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2024 FIRST LINE TREATMENT NAPLEX REVIEW EXAM WITH CORRECT ANSWERS
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2024 FIRST LINE TREATMENT NAPLEX REVIEW EXAM WITH CORRECT ANSWERS
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2024 FIRST LINE TREATMENTNAPLEX REVIEW EXAM WITH
CORRECT ANSWERS
Diabetes - CORRECT-ANSWERST1D: insulin
T2D: metformin
ASCVD or CKD risk: SGLT2 (-) or GLP-1 agonist
HF risk: SGLT2 (-)
wt loss: SGLT2 (-), GLP-1 agonist
cost: SU, TZDs
hypoglyemia risk: avoid insulin and SU together
H. pylori - CORRECT-ANSWERS-1st line: quadruple therapy (bismuth
subsalicylate, metronidazole, tetracycline, PPI BID)--10-14 days
-if clarithromycin resistance is < 15% and no hx of marcolide: 1st line:
amoxicillin, clarithromycin, metronidazole PPI BID------10-14 days
2nd line: amoxicillin, clarithromycin, PPI BID---14 days
-sequential.hybrid therapy: PPI + amoxicillin for 5-7 days, then PPI +
clarithromycin + metronidazole for rest of 7 days
-talicia (rifabutin + amoxicillin + omeprazole): FDA approved for H.pylori
NSAID-induced ulcer - CORRECT-ANSWERS-if using non-selective NSAIDs- can
use PPIs to prevent GI ulcer and bleeding
-alternative: cytoprotective drugs (misoprostol, sulcrafate), vimovo
(omeprazole/naproxen), duexis (ibuprofen/famotidine), arthrotec
(diclofenac/misoprostol), yosprala (aspirin/omeprazole)
constipation - CORRECT-ANSWERS-non drug: increase fluids, increase
physical activity, increase fiber in diet, schedule bathroom time
-OTC: fiber, docusate, senna, bisacodyl, glycerin--use OTC for 7 days then
see MD
-1st line: bulk forming: fiber
-alternatives: osmotics (miralax, fleet, MOM, lactulose), stimulants (senna,
bisacodyl)--used for pts taking opioids, stool softners (docusate), lubricants
(mineral oil)
others: Cl channel activator (lubiprostone--amitiza), guanylate cyclase C
agonist (linaclotide--linzess), PAMORAs (alvimopan), 5HT-4 agonists
(prucalopride)
,diarrhea - CORRECT-ANSWERSnon drug: fluids, electrolyte replacement
(ORS--pedialyte)
drug: pepto bismuul, loperamide, diphenoxylate/atropine (lomotil), viberzi
(eluxadoline), dicyclomine
other: rifaximin. alosetron--women only
Ulcerative colitis - CORRECT-ANSWERS-non drug: avoid food triggers
(sorbitol, lactose, alcohol, caffeine), increase fiber, drink water, peppermint,
chamomile
-OTC: vitamins (b12, folate, vitD, calcium, iron, zinc), probiotics, fish oil,
antidiarrheals, antispasmodics (bentyl), -drug: nicotine patches, steroids
(oral or rectal--exacerbations), aminosalicylates (1st line---maintenance)
-alternatives/add on: immunosupressants (TNF inhibitors, tofacitinib
(xeljanz), ustekinumab (stelara), vedolizumab (entiviyo), cyclosporine)
chron's disease - CORRECT-ANSWERS-non drug: avoid food triggers (sorbitol,
lactose, alcohol, caffeine), increase fiber, drink water, peppermint,
chamomile
-OTC: vitamins (b12, folate, vitD, calcium, iron, zinc), probiotics, fish oil,
antidiarrheals, antispasmodics (bentyl), drug: steroids (budosenide--
exacerbations 1st line for mild), mod-sev: immunosupressants (thiopurine,
TNF inhibitors, ustekinumab (stelara), MTX/cyclosporine--off label if cannot
use a thiopurine
motion sickness - CORRECT-ANSWERSnon drug: ginger, peppermint, wrist
band
drug: antihistamines (benadryl, dramamine, meclizine), anticholinergics
(scopolamine trans-behind ear), antiemetics (promethazine)
birth control - CORRECT-ANSWERS-hormonal contraceptives: implants, IUD,
injectables, pill, patch, ring
-temp and cervial mucus method: record temp changes to predict ovulation
(increase in temp)
-barrier methods: diaphragm, condoms
-other: foam. film cream, sponge, spermicide, withdrawal, sterilization
endometriosis - CORRECT-ANSWERScombination oral contraceptive
Heavy menstrual bleeding (menorrhagia) - CORRECT-ANSWERSIUD (mirena),
natazia, lysteda
emergency contraception - CORRECT-ANSWERSIUD (paragard), ullipristal
(ella), levonorgestrel (plan B, next choice)
infertility - CORRECT-ANSWERSclomiphene (SERM, letrozole (aromatase
inhibitor), (leuprolide (gonoadtropin)
, pregnanacy - CORRECT-ANSWERSN/V: pyridoxine
GERD: tums
flatuence: simethicone (gas-x)
constipation: fiber (1st line), docusate, PEG
cough/cold/allergies: cromolyn, antihistamines
pain: APAP
asthma: budosenide
anemia: iron supplements
HTN: labetolol, mehtyldopa, nifedipine
diabetes: insulin
infection: generally safe (PCNs, cephs, erythromyin, azithromycin), vaginal
(topical antifungals), UTI (cephalexin, ampicillin, nitrofurantoin, bactrim
VTE: LMWH
hypothyroidism: keep levo but inc dose 30-50%
hyperthyroidism: PTU (1st trim), methimazole (2nd and 3rd trim)
allergic rhinitis ("allergies") - CORRECT-ANSWERS-non drug: avoid allergen
exposure, nasal irrigation (neti-pot), wetting agents (saline)
-drug: mild (antihistamines), mod-sev (intranasal steroids), decongestants,
opthalamic solution (itchy eyes)
-additional: intranasal cormolyn, montelukast, intranasal ipratoropium
cough - CORRECT-ANSWERS-natural: zinc, vitamin c
-expectorants: guaifenisin (muciniex, robitussin)
-cough suppressants: dextromethorphan, codeine, benzonatate, benadryl
glaucoma - CORRECT-ANSWERS1st line: prostaglandin analogs ("prost"),
opthalmic beta blockers (timolol)--preferred if drops in one eye only
alternatives: miotics (cholinergic)---pilocarpine, CAIs ("amide"), alpha
adrenergic agonists ("nidine"), rho kinase inhibitor (rhopressa)
Conjuctivitis (Pink Eye) - CORRECT-ANSWERSviral: nothing (go away on own)
bacterial: moxifloxacin, neomyocin/polymixin/dexamethasone,
trimethoprin/polymyxin
allergen: mast cell stabilizers (cromolyn), antihistamines (azelastine,
olopatidine, zyrtec)
blepharitis (eyelid inflammation) - CORRECT-ANSWERSmild: warm compress
sev: ATB ointment, steroid eyedrops, artificial tears
chronic dry eye - CORRECT-ANSWERSartificial tears: restatsis,
refresh ,systane
occular redness - CORRECT-ANSWERSnaphzoline, tetrahydrozoline
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