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-(12 hours of CE)  $140.00

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.

Download

 1. A patient presents to your clinic and informs you that he is having a colonoscopy.  He wants to know what to do with his warfarin for the procedure and seeks out your advice.

1. Tell the patient to contact his PCP
2. Review the patients indication for warfarin therapy and provide appropriate recommendations to PCP
3. Stop warfarin for 5 days and bridge with LMWH
4. Continue warfarin

2. Which is the correct description of CHADS2 scoring?

1. CHF, hypertension, age >65, DM, prior history of stroke
2. Cardiomyopathy, hypertension, age >75, DM, prior history of stroke
3. CHF, hypertension, age > 75, DM, prior history of stroke
4. CHF, hyperlipidemia, age >75, DM, prior history of stroke

3. TL is a 75 year old male on warfarin indefinitely for atrial fibrillation.  His CHADS2 score is 5. TL is scheduled for a biopsy of his bladder. Per coordination with his cardiologist, LMWH bridging is ordered and implemented according to your clinic protocol.  Three days after the procedure, he continues to have hematuria and the urologist advises to hold warfarin but continue LMWH due to his high CHADS2 score.  The urologist seeks your advice on the appropriate dose of LMWH.

1. Continue full treatment dose and order antiXa levels
2. Reduce the dose of LMWH to a prophylactic regimen until hematuria resolves, then resume warfarin and continue LMWH bridging until INR is therapeutic
3. Stop LMWH and continue warfarin as it will take several days for warfarins fullest effects
4. Defer to cardiology

4. Warfarin therapy must be interrupted for the following:

1. Mole excision
2. Hip Replacement surgery
3. Cortisone injection in the knee
4. Epidural
5. B and D

Vitamin K Antagonist Pharmacology, Pharmacotherapy and Pharmacogenomics – 1 hour

Anticoagulation Management Pearls - 1 hour

Direct Oral Anticoagulants and Factor IIa and Xa Inhibitors – 1 hour

Laboratory Monitoring of Anticoagulation – 1 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

Perioperative Management of Warfarin Interruption – 1 hour

Hypercoagulable States – 1 hour

Challenging Topics in Anticoagulation – 1 hour

Available Strategies to Reverse Anticoagulation Medications - 1 hour

Case Studies in Drug Interactions with Anticoagulation Therapy – 1 hour

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-(12 hours of CE)  $140.00

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.

Download

1. Which of the following will not result in an acquired hypercoagulable state?

1. Obesity
2. Pregnancy
3. Recent surgery
4. Nephrotic syndrome
5. None of the above

2. Which of the following has the most thrombogenic potential?

1. Prothrombin gene mutation
2. Factor V leiden
3. Hyperhomocysteinemia
4. Antithrombin III deficiency
5. Protein C deficiency

3. Which of the following is the most commonly seen in Caucasians?

1. Prothrombin gene mutation
2. Factor V leiden
3. Protein C deficiency
4. Protein S deficiency
5. Antithrombin III deficiency

4. Laboratory testing for which of the following is not affected by warfarin?

1. Protein C deficiency
2. Protein S deficiency
3. Prothrombin gene mutation
4. Antithrombin III deficiency
5. All of the above

5. Management of patients with Protein C deficiency includes?

1. Initiate pt’s presenting with VTE on heparin drip
2. Ensure aPTT or factor Xa levels therapeutic before initiating warfarin
3. Start low dose warfarin to avoid warfarin induced skin necrosis
4. Lifelong anticoagulation following spontaneous thromboembolic event
5. All of the above

6. Arterial thrombosis is reported but not typically associated with which of the following conditions?

1. Protein C deficiency
2. Factor V leiden
3. Prothrombin gene mutation
4. Antithrombin III deficiency
5. All of the above

7. Factor V leiden causes

1. Resistance of factor V to inactivation by activated protein C
2. Guanine to adenine substitution at nucleotide 20210 of the prothrombin gene
3. Unexplained recurrent late pregnancy loss
4. A and C
5. All of the above

8. Antiphospholipid antibody syndrome

1. Can cause false elevation in INR
2. Is difficult to diagnose because laboratory errors are very common
3. Is associated with venous or arterial thromboembolism and pregnancy morbidity
4. A and C
5. All of the above

9. Hyperhomocysteinemia is noted in patients with deficiencies in

1. Vitamin K
2. Folic Acid
3. Vitamin B6
4. Vitamin B12
5. B, C and D

10. Laboratory testing for hypercoagulable states should be?

1. Performed on each patient that presents with VTE
2. Reserved for patients presenting with suspected inherited thrombophilia based on family history or atypical presentation
3. Performed on patient who presents with VTE after 8 hour plane ride
4. Performed on patient who presents with VTE 1 week after surgery
5. A & B

Vitamin K Antagonist Pharmacology, Pharmacotherapy and Pharmacogenomics – 1 hour

Anticoagulation Management Pearls - 1 hour

Direct Oral Anticoagulants and Factor IIa and Xa Inhibitors – 1 hour

Laboratory Monitoring of Anticoagulation – 1 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

Perioperative Management of Warfarin Interruption – 1 hour

Hypercoagulable States – 1 hour

Challenging Topics in Anticoagulation – 1 hour

Available Strategies to Reverse Anticoagulation Medications - 1 hour

Case Studies in Drug Interactions with Anticoagulation Therapy – 1 hour

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-(12 hours of CE)  $140.00

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.

Download

1. You get a phone call from a nurse, concerned that her patient with a new blood clot and being treated with heparin is going for dialysis today. She is unsure of how this will affect the patient’s heparin therapy. You respond:
a. You advise the nurse the patient will require an additional bolus dose of heparin after dialysis.
b. As heparin is contraindicated in patient’s on dialysis, you contact the doctor and get the order changed to LMWH.
c. You advise the nurse that dialysis will not affect heparin levels and it is safe to continue therapy without any intervention.
d. You advise the nurse to increase the heparin rate during dialysis.
e. As heparin is contraindicated in patient’s on dialysis, you contact the doctor and get the order changed to argatroban.

2. The following is true regarding low molecular weight heparins, except:
a. LMWH share a common pentasaccharide sequence that enables binding to antithrombin and thrombin
b. Protamine will not completely reverse LMWH effects
c. Dose adjustments are necessary for CrCl <30 ml/min d. Due to longer half life, once or twice daily dosing is possible e. All of the above are true 3. Low molecular weight heparins are approved for all of the following indications, except: a. Prevention of venous thromboembolism b. Treatment of venous thromboembolism c. Anticoagulation in patients with a history of HIT d. Acute coronary syndromes e. All of the above 4. TY, a 70 year old male is admitted to your hospital with an community acquired pneumonia. He is started on IV antibiotics, albuterol nebulizers, and IV fluids. He has no allergies. His INR on admission is 1.1. His BUN/Scr = 30/2.5 He is 5’5” and 75 kg. On interdisciplinary rounds, the attending physician asks for any pharmacological recommendations for this patient. You suggest that VTE prophylaxis should be considered if the patient does not have any contraindications to it. The patient does not have any contraindications, and the physician asks for your recommendation for choice of therapy. The most appropriate recommendation is: a. Enoxaparin 40mg SC daily b. IV Heparin per thromboembolic protocol c. Fondaparinux 2.5mg SC daily d. Enoxaparin 30mg SC daily e. Tinzaparin 13,125 anti Xa international units SC daily 5. The following are true about BOTH LMWH and fondaparinux, except: a. Dose adjustment or avoidance of use is necessary in patients with impaired renal function b. Anti Xa testing is recommended for most patients, and should be drawn on days 2 and 4 of therapy c. Active bleeding is a contraindication for use d. Both are associated with lower risk for development of HIT vs. heparin e. Both are indicated for the treatment and prophylaxis of VTE

Vitamin K Antagonist Pharmacology, Pharmacotherapy and Pharmacogenomics – 1 hour

Anticoagulation Management Pearls - 1 hour

Direct Oral Anticoagulants and Factor IIa and Xa Inhibitors – 1 hour

Laboratory Monitoring of Anticoagulation – 1 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

Perioperative Management of Warfarin Interruption – 1 hour

Hypercoagulable States – 1 hour

Challenging Topics in Anticoagulation – 1 hour

Available Strategies to Reverse Anticoagulation Medications - 1 hour

Case Studies in Drug Interactions with Anticoagulation Therapy – 1 hour

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-(12 hours of CE)  $140.00

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.

Download

1. You are not familiar with drug X. How would you determine if a drug interaction is likely between drug X and warfarin?

1. Check drug X prescribing information
2. Evaluate metabolic characteristics of drug X
3. Review case reports through Medline
4. Request information from the manufacturers of warfarin
5. All of the above

2.Warfarin is a racemic mixture of both R- and S- warfarin. What is the primary route of elimination for the S-warfarin version of this racemic mixture?

1. Renal
2. Hepatic CYP1A2, CYP3A4
3. Hepatic CYP2C15
4. Hepatic CYP2C9

3. Acute alcohol use “binge drinking” would have what effect on the INR of a patient who has been stable on warfarin anticoagulation therapy?

1. INR value would go down
2. INR value would remain the same
3. INR value would go up
4. None of the above

Patient Case:

JM is a 35 YO female with a history of DVT and is on chronic warfarin therapy with an INR goal of 2.0-3.0.  JM is not taking any other meds and has discontinued her birth control tablets several years earlier due to the association with her developing a DVT.  JM decides to self-treat what is believed to be a vaginal yeast infection with miconazole nitrate vaginal cream for 7 days.

4. Based upon the information provided in this patient case should you be concerned about JM self-treating her yeast infection?

1. Yes
2. No
3. Undecided

5. Based upon the information provided in this case what would you expect to happen to JM’s INR level after 3-4 days of her using the miconazole nitrate vaginal cream?

1. INR would go up
2. INR would remain the same
3. INR would go down
4. None of the above

6. Based upon the information that you have on patient JM when should you schedule her next INR testing time?

1. Recheck INR in 1 month
2. Recheck INR in 2 weeks
3. Recheck INR in 3-4 days
4. Recheck INR in 90 days

7. Warfarin decreases the production of which of the following vitamin K dependent clotting factors?

1. II
2. VII
3. IX
4. X
5. All of the above

8. Which of the following best describes examples of pharmacodynamic mechanisms for drug interactions?

1. Protein binding
2. Enzyme induction
3. Synergism
4. None of the above

9. Which of the following oral anticoagulant agents currently has an approved reversal agent to reverse their anticoagulant actions?

1. Fondaparinux
2. Rivaroxaban
3. Warfarin
4. Dabigatran
5. Both c and d above

10. The best over-the-counter (OTC) self-treatment option for a patient with minor headaches, aches and pains who is also taking warfarin is acetaminophen (APAP). Why would you recommend APAP over aspirin or NSAIDs to a patient on warfarin?

1. APAP does not inhibit platelet function
2. APAP does not cause injury to the GI mucosa
3. APAP is highly protein bound
4. Both a and b above

Vitamin K Antagonist Pharmacology, Pharmacotherapy and Pharmacogenomics – 1 hour

Anticoagulation Management Pearls - 1 hour

Direct Oral Anticoagulants and Factor IIa and Xa Inhibitors – 1 hour

Laboratory Monitoring of Anticoagulation – 1 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

Perioperative Management of Warfarin Interruption – 1 hour

Hypercoagulable States – 1 hour

Challenging Topics in Anticoagulation – 1 hour

Available Strategies to Reverse Anticoagulation Medications - 1 hour

Case Studies in Drug Interactions with Anticoagulation Therapy – 1 hour