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NAPLEX — Practice Questions, Part 1 flashcards

6 of 70 questions free to study here · 7 topics · the whole deck is built into Willys

Multiple-choice practice questions, one best answer each, on cardiovascular and renal drugs, diabetes, thyroid, GI and liver, asthma and COPD, oncology, transplant and biologics.

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Practice 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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  1. A 71-year-old man with bilateral renal artery stenosis is started on lisinopril. Within a week his serum creatinine has risen sharply. Which mechanism best explains this?

    A) An allergic interstitial nephritis caused by lisinopril
    B) Loss of angiotensin II constriction of the efferent arteriole
    C) Bradykinin-mediated constriction of the afferent arteriole
    D) Direct toxicity of lisinopril to the cells of the proximal tubule
    B) Loss of angiotensin II constriction of the efferent arteriole

    In bilateral renal artery stenosis, glomerular filtration depends on angiotensin II keeping the efferent arteriole constricted, so ACE inhibition makes GFR fall. A small creatinine rise after starting RAAS blockade is expected, but a steep rise like this one is not.
    Cardiovascular
  2. A patient with heart failure needs a loop diuretic but had a severe reaction to a sulfonamide-containing drug in the past. Which loop diuretic avoids the sulfonamide structure?

    A) Torsemide
    B) Ethacrynic acid
    C) Furosemide
    D) Bumetanide
    B) Ethacrynic acid

    Ethacrynic acid is the only loop diuretic without a sulfonamide group, though it carries a higher risk of ototoxicity. True cross-reactivity between sulfonamide antibiotics and sulfonamide diuretics is uncommon.
    Renal
  3. A man who has taken metformin for eight years develops numbness in both feet and a macrocytic anemia. Which deficiency should be checked first?

    A) Vitamin B12
    B) Vitamin D
    C) Folate
    D) Iron
    A) Vitamin B12

    Long-term metformin reduces ileal absorption of vitamin B12, and the deficiency causes anemia and a neuropathy that can be mistaken for diabetic neuropathy. B12 is checked periodically in patients on metformin.
    Endocrine
  4. A 24-year-old with asthma uses only albuterol, a few times a week. Under current GINA recommendations, which approach is preferred?

    A) Daily montelukast plus albuterol
    B) Daily salmeterol plus albuterol
    C) Albuterol alone, as needed
    D) As-needed ICS–formoterol
    D) As-needed ICS–formoterol

    GINA advises against SABA-only treatment for adults and adolescents because it leaves inflammation untreated and is linked to severe exacerbations and deaths; as-needed ICS–formoterol is the preferred reliever. A LABA such as salmeterol is never used without an ICS in asthma.
    Pulmonary
  5. A man with a bulky lymphoma at high risk of tumor lysis syndrome is to receive rasburicase. Which test must be done first?

    A) DPYD genotyping
    B) UGT1A1 genotyping
    C) G6PD testing
    D) TPMT testing
    C) G6PD testing

    Rasburicase generates hydrogen peroxide as it converts uric acid to allantoin, so G6PD-deficient patients can develop severe hemolysis and methemoglobinemia; it is contraindicated in G6PD deficiency. Uric acid samples go in prechilled tubes on ice because the drug keeps working in the tube.
    Oncology
  6. A kidney transplant recipient on tacrolimus starts taking St John's wort for low mood. What is the main risk?

    A) Tremor from higher tacrolimus brain uptake
    B) Acute rejection from lower tacrolimus levels
    C) Hyperkalemia from added potassium retention
    D) Nephrotoxicity from higher tacrolimus levels
    B) Acute rejection from lower tacrolimus levels

    St John's wort induces CYP3A4 and P-glycoprotein, lowering tacrolimus levels and risking acute rejection. Tacrolimus levels are checked whenever an interacting drug or supplement is started or stopped.
    Immunology

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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)
  • Guidelines checked against (reference only; no text copied): 2025 AHA/ACC hypertension guideline; 2022 AHA/ACC/HFSA heart failure guideline; GINA 2025 report and 2026 update; GOLD 2026 report; ACG 2024 H. pylori guideline; AGS 2023 Beers Criteria
  • Also checked against (reference only; no text copied): ADA Standards of Care in Diabetes 2026; ASH 2018 guideline on VTE in pregnancy; ASCO guideline on immune-related adverse events; ATA 2016 hyperthyroidism guideline; CPIC thiopurine guideline (2025 update); CDC guidance on vaccinating pregnant persons

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