NAPLEX Study Guide

Study and pass the 2026 - 2027 NAPLEX exam and become a professional, qualified pharmacist in the United States.
Future pharmacists train with us.

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#NAPLEX #pharmacy #medicine #statins

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💊How does methotrexate cause lung toxicity?

Methotrexate can cause pulmonary fibrosis by first injuring the lung tissue and triggering an inflammatory immune response:

🔸This damage leads to the release of profibrotic cytokines, particularly transforming growth factor-beta (TGF-β), which activates fibroblasts and promotes their transformation into myofibroblasts—the cells responsible for producing scar tissue.

🔸These myofibroblasts deposit excessive amounts of collagen and other extracellular matrix proteins in the lung interstitium.

🔸As scar tissue accumulates, the normal architecture of the lungs is replaced by fibrotic tissue, causing the lungs to become stiff and reducing their ability to exchange oxygen effectively.

Although methotrexate-induced pulmonary fibrosis is uncommon, it can occur following methotrexate-related lung inflammation and abnormal wound-healing responses.

[Pharmacy Times @Pharmacy_Times]

As endometrial cancer cases continue to rise, so does the need for earlier recognition, equitable care, and informed treatment decision-making.

Megan May, PharmD, BCOP, FHOPA, FAPO, Jennifer MacDonald, PharmD, BCOP, Erin Zacholski, PharmD, BCOP, and Justina Salib, PharmD, BCOP, discuss the growing clinical and economic burden of endometrial cancer, including the increasing prevalence of aggressive histologic subtypes, and the importance of screening and clinical trial enrollment to improve patient outcomes.

This conversation sets the stage for the evolving treatment landscape and the role pharmacists continue to play in supporting timely, evidence-based care.

Watch the clip below, then follow along with the full Peer Exchange series for more expert insights into the future of endometrial cancer management: https://t.co/wZhAvVwWUr

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💊Baxdrostat - what is it?

Baxdrostat is a drug that has just been recently FDA approved.

Key details:

☑️Indicated for the treatment of hypertension in combination with other drugs.

☑️It is a first-in-class drug that works as an aldosterone synthase inhibitor.

☑️Unlike other drugs that target the mineralocorticoid receptor itself, baxdrostat is different in that it targets aldosterone synthesis directly.

☑️Brand name: Baxfendy

[Pharmacy Times @Pharmacy_Times]

🚨 BREAKING: Retatrutide shows “bariatric-level” weight loss in Phase 3 TRIUMPH-1 trial.
New data suggest one of the strongest weight-loss effects seen yet from a GLP-1–based therapy class.
🔗 https://t.co/vKiVb9WAKM
#GLP1 #Obesity #ClinicalTrials #PharmacyTimes #WeightLoss #Healthcare

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💊Dietary Protein and Levodopa

Levodopa can interact with dietary protein.

They are linked because levodopa uses the same transport systems as certain amino acids (the building blocks of protein) in both the intestine and the blood–brain barrier. When a patient eats a high-protein meal, those amino acids compete with levodopa for absorption and brain entry, which can reduce or delay the medication’s effectiveness.

This interaction is especially important in patients with Parkinson's disease, where symptoms such as tremor or stiffness may worsen after protein-heavy meals. For that reason, some patients are advised to take levodopa 30–60 minutes before meals or to shift most protein intake to the evening (“protein redistribution diet”).

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💊What is Difamilast?

Difamilast was FDA approved in February 2026 for the treatment of atopic dermatitis:

✔️difamilast works as a PDE4 inhibitor

✔️it is recommended for mild-to-moderate atopic dermatitis

✔️administered topically

✔️it is sold under the brand name, Adquey

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💊Black Box Warning - Dronedarone

Dronedarone (Multaq) carries a black box warning for an increased risk of death, stroke, and heart failure in patients with permanent atrial fibrillation (AF) or decompensated heart failure.

It is strictly contraindicated in patients with NYHA Class IV heart failure, or Class II–III heart failure with recent hospitalization, as it can double the risk of death.

[Drugs.com @Drugscom]

FDA Approves Langlara (insulin glargine-aldy), an Interchangeable Biosimilar to Lantus https://t.co/lkvM0zssRF

[Medscape @Medscape]

Gabapentinoids like gabapentin and pregabalin are associated with an increased risk for poisoning, with the highest risk occurring around treatment initiation and when combined with benzodiazepines or opioids.

In a large UK study of nearly 17,000 primary care patients, those who had co-initiation of gabapentinoids and benzodiazepines showed double the risk for hospitalization due to drug poisoning within the first month, whereas those with concomitant opioid use showed a 30% increased risk compared with those who took neither medication. https://t.co/djHDrx5vjQ

[Drugs.com @Drugscom]

Dupixent Patient Tips: 7 Things you Should Know https://t.co/bjBhoLeLd6

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💊HbA1c - Numbers to Know for Your Exam

🟢Normal

< 42 mmol/mol ( < 6.0%)

🟡Prediabetes

42 - 47 mmol/mol (6 - 6.4%)

🔴Diabetes

> 48 mmol/mol ( > 6.5%)

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NSAIDS - Key Details (1/6)

Pharmacy technicians are required to have an extensive understanding of NSAIDs; a class of medicines widely used in the management of pain, fever, and inflammation.

Here, we've put together all the key facts that technicians need to know, covering:

☑ Indications
☑ Key examples
☑ Side effects / warnings
☑ Mechanism of action
☑ Interactions

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💊Carbamazepine Adult Dosage l Epilepsy

1⃣Immediate-Release:

Initial dose (tablets): 200 mg orally twice a day
Initial dose (oral suspension): 100 mg orally 4 times a day

Increase weekly in increments up to 200 mg per day (as equally divided doses 3 or 4 times a day) until an optimal response is obtained.

Maintenance dose: 800 to 1200 mg per day
Maximum dose: 1600 mg per day

2⃣Extended-release:

Initial dose: 200 mg orally 2 times a day

Increase weekly in increments of 200 mg per day as equally divided doses twice a day until an optimal response is obtained

Maximum dose: 1600 mg per day

[Drugs.com @Drugscom]

FDA Approves Idvynso (doravirine and islatravir) for the Treatment of HIV-1 Infection in Adults https://t.co/yf1YB0cBjm

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💊Key details - Cancer Myelosuppression Treatment

Cancer therapy–induced myelosuppression:

NEUTROPENIA:

Granulocyte colony-stimulating factors include:

🔸filgrastim
🔸pegfilgrastim

They act on myeloid progenitors via the G-CSF receptor to accelerate neutrophil proliferation, differentiation, and release from the bone marrow.

➡️Pegylation prolongs half-life and allows once-per-cycle dosing.

These agents reduce febrile neutropenia risk but can cause bone pain and, rarely, splenic complications.

ANEMIA:

Chemotherapy-induced anemia is addressed with erythropoiesis-stimulating agents such as:

🔸epoetin alfa
🔸darbepoetin alfa

These drugs activate erythropoietin receptors on erythroid progenitors to increase erythrocyte production.

However, their use is restricted due to risks of thromboembolism and potential tumor progression, and they are generally reserved for palliative settings with careful hemoglobin targets.

THROMBOCYTOPENIA:

🔸Oprelvekin: a recombinant human IL-11 drug used to prevent severe thrombocytopenia and reduce the need for platelet transfusions.

It acts as a thrombopoietic growth factor that stimulates the bone marrow to produce more megakaryocytes and platelets.

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💊Key Details - Upadacitinib

Upadacitinib is a selective Janus kinase (JAK1) inhibitor that reduces inflammation by blocking cytokine signaling involved in immune responses:

☑️Indications: autoimmune conditions such as rheumatoid arthritis, atopic dermatitis, and ulcerative colitis.

☑️Mechanism: by inhibiting JAK-STAT pathways, it decreases production of pro-inflammatory mediators.

☑️Adverse effects: upper respiratory tract infections, fever, thrombosis, and an increased risk of malignancy.

☑️Boxed warning: upadacitinib carries a boxed warning for serious heart-related events, cancer, blood clots, and death.

☑️Interactions: drugs that strongly inhibit CYP 3A4 increase upadacitinib levels.

☑️Brand name: Rinvoq

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💊Otitis Media - Drug Treatment Options

First-line treatment for acute otitis media in both adults and children is amoxicillin, due to its effectiveness against common pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.

In cases of penicillin allergy, alternatives like macrolides may be used, though resistance can be an issue.

If symptoms persist or the infection is treatment-resistant, amoxicillin-clavulanate is typically recommended to cover β-lactamase–producing organisms, with other options including cephalosporins or intramuscular ceftriaxone in more severe cases.

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💊Why is piperacillin effective against P. aeruginosa?

It's due to structural modifications of the penicillin side chain that enhance penetration into Gram-negative bacteria, particularly Pseudomonas aeruginosa.

Specifically, its ureido side chain increases polarity and mimics peptide substrates, allowing better passage through porin channels and stronger binding to penicillin-binding proteins (PBPs).

This improves activity against difficult-to-treat Gram-negative organisms compared to earlier penicillins, though it is still often combined with a β-lactamase inhibitor to prevent enzymatic degradation.

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💊TMP-SMX Dosing - Urinary Tract Infections

For uncomplicated urinary tract infections (UTIs), trimethoprim-sulfamethoxazole (TMP-SMX) is typically dosed as:

Standard dose: 1 double-strength (DS) tablet (160 mg trimethoprim / 800 mg sulfamethoxazole) every 12 hours for 3 days.

Key points:

☑️Short-course (3-day) therapy is typical for uncomplicated cystitis in otherwise healthy patients.

☑️Longer durations (7–14 days) may be used for complicated UTIs or in certain patient populations.

☑️Dose adjustments may be needed in renal impairment.