NAPLEX Exam Dumps : North American Pharmacist Licensure Examination

It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL . C. is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.

Diphenhydramine possesses anticholinergic properties. Xerostomia, or dry mouth, is a common side effect of anti-cholinergic medications, due to anti-muscarinic, parasympatholytic effects. Other adverse reactions may include: • Mydriasis with blurred vision, photophobia • Urinary retention • Constipation • Anhidrosis • Hyperthermia • Tachycardia • Altered mental status

A commonly referenced mnemonic for anti-cholinergic toxicity is “mad as a hatter, red as a beet, dry as a bone, hot as a hare, blind as a bat” to reflect confusion, flushing, dry mouth, hyperthermia and mydriasis, respectively.

Cefepime, levofloxacin, cefazolin does not provide good coverage of anaerobes. Ampicillin-sulbactam and piperacillin-tazobactam provide anaerobic coverage.