NAPLEX — Endocrine and GI flashcards
10 of 80 cards free to study here · 2 topics · the whole deck is built into Willys
Diabetes classes and cardiorenal choice, insulin, DKA and hypoglycemia rescue, thyroid, adrenal and bone drugs, hormone therapy, emergency contraception and testosterone, acid suppression, H. pylori, IBD, nausea, laxatives and antidiarrheals, and hepatic drug use — with no doses.
Learn deck · part of PTCB PTCE / NAPLEX · written against: Top-drug lists and federal pharmacy law as of 2026; PTCE content outline effective 6 January 2026. Updated 2026-10-10.
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Which vitamin deficiency is linked to long-term metformin use, and when should it be suspected?Vitamin B12 deficiency, from reduced ileal absorption. It is checked periodically, and especially when a patient on metformin develops anemia or peripheral neuropathy that could be mistaken for diabetic neuropathy.Endocrine › Noninsulin Diabetes Agents
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At which eGFR thresholds does metformin labeling advise against starting it, and contraindicate it?Starting metformin is not recommended at an eGFR of 30 to 45, and it is contraindicated below 30 because lactic acidosis risk rises as clearance falls. If eGFR drops below 45 during therapy, the benefit is reassessed.Endocrine › Noninsulin Diabetes Agents
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How do sulfonylureas lower glucose, and which two adverse effects follow directly from that mechanism?They close ATP-sensitive potassium channels on pancreatic beta cells, triggering insulin release regardless of glucose level. The result is hypoglycemia and weight gain.Endocrine › Noninsulin Diabetes Agents
Watch out: older adults and patients with kidney impairment, skipped meals or alcohol use are most at risk of hypoglycemia. -
Why is glyburide avoided in older adults, and which sulfonylurea is the usual alternative?Glyburide is long-acting with active metabolites cleared by the kidney, so it causes prolonged hypoglycemia in older or renally impaired patients and is on the Beers list. Glipizide, which is shorter-acting and hepatically cleared, is preferred when a sulfonylurea is needed.Endocrine › Noninsulin Diabetes Agents
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A patient on repaglinide plans to skip lunch. What counseling applies, and which lipid drug must never be combined with it?Repaglinide is taken just before each meal and skipped when the meal is skipped, because it stimulates a short burst of insulin. Gemfibrozil inhibits CYP2C8 and is contraindicated with repaglinide, since it greatly raises repaglinide levels and causes severe hypoglycemia.Endocrine › Noninsulin Diabetes Agents
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Which electrolyte and vitamin deficiencies are linked to long-term proton pump inhibitor use?Hypomagnesemia (which can cause secondary hypocalcemia and hypokalemia) and vitamin B12 deficiency, from reduced acid-dependent absorption. Magnesium is checked in patients on long-term PPIs with diuretics or digoxin.Gastrointestinal › GERD and Peptic Ulcer
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Why can stopping a long-term proton pump inhibitor abruptly make reflux symptoms flare?Rebound acid hypersecretion: gastrin and parietal-cell mass increase during prolonged acid suppression, so acid output overshoots for weeks after stopping. Tapering, or stepping down to an H2 blocker or on-demand use, eases deprescribing.Gastrointestinal › GERD and Peptic Ulcer
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Why does cimetidine cause more drug interactions and endocrine side effects than famotidine?Cimetidine inhibits several CYP450 enzymes, raising levels of drugs such as warfarin, theophylline and phenytoin, and it has antiandrogen effects such as gynecomastia. Famotidine has far fewer such problems, although its label calls it a weak CYP1A2 inhibitor and advises avoiding tizanidine.Gastrointestinal › GERD and Peptic Ulcer
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Misoprostol is prescribed to prevent NSAID-induced ulcers. What is its boxed warning?Misoprostol is a prostaglandin E1 analog that can cause abortion, premature birth, birth defects or uterine rupture, so it must not be used by pregnant patients to reduce NSAID ulcer risk. Patients who can become pregnant need effective contraception.Gastrointestinal › GERD and Peptic Ulcer
Watch out: diarrhea and abdominal cramping are its most common adverse effects. -
Why must sucralfate be separated from other oral drugs, and in which patients does its aluminum matter?Sucralfate forms a sticky paste that binds drugs such as fluoroquinolones, levothyroxine and phenytoin, lowering their absorption. It contains aluminum, which can accumulate in patients with chronic kidney disease.Gastrointestinal › GERD and Peptic Ulcer
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About these cards
Review status: Second-reader reviewed, with corrections applied.
Checked against:
- NABP NAPLEX competency statements (topic outline only; no text copied)
- Checked against FDA prescribing information and standard pharmacotherapy references (reference only; no text copied)
- Checked against the ADA Standards of Care in Diabetes—2026, the ACG 2024 clinical guideline on treatment of Helicobacter pylori infection, the ATA 2016 hyperthyroidism guidelines, the ATA 2026 guidelines for thyroid disease in preconception, pregnancy and postpartum, ACOG guidance on nausea and vomiting of pregnancy, the CDC US Selected Practice Recommendations for Contraceptive Use (2024), the FDA's January 2024 safety communication on denosumab and severe hypocalcemia, and the FDA's November 2025 announcement on menopausal hormone therapy labeling (reference only; no text copied)
- Also checked against the FDA Orange Book and drug shortage database, the Baveno VII portal hypertension consensus (2022), and the CPIC thiopurine dosing guideline (2025 update) (reference only; no text copied)
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