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NAPLEX — Practice Questions, Part 2 flashcards

6 of 70 questions free to study here · 4 topics · the whole deck is built into Willys

Multiple-choice practice questions, one best answer each, on antimicrobials, antivirals, HIV and TB drugs, antiepileptics, Parkinson and psychiatric drugs, and opioid and analgesic safety.

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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 40-year-old woman needs a beta-lactam for surgical prophylaxis. Several years ago she had hives, without breathing problems, after taking amoxicillin. Based on side-chain similarity, which agent is the best choice?

    A) Cephalexin
    B) Cefazolin
    C) Ampicillin–sulbactam
    D) Cefadroxil
    B) Cefazolin

    Cross-reactivity follows similar R1 side chains, and cefazolin has a side chain unlike amoxicillin's. Cephalexin and cefadroxil share a side chain with the aminopenicillins, and ampicillin–sulbactam is itself an aminopenicillin.
    Infectious Disease
  2. A 29-year-old man whose seizures are well controlled on valproate is admitted with a serious infection, and the team plans to start meropenem. What is the best recommendation?

    A) Use a non-carbapenem antibiotic if one is suitable
    B) Raise the valproate amount while meropenem is given
    C) Give meropenem as an extended infusion instead
    D) Give meropenem and recheck valproate in a week
    A) Use a non-carbapenem antibiotic if one is suitable

    Carbapenems cause a rapid, profound fall in valproate levels that raising the valproate does not overcome, so breakthrough seizures are likely. Another antibiotic (or another antiseizure drug) is chosen instead.
    Infectious Disease
  3. A 30-year-old woman of Han Chinese ancestry is to start carbamazepine for focal seizures. Which step is recommended before starting?

    A) Check G6PD activity
    B) Check TPMT activity
    C) Test for HLA-B*15:02
    D) Test for HLA-B*57:01
    C) Test for HLA-B*15:02

    Carriers of HLA-B*15:02, common in people of Asian ancestry, have a much higher risk of Stevens–Johnson syndrome and TEN with carbamazepine. HLA-B*57:01 predicts abacavir hypersensitivity, not carbamazepine reactions.
    Neurology
  4. A malnourished patient with a low serum albumin has nystagmus and ataxia on phenytoin, but the total phenytoin level is within the usual range. What is the best next step?

    A) Measure a free (unbound) phenytoin level
    B) Reassure, since the total level is in range
    C) Repeat the total level after a week
    D) Switch to IV fosphenytoin right away
    A) Measure a free (unbound) phenytoin level

    Phenytoin is highly albumin-bound, so with hypoalbuminemia the free fraction rises and a normal total level hides a toxic active concentration. A free level (or an albumin-corrected estimate) guides therapy.
    Neurology
  5. An 80-year-old woman taking hydrochlorothiazide started sertraline three weeks ago and is now confused and nauseated. Which lab should be checked first?

    A) Serum creatine kinase
    B) Serum sodium
    C) Serum lipase
    D) Serum ammonia
    B) Serum sodium

    SSRIs can cause hyponatremia from SIADH, most often in older adults and those on diuretics. Ammonia is the key check for confusion on valproate, not on an SSRI.
    Psychiatry
  6. A 66-year-old on long-term oxycodone has just been prescribed alprazolam. Which counseling action is most appropriate?

    A) Offer naloxone and teach family members to use it
    B) Suggest an OTC antihistamine for extra sleep
    C) Advise that the pair is safe when taken as directed
    D) Advise spacing the two drugs a few hours apart
    A) Offer naloxone and teach family members to use it

    Combining opioids with benzodiazepines raises the risk of fatal respiratory depression, so naloxone is offered and family are taught to use it. Spacing them apart does not remove the overlap in their sedating effects.
    Pain

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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)

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