NABP NAPLEX North American Pharmacist Licensure Examination Exam Practice Test

This patient shows symptoms of acute sinusitis. The most common etiology of which is viruses. Indications that an infection is viral as opposed to bacterial included a shorter infection tie (less than 10 days) and no purulent discharge (hers is watery). She does not show any evidence of a complication developing and even notes that her symptoms are improving. If her symptoms were attributed to a bacterium, then the most common cause of acute sinusitis is Streptococcus pneumoniae followed by Haemophilus influenza, then Moraxella catarrhalis. Anaerobic species such as Bacteroides fragilis and Staphylococcus aureus are more commonly found in patients with chronic sinusitis (sinusitis lasting longer than 12 weeks). This is important to realize before indiscriminately providing antibiotics for these patients.

DPP4 Inhibitors, (D)Glucagon-like peptide-1 receptor agonists, (E)Thiazolidinediones (F)Biguanide Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha- Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.

Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

Tachyphylaxis is the phenomenon where a patient experiences a rapid form of drug tolerance. Nitrates exhibit this property. It means that the patient becomes tolerance very quickly and so repeat doses become more and more ineffective. To overcome the problem of tachyphyaxis, then, sufficient time must elapse between doses.

A type III hypersensitivity reaction is mediated by immune complex deposition. In lupus, auto-antibodies are formed and these complexes are deposited in other tissues, especially in the kidneys, skin, and joints. Graves disease and myasthenia gravis are examples of type II but in some classification systems they are called type V reactions. The auto-antibodies created in Graves attack TSH receptors in the thyroid, whereas in

Myasthenia the target is the acetylcholine receptor. Hashimoto’s thyroiditis is usually considered an example of a combination of type II and IV reactions, as T cells are directed at thyroid antigens and antibodies are also produced. Allergic rhinitis is a classic example of a type I, IgE mediated reaction.

Rate of infusion: 100mL/40U × 0.03U/min × 60min/1 hr = 4.5mL/hr

Serum chloride levels should ideally fall between 96-106 mEq/L. For this reason, the patient’s chloride level has come back as normal.

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.

Cefazolin or an antistaphylococcal penicillin (oxacillin or nafcillin) is recommended for this patient because the C&S results indicate MSSA. Since the patient develops a rash to penicillins, it would be acceptable to use cefazolin in this case.

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Explanation

The direct Coombs test is used to test for autoimmune hemolyticanemia – a condition in which the body attacks red blood cells, leading to anemia. Some drugs can cause a positive direct Coombs test – methyldopa being one of the most well-known (via IgG-mediated type II hypersensitivity reaction). Other drugs that can cause this effect include quinidine (IgM-mediated activation) and penicillins (at very high doses).

Non-dihydropyridine calcium channel blockers – which are diltiazem and verapamil – are statistically more likely to cause constipation. Of these two, verapamil has a higher probability of causing this side effect.

Famotidine and Metoclopramide would need to be adjusted for poor renal function. Since his CrCl is less than 50, famotidine would need to be adjusted by decreasing the dose by 50% or increasing the interval to every 36 to 48 hours. Metoclopramide would also need to be adjusted by 50% of the normal dose since his CrCl is less than 40. ACEInhibitors and ARBs should be held if serum K is greater than 5.6 or there is a rise in serum creatinine greater than 30% after initiation.

Zileuton is the active ingredient found in the medicine Zyflo; a medicine that works as a 5-lipoxygenase inhibitor. As such, zileuton inhibits leukotrienes (LTB4, LTC4, LTD4, and LTE4) formation, and is used for the maintenance treatment of asthma in patients older than the age of 12. In 2 percent of patients, it raises liver enzymes. Sinusitis and nausea are the most common side effects.

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

Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha- Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia.Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletaland cardiac muscle, liver,and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport

proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

0.9%= 0.9g/100mL, 120mL/h × 24hrs = 2880mL. 0.9g/100ml = x/2880ml, x = 25.92g of NaCl.

Thiazolidinediones Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion;

(iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

Agents that can cause elevated triglycerides: oral estrogens, glucocorticoids, bile acid sequestrants, protease inhibitors, retinoic acid, anabolic steroids, sirolimus, raloxifene, tamoxifen, beta blockers (not carvedilol), and thiazides.

0.9% = 9 grams per every 1,000mL Molecular weight of NaCl = 58.5 9 / 58.5 = 0.154 moles 0.154 moles is the same as 154 millimoles There are 154 millimoles of sodium ions and 154 millimoles of chloride ions in 0.9% sodium chloride.

N-acetylcysteine can be used to prevent contrast-induced nephropathy. Whilst evidence is not overwhelming for use in favor, it does appear to have a clinical impact. N-acetylcysteine is typically given the day before treatment and the day when treatment commences. Other means to prevent contrast-induced nephropathy include adequate hydration, while some studied recommend ascorbic acid.

Metformin is associated with vitamin B12 deficiency because it affects the calcium dependent membrane uptake of it. All other drug classes are not associated with this.

A fasting blood glucose level of greater than 7 mmol/L (or greater than 126mg/dL) is an indicator of type 2 diabetes.

80kg person = 15mg/kg/day = 1200mg/day 80mg /5ml = 1200mg/X X= 75mL/day / 4 doses = 18.75 mL per dose

Dexamethasone is used to promote fetal lung maturation. This may be necessary in cases of women who need to deliver prematurely. A tocolytic drug, such as nifedipine, may be used to suppress labor whilst dexamethasone works to accelerate fetal lung development.