Foundational Knowledge
25%of exam
Medication Use Process
25%of exam
Assessment and Treatment
40%of exam
Professional Practice
5%of exam
ReportingPublic HealthEthicsSocial Drivers
Management and Leadership
5%of exam
Quick Facts
- Exam
- NAPLEX
- Owner
- NABP
- Delivery
- Pearson VUE
- Time
- 6 hours
- Questions
- 225 total
- Scored
- 200 scored
- Pass
- 75 scaled
- Result
- Pass/fail
- Attempts
- 5 total
- Blueprint
- May 1 2025
PK Triad
Vd, clearance, half-life travel together.
VdClt1/2ke
Scored vs Pretest
Scored
- 200 items
- Counts toward pass
Pretest
- 25 items
- Not identified
Treat every item as scored
Calculation Picker
- Renal dosing→Cockcroft-Gault(Use CrCl)
- Weight dose→mg/kg(Convert kg)
- Manual drip→gtt/min(Drop factor)
- Infusion pump→mL/hr(Concentration first)
- Electrolyte amount→mEq(Valence matters)
- Nutrition calories→TPN math(Macros separate)
- Chemo dosing→BSA(Verify caps)
- Mix strengths→Alligation(Percent check)
PK Core
- ADME
- Drug movement
- Vd
- Amount over concentration
- Cl
- Removal efficiency
- t1/2
- Concentration halves
- ke
- Elimination constant
- AUC
- Total exposure
- Css
- Steady state
- F
- Bioavailability fraction
First vs Zero Order
First-order
- Constant fraction
- Stable half-life
Zero-order
- Constant amount
- Capacity saturated
Phenytoin can saturate
Calculations
- lb to kg
- Divide by 2.2
- mg/kg
- Dose times weight
- mL/hr
- Volume over hours
- gtt/min
- mL/hr times factor
- mEq
- mg times valence/MW
- mOsm
- Particles per liter
- CrCl
- Cockcroft-Gault dosing
- BSA
- Mosteller formula
ARR vs RRR
ARR
- Absolute difference
- Needed for NNT
RRR
- Relative reduction
- Can look larger
NNT uses ARR
Evidence
- P value
- Chance under null
- CI
- Estimate precision
- ARR
- Absolute risk difference
- RRR
- Relative risk drop
- NNT
- One benefit count
- NNH
- One harm count
- Bias
- Systematic error
- Power
- Detects true effect
Compounding
- USP 795
- Nonsterile compounding
- USP 797
- Sterile compounding
- USP 800
- Hazardous drugs
- BUD
- Beyond-use date
- Aseptic
- Prevents contamination
- CSP
- Sterile preparation
- Incompatibility
- Physical or chemical
- Stability
- Potency maintained
Five Rights
Patient, drug, dose, route, time.
PatientDrugDoseRouteTime
Contraindication vs Precaution
Contraindication
- Do not give
- Risk unacceptable
Precaution
- Assess first
- May delay
Contraindication blocks therapy
Medication Use Picker
- Unclear order→Clarify(Before dispense)
- Contraindicated drug→Hold(Contact prescriber)
- Formulary issue→Therapeutic alternative
- Shortage exists→Reserve supply(Clinical priority)
- Vaccine adverse event→VAERS
- Temperature breach→Quarantine(Check stability)
Orders
- Indication
- Why drug needed
- Dose
- Amount per administration
- Route
- How administered
- Frequency
- How often
- Duration
- Treatment length
- Allergy
- Avoid trigger
- Contraindication
- Do not use
- Boxed warning
- Serious risk
Medication Use
- Prescribing
- Therapy ordered
- Transcribing
- Order documented
- Dispensing
- Product supplied
- Administering
- Dose given
- Monitoring
- Response checked
- Substitution
- Alternative selected
- Shortage
- Supply limited
- REMS
- Risk program
Immunizations
- Indication
- Vaccine recommended
- Contraindication
- Vaccine avoided
- Precaution
- Assess risk
- Live vaccine
- Avoid immunocompromise
- Cold chain
- Temperature control
- VIS
- Patient handout
- VAERS
- Vaccine event report
- ACIP
- Schedule guidance
Handling
- Storage
- Required conditions
- Excursion
- Temperature breach
- Quarantine
- Hold product
- Hazardous
- Special controls
- Sharps
- Puncture container
- Disposal
- Safe removal
- Recall
- Product removed
- Chain
- Custody trace
Therapy Problems
Need, fit, dose, safety, adherence.
IndicationEffectivenessSafetyAdherence
Interaction vs Duplication
Interaction
- Exposure changes
- Toxicity or failure
Duplication
- Same purpose
- Unneeded overlap
Check both every profile
Therapy Picker
- No indication→Stop therapy(Avoid harm)
- Untreated condition→Add therapy
- Goal unmet→Intensify(If adherent)
- ADR likely→Switch therapy
- Renal decline→Adjust dose
- Poor adherence→Simplify regimen
History
- PMH
- Disease history
- Med list
- All therapies
- Allergies
- Reaction details
- Adherence
- Actual use
- Pregnancy
- Fetal risk
- Renal
- Dose adjustment
- Hepatic
- Metabolism risk
- Social
- Care barriers
Efficacy vs Safety
Efficacy
- Goal achieved
- Disease controlled
Safety
- Harms acceptable
- Labs stable
Passing answers balance both
Therapy Fit
- Indication
- Needs therapy
- Efficacy
- Meets goal
- Safety
- Harms acceptable
- Duplication
- Same purpose
- Omission
- Missing therapy
- Interaction
- Exposure altered
- ADR
- Drug harm
- Toxicity
- Excess exposure
Monitoring
- Goal
- Target outcome
- Endpoint
- Measured result
- Baseline
- Starting value
- Follow-up
- Recheck timing
- Lab
- Objective measure
- Vitals
- Clinical signs
- TDM
- Drug concentration
- Deprescribe
- Stop safely
High-Yield Therapy
- HTN
- BP goal therapy
- Diabetes
- A1c plus comorbidities
- HFrEF
- Four pillars
- AFib
- Stroke prevention
- ID
- Site and organism
- Asthma
- Controller plus reliever
- Psych
- Efficacy plus safety
- Pain
- Function and risk
Reporting Split
Vaccines to VAERS; drugs to MedWatch.
VAERSMedWatchSafetySignal
MedWatch vs VAERS
MedWatch
- Drugs/devices
- FDA safety
VAERS
- Vaccines
- Adverse events
Vaccine event goes VAERS
Practice Safety
- MedWatch
- Drug event report
- VAERS
- Vaccine event report
- Stewardship
- Optimize antimicrobials
- Naloxone
- Opioid reversal
- Cessation
- Tobacco treatment
- SDOH
- Access barriers
- Autonomy
- Patient choice
- Confidentiality
- Protect privacy
Quality Cycle
Plan, do, study, act.
PlanDoStudyAct
RCA vs PDSA
RCA
- Find system causes
- After event
PDSA
- Test improvements
- Iterative cycle
Analyze then improve
Safety Picker
- High-alert drug→Double-check
- Name confusion→Tall man
- System error→RCA
- Process trend→CQI(PDSA cycle)
- Serious recall→Class I(Act immediately)
- Inventory mismatch→Cycle count
Operations
- ADC
- Automated dispensing
- BCMA
- Barcode administration
- CPOE
- Electronic ordering
- LASA
- Name confusion
- Tall man
- Name differentiation
- Double-check
- Independent verification
- Just culture
- Systems focus
- High-alert
- Severe harm risk
Inventory + Quality
- Cycle count
- Rotating inventory count
- Perpetual
- Real-time inventory
- Class I
- Serious recall
- Class II
- Reversible risk
- Class III
- Unlikely harm
- MUE
- Medication use review
- RCA
- System cause analysis
- PDSA
- Improvement cycle
Common Traps
75 Scaled
Not 75 percent ≠ Competency threshold
Pass Result
Numeric score hidden ≠ Fail report detailed
No Backtracking
No skipped items ≠ No later review
CrCl Dosing
Cockcroft-Gault ≠ Not eGFR default
Pretest Items
Mixed into exam ≠ Not marked
Live Vaccines
Avoid immunocompromise ≠ Inactivated usually safer
High-Alert Drugs
Not common drugs ≠ Severe harm drugs
Recall Classes
Class I serious ≠ Class III least harmful
Last Minute
- 1.Domain 3 is 40%
- 2.Use 200 scored weights
- 3.225 questions, 6 hours
- 4.Each answer locks
- 5.Treat all items scored
- 6.CrCl for renal dosing
- 7.NNT equals one over ARR
- 8.Five rights before administer
- 9.Quarantine temperature excursions
- 10.VAERS for vaccine events
- 11.MedWatch for drug events
- 12.RCA finds system causes
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