# Sample Question On Calculating Metabolic acidosis Anion Gap

The laboratory finding reveals that 57 year-old patient is suffering from metabolic acidosis. What kind of metabolic acidosis is he suffering from?

ABG: 7.21/32/98
100% O2 Sat on Room Air
Electrolytes: Na 145 mEq/L, K 4.5 mEq/L, Cl 105 mEq/L, HCO3 25 mEq/L

a.            Anion-gap metabolic acidosis
b.            Non-Anion-gap metabolic acidosis
c.             Cation gap metabolic acidosis
d.            Non-Cation-gap metabolic acidosis

The laboratory finding reveals that 57 year-old patient is suffering from metabolic acidosis. What kind of metabolic acidosis is he suffering from?

ABG: 7.21/32/98
100% O2 Sat on Room Air
Electrolytes: Na 145 mEq/L, K 4.5 mEq/L, Cl 105 mEq/L, HCO3 25 mEq/L

a.            Anion-gap metabolic acidosis
b.            Non-Anion-gap metabolic acidosis
c.             Cation gap metabolic acidosis
d.            Non-Cation-gap metabolic acidosis

Answer(a):  If the patient is suffering from metabolic acidosis (low pH with low HCO3), the next step is to calculate the anion gap because the anion gap helps determining the etiology of the metabolic acidosis.

The anion gap is the difference between the measured serum cations (positively charged particles) and the measured serum anions (negatively charged particles). The commonly measured cation is sodium and the measured anions include chloride and bicarbonate.

Anion gap = [Na+] - ([Cl-] + [HCO3-])

The normal anion gap value is between 8 and 12. An anion gap of greater than 12 is "increased".

The differential diagnosis for an elevated anion gap metabolic acidosis (simply called "anion gap acidosis") differs from the differential diagnosis for an non-elevated anion gap metabolic acidosis (simply called "non-anion gap acidosis").

So, in the above example:

Anion gap = [Na+] - ([Cl-] + [HCO3-])

Anion gap = 145 - (105 + 25)

Anion gap = 15

The calculated anion gap = 15(above the normal gap of 8-12), therefore there is an anion gap acidosis.

# Naplex Sample Question on Promethazine and Codeine

NABP reports a recent rise in forged prescriptions for Promethazine with Codeine. Promethazine with codeine, a Schedule V CS, has been used for years as a cough medication. Abusers commonly refer to it as:

a. Elixir of Heaven
b. Purple Drank
c. Orange Cocktail
d. Levoni's Drink
e. ProCod Mix

NABP reports a recent rise in forged prescriptions for Promethazine with Codeine. Promethazine with codeine, a Schedule V CS, has been used for years as a cough medication. Abusers commonly refer to it as:

a. Elixir of Heaven
b. Purple Drank
c. Orange Cocktail
d. Levoni's Drink
e. ProCod Mix

Answer: (b) Purple Drank. NABP reports a recent rise in forged prescriptions for promethazine with codeine. Promethazine with codeine, a Schedule V CS, has been used for years as a cough medication. Abusers commonly refer to it as "purple drank." "Purple drank" is a combination of promethazine with codeine mixed with a carbonated soda, such as Sprite or Mountain Dew, and candy, such as crushed Jolly Ranchers, mixed in for additional flavor.

The NABP has seen an increase in forged prescriptions for promethazine with codeine, and pharmacists have unknowingly filled them across United States in recent months. Pharmacists should be on the alert for promethazine with codeine prescriptions and perform due diligence in confirming that the prescription is legitimate.

Look for common red flags such as a prescription being presented right before closing, an out-of-the-area prescriber you do not recognize, a patient you do not recognize, a large quantity or exact quantity for "473 mL," or a cash-paying patient you do not know.

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# Naplex Sample Question on PMP InterConnect

Which of the following information is/are TRUE about PMP InterConnect?

I. InterConnect is comprehensive and thorough tool for prescribers and dispensers to use in identifying potential opioid abuse.

II. InterConnect is a highly secure communications exchange platform that facilitates the transmission of PMP data across state lines to authorized requestors, while ensuring that each state's data-access rules are enforced.

III. It is mandatory for all states to participate in PMP Interconnect.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Which of the following information is/are TRUE about PMP InterConnect?

I. InterConnect is comprehensive and thorough tool for prescribers and dispensers to use in identifying potential opioid abuse.

II. InterConnect is a highly secure communications exchange platform that facilitates the transmission of PMP data across state lines to authorized requestors, while ensuring that each state's data-access rules are enforced.

III. It is mandatory for all states to participate in PMP Interconnect.

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: (I and II only). PMP InterConnect is a highly secure communications exchange platform that facilitates the transmission of PMP data across state lines to authorized requestors, while ensuring that each state's data-access rules are enforced.
It is comprehensive and thorough tool for prescribers and dispensers to use in identifying potential opioid abuse.

The benefits of state PMPs are enhanced by PMP InterConnect because the system provides the means for physicians and pharmacists to more easily identify patients with prescription drug abuse and misuse problems, especially if those patients are crossing state lines to obtain drugs.

Utilizing the program's connected web of information allows appropriate intervention and aid in the prevention of substance abuse and diversion of controlled substances.

Additional information about PMP InterConnect, including a map of participants, is available in the Programs section of the NABP website.
It is NOT MANDATORY for states to participate in PMP InterConnect.

NABP also continues to work with other states to facilitate their participation.

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# A List of Drugs with Their Normal Therapeutic Concentrations.

A List of Drugs with Their Normal Therapeutic Concentrations.

A List of Drugs with Their Normal Therapeutic Concentrations.

Amikacin: 15 to 25 mcg/mL
Aminophylline: 10 to 20 mcg/mL
Amitriptyline: 120 to 150 ng/mL
Carbamazepine: 5 to 12 mcg/mL
Cyclosporine: 100 to 400 ng/mL (12 hours after dose)
Desipramine: 150 to 300 ng/mL
Digoxin: 0.8 to 2.0 ng/mL
Disopyramide: 2 to 5 mcg/mL
Ethosuximide: 40 to 100 mcg/mL
Flecainide: 0.2 to 1.0 mcg/mL
Gentamicin: 5 to 10 mcg/mL
Imipramine: 150 to 300 ng/mL
Kanamycin: 20 to 25 mcg/mL
Lidocaine: 1.5 to 5.0 mcg/mL
Lithium: 0.8 to 1.2 mEq/L
Methotrexate: varies with use
Nortriptyline: 50 to 150 ng/mL
Phenobarbital: 10 to 30 mcg/mL
Phenytoin: 10 to 20 mcg/mL
Primidone: 5 to 12 mcg/mL
Procainamide: 4 to 10 mcg/mL
Quinidine: 2 to 5 mcg/mL
Salicylate: varies with use
Sirolimus: 4 to 20 ng/mL (12 hours after dose; varies with use)
Tacrolimus: 5 to 15 ng/mL (12 hours after dose)
Theophylline: 10 to 20 mcg/mL
Tobramycin: 5 to 10 mcg/mL
Valproic acid: 50 to 100 mcg/mL

# Naplex Sample Questions Tall Man Letters

Which of the following information is TRUE ABOUT Tall Man Letters? [Select All that apply].

a. Several studies have shown that highlighting sections of words using tall man lettering can make similar drug names easier to distinguish.

b. The Institute for Safe Medication Practices (ISMP), the FDA, The Joint Commission, and other safety-conscious organizations such as the National Association of Boards of Pharmacy (NABP) have promoted the use of tall man letters as one means of reducing confusion between similar drug names.

c. Nearly all of surveyed (87%) conducted by ISMP for Tall Man Letters felt that the use of tall man letters by the medical product industry helped to reduce errors in drug selection.

d. Approximately 50% of all survey respondents reported using tall man letters in conjunction with pharmacy-generated product and shelf labels, computer screens, and medication administration records.

e. Use of the tall man letters on computer-generated pharmacy labels was the most prevalent and was considered to be most effective, whereas use of the letters on preprinted order forms was among the least prevalent and was considered to be least effective.

Which of the following information is TRUE ABOUT Tall Man Letters? [Select All that apply].

a. Several studies have shown that highlighting sections of words using tall man lettering can make similar drug names easier to distinguish.

b. The Institute for Safe Medication Practices (ISMP), the FDA, The Joint Commission, and other safety-conscious organizations such as the National Association of Boards of Pharmacy (NABP) have promoted the use of tall man letters as one means of reducing confusion between similar drug names.

c. Nearly all of surveyed (87%) conducted by ISMP for Tall Man Letters felt that the use of tall man letters by the medical product industry helped to reduce errors in drug selection.

d. Approximately 50% of all survey respondents reported using tall man letters in conjunction with pharmacy-generated product and shelf labels, computer screens, and medication administration records.

e. Use of the tall man letters on computer-generated pharmacy labels was the most prevalent and was considered to be most effective, whereas use of the letters on preprinted order forms was among the least prevalent and was considered to be least effective.

Answer: (a,b,c,d and e). Tall man (uppercase) letters are used within a drug name to highlight its primary dissimilarities and help to differentiate look-alike names. Several studies have shown that highlighting sections of words using tall man lettering can make similar drug names easier to distinguish, and fewer errors are made when tall man letters are used to differentiate products with look-alike names.

The Institute for Safe Medication Practices (ISMP), the FDA, The Joint Commission, and other safety-conscious organizations such as the National Association of Boards of Pharmacy (NABP) have promoted the use of tall man letters as one means of reducing confusion between similar drug names.

From a survey conducted by the ISMP in 2008, most respondents appeared to agree. Nearly all of those surveyed (87%) felt that the use of tall man letters by the medical product industry helped to reduce errors in drug selection, and two-thirds (64%) reported that tall man lettering actually prevented them from dispensing or administering the wrong medication.

A fully alphabetized list of drug names with tall man lettering can be found at www.ismp.org/Tools/tallmanletters.pdf.

TallMan Letter

Approximately 50% of all survey respondents reported using tall man letters in conjunction with pharmacy-generated product and shelf labels, computer screens, and medication administration records. Half to three-quarters of respondents who used tall man letters with look-alike drug name pairs felt that this strategy was effective in reducing the risk of errors, depending on where it was used.

Use of the tall man letters on computer-generated pharmacy labels was the most prevalent and was considered to be most effective, whereas use of the letters on preprinted order forms was among the least prevalent and was considered to be least effective. In general, between one-quarter and one-third of respondents were undecided about the effectiveness of tall man letters, but very few reported that the letters were wholly ineffective in reducing the risk of errors. The use of tall man letters was less widely reported for drugs listed on prescriber order entry screens and smart pump libraries.

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# Naplex Sample Question on Invokana Mechanism of Action

Which of the following statements correctly describes the mechanism of action of Invokana (Canagliflozin)?

a. Increase insulin sensitivity towards blood glucose.
b. Stimulates insulin release from functioning beta cells of pancreas.
c. Delayed the absorption of glucose from gut to blood.
d. Increase gluconeogenesis in the liver.
e. Increase excretion of glucose through kidney.

Which of the following statements correctly describes the mechanism of action of Invokana (Canagliflozin)?

a. Increase insulin sensitivity towards blood glucose.
b. Stimulates insulin release from functioning beta cells of pancreas.
c. Delayed the absorption of glucose from gut to blood.
d. Increase gluconeogenesis in the liver.
e. Increase excretion of glucose through kidney.

Answer: (e). Sodium-glucose co-transporter 2 (SGLT2), expressed in the proximal renal tubules, is responsible for the majority of the reabsorption of filtered glucose from the tubular lumen. Canagliflozin is an inhibitor of SGLT2. By inhibiting SGLT2, Canagliflozin reduces reabsorption of filtered glucose and lowers the renal threshold for glucose (RTG), and thereby increases urinary glucose excretion (UGE).

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# Naplex Sample Question On Invokana Drug Interaction

Which of the following drugs interacts with Invokana (Canagliflozin)? [SELECT All THAT APPLY]

a. Digoxin
b. Rifampin
c. Ketoconazole
d. Trazodone

Which of the following drugs interacts with Invokana (Canagliflozin)? [SELECT All THAT APPLY]

a. Digoxin
b. Rifampin
c. Ketoconazole
d. Trazodone

Answer: (a and b). Co-administration of Canagliflozin with rifampin, a nonselective inducer of several UGT enzymes, including UGT1A9, UGT2B4, decreased Canagliflozin area under the curve (AUC) by 51%. This decrease in exposure to Canagliflozin may decrease efficacy.

If an inducer of these UGTs (e.g., rifampin, phenytoin, phenobarbital, ritonavir) must be co-administered with Invokana (Canagliflozin) (Canagliflozin), consider increasing the dose to 300 mg once daily if patients are currently tolerating Invokana (Canagliflozin) 100 mg once daily, have an eGFR greater than 60 mL/min/1.73 m2, and require additional glycemic control.

Consider other antihyperglycemic therapy in patients with an eGFR of 45 to less than 60 mL/min/1.73 m2 receiving concurrent therapy with a UGT inducer and require additional glycemic control.

There was an increase in the AUC and mean peak drug concentration (Cmax) of digoxin (20% and 36%, respectively) when co-administered with Invokana (Canagliflozin) 300 mg. Patients taking Invokana (Canagliflozin) with concomitant digoxin should be monitored appropriately.

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# Warning - Please be aware of the scam

By

WARNING!

Please be aware of the scam, originally brought to our attention by one of our customer. This company website URL is rx-exam.com. The website phone number is 123-456-7890 - which itself suggests it is a fraud. They are claiming to sell materials from their websites for various pharmacy related exams. All materials are offered for online purchase. Many customers have lost their money since after purchasing using credit cards; they don't receive any material.

Please DO NOT PURCHASE any material from this site www.rx-exam.com.

PharmacyExam (RxExam) is not affiliated with this company and bears no responsibility for any financial loss. Please pass this message to your friends. The authenticated web site for our company is www.pharmacyexam.com

Thank you.

Founder and President

Manan Shroff

WARNING!

Please be aware of the scam, originally brought to our attention by one of our customer.This company website URL is rx-exam.com. The website phone number is 123-456-7890 - which itself suggests it is a fraud.They are claiming to sell materials from their websites for various pharmacy related exams. All materials are offered for online purchase. Many customers have lost their money since after purchasing using credit cards; they don't receive any material.

PleaseDO NOT PURCHASEany material from this sitewww.rx-exam.com.

PharmacyExam (RxExam) is not affiliated with this company and bears no responsibility for any financial loss. Please pass this message to your friends. The authenticated web site for our company iswww.pharmacyexam.com

Thank you.

Founder and President

Manan Shroff

By

Test 3

Test 3

# RxExam Sample Question on Naplex Veklury

a. IV infusion
b. Subcutaneously
c. Intramuscularly
d. Orally
e. Rectally

a. IV infusion
b. Subcutaneously
c. Intramuscularly
d. Orally
e. Rectally

Answer: (a). The active ingredient found in Veklury is Remdesivir. Veklury (Remdesivir) is authorized for use under an Emergency Use Authorization (EUA) only for the treatment of adult and pediatric patients hospitalized with suspected or laboratory-confirmed COVID-19, and for whom use of an intravenous (IV) agent is clinically appropriate. Veklury must be administered via IV infusion. It is only administered intravenously in a hospital setting under the care of a physician.

Remdesivir is an adenosine nucleotide prodrug that distributes into cells where it is metabolized to form the pharmacologically active nucleoside triphosphate metabolite. Metabolism of Remdesivir to Remdesivir triphosphate has been demonstrated in multiple cell types. Remdesivir triphosphate acts as an analog of adenosine triphosphate (ATP) and competes with the natural ATP substrate for incorporation into nascent RNA chains by the SARS-CoV-2 RNA-dependent RNA polymerase, which results in delayed chain termination during replication of the viral RNA. Remdesivir triphosphate is a weak inhibitor of mammalian DNA and RNA polymerases with low potential for mitochondrial toxicity.

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