North American Pharmacist Licensure Examination NAPLEX Exam Dumps

1. Which of the following represents the major route of metabolism for acetaminophen?

2. A 15-year-old presents with 6 days of nasal congestion with thin, clear rhinorrhea. She notes mild facial pain but has had no fevers. She feels her symptoms are improving.

What is the most likely cause of her symptoms?

3. A 72-year-old woman suffers from a major depressive episode. She has a history of coronary artery disease, atrial fibrillation on anticoagulation therapy, sick sinus syndrome, glaucoma, and chronic obstructive pulmonary disease.

Which of the following medications is most appropriate for the treatment of her depression?

4. A 20-year-old student came to the emergency department with primary complaints of palpitations, low-grade fever, and anxiety for 2 months. She reports that she is irritable and suffers severe mood swings that is interfering with her sleep and relationships (she admits to crying spells and frequent fights with friends and family). She has also lost 12 pounds in the past 2 months with no apparent alteration in her diet or physical activity (though she is happy with her weight loss). She denies any past medical problems, though her friends have always been worried that she eats too little.

Her temperature is 38.0 C (100.4 F), blood pressure is 148/62 mm Hg, pulse is 122/min and regular, and respiratory rate is 28/min. Examination reveals a bruit heard over the anterior neck, fine tremor of the hands, and warm, moist skin. Her eyes and eyelids do not move together during finger following test (with steady head). Laboratory work is sent, including a thyroid panel, but will not be available until tomorrow morning.

Which of the following is the most appropriate initial management at this time?

5. What is the best anti-thyroid regimen in a pregnant woman who has clinically significant hyperthyroidism?

6. Which of the following is true regarding extent of absorption of drugs?

7. Your patient is a 58-year-old male who presents with onset of severe substernal chest pain and shortness of breath. An ECG reveals an acute STEMI, and he is on his way to the cardiac catheterization suite for percutaneous coronary intervention.

Which of the following drugs used in acute coronary syndromes treated with PCI must undergo oxidation by hepatic P450 enzymes to an active form?

8. A patient with multibacillary leprosy is on dapsone, clofazimine, and rifampin.

Which of the following is true regarding the mechanism of action of the medications listed?

9. You prescribe doxepin to a 37-year-old woman to treat neurotic excoriations on her arms. The patient is concerned about the side effects of this drug.

Which of the following is not a side effect of doxepin:

10. Which of the following illnesses is an example of a type III hypersensitivity reaction?

11. Which of the following is a side effect of valproic acid?

12. A 55-year-old female is receiving chemotherapy for metastatic carcinoma. She threatens to stop her treatment because of severe nausea and vomiting. The oncologist plans to use prochlorperazine to reduce the nausea and vomiting associated with chemotherapeutic agents.

What is the mechanism of action of prochlorperazine?

13. A 27-year-old female with ovarian cancer is undergoing chemotherapy. She develops subsequent renal failure.

Which of the following drugs is most likely responsible for this?

14. Your patient is a 43-year-old male who is experiencing post-operative voiding difficulty after an elective inguinal hernia repair. His post void residual volume was 280 cc.

Which of the following medications is the most appropriate choice of therapy for this patient?

15. Which of the following statements is true regarding Drug-receptor bonds?

16. Which of the following NSAIDs is an Enolic acid derivative?

17. A 67-year-old female presents to your clinic complaining of fatigue, diarrhea, headaches and a loss of appetite. Upon examination you find that she is having some cognitive difficulty. Laboratory results reveal: MCV: 109fL; Hgb: 9g/dL; MMA and homocystine are both elevated. Shilling test is positive.

What is the next best step in the management of this patient?

18. Your patient, a 25-year-old G1P0 female at 26 weeks gestation presents due to an abnormal glucose tolerance test. One week prior, she was given 50 g of oral glucose and demonstrate a venous plasma glucose level of 156 mg/dL one hour later.

Which of the following is the most appropriate next step of management?

19. A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that usually last for several hours and are made worse by the presence of light. She endorses occasional nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and she has no significant past medical history.

Which of the following treatments is considered an abortive therapy for this patient’s underlying condition?

20. An 11-year-old male presents with his mother to your clinic with 5 days of frequent diarrhea, occasionally with streaks of blood mixed in. Stool cultures are pending, but preliminary stool samples demonstrate fecal WBC and RBC.

Assuming the patient is stable enough for outpatient management, what would be the optimal treatment assuming the underlying pathogen is Shigella?

21. A 22-year-old woman adopted a cat. Shortly thereafter, she developed itchy eyes and persistent rhinorrhea. She was clearly allergic to the pet, but desperately wanted to keep it. She tried taking diphenhydramine, but it had intolerable side effects.

Which of the following is a common effect of this type of medication?

22. An 18-year-old female is referred to a dermatologist for treatment of severe acne vulgaris. The dermatologist wants to start her on tetracycline.

What test should the patient have prior to starting treatment?

23. A 7-year-old boy has been suffering from influenza and had been given a drug by his father to decrease his high fever. A few hours later, his father brought him to the emergency room in a comatose state with a papulovesicular rash all over the body, moderate hepatomegaly, and asterixis. Laboratory studies reveal elevated levels of blood ammonia, AST, ALT, and PT. CT scan findings are suggestive for generalized cerebral edema.

The drug the father gave his son is most likely which of the following drugs?

24. A 50-year-old female has been receiving a diuretic for the treatment of essential hypertension. This drug acts by increasing the calcium content of urine and is the drug of choice for reducing acute pulmonary edema in congestive heart failure. Its side effects include ototoxicity and hyperuricemia.

What is the most likely mechanism of action of this drug?

25. A 54-year-old male with a long history of mild persistent asthma on daily fluticasone therapy has been using his albuterol inhaler every day for the past month, and presents requesting a refill.

What changes should be made to his current regimen?

26. 1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

Which of the following medication may increase LN’s Blood glucose?

27. 1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

Which of the following medication may cause tardive dyskinesia when given at a higher dose and for a long duration?

28. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock-out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135 mmol/L.

Which of the following medication may cause psychotic episode such as emotional lability, hallucinations, mania, mood swings and schizophrenic reasons?

29. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

Which of the following medication may significantly cause QT prolongation?

30. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

Which of the following medication/s should LN be on to prevent the most common side effect of hydromorphone?

31. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.

Which of the following medication may increase LN’s potassium?

32. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L.

What is the reason for holding metformin in patients with reduced renal function?

33. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L.

It is recommended to monitor complete blood count in patients on chronic metformin because of what reason?

34. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L.

LN used 5 on-demand bolus doses from the hydromorphone PCA, how much hydromorphone did the patient get in 24 hours?

35. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L.

Which of the following medication’s dose are adjusted for poor renal function?

36. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L. The bioavailability of levothyroxine is roughly 50%.

The physician requests you for a dose recommendation to convert her home dose of 75mcg po daily to intravenous.

What would be the appropriate intravenous dose?

37. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1mg. lock-out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L. Day 3 post-operation LN’s pain was much better and only used 3 mg of hydromorphone in the 24hrs.

Physician wants to change to oral morphine.

What would be your best recommendation?

38. LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock­out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K 5.0mmol/L, Na 135mmol/L.

What is LN’s creatinine clearance using Cockcroft and Gault equation based on IBW?

39. If LN receives Dextrose 5% half Normal Saline with 20 meq of Potassium as IVF at 125mls/hour.

How much dextrose is he getting in 24hrs?

40. You need 51.3 mEq of NaCl to make 1/3 NS 1 liter bag.

How many ml of 23.4% NaCl would you need? (Molecular weight of Na is 23 and Cl is 35.5)

41. Which of the following is/are a risk factor for myopathy with statin therapy?

42. Which of the following is considered first-line therapy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD)?

43. If you mix 30 gm 5% lidocaine cream and 90gm of 0.5% hydrocortisone cream, what percent of lidocaine and hydrocortisone do you have as the end product?

44. In a study where Rivaroxaban was compared to enoxaparin to find total VTE following HIP replacement surgery, there were 17 total VTE out of 1513 patients in the Rivaraoaban group and 57 total VTE out of 1473 patient in the enoxaparin group.

What is the relative risk reduction of using Rivaroxaban over Enoxaparin?

45. An order is received for heparin 18 units per kg per hour on a patient whose weight is 125lb. The IV bag comes as a concentration of 50 units /mL. Calculate the infusion rate in terms of mL/hr.

46. According to the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to ReduceAtherosclerotic Cardiovascular Risk in Adults, which of the following LDL cholesterol thresholds is an indication for high-intensity statin therapy?

47. Injectable Sulfamethoxazole/Trimethoprim comes as 400mg/80mg/5ml. Physician requests you to dose a Sulfamethoxazole/Trimethoprim intravenously for PCP. You know the dose is 15mg/kg/day (based on TMP component) divided q6h.

How many milliliters of Sulfamethoxazole/Trimethoprim of 400mg/80mg/5ml would you need for single dose? Patient weighs 80kg.

48. Which of the following is/are appropriate for pseudomonas skin/soft tissue infections?

49. What is the weight of 1000 ml of serum protein whose specific gravity is 1.27?

50. RL is a 54 YOM who’s calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 18 %.

Which of the following is the most appropriate pharmacotherapy recommendation for CR?