NAPLEX 2024 Questions And Answers
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Key drugs that can cause hypothyroidism - correct answer. "I TALC"
Interferons
Tyrosine Kinase Inhibitors
Amiodarone
Lithium
Carbamazepine
Conditions: Hashimoto's disease
Levothyroxine IV:PO - correct answer. 0.75:1 (IV:PO)
Full replacement dose levothyroxine - correct answer. 1.6 mcg/kg/day (IBW)
If known CAD: start with 12.5-25 mcg daily
Levothyroxine tablet colors - correct answer. Orangutans Will Vomit On You Right
Before They Become Large Proud Giants
25 Orange
50 White (no dye)
75 Violet
88 Olive
100 Yellow
112 Rose
125 Brown
137 Turquoise
150 Blue
175 Lilac
200 Pink
300 Green
,Drug induced causes of hyperthyroidism - correct answer. Iodine
Amiodarone
Interferons
Radiographic contrast media
treatment for thyroid storm - correct answer. Antithyroid (PTU preferred- give 1 hour
before iodide)
Inorganic iodide therapy (SSKI or Lugol's)
Beta Blocker (Propranolol)
Systemic steroid (dexamethasone)
Aggressive cooling (APAP, cooling blankets, supportive treatments)
Hyperthyroid in pregnancy - correct answer. Hyperthyroidism during pregnancy should
be treated with propylthiouracil (PTU) during the first trimester then methimazole during
the second and third trimesters. Although methimazole is a teratogen, the teratogenic
effects are less during the second and third trimesters, and PTU can cause liver failure,
which is why it is substituted out.
Cushing's syndrome - correct answer. Adrenal gland produces too much cortisol or
exogenous steroids are taken in doses higher than normal amounts of endogenous
cortisol
Addison's disease - correct answer. a condition that occurs when the adrenal glands
do not produce enough cortisol; Addisonian crisis (volume depletion and hypotension,
which can be fatal)
Steroids: least to most potent - correct answer. (Cute Hot Pharmacists and Physicians
Marry Together & Deliver Babies)
o Cortisone (25 mg): short acting
o Hydrocortisone (20 mg): short acting
o Prednisone (5 mg): intermediate acting
o Prednisolone (5 mg): intermediate acting
o Methylprednisolone (4 mg): intermediate acting
o Triamcinolone (4 mg): intermediate acting
o Dexamethasone (0.75 mg): long acting, highest potency
o Betamethasone (0.6 mg): long acting, highest potency
Immunosuppression from steroids - correct answer. A patient is immunosuppressed
when using >/= 2mg/kg/day or >/= 20mg/day of prednisone or prednisone equivalent for
>2 weeks
Immunosuppressed patients cannot receive live vaccines and have a high risk of
infection
steroid will need to be slowly tapered off: reduce 10-20% every few days (tapers can
last 7-14 days, longer or shorter)
,Traditional DMARDs (disease modifying anti-rheumatic drugs) - correct answer. MTX
(Trexall): first line in RA
Hydroxychloroquine (Plaquenil)
Sulfasalazine
Leflunomide (Arava)
Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - correct answer.
MTX (Trexall): first line in RA
- irreversibly binds and inhibit dihydrofolate reductase, inhibiting folate
- 7.5 to 20 mg once weekly
- hepatotoxicity (avoid alcohol), myelosuppression, mucosistis/stomatitis, teratogenic
- monitor: CBC, LFTs, chest X-ray, hep B/C
- folate replacement
- renal elimination is decreased by aspirin/NSAIDs
Traditional DMARDs (disease modifying anti-rheumatic drugs): hydroxychloroquine -
correct answer. Hydroxychloroquine (Plaquenil)
- Irreversible retinopathy
- take with food or milk
- alternative to MTX in liver disease
Traditional DMARDs (disease modifying anti-rheumatic drugs): Sulfasalazine - correct
answer. Sulfasalazine
- CI in sulfa/salicylate allergy
- can cause yellow-orange coloration of skin/urine
- caution in patients with G6PD deficiency
Traditional DMARDs (disease modifying anti-rheumatic drugs): Leflunomide - correct
answer. Leflunomide (Arava)
- inhibits pyrimidine synthesis
- teratogenic - must wait 2 years after use to become pregnant or use accelerated drug
elimination (cholestyramine + activated charcoal)
- hepatotoxic
JAK inhibitors - correct answer. Tofacitinib (Xeljanz)
Baracitinib (Olumiant)
Upadacitinib (Rinvoq)
Boxed warnings: serious infections, malignancy, thrombosis
Do not use with biologic DMARDs or potent immunosuppressants
Anti-TNF Biologic DMARDs - correct answer. Etanercept: Enbrel
Adalimumab: Humira
Infliximab: Remicade
Certolizumab: Cimzia
Golimumab: Simponi
, Used for a variety of diseases including RA (typically add on therapy to MTX)
Needles are provided
Each has a pregnancy registry
Boxed warnings: serious infections, malignancies
Warnings: demyelinating desease, hep B reactivations, HF, hepatotoxicity, lupus-like
syndrome, seizures, myelosuppression
Can cause: injection site reactions, infection, liver damage, HF
*Do NOT use with other biologic DMARDs or live vaccines
Notes: do not shake or freeze, requires refrigeration
Anti-TNF Biologic DMARDs: Etancercept - correct answer. Enbrel
SC weekly
CI: doses greater than 5 mg/kg in sepsis
stored at RT for max of 14 days
inject SC into abdomen, thigh, or upper arm
Anti-TNF Biologic DMARDs: Adalimumab - correct answer. Humira
every other week dosing
stored at RT for max of 14 days
inject SC into abdomen or thigh
Anti-TNF Biologic DMARDs: Infliximab - correct answer. Remicade
Weeks 0, 2, and 6, then every 8 weeks (can treat every 4 weeks based on need)
Requires filter and is stable in NS only
Infusion rxns and delayed hypersensitivity rxns (3-12 days after admin)
Anti-TNF Biologic DMARDs: Certolizumab pegol - correct answer. Cimzia
Every other week
Anti-TNF Biologic DMARDs: Golimumab - correct answer. Simponi
Monthly
IV requires a filter
Inject SC into the abdomen, thigh, or upper arm
Other Biologic DMARDs (Non-TNF inhibitors) - correct answer. Rituximab: Rituxan
(depletes CD20)
Anakinra: Kineret
Abatacept: Orencia
Tocilizumab: Actemra
Sarilumab: Kevzara
Other Biologic DMARDs (Non-TNF inhibitors): Rituximab - correct answer. Rituxan
Depletes CD20 B cells
Premedicate with steroid, APAP, antihistamine
Boxed warnings: serious, fatal, infusion-related rxns, HBV reactivation
