NAPLEX QBANK Therapeutic Treatment Planning 2 — Questions and Answers
Question 1: A 58-year-old with type 2 diabetes, eGFR 28 mL/min, and HbA1c 8.9% is on metformin. What is the most appropriate change to the treatment plan?
- Discontinue metformin and start a SGLT2 inhibitor
- Discontinue metformin and add a GLP-1 receptor agonist or insulin (Correct answer)
- Increase metformin to maximum dose
- Continue metformin and add a sulfonylurea
Correct answer: Discontinue metformin and add a GLP-1 receptor agonist or insulin
Metformin is contraindicated when eGFR is below 30 mL/min due to lactic acidosis risk, so it should be stopped and replaced with an agent safe in renal impairment.
Question 2: A patient with newly diagnosed stage 2 hypertension and no compelling indications has a blood pressure of 162/98 mmHg. What is the preferred initial pharmacologic approach?
- Single low-dose thiazide only
- Two first-line agents from different classes (Correct answer)
- A loop diuretic plus a beta-blocker
- An alpha-blocker monotherapy
Correct answer: Two first-line agents from different classes
Stage 2 hypertension generally warrants initiating two first-line antihypertensives of different classes to reach goal blood pressure.
Question 3: Which monitoring parameter is most important to establish at baseline before starting amiodarone for chronic atrial fibrillation?
- Serum potassium only
- Thyroid, liver, and pulmonary function tests (Correct answer)
- Fasting lipid panel
- Bone density scan
Correct answer: Thyroid, liver, and pulmonary function tests
Amiodarone can cause thyroid, hepatic, and pulmonary toxicity, so baseline TFTs, LFTs, and pulmonary function are required.
Question 4: A patient with heart failure with reduced ejection fraction (HFrEF) is on lisinopril and metoprolol succinate. Which addition best aligns with guideline-directed medical therapy?
- Diltiazem
- A mineralocorticoid receptor antagonist such as spironolactone (Correct answer)
- Verapamil
- Flecainide
Correct answer: A mineralocorticoid receptor antagonist such as spironolactone
Adding an MRA improves survival in HFrEF and is a core pillar of guideline-directed therapy.
Question 5: A patient on warfarin presents with an INR of 6.5 and no bleeding. What is the most appropriate management?
- Administer IV vitamin K and 4-factor PCC
- Hold warfarin and consider low-dose oral vitamin K (Correct answer)
- Increase the warfarin dose
- Transfuse fresh frozen plasma immediately
Correct answer: Hold warfarin and consider low-dose oral vitamin K
For an elevated INR without bleeding, holding warfarin with possible low-dose oral vitamin K is appropriate; aggressive reversal is reserved for serious bleeding.
Question 6: Which agent is the preferred first-line pharmacotherapy for a pregnant patient with newly diagnosed chronic hypertension?
- Lisinopril
- Labetalol (Correct answer)
- Losartan
- Hydrochlorothiazide
Correct answer: Labetalol
Labetalol is a preferred antihypertensive in pregnancy, while ACE inhibitors and ARBs are contraindicated due to fetal toxicity.
Question 7: A patient with osteoporosis and a history of esophageal stricture needs treatment. Which option best fits the treatment plan?
- Oral alendronate weekly
- Oral risedronate daily
- IV zoledronic acid annually (Correct answer)
- Oral ibandronate monthly
Correct answer: IV zoledronic acid annually
Oral bisphosphonates are contraindicated with esophageal abnormalities, so IV zoledronic acid is preferred.
NAPLEX QBANK Therapeutic Treatment Planning 2
A 58-year-old with type 2 diabetes, eGFR 28 mL/min, and HbA1c 8.9% is on metformin.
What is the most appropriate change to the treatment plan?