The best response is to: 1. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. 2 . Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. 3. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. 4. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. ____ 3. The safest drug to use to treat pregnant women who require anticoagulant therapy is: 1. Low-molecular-weight heparin 2. Warfarin 3. Aspirin 4.Heparin____4.The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? 1. Pregnant women 2. Elderly men 3 . Overweight or obese patients 4. Patients with multiple comorbidities ____ 5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be:
1. Administer one dose of low-molecular weight heparin 24 hours before travel. 2. Prescribe one dose of warfarin to be taken the day of travel. 3. Consult with a hematologist regarding a treatment plan for Cecil. 4 . Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling. ____ 6.Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? 1. He has arthritis and this will help with the inflammation and pain. 2 . Aspirin has anti-platelet activity and prevents clots that cause heart attacks. 3. Aspirin acidifies the urine and he needs this for prostrate health. 4. He has a history of GI bleed, and one aspirin a day is a safe dosage. ____ 7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would need to be evaluated? 1 . Tinnitus 2. Diarrhea 3. Hearing loss 4. Photosensitivity ____ 8. Patient education when prescribing clopidogrel includes: 1 . Do not take any herbal products without discussing it with the provider. 2. Monitor urine output closely and contact the provider if it decreases. 3. Clopidogrel can be constipating, use a stool softener if needed. 4. The patient will need regular anticoagulant studies while on clopidogrel. ____ 9. For patients taking warfarin, INRs are best drawn: 1. Monthly throughout therapy 2. Three times a week throughout therapy 3. Two hours after the last dose of warfarin to get an accurate peak level 4 . In the morning if the patient takes their warfarin at night ____ 10.
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