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NAPLEX Practice Exam A

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1. A 67-year-old man presents to the emergency department 1 hour after the sudden onset of right-sided weakness and slurred speech which occured 1 hr ago. A non-contrast CT scan of the head shows no evidence of hemorrhage. His blood pressure is 190/92 mmHg, and blood glucose is 110 mg/dL. His past medical history includes hypertension, type 2 diabetes, and peptic ulcer disease. His current medications include lisinopril, metformin, enoxaparin, and aspirin. Further review of the electronic medical record reveals that he underwent a lumbar laminectomy 10 days ago.

Which of the following is the most appropriate next step regarding administration of alteplase (tPA)?

A. Administer alteplase within the next 2 hours.

B. Do not administer alteplase due to recent surgery.

C. Administer alteplase after administering a loading dose of aspirin.

D. Administer alteplase only if blood pressure is lowered to below 185/110 mmHg.

E. Administer alteplase after discontinuing enoxaparin for 24 hours

Alteplase is contraindicated in recent intracranial or intraspinal surgery. Alteplase must be initiated within 3 hours (and possibly up to 4.5 hours) of symptom onset. Prior anticoag use (LMWH within 24 hrs, NOACs within 48 hrs) is contraindicated. If BP >185/110, may attempt to lower BP to under cutoff before consider tPA.

2 / 10

2. If 1 gallon of a 20% (w/v) solution is evaporated to a solution with a 40% (w/v) strength, what will be the new volume (in mL)?

A. 710 mL

B. 1666 mL

C. 1776 mL

D. 1893 mL

E. 2840 mL

1 gal = 3785 mL --> 3785×0.20 = V2×0.40 --> V2 = 1892.5 mL

3 / 10

3. A pharmacist dissolves 3 ketoconazole tablets, each containing 200 mg, into a base to prepare 30 mL of a topical solution. What is the % strength (w/v)?

A. 1.8%

B. 2%

C. 2.5%

D. 1.5%

E. 0.2%

3×200 = 600 mg = 0.6 g --> % = (0.6 / 30) × 100 = 2.0%

4 / 10

4. A 45-year-old male on warfarin, digoxin, carvedilol and amiodarone wants to use Pepto-Bismol for diarrhea. What is the pharmacist’s primary concern?

A. Risk of arrhythmia

B. Risk of bradycardia

C. Risk of digoxin toxicity

D. Risk of bleeding

E. Risk of heart block

Bismuth subsalicylate contains salicylate, which can increase bleeding risk—especially in those taking anticoagulants like warfarin.

5 / 10

5. A patient on chronic omeprazole therapy is concerned about nutrient absorption. Which of the following agents may have reduced absorption with acid suppression?

A. Iron

B. Itraconazole

C. Acetaminophen

D. Tetracycline

E. A and B only

Many drugs require an acidic environment for optimal absorption, including iron, azole antifungals, and certain antibiotics. Chronic acid suppression can impair this.

6 / 10

6. Which chemotherapy drugs have restricted lifetime dosing due to cumulative toxicity risks?

A. Idarubicin

B. Epirubicin

C. Daunorubicin

D. Doxorubicin

E. All of the above

Anthracyclines like doxorubicin, daunorubicin, idarubicin, and epirubicin have lifetime dose limits due to risk of cardiotoxicity.

7 / 10

7. Amy takes dornase alfa for cystic fibrosis. What is the correct statement regarding dornase alfa?

A. Reduces mucus viscosity and improves airflow

B. Taken as a 25 mg ampule nebulized daily

C. Store at room temp and protect from light

D. Brand name is Xolair

E. All of the above

Dornase alfa (Pulmozyme) is refrigerated, nebulized, breaks down DNA in mucus to reduce viscosity. It's dosed as 2.5mg ampules given in neublizer once daily for 6 months.

8 / 10

8. A patient reports ankle swelling after starting pregabalin. Where should this adverse effect be reported?

A. The Red Book

B. The Orange Book

C. The Pink Sheet

D. MedWatch

E. CMS

Adverse drug reactions are reported to the FDA MedWatch program.

9 / 10

9. An 75-year-old male with end stage renal disease is currently on venlafaxine, warfarin, lisinopril, and potassium. He had a recent serious bleed. What is the most likely cause?

A. Bleeding risk from warfarin and lisinopril

B. Increased bleed risk from warfarin and venlafaxine

C. Fall risk due to end stage renal disease and venlafaxine

D. A and B

E. None of the above

SSRIs/SNRIs like venlafaxine increase bleeding risk when used with anticoagulants such as warfarin.

10 / 10

10. What controlled category is Sonata?

A. C I

B. C II

C. C III

D. C IV