1. MR is a 66-year-old female with persistent atrial fibrillation, diabetes, and hypertension. Her height is 64 inches and her weight is 102 kg; her serum creatinine is 1.3 mg/dL and her INR is 1.1. Her vitals include a heart rate of 92 beats per minute and a blood pressure of 163/92 mmHg, which has been stable for the last few visits. She does not drink alcohol and has never been a smoker. Her medications include metformin 1000 mg twice daily, lisinopril 20 mg daily, diltiazem 240 mg daily, chlorthalidone 25 mg daily, carvedilol 25 mg twice daily, glipizide 5 mg daily, and aspirin 81 mg daily. Based on MR's history, what is her CHA2DS2-VASc score?

2. What is MR's HAS-BLED score?

3. Which of the following oral anticoagulants should be avoided in MR because of possible drug-drug interactions?

4. RH is a 62-year-old male with a history of atrial fibrillation, coronary disease, and heart failure with reduced ejection fraction (ejection fraction 30%) who presented with an ST-elevated myocardial infarction. He was taken to the cath lab where he received a drug-eluting stent to his mid-left anterior descending coronary artery. His home medications include aspirin 81 mg daily, lisinopril 10 mg daily, carvedilol 6.25 mg twice daily, atorvastatin 40 mg daily, spironolactone 25 mg once daily, and warfarin 5 mg alternating with 7.5 mg. His INR on admission was 1.86. The antiplatelet agent clopidogrel 75 mg daily was started as a new medication following stent placement. Based on RH's history, which of the following would be the most appropriate pharmacologic option for his coronary disease and atrial fibrillation?

5. GG is an 82-year-old male with a history of gout, hypertension, heart failure (ejection fraction 32%), and atrial fibrillation. His medications include lisinopril 10 mg daily, spironolactone 12.5 mg once daily, allopurinol 100 mg daily, carvedilol 6.25 mg twice daily, furosemide 40 mg daily, amiodarone 200 mg daily, and apixaban 5 mg twice daily. Based on the results of the sub-group analysis of the ARISTOPHANES study, which of the following is true regarding the use of oral anticoagulants in the elderly population?

6. BA is a 72-year-old female with a history of hypertension, diabetes, chronic kidney disease (serum creatinine 2.9 mg/dL), and heart failure with reduced ejection fraction (ejection fraction 32%). Her height is 64 inches and her weight is 59.5 kg. She presented to the emergency department with complaints of palpitations and was found to be in new-onset atrial fibrillation. She subsequently converted to sinus rhythm and was discharged on metoprolol 50 mg twice daily and a 30-day holter monitor. Her home medications include aspirin 81 mg, metoprolol 50 mg twice daily, amlodipine 10 mg daily, and glipizide 10 mg daily. During follow-up with her primary care provider, the holter monitor showed several episodes of atrial fibrillation. Which of the following would be the most appropriate anticoagulant option for this patient?

7. JS is a 62-year-old male with a past medical history of hypertension, gout, diabetes, and atrial fibrillation who presents to the emergency department with substernal chest pain. Following initial evaluation, he undergoes cardiac catheterization and receives 2 drug-eluting stents. He is placed on aspirin 81 mg daily, prasugrel 10 mg daily, and atorvastatin 80 mg daily. His home medications include metformin 1000 mg twice daily, empagliflozin 10 mg daily, lisinopril 10 mg daily, allopurinol 100 mg daily, and rivaroxaban 20 mg daily. According to the American College of Cardiology/American Heart Association guidelines, which of the following is the optimal treatment strategy for JS given his recent coronary stents and history of atrial fibrillation?

8. RP is a 62-year-old male with a history depression, herpes simplex virus, restless leg syndrome, heart failure with reduced ejection fraction, and uncontrolled hypertension. His height is 72 inches and his weight is 85 kg. He was instructed to come to the hospital from his primary care provider due to an irregular heart rhythm. An electrocardiogram found him to be in atrial fibrillation. His current home medications include citalopram 20 mg daily, pramipexole 0.25 mg daily, aspirin 81 mg daily, famciclovir 250 mg twice daily, lisinopril 10 mg daily, and hydrochlorothiazide 25 mg daily. Which of the following would be the most appropriate oral anticoagulant to recommend for RP?

9. BS is a 66-year-old female with a history of atrial fibrillation, heart failure (ejection fraction 37%), and alcohol abuse who presents to the emergency department with rectal bleeding. Her height is 65 inches and her weight is 72 kg. Her home medications include aspirin 81 mg daily, apixaban 5 mg twice daily, lisinopril 5 mg daily, spironolactone 12.5 mg daily, metoprolol succinate 25 mg daily, and furosemide 20 mg daily. Vitals include a heart rate of 102 beats per minute and a blood pressure of 82/48 mmHg. Lab work was completed, and her hemoglobin is 6.4 mg/dL. Intravenous fluids are initiated and a type and cross is ordered for blood transfusion. Gastroenterology is consulted and the team desires to reverse her anticoagulant due to her active gastrointestinal bleed. Which of the following would be the most appropriate agent and dose to recommend for BS to help control the bleeding?

10. CM is a 65-year-old female who has a strong aversion to taking medications and seeing physicians. She has recently been diagnosed with atrial fibrillation. Her only significant past medical history is for hypertension for which she takes hydrochlorothiazide 25 mg daily. Which of the following is least likely to encourage CM to be compliant with her anticoagulant?

Evaluation Questions

11. How confident are in your treatment decisions for the patients described in the questions above?

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