Medication And Non-Drug Therapy Selection - NAPLEX
Card 1 of 25
Which medication is first-line for acute mania in bipolar I disorder requiring pharmacotherapy?
Which medication is first-line for acute mania in bipolar I disorder requiring pharmacotherapy?
Tap to reveal answer
Lithium, valproate, or an atypical antipsychotic. These mood stabilizers or antipsychotics rapidly control manic symptoms by modulating neurotransmitters and neuronal excitability.
Lithium, valproate, or an atypical antipsychotic. These mood stabilizers or antipsychotics rapidly control manic symptoms by modulating neurotransmitters and neuronal excitability.
← Didn't Know|Knew It →
Which antidepressant class is generally first-line for major depressive disorder?
Which antidepressant class is generally first-line for major depressive disorder?
Tap to reveal answer
SSRI (or SNRI as an alternative first-line option). SSRIs enhance serotonin neurotransmission with a favorable efficacy and tolerability profile for depression treatment.
SSRI (or SNRI as an alternative first-line option). SSRIs enhance serotonin neurotransmission with a favorable efficacy and tolerability profile for depression treatment.
← Didn't Know|Knew It →
What is the first-line pharmacotherapy for type 2 diabetes without contraindications?
What is the first-line pharmacotherapy for type 2 diabetes without contraindications?
Tap to reveal answer
Metformin. ADA guidelines recommend it for improving insulin sensitivity and reducing hepatic glucose output with minimal hypoglycemia risk.
Metformin. ADA guidelines recommend it for improving insulin sensitivity and reducing hepatic glucose output with minimal hypoglycemia risk.
← Didn't Know|Knew It →
Which glucose-lowering drug class is preferred for type 2 diabetes with ASCVD benefit?
Which glucose-lowering drug class is preferred for type 2 diabetes with ASCVD benefit?
Tap to reveal answer
GLP-1 receptor agonist or SGLT2 inhibitor with ASCVD benefit. These classes have evidence from CVOTs showing reduction in major adverse cardiovascular events in diabetic patients with ASCVD.
GLP-1 receptor agonist or SGLT2 inhibitor with ASCVD benefit. These classes have evidence from CVOTs showing reduction in major adverse cardiovascular events in diabetic patients with ASCVD.
← Didn't Know|Knew It →
Which glucose-lowering drug class is preferred for type 2 diabetes with HFrEF or CKD progression benefit?
Which glucose-lowering drug class is preferred for type 2 diabetes with HFrEF or CKD progression benefit?
Tap to reveal answer
SGLT2 inhibitor (if eGFR allows). SGLT2 inhibitors reduce heart failure hospitalizations and slow CKD progression via hemodynamic and anti-inflammatory effects.
SGLT2 inhibitor (if eGFR allows). SGLT2 inhibitors reduce heart failure hospitalizations and slow CKD progression via hemodynamic and anti-inflammatory effects.
← Didn't Know|Knew It →
What is the first-line medication class for secondary prevention after ischemic stroke or TIA (non-cardioembolic)?
What is the first-line medication class for secondary prevention after ischemic stroke or TIA (non-cardioembolic)?
Tap to reveal answer
Antiplatelet therapy (aspirin or clopidogrel). Antiplatelets inhibit platelet aggregation to prevent recurrent atherothrombotic events post-stroke or TIA.
Antiplatelet therapy (aspirin or clopidogrel). Antiplatelets inhibit platelet aggregation to prevent recurrent atherothrombotic events post-stroke or TIA.
← Didn't Know|Knew It →
Which anticoagulant is preferred for stroke prevention in nonvalvular atrial fibrillation in most patients?
Which anticoagulant is preferred for stroke prevention in nonvalvular atrial fibrillation in most patients?
Tap to reveal answer
DOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). DOACs provide effective stroke prevention with lower intracranial bleeding risk and no routine monitoring compared to warfarin.
DOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). DOACs provide effective stroke prevention with lower intracranial bleeding risk and no routine monitoring compared to warfarin.
← Didn't Know|Knew It →
Which anticoagulant is preferred for atrial fibrillation with a mechanical heart valve?
Which anticoagulant is preferred for atrial fibrillation with a mechanical heart valve?
Tap to reveal answer
Warfarin. Warfarin is required for its adjustable anticoagulation in patients with mechanical valves to prevent thromboembolic complications.
Warfarin. Warfarin is required for its adjustable anticoagulation in patients with mechanical valves to prevent thromboembolic complications.
← Didn't Know|Knew It →
Which medication is first-line for acute gout flare in a patient without major contraindications?
Which medication is first-line for acute gout flare in a patient without major contraindications?
Tap to reveal answer
NSAID, colchicine, or systemic corticosteroid. These agents rapidly reduce inflammation and pain from monosodium urate crystal deposition in acute gout.
NSAID, colchicine, or systemic corticosteroid. These agents rapidly reduce inflammation and pain from monosodium urate crystal deposition in acute gout.
← Didn't Know|Knew It →
Which urate-lowering therapy is first-line for chronic gout prevention?
Which urate-lowering therapy is first-line for chronic gout prevention?
Tap to reveal answer
Allopurinol. As a xanthine oxidase inhibitor, it reduces uric acid production to maintain low serum urate levels and prevent gout flares.
Allopurinol. As a xanthine oxidase inhibitor, it reduces uric acid production to maintain low serum urate levels and prevent gout flares.
← Didn't Know|Knew It →
What is the first-line nonpharmacologic therapy for mild to moderate osteoarthritis of knee or hip?
What is the first-line nonpharmacologic therapy for mild to moderate osteoarthritis of knee or hip?
Tap to reveal answer
Exercise, weight loss if overweight, and physical therapy. ACR guidelines prioritize these to strengthen muscles, reduce joint load, and improve function without pharmacologic side effects.
Exercise, weight loss if overweight, and physical therapy. ACR guidelines prioritize these to strengthen muscles, reduce joint load, and improve function without pharmacologic side effects.
← Didn't Know|Knew It →
Which medication is first-line for neuropathic pain due to diabetic peripheral neuropathy?
Which medication is first-line for neuropathic pain due to diabetic peripheral neuropathy?
Tap to reveal answer
Duloxetine, pregabalin, gabapentin, or a TCA. These modulate central pain pathways, providing relief from neuropathic symptoms in diabetic neuropathy per guidelines.
Duloxetine, pregabalin, gabapentin, or a TCA. These modulate central pain pathways, providing relief from neuropathic symptoms in diabetic neuropathy per guidelines.
← Didn't Know|Knew It →
Which first-line medication class is preferred for uncomplicated primary hypertension in most adults?
Which first-line medication class is preferred for uncomplicated primary hypertension in most adults?
Tap to reveal answer
Thiazide diuretic, ACE inhibitor, ARB, or dihydropyridine CCB. These classes are recommended by ACC/AHA guidelines as initial therapy due to proven efficacy in reducing cardiovascular events in uncomplicated hypertension.
Thiazide diuretic, ACE inhibitor, ARB, or dihydropyridine CCB. These classes are recommended by ACC/AHA guidelines as initial therapy due to proven efficacy in reducing cardiovascular events in uncomplicated hypertension.
← Didn't Know|Knew It →
What medication class must be avoided in pregnancy due to fetotoxicity (renal failure, oligohydramnios)?
What medication class must be avoided in pregnancy due to fetotoxicity (renal failure, oligohydramnios)?
Tap to reveal answer
ACE inhibitors and ARBs. These inhibit the renin-angiotensin system, causing fetal renal damage, oligohydramnios, and other teratogenic effects during pregnancy.
ACE inhibitors and ARBs. These inhibit the renin-angiotensin system, causing fetal renal damage, oligohydramnios, and other teratogenic effects during pregnancy.
← Didn't Know|Knew It →
Which beta-blocker has the strongest evidence for mortality benefit in HFrEF?
Which beta-blocker has the strongest evidence for mortality benefit in HFrEF?
Tap to reveal answer
Carvedilol, metoprolol succinate, or bisoprolol. These beta-blockers have demonstrated mortality reduction in large clinical trials for heart failure with reduced ejection fraction.
Carvedilol, metoprolol succinate, or bisoprolol. These beta-blockers have demonstrated mortality reduction in large clinical trials for heart failure with reduced ejection fraction.
← Didn't Know|Knew It →
What is the preferred initial inhaler regimen for COPD with persistent symptoms and low exacerbation risk?
What is the preferred initial inhaler regimen for COPD with persistent symptoms and low exacerbation risk?
Tap to reveal answer
Long-acting bronchodilator (LAMA or LABA). GOLD guidelines recommend long-acting bronchodilators for symptom relief in low-risk COPD patients without frequent exacerbations.
Long-acting bronchodilator (LAMA or LABA). GOLD guidelines recommend long-acting bronchodilators for symptom relief in low-risk COPD patients without frequent exacerbations.
← Didn't Know|Knew It →
Which controller therapy is first-line for persistent asthma across age groups?
Which controller therapy is first-line for persistent asthma across age groups?
Tap to reveal answer
Inhaled corticosteroid (ICS). GINA guidelines endorse ICS as they target airway inflammation, the key pathophysiology in persistent asthma.
Inhaled corticosteroid (ICS). GINA guidelines endorse ICS as they target airway inflammation, the key pathophysiology in persistent asthma.
← Didn't Know|Knew It →
Which medication is first-line for acute anaphylaxis, and what is the route?
Which medication is first-line for acute anaphylaxis, and what is the route?
Tap to reveal answer
Epinephrine intramuscularly. IM epinephrine rapidly activates alpha and beta receptors to reverse hypotension, bronchospasm, and angioedema in anaphylaxis.
Epinephrine intramuscularly. IM epinephrine rapidly activates alpha and beta receptors to reverse hypotension, bronchospasm, and angioedema in anaphylaxis.
← Didn't Know|Knew It →
What is the preferred first-line antibiotic for uncomplicated cystitis in a nonpregnant adult woman?
What is the preferred first-line antibiotic for uncomplicated cystitis in a nonpregnant adult woman?
Tap to reveal answer
Nitrofurantoin, TMP-SMX, or fosfomycin. IDSA guidelines favor these for their efficacy against E. coli and low resistance in uncomplicated urinary tract infections.
Nitrofurantoin, TMP-SMX, or fosfomycin. IDSA guidelines favor these for their efficacy against E. coli and low resistance in uncomplicated urinary tract infections.
← Didn't Know|Knew It →
Which antibiotic is preferred for acute uncomplicated pyelonephritis requiring oral outpatient therapy?
Which antibiotic is preferred for acute uncomplicated pyelonephritis requiring oral outpatient therapy?
Tap to reveal answer
Fluoroquinolone (if local susceptibility is adequate). Fluoroquinolones provide broad gram-negative coverage and high renal concentrations for outpatient pyelonephritis treatment.
Fluoroquinolone (if local susceptibility is adequate). Fluoroquinolones provide broad gram-negative coverage and high renal concentrations for outpatient pyelonephritis treatment.
← Didn't Know|Knew It →
Which medication is preferred for chronic hepatitis B in a patient at risk for renal or bone toxicity?
Which medication is preferred for chronic hepatitis B in a patient at risk for renal or bone toxicity?
Tap to reveal answer
Tenofovir alafenamide (TAF) or entecavir. These nucleoside analogs inhibit HBV replication with lower risks of renal impairment or bone density loss compared to alternatives.
Tenofovir alafenamide (TAF) or entecavir. These nucleoside analogs inhibit HBV replication with lower risks of renal impairment or bone density loss compared to alternatives.
← Didn't Know|Knew It →
What is the first-line regimen for Helicobacter pylori when local clarithromycin resistance is high or unknown?
What is the first-line regimen for Helicobacter pylori when local clarithromycin resistance is high or unknown?
Tap to reveal answer
Bismuth quadruple therapy. This regimen uses bismuth and multiple antibiotics to eradicate H. pylori despite potential clarithromycin resistance.
Bismuth quadruple therapy. This regimen uses bismuth and multiple antibiotics to eradicate H. pylori despite potential clarithromycin resistance.
← Didn't Know|Knew It →
Which medication is first-line for GERD requiring long-term symptom control and healing of erosive esophagitis?
Which medication is first-line for GERD requiring long-term symptom control and healing of erosive esophagitis?
Tap to reveal answer
Proton pump inhibitor (PPI). PPIs inhibit the proton pump to suppress acid secretion, promoting esophageal healing and symptom relief in GERD.
Proton pump inhibitor (PPI). PPIs inhibit the proton pump to suppress acid secretion, promoting esophageal healing and symptom relief in GERD.
← Didn't Know|Knew It →
Which non-drug therapy is first-line for insomnia before initiating hypnotics?
Which non-drug therapy is first-line for insomnia before initiating hypnotics?
Tap to reveal answer
Cognitive behavioral therapy for insomnia (CBT-I). CBT-I modifies maladaptive sleep behaviors and cognitions for sustained insomnia improvement without medication dependence.
Cognitive behavioral therapy for insomnia (CBT-I). CBT-I modifies maladaptive sleep behaviors and cognitions for sustained insomnia improvement without medication dependence.
← Didn't Know|Knew It →
Which medication is first-line for smoking cessation when no contraindications exist?
Which medication is first-line for smoking cessation when no contraindications exist?
Tap to reveal answer
Varenicline. As a partial nicotinic agonist, it reduces cravings and withdrawal while blocking nicotine's rewarding effects.
Varenicline. As a partial nicotinic agonist, it reduces cravings and withdrawal while blocking nicotine's rewarding effects.
← Didn't Know|Knew It →