This CE activity is jointly provided by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-15-082-H01-P has been assigned to this knowledge-based home-study CE activity (initial release date 06-01-2015). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Completion of the evaluation and the post-test with a score of 70% or higher are required to receive CE credit. No partial credit will be given.

Faculty: Dennis J. Cada, PharmD, FASHP, FASCP (Editor), Founder and Contributing Editor, The Formulary; Jesse Wageman, PharmD, PGY1 Resident, Kootenai Health & Medical Center; Danial E. Baker, PharmD, FASHP, FASCP, Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University and Terri L. Levien, PharmD, Clinical Professor, College of Pharmacy, Washington State University. The authors indicate no relationships that could be perceived as a conflict of interest. This activity is self-funded by Hospital Pharmacy.

Release Date: July 1, 2015

Expiration Date: July 1, 2017

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to:

www.ProCE.com/HPJFDR

Click to access the activity page to enroll and complete the Post-Test and Evaluation

For questions related to registering for and obtaining CE credit, contact ProCE at 630-540-2848 or Info@ProCE.com.

1. Edoxaban is US Food and Drug Administration (FDA)–approved to reduce the risk of stroke and systemic embolic events:
   1. A.In patients with valvular atrial fibrillation (AF).
   2. B.In patients with nonvalvular AF.
   3. C.After total knee or total hip arthroplasty surgery.
   4. D.In patients with mechanical valve replacement.
      
      
2. Edoxaban is also FDA-approved for:
   1. A.Prevention of venous thromboembolism in patients with cancer.
   2. B.Prevention of venous thromboembolism after total knee arthroplasty surgery.
   3. C.Prevention of thromboembolism after ­cardioversion.
   4. D.Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
      
      
3. Edoxaban is best described as a:
   1. A.Direct thrombin inhibitor.
   2. B.Factor Xa inhibitor.
   3. C.Vitamin K antagonist.
   4. D.P2Y12 inhibitor.
      
      
4. For prevention of stroke in patients with AF, edoxaban is approved in which range of creatinine clearance (CrCl)?
   1. A.CrCl >95 mL/min.
   2. B.CrCl
   3. C.CrCl
   4. D.CrCl 35 to 105 mL/min.
      
      
5. Which of the following statements is true with regard to the use of edoxaban in patients with symptomatic DVT?
   1. A.Reduced efficacy has been observed in patients with CrCl greater than 95 mL/min.
   2. B.Concomitant use of strong P-gp inhibitors is contraindicated.
   3. C.Patients must be closely monitored for worsening heart failure.
   4. D.Edoxaban should be initiated after 5 to 10 days of parenteral anticoagulant therapy.
      
      
6. Which of the following is a contraindication to use of edoxaban?
   1. A.Active pathological bleeding
   2. B.Hypersensitivity to dalteparin
   3. C.Hypersensitivity to rivaroxaban
   4. D.Concomitant administration of nonsteroidal anti-inflammatory drugs
      
      
7. Edoxaban is in Pregnancy Category:
   1. A.A.
   2. B.B.
   3. C.C.
   4. D.X.
      
      
8. When used in the treatment of DVT or PE, edoxaban has a potentially significant drug-drug interaction with:
   1. A.Vitamin K.
   2. B.Verapamil.
   3. C.Digoxin.
   4. D.Atorvastatin.
       

Case History

T.C. is a 66-year-old female patient with no known drug allergies. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Her current medications include metoprolol, hydrochlorothiazide, metformin, glipizide, and aspirin. She was using aspirin for anticoagulation because she lives in a remote area and did not want to use warfarin, but she had an embolic stroke while on aspirin. She is soon to be discharged from the hospital, and her doctor is asking you about the use of edoxaban. 

9. What routine monitoring would you recommend for T.C. if edoxaban is initiated?
   1. A.Routine international normalized ratio every 2 weeks
   2. B.Signs and symptoms of bleeding
   3. C.Routine hemoglobin/hematocrit every 6 months
   4. D.Liver function tests every 6 months
      
      
10. What is the recommended dose of edoxaban for T.C. assuming her CrCl is 63 mL/min?
    1. A.15 mg daily
    2. B.45 mg daily
    3. C.60 mg daily
    4. D.90 mg daily
       
       
11. How should T.C. be counseled to take edoxaban? 
    1. A.Once daily on an empty stomach
    2. B.In divided doses with meals
    3. C.Once daily with the evening meal
    4. D.Once daily with or without food
       
       
12. The most common side effects associated with edoxaban include:
    1. A.Nausea, bleeding, and diarrhea.
    2. B.Anemia and bleeding.
    3. C.Upper gastrointestinal bleed and hemorrhagic stroke.
    4. D.Abnormal liver test and anemia.
       
       
13. T.C. is going to undergo a colonoscopy and polypectomy next week, when should she discontinue her edoxaban?
    1. A.At least 24 hours prior to polypectomy
    2. B.Discontinuation is unnecessary
    3. C.At least a week prior to polypectomy
    4. D.She should be transitioned to enoxaparin for a least 3 days prior to polypectomy.
       
       
14. T.C. was on edoxaban for 3 years without significant issues. She recently reported several nosebleeds and severe fatigue. After treatment for anemia and further evaluation, it was determined that her CrCl had reduced to 46 mL/min. What is the new dose T.C. should receive?
    1. A.15 mg daily
    2. B.30 mg daily
    3. C.45 mg daily
    4. D.60 mg daily
       
       
15. T.C. requires an emergency percutaneous coronary intervention. How should edoxaban anticoagulation be reversed?
    1. A.Administration of vitamin K and fresh frozen plasma
    2. B.Dialysis to remove edoxaban
    3. C.Administration of vitamin K alone
    4. D.No clearly established method