Student Resources

Guideline/Drug Updates and Errata

The RxPrep Course Book is published annually. Information in the Course Book is up to date at the time of publishing, but drug information can change rapidly. Refer to the Updates on this page for NAPLEX-relevant information that becomes available before the next RxPrep Course Book is published. Guideline updates that may be relevant to NAPLEX are included. If we find anything that needs a correction or clarification in the RxPrep Course Book it will be included in the Errata table on this page.

Download RxPrep’s Guidance on What to do When Guidelines Conflict


Guideline/Drug Updates: 2020 RxPrep Course Book
NAPLEX-relevant updates from June 2019-May 2020


PageUpdate TypeDescription
Chapter 20: Immunizations
p. 322-328Guideline Update November 2019

Prevnar 13 is no longer routinely recommended in those ≥ 65 years of age. It can be administered based on shared clinical decision making between the patient and healthcare provider. A single dose of Prevnar 13 is still recommended for immunocompromised patients ≥ 6 years old if not previously received (see Study Tip Gal p. 328).

The update above applies to the following content:

  • p. 322: Vaccinations for Special Groups, Older Adults: first bullet under Pneumococcal vaccines (age ≥ 65 years).
  • p. 323: Vaccinations for Adults, Pneumococcal: first bullet under Prevnar 13 (if not received before).
  • p. 327: Pneumococcal Vaccines: third bullet.
  • p. 328: Pneumococcal Vaccines drug table (top of page): Administration Recommendations for the 13-Valent Conjugate Vaccine (PCV-13): Prevnar 13.
  • p. 328: Pneumococcal Vaccine Indications Study Tip Gal: second bullet under column 1 for Prevnar 13 (PCV 13).
  • p. 328: Pneumococcal Sequence and Intervals, Immunocompetent Patients: the first bullet for patients ≥ 65 years is accurate if the shared clinical decision is to administer the vaccine.

ACIP/CDC Recommendations for Prevnar 13 for ages ≥ 65

Chapter 23: Infectious Diseases II: Bacterial Infections
p. 382Guideline Update October 2019

The American Thoracic Society and Infectious Diseases Society of America have published updated guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Key changes that can impact testing include:

Outpatient CAP Treatment

  • Study Tip Gal, column 1: Patient Characteristics, Category 1
    • Course book reads: No antibiotic use within the past 3 months and previously healthy
    • NEW criteria: No comorbidities (chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancy or asplenia) and no risk factors for MRSA or P. aeruginosa (prior respiratory infection with either pathogen or hospitalization with receipt of parenteral antibiotics in the last 90 days)
  • Study Tip Gal, column 2: Recommended Empiric Regimen, Category 1
    • Course book reads:
      • Option 1: Macrolide (azithromycin, clarithromycin, erythromycin)
      • Option 2: Doxycycline
    • Updated recommendations:
      • Option 1 (NEW): High-dose amoxicillin (1 gram TID)
      • Option 2: Doxycycline
      • Option 3 (NEW): Macrolide (azithromycin and clarithromycin) if local pneumococcal resistance is < 25%
  • Study Tip Gal, column 2: Recommended Empiric Regimen, Category 2
    • Option 1: Amoxicillin (high-dose) is no longer recommended and can be crossed out

Inpatient CAP Treatment

  • Drug treatment is based on location of patient and severity of infection
    • Non-ICU (nonsevere CAP)
      • Treatment options described on p. 382 remain appropriate
    • ICU (severe CAP) (NEW)
      • Recommended:
        1. Beta-lactam + macrolide
        2. Beta-lactam + respiratory quinolone
      • Not recommended:
        1. Respiratory quinolone alone
        2. Beta-lactam + doxycycline
    • Risk factors present for MRSA or P. aeruginosa: add appropriate coverage as noted in the last bullet on p. 382

Guidelines for the Treatment of Community-acquired Pneumonia

p. 384Guideline Update February 2020

The Centers for Disease Control and Prevention and the National Tuberculosis Controllers Association have published updated guidelines for the Treatment of Latent Tuberculosis Infection.

Regimens with shorter durations (e.g., 3 or 4 months) are preferred due to higher completion rates and less risk of hepatotoxicity when compared to longer courses of isoniazid (INH).

Preferred Regimens

  • INH + rifapentine weekly for 12 weeks
    • Recommended for adults, children > 2 years old and HIV-positive patients (if no drug interactions with antiretroviral therapy)
    • Do not use in pregnant women (see Alternative Regimens)
  • Rifampin daily for 4 months
    • Recommended for HIV-negative adults and children of any age
    • Watch for drug interactions with rifampin (a CYP inducer)
  • INH + rifampin daily for 3 months
    • Recommended for adults, children of any age and HIV-positive patients (if no drug interactions with antiretroviral therapy)

Alternative Regimens

  • INH daily for 6 months or 9 months
    • An option for all adults (HIV-negative and HIV-positive) and children of any age
    • The regimen of choice for pregnant women
    • May be preferred in HIV-positive patients who cannot take a preferred regimen due to drug interactions with antiretroviral therapy

Guidelines for the Treatment of Latent Tuberculosis Infection

Chapter 26: Human Immunodeficiency Virus
p. 418Guideline Update December 2019

Dolutegravir/lamivudine (Dovato) was added to the “Recommended Initial Regimens” as the first approved two-drug regimen. Dovato is only recommended for the following patients:

  • No active hepatitis B
  • Low viral load
  • No known resistance to the components of Dovato

Recommendations for Initial Combination Regimens for the Antiretroviral-Naive Patient

p. 419Guideline Update December 2019

The recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV have been updated. Dolutegravir can now be used with 2 NRTIs as a preferred treatment in pregnancy. The true incidence of neural tube defects in the United States from dolutegravir is unknown but is lower than previously reported.

In the section on Regimens for Antiretroviral-Naïve Pregnant Women:

  • Cross out the last sentence in the second paragraph. Dolutegravir should be avoided due to a risk of neural tube defects.
  • Add dolutegravir to the INSTI column of the table.

Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV

p.  433Labeling Change

Emtricitabine/tenofovir alafenamide (Descovy) has been FDA-approved for the indication of pre-exposure prophylaxis (PrEP).

Chapter 42: Chronic Obstructive Pulmonary Disease
p. 617Guideline Update January 2020

The 2020 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) was published. There were no significant changes impacting the 2020 RxPrep Course Book content.

2020 Gold Report for Prevention, Diagnosis and Management of COPD

Chapter 44: Diabetes
p. 639-642Guideline Update January 2020

The 2020 American Diabetes Standards of Care update was published. Key changes that can impact testing include:

Comprehensive Care

  • p. 639: Cholesterol Control – the last bullet should now read:
    • Ezetimibe (preferred) or a PCSK9 inhibitor can be added in patients with ASCVD and LDL cholesterol ≥ 70 mg/dL on a maximally tolerated statin.
    • (NEW) Ezetimibe can be added in patients without ASCVD but with ASCVD risk > 20% on a maximally tolerated statin.
    • (NEW) Icosapent ethyl (Vascepa) can be added in patients with ASCVD or other cardiovascular risk factors if LDL is controlled on a statin but triglycerides remain elevated.
  • p. 640: Diabetic Kidney Disease (second bullet):
    • Course Book reads: A urine test is performed annually to measure urine albumin excretion as an indicator of disease progression.
    • Updated recommendations:
      • (NEW) A urine test should be performed annually in patients without kidney disease to monitor for development of disease.
      • (NEW) Patients with established kidney disease should have a urine test twice a year to monitor disease progression.

Treatment for Type 2 Diabetes

  • p. 642: ASCVD and HF or CKD arms of the flow diagram (Study Tip Gal):
    • (NEW) GLP-1 agonists and SGLT2 inhibitors with cardiovascular benefit should be considered regardless of A1C (i.e., even if at goal).
    • (NEW) Dulaglutide (Trulicity) has a new indication for reduction of cardiovascular events in adults with type 2 diabetes who have ASCVD or multiple cardiovascular risk factors. It can be included in the list of drugs with proven CVD benefit shown in the treatment algorithm.
    • (NEW) Dapagliflozin (Farxiga) has an indication to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes who have ASCVD or multiple cardiovascular risk factors. It can be included in the list of drugs with proven HF or CKD benefit shown in the treatment algorithm.

ADA Standards of Medical Care in Diabetes - 2020

p. 649New Drug ApprovalSemaglutide (Rybelsus) has been approved as the first oral GLP-1 agonist. 
p. 659Labeling ChangeThe room temperature stability of Toujeo pen has changed to 56 days.
p. 660New Drug Approval

The FDA approved two novel formulations of glucagon for the treatment of hypoglycemia:

  • Intranasal glucagon (Baqsimi)
  • Glucagon solution prefilled syringes for SC injection (Gvoke)

Errata
Corrections or clarifications for the 2020 RxPrep Course Book


PageDescription
Chapter 1: Preparing for NAPLEX with RxPrep
p. 10 and p. 26

In the Dose Conversions section of the Required Formulas Checklist (p. 10), the Required Formulas Sheet (p. 26) and the Required Formulas tear-out (at the back of the RxPrep Course Book), the page number for Calcium Salts and Aminophylline ↔ Theophylline should be p. 183.

Chapter 15: Compounding I
p. 237

The section on "Media-Fill Test" should include this statement: "Media-fill testing must be performed initially during training and at least annually for low- and medium-risk level compounding and semiannually for high-risk compounding."

Chapter 16: Compounding II
p. 263-264

The title "Hydrophobic Solvents" (p. 263) is incorrectly placed. Alcohols (p. 263) and Glycols (p. 264) are hydrophilic solvents. Oils and Fats (p. 264) are hydrophobic solvents.

Chapter 17: Compounding III
p. 274

The section on "Melting Point Order" should say: "For any formulation, if melting ingredients, melt the ingredient with the highest melting point prior to adding the ingredient/s with lower melting points." The bullet underneath should say: "Line up the ingredients by the melting point temperature, and melt in that order, starting with the highest melting point."

Chapter 27: Dyslipidemia
p. 443

In the Key Drugs Guy for Select Drugs/Conditions that can Raise LDL and/or Triglycerides, "atypical antipsychotics" should be listed under "increased LDL and TG."

Chapter 35: Anemia
p. 549

For the Key Drugs Guy titled “Select Drugs that Can Cause Hemolytic Anemia,” all drugs in the front and back box are “must know” for testing. Valproic acid should be removed and replaced with sulfonamides.

Chapter 43: Tobacco Cessation
p. 630

The 12-week schedule for nicotine gum and lozenge is missing from the table:

Weeks 1-6

1 piece Q1-2H

Weeks 7-9

1 piece Q2-4H

Weeks 10-12

1 piece Q4-8H

Chapter 44: Diabetes
p. 656

The Study Tip Gal titled "Initiating Basal-Bolus Insulin" is intended to serve as an example and should have the following instructions: "Start a basal-bolus regimen with Lantus and Humalog in a 70 kg patient using a starting dose of 0.6 units/kg/day."

Chapter 49: Osteoporosis, Menopause & Testosterone Use
p. 716

The Bisphosphonates section in the Drug Summary for Osteoporosis Treatment and Prevention Study Tip Gal should include this statement:

  • Treatment duration: 3-5 years in patients at low risk of fracture (due to the rare risk of femur fracture and osteonecrosis of the jaw).
Chapter 62: Oncology II
p. 858

In the second paragraph of the section titled "Hormonal Therapies for Prostate Cancer," the second sentence should say "ADT is achieved with either a gonadotropin-releasing hormone (GnRH) antagonist (alone) or a GnRH agonist (initially taken with an antiandrogen)."


Download 2019 RxPrep Course Book Guideline/Drug Updates and Errata

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