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NABP NAPLEX 認定試験の出題範囲：
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質問 56
Which of the following antidiabetic medication may cause cyanocobalamin deficiency?
- A. Glimepiride
- B. Metformin
- C. Pioglitazone
- D. Saxagliptin
- E. Canagliflozin
正解: B
解説:
Explanation
Metformin is associated with vitamin B12 deficiency because it affects the calcium dependent membrane uptake of it. All other drug classes are not associated with this.
質問 57
FT is a 23-year-old newly diagnosed type I diabetes admitted to the hospital due to diabetes ketoacidosis. 2 days after being on insulin drip, anion gap is closed. Physician would like your help in transitioning her to subcutaneous insulin. She suggests using insulin glargine once a day and Insulin lispro three time a day at ratio of 70:30. 70 % of long and 30 % of short acting insulin. FT received average of 70 units of insulin in 24hrs.
Which of the following would be the best insulin regimen?
- A. 40 units of Insulin Glargine subcutaneous daily and 10 units of Insulin Lispro subcutaneous three times a day with meals
- B. 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals
- C. 52 units of Insulin Glargine subcutaneous daily and 6 units of Insulin Lispro subcutaneous three times a day with meals
- D. 25 units of Insulin Glargine subcutaneous daily and 15 units of Insulin Lispro subcutaneous three times a day with meals
- E. 46 units of Insulin Glargine subcutaneous daily and 8 units of Insulin Lispro subcutaneous three times a day with meals
正解: B
解説:
Explanation
70% of 70 units = 49 units of Insulin Glargine daily 30% of 70 units = 21 units of Insulin Lispro daily. Dived in 3 doses would be 7 units three times a day. FT's Insulin regimen should be 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals
質問 58
Mesna is typically administered alongside which of these chemotherapeutic agents?
- A. Paclitaxel
- B. Ifosfamide
- C. Doxorubicin
- D. Busulfan
正解: B
解説:
Explanation
Mesna is administered to patients taking either ifosfamide or cyclophoshamide to conjugate toxic acrolein and therefore prevent hemorrhagic cystitis (bladder bleeding).
質問 59
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Pancreases (A)
- A. Sulfonylureas
- B. Glucagon-like peptide-1 receptor agonists
- C. SGLT2 inhibitors
- D. DPP4 Inhibitors
- E. Thiazolidinediones
- F. Biguanide
- G. Alpha- Glucosidase Inhibitors
正解: B
解説:
(A) Sulfonylureas, (C) DPP4 Inhibitors, (D) Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia.Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletaland cardiac muscle, liver,and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.
質問 60
Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?
- A. Carvedilol
- B. Bisoprolol
- C. Nadolol
- D. Metoprolol Tartrate
- E. Metoprolol succinate
正解: D
解説:
Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained- release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials.
Reference:
http://circ.ahajournals.org/content/128/16/e240
質問 61
What is the amount of potassium permanganate in 300mL of a 1 in 25 solution?
- A. 1 gram
- B. 14 grams
- C. 12 grams
- D. 8 grams
正解: C
解説:
Explanation
We have 1g of potassium permanganate in 25mL We have 300mL of solution
For every 25mL of that 300mL, we have 1g of KmnO4
300mL must have 12g of potassium permanganate (300ml/25mL)
質問 62
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 20 K at
125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 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?
- A. Famotidine
- B. Metoclopramide
- C. Dexamethasone
- D. Lisinopril
- E. Hydromorphone
正解: B
解説:
Explanation
Metoclopramide may cause tardive dyskinesia when given at a higher dose and for a long duration of time of more than 3 months. Tardive dyskinesia is also listed as a Boxed Warning for metoclopramide. Tardive dyskinesia is a serious movement disorder that is irreversible. The risk increases with duration of treatment and the total cumulative dose. If signs or symptoms of tardive dyskinesia develop, then metoclopramide should be discontinued. There is currently no known treatment for it, but symptoms can lessen or resolve after metoclopramide is stopped. Treatment should not be more than 12 weeks unless the benefits outweigh the risks of developing tardive dyskinesia.
質問 63
TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.
While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt's home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.
What would be the most appropriate change to make on her therapy?
- A. Change Simvastatin 40mg to Atorvastatin 40mg po daily
- B. Increase Simvastatin to 80mg po daily
- C. Change Simvastatin to Lovastatin 20mg po daily
- D. Keep Simvastatin at 40mg po daily
- E. Discontinue Statins.
正解: A
解説:
Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.
Reference:
http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm
http://circ.ahajournals.org/content/129/25_suppl_2/S1
質問 64
A Physician orders amiodarone 1 mg/min for six hours, then 0.5 mg/min thereafter. The patient's weight is
156 lbs. The concentration of the IV bag comes as 1.8 mg per ml. Calculate the infusion rate in mL/hr.
- A. 30mls/hr then 15mls/hr
- B. 8.3mls/hr then 4.15mls/hr
- C. 33.33mls/hr then /16.67mls/hr
- D. 60mls/hr then 30mls/hr
- E. 16.67mls/hr then 8.3mls/hr
正解: C
解説:
Explanation
[1 mg/ 1 min] * 60min= 60mg/hr. 60 mg/hr * [1 mL/ 1.8 mg] = 33.33 mL/hr 0.5 mg/min * [60 min/ 1 hr] = 30 mg/hr 30 mg/hr * [1 mL/1.8 mg] = 16.67 mL/hr Infusion rates: 33.33 mL/hr for 6 hours, then 16.67 mL/hr
質問 65
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. 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.
Which of the following medication's dose are adjusted for poor renal function?
- A. Famotidine
- B. Ondansetron
- C. Citalopram
- D. Metoclopramide
- E. Lisinopril
正解: D
解説:
Explanation
Famotidine and Metoclopramide would need to be adjusted for poor renal function. Since his CrCl is less than
50, famotidine would need to be adjusted by decreasing the dose by 50% or increasing the interval to every 36 to 48 hours. Metoclopramide would also need to be adjusted by 50% of the normal dose since his CrCl is less than 40. ACEInhibitors and ARBs should be held if serum K is greater than 5.6 or there is a rise in serum creatinine greater than 30% after initiation.
質問 66
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?
- A. Ondansetron for N/V
- B. Dexamethasone for N/V
- C. Docusate sodium / Senna for Constipation
- D. Docusate sodium / Senna for Constipation and ondansetron for N/V
- E. Insulin Sliding scale for hyperglycemia
正解: D
解説:
LN should be on docusate sodium/Senna for constipation and ondansetron for N/V. Dexamethasone has an off label use for N/V that is chemotherapy-associated. It is mostly used as an anti-inflammatory or immunosuppressant agent. Hydromorphone does not cause hyperglycemia. The most common side effects of opioids are nausea, vomiting and constipation.
質問 67
In the US Nurses' Health Study (NHS) cohort study, where they looked at association of regular aspirin use (≥two 325 mg tablets/week) and colorectal cancer in 82,911 women found (RR, 0.77; 95% CI, 0.67-0.88) over
20 years of follow-up.
In an another analysis of the NHS, regular aspirin use, investigator also found (hazard ratio [HR]=0.72, 95% CI
0.56-0.92), what does this say about the mortality from colorectal cancer? How can this data best be interpreted?
- A. Those who takes aspirin ≥2 times/week have 28% lower risk of colorectal cancer
- B. Those who takes aspirin ≥2 times/week have 23% reduction in death from colorectal cancer
- C. Those who takes aspirin ≥2 times/week have 0.77% lower risk of colorectal cancer
- D. Those who takes aspirin ≥2 times/week have 23% lower risk of colorectal cancer
- E. None of the above is correct
正解: D
解説:
Explanation/Reference:
Explanation:
Relative risk can be stated as 0.77 times as likely or 0.77 times the risk, but it could also be illustrated as a relative risk reduction and stated as a 23% risk reduction or 23% lower risk by taking the medication.
Reference:
https://www.ncbi.nlm.nih.gov/books/NBK63647/
質問 68
What is the best anti-thyroid regimen in a pregnant woman who has clinically significant hyperthyroidism?
- A. Methimazole
- B. Stop treatment and resume post-partum
- C. Methimazole first trimester followed by propylthiouracil for the remainder of pregnancy
- D. Propylthiouracil first trimester followed by methimazole for the remainder of pregnancy
- E. Propylthiouracil
正解: D
解説:
Explanation
Propylthiouracil (PTU) is recommended for treatment of hyperthyroidism in women who are in their first trimester of pregnancy by the American Thyroid Association (ATA). Methimazole has been associated with congenital malformations including aplasia cutis in rare cases and thus it is not recommended in the first trimester. The ATA recommends switching to methimazole once in the second trimester as there is a risk of liver injury associated with the use of PTU.
質問 69
Which of the following are non-pharmacological measure that may control symptoms of gastroesophageal reflux disease?
- A. lower esophageal sphincter tone
- B. Discontinue nicotine use in patients that uses tobacco product.
- C. Increase fat intake to reduce gastric emptying time Reduce intake of food or beverage that may reduce
- D. Remain upright after a meal
- E. Wear tight fitted cloths to increase intra-abdominal pressure.
正解: B
解説:
Explanation
Non-pharmacological measure that may control symptoms of gastroesophageal reflux disease are: Avoid aggravating foods/beverages that may reduce LES pressure alcohol, citrus juices caffeine, garlic, onions or cause direct irritation such as spicy foods or tomato juice should be avoided. Reduce fat intake, remain upright after meals, avoid meal before bedtime. Avoid tight fitted cloths, decrease intra-abdominal pressure.
Discontinue nicotine use. Reduce intake of food or beverage that may reduce lower esophageal sphincter tone.
質問 70
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. 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.
What is LN's creatinine clearance using Cockcroft and Gault equation based on IBW?
- A. 53 mls/min
- B. 33 mls/min
- C. 23 mls/min
- D. 63 mls/min
- E. 43 mls/min
正解: B
解説:
Explanation/Reference:
Explanation:
ABW = 85 kg IBW = 50 kg + 2.3 kg (4) = 59.2 kg 85/59.2 = 1.44 AdjBW = 59.2 kg + 0.4(85 kg-59.2 kg) = 69.52 kg CrCl (IBW) = [(140-84) 59.2]/(72 × 1.4) = 32.8 CrCl (AdjBW) = [(140-84) 69.52]/(72 × 1.4) = 38.6
質問 71
Which of the following is/are nominal data?
- A. Stages of breast cancer
- B. Sex
- C. Blood Group
- D. NYHA stages I-IV
- E. Race
正解: C
解説:
Nominal data is considered unordered categories. Sex answers fall into male or female which is unordered.
Race can be multiple answers such as Caucasian, African American, Asian, etc which is unordered. Blood group can only have blood type O, A, B, or AB which is also unordered. Ordered, or ordinal data would have categories that are in some sort of order Reference:
http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
質問 72
Diabetic ketoacidosis, a potential complication of type 2 diabetes, is most associated which of the following antidiabetic drug classes?
- A. Sulfonylureas
- B. Biguanides
- C. DPP-4 inhibitors
- D. SGLT-2 inhibitors
- E. Thiazolidinediones
正解: D
解説:
Explanation
SGLT-2 inhibitors have a black box warning for diabetic ketoacidosis, which manifests as euglycemic and makes it relatively difficult to detect without monitoring. The complex physiology by which this occurs is not clearly understood. On the other end, they have been shown to reduce major cardiovascular events (MACE) in persons with type 2 diabetes and established cardiovascular disease.
質問 73
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