Errata and Updates
If we find anything that needs a correction or clarification in the RxPrep Course Book, or if there has been an update of interest, it will be included here on our Errata and Updates page. You may wish to take a look at this page several times prior to testing.
2017 RxPrep Course Book Errata and Updates
|Update p. 533||December 2016: The FDA removed the Boxed Warning for serious neuropsychiatric adverse events associated with the use of Chantix (varenicline). These are now listed in the warnings and precautions section of the package insert based on new data that the risks are lower than previously suspected. While a medication guide is still required, the REMS program for Chantix has been eliminated.|
|Update Chapter 39||January 2017: The Update to the ADA Standards of Medical Care in Diabetes was published. Key updates for testing include: 1) Stronger recommendations to periodically monitor vitamin B12 in patients taking metformin, especially patients with anemia or peripheral neuropathy, due to the risk for B12 deficiency with long-term metformin use, 2) Triple therapy now includes metformin + SGLT2 inhibitor + GLP-1 agonist as an option, 3) Empaglifozin or liraglutide should be considered in patients with long-standing, suboptimally controlled, type 2 diabetes and established atherosclerotic cardiovascular disease as they can reduce cardiovascular and all-cause mortality when added to standard care, 4) Blood pressure recommendations are now consistent with JNC 8; if the patient has diabetes but does not have albuminuria, an agent from any of the four preferred drug classes (thiazides, CCBs, ACE inhibitors or ARBs) may be selected (no longer gives preference to ACE inhibitors or ARBs unless the patient has albuminuria), 5) Pregabalin and duloxetine are the preferred agents for neuropathic pain, 6) Blood glucose goals for patients with pregestational diabetes are the same as for patients with gestational diabetes and the preferred pharmacologic treatment is insulin (metformin de-emphasized), 6) Patients should not sit for longer than 30 minutes at a time.|
|Errata p. 218||The table on vitamin names should read: Vitamin B2 = Riboflavin, Vitamin B3 = Niacin, Vitamin B6 = Pyridoxine, Vitamin B9 = Folic Acid, Vitamin B12 = Cobalamin.|
|Errata p. 429||Fluconazole should be adjusted for renal function when the CrCl is ≤ 50 mL/min.|
|Errata p. 638||The key time point with NuvaRing is 3 hours. If the NuvaRing has been out of the vagina for less than 3 hours, rinse it and insert it again right away. If the NuvaRing has been out of the vagina for more than 3 continuous hours during weeks 1 and 2, reinsert the ring as soon as you remember and use another method of birth control until the ring has been in place for 7 days in a row. If the NuvaRing has been out of the vagina for more than 3 continuous hours during week 3, discard the ring that has been out of the vagina. Use another method of birth control until the ring has been in place for 7 days in a row. Refer to the NuvaRing prescribing information for options on when to insert the new ring.|
|Errata p. 1089||Entry #186 should read “Drug: Azelastine (Ophthalmic), Brand Name: Optivar”. Astepro is the brand name for nasal azelastine.|
|Update p. 451||Tenofovir alafenamide (TAF)/emtricitabine can be used as an alternative to tenofovir disoproxil fumarate(TDF)/emtricitabine in INSTI-based regimens and PI-based regimens for antiretroviral-naïve patients. This is based on data from comparative studies demonstrating that TAF-containing regimens are as effective in achieving or maintaining virologic suppression as TDF-containing regimens while having more favorable effects on bone and renal health.|
|Errata p. 472||Under Non-Occupational Exposure Prophylaxis Recommendations, Emtricitabine/tenofovir disoproxil (Truvada) + Raltegravir or Dolutegravir constitutes an INSTI-based regimen, rather than an NNRTI-based regimen, as indicated in the heading.|
|Errata p. 49||The total body weight shown in the calculation of adjusted body weight (in problem #95) should be 130.4545 kg, instead of 103.4545 kg. The calculated adjusted body weight (108.4 kg) is correct.|
|Errata p. 709||Question 1: answer choice d. should say “Obesity” (which is a risk factor for gout). The answer key for question 1 is marked correctly.|
|Errata p. 386||Polymyxins demonstrate AUC:MIC-dependent killing.|
|Errata p. 118||The text under the picture of the syringe (third picture in the series) should say “Never touch the plunger of the syringe (between the pointer finger and thumb).”|
|Errata p. 961||Lorazepam (Ativan) dosing for status epilepticus should read “may repeat x 1 (0.1 mg/kg/dose, max of 4 mg/dose)”.|
|Errata p. 161||Bosentan is a CYP3A4 inducer rather than an inhibitor. Simeprevir is a CYP3A4 substrate; it is not an inducer.|
|Errata p. 263||A 4-hour post-ingestion acetaminophen level is recommended in suspected acetaminophen overdose. The level is interpreted based on the Rumack-Matthew Nomogram. When the 4-hour post-ingestion acetaminophen level is greater than 150 mcg/mL, N-acetylcysteine (NAC) is recommended. Treatment with NAC should begin within 8 hrs of ingestion or as soon as possible.|
|Update p. 341||The package labeling for patiromer (Veltassa) was updated. Other medications should be given at least 3 hours before or 3 hours after patiromer.|
|Errata p. 264||The dose of idarucizumab (Praxbind) for reversal of dabigatran should be 5 grams (two 2.5 gram doses, no more than 15 minutes apart).|
2016 RxPrep Course Book Errata and Updates
Anyone testing in 2017 should use the 2017 RxPrep Course Book. Major updates were made in the 2017 RxPrep material to match current NAPLEX Competency Statements.
|515||The correct dose for Advair HFA is 2 inhalations BID.|
|726||Calcium Channel Blocker Drug Interactions. All oral calcium channel blockers are major substrates of CYP 3A4. Product labeling for Procardia and Procardia XL state that grapefruit juice should be avoided (category X interaction in many tertiary sources). Details about use with other 3A4 inducers and inhibitors is product specific. Please consult individual package inserts. The amlodipine product labeling is less specific and suggests monitoring for hypotension and edema when used with moderate or strong 3A4 inhibitors.|
|805||An antidote has been approved for dabigatran (Pradaxa). The antidote is idarucizumab (Praxbind).|
Top Seller item #64: brand name for ergocalciferol is Drisdol.
Top Seller item #65: brand name for amitriptyline is Elavil.
Top Seller item #86: folic acid is vitamin B9.
|1081||Top Seller item #143: brand name for ketoconazole is Nizoral.|
|1082||Top Seller items #177 and #194: both are available as generics.|
Top Seller items #253 and 260: brand name for albuterol/ipratropium is Combivent or Combivent Respimat.
Top Seller items #253 and 256: brand name for insulin lispro is Humalog or Humalog Kwikpen.
Top Seller item #268: brand names for norgestrel/ethinyl estradiol are Cryselle 28, Elinest, Low-Ogestrel or Ogestrel.
Top Seller item #274: brand name for ipratropium is Atrovent.
|352||Antibiotics that inhibit protein synthesis are bacteriostatic (except for aminoglycosides and some pathogens for streptogramins).|
|46||Problem #104. Use a weight of 160 pounds for the patient’s actual body weight on 9/29/15.|
|301||Most influenza vaccines are Pregnancy Category B, with few exceptions. The CDC does not make specific recommendations on which approved vaccines to use in pregnant patients.|
|760||Recommendations for sodium restriction in heart failure differ with regard to HF stage and are not well-defined for patients in stage C or D. Per the 2013 guidelines, it is generally appropriate to restrict sodium to < 1,500 mg/day in patients in HF stages A and B. Restricting sodium to < 3,000 mg/day should be considered in patients with heart failure.|
|137||The answer choices for Question #3 should be: a. 2.5%, b. 4%, c. 40%, d. 50% and e. 250%|
|948||Temazepam is approved for insomnia.|
|168||The last formula on the page is for Specificity, as stated in the text above the formula box. Specificity = d / (b + d)|
|Update||December 2015: Lesinurad (Zurampic) was approved for use in combination with a xanthine oxidase inhibitor (XOI) to treat hyperuricemia associated with gout in patients who have not achieved target uric acid levels with a XOI alone. Lesinurad inhibits the urate transporter responsible for most of the renal reabsorption of uric acid.|
|360||The Beta-Lactam Spectrum of Activity graphic should read Ceftolozane/Tazobactam.|
|Update||January 2016: Dalbavancin (Dalvance) was approved as a single dose regimen. Dose: 1500 mg IV x 1 for CrCl >/= 30 mL/min (or on regular dialysis) or 1125 mg IV x 1 if CrCl < 30 mL/min and not undergoing regular dialysis.|
|Update||January 2016: Elbasvir/grazoprevir (Zepatier), a direct acting antiviral, was approved for hepatitis C virus infection. It is dosed 1 tablet PO daily +/– ribavirin, dependent of virus genotype & patient factors. It is contraindicated for use in moderate to severe hepatic impairment, and with strong 3A4 inducers, or OATP1B1/3 inhibitors. Patients should be counseled on signs and symptoms of liver failure. Drug interactions: Avoid strong 3A4 inhibitors (including cobicistat) and inducers. Many HIV protease inhibitors are contraindicated, as well as efavirenz. Atorvastatin max dose: 20 mg, rosuvastatin max dose: 10 mg, other statins: Use lowest dose possible.|
|Update||February 2016: Oritavancin (Orbactiv) label changes: Use of intravenous unfractionated heparin is contraindicated for 120 hours (5 days) after oritavancin dose. Warning: Oritavancin interferes with PT/INR results for up to 12 hours after a dose.|
|Update||The 2016 Update to the Standards of Medical Care in Diabetes was published in January 2016. Key updates for testing: (1) A change to the recommendations for aspirin use for primary prevention of ASCVD in women. Previously aspirin was recommended in men > 50 and women > 60 years of age with at least 1 additional risk factor (page 540 of the RxPrep Course Book). This was changed to men and women >/= 50 years of age with 1 additional major risk factor, (2) Changes regarding managing diabetes in pregnancy. The goal A1C in pregnant patients was previously < 6% (page 539 of the RxPrep Course Book). This was changed to a target of 6 – 6.5%. A target of < 6% or < 7% may be appropriate in certain patients based on hypoglycemia risk. Use of glyburide in gestational diabetes was de-emphasized in favor of insulin and metformin.|
|617||ACE inhibitors should not be used with azathioprine due to risk of severe anemia. Using azathioprine with other drugs that may cause myelosuppression (such as sulfamethoxazole/trimethoprim) should be undertaken cautiously.|
|641||Zometa is indicated for hypercalcemia of malignancy.|
|Update||February 2016 ACIP updates: HPV vaccination is recommended starting at age 9 when there is history of sexual abuse. Meningococcal B vaccine series is recommended for high risk patients starting at age 10 and can be considered in patients age 16 – 23 years.|
|Update||March 2016: FDA approved emtricitabine 200 mg/rilpivirine 25 mg/tenofovir alafenamide 25 mg (Odefsey) for treatment of HIV in patients 12 years and older. Dose: 1 tablet once daily with food when CrCl > 30 mL/min. It is not recommended for use when CrCl < 30 mL/min. Drug interactions and side effects similar to Complera. Tenofovir alafenamide is thought to be associated with decreased nephrotoxicity and osteoporosis.|
|185||Labetalol is a nonselective beta blocker and an alpha blocker.|
|143||Digoxin, warfarin, quinidine and procainamide must have the doses decreased by 30-50% when starting amiodarone.|
|Update||February 2016 CHEST Guideline and Expert Panel Report: Antithrombotic Therapy for VTE Disease. Key points for testing: 1) In patients with DVT of the leg or PE and no cancer dabigatran, rivaroxaban, apixaban or edoxaban are recommended over vitamin K antagonist (warfarin) therapy for the first three months of anticoagulation. Initial parenteral anticoagulation for 5-10 days is required before dabigatran and edoxaban but not before rivaroxaban or apixaban. 2) In patients with DVT of the leg or PE with cancer, LMWH is preferred over any of the oral therapies (including warfarin) for the first three months of anticoagulation. 3) In patients with unprovoked DVT who are stopping anticoagulation and have no contraindication to aspirin, aspirin is suggested vs no aspirin to prevent recurrent DVT.|
|303||Footnote **If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 1 year after the most recent dose of PPSV23 (PPSV23 --> 1 year --> PCV13)|
|94||Table heading: BUD Frozen ( -25C to </= -10C). The ante area for high risk sterile compounds should be ISO class 8 or better.|
|97||Cleaning schedule listed for Buffer Area is for ISO Class 5 PEC|
|800||Anti-Xa monitoring is not required in patients with a mechanical valve who are not pregnant.|
|893||The brand name of brexpiprazole is spelled Rexulti.|
|191||Vasopressin is a vasopressor (not a vasopressin antagonist) and it increases water retention. Vasopressin antagonists include tolvaptan (Samsca) and conivaptan (Vaprisol). Antagonism at the V2 receptor promotes the excretion of free water (without loss of electrolytes) resulting in fluid loss and increased urine output.|
|380 and 427-28||ValGANciclovir suspension requires refrigeration after reconstitution. ValACYclovir is not available in a suspension. Acyclovir is available as a suspension that should be stored at room temperature.|
|246||The title of the box should be "Drugs with Leaching Issues (Do Not Use PVC Containers)", as these medications can cause DHEP to leach out from the bag into the drug solution. Drugs that can stick to or become trapped in the PVC container are considered to have sorption issues and are listed in a table on page 249.|
|305||A booster dose is recommended every 2 years for the Typhim Vi (IM vaccine) and every 5 years for Vivotif Berna (oral capsules) if the patient is still at risk.|
|1076||Phendimetrazine (Bontril PDM) is a C-III substance.|
|335||Simeprevir inhibits P-gp. It increases concentrations of drugs that are P-gp substrates.|
|698||Correct answers for question 8 are b and e, rather than b,c,e.|
|79||Problem #199: Based on the wording of the problem, a total volume of 1,009 mL should be used. The final answer would be 140 mL/hr.|
|Update||The REMS program for Tikosyn (dofetilide) has been eliminated. Prescribers and pharmacies are no longer required to enroll in the program in order to prescribe or dispense dofetilide.|
|161||Table: Accept Ho/Ho True should read "no unnecessary treatment given" and for Reject Ho/Ho False it should read "necessary treatment given.”|
|563||Update: The stability of Toujeo at room temperature when in-use has changed to 42 days.|