NAPLEX 2023 Exam Questions And Answers

NAPLEX 2023 Exam Questions And Answers Key drugs that can cause hypothyroidism - ANS "I TALC" Interferons Tyrosine Kinase Inhibitors Amiodarone Lithium Carbamazepine Conditions: Hashimoto's disease Levothyroxine IV:PO - ANS 0.75:1 (IV:PO) Full replacement dose levothyroxine - ANS 1.6 mcg/kg/day (IBW) If known CAD: start with 12.5-25 mcg daily Levothyroxine tablet colors - ANS Orangutans Will Vomit On You Right Before They Become Large Proud Giants 25 Orange 50 White (no dye) 75 Violet 88 Olive 100 Yellow 112 Rose 125 Brown 137 Turquoise 150 Blue 175 Lilac 200 Pink 300 Green Drug induced causes of hyperthyroidism - ANS Iodine Amiodarone Interferons Radiographic contrast media treatment for thyroid storm - ANS Antithyroid (PTU preferred- give 1 hour before iodide) Inorganic iodide therapy (SSKI or Lugol's) Beta Blocker (Propranolol) Systemic steroid (dexamethasone) Aggressive cooling (APAP, cooling blankets, supportive treatments) Hyperthyroid in pregnancy - ANS Hyperthyroidism during pregnancy should be treated with propylthiouracil (PTU) during the first trimester then methimazole during the second and third trimesters. Although methimazole is a teratogen, the teratogenic effects are less during the second and third trimesters, and PTU can cause liver failure, which is why it is substituted out. Cushing's syndrome - ANS Adrenal gland produces too much cortisol or exogenous steroids are taken in doses higher than normal amounts of endogenous cortisol Addison's disease - ANS a condition that occurs when the adrenal glands do not produce enough cortisol; Addisonian crisis (volume depletion and hypotension, which can be fatal) Steroids: least to most potent - ANS (Cute Hot Pharmacists and Physicians Marry Together & Deliver Babies) o Cortisone (25 mg): short acting o Hydrocortisone (20 mg): short acting o Prednisone (5 mg): intermediate acting o Prednisolone (5 mg): intermediate acting o Methylprednisolone (4 mg): intermediate acting o Triamcinolone (4 mg): intermediate acting o Dexamethasone (0.75 mg): long acting, highest potency o Betamethasone (0.6 mg): long acting, highest potency Immunosuppression from steroids - ANS A patient is immunosuppressed when using >/= 2mg/kg/day or >/= 20mg/day of prednisone or prednisone equivalent for >2 weeks Immunosuppressed patients cannot receive live vaccines and have a high risk of infection steroid will need to be slowly tapered off: reduce 10-20% every few days (tapers can last 7-14 days, longer or shorter) Traditional DMARDs (disease modifying anti-rheumatic drugs) - ANS MTX (Trexall): first line in RA Hydroxychloroquine (Plaquenil) Sulfasalazine Leflunomide (Arava) Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - ANS MTX (Trexall): first line in RA - irreversibly binds and inhibit dihydrofolate reductase, inhibiting folate - 7.5 to 20 mg once weekly - hepatotoxicity (avoid alcohol), myelosuppression, mucosistis/stomatitis, teratogenic - monitor: CBC, LFTs, chest X-ray, hep B/C - folate replacement - renal elimination is decreased by aspirin/NSAIDs Traditional DMARDs (disease modifying anti-rheumatic drugs): hydroxychloroquine - ANS Hydroxychloroquine (Plaquenil) - Irreversible retinopathy - take with food or milk - alternative to MTX in liver disease Traditional DMARDs (disease modifying anti-rheumatic drugs): Sulfasalazine - ANS Sulfasalazine - CI in sulfa/salicylate allergy - can cause yellow-orange coloration of skin/urine - caution in patients with G6PD deficiency Traditional DMARDs (disease modifying anti-rheumatic drugs): Leflunomide - ANS Leflunomide (Arava) - inhibits pyrimidine synthesis - teratogenic - must wait 2 years after use to become pregnant or use accelerated drug elimination (cholestyramine + activated charcoal) - hepatotoxic JAK inhibitors - ANS Tofacitinib (Xeljanz) Baracitinib (Olumiant) Upadacitinib (Rinvoq) Boxed warnings: serious infections, malignancy, thrombosis Do not use with biologic DMARDs or potent immunosuppressants Anti-TNF Biologic DMARDs - ANS Etanercept: Enbrel Adalimumab: Humira Infliximab: Remicade Certolizumab: Cimzia Golimumab: Simponi Used for a variety of diseases including RA (typically add on therapy to MTX) Needles are provided Each has a pregnancy registry Boxed warnings: serious infections, malignancies Warnings: demyelinating desease, hep B reactivations, HF, hepatotoxicity, lupus-like syndrome, seizures, myelosuppression Can cause: injection site reactions, infection, l