NAPLEX / Special populations

NAPLEX

The questions in this section are intended to test your knowledge and skills in pharmacy practice including pharmacy calcuations and biostatistics for pharmacy student pursuing to get license. Select all that applies. May have multiple answers. ( Keep in mind the calulation questions on the NAPLEX exam are NOT multiple choice, you are required to type in your answers)

NAPLEX | Special populations

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Question 1

JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. After being brought to the ER his serum alcohol level was found to be 475 mg/dl. Toxicology report negative except for high alcohol level. 2 hours after admission in the ER he was intubated and then transferred to ICU. His liver enzymes and renal function are normal. PT/INR within normal limit. No past medical history. Upon transfer medications includes Propofol, MVI daily, Lorazepam prn and Piperacillin/Tazobactam. What measures can one take to prevent ventilator associated Pneumonia (VAP)?

A	Twice daily oral decontamination with Chlorhexidine
B	Give Pipercillin/Tazobactam 3.375gm IV q6hr prophylaxis
C	Elevate the head of the bed by 30-45
D	A and C are appropriate measures to prevent VAP

Question 1 Explanation:

Answer D. The following 5 elements are part of the Institute of Healthcare Improvement VAP bundle: oral care with Chlorhexidine, head of bed elevation, DVT prophylaxis, SUP, and daily sedation assessment and spontaneous breathing trials. Other suggested measures for VAP prophylaxis are small bowel feeding instead of gastric feeding, prophylactic probiotics, alcohol based hand washing policy, early discontinuation of invasive devices, early tracheostomy, and reducing reintubation rates. Giving prophylaxis antibiotic is not recommended. Reference: Kalanuria AA, Zai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical Care. 2014;18(2):208. doi:10.1186/cc13775.

Question 2

JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. After being brought to the ER his serum alcohol level was found to be 475 mg/dl. Toxicology report negative except for high alcohol level. 2 hours after admission in the ER he was intubated and then transferred to ICU . His liver enzymes and renal function are normal. PT/INR within normal limit. No past medical history. Upon transfer medications includes Propofol, MVI daily, Lorazepam prn and Piperacillin/Tazobactam. What vitamin should the patient receive to avoid Wernicke- Korsakoff syndrome?

A	Thiamine
B	Cyanocobalamin
C	Magnesium
D	Folic Acid

Question 2 Explanation:

Answer A. Thiamine should be administered to prevent Wernicke’s encephalopathy. Reference: Management of moderate and severe alcohol withdrawal syndromes. Uptodate.com. 2016. Available at: http://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes?source=machineLearning&search=alcohol+withdrawal+treatment&selectedTitle=1%7E124§ionRank=1&anchor=H13#H13. Accessed May 24, 2016.

Question 3

JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. After being brought to the ER his serum alcohol level was found to be 475 mg/dl. Toxicology report negative except for high alcohol level. 2 hours after admission in the ER he was intubated and then transferred to ICU. His liver enzymes and renal function are normal. PT/INR within normal limit. No past medical history. Upon transfer medications includes Propofol, MVI daily, Lorazepam prn and Piperacillin/Tazobactam. What is the treatment of choice for his acute alcohol withdrawal?

A	Haloperidol
B	Lorazepam
C	Ziprasidone
D	Alprazolam

Question 3 Explanation:

Answer B. Benzodiazepines are the most studied drugs for alcohol withdrawal treatment. Long-acting agents such as Diazepam and Chlordiazepoxide may be used. Antipsychotics are not recommended to treat alcohol withdrawal. Haloperidol is an antipsychotic, an inappropriate choice. Reference: 1) Kosten T, O’Connor P. Management of drug and alcohol withdrawal. N Engl J Med 2003;348:1786- 95. A good general review of the management of the most common syndromes.
2) Management of moderate and severe alcohol withdrawal syndromes. Uptodatecom. 2016. Available at: http://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes?source=machineLearning&search=alcohol+withdrawal+treatment&selectedTitle=1%7E124§ionRank=1&anchor=H13#H13. Accessed May 24, 2016

Question 4

JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. After being brought to the ER his serum alcohol level was found to be 475 mg/dl. Toxicology report negative except for high alcohol level. 2 hours after admission in the ER he was intubated and then transferred to ICU. His liver enzymes and renal function are normal. PT/INR within normal limit. No past medical history. Upon transfer medications includes Propofol, MVI daily, Lorazepam prn and Piperacillin/Tazobactam. Which of the following would be appropriate chronic treatment of choice for his alcohol withdrawal?

A	Acamprosate
B	Metronidazole
C	Diazepam
D	Duloxetine

Question 4 Explanation:

Answer A. Acamprosate is indicated for ethanol dependence, but only in patients who have become abstinent. Diazepam is not indicated for ethanol dependence but for acute alcohol withdrawal. Metronidazole may interfere with the metabolism of ethanol, resulting in disulfiram-like effects, not indicated for alcohol withdrawal. Patients should try to avoid ethanol ingestion to avoid the risk of undesirable side effects while on Metronidazole. Duloxetine is not indicated to treat alcohol withdrawal. Reference: 1) Doering P, Boothby L. Substance-related disorders: overview and depressants, stimulants, and halluci¬nogens. In: DiPiro J, Talbert R, Yee G, et al., eds. Pharmacotherapy. A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill, 2008.
2) Gold Standard, Inc. Acamprosate (Indications/Dosage).

Question 5

JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. After being brought to the ER his serum alcohol level was found to be 475 mg/dl. Toxicology report negative except for high alcohol level. 2 hours after admission in the ER he was intubated and then transferred to ICU. His liver enzymes and renal function are normal. PT/INR within normal limit. No past medical history. Upon transfer medications includes Propofol, MVI daily, Lorazepam prn and Piperacillin/Tazobactam. Which of the following is/are major risk factors for VTE?

A	Surgery
B	Cancer
C	A and B
D	Alcohol consumption

Question 5 Explanation:

Answer C. Surgery, trauma (major trauma or lower-extremity injury), immobility, lower-extremity paresis, cancer (active or occult), cancer therapy (hormonal, chemotherapy, angiogenesis inhibitors, radiotherapy), venous compression (tumor, hematoma, arterial abnormality), previous VTE, increasing age, pregnancy and the postpartum period, estrogen-containing oral contraceptives or hormone replacement therapy, selective estrogen receptor modulators, erythropoiesis-stimulating agents, acute medical illness, inflammatory bowel disease, nephrotic syndrome, myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, obesity, central venous catheterization, and inherited or acquired thrombophilia Reference: Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6_suppl):381S.

Question 6

What is/are the indication for Stress Ulcer Prophylaxis (SUP)?

A	Patients with coagulopathy not related to anticoagulation use
B	Requirement for mechanical Ventilator for over 48hrs
C	Use of high-dose corticosteroids (>250 mg of hydrocortisone or the equivalent per day)
D	All of the above

Question 6 Explanation:

Answer D. SUP is indicated for patients who have coagulopathy, a requirement for mechanical ventilation for over 48 hours, a history of GI ulceration or bleeding within one year before admission, and in patients with at least two of the following: ICU stay of more than one week, sepsis, use of high-dose corticosteroids (>250 mg of hydrocortisone or the equivalent per day) and occult bleeding lasting six days or more. Reference: ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm. 1999;56(4):347-379.

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