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NAPLEX 2023/2024 QUESTIONS AND ANSWERS
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NAPLEX 2023/2024 QUESTIONS AND ANSWERS NAPLEX 2023/2024 QUESTIONS AND ANSWERS NAPLEX 2023/2024 QUESTIONS AND ANSWERS
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NAPLEX 2023/2024Key drugs that can cause hypothyroidism - ANS "I TALC"
Interferons
Tyrosine Kinase Inhibitors
Amiodarone
Lithium
Carbamazepine
Conditions: Hashimoto's disease
Levothyroxine IV:PO - ANS 0.75:1 (IV:PO)
Full replacement dose levothyroxine - ANS 1.6 mcg/kg/day (IBW)
If known CAD: start with 12.5-25 mcg daily
Levothyroxine tablet colors - ANS 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 - ANS Iodine
Amiodarone
Interferons
Radiographic contrast media
treatment for thyroid storm - ANS 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 - ANS 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 - ANS Adrenal gland produces too much cortisol or exogenous steroids are taken in
doses higher than normal amounts of endogenous cortisol
Addison's disease - ANS 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 - ANS (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 - ANS 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) - ANS MTX (Trexall): first line in RA
Hydroxychloroquine (Plaquenil)
Sulfasalazine
Leflunomide (Arava)
Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - ANS 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 - ANS
Hydroxychloroquine (Plaquenil)
- Irreversible retinopathy
- take with food or milk
- alternative to MTX in liver disease
Traditional DMARDs (disease modifying anti-rheumatic drugs): Sulfasalazine - ANS 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 - ANS 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 - ANS Tofacitinib (Xeljanz)
Baracitinib (Olumiant)
Upadacitinib (Rinvoq)
Boxed warnings: serious infections, malignancy, thrombosis
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