CACP EXAM STUDY QUESTIONS WITH
COMPLETE SOLUTIONS GRADED A+
A 48-year-old female with a mechanical aortic value is taking warfarin for
stroke prevention. The patient's psychiatrist would like to switch her from
lithium carbonate to carbamazepine for bipolar disease. Which of the following
statements would be the best response to this proposed change?
- Lithium carbonate is known to reduce the renal clearance of warfarin;
carbamazepine is a better choice
- Carbamazepine will likely reduce the clearance of warfarin; the dose of
warfarin should be decreased 20% now and the INR checked again in 1 week
- Warfarin is likely to block the metabolism of carbamazepine; very low doses
of carbamazepine should be initially used to prevent toxicity
- Carbamazepine induces hepatic enzymes and the INR will likely substantially
decrease; monitor the INR every 7-14 days for the next 2-3 months Answer -
Which of the following meals would be the LEAST likely to interact with
warfarin?
- Baked macaroni & cheese and a glass of chocolate milk
- A 12-piece sushi dinner with a seaweed salad and glass of white wine
- Liver and onions served with garlic mashed potatoes and broccoli plus iced
coffee
- A tuna salad (made with mayonnaise) sandwich with tomatoes and a bottle of
green tea Answer -
,TW is a 65-year-old female with PMH atrial fibrillation, HTN, hyperlipidemia,
and osteoarthritis who presents to your Coumadin clinic for follow up. Her
current warfarin dose is 5mg daily except 7.5mg on Wednesdays. Her INR today
is 5.1; her previous INR on this dose 4 weeks ago was 2.8. She admits to
drinking several alcoholic beverages at her daughter's wedding last weekend
(usually she avoids alcohol) but otherwise denies changes in medications or
diet. She denies any signs or symptoms of bleeding.
Which of the following is the BEST option regarding her anticoagulation
therapy today?
- Hold warfarin x 1 week and recheck INR in 7 days
- Reduce warfarin dose to 5 mg daily and recheck INR in 7 days
- Hold 1-2 doses of warfarin, then resume current dose.
- Recheck INR in 5 daysStop warfarin and give 5 mg PO Vitamin K. Recheck INR
in 2 days Answer -
Patient JR (age 65, weight 92kg) presents to Anticoagulation Clinic after
beginning warfarin 5mg daily for atrial fibrillation four days ago. His INR today
is 1.8 (baseline INR: 1.0). During visit, he was also prescribed amiodarone
400mg twice daily for one week then changing to 200mg twice daily for two
weeks then 200mg daily, which he is going to start today. Which of the
following treatment options is best for this patient?
- Reduce warfarin dose to 2.5mg daily
- Continue warfarin 5mg daily
- Increase warfarin to 5mg daily except 7.5mg Monday/Wednesday/Friday
- Give warfarin 10mg dose today then resume at 5mg daily Answer -
,Which of the following statements best reflects the effects of thyroid disease
on warfarin dosing?
- Hypothyroidism: requires increased warfarin dose due to decreased
catabolism of the clotting factors; Hyperthyroidism: requires decreased
warfarin dose due to increased catabolism of the clotting factors
- Hypothyroidism: requires decreased warfarin dose due to decreased
catabolism of the clotting factors; Hyperthyroidism: requires increased warfarin
dose due to increased catabolism of the clotting factors
- Thyroid disease has no impact on warfarin dosing
- No matter what, the patient will require a much lower warfarin dose Answer
-
DP is a pharmacy student doing an APPE rotation at your pharmacy. You ask DP
to explain how the mechanism of rivaroxaban is different than warfarin. Which
one of the following is the best answer to your question?
- Rivaroxaban is a direct thrombin inhibitor
- Rivaroxaban inhibits factor Xa
- Rivaroxaban inhibits proteins C and S
- Rivaroxaban inhibits Factor IX Answer -
BV is a 60 year old female who is prescribed apixaban for VTE prevention after
knee replacement surgery. The surgery is scheduled for next week, but BV is
picking up her prescription today. BV is in good health, and other than this
knee replacement surgery, she's never had any "health problems." BV asks you
for some information about apixaban. Which of the following statements
regarding apixaban is CORRECT?
- Apixaban must be taken with the evening meal for best efficacy
- Apixaban must be taken for 35 days after knee replacement surgery
, - Apixaban has no significant food-drug interactions
- Apixaban is primarily eliminated by the kidneys Answer -
In addition to initiating warfarin sodium therapy, which one of the following is
the most appropriate INITIAL acute treatment regimen for a 57-year-old, 120-
kg man who has a proximal DVT, no other comorbid conditions, and all labs are
within normal limits?
- Dalteparin 5000 units intravenous bolus, followed by 2500 units
subcutaneously every 24 hours
- Enoxaparin 30 mg subcutaneously every 12 hours
- Fondaparinux 10 mg subcutaneously every 24 hours
- Unfractionated heparin (UFH) 5000 units subcutaneously every 8 hours
Answer - - Fondaparinux 10 mg subcutaneously every 24 hours
A patient is initiating dalteparin subcutaneously and warfarin sodium orally for
the treatment of DVT on an outpatient basis. Which one of the following
laboratory monitoring plans is most appropriate to determine response and
toxicity to this drug treatment regimen?
- Measure platelet count activated partial prothrombin time (aPTT), and INR
daily
- Measure INR in 3 days and platelet count in 7 days
- Measure INR in 12 hours, aPTT in 4 days, and hemoglobin in 30 days
- Measure clotting time, serum creatinine (SCr), and liver function tests every 3
days Answer -
Which of the following statements best describes the body's hemostasis
process and its associated drug targets?
COMPLETE SOLUTIONS GRADED A+
A 48-year-old female with a mechanical aortic value is taking warfarin for
stroke prevention. The patient's psychiatrist would like to switch her from
lithium carbonate to carbamazepine for bipolar disease. Which of the following
statements would be the best response to this proposed change?
- Lithium carbonate is known to reduce the renal clearance of warfarin;
carbamazepine is a better choice
- Carbamazepine will likely reduce the clearance of warfarin; the dose of
warfarin should be decreased 20% now and the INR checked again in 1 week
- Warfarin is likely to block the metabolism of carbamazepine; very low doses
of carbamazepine should be initially used to prevent toxicity
- Carbamazepine induces hepatic enzymes and the INR will likely substantially
decrease; monitor the INR every 7-14 days for the next 2-3 months Answer -
Which of the following meals would be the LEAST likely to interact with
warfarin?
- Baked macaroni & cheese and a glass of chocolate milk
- A 12-piece sushi dinner with a seaweed salad and glass of white wine
- Liver and onions served with garlic mashed potatoes and broccoli plus iced
coffee
- A tuna salad (made with mayonnaise) sandwich with tomatoes and a bottle of
green tea Answer -
,TW is a 65-year-old female with PMH atrial fibrillation, HTN, hyperlipidemia,
and osteoarthritis who presents to your Coumadin clinic for follow up. Her
current warfarin dose is 5mg daily except 7.5mg on Wednesdays. Her INR today
is 5.1; her previous INR on this dose 4 weeks ago was 2.8. She admits to
drinking several alcoholic beverages at her daughter's wedding last weekend
(usually she avoids alcohol) but otherwise denies changes in medications or
diet. She denies any signs or symptoms of bleeding.
Which of the following is the BEST option regarding her anticoagulation
therapy today?
- Hold warfarin x 1 week and recheck INR in 7 days
- Reduce warfarin dose to 5 mg daily and recheck INR in 7 days
- Hold 1-2 doses of warfarin, then resume current dose.
- Recheck INR in 5 daysStop warfarin and give 5 mg PO Vitamin K. Recheck INR
in 2 days Answer -
Patient JR (age 65, weight 92kg) presents to Anticoagulation Clinic after
beginning warfarin 5mg daily for atrial fibrillation four days ago. His INR today
is 1.8 (baseline INR: 1.0). During visit, he was also prescribed amiodarone
400mg twice daily for one week then changing to 200mg twice daily for two
weeks then 200mg daily, which he is going to start today. Which of the
following treatment options is best for this patient?
- Reduce warfarin dose to 2.5mg daily
- Continue warfarin 5mg daily
- Increase warfarin to 5mg daily except 7.5mg Monday/Wednesday/Friday
- Give warfarin 10mg dose today then resume at 5mg daily Answer -
,Which of the following statements best reflects the effects of thyroid disease
on warfarin dosing?
- Hypothyroidism: requires increased warfarin dose due to decreased
catabolism of the clotting factors; Hyperthyroidism: requires decreased
warfarin dose due to increased catabolism of the clotting factors
- Hypothyroidism: requires decreased warfarin dose due to decreased
catabolism of the clotting factors; Hyperthyroidism: requires increased warfarin
dose due to increased catabolism of the clotting factors
- Thyroid disease has no impact on warfarin dosing
- No matter what, the patient will require a much lower warfarin dose Answer
-
DP is a pharmacy student doing an APPE rotation at your pharmacy. You ask DP
to explain how the mechanism of rivaroxaban is different than warfarin. Which
one of the following is the best answer to your question?
- Rivaroxaban is a direct thrombin inhibitor
- Rivaroxaban inhibits factor Xa
- Rivaroxaban inhibits proteins C and S
- Rivaroxaban inhibits Factor IX Answer -
BV is a 60 year old female who is prescribed apixaban for VTE prevention after
knee replacement surgery. The surgery is scheduled for next week, but BV is
picking up her prescription today. BV is in good health, and other than this
knee replacement surgery, she's never had any "health problems." BV asks you
for some information about apixaban. Which of the following statements
regarding apixaban is CORRECT?
- Apixaban must be taken with the evening meal for best efficacy
- Apixaban must be taken for 35 days after knee replacement surgery
, - Apixaban has no significant food-drug interactions
- Apixaban is primarily eliminated by the kidneys Answer -
In addition to initiating warfarin sodium therapy, which one of the following is
the most appropriate INITIAL acute treatment regimen for a 57-year-old, 120-
kg man who has a proximal DVT, no other comorbid conditions, and all labs are
within normal limits?
- Dalteparin 5000 units intravenous bolus, followed by 2500 units
subcutaneously every 24 hours
- Enoxaparin 30 mg subcutaneously every 12 hours
- Fondaparinux 10 mg subcutaneously every 24 hours
- Unfractionated heparin (UFH) 5000 units subcutaneously every 8 hours
Answer - - Fondaparinux 10 mg subcutaneously every 24 hours
A patient is initiating dalteparin subcutaneously and warfarin sodium orally for
the treatment of DVT on an outpatient basis. Which one of the following
laboratory monitoring plans is most appropriate to determine response and
toxicity to this drug treatment regimen?
- Measure platelet count activated partial prothrombin time (aPTT), and INR
daily
- Measure INR in 3 days and platelet count in 7 days
- Measure INR in 12 hours, aPTT in 4 days, and hemoglobin in 30 days
- Measure clotting time, serum creatinine (SCr), and liver function tests every 3
days Answer -
Which of the following statements best describes the body's hemostasis
process and its associated drug targets?
