Mixed Deck — All NAPLEX QBANK Topics Flashcards

A patient with hypothyroidism on levothyroxine has a persistently elevated TSH despite good adherence. Which medication taken concurrently most likely impairs absorption?

Answer: Calcium carbonate

Calcium carbonate binds levothyroxine and reduces its absorption, so the two should be separated by several hours.

A patient starting montelukast should be counseled about which potential adverse effect?

Answer: Neuropsychiatric effects such as mood changes

Montelukast carries a warning for neuropsychiatric events including mood and behavior changes.

An asthmatic patient using a rescue albuterol inhaler more than twice weekly indicates the need for which therapy adjustment?

Answer: Add an inhaled corticosteroid

Frequent rescue inhaler use signals inadequate control, requiring a controller such as an inhaled corticosteroid.

While reviewing a patient's profile, a pharmacist notices that a 45-year-old male with hypertension has been refilling his lisinopril prescription every 40-45 days, despite it being a 30-day supply. What is the most appropriate initial action for the pharmacist to take?

Answer: Ask the patient in a non-judgmental, open-ended way, "I noticed it's been a little while since your last refill, how have you been taking your medication?"

The best initial approach to suspected non-adherence is to use open-ended, non-judgmental communication to gather information. Asking an exploratory question like this opens a dialogue, allowing the patient to share potential barriers (e.g., side effects, cost, forgetfulness) without feeling accused. Calling the prescriber or making a threatening statement is premature and can damage the pharmacist-patient relationship. Refusing the refill is inappropriate and punitive.

A patient on an MAOI must avoid which food to prevent hypertensive crisis?

Answer: Aged cheese

Tyramine-rich foods like aged cheese can trigger a hypertensive crisis with MAOIs.

What does a hazardous drug (HD) compounding facility require for the primary engineering control under USP ?

Answer: A negative-pressure containment device such as a BSC or CACI

Hazardous drugs require negative-pressure containment primary engineering controls like a Class II BSC or CACI.

A patient is brought to the emergency department with respiratory depression following a suspected heroin overdose. The administration of naloxone rapidly improves the patient's breathing. What is the mechanism of action of naloxone?

Answer: It is a competitive antagonist at opioid receptors

Naloxone is a competitive opioid receptor antagonist. It has a high affinity for opioid receptors, particularly the mu-receptor, and displaces opioids that are already bound, thereby reversing their effects, including respiratory depression.

Which of the following statements most accurately describes the pharmacological mechanism of selective serotonin reuptake inhibitors (SSRIs) like sertraline?

Answer: They selectively block the presynaptic serotonin transporter (SERT), increasing serotonin concentration in the synaptic cleft.

SSRIs, as their name implies, work by specifically and selectively inhibiting the serotonin transporter (SERT) on the presynaptic neuron. This action reduces the reuptake of serotonin from the synapse, which leads to an increased concentration and prolonged availability of serotonin to bind with postsynaptic receptors.

Which agent should be avoided in a patient with a sulfa allergy who needs a diuretic, when caution is warranted?

Answer: Hydrochlorothiazide

Thiazides contain a sulfonamide moiety and warrant caution in patients with sulfa hypersensitivity.

A hospital's Pharmacy and Therapeutics (P&T) committee is updating its list of approved 'Tall Man Lettering' conventions to reduce medication errors. Which of the following pairs correctly uses this technique according to ISMP/FDA recommendations?

Answer: predniSONE and prednisoLONE

Tall Man Lettering is a safety strategy that uses a mix of uppercase and lowercase letters to draw attention to the dissimilarities in look-alike drug names. The FDA and ISMP have established official lists of recommended name pairs. Among the choices, 'predniSONE' and 'prednisoLONE' is a well-established pair on these lists designed to prevent mix-ups. The other options either do not represent common look-alike pairs or do not use the standard lettering convention.

You are asked to compound 240 mL of a 1:500 (w/v) solution. The drug is available as a pure powder. How many milligrams of the drug powder are needed?

Answer: 480 mg

A 1:500 w/v solution means there is 1 gram of solute in every 500 mL of solution. To find out how much drug is needed for 240 mL, a proportion can be set up: (1 g / 500 mL) = (x g / 240 mL). Solving for x gives: x = (1 * 240) / 500 = 0.48 g. To convert grams to milligrams, multiply by 1000: 0.48 g * 1000 mg/g = 480 mg.

Which of the following types of data are ordinal?

Answer: Grade of breast cancer

Ordinal data is a type of categorical data where the categories have a natural, meaningful order or ranking, but the differences between categories are not necessarily equal. The grade of breast cancer (e.g., Grade 1, 2, 3) exemplifies ordinal data because it represents increasing severity or aggressiveness in a ranked sequence. Other options like sex or improvement (yes/no) are nominal, lacking an inherent order.

A hospital pharmacy is implementing new safety protocols for U-500 regular insulin, a high-alert medication. Which of the following strategies is the MOST critical to prevent a catastrophic dosing error?

Answer: Dispensing U-500 insulin only with U-500 specific syringes or dedicated pens.

U-500 insulin is five times more concentrated than standard U-100 insulin. The greatest risk of error comes from accidentally measuring a U-500 dose using a standard U-100 syringe, which can lead to a 5-fold overdose. Therefore, the most critical safety measure is to eliminate this possibility by dispensing U-500 insulin ONLY with syringes calibrated specifically for it or in its own dedicated pen device. While storage, education, and labels are important, they are less effective at preventing this specific, high-risk error than using the correct administration device.

What is the weight of 1000 mL of 1.27 specific gravity serum protein?

Answer: 1270 gm

Specific gravity (SG) is a dimensionless quantity that represents the ratio of a substance's density to the density of water (approximately 1 g/mL). If the specific gravity of serum protein is 1.27, its density is 1.27 g/mL. To find the weight of 1000 mL, you multiply the density by the volume: 1.27 g/mL * 1000 mL = 1270 grams.

Which monitoring is essential when a patient begins long-term oral corticosteroid therapy?

Answer: Blood glucose and bone density

Chronic corticosteroids cause hyperglycemia and osteoporosis, so glucose and bone health are monitored.

A patient is to receive 1 liter of D5W over 10 hours. The IV administration set delivers 15 gtt/mL. What is the flow rate in drops per minute (gtt/min)?

Answer: 25 gtt/min

First, calculate the flow rate in mL/hr: 1000 mL / 10 hours = 100 mL/hr. Next, convert mL/hr to mL/min: 100 mL/hr / 60 min/hr = 1.67 mL/min. Finally, calculate the flow rate in gtt/min using the drop factor: 1.67 mL/min * 15 gtt/mL = 25 gtt/min.

GLP-1 receptor agonists (e.g., semaglutide) lower glucose by:

Answer: Enhancing glucose-dependent insulin secretion and slowing gastric emptying

GLP-1 agonists augment glucose-dependent insulin release, suppress glucagon, and slow gastric emptying.

Which diuretic acts on the Na-K-2Cl cotransporter in the thick ascending limb?

Answer: Furosemide

Loop diuretics like furosemide inhibit the Na-K-2Cl cotransporter.

Which neurotransmitter system do SSRIs primarily modulate?

Answer: Serotonin reuptake at the presynaptic transporter

SSRIs block the serotonin transporter (SERT), increasing synaptic serotonin.

According to USP , the primary engineering control (PEC), such as a laminar airflow workbench or biological safety cabinet, must maintain which minimum ISO Class air quality in the direct compounding area?

Answer: ISO Class 5

USP requires that the direct compounding area within a primary engineering control (PEC) must maintain ISO Class 5 air quality to protect critical sites from contamination. ISO Class 7 is the standard for the buffer area, and ISO Class 8 is the standard for the ante-area.