Pass the NABP NAPLEX Certification NAPLEX Questions and answers with ExamsMirror

Non-pharmacological measure that may control symptoms of gastroesophageal reflux disease are: Avoid aggravating foods/beverages that may reduce LES pressure alcohol, citrus juices caffeine, garlic, onions or cause direct irritation such as spicy foods or tomato juice should be avoided. Reduce fat intake, remain upright after meals, avoid meal before bedtime. Avoid tight fitted cloths, decrease intra-abdominal pressure. Discontinue nicotine use. Reduce intake of food or beverage that may reduce lower esophageal sphincter

tone.

It is not necessary that all the drugs get completely absorbed after oral administration. Most of them are incompletely absorbed. The extent of absorption varies from 5 to less than 100 % with oral ingestion of drugs.

Drugs which are too hydrophilic like atenolol are incompletely absorbed because the drug cannot cross the

lipid membrane due to high hydrophilic nature of the drug. Similarly, drugs which are too lipophilic like acyclovir are not soluble enough to cross the water layer adjacent to the cell. P-glycoprotein is an efflux transporter which is present in the enterocytes and it inhibits absorption of drug. It is also known as export transporter or reverse transporter. It has many drugs as its substrate. Grape juice in fact inhibits P-glycoprotein in the intestine thereby decreasing the efflux of drug from the cells by P-glycoprotein. Thus ingestion of grape juice may lead to significantly increased absorption of the drug.

80kg person = 15mg/kg/day = 1200mg/day 80mg /5ml = 1200mg/X X= 75mL/day / 4 doses = 18.75 mL per dose

Drugs mainly interact with the receptors by means of chemical forces or bonds. There are three major types of drug receptor bonds: - Covalent - Electrostatic - Hydrophobic Covalent bonds are very strong bonds and in most of the cases they are irreversible under biologic conditions. For example, the covalent bond between the acetyl group of aspirin and cyclo-oxygenase enzyme (target enzyme present on the platelets) does not breaks easily. The platelet aggregation effect of aspirin lasts long after free acetyl-salicylic acid has disappeared from the blood (about 15 minutes) and it is reversed only by the synthesis of new cyclo-oxygenase enzyme in new platelets which takes a long time. Hence the effect of aspirin is seen after the drug is stopped. Among the drug receptor interactions, electrostatic bond is much more commonly found than covalent bond. The electrostatic bonds vary from relatively strong linkages between permanently charged ionic molecules to weaker hydrogen bonds and very weak induced dipole interactions such as van der Waals force. The electrostatic bonds are weaker than covalent bonds. Hydrophobic bonds are usually very weak bonds and probably important in the interactions of highly lipid soluble drugs with the lipids of cell membranes and perhaps in the interactions of the drugs with the internal walls of receptor “pockets”.

If 40mg of amoxicillin are needed per kg of body weight, then the dose of amoxicillin is 40mg multiplied by the

patient’s body weight. This patient weighs 18 lbs, based on the conversion of 2.2 lbs = 1 kg, the patient weighs

8.2 kg. 40 mg multiplied by 8.2 kg is equal to 328 mg, this is one dose of amoxicillin. If the amoxicillin comes in 250 mg/5 mL, then it needs to be determined how many mLs it will take to get 328 mg of amoxicillin. In order to do this 328 mg needs to be divided by 250 mg to get a ratio. This comes out to be 1.312. This ratio can be multiplied by the number of mLs it takes to make up 250 mg, which is 5 mLs. 1.312 multiplied by 5 mLs is 6.56 mL, this is how many mLs it will take to have 328 mg. This volume is for 1 single dose of amoxicillin. The patient is receiving 2 doses per day and for a total of 10 days, this means the patient will be receiving 20

doses. 20 doses multiplied by 6.56 mL doses equals the total volume the patient will be receiving, which is

131.2 mL.

Pregnancy test. Tetracyclines are effective in the treatment of severe cases of acne. They are however teratogenic. As such, it is imperative to make sure female patients are not pregnant prior to starting this medication. In many instances patients are started on concurrent birth control to mitigate this risk even further.

A chest x-ray (B) is an important exam to obtain prior to starting drugs which have pulmonary toxicity as a side effect such as amiodarone. A complete blood count (C) would be useful prior to starting a medication that causes anemia, such as immunosuppressive and chemotherapeutic agents. Liver function tests (D) are important to establish as a baseline prior to starting anti-mycobacterial agents. Creatine kinase levels (E) are used to establish as a baseline prior to starting statins.

Gestational diabetes is typically asymptomatic but identified via a 1-hour 50g oral glucose challenge administered at 24–28 weeks of gestation. A venous plasma glucose blood level of > 140 mg/dL is suggestive, and must be confirmed with a 3-hour 100g oral glucose tolerance test. After administration of the 100g glucose challenge, at least two of the following are required for diagnosis: (1) fasting glucose > 95 mg/dL, (2) one-hour glucose >180 mg/dL, (3) two hour glucose >155 mg/dL, and (4) three hour glucose > 140 mg/dL. Choice A –

To diagnose gestational diabetes, a positive 1-hour 50g oral glucose challenge must be followed up by a three-hour 100g oral glucose challenge. The diagnosis is only confirmed after both challenges are completed and the thresholds are met. Choice C – Following the diagnosis of gestational diabetes, the first step is strict glycemic control (fasting glucose).

Agents that can cause elevated triglycerides: oral estrogens, glucocorticoids, bile acid sequestrants, protease inhibitors, retinoic acid, anabolic steroids, sirolimus, raloxifene, tamoxifen, beta blockers (not carvedilol), and thiazides.

Section: (none)

Explanation

Since LN used 3 mg of hydromorphone, this would be equivalent to a total of morphine 60 mg po daily. Since you would start with 70-80% of that dose, Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain would be appropriate regimen.

LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.