MTM Anticoagulation Management 5

Question 1

A patient on warfarin therapy has a time in therapeutic range (TTR) of 42% over the past 6 months. What is the most appropriate next step?

Accepted Answer

Investigate causes of poor INR control before considering a DOAC switch

Answer

Before switching to a DOAC, clinicians should assess the causes of low TTR (diet, adherence, drug interactions) as some causes are correctable, though a DOAC may ultimately be preferred.

Question 2

Which anticoagulant is preferred for the treatment of cancer-associated thrombosis based on current guidelines?

Accepted Answer

Low molecular weight heparin or edoxaban/rivaroxaban (DOACs)

Answer

LMWH has historically been preferred for cancer-associated thrombosis, but DOACs (edoxaban, rivaroxaban) are now guideline-endorsed alternatives except in patients with GI malignancies at high bleeding risk.

Question 3

A patient taking warfarin for a mechanical aortic valve reports consistently eating large amounts of spinach and kale. What dietary counseling should be provided?

Accepted Answer

Maintain a consistent daily intake of vitamin K-rich foods rather than avoiding them

Answer

Patients on warfarin should be counseled to maintain consistent (not eliminate) vitamin K intake, as sudden increases or decreases alter INR unpredictably.

Question 4

A patient with PE has a submassive (intermediate-risk) PE with right heart strain on echo. They are hemodynamically stable. What is the initial anticoagulation of choice?

Accepted Answer

Anticoagulation with LMWH or DOAC and close monitoring

Answer

For submassive PE with hemodynamic stability, anticoagulation alone is the recommended initial therapy, with systemic thrombolysis reserved for clinical deterioration.

Question 5

A pharmacist is managing an anticoagulation clinic and receives labs for a patient on warfarin who also started taking naproxen OTC. Which concern is most clinically relevant?

Accepted Answer

Naproxen can displace warfarin from protein binding and inhibit platelet function, increasing bleeding risk

Answer

NSAIDs like naproxen inhibit platelet aggregation and can displace warfarin from albumin, compounding bleeding risk even if the INR does not markedly change.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Anticoagulation Management 5