NAPLEX Exam Dumps - North American Pharmacist Licensure Examination

40mEq × 1equiv/1000mEq × 74.5g/1equiv = 2.98 gm of KCl in 100ml. Calculate: mOsm/L. 2.98g/100ml × 1mol/74.5g × 2Osm/1mol × 1000mOsm/ Osm × 1000ml/1L = 800mOsm/L

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.

If 40mg of amoxicillin are needed per kg of body weight, then the dose of amoxicillin is 40mg multiplied by the

patient’s body weight. This patient weighs 18 lbs, based on the conversion of 2.2 lbs = 1 kg, the patient weighs

8.2 kg. 40 mg multiplied by 8.2 kg is equal to 328 mg, this is one dose of amoxicillin. If the amoxicillin comes in 250 mg/5 mL, then it needs to be determined how many mLs it will take to get 328 mg of amoxicillin. In order to do this 328 mg needs to be divided by 250 mg to get a ratio. This comes out to be 1.312. This ratio can be multiplied by the number of mLs it takes to make up 250 mg, which is 5 mLs. 1.312 multiplied by 5 mLs is 6.56 mL, this is how many mLs it will take to have 328 mg. This volume is for 1 single dose of amoxicillin. The patient is receiving 2 doses per day and for a total of 10 days, this means the patient will be receiving 20

doses. 20 doses multiplied by 6.56 mL doses equals the total volume the patient will be receiving, which is

131.2 mL.

Clopidogrel and ticlopidine are ADP receptor pathway inhibitors. The irreversible inhibition of the ADP- dependent pathway of platelet activation is thought to be the result of covalent modification and inactivation of the platelet P2Y ADP receptor. This receptor is coupled to the inhibition of adenylyl cyclase. Both drugs are prodrugs and undergo conversion to active metabolites in the liver. However, clopidogrel must undergo oxidation by hepatic P450 enzymes to its active form. This is significant because many drugs are metabolized the hepatic P450 enzymes, including statins, and clopidogrel may interact with these medications. Clopidogrel is a second-generation thienopyridine and ticlopidine is a first-generation thienopyridine. Both drugs are indicated in combination with aspirin to prevent stent thrombosis. Eptifibatide is a GPIIb-IIIa receptor antagonist that is used to treat unstable angina and non-ST segment elevation myocardial infarction. Eptifibatide is also used to reduce ischemic events in patients who are undergoing percutaneous coronary intervention. The drug is a synthetic peptide that directly antagonizes the GPIIb-IIIa receptor on the platelet. Aspirin is an antiplatelet drug that works by inhibition of synthesis of prostaglandins. Prostaglandin G2 is the result of a synthesis pathway that is activated by platelets and endothelial cells, and results in localized

vasoconstriction and induction of platelet aggregation, as well as causing release of platelet granules. Warfarin is an anticoagulant that acts on vitamin K-dependent reactions in the coagulation pathway. Vitamin K is necessary for hepatic synthesis of coagulation factors II, VII, IX and X, protein C and protein S. Vitamin K- dependent carboxylation is necessary for induction of enzymatic activity of these coagulation factors. Take- home message: Clopidogrel, a second-generation thienopyridine ADP receptor pathway inhibitor, is indicated in combination with aspirin to prevent stent thrombosis in patients who undergo percutaneous coronary intervention after myocardial infarction. Clopidogrel is a prodrug that must undergo oxidation by hepatic P450 enzymes, and therefore may affect the activity of statins and other drugs dependent on the hepatic P450 enzymes.

IV dextrose provides 3.4 kcal/g.

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

22 × 2 + 7 = 51 units of total insulin per day. Decrease by 10% 51 units × 0.9 = 45.9 units per day round up to 46 units. 46 units × 0.50 = 23 units, administer 23 units of insulin glargine once daily. 46 units × 0.50 = 23 units total Insulin Lispro. Round down, divided by three times a day, 7 units 3 times a day with meals.

Dexamethasone can increase LN’s blood glucose. All glucocorticosteroids are known to increase blood glucose. Blood glucose would need to be monitored while LN is being treated with dexamethasone.

This patient is displaying signs of a severe case of cellulitis. Severe cellulitis is defined as having one of the following: failed oral antibiotic treatment, immunocompromised, clinical signs of deeper infection, or meeting the SIRS criteria. Based on this patient’s presentation they have failed antibiotic treatment and meet SIRS criteria. For severe cellulitis, IDSA SSTI guidelines recommend using Vancomycin along with Zosyn.

[1 mg/ 1 min] × 60min= 60mg/hr. 60 mg/hr × [1 mL/ 1.8 mg] = 33.33 mL/hr 0.5 mg/min × [60 min/ 1 hr] = 30 mg/hr 30 mg/hr × [1 mL/1.8 mg] = 16.67 mL/hr Infusion rates: 33.33 mL/hr for 6 hours, then 16.67 mL/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.

Add salmeterol to the current regimen. This patient had mild persistent asthma but was using his albuterol daily, which indicates that a step up in therapy is warranted. The preferred first line treatment regimen for moderate persistent asthma are low to medium dose inhaled corticosteroids plus a long acting beta2 agonist, as well as a short acting beta2 agonist as needed. A is incorrect. Ciclesonide is an inhaled corticosteroid. The patient in the case is already using fluticasone, so adding ciclesonide would be therapeutic duplication. C is incorrect. Long-acting beta2 agonists should only be used as adjunctive therapy in patients who are currently receiving but not adequately controlled on an inhaled corticosteroid. These medications should not be used as monotherapy, due to an increased risk of asthma related deaths. D is incorrect. Cromolyn prevents the release of vasoactive mediators from mast cell and is primarily used for exercise-induced asthma, it is not indicated as an alternative agent in patients with moderate persistent asthma. E is incorrect. Ipratropium is a short-acting anticholinergic, which is often used in COPD or in asthma exacerbations. It is not indicated for maintenance treatment of moderate persistent asthma.

Cefepime, levofloxacin, cefazolin does not provide good coverage of anaerobes. Ampicillin-sulbactam and piperacillin-tazobactam provide anaerobic coverage.

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

Corrected phenytoin (mg/L) = Observed phenytoin (mg/L) / (0.2 x albumin [g/dL]) + 0.1 = 17.8 / (0.2 x 2.1) +

0.1 = 17.8 / 0.42 + 0.1 = 42.48mg/L ← phenytoin level is high. Normal therapeutic range is: 10-20mg/dL

Lidocaine: 30g × 0.05 = 1.5g. Hydrocortisone: 90g × 0.005 = 0.45g. 90g + 30g = 120g. 1.5g/120g = 0.0125 × 100 = 1.25% Lidocaine. 0.45g/120g = 0.00375 × 100 = 0.375% Hydrocortisone.

Absolute risk reduction: 0.027 = 2.7% (Event rate in enoxaparin group) – (Event rate in rivaroxaban group) = (57/1473) – (17/1513) = 0.02746

The dihydropyridine drug – nifedipine – is the active ingredient found in the medicine Adalat. Nifedipine is used to treat angina, Reynaud’s phenomenon and hypertension. It is also used as a tocolytic agent in premature labor.

Lifelong Vitamin B12 supplementation. Vitamin B12 (cyanocobalamin) deficiency generally presents in patients as fatigue, diarrhea and headaches but can also be the cause of cognitive changes (difficulty concentrating, even mild dementia). Pernicious anemia is a macrocytic anemia, therefore laboratory findings indicate an increased mean corpuscular volume (MCV), with a decreased hemoglobin. A positive Schilling test indicates that the B12 deficiency is due to a lack of intrinsic factor. Lifelong cyanocobalamin supplementation (either orally or via injections) is needed to treat pernicious anemia. A is incorrect. Folic acid deficiency anemia is another common type of macrocytic anemia. However, cognitive deficits are not typically seen with folic acid deficiency. Furthermore, a schilling test would be negative and the methylmalonic acid (MMA) would be normal, rather than elevated. C is incorrect. Iron deficiency anemia causes a microcytic anemia, characterized by a decreased MCV. D is incorrect. A Coomb’s test is used to detect autoimmune hemolysis that may be suspected in patients with normocytic anemia (anemia with an MCV in the normal range). E is incorrect. Corticosteroids and iron supplementation are indicated as treatment in hemolytic anemia.

A, B – false – dapsone inhibits bacterial synthesis of dihydrofolic acid, via competition with para- aminobenzoate for the active site of dihydropteroate synthetase. Dapsone is both bacteriostatic and weakly bactericidal against M. leprae. Neither of the listed mechanisms are the cause of these effects. C – False – A substance with both anti-leprosy and anti-inflammatory activity, clofazimine is weakly bactericidal against M. leprae by binding to the guanine bases of bacterial DNA, not DNA polymerase directly. D – False – See below. E – True – Rifampin is bactericidal by inhibiting RNA synthesis by blocking DNA-dependent RNA polymerase.