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.
See "What to do When Guidelines Conflict" at the bottom of this page.
Guideline/Drug Updates: 2019 RxPrep Course Book
NAPLEX-relevant updates from August 2018-May 2019
|Chapter 18: Immunizations|
|p. 255 and 257||Labeling Change||
The FDA expanded approval of Gardasil 9 to include women and men aged 27-45 years.
|Chapter 23: Infectious Diseases IV: Opportunistic Infections|
|p. 343||Guideline Update||
The Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents has updated recommendations for primary prophylaxis of Mycobacterium avium complex (MAC) infections:
|Chapter 24: Human Immunodeficiency Virus|
|p. 348 and 360||Guideline Update||
The Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV have been updated. Key points for testing include:
|p. 353||New Drug Approvals||
The FDA has approved the following new medications for the treatment of HIV:
|Chapter 25: Dyslipidemia|
|p. 374 - 375||Guideline Update||
The AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on The Management of Blood Cholesterol was published. Key points for testing include:
Update to Determining Appropriate Statin Treatment Intensity Based on Patient Risk (p. 375)
Non-Statin Treatments (p. 374)
|Chapter 32: Anticoagulation|
|p. 467-468||Guideline Update||
The Chest Guideline for Antithrombotic Therapy for Atrial Fibrillation and the AHA/ACC/HRF Guideline for the Management of Patients with Atrial Fibrillation were updated. Key points for testing include:
|Chapter 40: Chronic Obstructive Pulmonary Disease|
|p. 545||Guideline Update||
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report was published. Key points for testing include:
|Chapter 42: Diabetes|
|p. 563 and 566||Guideline Update||
The American Diabetes Association Standards of Medical Care in Diabetes – 2019 has been published. Key points for testing include:
Comprehensive Care (p. 563)
Treatment for Type 2 Diabetes (p. 566)
|Chapter 66: Gout|
|p. 753-754||Labeling Change||
The FDA is requiring a boxed warning for febuxostat (Uloric) due to an increased risk of death compared to allopurinol. Allopurinol is now considered first-line for chronic urate-lowering therapy. Febuxostat should be reserved for patients who have failed or do not tolerate allopurinol.
Errata: 2019 RxPrep Course Book
Corrections or clarifications for the RxPrep Course Book
|Chapter 5: Preparing IV Medications|
In the Vesicants are Safer with a Central Line section, the second sentence should say “Vesicants are preferentially administered through a central line because the line is less likely…”
|Chapter 17: Hepatitis & Liver Disease|
The footnote at the bottom of the Direct Acting Antivirals Study Tip should say: fosamprenavir oral susp (without food in adults).
|Chapter 18: Immunizations, Chapter 42: Diabetes|
|p. 254 and 565||
Patients with diabetes should receive an annual influenza vaccine (not live), a hepatitis B series, Pneumovax 23 from ages 19-64 years, and both Prevnar 13 and Pneumovax 23 at ages ≥ 65 years. Wait 12 months after Prevnar 13 to give Pneumovax 23.
|Chapter 20: Infectious Diseases I|
The word "methotrexate" is missing in the section on Penicillin Drug Interactions. It should say “Penicillins can increase the concentration of methotrexate, and...”
|Chapter 32: Anticoagulation|
The Notes section of the drug table should say “Antidote for apixaban and rivaroxaban: andexanet alfa (Andexxa).”
|Chapter 61: Oncology I: Overview & Side Effect Management|
The “N” on the legend for chemo person should say “Neurotoxic (crosses blood brain barrier)."
What to do When Guidelines Conflict!
Practice guidelines change frequently.
Guideline updates that may be relevant for NAPLEX are reviewed in the table at the top of this page.
Many guidelines are now updated throughout the year, as needed, to address rapidly changing information. Examples include the American Diabetes Association's Standards of Medical Care in Diabetes, Guidelines for Use of Antiretroviral Agents from the U.S. Department of Health and Human Services and many others.
This can make NAPLEX preparation seem confusing!
NABP writes the NAPLEX questions, and NABP states that the current guideline (for any condition) should be used to respond to questions.
You can follow this recommendation even when a new guideline is released a week before your exam date.
How can that be true? Because the questions are largely guideline-version independent. The quantity of pre-test questions helps, too. New questions do not count towards the NAPLEX score until they make their way through NABP's question validation process. This takes time. A question based on information that changed recently is unlikely to count until several months later.
Here are two examples of common question types. The response would stay the same, regardless of the guideline version:
Atripla was a recommended initial treatment option for HIV infection until 2015. The specific drug information (what is in the drug, the side effects, warnings, monitoring) has not changed substantially, though Atripla is no longer recommended as first-line treatment for most patients with HIV.
HIV Question Example
A patient is taking Atripla 1 tablet daily to treat HIV infection. Select the components of Atripla (Select ALL that apply.)
Most pharmacists have been taught to treat blood pressure to a goal of < 140/90 mmHg. JNC 8 recommended a goal of < 150/90 mmHg for patients ≥ 60 years old who do not have diabetes or renal disease. Recently, the ACC/AHA guidelines recommended a goal of < 130/80 mmHg for all patients.
Hypertension Question Example
JT is a 51-year-old Hispanic male taking aspirin 81 mg daily, simvastatin 20 mg QHS and Lantus 16 units QHS. He presents to the clinic for medication refills. JT has recorded his blood pressure readings since his last clinic visit. They ranged from 164-182/96-108 mmHg. His blood pressure is 168/110 mmHg today. Select the most appropriate treatment for the patient's blood pressure:
- Diovan HCT 160/12.5 mg once daily
- Catapres 0.1 mg twice daily
- Verapamil 120 mg three times daily
- Tenoretic 50/25 mg once daily
- Maxzide-25 once daily
RxPREP helps students preparing for pharmacist licensure. It's what we do best.
We have found that students who have difficulty when testing have lapses in drug knowledge rather than lapses in knowledge of guideline details. It is best to focus your study time on becoming a drug therapy expert.
Feel confident using the material in the current RxPrep Course Book and any updates we have posted under the Student Resources tab on the RxPrep website at www.rxprep.com and your studies will proceed nicely.
Best wishes from our Pharmacist team for your successful preparation!