PRE-NAPLEX EXAM COMPLETE REVIEW WITH QUESTIONS AND CORRECT VERIFIED ANSWERS

PRE-NAPLEX EXAM COMPLETE REVIEW WITH QUESTIONS AND CORRECT VERIFIED ANSWERS HTN ranges 1. normal 2. elevated 3. HTN stage 1 4. HTN stage 2 - Correct Answer 1. normal <120/80 2. elevated 120-129/<80 3. HTN stage 1: 130-139/80-89 4. HTN stage 2: >140/90" "blood pressure monitoring 1. Dos 2. Don't - Correct Answer 1. Do - go to the restroom and empty the bladder - sit in a chair, both feet on the floor and relax for at least 5 minutes - use the correct cuff size - support the arm at heart level - wait 1-2 minutes in between measurements 2. don'ts - talk - sit or lie down on an examination table - drink caffeine, exercise or smoke 30 min prior - use a finger or wrist monitor" "risk and lifestyle treatment for diabetes - Correct Answer - normal BMI < 25 or < 23 in asian american - waist circumference < 35 inches females and < 40 in males - physical activity at least 150 minutes of moderate intensity aerobic activity/week" "what is the 10-g monofilament - Correct Answer assess at least annually in all patients with T2dm" "apgar score - Correct Answer test to assess general health of newborn" "drugs that can increase blood pressure - Correct Answer - ampetamines and ADHD drugs - cocaine - decongestants - erythropoiesis stimulating agent - immunosuppressants - NSAIDS - systemic steroids" "1. which HTN med to NOT use during pregnancy 2. which HTN med to use during pregnancy - Correct Answer 1. ACEi, ARB, aliskiren (all have BBW for fetal toxicity) 2. only if chronic HTN if >160/105 and use: - labetalol, nifedipine - methyldopa" "do combination drugs brand generic page 457 - Correct Answer " "ACEi and ARB major drug class - Correct Answer - angioedema - hyperkalemia - hypotension - renal impairment - COUGH - increased SCr - ARBs less cough, angioedema" "Beta blockers - Correct Answer - not first line unless HF, MI, IHD - common SE: decreased HR, fatigue, dizziness, depression - metoprolol tartrate IV:PO= 1:2.5" "central acting alpha 2 adrenergic agonist - Correct Answer 1. clonidine (catapres) - Kapvay for adhd - do not discontinue abruptly - rebound HTN/must taper - dry mouth, somnolence, fatigue, dizziness, constipation, decrease HR, hypotension - clonidine patch: apply weekly to clean, dry, hairless area on upper arm or chest, remove before MRI" "CHF - Correct Answer CHF" "chronic heart failure is - Correct Answer - failure occurs when the heart is not able to supply sufficient oxygen rich blood to the body" "HF ejection fraction - Correct Answer 1. EF < 40% systolic dysfunction (HFrEF) 2. EF > 40% diastolic dysfunction (HFpEF)" "drugs that can cause or worsen HF - Correct Answer 1. Drug Information NATION - DPP 4 inhibitors (saxagliptin, alogliptin) - immunosuppressants (adalimumab, etanercept) - Non DHP CCB (diltiazem, verapamil) - anti-arrhythmics (procainamide, flecainide, amiodarone) - Thiazolidinediones - itraconazole - oncology drugs - NSAIDs" "Loop diuretics - Correct Answer - CI if sulfa allergy (use ethacrynic acid) - ototoxicity - furosemide 40 mg = torsemide 20mg = bumetanide 1 mg - furosemide IV:PO = 1:2" "LDL equation (friedwald equation) - Correct Answer LDL = TC - HDL - TG/5 - cannot use this equation if TG is >400" "what is part of ASCVD calculator - Correct Answer - age, sex, race - TC, HDL, LDL - SBP - diabetes - HTN tx - statin - on ASA - current/former smoker" "what is ASCVD - Correct Answer - ACS/MI - Angina - revascularization - stroke/TIA - PAD" "when to use HI statin - Correct Answer - clinical ASCVD - LDL >190 - 10 year ASCVD risk > 20% - diabetes with multiple risk factors" "when to use moderate intensity statin - Correct Answer - any patient with diabetes - 10 year ASCVD risk 7.5-19%" "statin equivalent doses - Correct Answer -Pitavastatin 2 mg -Rosuvastatin 5 mg -Atorvastatin 10 mg -Simvastatin 20 mg -Lovastatin 40 mg -Pravastatin 40 mg -Fluvastatin 80 mg * Pharmacists Rock At Saving Lives and Preventing Flu" "ordered strength of statins (example) - Correct Answer - pitavastatin - rosuvastatin - simvastatin - pravastatin - fluvastatin" "safety issues with statins - Correct Answer - liver damage -- stop statin if AST or ALT > 3 times upper limit of normal - muscle damage -- myopathy leads to rhabdomyolysis -- increase CPK, renal failure - if patient has mylagia -- hold statin, check CPK -- after 2-4 weeks rechallenge with same statin or decrease dose. if myalgia comes back discontinue statin" "statins to drop dose with amiodarone - Correct Answer - simvastatin 20 mg / day - lovastatin 40 mg / day" "statins to drop dose with diltiazem or verapamil - Correct Answer - simvastatin 10 mg/ day - lovastatin 20 mg/day" "statin drug interactions?? - Correct Answer page 445" "select drugs that cause kidney disease - Correct Answer - aminoglycosides - ampho B - cisplatin - cyclosporine - loop diuretics - NSAIDs - polymyxin - radioactive contrast dye - tacrolimus - vancomycin" "diagnosis and screening of diabetes - Correct Answer 1. diagnosis - a1c > 6.5% - FPG > 126 - symptoms + random BG > 200 - OGTT 2 hour BG > 200" "goals for diabetes - Correct Answer - a1c < 7% - preprandial BG 80-130 - proprandial BG < 180" "urea breath test - Correct Answer used to diagnose H. pylori infection" "sweat test - Correct Answer test to help diagnose cystic fibrosis (higher chloride in sweat)" "PSA - Correct Answer used in patients with BPH high PSA is concerning for prostate cancer" "hyperglycemia causes (microvascular disease) - Correct Answer - retinopathy -- comprehensive dilated eye exam every 2 ears - nephropathy -- urine albumin ever 6-12 months - neuropathy -- monofilament + sensation test + foot exam every year" "hyperglycemia causes (macrovascular disease) - Correct Answer - atherosclerosis (ASCVD) -- coronary artery disease -- cerebrovascular disease -- peripheral artery disease - control BP and cholesterol - use ASA for 2ndary prevention" "statins and diabetes - Correct Answer - use at least MI statin - HI if ASCVD or risk > 20%" "nephropathy and diabetes - Correct Answer use ACEi or ARB" "neuropathy and diabetes - Correct Answer use either duloxetine, pregabalin or gabapentin" "which diabetic medications are insulin sensitizers - Correct Answer - metformin - TZDs (glitazone)" "which diabetic medications increase insulin - Correct Answer - insulin - sulfonylureas (G--ide) - meglitinides" "which diabetic medications decrease glucose production - Correct Answer - metformin - DPP-4i (-gliptin) - GLP-1 agonist (-tide) - pramlinitide" "which diabetic medications gastric emptying - Correct Answer - GLP-1 agonist (-tide) - pramlinitide" "which diabetic medications increase glucose excretion - Correct Answer - SGLT2 inhibitors (-flozin)" "diabetes diagnosis and treatment 1. A1C < 8.5% 2. A1C 8.6-10% 3. A1C > 10% - Correct Answer 1. A1C < 8.5% - metformin 2. A1C 8.6-10% - dual treatment (include metformin) 3. A1C > 10% - insulin + metformin" "ADA treatment guideline for diabetes 1. 1st line 2. if ASCVD/or risk 3. if HF 4. if CKD - Correct Answer 1. 1st line = metformin + lifestyle modification 2. if ASCVD/or risk - GLP-1 or SGLT2 3. if HF - SGLT2 (dapagliflozin is best) 4. if CKD - SGLT2" "diabetes and renal disease (what to avoid) - Correct Answer 1. metformin - eGFR < 30 or 30-45 for new start 2. SGLT2 inhib - eGFR < 30 or 30-45 for most 3. exenatide CrCl < 30 4. glyburide risk of hypoglycemia" "diabetes and renal disease what is safe - Correct Answer - GLP-1 (except exenatide) - linagliptin - TZDs - insulin - sulfonylureas (not glyburide)" "diabetic medications weight loss and weight gain - Correct Answer 1. weight loss - SGLT2 inhib - GLP-1 - Pramlinatide 2. weight gain - insulin - secretagogues - TZDs" "rapid acting insulin - Correct Answer - aspart (novolog) - lispro (humalog, admelog) - glulisine (apidra) - afrezza (oral inhalation) - prandial/mealtime" "short acting insulin - Correct Answer - regular (humulin R, novolin R) - U-500 (humulin R, U-500) - prandial/mealtime" "intermediate acting insulin - Correct Answer - NPH (humulin N, novolin N) - basal" "long acting insulin - Correct Answer - glargine (lantus, toujeo) - detemir (levemir) - degludec (tresiba) - basal" "insulin administration steps for toujeo - Correct Answer 1. attach a new needle 2. turn the knob to 2 units and press the injection button while face the needle away from you 3. pinch a 2 inch portion of the abdomen 4. insert the needle at a 90 degree angle 5. count 5-10 seconds, then remove the needle" "if pcn allergy and there is ertapenem - Correct Answer do not use" "natural penicillin spectrum - Correct Answer - streptococci - enterococci - G+ anaerobes" "aminopenicillins spectrum - Correct Answer - HNPE - beta lactamase inhibitors - MSSA - HNPEK - G- anaerobes" "extended spectrum penicillins - Correct Answer - CAPES -- citro -- acineto -- proidencia --enterobacter -- serratia - MSSA - pseudomonas - G- anaerobes" "antistaphyococcal penicillins - Correct Answer - MSSA - streptococcus" "penicillin class effects - Correct Answer - beta lactam allergy - risk of seizure" "1st generation cephalosporin spectrum - Correct Answer - streptococci - MSSA - PEK - G+ anaerobes" "page 378 treatment/drugs for each bacterial infection - Correct Answer " "TPN for EN 1. carbs 2. fat 3. proteins - Correct Answer 1. carbs - 4 kcal/g 2. fat - 9 kcal/g 3. proteins - 4 kcal/g" "TPN for PN 1. carbs 2. fat 3. proteins - Correct Answer 1. carbs - dextrose monohydrate = 3.4 kcal/g - glycerol/glycerin = 4.3 kcal/g 2. fat - injectable lipid 10% = 1.1 kcal/ml - injectable lipid 20% = 2 kcal/ml - injectable lipid 30% = 3 kcal/ml 3. proteins - amino acid (same as EN) = 4 kcal/g" "BMI formula - Correct Answer - BMI = weight (kg)/ [height (m)] ^2 or - BMI = [weight (pound)/height (inch)^2 x] 703" "ideal body weight (IBW) - Correct Answer 1. males - IBW = 50 kg + (2.3 x # of inches over 5 feet) 2. females - IBW = 45.5 + (2.3 x # of inches over 5)" "2nd generation cephalosporin spectrum - Correct Answer - HNPEK - cefotetan and cefoxitin have G- anaerobes" "3rd group 1 generation cephalosporin spectrum - Correct Answer - same as 2nd generation with coverage for more resistant strep and HNPEK" "3rd group 2 generation cephalosporin spectrum - Correct Answer - ceftazidime = PSA - beta lactamase inhibitors add coverage for MDR G- rods" "4th generation cephalosporin spectrum - Correct Answer - HNPEK - CAPES - PSA (pseudomonas) - G+ activity similar to 3rd generation" "5th generation cephalosporin spectrum - Correct Answer broad G+ activity - MRSA - G- activity similar to ceftriaxone" "HNPEK stands for - Correct Answer - heamo - neisseria - proteous - e coli - klebsiella" "CAPES - Correct Answer - Citrobacter - Acinetobacter - Providencia - Enterobacter - Serratia" "surgical prophylaxis you use which cephalosporin - Correct Answer - 1st generation cefazolin - 2nd generation cefotetan (disulfram reaction), cefoxitin" "carbapenems spectrum, what they dont cover and warnings - Correct Answer - all cover ESBL producing organisms - all except ertapenem cover pseudomonas, acinetobacter, enterococcus (PEA) - do not use with penicillin allergy - seizure risk - all do not cover atypicals, VRE, MRSA, C. diff, stenotrophomonas" "aminoglycoside spectrum and toxicities - Correct Answer - gram (-) bacteria including pseudomonas - synergy for gram + infections - nephrotoxicity - ototoxicity" "respiratory quinolones - Correct Answer - levofloxacin - moxifloxacin (do not use for UTIs) - gemifloxacin - used for pneumonia" "anti-pseudomonal quinolones - Correct Answer - ciprofloxacin - levofloxacin 1. used for: - pseudomonas infection - UTIs - intra-abdominal infections - travelers diarrhea" "1. levofloxacin and moxifloxacin IV:PO ratio 2. counsel points - Correct Answer - 1:1 2. avoid sun exposure - separate for cations - monitor blood glucose (DM)" "macrolides spectrum and ADR - Correct Answer - atypical coverage - QT prolongation - part of gpacMans - clarithro and erythro is CI with lovastatin and simvastatin" "tetracycline avoid in and ADRs - Correct Answer - avoid in pregnancy and children < 8yo - photosensitivity, chelation" "sulfonamides information - Correct Answer - SMX:TMP = 5:1 ratio dose per TMP component - SE = photosensitivity, hemolytic anemia + COOMBs test - warfarin interation" "vancomycin uses, dosing, and monitoring - Correct Answer 1. MRSA and C. Diff 2. Dosing - IV weight based - PO fixed dose 3. monitoring - serious MRSA infection AUC/MIC ratio 400-600 or goal trough 15-20" "arterial blood gas metabolic acidosis - Correct Answer 1. pH - low 2. primary problem - low HCO3 3. compensation? - respiratory low pCO2" "arterial blood gases metabolic alkalosis - Correct Answer 1. pH - increase pH 2. primary problem - increase HCO3 3. compensation? - respiratory increase pCO2" "arterial blood gases respiratory acidosis - Correct Answer 1. pH - decrease pH 2. primary problem - increase HCO3 3. compensation? - metabolic increase HCO3" "arterial blood gases respiratory alkalosis - Correct Answer 1. pH - increase pH 2. primary problem - decrease pCO2 3. compensation? - metabolic decrease HCO3" "ROME Arterial Blood Gas - Correct Answer - respiratory opposite - metabolic equal" "LABA for asthma - Correct Answer - salmeterol (severent diskus)" "LAMA for asthma - Correct Answer " "599 for counseling points for inhalers - Correct Answer " "pulmicort flexhaler (DPI) counseling - Correct Answer - do not shake - cannot use a spacer - deep forceful inhalation - rinse mouth after use" "prevnar 13 give dose if - Correct Answer - never recieved - immunocompromised patient age 6-64 - can be considered in patient age > 65 (up to dr)" "pneumovax 23 give 1, 2, or 3 doses in their lifetime - Correct Answer 1. give 1 dose before age 65 if - immunocompromised check page 336" "cox 2 selective NSAIDs - Correct Answer - celecoxib - diclofenac - meloxicam - etodolac - nabumetone" "opioid conversions IV/IM and oral in mg - Correct Answer 1. morphine 10 and 30 2. hydromorphone 1.5 and 7.5 3. oxycodone -- and 20 4. hydrocodone -- and 30 5. codeine 130 and 200 6. fentanyl 0.1 and -- 7. meperidine 75 and 300 8. oxymorphone 1 and 10 -- know if anything # 1 and 2" "anion gap - Correct Answer AG = Na - Cl - HCO3" "starting dose of warfarin < 5 mg for these - Correct Answer - heart failure - liver disease - malnutrition - elderly - high risk of bleeding (including from drugs which increase warfarin levels)" "warfarin color tablets - Correct Answer 1. Please Let Greg Brown Bring Peaches To Your Wedding - pink 1 mg - lavender 2 mg - green 2.5 mg - brown/ran 3 mg - blue 4 mg - peach 5 mg - teal 6 mg - yellow 7.5 mg - white 10 mg" "warfarin drug interactions - Correct Answer 1. CYP 450 interactions (especially 2C9) - increase INR (MAT) -- Metronidazole/macrolides -- Amiodarone and azoles -- Trimethoprim/sulfamethoxazole - decrease INR -- rifampin -- phenytoin -- phenobarbital -- st. john's wort 2. ADDITIVE BLEED RISK (no increase in INR) - NSAIDs - ASA - SSRI - SNRI 3. natural products (5 Gs) - garlic, ginger, ginkgo, ginseng, glucosamine" "ICS top selling drugs brand/generic for asthma - Correct Answer - beclomethasone (QVAR redihaler) - budesonide (pulmicort flexhaler) - fluticasone (flovent, flovent diskus, arnuity ellipta) - non for COPD" "read slide 596-598 - Correct Answer "