North American Pharmacist Licensure Examination (NAPLEX) Pharmacotherapy and Disease State Management Syllabus

Pharmacotherapy and Disease State Management syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Pharmacotherapy and Disease State Management in North American Pharmacist Licensure Examination (NAPLEX), not a summary of it.

1. 1

   Cardiovascular and Renal Disorders

   7 topics

   • Hypertension
     • JNC/ACC-AHA staging and BP goals
     • First-line agents by compelling indication
     • Resistant hypertension and hypertensive emergency
   • Heart Failure
     • HFrEF guideline-directed quadruple therapy
     • HFpEF management and SGLT2 inhibitors
     • Acute decompensated HF and diuretic strategies
   • Dyslipidemia
     • Statin intensity and ASCVD risk categories
     • Non-statin add-ons: ezetimibe, PCSK9, bempedoic acid
   • Atrial fibrillation and anticoagulation
     • Rate vs rhythm control
     • CHA2DS2-VASc and HAS-BLED stroke prevention
   • Acute coronary syndromes and antiplatelet therapy
   • Venous thromboembolism prophylaxis and treatment
   • Chronic kidney disease and dose adjustment principles
2. 2

   Endocrine and Metabolic Disorders

   5 topics

   • Type 2 diabetes mellitus
     • A1c targets and individualization
     • Agent selection: cardiorenal benefit and hypoglycemia risk
     • Insulin titration and basal-bolus regimens
   • Type 1 diabetes and diabetic emergencies (DKA, HHS)
   • Thyroid disorders: hypo- and hyperthyroidism
   • Adrenal disorders and corticosteroid equivalence
   • Osteoporosis and bone-modifying agents
3. 3

   Infectious Diseases

   7 topics

   • Antimicrobial spectrum and empiric selection
     • Beta-lactams, fluoroquinolones, aminoglycosides
     • Coverage of MRSA, Pseudomonas, and anaerobes
   • Common syndromes: pneumonia, UTI, skin and soft tissue
   • Sepsis and bloodstream infections
   • Antifungal and antiviral therapy
   • HIV antiretroviral regimens and prophylaxis
   • Tuberculosis and latent TB treatment
   • Antimicrobial stewardship and resistance
4. 4

   Central Nervous System and Psychiatric Disorders

   7 topics

   • Major depressive disorder and antidepressant classes
   • Bipolar disorder and mood stabilizers
   • Schizophrenia and antipsychotic selection
     • Typical vs atypical agents
     • Metabolic and extrapyramidal monitoring
   • Anxiety disorders and benzodiazepine risks
   • Epilepsy and antiseizure drug selection
   • Parkinson disease and movement disorders
   • Pain management and opioid stewardship
5. 5

   Respiratory, GI, and Specialty Conditions

   6 topics

   • Asthma stepwise therapy and inhaler technique
   • COPD GOLD classification and maintenance therapy
   • GERD and peptic ulcer disease
   • Inflammatory bowel disease and biologics
   • Oncology supportive care and chemotherapy basics
   • Transplant immunosuppression

Pharmacotherapy and Disease State Management flashcards for North American Pharmacist Licensure Examination (NAPLEX)

22 of 62 cards from the Pharmacotherapy and Disease State Management deck — real questions with worked answers.

1. According to current ACC/AHA US guidelines, what blood pressure ranges define Stage 1 and Stage 2 hypertension?

   Stage 1: systolic $130$–$139$ mmHg OR diastolic $80$–$89$ mmHg. Stage 2: systolic $\geq 140$ mmHg OR diastolic $\geq 90$ mmHg.

2. What are the four first-line drug classes for primary hypertension?

   Thiazide-type diuretics (e.g., chlorthalidone), ACE inhibitors, ARBs, and dihydropyridine calcium channel blockers (e.g., amlodipine).

3. Why must an ACE inhibitor and an ARB never be combined?

   Dual RAAS blockade greatly increases hyperkalemia, hypotension, and acute kidney injury risk with no added cardiovascular benefit.

4. Which comorbidity makes an ACE inhibitor or ARB the preferred antihypertensive regardless of race?

   Chronic kidney disease with albuminuria (including diabetic nephropathy), because RAAS blockade reduces proteinuria and slows progression; also compelling in HFrEF and post-MI.

5. Name the four 'pillars' of guideline-directed medical therapy that reduce mortality in HFrEF.

   ARNI (or ACEi/ARB), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (spironolactone/eplerenone), and an SGLT2 inhibitor.

6. What washout period is required when switching from an ACE inhibitor to sacubitril/valsartan, and why?

   A $36$-hour washout, to avoid overlapping neprilysin and ACE inhibition, which raises bradykinin and angioedema risk.

7. How is LVEF used to classify heart failure into HFrEF, HFmrEF, and HFpEF?

   HFrEF: LVEF $\leq 40\%$. HFmrEF: LVEF $41$–$49\%$. HFpEF: LVEF $\geq 50\%$.

8. Which three beta-blockers have proven mortality benefit in HFrEF?

   Carvedilol, metoprolol succinate (extended-release), and bisoprolol.

9. What is the calculated LDL-C using the Friedewald equation?

   $$\text{LDL-C} = \text{TC} - \text{HDL-C} - \frac{\text{TG}}{5}$$ (mg/dL units), valid only when triglycerides are $< 400$ mg/dL.

10. Which patients qualify for high-intensity statin therapy under the ACC/AHA cholesterol guideline?

    Patients with clinical ASCVD, LDL-C $\geq 190$ mg/dL, or diabetes aged $40$–$75$ with high risk; goal is to lower LDL-C by $\geq 50\%$.

11. Name two high-intensity statin regimens.

    Atorvastatin $40$–$80$ mg daily and rosuvastatin $20$–$40$ mg daily.

12. What is the mechanism and key indication of PCSK9 inhibitors (e.g., evolocumab, alirocumab)?

    They bind PCSK9, increasing LDL receptor recycling to lower LDL-C; used as add-on in ASCVD or familial hypercholesterolemia when LDL remains high on maximal statin.

13. What CHA₂DS₂-VASc score components and thresholds guide anticoagulation in atrial fibrillation?

    CHF, Hypertension, Age $\geq 75$ (2 pts), Diabetes, prior Stroke/TIA (2 pts), Vascular disease, Age $65$–$74$, Sex (female). Anticoagulate when score $\geq 2$ in men or $\geq 3$ in women.

14. Which anticoagulant is preferred over warfarin for most patients with nonvalvular atrial fibrillation, and what is the key exception?

    A DOAC (apixaban, rivaroxaban, dabigatran, edoxaban) is preferred; the exception is mechanical heart valves or moderate–severe mitral stenosis, where warfarin is required.

15. What are the specific reversal agents for dabigatran and for factor Xa inhibitors (apixaban/rivaroxaban)?

    Idarucizumab reverses dabigatran; andexanet alfa reverses apixaban and rivaroxaban.

16. What is the target INR for atrial fibrillation and most warfarin indications versus a mechanical mitral valve?

    Target INR $2.0$–$3.0$ for AF and VTE; a mechanical mitral valve requires INR $2.5$–$3.5$.

17. What is the dual antiplatelet therapy regimen and duration after a drug-eluting stent for acute coronary syndrome?

    Aspirin plus a P2Y12 inhibitor (ticagrelor or prasugrel preferred over clopidogrel) for at least $12$ months, then aspirin indefinitely.

18. Which P2Y12 inhibitor is contraindicated in patients with a prior stroke or TIA?

    Prasugrel, due to increased intracranial bleeding risk; it is also avoided in patients $\geq 75$ years or $< 60$ kg.

19. What is the maintenance aspirin dose that must NOT be exceeded when combined with ticagrelor?

    $\leq 100$ mg daily, because higher aspirin doses reduce ticagrelor's efficacy.

20. What is the time goal for fibrinolytic therapy ('door-to-needle') and for primary PCI ('door-to-balloon') in STEMI?

    Door-to-needle $\leq 30$ minutes for fibrinolytics; door-to-balloon $\leq 90$ minutes for primary PCI.

21. Which patients with hospitalized acute medical illness should receive pharmacologic VTE prophylaxis, and with what agents?

    Acutely ill patients with elevated VTE risk and low bleeding risk; use low-dose unfractionated heparin, LMWH (enoxaparin), or fondaparinux.

22. What is the standard treatment-dose enoxaparin regimen for acute VTE?

    $1$ mg/kg subcutaneously every $12$ hours, or $1.5$ mg/kg subcutaneously once daily.

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