The NAPLEX exam (or North American Pharmacist Licensure Examination) is a comprehensive and challenging assessment for men and women looking to enter this rewarding and fast-paced field of health care. A key component of certification in many jurisdictions, the exam is developed by the National Association of Boards of Pharmacy in consultation with an expert team of test administrators.
The NAPLEX consists of 185 selected-response and constructed-response questions. Selected-response questions have a multiple-choice format, while constructed-response questions require candidates to compose an extended answer. Thirty-five of the questions on the test are pretest questions, which are used to develop future versions of the exam. It is impossible to identify pretest questions, which do not contribute to the final score.
The content of the NAPLEX Exam is broken down into three task statements: assessing pharmacotherapy to assure safe and effective therapeutic outcomes (56 percent of the test); assessing safe and accurate preparation and dispensing of medications (33 percent of the test); and assessing, recommending, and providing healthcare information that promotes public health (11 percent of the test).
The official score report is mailed to the board of pharmacy in which the candidate is seeking licensure. In order to receive a score, test takers must complete at least 162 questions. The score is placed on a scale of 1 to 100, with 75 the minimum passing score. This score does not represent the percentage of questions answered correctly but rather is based on performance and the relative difficulty of the NAPLEX test version.
1. Which of the following statements regarding Addison’s disease is TRUE?
a. The dexamethasone suppression test helps diagnose Addison’s disease
b. Decrease corticosteroid use during the illness
c. Clinical findings include truncal obesity, rounded face, and hirsutism
d. Fludrocortisone normalizes blood pressure and serum potassium
e. Addison’s disease is never life-threatening
2. Which of the following benzodiazepines is intermediate-acting?
a. I only
b. III only
c. I and II
d. II and III
e. I, II, and III
3. To convert Hydrocortisone 50 mg IV every 8 hours to the equivalent dose of oral prednisone, give:
a. 10 mg three times daily
b. 20 mg once daily
c. 20 mg twice daily
d. 50 mg once daily
e. 50 mg twice daily
4. Which combination is NOT a correct pairing of a proprietary name with a generic name?
a. Spiriva (tiotropium)
b. Gleevec (imatinib)
c. Amitiza (alosetron)
d. Prezista (darunavir)
e. Lialda (mesalamine)
5. Which of the following statements about Digibind are TRUE?
I. Digoxin levels increase after administration of Digibind
II. Digibind is contraindicated for patients who are allergic to bovine products
III. 12 vials of Digibind are necessary to reverse an acute ingestion of thirty 250 mcg Digitalis tablets
a. I only
b. III only
c. I and II
d. II and III
e. I, II, and III
1. D: The dexamethasone suppression test diagnoses Cushing syndrome, whereas the cosyntropin stimulating test diagnoses Addison’s disease. Corticosteroid use during illness or the perioperative period should be doubled for 3 days, rather than reduced. Truncal obesity, rounded face, and hirsutism are clinical findings of Cushing syndrome (hypercortisolism), which involves excessive cortisol. Addison’s disease means lack of cortisol (hypocortisolism). Clinical findings of Addison’s disease are nonspecific and include anorexia, fatigue, vomiting, and weight loss. Fludrocortisone 0.05 to 0.3 mg daily, with liberal salt intake, helps to maintain supine and standing blood pressure, and serum potassium. Addison’s disease can be life-threatening. Symptoms of Addisonian crisis include hyperkalemia, hypotension, loss of consciousness, and severe vomiting and diarrhea.
2. C: Triazolam is a short-acting benzodiazepine derivative drug, with a half-life of approximately 2 hours. Alprazolam and temazepam are intermediate-acting, with half-lives of up to 15 hours.
3. C: The patient’s 20 mg dose of intravenous hydrocortisone is approximately equivalent to a 5 mg oral dose of prednisone (20 / 4 = 5). 150 mg of intravenous hydrocortisone is equivalent to 37.5 mg of oral prednisone (150 / 4 = 37.5). Thus, the answer is 40 mg p.o. daily, divided into two equal doses of 20 mg each.
4. C: Spiriva (tiotropium) is an anticholinergic used to prevent bronchospasm in patients with COPD, bronchitis, or emphysema. Gleevec (imatinib) is a protein-tyrosine kinase inhibitor used to treat chronic myelogenous leukemia (CML) and other cancers. Amitiza (lubiprostone) is a chloride channel activator used for chronic constipation. Lotronex is alosetron and is used to treat irritable bowel syndrome. Prezista (darunavir) is a protease inhibitor used for HIV. Lialda (mesalamine) is used for ulcerative colitis, proctitis, and proctosigmoiditis.
5. B: Digibind decreases digoxin and digitoxin, so it is the intravenous antidote used to treat potentially lethal digoxin and digitoxin overdoses. Monitor body stores of digoxin via continuous EKG after Digibind administration, rather than via digoxin blood levels. However, do monitor potassium blood levels after Digibind administration. Digibind is contraindicated in patients allergic to ovine (sheep) products. Each 38 mg vial of the antidote Digibind can bind 500 mcg of digoxin. To calculate dose (# of Digibind vials), divide the total body load of ingested digoxin in mg (250 mcg x 30 tablets x 80% bioavailability) by 0.5 mg of digitalis bound per vial. Thus, 6 mg / 0.5mg = 12 vials.
A pharmacist is someone who works in a variety of settings and essentially oversees, disperses, and packages medicine. Work settings for a pharmacist may include hospitals, doctors’ offices, retail pharmacies, and long-term care facilities. Although pharmacists very rarely select and prescribe medicine, they do fulfill prescriptions ordered by doctors or other clinicians. A pharmacist is subject to intense training and education in chemistry to learn how drugs affect humans and how drugs interrelate with other drugs. The precise measurement of medicine is critical to ensure the dosage is safe and administered properly. The pharmacist educates patients on medications, potential side effects, and warning signs. Personality traits of a good pharmacist are attention to detail, patience, desire to help and serve, strong interpersonal skills, and a strong science aptitude.
To become a pharmacist, a person begins by entering a four-year college degree program. Within the first two years of undergraduate work, the student will take a pharmacy college admission test (PCAT). If the student passes the test, he or she can then apply to a four-year pharmacy program, or PharmD, as it is commonly called. If accepted into a pharmacy program, the student will study subjects such as physiology, anatomy, biology, physics, and chemistry. The courses teach students about drug therapy and how to communicate about drug information. While in school, students learn about ethics, business management, and public health and have the chance to work under the direction of licensed pharmacists. Some students fulfill one- to two-year residency or fellowship programs, which are usually required for those wanting to work in clinical settings. Fellowships are highly individualized to prepare a student for a specialized area within the pharmaceutical industry. Seven to ten rotations of about six weeks in length are required. These rotations consist of work within clinical and pharmaceutical settings and essentially could take a total of six years to complete.
According to the Bureau of Labor Statistics, the future outlook for this profession is expected to grow. Availability for this job is nationwide, offering job stability, security, and high salaries. After working in this field for a number of years, a person can find this job repetitive, and many pharmacists experience burn out. This job does require intense, consistent concentration, with most of the day spent standing. There are advancement opportunities and other career options in this profession; some pharmacists in retail drugstores decide to go into supervisory or management-type positions. Others get promoted to district, regional, or executive levels. When given the opportunity, a pharmacist may own or become part owner of an independent pharmacy, while others go into sales, research, marketing, or quality control. Expected future growth opportunities may appear in retail pharmacy or in hospital or other health care settings. According to Payscale.com, a pharmacist’s salary range is between $50,000 and $122,000 per year, and many pharmacists report earning bonuses and profit sharing. This brings the total average pay of pharmacists nationwide to $51,000 to $130,000 per year. The top five popular industries for a pharmacist are hospital settings, pharmaceuticals, health care, and retail. The top employers in the field, offering the highest salaries are CVS/Pharmacy, with top earners making $123,000′ Walgreens, with top earners making $112,000 a year; Rite Aid Pharmacy pays top salaries at $124,000; Walgreen Co. has the highest pay, with $183,000; and Wal-Mart Pharmacy pays approximately $121,000 a year.
Additional demographic data shows that there is little difference in gender; 52 percent of people in the profession are male, and 48 percent are women. The largest percentage of people working in the field has one to four years of experience (44 percent). The educational degrees for pharmacists are bachelor’s, bachelor of science (BS/BSc), pharmacy; doctor of pharmacy (PharmD); doctorate (PhD); and doctorate (PhD), pharmacy. The most popular cities for pharmacist jobs are Chicago, Houston, Miami, Seattle, New York, Atlanta, and Pittsburgh.