1. A 68-year-old female patient recently diagnosed with nonvalvular atrial fibrillation (NVAF) presents to the pharmacy with new prescriptions for apixaban and metoprolol. She has no symptoms of atrial fibrillation (AF). She states: “I don't feel bad, so why do I need to start these medications? I already take too many meds as it is. Will something bad really happen?” How do you respond?

2. The United States Preventive Services Task Force (USPSTF) endorses which of the following regarding AF screening?

3. A 69-year-old Caucasian woman (weight 74 kg) with hypertension, type 2 diabetes, gastric reflux, stage 4 chronic kidney disease (CKD 4), and morbid obesity was diagnosed with NVAF today. Her CHA2DS2-VASc score is 4 and HAS-BLED score is 1. Her SCr is 2.3 (CrCl ~25 mL/min). Which regimen is most appropriate for stroke prevention?

4. A 78-year-old female patient was newly diagnosed with NVAF during her current hospital admission. You are the pharmacist who is meeting with her to provide discharge medication counseling, and you see that she was prescribed rivaroxaban 20 mg once daily by the cardiologist. Which of the following patient-specific factors in her chart would represent a need to contact the cardiologist for an alternative anticoagulant regimen?

5. You call the patient 1 week after hospital discharge as part of your health system's anticoagulant transition of care program and discover that she has stopped taking her anticoagulant medication because she is “feeling so much better.” What is the best way to counsel her to address this barrier to adherence?

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