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1. Complicating the underdiagnosis of atrial fibrillation is the proportion of asymptomatic cases, which is estimated to be

A. 1/4 of cases B. 1/3 of cases C. 1/2 of cases D. 2/3 of cases E. Unsure

2. Which of the following is TRUE regarding nonvalvular atrial fibrillation (NVAF)?

A. NVAF patients have no valvular heart disease B. NVAF patients may have an artificial heart valve but no mitral stenosis C. NVAF patients may have moderate-to-severe mitral stenosis but no artificial heart valve D. NVAF patients may have mild mitral stenosis but no artificial heart valve E. Unsure

3. Which of the following is an advantage of DOACs compared to vitamin K antagonists?

A. DOACs do not exhibit any potential for drug interactions B. DOACs are all dosed once daily C. DOACs do not require routine monitoring D. DOACs are irreversible inhibitors of their targets E. Unsure

4. Current clinical evidence suggests which of the following regarding screening for asymptomatic NVAF?

A. All patients older than 50 years should be screened at annual check up B. All patients older than 60 years should be screened at annual check up C. Screening should be conducted in patients with HAS-BLED score greater than 3 D. There is insufficient evidence for short-term screening of asymptomatic NVAF patients E. Unsure

5. When considering the use of DOACs in patients with decreased renal function, which dose adjustment is correct?

A. Apixaban 2.5 mg twice daily in an 85-year-old man with SCr of 1.62 mg/dL B. Edoxaban 30 mg twice daily in an 85-year-old man with CrCl of 22 mL/min C. Rivaroxaban 15 mg twice daily an 85-year-old man with SCr of 1.62 mg/dL D. Dabigatran 150 mg twice daily in an 85-year-old man with CrCl of 22 mL/min E. Unsure

6. Which of the following is a modifiable bleeding risk factor considered as part of the HAS-BLED score?

A. Abnormal renal function B. Abnormal hepatic function C. High blood pressure D. Diabetes mellitus type 2 E. Unsure

7. Questions 7 and 8 are related to the following case: A 55-year-old male patient is currently admitted to your hospital with a chief complaint of palpitations and shortness of breath. His EKG on admission showed a rhythm of paroxysmal atrial fibrillation, so his cardiologist would like to initiate a medication to reduce his stroke risk. His past medical history includes hypertension, type 2 diabetes, gout, and obesity (BMI = 37). His CrCl is 100 mg/dL

Which of the following medication options would be the best fit for this patient?

A. Aspirin 325 mg once daily B. Warfarin 5 mg once daily C. Dabigatran 150 mg twice daily D. Edoxaban 60 mg once daily E. Unsure

8. This patient is scheduled to be discharged from your hospital tomorrow. What transitions of care factors should be considered related to his new medication?

A. A list of atrial fibrillation symptoms should be provided to the patient so he knows when to stop taking the medication if symptoms cease B. A printed pamphlet should be provided to the patient with a list of anticoagulant reversal agents in case of bleeding C. Details of his anticoagulation therapy should be provided to both the patient and his outpatient provider so any barriers to care can be managed effectively D. Nothing specific needs to be provided to the patient at discharge since these details should be handled entirely by their outpatient provider E. Unsure

9. Questions 9 and 10 are related to the following case: You are meeting with a 79-year-old female patient with permanent NVAF for a comprehensive medication review. Her current medications include: apixaban 5 mg twice daily, lisinopril 20 mg once daily, atorvastatin 20 mg once daily, and metoprolol ER 100 mg once daily. Besides NVAF, her past medical history includes hypertension, aortic stenosis (mild), chronic kidney disease stage 3, and dyslipidemia. Her recent labs include a serum creatinine of 1.2 mg/dL (CrCl = 40 mL/min).

Which of the following is TRUE regarding this patient’s ongoing apixaban use for NVAF?

A. Her apixaban dose should be adjusted at her next birthday if she weighs less than 60 kg B. Her apixaban dose should be adjusted right away due to her CrCl < 50 mL/min C. Her apixaban should be switched to warfarin today given her mild aortic valve stenosis D. Her apixaban should be switched to rivaroxaban for better stroke prevention and bleeding outcomes E. Unsure

10. Upon reviewing the medications the patient brought with her to the appointment, you discover a new medication that was prescribed today for a fungal infection may have a drug interaction with her apixaban. Which of the following medications requires apixaban dose adjustment or avoidance?

A. Ketoconazole B. Fluconazole C. Terbinafine D. Nystatin E. Unsure

Evaluation Questions

11. How confident are you in your treatment choices for the patients presented above?

A. Not at all confident B. Somewhat confident C. Confident D. Highly confident

Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

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1. Complicating the underdiagnosis of atrial fibrillation is the proportion of asymptomatic cases, which is estimated to be

2. Which of the following is TRUE regarding nonvalvular atrial fibrillation (NVAF)?

3. Which of the following is an advantage of DOACs compared to vitamin K antagonists?

4. Current clinical evidence suggests which of the following regarding screening for asymptomatic NVAF?

5. When considering the use of DOACs in patients with decreased renal function, which dose adjustment is correct?

6. Which of the following is a modifiable bleeding risk factor considered as part of the HAS-BLED score?

8. This patient is scheduled to be discharged from your hospital tomorrow. What transitions of care factors should be considered related to his new medication?

10. Upon reviewing the medications the patient brought with her to the appointment, you discover a new medication that was prescribed today for a fungal infection may have a drug interaction with her apixaban. Which of the following medications requires apixaban dose adjustment or avoidance?

Evaluation Questions

11. How confident are you in your treatment choices for the patients presented above?

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Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

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1. Complicating the underdiagnosis of atrial fibrillation is the proportion of asymptomatic cases, which is estimated to be

2. Which of the following is TRUE regarding nonvalvular atrial fibrillation (NVAF)?

3. Which of the following is an advantage of DOACs compared to vitamin K antagonists?

4. Current clinical evidence suggests which of the following regarding screening for asymptomatic NVAF?

5. When considering the use of DOACs in patients with decreased renal function, which dose adjustment is correct?

6. Which of the following is a modifiable bleeding risk factor considered as part of the HAS-BLED score?

8. This patient is scheduled to be discharged from your hospital tomorrow. What transitions of care factors should be considered related to his new medication?

10. Upon reviewing the medications the patient brought with her to the appointment, you discover a new medication that was prescribed today for a fungal infection may have a drug interaction with her apixaban. Which of the following medications requires apixaban dose adjustment or avoidance?

Evaluation Questions

11. How confident are you in your treatment choices for the patients presented above?

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