NAPLEX Online Practice Questions and Answers

Correct Answer: B

B: A variety of drugs have been found to be of some value in the prevention and treatment of vomiting, especially cancer chemotherapy-induced vomiting. With the exception of thioridazine, most of the neuroleptic drugs have antiemetic effects that are mediated by blocking D2 dopaminergic receptors of the chemoreceptor trigger zone of the medulla. Phenothiazines, such as prochlorperazine, were the first drugs shown to be effective antiemetic agents and act by blocking dopamine receptors. They are effective against low to moderately emetogenic chemotherapeutic agents (for example, fluorouracil and doxorubicin). Although increasing the dose improves antiemetic activity, side effects, including hypotension and restlessness, are dose limiting. Other adverse reactions include extrapyramidal symptom and sedation. A: Serotonin 5-HT3 antagonist is incorrect. The specific antagonists of the 5-HT3 receptor, ondansetron and granisetron, selectively block 5-HT3 receptors in the periphery and in the brain (chemoreceptor trigger zone). C: Cannabinoids related is incorrect. Cannabinoids are marijuana derivatives including dronabinol and nabilone and are effective against moderately emetogenic chemotherapy. However, they are seldom first-line antiemetics because of serious side effects. D: Blockage of prostaglandins is incorrect. Dexamethasone and methylprednisolone used alone are effective against mildly to moderately emetogenic chemotherapy. Their antiemetic mechanism is not known, but it may involve blockade of prostaglandins. E: H2 receptor antagonist is incorrect. Antagonists of histamine H2 receptor block the action of histamine at all H2 receptors; their chief clinical use is as inhibitors of gastric acid secretion.

Correct Answer: B

The following NSAIDs belong to the propionic acid derivatives group - Ibuprofen - Ketoprofen - Naproxen -Fenoprofen - Flurbiprofen - Oxaprozin whereas piroxicam belongs to the class of Enolic acid derivative which also includes other agents like meloxicam and Nabumetone. They are non-selective COX inhibitors and act by preventing the production of certain prostaglandins.

Correct Answer: B

Add salmeterol to the current regimen. This patient had mild persistent asthma but was using his albuterol daily, which indicates that a step up in therapy is warranted. The preferred first line treatment regimen for moderate persistent asthma are low to medium dose inhaled corticosteroids plus a long acting beta2 agonist, as well as a short acting beta2 agonist as needed. A is incorrect. Ciclesonide is an inhaled corticosteroid. The patient in the case is already using fluticasone, so adding ciclesonide would be therapeutic duplication. C is incorrect. Long-acting beta2 agonists should only be used as adjunctive therapy in patients who are currently receiving but not adequately controlled on an inhaled corticosteroid. These medications should not be used as monotherapy, due to an increased risk of asthma related deaths. D is incorrect. Cromolyn prevents the release of vasoactive mediators from mast cell and is primarily used for exercise-induced asthma, it is not indicated as an alternative agent in patients with moderate persistent asthma. E is incorrect. Ipratropium is a short-acting anticholinergic, which is often used in COPD or in asthma exacerbations. It is not indicated for maintenance treatment of moderate persistent asthma.

Correct Answer: B

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.

Correct Answer: A

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.

Correct Answer: D

RR = rate of an outcome occurring in an exposed group (treatment group/intervention group) divided by the rate of an outcome occurring in an unexposed group (control group) Ex: Relative Risk = Rate of UTI in patients taking drug XYZ / rate of UTI in patients not on drug XYZ

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/

Correct Answer: A

Incidence rate = New reported cases / summed person-years of observation (avg population during time interval). Prevalence = Cases in a population in a given time period / total population at that time Mortality rate = deaths during specified time interval / population size at risk for death.

Reference: https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html

Correct Answer: C

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.

Reference: http://circ.ahajournals.org/content/129/25_suppl_2/S1

Correct Answer: B

If 40mg of amoxicillin are needed per kg of body weight, then the dose of amoxicillin is 40mg multiplied by the patient's body weight. This patient weighs 18 lbs, based on the conversion of 2.2 lbs = 1 kg, the patient weighs 8.2 kg. 40 mg multiplied by 8.2 kg is equal to 328 mg, this is one dose of amoxicillin. If the amoxicillin comes in 250 mg/5 mL, then it needs to be determined how many mLs it will take to get 328 mg of amoxicillin. In order to do this 328 mg needs to be divided by 250 mg to get a ratio. This comes out to be

1.312. This ratio can be multiplied by the number of mLs it takes to make up 250 mg, which is 5 mLs.

1.312 multiplied by 5 mLs is 6.56 mL, this is how many mLs it will take to have 328 mg. This volume is for 1 single dose of amoxicillin. The patient is receiving 2 doses per day and for a total of 10 days, this means the patient will be receiving 20 doses. 20 doses multiplied by 6.56 mL doses equals the total volume the patient will be receiving, which is 131.2 mL.

Correct Answer: C

Common GI side effects of Valproic Acid and Divalproex Sodium are Weight gain, Nausea, Vomiting, Diarrhea, abdominal pain, dyspepsia. Divalproex sodium or valproic acid affects reproductive endocrine function in women. Menstrual irregularities defined as amenorrhea, oligomenorrhea, and prolonged cycles were common. Gynecomastia is not a side effect of Divalproex Sodium. For list of drugs that causes gynecomastia refer the reference. Gingival hyperplasia is a well- known side effect of phenytoin.

Reference: http://www.pharmaco-vigilance.eu/content/drug-induced-gynecomastia

Correct Answer: A

This patient is displaying signs of a severe case of cellulitis. Severe cellulitis is defined as having one of the following: failed oral antibiotic treatment, immunocompromised, clinical signs of deeper infection, or meeting the SIRS criteria. Based on this patient's presentation they have failed antibiotic treatment and meet SIRS criteria. For severe cellulitis, IDSA SSTI guidelines recommend using Vancomycin along with Zosyn.

Reference: https://academic.oup.com/cid/article/59/2/e10/2895845/Practice-Guidelines-for-the-Diagnosis-and

Correct Answer: D

IV dextrose provides 3.4 kcal/g.

Correct Answer: A

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.

Correct Answer: A

In the management of acute ischemic stroke, alteplase should be administered within 3 hours of symptom onset.

Correct Answer: C

Cimetidine has multiple drug interactions due to its inhibitory effects on CYP1A2, 2C9, 2D6, and 3A4. Inhibition of these enzymes can cause an increase in the serum concentrations of drugs metabolized by these enzymes, leading to toxicity.