NAPLEX試験対策

1. 問題 1 · NAPLEX Pharmacotherapy Foundations

   Chronic prednisone 20 mg daily for several months is most likely to cause which cluster of adverse effects?

   1. AHyperglycemia, osteoporosis, adrenal suppression, cataracts and mood changes
   2. BHypoglycemia, hypotension and weight loss
   3. CHemolytic anemia with G6PD deficiency
   4. DHyperthyroidism
   5. EGingival hyperplasia and hirsutism
   正解と解説を表示

   正解: A Hyperglycemia, osteoporosis, adrenal suppression, cataracts and mood changes

   解説

   Glucocorticoids cause dose- and duration-dependent systemic effects. Patients on more than about 3 weeks of therapy should be tapered, and calcium, vitamin D and bone protection considered.

   参考文献

   • Prednisone - StatPearls (NCBI Bookshelf)
   • DailyMed (FDA drug labels): prednisone

2. 問題 2 · NAPLEX Cardiovascular Therapeutics

   A 54-year-old woman with hypertension and type 2 diabetes started lisinopril 20 mg daily 6 weeks ago. Her BP is now 128/78 mm Hg, potassium is 4.6 mEq/L and SCr is stable, but she reports a persistent dry, nonproductive cough that disrupts her sleep. She has no lip or tongue swelling. Which recommendation is most appropriate?

   1. AReduce lisinopril to 10 mg daily and reassess
   2. BSwitch lisinopril to enalapril at an equivalent dose
   3. CDiscontinue lisinopril and start losartan
   4. DDiscontinue lisinopril and start atenolol
   5. EAdd benzonatate and continue lisinopril
   正解と解説を表示

   正解: C Discontinue lisinopril and start losartan

   解説

   ACE inhibitor cough is caused by bradykinin and substance P accumulation and is a class effect, so switching to another ACE inhibitor or lowering the dose rarely resolves it. ARBs such as losartan do not inhibit kininase II, cause cough at placebo-like rates, and preserve the renal protection desired in diabetes. Atenolol would lose RAAS-related kidney benefit and is not a preferred first-line agent.

   参考文献

   • DailyMed: losartan potassium label
   • DailyMed: lisinopril label

3. 問題 3 · NAPLEX Infectious Disease

   An 8-year-old boy weighing 22 kg has fever, tonsillar exudates, and tender anterior cervical lymphadenopathy, with no cough. A rapid antigen detection test is positive for group A Streptococcus. He has no drug allergies. Which regimen is most appropriate?

   1. AAzithromycin 264 mg orally once daily for 5 days
   2. BAmoxicillin-clavulanate 550 mg orally twice daily for 10 days
   3. CAmoxicillin 1000 mg orally once daily for 10 days
   4. DCefdinir 300 mg orally once daily for 3 days
   5. EAmoxicillin 1000 mg orally once daily for 5 days
   正解と解説を表示

   正解: C Amoxicillin 1000 mg orally once daily for 10 days

   解説

   Penicillin or amoxicillin is first line for GAS pharyngitis in patients without penicillin allergy. Amoxicillin is dosed at 50 mg/kg once daily, maximum 1000 mg, which gives 1000 mg for this child (22 kg x 50 mg/kg = 1100 mg, capped at 1000 mg). It is given for 10 days to eradicate the organism and prevent acute rheumatic fever, so a 5-day course is too short. Macrolides are reserved for patients with penicillin allergy, and amoxicillin-clavulanate adds unnecessary spectrum.

   参考文献

   • DailyMed: Amoxicillin label search

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