NAPLEX QBANK Therapeutic Treatment Planning 2

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?

Accepted Answer

Discontinue metformin and add a GLP-1 receptor agonist or insulin

Answer

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?

Accepted Answer

Two first-line agents from different classes

Answer

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?

Accepted Answer

Thyroid, liver, and pulmonary function tests

Answer

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?

Accepted Answer

A mineralocorticoid receptor antagonist such as spironolactone

Answer

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?

Accepted Answer

Hold warfarin and consider low-dose oral vitamin K

Answer

For an elevated INR without bleeding, holding warfarin with possible low-dose oral vitamin K is appropriate; aggressive reversal is reserved for serious bleeding.

NAPLEX QBANK Practice Test

NAPLEX QBANK Practice Test

NAPLEX QBANK Therapeutic Treatment Planning 2