If desired, “bundle” pricing can be obtained by registering for the activities in groups. It consists of thirteen anticoagulation activities in our online selection.

You may register for individual topics at $17/CE Credit Hour, or for the Entire Anticoagulation Pre-requisite Series.

Pharmacist General Registration for 13 Anticoagulation Pre-requisite activities-(17.25 hours of CE)  $199.00

In order to attend the 2-day Anticoagulation Traineeship, you must complete all of the Pre-requisite Series or the equivalent.

Anticoagulation Traineeship at the University of Connecticut Health Center, Farmington, CT

The University of Connecticut School of Pharmacy and The UConn Health Center Outpatient Anticoagulation Clinic have developed 2-day practice-based ACPE certificate continuing education activity for registered pharmacists and nurses who are interested in the clinical management of patients on anticoagulant therapy and/or who are looking to expand their practice to involve patient management of outpatient anticoagulation therapy. This traineeship will provide you with both the clinical and administrative aspects of a pharmacist-managed outpatient anticoagulation clinic. The activity features ample time to individualize your learning experience. A “Certificate of Completion” will be awarded upon successful completion of the traineeship.

More Information About Traineeship

To receive CE Credit go to Blue Button labeled "take Test/Evaluation" at the top of the page.

Type in your NABP ID, DOB and the session code for the activity.  You were sent the session code in your confirmation email.

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Drug Interaction Cases with Anticoagulation Therapy

Post-test

After completing this continuing education activity, the learner will be able to
1) Identify anticoagulation therapy’s clinically significant drug interactions
2) Discuss drug interactions that patients may ask about, but are generally not clinically significant
3) Analyze cases to determine if a drug interaction is clinically significant
4) Diminish the effect of identified drug interactions in simulated cases
5) Describe monitoring parameters for the identified drug interactions in the simulated cases

1. A patient arrives at the clinic with a new prescription for bananamycin. This drug was approved yesterday and the patient is on warfarin. Bananamycin’s prescribing information doesn’t discuss anticoagulants as it was approved based on very small studies. What would be the BEST way to determine if bananamycin is likely to interact with warfarin?
A. Check warfarin’s prescribing information
B. Request information from warfarin’s manufacturer
C. Evaluate bananamycin’s metabolic characteristics

2. Which of the following pairs correctly links the warfarin enantiomer with the CYP enzyme of concern?
A. R enantiomer = CYP1A2
B. R enantiomer = CYP2C19
C. R enantiomer = CYP3A4

3. Which of the following pairs correctly links the warfarin enantiomer with the CYP enzyme of concern?
A. S enantiomer = CYP2C9
B. S enantiomer = CYP2C19
C. S enantiomer = CYP3A4

4. Arlene comes to the clinic to have a PT/INR drawn. You note that she is drinking green tea. You tell her that under certain circumstances, green tea can affect INR, and you ask her how much green tea she drinks. Which of the following answers would be of MOST concern?
A. “I usually drink a 16 ounce bottle every day over six hours or so.”
B. “I don’t know… a gallon a day…maybe more? It’s good for you.”
C. “This is the first time I ever had it.”

5. Bob is a 77-year-old fellow who has been on warfarin for five years. He has stable hypertension and hypercholesteremia but is pretty healthy otherwise. You say, “Tell me anything that has changed regarding your health or diet since we last talked.” He responds that he recently received a diagnosis of osteoarthritis and is now taking acetaminophen. What should your next question be?
A. Is the acetaminophen providing some relief from the pain?
B. How much acetaminophen are you taking and how often?
C. Did your prescriber call your hematologist before prescribing?

6. Patients may experience drug-drug interactions that are unpredictable. Which four factors might vary between patients?
A. Patient susceptibility, response magnitude, time of onset, duration of effect
B. Drug manufacturer, INR testing method, dietary preferences, reason for anticoag
C. Brand, lot number, manufacturer reliability, patient health literacy level

7. Olivia is an 82-year-old who has frequent urinary tract infections. She takes 5 mg of warfarin daily. The culture/sensitivity results indicate that this organism is sensitive to cotrimoxazole. Her gynecologist wants to start cotrimoxazole for 10 days to treat the active infection and then use trimethoprim 100 mg daily as prophylaxis for six months. What should you expect? (You may need a drug interaction checker to answer this question.)
A. Sulfamethoxazole will decrease warfarin levels so you may need to increase the warfarin dose by 10-20%.
B. Trimethoprim will increase warfarin levels so you may need to decrease the warfarin dose by 10-20%.
C. Sulfamethoxazole usually increases warfarin levels, but trimethoprim is not expected to interact with warfarin.

8. Which of the following medications is MOST LIKELY to affect warfarin levels because it affects both warfarin enantiomers?
A. Amiodarone
B. Cimetidine
C. Omeprazole

9. According to the Anticoagulation Forum’s Direct Oral Anticoagulant (DOAC) Drug-Drug Interaction Guidance, which medications are MOST LIKELY to cause clinically significant drugs interactions? (You may pull the Guidance to answer this question.)
A. Drugs that are STRONG modifiers of CYP3A4 and CYP2C19
B. Drugs that modify BOTH p-gp and are STRONG modifiers of CYP3A4
C. The DOACs have few if any drug interactions, which is why they are so popular.

10. Roger is a 76-year-old man who is on apixaban pursuant to a diagnosis of atrial fibrillation. He has contracted an infection that is sensitive to clarithromycin, a combined p-gp and STRONG CYP3A4 inhibitor. The infection control specialist wants to prescribe it as soon as possible. What does the Anticoagulation Forum’s Direct Oral Anticoagulant (DOAC) Drug-Drug Interaction Guidance say about concurrent use of apixaban and clarithromycin?
A. Avoid use of clarithromycin entirely
B. Reduce the apixaban dose by 50% while taking clarithromycin
C. Clarithromycin does not significantly increase apixaban exposure

11. Jerrilyn, age 57, has diagnoses including HTN, hypercholesterolemia, and osteoarthritis. She takes warfarin 7.5 mg Monday and Friday, and 5 mg x 5 days after an atrial valve replacement. She develops a vaginal infection and decides to use OTC miconazole to treat it. What monitoring should you implement?
A. Recheck INR in 3-4 days
B. Recheck INR in 2 weeks
C. Recheck INR in 1 month

12. A patient is taking griseofulvin and his prescriber indicates it’s time to discontinue it. Right now! Today! When should you call the patient in for the next INR?
A. Recheck INR in 5 days
B. Recheck INR in 2 weeks
C. Recheck INR in 1 month

Vitamin K Antagonist Pharmacology, Pharmacotherapy and Pharmacogenomics – 1 hour

Anticoagulation Management Pearls - 1.5 hour

Clinical Overview of Direct Oral Anticoagulants– 1.25 hour

Laboratory Monitoring of Anticoagulation – 2 hour

Heparin/Low Molecular Weight Heparin and Fondaparinux Pharmacology and Pharmacotherapy – 0.5 hours

Developing an Anticoagulation Clinic – 1.0 hour

Pharmacist Reimbursement for Anticoagulation Services – 0.5 hour

Risk Management in Anticoagulation – 1 hour

A Practical Approach to Perioperative Oral Anticoagulation Management – 2 hour

Management of Hypercoagulable States – 1.5 hour

Challenging Topics in Anticoagulation – 2 hour

Available Strategies to Reverse Anticoagulation Medications - 2 hour

Drug Interaction Cases with Anticoagulation Therapy – 1 hour