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NABP Certification
NAPLEX Exam
NABP.NAPLEX.v2022-03-23.q76 Dumps

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Question 41

Concomitant use of warfarin and omeprazole is associated with increased INR and prothrombin time(PT).
What enzyme dose the omeprazole inhibits that is metabolized by warfarin?

A.CYP3A4
B.CYP2C9
C.CYP2C19
D.CYP2D9
E.CYP1A2

Correct Answer: C

Explanation
Omeprazole is CYP2C19 inhibitor which can prolong the elimination of warfarin, particularly R-warfarin. R- warfarin is partially metabolized by CYP2C19. The combined use of omeprazole and warfarin has been associated with reports of increased INR and prothrombin time (PT).

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Question 42

Your patient is a 43-year-old male who is experiencing post-operative voiding difficulty after an elective inguinal hernia repair. His post void residual volume was 280 cc.
Which of the following medications is the most appropriate choice of therapy for this patient?

A.Bethanechol
B.Oxybutynin
C.Phenylephrine
D.Finasteride
E.Imipramine

Correct Answer: A

The patient is experiencing a common complication of low abdominal surgery. Post-operative urinary retention occurs in almost 25% of patients after low abdominal surgical procedures. A normal post-void residual volume is less than 50 cc or urine. The effects of anesthesia and analgesia both contribute to bladder distension, decreased micturition reflex, reduction of contractility of the detrusor muscle of the bladder, and incomplete voiding. The detrusor muscle of the bladder is stimulated to contract by muscarinic cholinergic agonists.
Bethanechol is a muscarinic agonist and is frequently used in this setting to improve bladder emptying.
Finasteride is a drug that is a 5 alpha reductase inhibitor indicated for use in patients with bladder outlet obstruction as a result of prostatic hypertrophy. The inhibition of 5 alpha reductase decreases local conversion of testosterone to dihydrotestosterone in the prostate gland, which results in gradual shrinkage over a period of six to twelve months. Phenylephrine is an alpha-adrenergic agonist that is selective for alpha-1 receptors.
Activation of the alpha 1 receptors in the bladder results in contraction of the trigone muscle and sphincter.
This promotes urinary retention. Oxybutynin is an antimuscarinic agent that is useful for treatment of urge incontinence, and would have a detrimental effect on this patient's bladder disorder. Imipramine is a medication with anticholinergic properties that would also cause worsening of the patient's condition. Take home message:
Post-operative urinary retention with concomitant incomplete voiding is a complication that results from a decreased micturition reflex, increased vesical sphincter tone, or decreased contractility of the detrusor muscle of the bladder. It can be successfully treated with a muscarinic agonist, such as bethanechol, or with an alpha-
1 adrenergic antagonist.

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Question 43

Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Alpha cells in pancreases

A.Sulfonylureas
B.Alpha- Glucosidase Inhibitors
C.DPP4 Inhibitors
D.Glucagon-like peptide-1 receptor agonists
E.Thiazolidinediones
F.Biguanide
G.SGLT2 inhibitors

Correct Answer: C

DPP4 Inhibitors, D Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body.
Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.
Reference:
https://doi.org/10.1093/eurheartj/ehv239

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Question 44

What indication usually requires higher dose of proton pump inhibitor?

A.Helicobacter pylori
B.Esophagitis
C.Duodenal ulcer
D.Stress ulcer prophylaxis
E.Zollinger-Ellison syndrome

Correct Answer: E

Explanation
The diagnosis of Zollinger-Ellison syndrome is suggested when plasma gastrin is > 1000 pg/ml and the basal acid output is > 15 mEq/h or when associated with a pH < 2. The treatment is focused on controlling gastric acid hypersecretion and localisation of the tumour and its metastases. Proton pump inhibitors are the most effective antisecretory drugs and can be administered at high dosages

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Question 45

Which of the following should be monitored when a patient is on SGLT2 inhibitor?

A.Hydration status
B.Blood pressure
C.Blood glucose
D.Renal function
E.All of the above

Correct Answer: E

Explanation
Because SGLT2 inhibitors work by preventing reabsorption of glucose in the kidneys, this increases frequency of urination. All of the options are monitoring requirements since the hydration status, blood pressure, blood glucose, and renal function may all be changed from increased urination (from the mechanism of the drug).

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