Student Resources

Updates and Errata

The RxPrep Course Book is published annually in early September. 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. 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. Guideline updates that may be relevant to NAPLEX are provided below.

Errata: 2019 RxPrep Course Book
Corrections or clarifications for the RxPrep Course Book

Page Description
Chapter 18: Immunizations, Chapter 42: Diabetes

Ch 18, p. 254
Ch 42, p. 565

Patients with diabetes should receive an annual influenza vaccine (not live), Hep B series, Pneumovax 23 from ages 19-64, and both Prevnar and Pneumovax ages  65. Wait 12 months after Prevnar to give Pneumovax.

Chapter 20: Infectious Diseases I

p. 280

The word "methotrexate" is missing: Penicillins can increase the concentration of methotrexate, and...

Global Updates: 2019 RxPrep Course Book
NAPLEX-relevant updates from August 2018-August 2019

Name & Description
COPD Guideline update

COPD guideline update can be found here.

2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Eosinophils predict the benefit from inhaled corticosteroids (ICS).

  • Eosinophils > 300 cells/µL predicts the highest benefit from ICS.

Initial treatment recommendations stayed the same—the difference in the new guideline involves what to give when an escalation in treatment is needed. During an escalation, identify the treatment target: either dyspnea (difficulty breathing) and/or exacerbations.

Escalate treatment according to the following pathway.

  • Note that the first escalation with exacerbations can be to either LABA + LAMA or LABA + ICS (this option is new). ICSs work better with a higher eosinophil count.
  • When eosinophils are < 100 cells/uL, a poor response to ICS can be expected—and either roflumilast (a phosphodiesterase inhibitor) or azithromycin (for former smokers) are given with the LABA + LAMA therapy. Both roflumilast and azithromycin reduce exacerbations.
  • With both dyspnea and exacerbation, follow the exacerbation pathway.

CHEST Guideline update

Anticoagulation with Atrial Fibrillation guideline update can be found here.

Antithrombotic Therapy for Atrial Fibrillation

Note: what pharmacists call things can be different from words used for the same thing in a guideline:
Antithrombotics = Anticoagulants and Antiplatelets, and NOACs (non-vitamin K antagonist oral anticoagulants) = DOACs (direct oral anticoagulants)

Do not treat with low stroke risk (CHA2DS2-VASc score of 0 in males or 1 in females). The risk of bleeding is not worth giving treatment.
The risk is higher with higher CHA2DS2-VASc scores, and treatment is recommended.

Treatment change: warfarin is out, antiplatelets alone (aspirin) or in combination (e.g., aspirin + clopidogrel) are out, and NOACS are in.

  • All anticoagulants have the same major toxicity: bleeding risk, but some are worse than others. In patients with higher bleeding risk use drugs with a lower bleeding risk: apixaban, edoxaban or dabigatran 110 mg (instead of dabigatran 150 mg capsules).

The guidelines emphasize that when warfarin is used (many patients are already using it for stroke prevention and many will not be changed), at least try to make sure the INR is therapeutic most of the time.

Lipid Guideline update

Lipid guideline update can be found here.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

Statins remain first-line treatment, based on the statin benefit groups.

  1. Clinical ASCVD: high-intensity
  2. LDL ≥ 190 mg/dL: high-intensity
  3. Diabetes in ages 40-75 and LDL ≥ 70 mg/dL: moderate-intensity
  4. No diabetes, with LDL ≥ 70 mg/dL and ≥ 7.5% 10-year ASCVD risk: moderate-intensity
  5. No diabetes, with LDL ≥ 70 mg/dL and ≥ 20% 10-year ASCVD risk: high-intensity

The risk assessments are more detailed and include additional risk factors. In addition to the traditional risk factors (smoking, high blood pressure and high blood glucose), the guideline adds family history, ethnicity, metabolic syndrome, CKD, chronic inflammatory conditions, premature menopause, pre-eclampsia and high lipid biomarkers.
Additional cholesterol-lowering drug options for those receiving statins (at maximized dose) but still at high risk of ASCVD (e.g., clinical ASCVD and LDL remains > 70 mg/dL).
Consider adding ezetimibe or a PCSK9 inhibitor. Due to the high cost of PCSK9 inhibitors, use ezetimibe first.
The coronary artery calcium (CAC) score is based on the degree of plaque in the coronary arteries. It can be helpful in deciding to whether to start a statin. 

Download 2018 RxPrep Course Book Errata and Updates

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