Student Resources

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.

2018 RxPrep Course Book Errata and Updates

PAGEDESCRIPTION
Update P. 380 and
P. 429
The FDA has approved Vabomere (meropenem/vaborbactam) for complicated urinary tract infections, including pyelonephritis. Use should be restricted to infections caused by resistant forms of E. coli, K. pneumoniae and Enterobacter species. It is given intravenously (3 hour infusions) every 8 hours or every 12 hours, based on eGFR.
Update P. 708-709The FDA has approved Duzallo (allopurinol/lesinurad) for the treatment of hyperuricemia in gout patients who have not achieved target serum uric acid levels with allopurinol alone. Lesinurad should always be used with a xanthine oxidase inhibitor.
Errata P. 196When the odds ratio (OR) or hazards ratio (HR) < 1: the event rate in the treatment group is lower than the event rate in the control group.
Errata P. 189When comparing the p-value to alpha, if the p-value is less than alpha (p < 0.05), the null hypothesis is rejected, and the result is termed statistically significant. If p = alpha, the result is not statistically significant.
Errata P. 201A test with 100% specificity will be negative in all patients without the condition.
Update P. 930The FDA has approved Gocovri (amantadine extended-release) for the treatment of dyskinesia in patients with Parkinson disease receiving levodopa-based therapy. It is dosed once daily at bedtime.
Errata P. 266Phytonadione should be included as a must know Key Drug for light protection. Remember Deliver Every Needed Medication Protected (P for Phytonadione).
Update P. 398 and
P. 433
The FDA has approved Solosec (secnidazole), the first single dose treatment option for bacterial vaginosis in adult women. Solosec comes as a 2-gram packet of granules that should be sprinkled on applesauce, yogurt or pudding and eaten within 30 minutes (without chewing or crunching the granules). Women who are breastfeeding should not take Solosec, or they should avoid breastfeeding for 96 hours after administration.
Update P. 514The FDA has approved the first once-daily, triple-therapy inhaler (ICS/LAMA/LABA) for COPD. Trelegy Ellipta contains fluticasone furoate/umeclidinium/vilanterol; these are the same ingredients as Breo Ellipta (ICS/LABA) and Incruse Ellipta (LAMA). Patients should not use Trelegy Ellipta in addition to these inhalers.
Errata P. 875The correct answer to #7 regarding auxiliary labels for vincristine is c. "For intravenous use only. Fatal if given by other routes."
Errata P. 123Each type of compounded preparation (sterile HDs, non-sterile HDs, sterile non-HDs, non-sterile non-HDs) is prepared in a separate room.
Errata P. 125The primary engineering control must be externally vented or cleaned by redundant HEPA filters, in series. The room air must be externally vented.
Update P. 687As of September 29, 2017, naldemedine (Symproic) is descheduled and no longer a controlled substance.
Errata P. 378Cefotaxime does require renal dosage adjustment. Ceftriaxone does not require adjustment.
Errata P. 54The last sentence of the second paragraph should read "When the intravenous fat emulsion is contained in the same bag, it is referred to as a total nutrient admixture (TNA), or 3-in-1, or all-in-one formulation.” Of note, ISMP and ASPEN no longer use the abbreviation for intravenous fat emulsion (IVFE) due to concerns for confusion with IV iron preparations (IVFe). For this reason, you may now see intravenous fat emulsions referred to as Lipid Injectable Emulsions.
Update P. 575The FDA has approved a new formulation of insulin aspart (Fiasp) 100 units/mL. This new formulation contains niacinamide (vitamin B3) which helps to increase the speed of insulin absorption. Fiasp has an onset of approximately 2.5 minutes; it can be dosed at the beginning of a meal or within 20 minutes after starting a meal. It will be available as a pre-filled FlexTouch pen and a 10 mL vial.
Errata P. 213The answer key should include: 10-b, 11-a,c,d.
Errata P. 202In the section on Comparing Ratio Data, the paragraph should say “The second study (right column) uses a forest plot to test for significance with ratio data.”
Errata P. 195In the “NNH Calculation” paragraph, the risk of major bleeding in the treatment group should be 3.9%.
Update Chapter 49November 2017: The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults was published. Key updates for those taking the NAPLEX in Spring/Summer of 2018 include:

1) Updated blood pressure definitions: Normal is < 120/80 mmHg, Elevated is 120-129/< 80 mmHg, Stage 1 Hypertension is 130-139/80-89 mmHg, and Stage 2 Hypertension is ≥ 140/90 mmHg.

2) Thresholds for initiation of drug treatment: The guideline strongly recommends that an ASCVD risk assessment be performed to determine the need for drug treatment. Patients with clinical CVD (defined as coronary heart disease, CHF, or stroke) or an ASCVD risk ≥ 10% (http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/) should be treated if BP is ≥ 130/80 mmHg. Patients without clinical CVD and an ASCVD risk < 10% should be treated if BP is ≥ 140/90 mmHg. The guideline emphasizes that if ASCVD risk is not known, it can be assumed that most elderly patients (≥ 65 years) and patients with comorbid conditions, including CKD [eGFR < 60 mL/min/1.73 m2 or albuminuria (urine albumin ≥ 300 mg/day)] and diabetes, will have an ASCVD risk ≥ 10%.

3) Blood pressure goals: The blood pressure goal for all adult patients is < 130/80 mmHg. This includes patients without additional comorbidities and patients with comorbidities (e.g., CKD, diabetes, stroke, CVD, heart failure). For patients ≥ 65 years who are noninstitutionalized and ambulatory, the BP goal is a systolic blood pressure < 130 mmHg.

4) Initial drug selection: Initiation of two drugs is recommended in patients with a baseline BP ≥ 140/90 mmHg (stage 2 hypertension) and if BP is > 20/10 mmHg above goal. Importantly, the preferred antihypertensive agents have not changed; a thiazide-type diuretic, dihydropyridine calcium channel blocker (CCB), ACE inhibitor or ARB should be used first-line in most patients (including patients with diabetes who do not have albuminuria). Black patients should preferably be treated with a thiazide-type diuretic or CCB. Any patient (regardless of race) with stage 3 CKD, stage 1 or 2 CKD with albuminuria, or diabetes with albuminuria, should receive an ACE inhibitor or ARB first line.
Update P. 325 and
P. 451
A new shingles vaccine, Shingrix, was FDA approved in October 2017 for adult patients ≥ 50 years of age. Shingrix is a non-live vaccine administered as a two-dose series (2nd dose given 2-6 months after the 1st dose). It has improved efficacy (longer duration of effect over time) compared to Zostavax. ACIP recommends Shingrix over Zostavax in patients ≥ 50 years of age, and recommends revaccination with Shingrix in patients previously vaccinated with Zostavax.
Errata P. 197The last paragraph in column 2 should state that the Kelvin temperature scale is an example of interval data, not ratio data.

The interval data box in the figure should read “70°F is 10 degrees lower than 80°F (hotter, and measurable) with no meaningful zero.”
Errata P. 312The last full sentence in the last paragraph on the page should read: “This will be administered at the same time as the vaccination, which takes time to offer protection.”

2017 RxPrep Course Book Errata and Updates

PAGEDESCRIPTION
Update p. 533December 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 39January 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. 218The table on vitamin names should read: Vitamin B2 = Riboflavin, Vitamin B3 = Niacin, Vitamin B6 = Pyridoxine, Vitamin B9 = Folic Acid, Vitamin B12 = Cobalamin.
Errata p. 429Fluconazole should be adjusted for renal function when the CrCl is ≤ 50 mL/min.
Errata p. 638The 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. 1089Entry #186 should read “Drug: Azelastine (Ophthalmic), Brand Name: Optivar”. Astepro is the brand name for nasal azelastine.
Update p. 451Tenofovir 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. 472Under 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).
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