NAPLEX Exam Dumps : North American Pharmacist Licensure Examination

Lifelong Vitamin B12 supplementation. Vitamin B12 (cyanocobalamin) deficiency generally presents in patients as fatigue, diarrhea and headaches but can also be the cause of cognitive changes (difficulty concentrating, even mild dementia). Pernicious anemia is a macrocytic anemia, therefore laboratory findings indicate an increased mean corpuscular volume (MCV), with a decreased hemoglobin. A positive Schilling test indicates that the B12 deficiency is due to a lack of intrinsic factor. Lifelong cyanocobalamin supplementation (either orally or via injections) is needed to treat pernicious anemia. A is incorrect. Folic acid deficiency anemia is another common type of macrocytic anemia. However, cognitive deficits are not typically seen with folic acid deficiency. Furthermore, a schilling test would be negative and the methylmalonic acid (MMA) would be normal, rather than elevated. C is incorrect. Iron deficiency anemia causes a microcytic anemia, characterized by a decreased MCV. D is incorrect. A Coomb’s test is used to detect autoimmune hemolysis that may be suspected in patients with normocytic anemia (anemia with an MCV in the normal range). E is incorrect. Corticosteroids and iron supplementation are indicated as treatment in hemolytic anemia.

Thiazolidinediones may cause fluid retention through proposed mechanism of increasing reabsorption in the collecting duct of the kidney and increasing vascular permeability in adipose tissue. Bile acid sequestrants work in the intestine to bind bile acids which doesn’t affect fluid retention. GLP-1 receptor agonists work to activate these receptors to secrete insulin from beta pancreatic cells/decrease glucagon secretion/ increase satiety and doesn’t affect fluid retention. SGLT2 inhibitors actually cause increase of fluid elimination through the kidneys. Alpha-glucosidase inhibitors work in the gut to decrease carb absorption/digestion and have no affect on fluid retention.

It is not necessary that all the drugs get completely absorbed after oral administration. Most of them are incompletely absorbed. The extent of absorption varies from 5 to less than 100 % with oral ingestion of drugs.

Drugs which are too hydrophilic like atenolol are incompletely absorbed because the drug cannot cross the

lipid membrane due to high hydrophilic nature of the drug. Similarly, drugs which are too lipophilic like acyclovir are not soluble enough to cross the water layer adjacent to the cell. P-glycoprotein is an efflux transporter which is present in the enterocytes and it inhibits absorption of drug. It is also known as export transporter or reverse transporter. It has many drugs as its substrate. Grape juice in fact inhibits P-glycoprotein in the intestine thereby decreasing the efflux of drug from the cells by P-glycoprotein. Thus ingestion of grape juice may lead to significantly increased absorption of the drug.