Naplex/BCPS/NBME/USMLE Pharm Questions

💉💊🩺 🥼🩹🌡🧫 *These are not medical recommendations. Consult your healthcare professional for more details.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 35 YOF has N/V & fatigue over the past 2 wks. She reports missing her last menstrual period.
Labs:
+ pregnancy test
serum βhCG elevated for gestational age
low TSH
high fT4
US- snowstorm appearance of uterus w/o evidence of fetus
Which med is most appropriate for management?

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

Statins have minimal impact on renal function. The primary concern with statins is myopathy or rhabdomyolysis, which could lead to AKI, but this is rare.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 72 YOM with a history of T1DM, CHF (EF 35%), and PAD is admitted for cellulitis and started on vancomycin. After 3 days, he develops AKI with a SCr increase from 1.2 mg/dL to 2.1 mg/dL.

Which of the following meds is most likely contributing to his AKI? #MedTwitter #TwitteRx

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

hypovolemia, its role in AKI would be less significant.
Metformin: Metformin does not directly cause AKI but is CI in patients with worsening renal function because it increases the risk of lactic acidosis. However, it does not directly impair renal perfusion.
Rosuvastatin:

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

idarucizumab; Idarucizumab is a monoclonal antibody approved for reversing the effects of dabigatran in cases of life-threatening bleeding or emergency surgery. It binds dabigatran, neutralizing its anticoagulant effects almost immediately, making it the best choice here.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 64 YOM w/ afib & CKD (eGFR 25 mL/min) is prescribed dabigatran for stroke prevention. After 3 months, he presents to the ED w/ GI bleeding.

Hgb: 9.5 g/dL
Plts: 220,000/mm³
Scr: 2.4 mg/dL
aPTT: 52 s

Which of the following is the most appropriate initial intervention?

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

#MedTwitter #TwitterX #medicine #pharmacy #PharmacyWeek

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

benztropine; The most likely cause of this patient’s SX (dry mouth, blurred vision, and difficulty urinating) is benztropine. These are classic anticholinergic SEs, and benztropine is an anticholinergic med often used in Parkinson’s disease to help control tremors.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 58 YOM w/ Parkinson’s is started on a med to control tremors. 2 wks later, he complains of dry mouth/blurred vision/ difficulty urinating. Which is most likely responsible for his SX? #MEDTwitter #TwitterX #usmle #pharmacy

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

Answer: folic acid; The pt. is experiencing SX of MTX toxicity, which can include mouth sores, increased fatigue, pallor, and macrocytic anemia. MTX inhibits dihydrofolate reductase, which can lead to folate deficiency.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 55 YOF w/ a HX of RA has been on MTX TX for 6 months w/ good SX control. However, she reports mouth sores & increased fatigue recently. PE shows pallor & po ulcers. Labs show macrocytic anemia. Which of the following could have prevented the most likely AE of this patient's TX?

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

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[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

Correct answer: hemorrhagic cystitis; Cyclophosphamide can cause damage to the bladder lining, leading to hematuria and dysuria, which are characteristic of hemorrhagic cystitis. This occurs due to the toxic metabolite acrolein, which accumulates in the bladder.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 45 YOM is undergoing TX for NHL with a regimen that includes cyclophosphamide. He presents with SX of hematuria and dysuria. UA reveals the presence of blood and leukocytes. Which of the following AEs is most likely associated with cyclophosphamide here? #MedTwitter #TwitterX

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

Correct answer: risperidone; Risperidone is a 2nd-gen. antipsychotic and has a higher risk of causing NMS compared to clozapine and olanzapine, which are also atypical antipsychotics.

[Naplex/BCPS/NBME/USMLE Pharm Questions @ChickNaplex]

A 79 YOM who lives in a nursing home has a fever and muscle rigidity after receiving a drug for treatment of a psychotic episode. Serum CK is increased. Which of the following drugs is the most likely cause of these adverse effects? #MedTwitter #medicine #Pharmacy #TwitterX