NAPLEX North American Pharmacist Licensure Examination Questions and Answers

Because SGLT2 inhibitors work by preventing reabsorption of glucose in the kidneys, this increases frequency of urination. All of the options are monitoring requirements since the hydration status, blood pressure, blood glucose, and renal function may all be changed from increased urination (from the mechanism of the drug).

Odds ratio of 0.44 (44%) means that this group was associated with an event happening 44% of the time, compared to 1 (an event happening 100% of the time if unexposed), therefore 100 - 44 = 56%, which is the reduction caused by the exposure. Exposure is the use of ascorbic acid.

Lecithin is used as a surfactant, not as a preservative. All other listed substances may be used as a preservative in compounding.

80kg person = 15mg/kg/day = 1200mg/day 80mg /5ml = 1200mg/X X= 75mL/day / 4 doses = 18.75 mL per dose

This patient shows symptoms of acute sinusitis. The most common etiology of which is viruses. Indications that an infection is viral as opposed to bacterial included a shorter infection tie (less than 10 days) and no purulent discharge (hers is watery). She does not show any evidence of a complication developing and even notes that her symptoms are improving. If her symptoms were attributed to a bacterium, then the most common cause of acute sinusitis is Streptococcus pneumoniae followed by Haemophilus influenza, then Moraxella catarrhalis. Anaerobic species such as Bacteroides fragilis and Staphylococcus aureus are more commonly found in patients with chronic sinusitis (sinusitis lasting longer than 12 weeks). This is important to realize before indiscriminately providing antibiotics for these patients.

The patient is experiencing a common complication of low abdominal surgery. Post-operative urinary retention occurs in almost 25% of patients after low abdominal surgical procedures. A normal post-void residual volume is less than 50 cc or urine. The effects of anesthesia and analgesia both contribute to bladder distension, decreased micturition reflex, reduction of contractility of the detrusor muscle of the bladder, and incomplete voiding. The detrusor muscle of the bladder is stimulated to contract by muscarinic cholinergic agonists. Bethanechol is a muscarinic agonist and is frequently used in this setting to improve bladder emptying. Finasteride is a drug that is a 5 alpha reductase inhibitor indicated for use in patients with bladder outlet obstruction as a result of prostatic hypertrophy. The inhibition of 5 alpha reductase decreases local conversion of testosterone to dihydrotestosterone in the prostate gland, which results in gradual shrinkage over a period of six to twelve months. Phenylephrine is an alpha-adrenergic agonist that is selective for alpha-1 receptors. Activation of the alpha 1 receptors in the bladder results in contraction of the trigone muscle and sphincter.

This promotes urinary retention. Oxybutynin is an antimuscarinic agent that is useful for treatment of urge incontinence, and would have a detrimental effect on this patient’s bladder disorder. Imipramine is a medication with anticholinergic properties that would also cause worsening of the patient’s condition. Take home message: Post-operative urinary retention with concomitant incomplete voiding is a complication that results from a decreased micturition reflex, increased vesical sphincter tone, or decreased contractility of the detrusor muscle of the bladder. It can be successfully treated with a muscarinic agonist, such as bethanechol, or with an alpha-1 adrenergic antagonist.

This patient belongs in one of the four statin benefit groups because his estimated 10-year ASCVD risk is over 7.5%. Adults 40 to 75 years of age with LDL–C 70 to 189 mg/dL, with an estimated 10-year ASCVD risk ≥7.5% and without clinical ASCVD or diabetes should receive either a moderate-intensity or high-intensity statin. Since the extent of reducing the risk of ASCVD is proportionally related to the degree of LDL-C reduction, risk could be reduced more so with a high intensity statin. Considering the given options, Atorvastatin 80 mg PO QHS is the best choice.

Relative risk can be stated as 0.77 times as likely or 0.77 times the risk, but it could also be illustrated as a relative risk reduction and stated as a 23% risk reduction or 23% lower risk by taking the medication.

A CD4 count of 180 cells per cubic meter is considered very low – typically an indicator that the patient has an immunocompromised state, such as AIDS. CD4 counts are a measure of healthy T-cell levels. The lower the count, the more susceptible the patient is to opportunistic infections. A normal range is between 500 and 1,500 cells.

(A) Sulfonylureas, (C) DPP4 Inhibitors, (D) Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia.Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in

skeletaland cardiac muscle, liver,and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

25g/100ml = 300g/Xml Xml = 1200mL

Relative risk reduction: 0.71 = 71% Relative risk: (Event rate in rivaroxaban group)/(Event rate in enoxaparin group) = (17/1513)/(57/1473) = 0.2903 Relative risk reduction: 1 – (relative risk) = 1 – 0.2903 = 0.7097 = 0.71.

It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL . C. is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.

Since the bioavailability of levothyroxine is roughly 50% (given in the QUESTION NO:). To convert the home dose to intravenous, it would be 50% of the oral dose. So 50% of oral 75 mcg would be 37.5 mcg intravenously.

Risk factors for myopathy are hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases.

Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.

Primidone is an anticonvulsant drug that is structurally related to phenobarbital. Primidone is metabolized to

phenobarbital and therefore shares its anticonvulsant and sedative properties. Primidone may be more effective than therapy with phenobarbital alone because primidone and both of its metabolites, phenobarbital and phenylethylmalonamide (PEMA), possess anticonvulsant activity.

Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

Mesna is administered to patients taking either ifosfamide or cyclophoshamide to conjugate toxic acrolein and therefore prevent hemorrhagic cystitis (bladder bleeding).

0.9% = 9 grams per every 1,000mL Molecular weight of NaCl = 58.5 9 / 58.5 = 0.154 moles 0.154 moles is the same as 154 millimoles There are 154 millimoles of sodium ions and 154 millimoles of chloride ions in 0.9% sodium chloride.