This is Part 1 of the Doctor of Pharmacy
(PharmD) Program Comprehensive Test
Bank based on the NAPLEX Content
Blueprint by the National Association of
Boards of Pharmacy (NABP).
TABLE OF CONTENTS - PART 1 of 5
Cardiovascular Pharmacotherapy - Questions 1-15
Infectious Disease Pharmacotherapy - Questions 16-30
Endocrine Pharmacotherapy - Questions 31-45
Gastrointestinal Pharmacotherapy - Questions 46-55
Pulmonary Pharmacotherapy - Questions 56-65
Safe Medication Preparation and Dispensing - Questions 66-75
Medication Therapy Management - Questions 76-85
Monitoring and Evaluation - Questions 86-100
CARDIOVASCULAR PHARMACOTHERAPY
Q1. A 62-year-old man with heart failure with reduced ejection fraction (HFrEF, EF 28%) is currently
on lisinopril, carvedilol, and furosemide. His blood pressure is 118/72 mm Hg, potassium 4.1 mEq/L,
and creatinine 1.1 mg/dL. Which of the following additions has the strongest evidence for reducing
mortality in HFrEF?
A. Hydralazine-isosorbide dinitrate
B. Spironolactone
C. Digoxin
D. Amlodipine
Correct Answer: Spironolactone
,Rationale: Mineralocorticoid receptor antagonists such as spironolactone have demonstrated
mortality benefit in HFrEF, particularly in patients with NYHA class II-IV symptoms. The patient's
potassium and renal function are adequate for initiation. Hydralazine-isosorbide dinitrate has
mortality benefit primarily in self-identified Black patients already on optimal therapy. Digoxin
reduces hospitalizations but does not reduce mortality. Amlodipine is a dihydropyridine calcium
channel blocker that is safe in HFrEF but has no mortality benefit.
Q2. A 58-year-old woman with atrial fibrillation and a CHA2DS2-VASc score of 3 is being started on
anticoagulation. She has a history of severe mitral stenosis. Which anticoagulant is the most
appropriate?
A. Apixaban
B. Rivaroxaban
C. Warfarin
D. Dabigatran
Correct Answer: Warfarin
Rationale: Warfarin remains the anticoagulant of choice for patients with atrial fibrillation and
moderate-to-severe mitral stenosis or a mechanical heart valve. Direct oral anticoagulants have not
been adequately studied in this population and are not recommended. Apixaban, rivaroxaban, and
dabigatran are direct oral anticoagulants that are appropriate for non-valvular atrial fibrillation but
are contraindicated or not recommended in valvular atrial fibrillation with mitral stenosis.
Q3. A 55-year-old man presents with acute decompensated heart failure. He is volume overloaded
with jugular venous distension and 3+ lower extremity edema. His blood pressure is 145/88 mm Hg.
Which of the following is the most appropriate initial diuretic strategy?
A. Oral furosemide 40 mg daily
B. Intravenous furosemide at 2.5 times his home oral dose
C. Oral metolazone 5 mg daily
D. Intravenous acetazolamide 500 mg
Correct Answer: Intravenous furosemide at 2.5 times his home oral dose
Rationale: In acute decompensated heart failure with volume overload, intravenous loop
diuretics are preferred over oral due to more reliable and rapid delivery. The recommended starting
IV dose is 2.5 times the patient's home oral dose for patients on chronic loop diuretics. Oral
furosemide would be inappropriate in this acute setting. Metolazone is a thiazide-like diuretic used
as add-on therapy, not first-line. Acetazolamide is not indicated for acute volume overload in heart
failure.
,Q4. A 68-year-old woman with hypertension is currently on lisinopril 20 mg daily. Her blood pressure
remains 158/94 mm Hg. She has a history of angioedema with an ARB. Which of the following is the
most appropriate add-on antihypertensive?
A. Amlodipine
B. Valsartan
C. Sacubitril-valsartan
D. Spironolactone
Correct Answer: Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that is safe and effective as
add-on therapy in patients with hypertension who have failed ACE inhibitor monotherapy. Valsartan
is an ARB and should be avoided due to the patient's history of angioedema with an ARB. Sacubitril-
valsartan also contains an ARB and carries a risk of angioedema, especially in patients with prior ACE
inhibitor-related angioedema. Spironolactone is a diuretic that is not first-line for uncomplicated
hypertension.
Q5. A 72-year-old man with HFrEF (EF 22%) and NYHA class III symptoms is being optimized on
guideline-directed medical therapy. He is currently on lisinopril, carvedilol, and spironolactone. His
blood pressure is 122/76 mm Hg, heart rate 78 bpm, potassium 4.2 mEq/L, and creatinine 1.3 mg/dL.
Which of the following should be added next?
A. Sacubitril-valsartan
B. Digoxin
C. Hydralazine-isosorbide dinitrate
D. Ivabradine
Correct Answer: Sacubitril-valsartan
Rationale: Sacubitril-valsartan has replaced ACE inhibitors or ARBs as the preferred first-line
therapy in HFrEF due to its superior mortality benefit in the PARADIGM-HF trial. In a patient already
on an ACE inhibitor, the ACE inhibitor should be discontinued and sacubitril-valsartan started after a
36-hour washout. Digoxin reduces hospitalizations but does not improve survival. Hydralazine-
isosorbide dinitrate is reserved for patients who cannot tolerate ACE inhibitors or ARBs. Ivabradine is
used for heart rate reduction in patients already on maximum tolerated beta-blocker therapy.
Q6. A 65-year-old man is started on warfarin for a new diagnosis of atrial fibrillation. Three days later,
his INR is 7.8. He is asymptomatic with no bleeding. Which of the following is the most appropriate
management?
A. Vitamin K 10 mg IV
B. Hold warfarin and give vitamin K 2.5 mg PO
, C. Hold warfarin only
D. Fresh frozen plasma
Correct Answer: Hold warfarin and give vitamin K 2.5 mg PO
Rationale: For an asymptomatic patient on warfarin with an INR between 4.5 and 10 and no
bleeding, the recommended management is to hold warfarin and consider low-dose oral vitamin K
(2.5 mg or less). High-dose IV vitamin K (10 mg) risks overcorrection and subsequent warfarin
resistance. Holding warfarin alone may be sufficient for INR 4.5-10 in some guidelines, but the
addition of low-dose oral vitamin K is reasonable for a rapidly rising or markedly elevated INR. Fresh
frozen plasma is reserved for active bleeding.
Q7. A 58-year-old woman with hypertension is being started on lisinopril. Baseline labs show a
potassium of 5.2 mEq/L and creatinine of 1.6 mg/dL with an estimated glomerular filtration rate of
38 mL/min/1.73 m2. Which of the following is the most appropriate action?
A. Start lisinopril at a reduced dose
B. Start lisinopril at the standard dose
C. Hold lisinopril and address the hyperkalemia and renal function first
D. Start lisinopril and monitor outpatient labs in 3 months
Correct Answer: Hold lisinopril and address the hyperkalemia and renal function first
Rationale: ACE inhibitors should be held when the potassium is greater than 5.0 mEq/L or when
there is significant renal impairment with concern for further decline, because ACE inhibitors can
worsen hyperkalemia and reduce renal function. Correcting the underlying cause of hyperkalemia
and reassessing renal function prior to initiation is appropriate. Starting at a reduced dose without
addressing the metabolic abnormalities risks further hyperkalemia and renal deterioration. Starting
at standard dose is contraindicated. Monitoring in 3 months is too far out in this high-risk patient.
Q8. A 45-year-old man with a history of myocardial infarction is being started on a statin. His LDL is
148 mg/dL. Which of the following statin regimens is most appropriate for secondary prevention?
A. Atorvastatin 10 mg daily
B. Atorvastatin 80 mg daily
C. Simvastatin 20 mg daily
D. Pravastatin 40 mg daily
Correct Answer: Atorvastatin 80 mg daily
Rationale: High-intensity statin therapy is recommended for secondary prevention in patients
with established atherosclerotic cardiovascular disease, including those with prior myocardial
infarction, to reduce LDL by at least 50 percent. Atorvastatin 80 mg daily is a high-intensity statin.
(PharmD) Program Comprehensive Test
Bank based on the NAPLEX Content
Blueprint by the National Association of
Boards of Pharmacy (NABP).
TABLE OF CONTENTS - PART 1 of 5
Cardiovascular Pharmacotherapy - Questions 1-15
Infectious Disease Pharmacotherapy - Questions 16-30
Endocrine Pharmacotherapy - Questions 31-45
Gastrointestinal Pharmacotherapy - Questions 46-55
Pulmonary Pharmacotherapy - Questions 56-65
Safe Medication Preparation and Dispensing - Questions 66-75
Medication Therapy Management - Questions 76-85
Monitoring and Evaluation - Questions 86-100
CARDIOVASCULAR PHARMACOTHERAPY
Q1. A 62-year-old man with heart failure with reduced ejection fraction (HFrEF, EF 28%) is currently
on lisinopril, carvedilol, and furosemide. His blood pressure is 118/72 mm Hg, potassium 4.1 mEq/L,
and creatinine 1.1 mg/dL. Which of the following additions has the strongest evidence for reducing
mortality in HFrEF?
A. Hydralazine-isosorbide dinitrate
B. Spironolactone
C. Digoxin
D. Amlodipine
Correct Answer: Spironolactone
,Rationale: Mineralocorticoid receptor antagonists such as spironolactone have demonstrated
mortality benefit in HFrEF, particularly in patients with NYHA class II-IV symptoms. The patient's
potassium and renal function are adequate for initiation. Hydralazine-isosorbide dinitrate has
mortality benefit primarily in self-identified Black patients already on optimal therapy. Digoxin
reduces hospitalizations but does not reduce mortality. Amlodipine is a dihydropyridine calcium
channel blocker that is safe in HFrEF but has no mortality benefit.
Q2. A 58-year-old woman with atrial fibrillation and a CHA2DS2-VASc score of 3 is being started on
anticoagulation. She has a history of severe mitral stenosis. Which anticoagulant is the most
appropriate?
A. Apixaban
B. Rivaroxaban
C. Warfarin
D. Dabigatran
Correct Answer: Warfarin
Rationale: Warfarin remains the anticoagulant of choice for patients with atrial fibrillation and
moderate-to-severe mitral stenosis or a mechanical heart valve. Direct oral anticoagulants have not
been adequately studied in this population and are not recommended. Apixaban, rivaroxaban, and
dabigatran are direct oral anticoagulants that are appropriate for non-valvular atrial fibrillation but
are contraindicated or not recommended in valvular atrial fibrillation with mitral stenosis.
Q3. A 55-year-old man presents with acute decompensated heart failure. He is volume overloaded
with jugular venous distension and 3+ lower extremity edema. His blood pressure is 145/88 mm Hg.
Which of the following is the most appropriate initial diuretic strategy?
A. Oral furosemide 40 mg daily
B. Intravenous furosemide at 2.5 times his home oral dose
C. Oral metolazone 5 mg daily
D. Intravenous acetazolamide 500 mg
Correct Answer: Intravenous furosemide at 2.5 times his home oral dose
Rationale: In acute decompensated heart failure with volume overload, intravenous loop
diuretics are preferred over oral due to more reliable and rapid delivery. The recommended starting
IV dose is 2.5 times the patient's home oral dose for patients on chronic loop diuretics. Oral
furosemide would be inappropriate in this acute setting. Metolazone is a thiazide-like diuretic used
as add-on therapy, not first-line. Acetazolamide is not indicated for acute volume overload in heart
failure.
,Q4. A 68-year-old woman with hypertension is currently on lisinopril 20 mg daily. Her blood pressure
remains 158/94 mm Hg. She has a history of angioedema with an ARB. Which of the following is the
most appropriate add-on antihypertensive?
A. Amlodipine
B. Valsartan
C. Sacubitril-valsartan
D. Spironolactone
Correct Answer: Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that is safe and effective as
add-on therapy in patients with hypertension who have failed ACE inhibitor monotherapy. Valsartan
is an ARB and should be avoided due to the patient's history of angioedema with an ARB. Sacubitril-
valsartan also contains an ARB and carries a risk of angioedema, especially in patients with prior ACE
inhibitor-related angioedema. Spironolactone is a diuretic that is not first-line for uncomplicated
hypertension.
Q5. A 72-year-old man with HFrEF (EF 22%) and NYHA class III symptoms is being optimized on
guideline-directed medical therapy. He is currently on lisinopril, carvedilol, and spironolactone. His
blood pressure is 122/76 mm Hg, heart rate 78 bpm, potassium 4.2 mEq/L, and creatinine 1.3 mg/dL.
Which of the following should be added next?
A. Sacubitril-valsartan
B. Digoxin
C. Hydralazine-isosorbide dinitrate
D. Ivabradine
Correct Answer: Sacubitril-valsartan
Rationale: Sacubitril-valsartan has replaced ACE inhibitors or ARBs as the preferred first-line
therapy in HFrEF due to its superior mortality benefit in the PARADIGM-HF trial. In a patient already
on an ACE inhibitor, the ACE inhibitor should be discontinued and sacubitril-valsartan started after a
36-hour washout. Digoxin reduces hospitalizations but does not improve survival. Hydralazine-
isosorbide dinitrate is reserved for patients who cannot tolerate ACE inhibitors or ARBs. Ivabradine is
used for heart rate reduction in patients already on maximum tolerated beta-blocker therapy.
Q6. A 65-year-old man is started on warfarin for a new diagnosis of atrial fibrillation. Three days later,
his INR is 7.8. He is asymptomatic with no bleeding. Which of the following is the most appropriate
management?
A. Vitamin K 10 mg IV
B. Hold warfarin and give vitamin K 2.5 mg PO
, C. Hold warfarin only
D. Fresh frozen plasma
Correct Answer: Hold warfarin and give vitamin K 2.5 mg PO
Rationale: For an asymptomatic patient on warfarin with an INR between 4.5 and 10 and no
bleeding, the recommended management is to hold warfarin and consider low-dose oral vitamin K
(2.5 mg or less). High-dose IV vitamin K (10 mg) risks overcorrection and subsequent warfarin
resistance. Holding warfarin alone may be sufficient for INR 4.5-10 in some guidelines, but the
addition of low-dose oral vitamin K is reasonable for a rapidly rising or markedly elevated INR. Fresh
frozen plasma is reserved for active bleeding.
Q7. A 58-year-old woman with hypertension is being started on lisinopril. Baseline labs show a
potassium of 5.2 mEq/L and creatinine of 1.6 mg/dL with an estimated glomerular filtration rate of
38 mL/min/1.73 m2. Which of the following is the most appropriate action?
A. Start lisinopril at a reduced dose
B. Start lisinopril at the standard dose
C. Hold lisinopril and address the hyperkalemia and renal function first
D. Start lisinopril and monitor outpatient labs in 3 months
Correct Answer: Hold lisinopril and address the hyperkalemia and renal function first
Rationale: ACE inhibitors should be held when the potassium is greater than 5.0 mEq/L or when
there is significant renal impairment with concern for further decline, because ACE inhibitors can
worsen hyperkalemia and reduce renal function. Correcting the underlying cause of hyperkalemia
and reassessing renal function prior to initiation is appropriate. Starting at a reduced dose without
addressing the metabolic abnormalities risks further hyperkalemia and renal deterioration. Starting
at standard dose is contraindicated. Monitoring in 3 months is too far out in this high-risk patient.
Q8. A 45-year-old man with a history of myocardial infarction is being started on a statin. His LDL is
148 mg/dL. Which of the following statin regimens is most appropriate for secondary prevention?
A. Atorvastatin 10 mg daily
B. Atorvastatin 80 mg daily
C. Simvastatin 20 mg daily
D. Pravastatin 40 mg daily
Correct Answer: Atorvastatin 80 mg daily
Rationale: High-intensity statin therapy is recommended for secondary prevention in patients
with established atherosclerotic cardiovascular disease, including those with prior myocardial
infarction, to reduce LDL by at least 50 percent. Atorvastatin 80 mg daily is a high-intensity statin.
