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Anticoagulation Management Flashcards

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

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  1. A patient on warfarin has a new prescription for fluconazole for a vaginal infection. What is the expected interaction?

    Answer: Fluconazole increases warfarin effect by inhibiting CYP2C9

    Fluconazole is a potent CYP2C9 inhibitor, reducing warfarin metabolism and significantly increasing INR.

  2. When using the HAS-BLED score in a patient with atrial fibrillation, what does a score of ≥3 indicate?

    Answer: High risk of bleeding, warrants caution and closer monitoring

    HAS-BLED ≥3 indicates high bleeding risk, prompting caution and more frequent monitoring, but is not a contraindication to anticoagulation.

  3. A patient with a mechanical mitral valve requires anticoagulation. Which regimen is most appropriate?

    Answer: Warfarin with a target INR of 2.5–3.5

    Mechanical mitral valves require warfarin with a higher INR target of 2.5–3.5; DOACs are contraindicated for mechanical valves.

  4. A patient receives idarucizumab for dabigatran reversal. Which statement is correct?

    Answer: Idarucizumab is a specific reversal agent for dabigatran

    Idarucizumab (Praxbind) is a humanized monoclonal antibody fragment that specifically and rapidly reverses dabigatran's anticoagulant effect.

  5. A patient with antiphospholipid syndrome (APS) and recurrent DVT is on a DOAC. What change should be made?

    Answer: Switch to warfarin with target INR 2.0–3.0

    Guidelines recommend warfarin over DOACs for triple-positive APS due to higher rates of recurrent thrombosis seen with DOACs in clinical trials.

  6. A patient starting warfarin therapy has a CYP2C9 *2/*3 genotype. What clinical implication does this have?

    Answer: Patient will require lower than average warfarin doses due to reduced enzyme activity

    CYP2C9 *2 and *3 alleles encode enzymes with reduced activity, leading to decreased warfarin metabolism and lower dose requirements.

  7. A patient on apixaban 5 mg twice daily for atrial fibrillation develops end-stage renal disease requiring hemodialysis. What is the most appropriate action?

    Answer: Continue apixaban 5 mg twice daily

    Apixaban is now FDA-approved for use in ESKD patients on dialysis at the standard 5 mg twice daily dose based on pharmacokinetic data and clinical studies.