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Guide for North American Pharmacist Licensure Examination

Quiz North American Pharmacist Licensure Examination

Updated on 2025/04/04

PDF|

Guide for North American Pharmacist Licensure Examination

Updated on 2025/04/04

Randomized | 10 Questions per Test | 20 Minutes | 70% to pass

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4.8

Quiz

Question 1/101/10

Which of the following represents the major route of metabolism for acetaminophen?

Select the answer:Select the answer

1 correct answer

Glucuronidation

Sulfation

Cytochrome P-450 oxidation

Direct renal excretion

Plasma breakdown

Quiz

Question 2/102/10

A 15-year-old presents with 6 days of nasal congestion with thin, clear rhinorrhe
a. She notes mild facial pain but has had no fevers. She feels her symptoms are improving.

What is the most likely cause of her symptoms?

Select the answer:Select the answer

1 correct answer

Streptococcus pneumoniae

Viral

Moraxella catarrhalis

Haemophilus influenzae

Staphylococcus aureus

Quiz

Question 3/103/10

A 72-year-old woman suffers from a major depressive episode. She has a history of coronary artery
disease, atrial fibrillation on anticoagulation therapy, sick sinus syndrome, glaucoma, and chronic
obstructive pulmonary disease.

Which of the following medications is most appropriate for the treatment of her depression?

Select the answer:Select the answer

1 correct answer

Amitriptyline

Nortriptyline

Doxepin

Fluvoxamine

Escitalopram

Quiz

Question 4/104/10

A 20-year-old student came to the emergency department with primary complaints of palpitations,
low-grade fever, and anxiety for 2 months. She reports that she is irritable and suffers severe mood
swings that is interfering with her sleep and relationships (she admits to crying spells and frequent
fights with friends and family). She has also lost 12 pounds in the past 2 months with no apparent
alteration in her diet or physical activity (though she is happy with her weight loss). She denies any
past medical problems, though her friends have always been worried that she eats too little.

Her temperature is 38.0 C (100.4 F), blood pressure is 148/62 mm Hg, pulse is 122/min and regular,
and respiratory rate is 28/min. Examination reveals a bruit heard over the anterior neck, fine tremor
of the hands, and warm, moist skin. Her eyes and eyelids do not move together during finger
following test (with steady head). Laboratory work is sent, including a thyroid panel, but will not be
available until tomorrow morning.

Which of the following is the most appropriate initial management at this time?

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1 correct answer

Diltiazem therapy

Iodine therapy

Methimazole therapy

Propranolol therapy

Referral to a surgeon

Quiz

Question 5/105/10

What is the best anti-thyroid regimen in a pregnant woman who has clinically significant
hyperthyroidism?

Select the answer:Select the answer

1 correct answer

Stop treatment and resume post-partum

Propylthiouracil

Methimazole

Propylthiouracil first trimester followed by methimazole for the remainder of pregnancy

Methimazole first trimester followed by propylthiouracil for the remainder of pregnancy

Quiz

Question 6/106/10

Which of the following is true regarding extent of absorption of drugs?

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1 correct answer

After oral ingestion of drugs, the absorption of drug may be incomplete

Drugs which are too lipophilic cannot cross the lipid cell membrane

Drugs which are too hydrophilic 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 enhances the
absorption of drug

Grape juice activates P-glycoprotein leading to substantial inhibition of absorption of drugs

Quiz

Question 7/107/10

Your patient is a 58-year-old male who presents with onset of severe substernal chest pain and
shortness of breath. An ECG reveals an acute STEMI, and he is on his way to the cardiac
catheterization suite for percutaneous coronary intervention.

Which of the following drugs used in acute coronary syndromes treated with PCI must undergo
oxidation by hepatic P450 enzymes to an active form?

Select the answer:Select the answer

1 correct answer

Clopidogrel

Ticlopidine

Eptifibatide

Aspirin

Warfarin

Clopidogrel and ticlopidine are ADP receptor pathway inhibitors. The irreversible inhibition of the
ADP- dependent pathway of platelet activation is thought to be the result of covalent modification
and inactivation of the platelet P2Y ADP receptor. This receptor is coupled to the inhibition of
adenylyl cyclase. Both drugs are prodrugs and undergo conversion to active metabolites in the liver.
However, clopidogrel must undergo oxidation by hepatic P450 enzymes to its active form. This is
significant because many drugs are metabolized the hepatic P450 enzymes, including statins, and
clopidogrel may interact with these medications. Clopidogrel is a second-generation thienopyridine
and ticlopidine is a first-generation thienopyridine. Both drugs are indicated in combination with
aspirin to prevent stent thrombosis. Eptifibatide is a GPIIb-IIIa receptor antagonist that is used to
treat unstable angina and non-ST segment elevation myocardial infarction. Eptifibatide is also used to
reduce ischemic events in patients who are undergoing percutaneous coronary intervention. The
drug is a synthetic peptide that directly antagonizes the GPIIb-IIIa receptor on the platelet. Aspirin is
an antiplatelet drug that works by inhibition of synthesis of prostaglandins. Prostaglandin G2 is the
result of a synthesis pathway that is activated by platelets and endothelial cells, and results in
localized
vasoconstriction and induction of platelet aggregation, as well as causing release of platelet granules.
Warfarin is an anticoagulant that acts on vitamin K-dependent reactions in the coagulation pathway.
Vitamin K is necessary for hepatic synthesis of coagulation factors II, VII, IX and X, protein C and
protein S. Vitamin K- dependent carboxylation is necessary for induction of enzymatic activity of
these coagulation factors. Take- home message: Clopidogrel, a second-generation thienopyridine
ADP receptor pathway inhibitor, is indicated in combination with aspirin to prevent stent thrombosis
in patients who undergo percutaneous coronary intervention after myocardial infarction. Clopidogrel
is a prodrug that must undergo oxidation by hepatic P450 enzymes, and therefore may affect the
activity of statins and other drugs dependent on the hepatic P450 enzymes.

Right Answer: A

Quiz

Question 8/108/10

A patient with multibacillary leprosy is on dapsone, clofazimine, and rifampin. Which of the following
is true regarding the mechanism of action of the medications listed?

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1 correct answer

Dapsone is bacteriostatic because of its inhibitory effects on dihydrofolate reductase

Dapsone is bacteriostatic because of its inhibitory effects on myeloperoxidase

Clofazimine is bactericidal by directly inhibiting bacterial DNA polymerase

Rifampin is bacteriostatic by inhibiting RNA synthesis by blocking DNA-dependent RNA
polymerase

Rifampin is bactericidal by inhibiting RNA synthesis by blocking DNA-dependent RNA polymerase

Quiz

Question 9/109/10

You prescribe doxepin to a 37-year-old woman to treat neurotic excoriations on her arms. The
patient is concerned about the side effects of this drug. Which of the following is not a side effect of
doxepin:

Select the answer:Select the answer

1 correct answer

Xerostomia

Liver toxicity

Somnolence

Urinary retention

Constipation

Quiz

Question 10/1010/10

Which of the following illnesses is an example of a type III hypersensitivity reaction?

Select the answer:Select the answer

1 correct answer

Lupus

Graves disease

Hashiomoto’s thyroiditis

Allergic rhinitis

Myasthenia gravis

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Quiz name:North American Pharmacist Licensure Examination
Total number of questions:154
Number of questions for the test:50
Pass score:80%

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