Practice Test Geeks(PSA) Prescribing Safety Assessment Practice Test
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Cardiovascular Prescribing Flashcards

7 cards from real PSA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Cardiovascular Prescribing flashcards as text

  1. A 75-year-old woman with non-valvular AF and a CHA₂DS₂-VASc score of 4 requires anticoagulation. Which agent is most appropriate as first-line therapy?

    Answer: Apixaban 5mg twice daily

    DOACs such as apixaban are recommended over warfarin for non-valvular AF due to superior efficacy and safety; antiplatelet therapy is not an acceptable alternative.

  2. A 68-year-old man with AF and CKD (eGFR 25 mL/min) needs anticoagulation. Which DOAC is most problematic at this level of renal impairment?

    Answer: Dabigatran

    Dabigatran is approximately 80% renally eliminated and is contraindicated when eGFR < 30 mL/min, making it the most problematic DOAC in severe CKD.

  3. A patient on warfarin for AF presents with an INR of 8.5 and no active bleeding. What is the most appropriate initial management?

    Answer: Withhold warfarin, give oral vitamin K 1–2.5mg, and recheck INR in 24 hours

    For markedly elevated INR (>8) without active bleeding, withholding warfarin and administering low-dose oral vitamin K 1–2.5mg is the appropriate management.

  4. A 78-year-old man on apixaban 5mg twice daily for AF has his medication reviewed. His weight is 58kg and serum creatinine is 140 µmol/L. What dose adjustment is required?

    Answer: Reduce to 2.5mg twice daily based on two criteria being met

    Apixaban dose should be reduced to 2.5mg twice daily when at least 2 of 3 criteria are met: age ≥80, weight ≤60kg, or creatinine ≥133 µmol/L; this patient meets weight and creatinine criteria.

  5. A patient with AF on rivaroxaban 20mg daily requires an elective colonoscopy with low bleeding risk. When should rivaroxaban be withheld?

    Answer: 24 hours before the procedure

    For procedures with low bleeding risk, rivaroxaban should be withheld for 24 hours (one dose missed) prior to the procedure given its half-life of 5–9 hours.

  6. An 80-year-old woman with AF on warfarin has had time in therapeutic range (TTR) of 38% over the past 6 months despite good adherence. What is the most appropriate next step?

    Answer: Consider switching to a DOAC

    Consistently poor TTR (<65–70%) on warfarin despite adherence is an indication to switch to a DOAC in eligible patients with non-valvular AF.

  7. A 66-year-old man with AF on apixaban 5mg twice daily is prescribed clarithromycin for a respiratory tract infection. What is the primary concern?

    Answer: Clarithromycin inhibits CYP3A4 and P-glycoprotein, substantially increasing apixaban exposure and bleeding risk

    Clarithromycin is a potent dual inhibitor of CYP3A4 and P-glycoprotein, both major elimination pathways for apixaban, leading to significantly elevated drug levels and bleeding risk.