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NAPLEX 2023 QUESTIONS AND ANSWERS
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NAPLEX 2023 QUESTIONS AND ANSWERS
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NAPLEX 2023 QUESTIONS ANDANSWERS
Keytdrugstthattcantcausethypothyroidismt-tans✔✔"ItTALC"
Interferons
TyrosinetKinasetInhibitors
Amiodarone
Lithium
Carbamazepine
Conditions:tHashimoto'stdisease
LevothyroxinetIV:POt-tans✔✔0.75:1t(IV:PO)
Fulltreplacementtdosetlevothyroxinet-tans✔✔1.6tmcg/kg/dayt(IBW)
IftknowntCAD:tstarttwitht12.5-25tmcgtdaily
Levothyroxinettablettcolorst-
tans✔✔OrangutanstWilltVomittOntYoutRighttBeforetTheytBecometLargetProudtGiants
25tOrange
50tWhitet(notdye)
75tViolet
88tOlive
100tYellow
112tRose
125tBrown
137tTurquoise
150tBlue
175tLilac
200tPink
300tGreen
Drugtinducedtcausestofthyperthyroidismt-tans✔✔Iodine
Amiodarone
,Interferons
Radiographictcontrasttmedia
treatmenttfortthyroidtstormt-tans✔✔Antithyroidt(PTUtpreferred-tgivet1thourtbeforetiodide)
Inorganictiodidettherapyt(SSKItortLugol's)
BetatBlockert(Propranolol)
Systemictsteroidt(dexamethasone)
Aggressivetcoolingt(APAP,tcoolingtblankets,tsupportivettreatments)
Hyperthyroidtintpregnancyt-
tans✔✔Hyperthyroidismtduringtpregnancytshouldtbettreatedtwithtpropylthiouracil t(PTU)tdur
ingtthetfirstttrimestertthentmethimazoletduringtthetsecondtandtthirdttrimesters.tAlthoughtmet
himazoletistatteratogen,tthetteratogenicteffectstaretlesstduringtthetsecondtandtthirdttrimester
s,tandtPTUtcantcausetlivertfailure,twhichtistwhytittistsubstitutedtout.
Cushing'stsyndromet-
tans✔✔Adrenaltglandtproducesttootmuchtcortisoltortexogenouststeroidstarettakentintdosest
highertthantnormaltamountstoftendogenoustcortisol
Addison'stdiseaset-
tans✔✔atconditiontthattoccurstwhentthetadrenaltglandstdotnottproducetenoughtcortisol;tAdd
isoniantcrisist(volumetdepletiontandthypotension,twhichtcantbetfatal)
Steroids:tleastttotmosttpotentt-
tans✔✔(CutetHottPharmacists tandtPhysicianstMarrytTogethert&tDelivertBabies)t
otCortisonet(25tmg):tshorttacting
otHydrocortisonet(20tmg):tshorttacting
otPrednisonet(5tmg):tintermediatetacting
otPrednisolonet(5tmg):tintermediatetacting
otMethylprednisolonet(4tmg):tintermediatetacting
otTriamcinolonet(4tmg):tintermediatetacting
otDexamethasonet(0.75tmg):tlongtacting,thighesttpotency
otBetamethasonet(0.6tmg):tlongtacting,thighesttpotency
Immunosuppressiontfromtsteroidst-
tans✔✔Atpatienttistimmunosuppressed twhentusingt>/=t2mg/kg/daytort>/=t20mg/
daytoftprednisonetortprednisonetequivalenttfort>2tweekst
Immunosuppressedtpatientstcannottreceivetlivetvaccinestandthavetathightrisktoftinfectiont
steroidtwilltneedttotbetslowlyttaperedtoff:treducet10-20%teverytfewtdayst(taperstcantlastt7-
14tdays,tlongertortshorter)
TraditionaltDMARDst(diseasetmodifyingtanti-rheumatictdrugs)t-
tans✔✔MTXt(Trexall):tfirsttlinetintRA
Hydroxychloroquinet(Plaquenil)
,Sulfasalazine
Leflunomidet(Arava)
TraditionaltDMARDst(diseasetmodifyingtanti-rheumatictdrugs):tMTXt-
tans✔✔MTXt(Trexall):tfirsttlinetintRA
-tirreversiblytbindstandtinhibittdihydrofolatetreductase,tinhibitingtfolate
-t7.5ttot20tmgtoncetweekly
-thepatotoxicityt(avoidtalcohol),tmyelosuppression,tmucosistis/stomatitis,tteratogenic
-tmonitor:tCBC,tLFTs,tchesttX-ray,theptB/Ct
-tfolatetreplacement
-trenalteliminationtistdecreasedtbytaspirin/NSAIDs
TraditionaltDMARDst(diseasetmodifyingtanti-rheumatictdrugs):thydroxychloroquinet-
tans✔✔Hydroxychloroquine t(Plaquenil)
-tIrreversibletretinopathy
-ttaketwithtfoodtortmilk
-talternativettotMTXtintlivertdisease
TraditionaltDMARDst(diseasetmodifyingtanti-rheumatictdrugs):tSulfasalazinet-
tans✔✔Sulfasalazine
-tCItintsulfa/salicylatetallergy
-tcantcausetyellow-orangetcolorationtoftskin/urine
-tcautiontintpatientstwithtG6PDtdeficiency
TraditionaltDMARDst(diseasetmodifyingtanti-rheumatictdrugs):tLeflunomidet-
tans✔✔Leflunomidet(Arava)
-tinhibitstpyrimidinetsynthesis
-tteratogenict-
tmusttwaitt2tyearstaftertusettotbecometpregnant tortusetacceleratedtdrugteliminationt(cholest
yraminet+tactivatedtcharcoal)
-thepatotoxic
JAKtinhibitorst-tans✔✔Tofacitinibt(Xeljanz)
Baracitinibt(Olumiant)
Upadacitinibt(Rinvoq)
Boxedtwarnings:tserioustinfections,tmalignancy,tthrombosis
DotnottusetwithtbiologictDMARDstortpotenttimmunosuppressants
Anti-TNFtBiologictDMARDst-tans✔✔Etanercept:tEnbrelt
Adalimumab:tHumira
Infliximab:tRemicadet
Certolizumab:tCimzia
Golimumab:tSimponi
UsedtfortatvarietytoftdiseasestincludingtRAt(typicallytaddtonttherapyttotMTX)
Needlestaretprovidedt
, Eachthastatpregnancytregistry
Boxedtwarnings:tserioustinfections,tmalignancies
Warnings:tdemyelinatingtdesease,theptBtreactivations,tHF,thepatotoxicity,tlupus-
liketsyndrome,tseizures,tmyelosuppression
Cantcause:tinjectiontsitetreactions,tinfection,tlivertdamage,tHF
*DotNOTtusetwithtothertbiologictDMARDstortlivetvaccines
Notes:tdotnottshaketortfreeze,trequirestrefrigeration
Anti-TNFtBiologictDMARDs:tEtancerceptt-tans✔✔Enbrel
SCtweekly
CI:tdosestgreatertthant5tmg/kgtintsepsis
storedtattRTtfortmaxtoft14tdays
injecttSCtintotabdomen,tthigh,tortuppertarm
Anti-TNFtBiologictDMARDs:tAdalimumabt-tans✔✔Humira
everytothertweektdosing
storedtattRTtfortmaxtoft14tdays
injecttSCtintotabdomentortthigh
Anti-TNFtBiologictDMARDs:tInfliximabt-tans✔✔Remicade
Weekst0,t2,tandt6,tthenteveryt8tweekst(canttreatteveryt4tweekstbasedtontneed)
RequirestfiltertandtiststabletintNStonly
Infusiontrxnstandtdelayedthypersensitivitytrxnst(3-12tdaystaftertadmin)
Anti-TNFtBiologictDMARDs:tCertolizumabtpegolt-tans✔✔Cimziat
Everytothertweek
Anti-TNFtBiologictDMARDs:tGolimumabt-tans✔✔Simponi
Monthly
IVtrequirestatfilter
InjecttSCtintotthetabdomen,tthigh,tortuppertarm
OthertBiologictDMARDst(Non-TNFtinhibitors)t-tans✔✔Rituximab:tRituxant(depletestCD20)t
Anakinra:tKineret
Abatacept:tOrenciat
Tocilizumab:tActemra
Sarilumab:tKevzara
OthertBiologictDMARDst(Non-TNFtinhibitors):tRituximabt-tans✔✔Rituxant
DepletestCD20tBtcells
Premedicatetwithtsteroid,tAPAP,tantihistamine
Boxedtwarnings:tserious,tfatal,tinfusion-relatedtrxns,tHBVtreactivation
Warnings:tdotnottgivetwithtothertbiologictDMARDstortlivetvaccines
OthertBiologictDMARDst(Non-TNFtinhibitors):tAnakinrat-tans✔✔Kineret
IL-1treceptortantagonist
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