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Sample NAPLEX Question 1

Which medication can inhibit the peripheral conversion of T4 to the more potent form of thyroid hormone, T3, in a patient suffering from thyroid storm?

Atenolol

Methimazole

Propranolol

SSKI

Answer: C

Rationale:

The only drug listed that has been shown to reduce the peripheral conversion of T4 to T3 is the non-selective beta-blocker, propranolol, which is sometimes used in the acute management of thyroid storm (thyrotoxicosis).
Methimazole (Tapazole) is a thionamide (antithyroid agent) that inhibits the synthesis of thyroid hormone by blocking the iodination of thyroglobulin inside the thyroid gland itself and not the periphery.
SSKI (supersaturated potassium iodine) impairs both thyroid hormone production within the thyroid gland and vascularity to the thyroid gland but has nothing to do with T4 conversion to T3 in the periphery.
Atenolol is a selective beta-blocker and is only a distractor.

High-Yield Core Concept:

Propranolol is a non-selective beta-blocker that is commonly used in the initial or acute management of thyroid storm in part for its ability to block the peripheral conversion of T4 to T3.

High-Yield Fast Fact(s):

Propranolol is also used for migraine prophylaxis and prevention of bleeding from esophageal varices in patients with cirrhosis.

References:

J Clin Endocrinol Metab 1977;45:293-8.
J Clin Pharmacol 1982;22:110-6.
J Clin Endocrinol Metab 1982;54:1097-100.

Sample NAPLEX Question 2

A 66-year-old female with type 2 DM and a history of MI one year ago comes in for a follow-up evaluation and reports taking atorvastatin 80 mg daily without adverse effects. Her pertinent labs are: A1c = 7.3%, TC = 210 mg/dL, HDL = 40 mg/dL, LDL = 74 mg/dL, TG = 480 mg/dL. Which of the following is recommended to decrease her CVD risk further?

Vascepa 2 gm BID

Lovaza 2 gm BID

Niaspan 1 gm HS

Tricor 48 mg daily

Answer: A

Rationale:

Vascepa (icosapent ethyl) added to statin therapy in patients with moderately elevated TG (135-499 mg/dL) demonstrated a reduction in a composite of CV death, nonfatal MI, nonfatal stroke, coronary revascularization, or unstable angina in the REDUCE-IT trial.
Lovaza does not have clinical trial evidence to demonstrate a reduction in CV events in combination with statins.
Niaspan has not demonstrated additional CV benefit in patients with controlled LDL (AIM-HIGH was stopped early for lack of benefit).
Fibrates combined with statins have demonstrated an increased risk for elevated LFTs and risk of rhabdomyolysis without a consistent reduction in CV events (possibly a benefit in men).

High-Yield Core Concept:

Vascepa (icosapent ethyl) can be considered for patients meeting LDL goals with mild TG elevations to reduce CV risk.

High-Yield Fast Fact(s):

EPA and DHA are both omega-3 fatty acids.

References:

Diabetes Care 2020;43(Suppl. 1):S1-S212.
N Engl J Med 2019;380:11-22.

Sample NAPLEX Question 3

A patient with uncontrolled blood pressure is given Catapres despite being on other antihypertensive medications. Which of the following best describes the mechanism of action of Catapres?

Functions as an alpha-2 receptor agonist in the CNS and results in a decreased release of norepinephrine

Irreversibly inhibit the P2Y12 component of the ADP receptor

Inhibits the reuptake of serotonin and norepinephrine in the central nervous system

Mainly inhibits the reuptake of dopamine and norepinephrine in the synaptic cleft of the CNS

Answer: A

Rationale:

Clonidine (Catapres; Kapvay) functions as an alpha-2 receptor agonist in the CNS and results in a decreased release of norepinephrine that causes a relaxation of the blood vessels that can lead to reduced blood pressure.
Clopidogrel (Plavix) is known to irreversibly inhibit the P2Y12 component of the ADP receptor on platelet surface receptors to impair platelet aggregation in patients with coronary artery disease or risk of ischemic stroke.
Drugs like desvenlafaxine (Pristiq) inhibit the reuptake of serotonin and norepinephrine in the central nervous system and is used for the treatment of major depressive disorder.
Dexmethylphenidate (Focalin; Focalin XR) mainly inhibits the reuptake of dopamine and norepinephrine in the synaptic cleft of the CNS.

High-Yield Core Concept:

Clonidine (Catapres; Kapvay) functions as an alpha-2 receptor agonist in the CNS and results in a decreased release of norepinephrine that causes a relaxation of the blood vessels that can lead to reduced blood pressure.

High-Yield Fast Facts:

If clonidine is stopped abruptly, it can lead to clinically relevant tachycardia and rebound hypertension. As such, this agent is not a great option for patients who are non-compliant.
The brand option of clonidine, Kapvay, is indicated for the treatment of ADHD, not hypertension.

Sample NAPLEX Questions

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Sample NAPLEX Q-Bank Questions

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Sample NAPLEX Question 1

Answer: C

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

References:

Sample NAPLEX Question 2

Answer: A

Rationale:

High-Yield Core Concept:

High-Yield Fast Fact(s):

References:

Sample NAPLEX Question 3

Answer: A

Rationale:

High-Yield Core Concept:

High-Yield Fast Facts:

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