NABP NABP-NAPLEX Online Practice Questions and Exam Preparation

NABP NABP-NAPLEX Online Questions & Answers

• Question 11:

  A fasting blood glucose level greater than what value is an indicator of type 2 diabetes?

  A. 5 mmol/L
  B. 6 mmol/L
  C. 7 mmol/L
  D. 8 mmol/L
  E. 9 mmol/L
  C. 7 mmol/L

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  A fasting blood glucose level of greater than 7 mmol/L (or greater than 126mg/dL) is an indicator of type 2 diabetes.

• Question 12:

  A 20-year-old student came to the emergency department with primary complaints of palpitations, low-grade fever, and anxiety for 2 months. She reports that she is irritable and suffers severe mood swings that is interfering with her sleep and relationships (she admits to crying spells and frequent fights with friends and family). She has also lost 12 pounds in the past 2 months with no apparent alteration in her diet or physical activity (though she is happy with her weight loss). She denies any past medical problems, though her friends have always been worried that she eats too little.

  Her temperature is 38.0 C (100.4 F), blood pressure is 148/62 mm Hg, pulse is 122/min and regular, and respiratory rate is 28/min. Examination reveals a bruit heard over the anterior neck, fine tremor of the hands, and warm, moist skin. Her eyes and eyelids do not move together during finger following test (with steady head). Laboratory work is sent, including a thyroid panel, but will not be available until tomorrow morning.

  Which of the following is the most appropriate initial management at this time?

  A. Diltiazem therapy
  B. Iodine therapy
  C. Methimazole therapy
  D. Propranolol therapy
  E. Referral to a surgeon
  D. Propranolol therapy

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  This patient had hyperthyroidism, though the exact cause of her condition is not currently clear. The immediate treatment should focus on controlling the patient's symptoms for which a non-specific beta-blocker is seemingly an ideal choice. Propranolol therapy can be initiated without any adverse effects while the patient undergoes further workup of her condition. As the treatment for hyperthyroidism varies depending upon the cause of the condition, more definitive therapy should be avoided. Diltiazem (choice A) helps control heart rate but does not have the same antiadrenegenic properties as beta-blockers/ The initial treatment for symptomatic hyperthyroidism is propranolol. Iodine (choice B) can be used in high doses to inhibit thyroid production of T3 and T4. Until it's clear that this patient does not have an exogenous source of thyroid hormone (and until it is clear she is not pregnant), this agent should not be considered. Propylthiouracil (PTU) and Methimazole (choice C) inhibit the organification of iodine to tyrosine residues. If this patient has Graves diseases, this would be an appropriate treatment. Until a diagnosis is made, however, initial therapy should consist of a beta- blocker. Surgical treatment (choice E) of hyperthyroidism is often a reasonable treatment for patients who cannot tolerate medical therapy of radioactive iodine ablation.

• Question 13:

  Which of the following class of antidiabetic medication may cause fluid retention?

  A. Bile acid sequestrant
  B. GLP-1 agonist
  C. Thiazolidinediones
  D. SGLT2 Inhibitor
  E. Alpha-glucosidase inhibitor
  C. Thiazolidinediones

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  Thiazolidinediones may cause fluid retention through proposed mechanism of increasing reabsorption in the collecting duct of the kidney and increasing vascular permeability in adipose tissue. Bile acid sequestrants work in the intestine to bind bile acids which doesn't affect fluid retention. GLP-1 receptor agonists work to activate these receptors to secrete insulin from beta pancreatic cells/decrease glucagon secretion/ increase satiety and doesn't affect fluid retention. SGLT2 inhibitors actually cause increase of fluid elimination through the kidneys. Alpha-glucosidase inhibitors work in the gut to decrease carb absorption/digestion and have no affect on fluid retention.

• Question 14:

  Which of these drugs is used to prevent contrast-induced nephropathy?

  A. Metformin
  B. Activated charcoal
  C. N-acetylcysteine
  D. Spironolactone
  E. Mannitol
  C. N-acetylcysteine

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  N-acetylcysteine can be used to prevent contrast-induced nephropathy. Whilst evidence is not overwhelming for use in favor, it does appear to have a clinical impact. N-acetylcysteine is typically given the day before treatment and the day when treatment commences. Other means to prevent contrast-induced nephropathy include adequate hydration, while some studied recommend ascorbic acid.

• Question 15:

  Your patient is a 58-year-old male who presents with onset of severe substernal chest pain and shortness of breath. An ECG reveals an acute STEMI, and he is on his way to the cardiac catheterization suite for percutaneous coronary intervention. Which of the following drugs used in acute coronary syndromes treated with PCI must undergo oxidation by hepatic P450 enzymes to an active form?

  A. Clopidogrel
  B. Ticlopidine
  C. Eptifibatide
  D. Aspirin
  E. Warfarin
  A. Clopidogrel

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  Clopidogrel and ticlopidine are ADP receptor pathway inhibitors. The irreversible inhibition of the ADP-dependent pathway of platelet activation is thought to be the result of covalent modification and inactivation of the platelet P2Y ADP receptor. This receptor is coupled to the inhibition of adenylyl cyclase. Both drugs are prodrugs and undergo conversion to active metabolites in the liver. However, clopidogrel must undergo oxidation by hepatic P450 enzymes to its active form. This is significant because many drugs are metabolized the hepatic P450 enzymes, including statins, and clopidogrel may interact with these medications. Clopidogrel is a second-generation thienopyridine and ticlopidine is a first- generation thienopyridine. Both drugs are indicated in combination with aspirin to prevent stent thrombosis. Eptifibatide is a GPIIb-IIIa receptor antagonist that is used to treat unstable angina and non-ST segment elevation myocardial infarction. Eptifibatide is also used to reduce ischemic events in patients who are undergoing percutaneous coronary intervention. The drug is a synthetic peptide that directly antagonizes the GPIIb-IIIa receptor on the platelet. Aspirin is an antiplatelet drug that works by inhibition of synthesis of prostaglandins. Prostaglandin G2 is the result of a synthesis pathway that is activated by platelets and endothelial cells, and results in localized vasoconstriction and induction of platelet aggregation, as well as causing release of platelet granules. Warfarin is an anticoagulant that acts on vitamin K-dependent reactions in the coagulation pathway. Vitamin K is necessary for hepatic synthesis of coagulation factors II, VII, IX and X, protein C and protein S. Vitamin K-dependent carboxylation is necessary for induction of enzymatic activity of these coagulation factors. Take-home message: Clopidogrel, a second-generation thienopyridine ADP receptor pathway inhibitor, is indicated in combination with aspirin to prevent stent thrombosis in patients who undergo percutaneous coronary intervention after myocardial infarction. Clopidogrel is a prodrug that must undergo oxidation by hepatic P450 enzymes, and therefore may affect the activity of statins and other drugs dependent on the hepatic P450 enzymes.

• Question 16:

  An order is received for 0.03 units /min of vasopressin for Sepsis to maintain MAP >65. The standard mixed in your hospital for vasopressin is 40 units in 100ml NS. What is the rate in mLs/hr should the vasopressin be infused at?

  A. 4.0 ml/hr
  B. 4.9ml/hr
  C. 4.5ml/hr
  D. 3.5ml/hr
  E. 6ml/hr
  C. 4.5ml/hr

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• Question 17:

  Alteplase is ordered for a 72 YOM who weighs 68kg for Ischemic stroke. The ER physician would like you to dose. As an ER pharmacist you know the dose is 0.9 mg/kg IV (not to exceed 90 mg); give 10% of the total dose as an IV bolus over 1 minute, then give the remaining 90% as an IV infusion over 60 minutes. After reconstitution, the concentration of Altaplace is 1mg/ml. How many ml is needed for the bolus and how many ml is needed for the infusion? Round to the nearest ml.

  A. 6ml IV bolus, followed by 55mL IV over 60 minutes
  B. 4ml IV bolus, followed by 57mL IV over 60 minutes
  C. 3ml IV bolus, followed by 58mL IV over 60 minutes
  D. 8ml IV bolus, followed by 52mL IV over 60 minutes
  E. 9ml IV bolus, followed by 82mL IV over 60 minutes
  A. 6ml IV bolus, followed by 55mL IV over 60 minutes

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• Question 18:

  Which of the following class of antidiabetic medications can increase triglycerides?

  A. Bile acid sequestrant
  B. GLP-1 agonist
  C. Thiazolidinediones
  D. SGLT2 Inhibitor
  E. Alpha-glucosidase inhibitors
  A. Bile acid sequestrant

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  The only bile acid sequestrant, colesevelam (Welchol), has been shown to increase triglycerides through mechanism of: activation of phosphatidic acid phosphatase with promotes triglyceride synthesis. GLP-1 agonists work on GLP 1 receptors to increase insulin secretion, decrease glucagon secretion, and increase satiety. Thiazolidinediones activate nuclear transcription factor PPAR gamma to increase insulin sensitivity. SGLT2 inhibitors inhibit glucose reabsorption in the kidney. Alpha-glucosidase inhibitors slow down digestion and absorptions of carbs in the gut.

• Question 19:

  Before use, which of the following products should be used to clean surfaces of a laminar flow hood?

  A. 95% ethyl alcohol
  B. 70% isopropyl alcohol
  C. Purified water
  D. Purified WFI
  B. 70% isopropyl alcohol

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  Before each use, 70% isopropyl alcohol should be used to clean surfaces of a laminar flow hood.

• Question 20:

  LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA. His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain.

  Post-op day 1, LN's medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20 K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

  Which of the following medication may increase LN's Blood glucose?

  A. Lisinopril
  B. Dexamethasone
  C. Famotidine
  D. Metoclopramide
  E. Hydromorphone
  B. Dexamethasone

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  Dexamethasone can increase LN's blood glucose. All glucocorticosteroids are known to increase blood glucose. Blood glucose would need to be monitored while LN is being treated with dexamethasone.