NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
Key drugs that can cause hypothyroidism - CORRECT ANSWERS "I TALC"
Interferons
Tyrosine Kinase Inhibitors
Amiodarone
Lithium
Carbamazepine
Conditions: Hashimoto's disease
Levothyroxine IV:PO - CORRECT ANSWERS 0.75:1 (IV:PO)
Full replacement dose levothyroxine - CORRECT ANSWERS 1.6 mcg/kg/day (IBW)
If known CAD: start with 12.5-25 mcg daily
Levothyroxine tablet colors - CORRECT ANSWERS 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
,NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
300 Green
Drug induced causes of hyperthyroidism - CORRECT ANSWERS Iodine
Amiodarone
Interferons
Radiographic contrast media
treatment for thyroid storm - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Adrenal gland produces too much cortisol or exogenous
steroids are taken in doses higher than normal amounts of endogenous cortisol
Addison's disease - CORRECT ANSWERS 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 - CORRECT ANSWERS (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
,NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
o Dexamethasone (0.75 mg): long acting, highest potency
o Betamethasone (0.6 mg): long acting, highest potency
Immunosuppression from steroids - CORRECT ANSWERS 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) - CORRECT ANSWERS MTX (Trexall):
first line in RA
Hydroxychloroquine (Plaquenil)
Sulfasalazine
Leflunomide (Arava)
Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - CORRECT ANSWERS 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 - CORRECT
ANSWERS Hydroxychloroquine (Plaquenil)
- Irreversible retinopathy
- take with food or milk
- alternative to MTX in liver disease
, NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
Traditional DMARDs (disease modifying anti-rheumatic drugs): Sulfasalazine - CORRECT ANSWERS
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 - CORRECT ANSWERS
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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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, liver damage, HF
2024-2025
NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
Key drugs that can cause hypothyroidism - CORRECT ANSWERS "I TALC"
Interferons
Tyrosine Kinase Inhibitors
Amiodarone
Lithium
Carbamazepine
Conditions: Hashimoto's disease
Levothyroxine IV:PO - CORRECT ANSWERS 0.75:1 (IV:PO)
Full replacement dose levothyroxine - CORRECT ANSWERS 1.6 mcg/kg/day (IBW)
If known CAD: start with 12.5-25 mcg daily
Levothyroxine tablet colors - CORRECT ANSWERS 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
,NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
300 Green
Drug induced causes of hyperthyroidism - CORRECT ANSWERS Iodine
Amiodarone
Interferons
Radiographic contrast media
treatment for thyroid storm - CORRECT ANSWERS 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 - CORRECT ANSWERS 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 - CORRECT ANSWERS Adrenal gland produces too much cortisol or exogenous
steroids are taken in doses higher than normal amounts of endogenous cortisol
Addison's disease - CORRECT ANSWERS 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 - CORRECT ANSWERS (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
,NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
o Dexamethasone (0.75 mg): long acting, highest potency
o Betamethasone (0.6 mg): long acting, highest potency
Immunosuppression from steroids - CORRECT ANSWERS 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) - CORRECT ANSWERS MTX (Trexall):
first line in RA
Hydroxychloroquine (Plaquenil)
Sulfasalazine
Leflunomide (Arava)
Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - CORRECT ANSWERS 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 - CORRECT
ANSWERS Hydroxychloroquine (Plaquenil)
- Irreversible retinopathy
- take with food or milk
- alternative to MTX in liver disease
, NAPLEX QuestionssAAs Aoonrret AAsseersATes baskA
2024-2025
Traditional DMARDs (disease modifying anti-rheumatic drugs): Sulfasalazine - CORRECT ANSWERS
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 - CORRECT ANSWERS
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 - CORRECT ANSWERS 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 - CORRECT ANSWERS 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, liver damage, HF
