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. For more information, see our New Guidelines page.

Updates: 2018 RxPrep Course Book
NAPLEX-relevant updates from August 2017-August 2018

Page Update Type Description
Chapter 24: Immunizations

p. 325 and 451

New Drug

Zoster vaccine, recombinant (Shingrix)
Approved 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.

Chapter 28: Infectious Diseases I: Background & Antibacterials by Drug Class

p. 380 and 429

New Drug

Meropenem/vaborbactam (Vabomere)  
Approved for complicated urinary tract infections, including pyelonephritis. Given as a 3-hour infusion every 8 hours or every 12 hours, based on eGFR.

p. 398 and 433

New Drug

Secnidazole (Solosec)
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.

Chapter 29: Infectious Diseases II: Bacterial Infections

p. 430-431

New Guideline

February 2018: The Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America was published. Key updates for those taking the NAPLEX in Spring/Summer of 2018 include:

  1. Metronidazole is no longer first-line treatment for C. difficile infections (CDI). For a first episode of non-severe (WBC ≤ 15,000 cells/mL and SCr < 1.5 mg/dL) or severe (WBC ≥ 15,000 cells/mL or SCr > 1.5 mg/dL) CDI, the first-line treatment is now the same: vancomycin 125 mg PO QID or fidaxomicin 200 mg PO BID for 10 days. Treatment of initial fulminant CDI (presence of hypotension, shock, ileus or megacolon) has not changed.
  2. Recurrent infections should no longer be treated the same as the initial episode. If vancomycin was used to treat the initial episode, a vancomycin pulse and taper (as described on page 431) or fidaxomicin 200 mg PO BID for 10 days may be used. If metronidazole was used first, vancomycin 125 mg PO QID for 10 days can be given for the first recurrence.
Chapter 35: Asthma

p. 514

New Drug

Fluticasone furoate/umeclidinium/vilanterol (Trelegy Ellipta)
The first once-daily, triple-therapy inhaler (ICS/LAMA/LABA) for COPD.

Chapter 39: Diabetes

p. 575

New Formulation

Insulin aspart (Fiasp) 100 units/mL. 
Contains niacinamide (vitamin B3) to increase the speed of insulin absorption. Fiasp has an onset of approximately 2.5 minutes. It is available as a pre-filled FlexTouch pen and a 10 mL vial.

p. 556- 588

Guideline Update

January 2018: The American Diabetes Association has released its 2018 update to the Standards of Medical Care in Diabetes guideline. Key updates for testing include:

  1. The treatment algorithm was modified: Metformin and lifestyle modifications are still first-line, but for dual therapy, clinical ASCVD should be considered before selecting an agent. If ASCVD is present, choose liraglutide, empagliflozin, or canagliflozin; these drugs reduce the risk of major cardiovascular events in patients with diabetes and ASCVD. Of these three, liraglutide and empagliflozin are FDA-approved for this indication and also reduce mortality. If no ASCVD is present, a drug from any of the six medication classes can be considered as shown in the treatment algorithm on p. 563 of the RxPrep Course Book.
  2. Cholesterol recommendations were updated: Any patient with diabetes and clinical ASCVD should receive a high-intensity statin. Patients with diabetes without clinical ASCVD should receive a moderate-intensity statin if they are ≥ 40 years of age, or if they are < 40 years of age and have ASCVD risk factors. The guidelines now recommend adding ezetimibe or a PCSK9 inhibitor for patients of any age with diabetes and ASCVD if LDL cholesterol ≥ 70mg/dL on maximally tolerated doses of a statin.
Chapter 45: Pain

p. 687

Labeling Change

Naldemedine (Symproic) is descheduled and no longer a controlled substance.

Chapter 47: Gout

p. 708-709

New Drug

Allopurinol/lesinurad (Duzallo) 
Approved for the treatment of hyperuricemia in gout patients who have not achieved target serum uric acid levels with allopurinol alone.

Chapter 49: Hypertension

p. 733-752

Guideline Update

November 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% (!/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.
Chapter 62: Parkinson Disease

p. 930

New Drug

Amantadine extended-release (Gocovri)  
Approved for the treatment of dyskinesia in patients with Parkinson disease receiving levodopa-based therapy.

Errata: 2018 RxPrep Course Book
Corrections or clarifications for the RxPrep Course Book

Page Description
Chapter 3: Calculations II

p. 54

The 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."

Chapter 6: Handling Hazardous Drugs

p. 123

Each type of compounded preparation (sterile HDs, non-sterile HDs, sterile non-HDs, non-sterile non-HDs) is prepared in a separate room.

p. 125

The primary engineering control must be externally vented or cleaned by redundant HEPA filters, in series. The room air must be externally vented.

Chapter 12: Biostatistics & Pharmacoeconomics

p. 189

When 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.

p. 195

In the "NNH Calculation" paragraph, the risk of major bleeding in the treatment group should be 3.9%.

p. 196

When 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.

p. 197

The last paragraph in column 2 should state that the Fahrenheit temperature scale is an example of interval data, because it has a meaningless zero. The Kelvin temperature scale is an example of ratio data, as the zero does have meaning and is considered "absolute cold."
The interval data box in the figure should read "70°F is 10 degrees lower than 80°F (colder, and measurable) with no meaningful zero."

p. 201

A test with 100% specificity will be negative in all patients without the condition.

p. 202

In 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."

p. 213

The answer key should read: 10-b, 11-a,c,d

Chapter 19: IV Drug Compatibility, Stability, Administration & Degradation

p. 266

Phytonadione should be included as a must know Key Drug for light protection. Remember Deliver Every Needed Medication Protected (P for Phytonadione).

Chapter 24: Immunizations

p. 312

The 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."

Chapter 28: Infectious Diseases I: Background & Antibacterials by Drug Class

p. 378

Cefotaxime does require renal dosage adjustment. Ceftriaxone does not require adjustment.

Chapter 56: Oncology II: Common Cancer Types & Treatment

p. 875

The correct answer to #7 regarding auxiliary labels for vincristine is c. "For intravenous use only. Fatal if given by other routes."

Chapter 59: Depression

p. 894

Under warnings of SSRIs, the first sentence should state: "QT prolongation - recommended max dose citalopram 40 mg/day; do not exceed 20 mg/day in elderly (60+ years), liver disease, with CYP 2C19 poor metabolizers or on 2C19 inhibitors."

Chapter 60: Schizophrenia/Psychosis

p. 912

The clozapine-specific boxed warning should say bradycardia, orthostatic hypotension, syncope.

Download 2017 RxPrep Course Book Errata and Updates

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