarin which is teratogenic, and DOACs which lack adequate safety data in pregnancy.

Question 4

A patient's warfarin dose was stable for 6 months but now has an INR of 1.5. They deny dietary changes. What is the MOST important factor to assess?

Accepted Answer

New medications, supplements, or OTC products started

Answer

A drop in INR with stable warfarin dosing most commonly results from drug interactions with inducers of CYP2C9 or reduced warfarin absorption from new medications or supplements.

Question 5

What is the primary mechanism of action of protamine sulfate when used to reverse heparin?

Accepted Answer

Directly binds heparin via electrostatic interaction, forming an inactive complex

Answer

Protamine sulfate, a positively charged protein, binds electrostatically to negatively charged heparin, forming a stable inactive complex that has no anticoagulant activity.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Anticoagulation Management 4