NAPLEX - ANTICOAGULATION/VTE - MCGRAW HILL TEST
QUESTIONS AND ALL ANSWERS CORRECT
Which of the following agents would be the best pain management
option for TS to utilize while on chronic warfarin therapy?
A
Celebrex®
B
Excedrin®
C
Aspirin
D
Acetaminophen - ANSWER D
Excedrin: APAP, ASA, caffeine
Although use of high doses of acetaminophen over several days can
cause an interaction with warfarin therapy, as needed, doses <1500 mg
daily is a safe option. Acetaminophen is the recommended over-the-
counter (OTC) agent for the management of mild to moderate pain with
chronic warfarin therapy.
Answer a is incorrect. Celebrex® is the brand name for celecoxib, a
cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors increase bleeding
risk in warfarin patients due to their potential to cause gastrointestinal
ulceration, albeit lower than nonselective nonsteroidal ani-inflammatory
drugs (NSAIDs).
Answers b and c are incorrect. Both of these products contain aspirin
which can increase the risk of bleeding when taken concomitantly with
warfarin.
Select the factors that could result in a supratherapeutic international
normalized ratio (INR). Select all that apply.
A
Binge alcohol use
B
,Diarrhea
C
Missed doses
D
Increased dietary vitamin K
E
Initiation of azole antifungal agents - ANSWER ABE
*Binge alcohol use can increase anticoagulation by decreasing the
metabolism of warfarin. In contrast, chronic alcohol use can result in a
subtherapeutic INR due to increased metabolism of warfarin. Diarrhea
can result in malabsorption, specifically reducing absorption of dietary
vitamin K and can result in an increased INR*. Initiation of medications
affect the CYP 450 group, especially CYP2C9, can increase or decrease
the INR depending upon if they are inhibitors or inducers. Azole
antifungals are inhibitors of CYP2C9 and can result in decreased
warfarin metabolism and increased INR.
Answers c and d are incorrect. Extra doses not missed doses would
expect to increase the INR. Also less vitamin K intake would increase
the INR, not more vitamin K intake.
In which procedure should enoxaparin use be avoided?
A
Epidural anesthesia
B
Total knee arthroplasty
C
Computed tomography (CT) scan
D
Liver biopsy - ANSWER A
Low molecular weight heparins (LMWHs) should be avoided in patients
undergoing epidural anesthesia due to the potential of developing a
spinal hematoma, which can result in long-term or permanent paralysis.
Answer b is incorrect. LMWH can be used after total knee and hip
arthroplasty asdeep vein thrombosis (DVT) prophylaxis.
Answer c is incorrect. These procedures are noninvasive and pose no
added bleeding risk in patients receiving LMWHs.
Answer d is incorrect. There is no contraindication to the use of LMWHs
in patients undergoing liver biopsy.
, A 62-year-old woman who is taking warfarin for recurrent deep vein
thrombosis (DVT) presents to her primary care physician (PCP) with
polyuria and pain on urination and is diagnosed with a urinary tract
infection. Which antibiotic would be expected to have the least effect on
her warfarin therapy?
A
Sulfamethoxazole-trimethoprim
B
Nitrofurantoin
C
Ciprofloxacin
D
Fluconazole - ANSWER B
Nitrofurantoin can be used safely in patients receiving warfarin therapy
without interaction.
Answers a, c, and d are incorrect. These antibiotics have been known to
interact with warfarin, often severely. Sulfamethoxazole-trimethoprim,
ciprofloxacin, and fluconazole can increase the INR and thus increase
the risk of bleeding.
A 66-year-old man presents to the anticoagulation clinic for initiation of
anticoagulation after receiving a diagnosis of recurrent deep vein
thrombosis (DVT). He states he tried one anticoagulant previously but
he couldn't tolerate it due to nausea, bloating, and indigestion. He can't
remember the name of the medication. Which anticoagulant is the most
likely culprit?
A
Apixaban
B
Aspirin
C
Dabigatran
D
Warfarin - ANSWER C
A common side effect associated with dabigatran is dyspepsia.
Answers a, c, and d are incorrect. None of the other oral anticoagulants
are commonly associated with dyspepsia.
A 64-year-old man (77 kg) has been taking warfarin for 3 years to
prevent recurrent deep vein thrombosis (DVT). His international
QUESTIONS AND ALL ANSWERS CORRECT
Which of the following agents would be the best pain management
option for TS to utilize while on chronic warfarin therapy?
A
Celebrex®
B
Excedrin®
C
Aspirin
D
Acetaminophen - ANSWER D
Excedrin: APAP, ASA, caffeine
Although use of high doses of acetaminophen over several days can
cause an interaction with warfarin therapy, as needed, doses <1500 mg
daily is a safe option. Acetaminophen is the recommended over-the-
counter (OTC) agent for the management of mild to moderate pain with
chronic warfarin therapy.
Answer a is incorrect. Celebrex® is the brand name for celecoxib, a
cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors increase bleeding
risk in warfarin patients due to their potential to cause gastrointestinal
ulceration, albeit lower than nonselective nonsteroidal ani-inflammatory
drugs (NSAIDs).
Answers b and c are incorrect. Both of these products contain aspirin
which can increase the risk of bleeding when taken concomitantly with
warfarin.
Select the factors that could result in a supratherapeutic international
normalized ratio (INR). Select all that apply.
A
Binge alcohol use
B
,Diarrhea
C
Missed doses
D
Increased dietary vitamin K
E
Initiation of azole antifungal agents - ANSWER ABE
*Binge alcohol use can increase anticoagulation by decreasing the
metabolism of warfarin. In contrast, chronic alcohol use can result in a
subtherapeutic INR due to increased metabolism of warfarin. Diarrhea
can result in malabsorption, specifically reducing absorption of dietary
vitamin K and can result in an increased INR*. Initiation of medications
affect the CYP 450 group, especially CYP2C9, can increase or decrease
the INR depending upon if they are inhibitors or inducers. Azole
antifungals are inhibitors of CYP2C9 and can result in decreased
warfarin metabolism and increased INR.
Answers c and d are incorrect. Extra doses not missed doses would
expect to increase the INR. Also less vitamin K intake would increase
the INR, not more vitamin K intake.
In which procedure should enoxaparin use be avoided?
A
Epidural anesthesia
B
Total knee arthroplasty
C
Computed tomography (CT) scan
D
Liver biopsy - ANSWER A
Low molecular weight heparins (LMWHs) should be avoided in patients
undergoing epidural anesthesia due to the potential of developing a
spinal hematoma, which can result in long-term or permanent paralysis.
Answer b is incorrect. LMWH can be used after total knee and hip
arthroplasty asdeep vein thrombosis (DVT) prophylaxis.
Answer c is incorrect. These procedures are noninvasive and pose no
added bleeding risk in patients receiving LMWHs.
Answer d is incorrect. There is no contraindication to the use of LMWHs
in patients undergoing liver biopsy.
, A 62-year-old woman who is taking warfarin for recurrent deep vein
thrombosis (DVT) presents to her primary care physician (PCP) with
polyuria and pain on urination and is diagnosed with a urinary tract
infection. Which antibiotic would be expected to have the least effect on
her warfarin therapy?
A
Sulfamethoxazole-trimethoprim
B
Nitrofurantoin
C
Ciprofloxacin
D
Fluconazole - ANSWER B
Nitrofurantoin can be used safely in patients receiving warfarin therapy
without interaction.
Answers a, c, and d are incorrect. These antibiotics have been known to
interact with warfarin, often severely. Sulfamethoxazole-trimethoprim,
ciprofloxacin, and fluconazole can increase the INR and thus increase
the risk of bleeding.
A 66-year-old man presents to the anticoagulation clinic for initiation of
anticoagulation after receiving a diagnosis of recurrent deep vein
thrombosis (DVT). He states he tried one anticoagulant previously but
he couldn't tolerate it due to nausea, bloating, and indigestion. He can't
remember the name of the medication. Which anticoagulant is the most
likely culprit?
A
Apixaban
B
Aspirin
C
Dabigatran
D
Warfarin - ANSWER C
A common side effect associated with dabigatran is dyspepsia.
Answers a, c, and d are incorrect. None of the other oral anticoagulants
are commonly associated with dyspepsia.
A 64-year-old man (77 kg) has been taking warfarin for 3 years to
prevent recurrent deep vein thrombosis (DVT). His international
