The NAPLEX – Part 2, Important Chapters

Let’s continue with Part 2 – which chapters to focus on. Now the new Naplex covers all the chapters, so basically you need to review everything in details (at my time, there were chapters that I focused on more). However, I think the scale would be similar, so I would definitely focus on the following areas:

Math: This is the key. You cannot pass Naplex if you cannot do well in math. As I mentioned in Part 1, practicing the SDN 120 math questions is a must (unless you’re very good in math) to be familiar with the wordings of the problems and have an idea what type of math questions will be asked. The problems in the Naplex exam are more complicated than the ones in Rxprep. You need to practice on complex math problems that make you use different steps to get the answer, not just plugging in numbers.

Pay attention to the units because you can get the wrong answer easily if the unit is wrong.
Dose conversion and equivalence: Important to remember and practice for the main drugs such as opioids, statins, diuretics.
Flow rate, creatinine clearance with different conditions/body weight, BMI, BSA, etc. Practice until you know by heart and do it like a robot. These are easy questions, so you don’t want to loose points, they might save you.
If math questions occur at the end, with a 6 hours exam, you’re already tired at that point. Your brain might not be as sharp as usual, especially if you previously bump into questions that you cannot answer. Your morals might be down and you might feel anxious, so your brain cannot think straight anymore. Therefore, if you’re already familiar with the complexity of the wordings, you won’t be surprised or panic. You don’t want to be in the situation in which you read but still cannot understand what the problem is asking (your brain is so tired, so you can’t think any more). Familiarity will help you in the last hour.
In summary, practice math every day is the best way to do well in math, especially during crunch time.

Biostats: Another key to pass.

NNT, ARR, RR: A MUST-know. Practice the same way as math, they’re easy, so again you don’t want to miss these points.
Evaluation of clinical trial results: You also should practice this so that you can answer fast. I don’t think the Biostats chapter in Rxprep is enough although there’s an extra video that goes with it. The same chapter in the APhA book is way too much with details you don’t need to know. So what I did was I ordered the ACCP “Clinical Pharmacist’s Guide to Biostatistics and Literature Evaluation” ($19.95). This book is for pharmacists who want to take the Board Certified Pharmacotherapy Specialists (BCPS) exam. I was thinking to take the BCPS exam later, so there’s no harm to buy the book now. It does have some questions about clinical trials evaluation, so I’m more familiar with the biostats clinical trials questions. Since I didn’t have time to read the whole book, I just selected the chapters that I thought relevant to Naplex.

Brand vs. generics: Very important

People say make sure to know the top 200 drugs. It’s not true in this area. Strange names will be given. The point is if you cannot recognize the drug, you cannot answer a series of questions in a case related to the drug. So make sure to learn this again and again. I didn’t pay attention to brand names during pharmacy school, so I had to double the effort to learn the brand and generic names when studying for the exam. Had I known this, I would definitely memorize the brand names. But since there are new drugs anyway, you have to learn brand and generic names yourself. Keep on repeating is the key to remember.
Combination drugs: Know the brand names as well as the drug components. Again, if you don’t know the brand names, how could you know which drugs are included in the combinations? For sure you will be asked about them.

Infectious Diseases:

Rxprep has five very good chapters on Infectious Diseases. Make sure to know them very well because anything could be asked in patients’ cases with chronic or acute conditions. These are basic questions, not tricky at all; however, since the case might be complicated, you must pay attention to the patient’s conditions and other drugs he/she is taking in order to select the correct drug and dose.
My summary and notes during pharmacy school really help me because I made good notes. I was very fortunate to have Dr. MacDougall as my professor, and he’s excellent, so I had a good background in Infectious Diseases drugs.
Know the doses of the main drugs, for sure they will be asked.
Know which bacteria causing which diseases. The best chapter to study is the Rxprep ID chapter about both drugs and diseases together.
Should know the uniqueness of the drugs, i.e. refrigerated or not, with or without food.
Pediatric doses: Review AOM, meningitis. Know which bacteria causes what disease in children based on their age ranges.

Diabetes, Hypertension, Dyslipidemia: These chapters are as important as the ID chapters. I suggest to study the current guidelines very well.

Since there are so many drug classes, make sure to recognize the drug and its class in order to know the mechanism of action.
Again brand and generic names, combination drug names, especially diabetes drugs.
Make sure to know different types of insulin and its storage.
Know how to calculate LDL, TC or TC from the lab results.

Anticoagulants: You don’t like doses, right? But for this chapter, you must know the doses of different types of heparin/LMWH as well as the new oral anticoagulants and its storage, renal adjustment, the monitoring parameters, etc. Warfarin cannot be missed, which medications or herbs could affect the INR. Both Rxprep and APhA have good summary of the doses. Again, I prefer the way the APhA book presents the drugs and its doses.

Difficult chapters such as Oncology, HIV, Organ transplant, Autoimmune diseases: Although my exam is adaptive, there are oncology and HIV questions.

Oncology: Know the side effects of the drug or drug class and how to deal with them. There’s a whole section about this. The guideline is also a good resource to review. There are some special drugs you should know such as the lifetime limit dose of darubicin, how the CNIs affect metabolism and renal functions, etc.
HIV: Definitely know brand names, combination drugs and side effects, renal contraindications. Cases in HIV, infectious diseases are common. I had an ambulatory care rotation at a HIV clinic where I provided counseling and medication reconciliation to patients with HIV, so I feel comfortable in this area.
Organ transplant and autoimmune diseases drugs appear on my exam, which gave me quite a hard time because I didn’t focus on them. I just answered based on what came to my mind first.

Immunizations: Don’t forget to review vaccine administration techniques.

Skin conditions: Know the potency of steroids.

Compounding: There are more compounding questions now. I found the Compounding chapter in the APhA book easier to remember, and might be more helpful because there are sections about compounding techniques. Also make sure to review the definitions of the techniques, otherwise you have no clue what the question is about.

Drug-drug interactions, allergies, side effects, contraindications: Know the main drugs that are obviously contraindicated to each other, for example PDE-5 inhibitors and Nitroglycerin, etc. There will be a lot of cases, so you should practice in order to recognize the contraindications quickly.

Renal adjustments: Pay attention to this, this is important, and definitely will be asked in some cases.

The way I studied was I made index cards for each chapter. Because I’m a visual person, I also created tables for drugs that need renal adjustment or special storage, to be taken with food. I also used mnemonics to help me memorizing the side effects of the drugs, so it depends on your creativity. After making the cards, I talked out loud, pretending to counsel myself on the use of the drugs. Practice questions and repetition are the main things to memorize these two thick books, and each person definitely has different ways to retain the information.

Don’t forget the quizlet that I mentioned in Part 1. It helps me to review the main points of each chapter.

Optional:

If you are an APhA member, you receive Pharmacy Today monthly. The last section of the magazine is for Continuing Pharmacy Education (CPE) that might be helpful for Naplex because there are questions for you to answer. Here are the monthly issues that have such CPE sections:

February 2016: Naloxone use for opioid overdose
May 2016: Immunization
June 2016: Managing drug interactions in patients with HIV
August 2016: Individualized diabetes management

From the feedback of people taking the Naplex after November 2016, the new format is longer but definitely not more difficult (actually, most of them prefer this format). It’s just a long exam, and I will talk about the exam day in Part 3.

Best of luck!

Vivian
12/14/2016