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The questions for NAPLEX were last updated on Dec 20, 2024.
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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 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2mg/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/s should LN be on to prevent the most common side effect of hydromorphone?
LN should be on docusate sodium/Senna for constipation and ondansetron for N/V. Dexamethasone has an off label use for N/V that is chemotherapy-associated. It is mostly used as an anti-inflammatory or immunosuppressant agent. Hydromorphone does not cause hyperglycemia. The most common side effects of opioids are nausea, vomiting and constipation.
Which of the following antidiabetic medication works by inhibiting carbohydrate breakdown?
Acarbose is an alpha glucosidase inhibitor that inhibits carbohydrate breakdown. Metformin is a biguanide that decreases hepatic glucose production. Dapagliflozin is a SGLT2 inhibitor to decrease glucose reabsorption in
the kidney. Pioglitazone is a TZD that increases insulin sensitivity. Sitagliptin is a DPP-4 inhibitor that works on incretins/increase insulin secretion/decrease glucagon secretion.
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemi
a. Select all that applies. Pancreases (A)
(A) Sulfonylureas, (C) DPP4 Inhibitors, (D) Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop -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.
An 18-year-old female is referred to a dermatologist for treatment of severe acne vulgaris. The dermatologist wants to start her on tetracycline.
What test should the patient have prior to starting treatment?
Pregnancy test. Tetracyclines are effective in the treatment of severe cases of acne. They are however teratogenic. As such, it is imperative to make sure female patients are not pregnant prior to starting this medication. In many instances patients are started on concurrent birth control to mitigate this risk even further.
A chest x-ray (B) is an important exam to obtain prior to starting drugs which have pulmonary toxicity as a side effect such as amiodarone. A complete blood count (C) would be useful prior to starting a medication that causes anemia, such as immunosuppressive and chemotherapeutic agents. Liver function tests (D) are important to establish as a baseline prior to starting anti-mycobacterial agents. Creatine kinase levels (E) are used to establish as a baseline prior to starting statins.
A patient presents in the pharmacy in a delirious state with pinpoint pupils. Which of the following toxicity states does the patient most likely have?
Signs of opioid overdose include pinpoint pupils, delirious state, nausea / vomiting, respiratory depression and sleepiness or loss of consciousness. Naloxone may be used to reverse the effects of opioid overdose.
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