North American Pharmacist Licensure Examination (NAPLEX) Pharmacy Practice, Law, and Patient Care Syllabus

Pharmacy Practice, Law, and Patient Care syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Pharmacy Practice, Law, and Patient Care in North American Pharmacist Licensure Examination (NAPLEX), not a summary of it.

1. 1

   Clinical Decision-Making and Patient Assessment

   4 topics

   • Interpreting laboratory values
   • Evaluating signs, symptoms, and vital signs
   • Medication reconciliation and history taking
   • Patient counseling and adherence strategies
2. 2

   Pharmacy Law and Regulation

   4 topics

   • Controlled Substances Act and DEA scheduling
   • Prescription requirements and dispensing limits
   • Federal regulations (FDCA, HIPAA, OBRA-90)
   • Pharmacist scope of practice and standards of care
3. 3

   Medication Safety and Quality

   4 topics

   • Medication error prevention systems
   • Look-alike/sound-alike drugs and tall man lettering
   • Root cause analysis and continuous quality improvement
   • Pharmacovigilance and post-marketing surveillance
4. 4

   Biostatistics and Literature Evaluation

   4 topics

   • Study designs and levels of evidence
   • Statistical tests and significance interpretation
   • Risk measures: NNT, relative and absolute risk
   • Critical appraisal and applying evidence to practice
5. 5

   Public Health and Preventive Care

   4 topics

   • Immunization schedules and administration
   • Smoking cessation and substance use screening
   • Travel health and prophylaxis
   • Point-of-care testing and screening services

Pharmacy Practice, Law, and Patient Care flashcards for North American Pharmacist Licensure Examination (NAPLEX)

21 of 59 cards from the Pharmacy Practice, Law, and Patient Care deck — real questions with worked answers.

1. What is the normal reference range for serum potassium, and what ECG change signals dangerous hyperkalemia?

   Normal serum potassium is $3.5\text{–}5.0\ \text{mEq/L}$. Hyperkalemia ($>5.0$) classically produces peaked T waves and can progress to widened QRS and arrhythmia.

2. What is the normal serum sodium range, and what defines hyponatremia vs hypernatremia?

   Normal serum sodium is $135\text{–}145\ \text{mEq/L}$. Hyponatremia is $<135\ \text{mEq/L}$; hypernatremia is $>145\ \text{mEq/L}$.

3. How is the corrected calcium calculated for hypoalbuminemia?

   $$\text{Corrected Ca} = \text{measured Ca} + 0.8 \times (4.0 - \text{albumin})$$ where albumin is in g/dL and calcium in mg/dL. Add $0.8\ \text{mg/dL}$ per $1\ \text{g/dL}$ albumin below $4$.

4. What is the Cockcroft-Gault equation for estimating creatinine clearance?

   $$CrCl = \frac{(140 - \text{age}) \times \text{weight (kg)}}{72 \times S_{cr}} \times (0.85\ \text{if female})$$ with $S_{cr}$ in mg/dL; result in mL/min.

5. What HbA1c value defines diabetes, and what is the approximate estimated average glucose for an $\text{HbA1c}$ of 7%?

   Diabetes is diagnosed at $\text{HbA1c} \geq 6.5\%$. An $\text{HbA1c}$ of $7\%$ corresponds to an estimated average glucose of about $154\ \text{mg/dL}$ (each $1\%$ rise $\approx 28\text{–}29\ \text{mg/dL}$).

6. Which lab values are used to assess hepatic synthetic function versus hepatocellular injury?

   Synthetic function: albumin, INR/PT, and bilirubin. Hepatocellular injury: ALT and AST (transaminases). Cholestasis: alkaline phosphatase and GGT.

7. What INR range is therapeutic for most warfarin indications, and what range applies to mechanical mitral valves?

   Most indications (AFib, VTE) target $\text{INR}\ 2.0\text{–}3.0$. Mechanical mitral valves target a higher $\text{INR}\ 2.5\text{–}3.5$.

8. List the components of a normal adult vital sign set (temperature, HR, RR, BP, $\text{SpO}_2$).

   Temperature $\approx 37^{\circ}\text{C}$ ($98.6^{\circ}\text{F}$); heart rate $60\text{–}100\ \text{bpm}$; respiratory rate $12\text{–}20/\text{min}$; blood pressure $<120/80\ \text{mmHg}$; $\text{SpO}_2 \geq 95\%$.

9. How do the 2017 ACC/AHA guidelines define Stage 1 and Stage 2 hypertension?

   Stage 1: systolic $130\text{–}139$ or diastolic $80\text{–}89\ \text{mmHg}$. Stage 2: systolic $\geq 140$ or diastolic $\geq 90\ \text{mmHg}$.

10. What are the classic signs and symptoms of digoxin toxicity?

    Nausea, vomiting, anorexia, confusion, visual disturbances (yellow-green halos/xanthopsia), bradycardia, and arrhythmias. Risk increases with hypokalemia and renal impairment.

11. What are the key elements obtained during medication reconciliation?

    A complete list of all current medications (prescription, OTC, herbals, supplements) with drug name, dose, route, frequency, and indication, then comparing against new orders to resolve discrepancies (omissions, duplications, interactions) at transitions of care.

12. During medication history taking, what does the mnemonic 'best possible medication history' (BPMH) require beyond the med list?

    It requires verifying actual use (adherence vs prescribed), last dose taken, allergies and reactions, and using two or more reliable sources (patient interview plus pharmacy records or pill bottles).

13. What are the four prime questions used in patient counseling (Indian Health Service method)?

    1) What did the doctor tell you the medication is for? 2) How did the doctor tell you to take it? 3) What did the doctor tell you to expect? Plus the 'show-and-tell' final verification check (teach-back).

14. What is the 'teach-back' method and why is it used in counseling?

    Teach-back asks the patient to restate or demonstrate instructions in their own words to confirm understanding. It verifies comprehension rather than simply asking 'Do you understand?' and reduces errors and improves adherence.

15. How is medication adherence quantified by the Proportion of Days Covered (PDC), and what threshold is generally considered adherent?

    $$PDC = \frac{\text{days covered by medication supply}}{\text{days in measurement period}} \times 100\%$$ A $PDC \geq 80\%$ is generally considered adherent.

16. Name evidence-based strategies to improve medication adherence.

    Simplifying regimens (once-daily dosing, fixed-dose combinations), using pillboxes/blister packs, reminder systems, motivational interviewing, addressing cost/access, synchronizing refills, and follow-up via MTM or telephone calls.

17. Under the Controlled Substances Act, what characterizes a Schedule I drug?

    Schedule I drugs have a high potential for abuse, NO currently accepted medical use in the U.S., and lack accepted safety for use under medical supervision (e.g., heroin, LSD, marijuana federally).

18. Compare the abuse potential and refill rules for Schedule II versus Schedule III–IV controlled substances.

    Schedule II: high abuse potential, NO refills allowed, new prescription required each time. Schedule III–IV: lower abuse potential, may be refilled up to 5 times within 6 months.

19. How long is a Schedule III, IV, or V prescription valid, and how many refills are permitted?

    Schedule III and IV prescriptions are valid for 6 months from the date written and may be refilled up to 5 times within that period. Schedule V follows state-specific rules but federally allows refills as authorized.

20. What DEA form is required for ordering Schedule II controlled substances, and how is theft/loss reported?

    Schedule II ordering requires DEA Form 222 (or its electronic CSOS equivalent). Theft or significant loss is reported using DEA Form 106.

21. What is the check-digit method for verifying a DEA number?

    Add the 1st, 3rd, and 5th digits; add the 2nd, 4th, and 6th digits and multiply by 2; sum these two results. The last digit of that sum must equal the 7th (check) digit of the DEA number.

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