NAPLEX QBANK Therapeutic Treatment Planning 3 — Questions and Answers
Question 1: A patient with major depressive disorder and significant insomnia and poor appetite would benefit most from which antidepressant?
- Fluoxetine
- Bupropion
- Mirtazapine (Correct answer)
- Sertraline
Correct answer: Mirtazapine
Mirtazapine promotes sleep and increases appetite, making it well suited for depressed patients with insomnia and weight loss.
Question 2: A patient with COPD has 3 exacerbations in the past year despite a LABA/LAMA combination. What is the best step in the treatment plan?
- Add an inhaled corticosteroid (Correct answer)
- Switch to a short-acting beta-agonist only
- Discontinue the LAMA
- Start chronic oral prednisone
Correct answer: Add an inhaled corticosteroid
Frequent exacerbations on dual bronchodilator therapy support escalation to triple therapy by adding an inhaled corticosteroid.
Question 3: Which empiric antibiotic regimen is most appropriate for an otherwise healthy adult outpatient with community-acquired pneumonia and no comorbidities or recent antibiotics?
- Amoxicillin or doxycycline (Correct answer)
- Vancomycin plus cefepime
- Ciprofloxacin alone
- IV ceftriaxone plus azithromycin
Correct answer: Amoxicillin or doxycycline
Healthy outpatients with CAP and no comorbidities can be treated with amoxicillin or doxycycline monotherapy.
Question 4: A patient with gout has 3 attacks per year and a serum urate of 9 mg/dL. After acute treatment, what is the appropriate long-term plan?
- Start allopurinol with a urate target below 6 mg/dL (Correct answer)
- Use colchicine only during attacks indefinitely
- Avoid all urate-lowering therapy
- Start probenecid in a patient with nephrolithiasis
Correct answer: Start allopurinol with a urate target below 6 mg/dL
Recurrent gout with elevated urate warrants urate-lowering therapy such as allopurinol titrated to a target below 6 mg/dL.
Question 5: A patient with stable angina remains symptomatic on maximally tolerated metoprolol. Which addition is most appropriate?
- A dihydropyridine calcium channel blocker (Correct answer)
- Digoxin
- An oral nitrate as needed only
- Flecainide
Correct answer: A dihydropyridine calcium channel blocker
Adding a dihydropyridine calcium channel blocker to a beta-blocker provides additional antianginal control in stable angina.
Question 6: A patient with hypothyroidism on levothyroxine has a persistently elevated TSH despite good adherence. Which medication taken concurrently most likely impairs absorption?
- Acetaminophen
- Calcium carbonate (Correct answer)
- Loratadine
- Amlodipine
Correct answer: Calcium carbonate
Calcium carbonate binds levothyroxine and reduces its absorption, so the two should be separated by several hours.
Question 7: Which treatment plan adjustment is most appropriate for a patient with type 2 diabetes and established atherosclerotic cardiovascular disease already on metformin?
- Add a sulfonylurea
- Add a GLP-1 receptor agonist with proven cardiovascular benefit (Correct answer)
- Add pioglitazone
- Add acarbose
Correct answer: Add a GLP-1 receptor agonist with proven cardiovascular benefit
In type 2 diabetes with ASCVD, a GLP-1 receptor agonist with proven cardiovascular benefit is recommended regardless of A1c.
NAPLEX QBANK Therapeutic Treatment Planning 3
A patient with major depressive disorder and significant insomnia and poor appetite would benefit most from which antidepressant?