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09/13/2026

A patient injects 50 units of U-100 insulin once daily. The pharmacy dispenses one 10 mL vial. What is the days supply?
A) 10 days
B) 20 days
C) 50 days
D) 200 days

Answer: B, 20 days. Do it in three steps.

Step 1. Find total units. U-100 means 100 units per mL. A 10 mL vial is 10 times 100, which is 1,000 units.
Step 2. Find units per day. The patient uses 50 units once a day, so 50 units per day.
Step 3. Divide. 1,000 divided by 50 equals 20 days.

Watch the traps. Do not forget U-100 means 100 units per mL. Do not divide by the volume (10 mL) instead of total units (1,000).

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09/12/2026

Grapefruit juice can change how many drugs work. What is the main mechanism?
A) It induces CYP3A4, so blood levels of many drugs fall
B) It speeds up kidney clearance of drugs
C) It blocks drug absorption in the stomach
D) It inhibits CYP3A4, so blood levels of many drugs rise

Answer: D. Grapefruit juice blocks the enzyme CYP3A4, mostly in the gut wall.

CYP3A4 helps break down about half of all drugs. When grapefruit blocks it, less drug is broken down in the gut. So more drug reaches the blood and levels go up. That raises the risk of side effects and toxicity.

Watch drugs like some statins, some calcium channel blockers, and cyclosporine. The active parts of grapefruit are called furanocoumarins.

Remember: inhibitor raises drug levels, inducer lowers them.

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09/11/2026

A pharmacy discovers a theft of controlled substances. What must it do under federal law?
A) Only submit DEA Form 106 within 30 days, with no earlier notice
B) Nothing, if the amount stolen is small
C) Notify the local DEA field office in writing within one business day, then submit DEA Form 106
D) Call the DEA within 24 hours, but no written report is needed

Answer: C. There are two steps, not one.

Step 1: Notify the local DEA field office in writing within one business day of discovery. Step 2: Submit the detailed DEA Form 106 within 45 days. Since 2023, Form 106 is filed online only. Paper is no longer accepted.

Watch the traps. Any theft is reported, no matter how small. A loss must be reported if it is significant, and the DEA does not give a fixed number. State law can also be stricter.

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09/10/2026

Per the 2020 guidelines, how should you monitor vancomycin for serious MRSA infections?
A) A trough level of 15 to 20 mg/L
B) An AUC/MIC ratio of 400 to 600, using Bayesian software
C) A trough level of 5 to 10 mg/L
D) A peak level of 30 to 40 mg/L

Answer: B. The 2020 guidelines moved away from trough-only monitoring. The new target is an AUC/MIC ratio of 400 to 600.

Here is why the change happened. Old trough targets of 15 to 20 often pushed the drug too high. That raised the risk of kidney injury. AUC-guided dosing keeps the drug effective while lowering kidney harm. The guidelines prefer Bayesian software to estimate the AUC, because it needs fewer samples and does not wait for steady state.

Quick note: vancomycin covers gram-positive bugs, including MRSA.

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09/09/2026

A prescription sig reads "1 tab PO BID pc." What does it mean?
A) Take 1 tablet by mouth twice daily before meals
B) Take 1 tablet by mouth three times daily after meals
C) Take 1 tablet by mouth at bedtime as needed
D) Take 1 tablet by mouth twice daily after meals

Answer: D. Take it one part at a time. 1 tab is one tablet. PO is by mouth. BID is twice a day. pc means after meals.

So the full sig is: take one tablet by mouth twice daily after meals.

Watch the traps. pc means after meals, but ac means before meals. Do not mix them up. Also, BID is twice a day, TID is three times, and QID is four times.

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09/08/2026

How does warfarin produce its anticoagulant effect?
A) It directly inhibits thrombin (factor IIa)
B) It directly inhibits factor Xa
C) It inhibits vitamin K epoxide reductase (VKORC1), lowering clotting factors II, VII, IX, and X
D) It binds antithrombin to inactivate thrombin and factor Xa

Answer: C. Warfarin blocks the enzyme VKORC1. This enzyme recycles vitamin K into its active form.

Without active vitamin K, the body cannot make working clotting factors II, VII, IX, and X. So the blood clots less. This is why warfarin is called a vitamin K antagonist. It takes a few days to work fully, because old clotting factors must clear first. It is monitored with the INR, and the usual target is 2 to 3.

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09/07/2026

A pharmacy needs to order Schedule II drugs from a supplier. What must it use?
A) A standard written prescription from a prescriber
B) A DEA Form 222, or its electronic equivalent through CSOS
C) A verbal order over the phone
D) A regular purchase invoice, like any other drug

Answer: B. Schedule II drugs need a DEA Form 222. You cannot buy them with a normal invoice or a prescription.

The paper Form 222 is now a single sheet with 20 order lines. CSOS is the electronic version. It uses a DEA digital certificate to sign the order. CSOS is optional, since the paper form still works. Only the registrant, or a person with a valid power of attorney, can sign. Keep copies for at least 2 years. Schedules III to V do not need a Form 222.

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09/04/2026

Mavacamten (Camzyos) and aficamten (Myqorzo) treat obstructive HCM. What is the key safety monitoring?
A) Increase the heart's squeezing and monitor blood pressure
B) Monitor potassium levels with weekly blood tests
C) No monitoring is needed because they are very safe
D) Monitor ejection fraction (LVEF) with echocardiograms, due to heart failure risk

Answer: D. These drugs reduce the heart's over-squeezing in HCM. But they can lower the ejection fraction too much and cause heart failure.

That is why both have a boxed warning for heart failure. Both need echocardiograms to check LVEF before and during therapy. Both are dispensed only through a restricted REMS program. For mavacamten, you do not start if LVEF is under 55 percent. Mavacamten came first in 2022. Aficamten was approved in December 2025.

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09/03/2026

The revised USP became official in November 2023. What was a major change to how CSPs are classified?
A) It now covers only nonsterile compounding
B) It removed beyond-use dating entirely
C) It changed the old low, medium, and high risk levels to Category 1, 2, and 3
D) It switched to only two categories with no beyond-use dates

Answer: C. The old low, medium, and high risk levels are gone. Now CSPs are Category 1, Category 2, and Category 3.

The category now depends mainly on where the preparation is made. Less controlled space means a shorter beyond-use date. Category 3 was newly added for the longest dates when strict rules are met. Quick anchor: Category 1 gets the shortest beyond-use date, up to 12 hours at room temperature or 24 hours refrigerated.

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09/02/2026

Let's be honest — the hardest part of NAPLEX prep isn't the volume. It's the mechanisms. 🧠

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