NABP has released revised NAPLEX Competency Statements (their blueprint of tested items).

Impact for NAPLEX Candidates testing after January 1, 2021:

• The 2021 NAPLEX Competency Statements have been reorganized across more “Areas” which provides clarity on the percentage of test questions from each Competency Area (see table below).
• The content you need to know has not changed. Continue to use the 2021 RxPrep Course materials for your NAPLEX preparation.
• The types of questions and general format of the exam (e.g., number of questions and time to take the test) is the same.

Comparison of 2020 and 2021 NAPLEX Competency Areas:

Individual Competency Statement wording is different, and often more descriptive and detailed, but the items that will be tested are the same:

• 2020 Example:
  • Obtain, interpret, assess and/or evaluate patient medical records.
• 2021 Example:
  • Obtain, interpret, or assess data from medical records: treatment adherence, or medication-taking behavior, chief complaint, medication history, medical history, family history, social history, lifestyle habits, socioeconomic background.

The revised NABP Candidate Application Bulletin reflects the following changes:

• The number of questions on the NAPLEX has decreased from 250 to 225 total questions. Exam results will still be calculated based on answers to 200 questions, but the number of pretest questions has decreased from 50 to 25.
• NABP will no longer provide a scaled score for the NAPLEX (or MPJE). Exam results will now be provided as either Pass or Fail.
  • For the NAPLEX, exam reports for those who receive a “Fail” will include a section indicating relative performance in each of the 6 competency areas tested on the exam.

The shingles vaccine Zostavax is no longer available. Continue to recommend the Shingrix vaccine in patients ≥ 50 years.

The CDC published an update to the treatment guidelines for gonococcal infection:

• Dual treatment with azithromycin is no longer recommended due to an increased incidence of resistance in N. gonorrhoeae.
• Monotherapy with higher doses of ceftriaxone is recommended:
  • < 150 kg: 500 mg IM x 1
  • ≥ 150 kg: 1 gram IM x 1
• Doxycycline 100 mg PO BID x 7 days can be added if chlamydial infection has not been excluded.

Baloxavir marboxil (Xofluza) has been FDA-approved for post-exposure influenza prophylaxis in patients ≥ 12 years old following contact with an individual who has influenza. It is given as a one-time dose within 48 hours of exposure.

Cabotegravir/rilpivirine (Cabenuva) has been FDA-approved for the treatment of HIV in adults. This is an extended-release injectable formulation that is given once monthly as a complete treatment regimen in patients who have been virologically suppressed on a stable regimen.

The FDA also approved cabotegravir in a tablet formulation (Vocabria). Oral cabotegravir plus rilpivirine should be given for one month prior to initiation of Cabenuva to assess tolerability.

Ivermectin lotion (Sklice) has been FDA-approved to switch from prescription status to over-the-counter (OTC) status. It is indicated as a topical treatment of head lice in individuals 6 months of age and older. Availability is anticipated at the end of the second quarter of 2021.

A new three-drug combination inhaler, budesonide/formoterol/glycopyrrolate (Breztri Aerosphere), has been approved for COPD.

Umeclidinium/vilanterol/fluticasone (Trelegy Ellipta) has been FDA-approved for maintenance treatment of asthma in patients ≥ 18 years old.

Dapagliflozin (Farxiga) has been FDA-approved to reduce the risk of cardiovascular death and hospitalization in heart failure with reduced ejection fraction without diabetes.

The 2021 American Diabetes Association Standards of Care update was published. Key changes that can impact testing include:

Comprehensive Care

• p. 629: Antiplatelet Therapy
  • (NEW) Aspirin plus low-dose rivaroxaban can be added in patients with CAD and/or PAD.
• p. 629: Blood Pressure Control & Kidney Disease
  • (NEW) Diabetes with CAD: use ACE inhibitor or ARB for blood pressure control.

Treatment for Type 2 Diabetes

• p. 630: The HF, CKD, ASCVD/High ASCVD Risk arm of the flow diagram is simplified to three separate arms, but there are no changes in recommended medications.

Oliceridine (Olinvyk) is a new IV opioid agonist approved for moderate to severe acute pain in adults. It is indicated for short-term use in controlled clinical settings (i.e., inpatient or outpatient procedures).

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."

On the clipboard describing USP 797 cleaning requirements, the minimum frequency of cleaning the walls, windows, shelving, bins, carts, chairs and ceiling should be monthly.

In the Study Tip Gal for HAP/VAP: Selecting an Empiric Regimen, the section on “Antibiotics for Pseudomonas (do not use two beta-lactams together)” should include aztreonam.

In the row for Delstrigo, cross out 2 NNRTI + 1 NRTI and replace with 2 NRTIs + 1 NNRTI.

In the row for Descovy, cross out the statement in the right column. Test HLA-B*5701 prior to use (abacavir).

The answer key for the fill-in-the-blank quiz should say:

• 4. Down, up, up
• 8. Tenofovir DF & emtricitabine
• 9. Tenofovir AF & emtricitabine

The last bullet under Vaccinations should say "Pneumococcal vaccine: Pneumovax 23 (1 dose before age 65)."

In the Study Tip Gal for Converting Between Insulins, Exception #1 should say "NPH dosed BID → Lantus, Basaglar or Toujeo dosed daily."

All controlled substances (schedule II – V) can be stored in a locked cabinet or dispersed among other drugs. Prior to this change, schedule II drugs needed to be stored in a securely locked cabinet or vault and could not be dispersed throughout the stock of non-controlled drugs.

Regarding the prescription drugs that do not require child-resistant packaging, colesevelam powder should read ≤ 3.75 grams/package.

The 4th bullet in the Methadone Study Tip should read “(days 271 - 365).”

The following updates were made to secure prescription form requirements:

• In addition to the features noted on p. 120 and 121, security prescription forms must now contain a barcode and the prescriber's pre-printed address.
• The serial number formatting has also changed from 15 digits (3 letters followed by 12 numbers) to 12 digits (any combination of letters and numbers) that corresponds with the barcode.