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

24 sample cards from the Pharmacotherapy and Disease State Management deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What laboratory pattern characterizes primary hyperthyroidism (e.g., Graves disease)?

   Suppressed (low) TSH with elevated free $T_4$ and/or $T_3$.

2. Which antithyroid drug is preferred in the first trimester of pregnancy and which in later pregnancy?

   Propylthiouracil (PTU) is preferred in the first trimester; methimazole is preferred in the second and third trimesters (avoid PTU later due to hepatotoxicity).

3. What is the cortisol/biochemical hallmark of primary adrenal insufficiency (Addison disease)?

   Low cortisol with high ACTH, often with hyponatremia and hyperkalemia; confirmed by an inadequate cortisol rise on the cosyntropin (ACTH) stimulation test.

4. Using corticosteroid equivalence, how many mg of prednisone equal 20 mg of hydrocortisone?

   $5$ mg prednisone $=$ $20$ mg hydrocortisone (both anti-inflammatory equivalents); $0.75$ mg dexamethasone is also equivalent.

5. Rank hydrocortisone, prednisone, and dexamethasone by mineralocorticoid (sodium-retaining) activity.

   Hydrocortisone has high mineralocorticoid activity, prednisone has low, and dexamethasone has essentially none.

6. What FRAX-based or T-score criteria define osteoporosis and warrant pharmacologic therapy?

   Osteoporosis is a DXA T-score $\leq -2.5$, a fragility hip/vertebral fracture, or osteopenia (T-score $-1.0$ to $-2.5$) with high FRAX 10-year fracture probability.

7. What are the administration instructions for oral bisphosphonates to maximize absorption and prevent esophagitis?

   Take on an empty stomach with a full glass of plain water, then remain upright and fasting for at least $30$ minutes (60 for ibandronate).

8. What is the mechanism of denosumab and a key counseling point about discontinuation?

   Denosumab is a RANK ligand inhibitor that decreases osteoclast activity; abrupt discontinuation causes rapid bone loss and rebound vertebral fractures, so transition to another agent is needed.

9. Which oral antibiotics provide reliable coverage of MRSA for skin and soft tissue infections?

   Trimethoprim-sulfamethoxazole, doxycycline, clindamycin, and linezolid.

10. What is the empiric IV agent of choice for serious MRSA infections, and what therapeutic monitoring parameter is used?

    Vancomycin, monitored by an AUC/MIC ratio target of $400$–$600$ (or trough $15$–$20$ mcg/mL) to balance efficacy and nephrotoxicity.

11. Which antibiotic classes cover Pseudomonas aeruginosa?

    Antipseudomonal beta-lactams (piperacillin-tazobactam, cefepime, ceftazidime, meropenem), aztreonam, fluoroquinolones (cipro/levofloxacin), and aminoglycosides.

12. What is the recommended empiric outpatient regimen for community-acquired pneumonia in a previously healthy adult with no comorbidities?

    Amoxicillin high-dose, OR doxycycline, OR a macrolide (azithromycin) where pneumococcal macrolide resistance is low.

13. What is the first-line oral agent for uncomplicated cystitis, and what is a key contraindication?

    Nitrofurantoin; it is contraindicated when CrCl $< 30$ mL/min due to inadequate urinary concentration and toxicity risk. Other options are TMP-SMX and fosfomycin.

14. In sepsis management, within what time window should broad-spectrum antibiotics be administered, and what is the initial fluid resuscitation?

    Antibiotics within $1$ hour of recognition; initial crystalloid bolus of $30$ mL/kg for sepsis-induced hypotension or lactate $\geq 4$ mmol/L.

15. Which vasopressor is first-line for septic shock unresponsive to fluids?

    Norepinephrine is the first-line vasopressor for septic shock.

16. What is the drug of choice for invasive candidiasis/candidemia in most hospitalized patients?

    An echinocandin (caspofungin, micafungin, or anidulafungin).

17. What is the mechanism of azole antifungals and a major clinical caution?

    Azoles inhibit fungal CYP450 ($14\alpha$-demethylase), blocking ergosterol synthesis; caution is needed because they are potent CYP3A4 inhibitors causing many drug interactions, plus QT prolongation and hepatotoxicity.

18. Which antiviral is first-line for herpes simplex and varicella-zoster infections, and what is its key toxicity?

    Acyclovir (or valacyclovir); key toxicity is crystalline nephropathy, prevented with adequate hydration and slow IV infusion.

19. What is the preferred first-line antiretroviral regimen class combination for treatment-naive HIV patients?

    An integrase strand transfer inhibitor (INSTI, e.g., bictegravir or dolutegravir) plus two NRTIs (e.g., tenofovir alafenamide/emtricitabine).

20. What regimens are used for HIV pre-exposure prophylaxis (PrEP)?

    Oral tenofovir/emtricitabine (TDF/FTC or TAF/FTC) daily, or long-acting injectable cabotegravir every $2$ months.

21. What is the standard four-drug intensive-phase regimen (RIPE) for active tuberculosis?

    Rifampin, Isoniazid, Pyrazinamide, and Ethambutol for the initial $2$ months, followed by rifampin + isoniazid for $4$ months.

22. Why is pyridoxine (vitamin $B_6$) co-administered with isoniazid?

    Isoniazid increases pyridoxine excretion and can cause peripheral neuropathy; supplemental pyridoxine prevents it.

23. What are two preferred shorter regimens for latent tuberculosis infection?

    Once-weekly isoniazid plus rifapentine for $12$ weeks (3HP), or daily rifampin for $4$ months (4R); isoniazid alone for $6$–$9$ months is an alternative.

24. What characteristic adverse effect distinguishes ethambutol among the anti-TB drugs?

    Optic neuritis causing decreased visual acuity and red-green color discrimination loss; visual function must be monitored.

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