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Naplex things to remember correctly answered 2023

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Naplex things to remember correctly answered 2023CYP INHIBITORS *G PACMAN* Grapefruit Protease inhibitors (Ritonavir) Azole antifungals C - cyclosporine, cimetidine, cobicistat Macrolides (NOT azithromycin) Amiodarone (and dronedarone) Non-DHP CCBs CYP INDUCERS *PS PORCS* Phenytoin...

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  • April 1, 2023
  • 31
  • 2022/2023
  • Exam (elaborations)
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  • cimetidine
  • naplex things to remember correctly answered 2023
  • cyp inhibitors g pacman grapefruit protease inhibitors ritonavir azole antifungals c cyclosporine
  • cobicistat macrolides not azithr

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Naplex things to remember correctly
answered 2023

CYP INHIBITORS - correct answer **G PACMAN**
Grapefruit
Protease inhibitors (Ritonavir)
Azole antifungals
C - cyclosporine, cimetidine, cobicistat
Macrolides (NOT azithromycin)
Amiodarone (and dronedarone)
Non-DHP CCBs

CYP INDUCERS - correct answer **PS PORCS**
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine (and eslicarbazepine)
Rifampin
Carbamazepine (also auto-inducer)
St. Johns wort

Digoxin Levels - correct answer 0.8-2 (Afib)
0.5-0.9 (HF)
Toxicity:
Initial s/sx: N/V, loss of appetite, bradycardia
Severe s/sx: blurred/double vision, greenish-yellow halos

FDA Orange Book - correct answer List approved drugs that can be interchanged with
generics based on therapeutic equivalence

CDC Pink Book - correct answer Info on epidemiology and vaccine preventable
diseases

Pink SHEET - correct answer News reports on regulatory, legislative, legal and
business developments

FDA Purple Book - correct answer List of biological drug products, including biosimilars

RED BOOK (Pharmacy) - correct answer drug pricing

Red Book (pedes) - correct answer Summaries of pediatric infectious diseases, abx
treatment and vaccines

,CDC Yellow Book - correct answer Info on the health risk of international travel,
required vaccines and prophylaxis meds

FDA Green Book - correct answer Info on approved animal drug products

Drugs that require PCV containers - correct answer **Leach Absorbs To Take In
Nutrients**
Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin

Drugs with FILTER requirements - correct answer my ***GAL, PLAT*** needs a filter
Golimumab (simponi)
Amiodarone
Lorazepam

Phenytoin
Lipids - 1.2 micron
Amphotericin B (lipid formualtions)
Taxanes (except docetaxel)

PROTECT FROM LIGHT - correct answer **Protect Every Necessary Med from
Daylight**
Phytonadione (Vit K, Mephyton)
Epoprogestenol
Nitroprusside
Micafungin
Doxycycline

SALINE ONLY - correct answer **A DIAbetic Can't Eat Pie**
Ampicillin
Daptomycin
Infliximab
Ampicillin/Sulbactam
Caspofungin
Ertapenem
Phenytoin

DEXTROSE ONLY - correct answer ***BOAS like dextrose***
Bactrim
Oxaliplatin
Amphotericin B

,Synercid (Quinupristin/Dalfopristin)

DO NOT REFRIDERATE - correct answer **Dear Sweet Pharmacist, Freezing Makes
Me Edgy**
Dexamedetomidine (Precedex)
Sulfa/Trimeth (Bactrim)
Phenytoin
Furosemide
Metronidazole
Moxifloxacin
Enoxaparin

Common LIVE vaccines - correct answer **COZY IV RM***
Cholera (PO) (Vaxchora)
Oral Typhoid (PO) (Vivotif)
Zoster (Zostavax)
Yellow Fever
Intranasal Influenza (Flu-Mist)
Varicella (Varivax)
Rotavirus (PO) (Rotarix, Rotateq)
MMR

pneumococcal vaccines - correct answer 13 Valent Conjugate Vaccine (PCV 13) -
PREVNAR 13
- Patients should only receive 1 dose in their lifetime
- Given IM Routinely
- indicated in children < 5 Give
1 dose if never received:
-Immunocompromised patients 6-64 yo
- Can be considered in patients age ≥ 65 (provider discussion)
23 Valent Polysaccharide Vaccine (PPSV 23) - PNEUMOVAX 23
- Patients may receive 1,2, or 3 doses in their lifetime
- Given IM or SQ
- Give 1 dose before age 65: immunoCOMPETENT age 2-64 (diabetes, heart, lung, or
liver disease, alcohol abuse, smoker)
- Give 2 doses before age 65 Immunocompromised 2-64 yo Sickle cell disease,
asplenia, HIV
- Give 1 dose at age ≥65 ALL patients
PPSV23 ---> PPSV 23: SEPARATE BY 5 YEARS
PCV 13 ---> PPSV 23: SEPARATE BY 1 YEAR
**UNLESS - immunocompromised - 8 weeks

Flu Vaccine - correct answer Given annually unless -
Age 6 months - 8 years (previously not vaccines) GIVE 2 DOSES (4 weeks apart)
All pts ≥6 months
All brand names have FLU in the name (Afluria, Fluzone, FluMist, Fluarix, FluLaval)

,HIGH DOSE (≥65): Fluad, Fluzone High Dose (both only Trivalent) and Fluzone High
Dose Quadrivalent & Flublock Quadravalent
Flublok (egg free) is approved for ≥18 yo
Do not admin live intranasal influenza vaccine (FluMist) in egg allergy patients
Flu Mist (LAIV4): healthy people aged 2-49 yo

Immunizations allergy CI - correct answer Yellow fever: CI with severe allergy to eggs
or gelatin
Varivax/Zostavax: hypersensitivity to gelatin or neomycin

Tylenol and Motrin dose in CHILDREN - correct answer Tylenol: 10-15 mg/kg/dose q 4-
6h (160mg/5mL)
Motrin: 5-10 mg/kg/dose q6-8h

Morphine and Hydromorphone conversions - correct answer Morphine 10mg IV = 30
mg PO =
Hydromorphone 1.5 mg IV = 7.5 mg PO

Pregnancy Treatment for:
HTN
UTI
Hyperthyroidism
Hypothyroidism - correct answer HTN: (LMN) - labetalol, methyldopa, nifedapine
UTI: cephalexin or ampicillin
Hyper: PTU (1st tri), Methimazole (2&3rd)
Hypo: increase levothyroxine dose by 30-50%

ED PDE-5 dosing - correct answer Reduce start dose by 50% if:
- ≥65 Using alpha blocker
- Using CYP 3A4 inhibitor
- Severe renal or liver disease
DOSES:
Viagra (sildenafil) = 50 mg --> 25 mg
Cialis (Tadalafil) /Levitra (Vardenafil) = 10 mg --> 5 mg
Stendra (Avanafil) = 100 mg --> 50 mg

alpha 1 blockers
5 alpha reductase inhibitors - correct answer doxazosin, terazosin (nonselective),
tamsulosin, alfuzosin, silodosin (selective)
finasteride, dutasteride

Vassopressors and extravastation antidote - correct answer Dopamine, Epinephrine,
NE, phenylephrine, vasopressin (all alpha 1 agonist)
phentolamine (alpha 1 blocker)

Dopamine dosing - correct answer LOW (renal) 1-4 = dopamine 1 agonist

,MEDIUM (+ inotrope) 5-10 = beta 1 agonist
HIGH (vasopressor) 10-20 = alpha 1 agonist

Epinephrine dosing - correct answer IV push = 0.1 mg/mL (1:10,000)
IM or IV compounds = 1 mg/mL (1: 1,000)

MAX Rate to correct Na and K - correct answer Na - no > than 12 meq/L/24 hours
K - max infusion rate ≤ 10 meq/hr, max concentration 10meq/100mL

Vasodilators - correct answer Nitroglycerin (Low = venous, high = arterial. used in
active MI)
Nitroprusside (equal venous/arterial. DO NOT use in active MI OR if color is BLUE
[cyanide degradation]
Nesiritide (dilation via increased cGMP)

SHOCK TREATMENT - correct answer 1. IV crystalloid bolus - Dextrose or saline
2. Vasopressors - Phenylephrine or high doses of dopamine or NE
3. INOTROPE - DOBUTAMINE, Medium dose dopamine

Inotropes - correct answer Dobutamine (B1 agonist) - if turns PINK = OK TO USE
Milrinone (IV only - inotrope and vasodialtor)

Acute Decomp HF Treatment - correct answer VOLUME OVERLOADED:
- Loop diuretics, Vasodilators (NTG, nitroprusside, nesiritide)
HYPOPERFUSION:
- Inotropes (dobutamine, milrinone)
- if hypotensive consider adding: vasopressor (DA, NE, phenylephrine)

Neuromusclar blocking agents - correct answer LABEL: WARNING PARALYZING
AGENT
Depolarizing - Succinylcholine (only one, used for intubation)
Polarizing (END IN CURIUM/CURONIUM) - Atracurium, Cistracurium, Pancuronium,
Rocuronium, Vecuronium

seek urgent care for child - correct answer Age < 3 months: temp of 100.4 F/38 C
(Rectal)
Age 3-6 months: temp of 101 F/38.3 C (Rectal)
Age > 6 monhts: temp of 103 F/39.4 C (Rectal)

Avoid in Pedes - correct answer Contraindicated
-Codeine < 12
-Tramadol < 12
-Promethazine < 2
-Ceftriaxone neonates (1-28 days)
Not generally recommended
- Quinolones (-floxacin)

,- Tetracyclines < 8 (Except doxycycline in rocky mountain)
- OTC teething meds - benzocaine < 2 OTC cold/cold meds < 6 (per AAP)

PEDES:
Respiratory Syncytial Virus (RSV) - tx/prophylaxis
Croup - tx
Nocturnal Enuresis - tx - correct answer [severe] Inhaled Ribavirin
(Virazole)/Palivizumab (Synagis)
dexamethasone +/- nebulized racemic epinephrine (L isomer)
Desmopressin

Children vaccines - correct answer Measles (Koplik spots - small white spots on the
inside of the cheeks, airborne transmission
Mumps (S/S: swollen/tender salivary glands)

CF inhaled meds - correct answer 1st - Inhaled bronchodilators (albuterol)
2nd - Hypertonic saline (HyperSol, pulmosol)
3rd - Dornase alfa (Pulmozyme)
4th - Chest physiotherapy
5th - inhaled abx (Tobramycin, Aztreonam - 28 days on, 28 days off)

transplant drugs - correct answer Induction:
- Basiliximab (IL-2 antagonist)
- Antithynicyte globulin in higher risk patients
- Maintenance drugs at higher doses
Maintenance:
- CNIs - tacrolimus or cyclosporine
Adjuvant meds:
- Antiproliferative agents - mycophenolate or azathioprine
- mTOR inhibitors (everolimus or sirolimus)
- Belatacept
- Steroids - prednisone

weightloss drugs - avoid - correct answer phenteramine/topiramate (Qsymia = Q),
naltrexone/bupropion (Contrave = C)
PREGNANCY = AVOID ALL
HTN = AVOID C, CAUTION Q
DEPRESSION = CAUTION C
SEIZURES = AVOID C, CAUTION Q
OPIODS = AVOID C

DRUGS CI in CKD - correct answer CrCl < 60: Nitrofurantoin
CrCl < 50:
- TDF products (stribild, complera, atripla, symfi)
- Voriconazole IV
CrCl <30:

,- TAF products (genvoya, biktarvy, descovy, odesefy)
- NSAIDs
- Dabigatran (DVT/PE)
- Rivaroxaban (DVT/PE)
GFR < 30
- SGLT2 inhibitors (-gliflozin)
- Metformin (for treated pts. Do not initiate if ≤45)

Hyperkalemia treatment - correct answer 1. stabalize the heart - Ca gluconate
2. shift K intracellulary - Regluar insulin, Dextrose, Sodium bicarb, Albuterol
3. Remove K from the body - Furosemide (fastest), Sodium polystyrene sulfonate,
Patiromer, Sodium zirconium cyclosillate, HD

HBV Preferred Drugs - correct answer Interferon Alfa
TDF (Viread)
TAF (Vemlidy)
Enetcavir (Baraclude)

Liver Lab Values - correct answer Acute liver toxicity, including from drugs = ↑ AST/ALT
Chronic liver disease (cirrhosis) = ↑ AST/ALT, Alk Phos, total bilirubin, LDH, PT/INR ↓
albumin
Alcoholic liver disease = ↑ AST > ALT (AST will be about double ALT), ↑ gamma
glutamyl transpeptidase (GGT)
Hepatic encephalopathy = ↑ Ammonia
Jaundice = ↑ total bilirubin

Portal HTN and variceal bleeding tx - correct answer - Octreotide (Sandostatin) -
Selective
- Vasopressin - non-selective
- Non selective BB: Nadolol & Propranolol (target HR 55-60 bpm)

Hepatic encephalopathy tx - correct answer Limit ammonia intake from food (animal
protien)
Lactulose = 1st line for both acute and chronic prevention therapy
Rifaxamin = 2nd line

Liver Drug interactions - correct answer ALL: CYP3A4 inducers, amiodarone
(bradycardia)
Sofosbuvir containing: antacids, PPI, H2RA
Technivie & Viekira Pak: estradiol containing, lovastatin & simvastatin

Hep B Lab Values - correct answer HBsAg + = infected by Hep B in blood & can
spread
HBsAb + = has antibodies from Hep B vaccine
HBcAb + = has antibodies from past or current infection

,PAH drug treatment - correct answer Vasoreactivity test:
responder = oral CCB (NDA) - nifedipine, diltiazem, amlodipine
non responder = Potent vasodilators:
- Prostacyclin analogues and receptor agonists (IV epoprostenol [Flolan, Veletri],
Treprostinil [Remodulin])
- endothelin receptor antagonists (ERA - end in entan) (Bosenten, Ambrisentran,
Macitentan = teratogenic & hepatotoxic )
- PDE-5 inhibitors (revatio, adcirca)
- soluble guanylate cycle stimulator (Riociguat = teratogenic)

Asthma severity based on SABA use - correct answer INTERMITTENT: < 2 days/ week
PERSISTANT MILD: > 2 days/week but NOT daily
OR > 1x/day
PERSISTANT MODERATE: daily
PERSISTANT SEVERE: Several times a day

HOW TO USE INHALERS - correct answer RESPIMAT products (MDI): TOP - turn,
open, press
Tiotropium - spiriva handihaler (DPI) = press once, bring to mouth horizonallty. inhale
TWICE
Aclidinium (Tudorza Pressair) - turns from red to green when ready. then green to red
after dose complete

smoking cessation 5 A's - correct answer ASK about tobacco use
ADVISE to quit
ASSESS willingness to make a quit attempt
ASSIST in quit attempt
ARRANGE follow up

smoking cessation treatment considerations - correct answer weight gain: USE: Gum,
lozenge, and bupropion SR (delay weight gain)
depression: USE: Bupropion SR
dentures: AVOID:Gum
Asthma/COPD: AVOID: Inhaler or spray
skin conditions: AVOID: Patch
seizures: AVOID: Bupropion SR, Varenicline
cost: AVOID: Inhaler, spray, bupropion SR, varenicline (rx drugs)

MAOi - 2 week washout period most drugs, 5 weeks Fluoxetine - correct answer
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (transdermal patch) (MAO-B selective)
Zelapar

selecting best antidepressant - correct answer Cardiac risk = sertraline

,smoking cessation = Bupropion SR (Zyban)
Peripheral neuropathy or pain = duloxetine
Seizure disorder or anorexia/bulimia = DO NOT USE BUPROPION
pregnancy = DO NOT use paroxetine. Can use other SSRI (Risk of persistent
pulmonary hypertension)
daytime sedation = ACTIVATING DRUGS - fluoxetine, buproprion (FB = fontaiblue is
active hotel)
insomnia = SEDATING DRUGS - trazodone, paroxetine, mirtazapine (TPM = Take in
PM)
sexual dysfunction = bupropion, mirtazapine

Clozapine REMS - correct answer ANC ≥ 1500
STOP IF < 1000
Used no sooner than 3RD LINE due to severe SE potential (Agranulocytosis, seizures,
constipation, increase weight, hypersalivation)

Bipolar treatment (+ prepgnancy) - correct answer Acute Treatment
- Manic episode: Lithium or valproate (MLV)
- Depressive episode: Lithium (1st line) or Lamotrigine (DLL - down low low)
Maintenance
- Lithium or Valproate are 1st line (MLV)
Pregnancy: USE: Lamotrigine (safer option) - think BABY = LAMB (Li, valproate,
carbamazepine is teratogenic)

Li therapeutic range - correct answer 0.6-1.2 mEq/L (trough level)
TOXICITY:
>1.5 = ataxia, coarse hand tremor, vomiting
>2.5 = CNS depression, arrhythmia, seizure, coma

LEVELS increase: Decrease salt intake (ACE, ARBS)
NSAIDS
LEVELS decrease: increase salt intake

converting lithium
drugs that increase/decrease Li - correct answer 5 mL Li syrup = 8 mEq Li ion = 300
mg Li cap/tabs
increase: NSAIDs, ACEi, ARBs (decrease Na)
decrease: increase salt

ADHD treatment - correct answer Stimulants (1st line) - TAKE IN AM (all CIIs)
- Methylphenidate (Concerta, Daytrana patch, Ritalin, Ritalin LA*)
- dexmethylphendiate (Focalin)
- Lis dexamphetamine (Vyvanse Capsules**)
- Dextroamphetamine/amphetamine (Adderall, Adderall XR*)
Non stimulants (second line) - take if abuse risk
- Atomoxetine (Straterra)

, Add on medications or used alone (Central alpha 2A adrenergic receptor agonists):
- Guafacine (Intuniv)
- Clonidine ER (Kapvay)
ZZzzzzz to help sleep at night:
- Clonidine IR (Catapres)
- Diphenhydramine OTC (25-50 mg)
- Melatonin OTC (2-5 mg)
*capsule can be be opened and put on applesauce
**cap can be mixed in water, orange juice or yogurt

Methyphenidate - correct answer Comes in: ODT, ORAL SUSPENTION, CHEWABLE
AND TRANSDERMAL PATCH
Ritalin IR: 5 mg BID starting
Concerta: 18-36 mg QD AM, has GHOST TAB (CONCERning theres a ghost tab=
CONCERta)
Daytrana PATCH: apply in AM 2 hours before desired effect, remove after 9 hours;
alternate hips daily

Anxiety Tx - correct answer 1st line: SSRI (1/2 dose of depression - takes about 4
weeks to see effects)
2nd Line:
Buspirone (takes 2-4 weeks for effects)
TCAs: amitriptyline, imipramine, nortriptyline
Hydroxyzine
Pregabalin
Gabapentin
Propranolol (Inderal LA) (special situations)

BZDs - fast relief of symptoms (enhance GABA) - short term

SAFE USE OF BZDs - correct answer HIGHLY SEDATING
Not preferred for sleep or anxiety
IF USED: CHOOSE SAFE BZD:
Elderly & Liver impairment: L-O-T drugs: Lorazepam, oxazepam, temazepam preferred
Axiety: UN-do anxiety: UN-CLAD - (Clonazepam, Lorazepam, Alprazolam, Diazepam)
Sleep: temazepam or Lorazepam (TL - sleep TOO LATE)
Seizures: injectable BZDs or diazepam rectal gel (Diastat)

Anitdote: flumazenil

INSOMNIA TX - correct answer Eszopiclone (lunesta)
Zolpidem (Ambien)
- Female/Elderly: 5 mg PO/SL/ORAL spray qHS
- Male: 5-10 mg PO/SL/ ORAL spray qHS

Drugs used for RLS - correct answer Pramipexole (Mirpex)

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