Notes Page / Learning Assessment Questions

“Direct Oral Anticoagulants (DOACs) in Cancer-Associated Thrombosis” - Nick Young, Pharm.D.

Pharmacist learning objectives / Learning assessment questions:

1. Review current guideline recommendations for anticoagulation in Cancer-Associated Thrombosis.

Learning assessment question: Current treatment guidelines prefer or recommend what class of anticoagulant for treatment of Cancer-Associated Thrombosis?

A.Vitamin K Antagonists

B.Factor Xa Inhibitors

C.Low Molecular Weight Heparin

D.Direct Thrombin Inhibitors

2. Evaluate the literature for the use of Direct Oral Anticoagulants (DOACs) in Cancer-Associated Thrombosis.

Learning assessment question: Which of the following regarding edoxaban (Savaysa®) for the treatment of Cancer-Associated Venous Thromboembolism is TRUE?

A.Edoxabanwas shown to be noninferior to subcutaneous dalteparin for the composite outcome of recurrent VTE or major bleeding.

B.The rate of major bleeding was lower with edoxaban compared to dalteparin.

C.The rate of recurrent VTE was higher with edoxaban compared to dalteparin.

D.None of the above.

______

Technician learning objectives / Learning assessment questions:

1. Identify the generic and brand names of Direct Oral Anticoagulants (DOACs)

Learning assessment question: Which of the following generic is correctly matched with its Brand® name?

A.rivaroxaban (Eliquis®)

B.apixaban (Xarelto®)

C.edoxaban (Savaysa®)

D.dabigatran (Lovenox®)

2. Identify different formulations of medications available for treatment of VTE.

Learning assessment question: All of the following are available as oral medication EXCEPT:

A.enoxaparin

B.warfarin

C.apixaban

D.edoxaban

A Review on New Agents for the Treatment of Hepatitis C” – Margit Hansing, Pharm.D.

Pharmacist learning objectives / Learning assessment questions:

1. Identify new medication approved for the treatment of chronic hepatitis C.

Learning assessment question: Which medication was recently approved for the treatment of chronic hepatitis C in patients without cirrhosis or with compensated cirrhosis of ANY genotype AND have previously been treated with a regimen containing an NS5A inhibitor?

  1. VOSEVITMB. MAVYRETTM C. EPCLUSATMD. HARVONITM

2. Evaluate the efficacy of VOSEVOITM and MAVYRETTM in the treatment of chronic hepatitis C; Learning assessment question: The ENDURANCE-1 study showed sustained virologic response after how many weeks of treatment with MAVYRETTM?

  1. 8 weeks B. 12 weeks C. 20 weeks D. Both A & B

3. Recognize the most common side effects associated with VOSEVOITM and AVYRETTM.

Learning assessment question: The most common side effect(s) associates with both VOSEVOITM and AVYRETTM are:

  1. Headache and fatigue
  2. Constipation
  3. Hyperkalemia
  4. Loss of appetite

______

Technician learning objectives / Learning assessment questions:

1. Identify populations as high-risk for acquiring hepatitis C infection;

Learning assessment question: Which of the following populations has the highest risk of hepatitis C in the United States?

  1. Those who use injectable drugs
  2. Hemodialysis patients
  3. Persons with HIV
  4. Persons who have received blood transfusions

2. Distinguish brand/generic names for new agents used to treat chronic hepatitis C.

Learning assessment question: What is the brand name of glecaprevir/pibrentasvir?

  1. VOSEVITMB. MAVYRETTM C. EPCLUSATM D. HARVONITM

3. Describe storage, handling, and administration recommendations for medications used to treat hepatitis C.

Learning assessment question: Which medication should be dispensed in the original container?

  1. VOSEVITM
  2. MAVYRETTM
  3. Both A & B
  4. Neither A nor B

“Controversies in Oral Anticoagulation in Chronic Kidney Disease-Stage 5 Patients with Nonvalvular Atrial Fibrillation” - Elizabeth Pegelow, Pharm.D.

Pharmacist learning objectives / Learning assessment questions:

1. Summarize increased risk factors for patients with nonvalvular atrial fibrillation and CKD-5.

Learning assessment question: Which of the following is true in CKD-5 patients with atrial fibrillation?

  1. CKD-5 patients are at a 4-fold increased risk of stroke
  2. CKD-5 white women have the highest risk of stroke
  3. Overall risk of stroke is highest during initiation of dialysis
  4. All of the above

2. Evaluate pharmacokinetic differences in oral anticoagulants utilized for stroke prevention in CKD-5 with nonvalvular atrial fibrillation.

Learning assessment question: Apixaban 5mg PO twice daily has led to supratherapeutic levels in dialysis patients.

  1. True
  2. False

3. Evaluate the current recommendations for oral anticoagulation in CKD-5 patients with nonvalvular atrial fibrillation.

Learning assessment question: Which of the following DOACs is FDA approved in CKD-5?

  1. Edoxaban
  2. Rivaroxaban
  3. Apixaban
  4. Dabigatran

______

Pharmacy Technician learning objectives / Learning assessment questions:

1. Identify oral anticoagulants commonly used in stroke prevention for atrial fibrillation patients.

Learning assessment question: Which of the following is an oral anticoagulant?

  1. Heparin
  2. Argatroban
  3. Enoxaparin
  4. Rivaroxaban

2. Differentiate between the classes of chronic kidney disease.

Learning assessment question: Controversies in oral anticoagulation are most prevalent in which stage of chronic kidney disease?

  1. CKD stage 2 (GFR 60-89)
  2. CKD stage 3 (GFR 30-59)
  3. CKD stage 4 (GFR 15-29)
  4. CKD stage 5 (GFR <15)

3. Distinguish between brand and generic names for oral anticoagulant medications.

Learning assessment question: Which of the following is the brand name of apixaban?

  1. Eliquis®
  2. Pradaxa®
  3. Xarelto®
  4. Brilinta®

“Shingles Prevention: Shingrix® vs Zostavax®” - Dacey R. Eggers

Pharmacist learning objectives / Learning assessment questions:

1. Explain the pathophysiology of Herpes Zoster and its relation to chickenpox and shingles.

Learning assessment question: True or False: A patient who has been vaccinated for chickenpox should get a shingles vaccine when they are ≥50.

  1. True
  2. False
  3. In some situations

2. Evaluate treatments for shingles prevention and areas where Shingrix® (Zoster Vaccine - Recombinant, Adjuvanted) may have better efficacy than Zostavax® (Zoster Vaccine Live).

Learning assessment question:Shingrix® was found to be effective in preventing _____% of shingles cases in patients ages 60-69, compared to Zostavax® which prevented _____ %.

  1. 97%: 64%
  2. 100%: 50%
  3. 64%: 97%
  4. 50%: 100%

3. Describe situations where Shingrix® may not be appropriate.

Learning assessment question: If a patient is immunocompromised, which vaccination should

they be given for shingles.

  1. Shingrix®
  2. Zostavax®
  3. Varivax®
  4. Undetermined

______

Pharmacy Technician learning objectives / Learning assessment questions:

1. Describe key symptoms of Shingles.

Learning assessment question: Post herpetic neuropathy is a long term complication of shingles.

  1. True
  2. False

2. Explain when Shingrix®can be administered to patients.

Learning assessment question: If a patient receives an inactivated flu vaccination today, when is

the soonest that Shingrix® can be administered?

  1. Today
  2. In 7 days
  3. In 1 month
  4. In 6 months

3. Explain how Shingrix® should be stored.

Learning assessment question: Shingrix® is stored in the freezer prior to administration.

  1. True
  2. False

“Bridging the Gaps in Periprocedural Anticoagulation Management for Atrial Fibrillation Patients” – Brittanie Venard, Pharm.D.

Pharmacist learning objectives / Learning assessment questions:

1. Identify pertinent factors that should be considered when developing a periprocedural anticoagulation plan

Learning assessment question: Which of the following factors should be considered when developing

aperiprocedural anticoagulation plan?

A.Bleeding risk of the procedure

B.Bleeding and thrombotic risk of the patient

C.Clinical effect of bleeding should it occur

D.Renal function for patients taking a DOAC

E.All the above

2. Given a patient case, design an appropriate periprocedural anticoagulation plan for a patient with nonvalvular atrial fibrillation on chronic anticoagulation

Learning assessment question: A patient with a CHA2DS2-VASc score of 4 and no prior history of ischemic stroke, TIA, or systemic embolism is undergoing an intermediate bleeding risk procedure.

The patient is currently on warfarin 4 mg daily with a consistent outpatient INR of 2.5. Which of the following is an appropriate anticoagulation plan prior to the procedure?

A.Continue warfarin per usual without holding any doses

B.Hold warfarin 5 days prior to the procedure and bridge with subcut LMWH

C.Hold warfarin 5 days prior to the procedure, no bridging required

D.Consult a proceduralist

______

Technician learning objectives / Learning assessment questions:

1. Define the role of chronic anticoagulation in atrial fibrillation patients

Learning assessment question: Atrial fibrillation is the most common indication for chronic oral anticoagulation.

  1. True
  2. False

2. Identify brand and generic names of direct oral anticoagulants

Learning assessment question: Which of the following direct oral anticoagulants is a correctly

paired generic (Brand) name combination?

A.rivaroxaban (Eliquis®)

B.apixaban (Eliquis®)

C.edoxaban (Xarelto®)

D.dabigatran (Savaysa®)

“2018 Diabetes Update” - Amanda Janisch, Pharm.D.

Pharmacist learning objectives / Learning assessment questions:

1. List diabetes medications that have shown a reduction in cardiovascular events.

Learning Assessment question: Which diabetic agent would be preferred after metformin in a

patient with a history of ASCVD?

  1. Exenatide IR
  2. Liraglutide
  3. Dulaglutide
  4. Albiglutide

2. Describe patient specific factors that guide therapy selection.

Learning Assessment question: What factors should be considered when selecting drug therapy

for

the treatment of diabetes?

  1. Patient weight
  2. Cost of drug therapy
  3. History of ASCVD
  4. All of the above

3. Identify guideline recommended lipid lowering agents and goals of therapy.

Learning Assessment question: Select the most appropriate lipid lowering agent in a statin intolerant, diabetic patient with atherosclerotic cardiovascular disease and an LDL of 130 mg/dL?

  1. Ezetimibe
  2. Alirocumab
  3. Evolocumab
  4. B. & C.

Technician learning objectives / Learning assessment questions:

1. Categorize diabetes medications based on cost.

Learning Assessment question: Which diabetes medications are associated with a lower drug cost (ie <$350/month AWP)?

  1. Metformin
  2. Glipizide
  3. Empagliflozin
  4. A. & B.
  5. All of the above

2. Describe diabetes specific vaccination requirements for adults.

Learning Assessment question: What vaccines should a 62-year-old diabetic patient receive or

have on record?

  1. Annual influenza vaccination
  2. PPSV23
  3. Hepatitis B series
  4. A. & B.
  5. All of the above