Wattle Pharmacy Prep

Cardiovascular therapeutics
Practice questions with explanations

Cardiovascular therapeutics belongs to Therapeutics and patient care, which makes up about 45% of the Overseas Pharmacist Readiness Assessment (OPRA®). Answer each question yourself before opening the explanation.

1. Which factor should be assessed before starting an anticoagulant in an older patient with atrial fibrillation?

  1. Bleeding risk including falls, previous bleeding, renal function, alcohol use and concurrent antiplatelets, weighed against stroke risk
  2. Only the patient's preference
  3. Age alone, with anticoagulation avoided over 80
  4. Falls risk alone, which usually contraindicates anticoagulation
Show answer

A. Bleeding risk including falls, previous bleeding, renal function, alcohol use and concurrent antiplatelets, weighed against stroke risk

Both risks rise with age, but stroke risk rises faster, so most older patients benefit. Falls are frequently cited as a reason to withhold anticoagulation, yet the number of falls required to offset the stroke benefit is very large. The productive approach is to modify reversible bleeding risks rather than to withhold treatment.

2. Which explains why a patient on warfarin needs monitoring after starting a course of antibiotics?

  1. Antibiotics always lower the INR
  2. Only intravenous antibiotics interact
  3. Many antibiotics inhibit warfarin metabolism or reduce vitamin K producing gut flora, raising the INR unpredictably
  4. There is no interaction
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C. Many antibiotics inhibit warfarin metabolism or reduce vitamin K producing gut flora, raising the INR unpredictably

Metronidazole, trimethoprim-sulfamethoxazole, fluconazole and macrolides inhibit metabolism, while broad-spectrum agents reduce gut flora vitamin K production, and the illness itself alters intake and metabolism. An INR check within a few days of starting, and again after finishing, catches the change before bleeding occurs.

3. Which explains why a patient with atrial fibrillation may remain symptomatic despite a controlled resting heart rate?

  1. Resting rate is the only relevant measure
  2. Rate control during exertion may be inadequate, and loss of atrial contribution to filling causes symptoms independent of rate
  3. Rate control always relieves symptoms
  4. Symptoms are unrelated to the arrhythmia
Show answer

B. Rate control during exertion may be inadequate, and loss of atrial contribution to filling causes symptoms independent of rate

Assessing rate during activity, rather than only at rest, identifies inadequate control that a clinic reading misses. Where symptoms persist despite adequate rate control, rhythm control with cardioversion or ablation is considered, particularly in younger patients and in recently diagnosed atrial fibrillation.

These are 3 of the 88 questions on cardiovascular therapeutics in the app.

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More topics in Therapeutics and patient care

Australian pharmacy practice and law · CNS and psychiatry · Counselling, OTC and triage · Dermatology · Diabetes and endocrine therapeutics · Eye, ear, nose and throat · Gastrointestinal therapeutics · Infectious diseases · Musculoskeletal · Older people and polypharmacy · Oncology and supportive care · Paediatrics · Pain and palliative care · Pharmaceutical calculations · Renal and urology · Respiratory therapeutics · Vaccines and immunisation · Women's health