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The questions for NAPLEX were last updated on Feb 22, 2025.
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MT is 47-year-old man who presents to the ER with painful, red, swollen area on his left leg. His temperature is 38.4, respiratory rate 30 and heart rate 95. He has been taking cephalexin day 4 today, as prescribed by his primary care physician. His CMP is normal a CBC shows elevated WBC of 16,000/mm3.
What would be the most appropriate antibiotic/s to initiate on MT empirically?
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.
https://academic.oup.com/cid/article/59/2/e10/2895845/Practice-Guidelines-for-the-Diagnosis-and
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock- out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.
Which of the following medication may increase LN's potassium?
Lisinopril may increase LN's potassium. One of the warnings/precautions of lisinopril is hyperkalemia. ACE inhibitors block the formation of circulating angiotensin II, which can lead to a decrease in aldosterone secretion that can result in an increase in potassium. Risk factors for hyperkalemia while taking lisinopril include renal impairment, diabetes, and concomitant use of potassium-sparing diuretics, potassium
supplements and/or potassium containing salts. Potassium should be monitored closely when taking any of the other agents listed. Hyperkalemia is not listed in the warnings/precautions section for the other medications.
What vitamin should the a patient receive to avoid Wernicke- Korsakoff syndrome?
Thiamine should be administered to prevent Wernicke's encephalopathy.
http://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes
Which of the following medication should be avoided in patients with heart failure?
Patients with heart failure should avoid taking NSAIDs (which includes naproxen), COX-2 inhibitors, nondihydropyridine calcium channel blockers (for reduced EF), thiazolidinediones (which includes pioglitazone), cilostazol, and dronedarone (for severe or recently decompensated heart failure).
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock-out
every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/ dl, K 5.0mmol/L, Na 135mmol/L.
Which of the following medication's dose are adjusted for poor renal function?
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.
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