The APhA Complete Review for Pharmacy contains:
- 869 pages
37 chapters
12 appendices
A CD-ROM with nearly a thousand interactive questions and answers
Study Guide to NAPLEX® Test-Taking Strategies
James C. Eoff III, Pharm.D.
University of Tennessee College of Pharmacy
Welcome to The APhA Complete Review for Pharmacy. With so many different academic backgrounds, such a variety of learning experiences, and the increasing volume of information taught at U.S. colleges of pharmacy, it is impossible to cover all materials from each course you have taken while in pharmacy school. Therefore the primary purpose of The APhA Complete Review for Pharmacy is to provide a summary of therapeutics as well as other basic pharmaceutical principles (dosage forms, math, biopharmaceutics, kinetics, basic and parenteral compounding, among others) which will be valuable in your preparation for the NAPLEX®, and also be a resource as you enter practice.
This review book is not an exhaustive discussion of the topics presented; it utilizes instead an abbreviated outline format to enable you to review and organize the material in an efficient manner for easy recall and recognition. The NAPLEX® is a difficult exam, and it covers a tremendous amount of material. In recent years, the NAPLEX® has become even more relevant to professional practice, with less emphasis on the basic sciences and more emphasis on drug therapy and pharmaceutical care.
Your success in pharmacy school has been due to diligence and hard work. You should have confidence that your pharmacy education has prepared you for the NAPLEX® and you should not have anxieties about the exam. However, your self-confidence should not prevent you from being meticulous about preparation for the NAPLEX®. Realizing that approximately 10% of students fail to achieve a passing score on their first attempt at the NAPLEX®, do not take this exam lightly.
The following are helpful hints that will improve your success on this examination:
1. Positive attitude: You are encouraged to approach preparation for the NAPLEX® with a positive attitude. Study to learn and understand concepts, not just memorize enough facts to pass the exam. Remember that in addition to being a minimum standard required for entry into pharmacy practice, an important benefit of taking the NAPLEX® is the comprehensive review, which will make you a better pharmacy practitioner. Without the NAPLEX®, few pharmacy graduates would spend the time and effort to review the entire discipline immediately prior to completing their studies. You should be confident that you have the knowledge to pass the exam if you have prepared diligently.
2. Plan ahead: Do not delay your review and preparation for the NAPLEX® until the last week before your scheduled exam date. While the total amount of time varies greatly from student to student, it is recommended that you start a serious review no less than 4-6 weeks
before you plan to take the exam. However, if you have limited pharmacy work experience, you should start much earlier, especially learning generic and trade names. Be conscientious about scheduling specific times to prepare for the NAPLEX® over this time period. Cramming the last few days before the NAPLEX® will potentially increase your anxiety and could also confuse you with such a large volume of material. Read one or two chapters per day 4 or 5 days per week, and review the generic and trade names daily.
3. Generic and trade names: The first place to begin your preparation is to learn the generic and trade names for the top 200 drugs. The importance of this basic recommendation cannot be overemphasized. Without this base, you will experience tremendous difficulty on the
NAPLEX®, which is traditionally over half trade names. In addition, you will also need to learn the generic and trade names for the unique drugs, which may not be among the top 200 drugs (eg, Cogentin® & Artane®, which are used to manage the extrapyramidal side effects of psychotherapeutic agents; Tofranil®, which is used to treat enuresis; Tapazole®, which is used to treat hyperthyroidism). Most of the patient medication profiles contain numerous drugs that may be listed either by the generic or trade name. Therefore knowledge of generic and trade names is essential to identify therapeutic duplication (eg, the patient who is prescribed Corgard® who is already taking the beta-blocker
propranolol). You will also be expected to determine potential causes for adverse effects, as well as screen for drug interactions and drug-disease interactions, either from drugs on the profile or the new prescriptions. In some cases drugs will be listed by their generic names and in others by their trade names.
4. Math: Other than generic and trade names, pharmacy math is the most important single area to review. You should practice working several examples of each type of math problem to be sure you are comfortable and confident in your ability. While some therapeutic topics may not be covered extensively, the large number of math questions on the NAPLEX® makes this a high priority. Many students struggle with math on the NAPLEX®. Therefore it is recommended that you schedule several math study sessions. The metric system is emphasized, but you must know the other systems and be able to make conversions. While the apothecary system is used infrequently, the avoirdupois system (sometimes called the “household” system) is still used (eg, prepare one pound of ointment). When apothecary or avoirdupois measures are used, you should usually convert them to metric.
5. Competencies: You should review the areas of emphasis defined in the NAPLEX® competency statements that are available on the NABP®
website: www.nabp.net. As you review the top 200 drugs you should ask yourself the following questions:
* What is the therapeutic category of this drug?
* What is the mechanism of action?
* What type of patient counseling information should be provided?
* What are the major adverse effects (side effects and toxic effects)?
* What is the dosage schedule (frequency)?
* What are the major drug interactions and disease contraindications?
These topics should also be the priority areas as you review each therapeutic class of agents.
6. Dosage schedules: Summary charts of the major categories of drugs are provided in each of the therapeutic chapters of this book. You will find the generic as well as trade names, along with commonly available dosage forms, dosage, and frequency of use. The frequency of use is emphasized more on the NAPLEX® than the specific dosages. The following therapeutic lists with multiple agents should also be emphasized in your studying: β-blockers, calcium channel blockers, ACE inhibitors, benzodiazepines, cephalosporins, quinolones, aminoglycosides, NSAIDs, H2 blockers, protease inhibitors, oral antidiabetics, and statins. Be able to recognize the agents within these categories, and to know how to compare the differences within the category (eg, length of action, dosage schedules, side effects, and distinct advantages in patients with certain diseases).
7. Appendices: There are also many tables that can help you recall or recognize answers for NAPLEX® questions in the appendices, such as the major drug-drug interactions, the drugs that should not be crushed, and the top 200 OTC agents. There are also other important tables to study throughout the book, such as the table of common antidotes for poisons and overdosages in the toxicology chapter. By reviewing these therapeutic agents by categories and in tables, you will increase your recall of them on the exam.
8. Chronic and common diseases: The NAPLEX® emphasizes the more common and chronic diseases and their therapy. While it is a good idea to have a general knowledge of the disease process, remember that the NAPLEX® is heavily weighted toward drug therapy. Therefore you should not devote the majority of your study time on the disease process (eg, etiology, pathophysiology, diagnosis, and signs and symptoms) at the expense of the therapy (including nondrug therapy). While it is helpful to review your areas of strength, you should concentrate more on your areas of weakness. The less familiar you are with a topic, the more time the topic should be given in review.
9. Priorities: There are several areas that should not be emphasized in your review: (1) the manufacturer of the specific drug (eg, Zithromax® manufactured by Pfizer); (2) chemical structures; and (3) identification or physical descriptions (eg, color, shape, etc). These areas are covered only minimally on the NAPLEX®.
10. Review questions: Reviewing sample exam questions is very helpful. However, to make this a more effective learning experience, study the explanations along with their answers. Do not look only at the correct answer, but look at distractors and learn why they are incorrect.
Therapeutics reference texts may also be helpful in your NAPLEX® review for their more detailed information and to assist with difficult or complex material. This will also reinforce learning points about material covered in your review.
11. Exam format: The NAPLEX® consist of 185 multiple-choice questions in a computer adaptive format that is individualized to each candidate’s level of ability. The computer adapted test system selects your next questions based on your response to previous questions, and thus each question must be answered before you can proceed. The 150 questions that have been pre-tested for validity are the basis for your evaluation. In addition, 35 questions that are being evaluated for use in future exams are distributed throughout the exam.
12. Question format: You should log on to the NABP® website (www.napb.net) to review the format for exam questions and the patient profiles. NABP® also offers a “pre-NAPLEX®” test for a fee, that will allow you to practice with the computerized format. This will help allay your anxiety and be especially beneficial if you are not comfortable with exams given in a computer format.
All questions have 5 choices with only one “best” answer. You may not continue the exam until you have answered the question. You may not skip the question and come back. Therefore you will be unable to leave any question blank. The question is superimposed at the bottom of the screen below the patient medication record. After deciding on the best answer you will:
1. Highlight the answer.
2. Request the next question.
3. Confirm that you want the next question, which will finalize your answer.
You cannot go back to change an answer after step 3.
There are two types of multiple-choice questions:
1. The traditional single-answer type as in the example below:
The agent of choice for the initial treatment of contact dermatitis, whether irritant or allergic, is a:
A. topical antihistamine
B. oral antihistamine
C. topical corticosteroid
D. local anesthetic
E. coal tar product
And
2. The combined-response (“K” type) question with 1, 2, or 3 components listed, as in the example below:
The most common side effects of isotretinoin include which of the following?
I. Cheilitis
II. Acute depression
III. Decreased night vision
A. I only
B. II only
C. III only
D. I and II
E. I, II, and III
13. Patient medication record: The patient medication record is usually followed by 10-15 questions. You must refer to the patient profile for many of the questions. However, some questions may be answered as presented or “stand alone.” You will not be able to see the entire profile on the top of the screen without scrolling down to review the whole profile. You may want to write down the significant points from the profile, such as allergies, age of the patient, and preexisting diseases, on scrap paper. Note carefully if the patient has multiple diseases, and for females, look for pregnancy or nursing, or likely to become pregnant. Some prefer to read the questions prior to reviewing the profile, but you could miss an important fact like a drug allergy, a drug-disease contraindication, or an adverse effect being treated currently that resulted from a previously prescribed drug, and answer the question without all of the necessary information. Therefore always conduct a quick review of the profile prior to answering the questions.
14. Testing center location: If you are not familiar with the exact location of the testing center, locate it no later than the day before the exam. Arrive at the testing site at least 30 minutes prior to the scheduled time in order to be as calm as you can. You do not want to be caught in traffic or get lost trying to find the testing center and panic immediately prior to taking the exam.
15. The night before the exam: Do not study the night before the exam; last minute cramming will only add to your anxiety and will not improve your test score. I recommend that you take a night off from study the evening before the exam. Go out for a relaxing dinner and/or a movie. Be sure to get to bed early, especially if you are scheduled for a morning exam, so your ability to reason, recognize, and recall information is sharp.
16. Afternoon exam: If your exam is scheduled in the afternoon, fatigue can dull your test-taking abilities. Be on guard against this by having a light lunch, preferably with coffee, tea, or some caffeine-containing beverage to be sure that you stay sharp for the afternoon session.
Taking the Pharmacy Exam
1. Read all directions carefully. Read each question a minimum of two times to determine the nature of the question and the point of asking the question. Note any modifying terms like always, all, never, most, usually, double negatives, and anything else that may change the meaning of the question. Modifiers like “always” and “never” mean what they say.
2. Read all the choices thoroughly before you answer the question. Attempt to eliminate the distractor choices or incorrect answers. Two or three answers can usually be eliminated for one reason or another, and the final choice is between two answers. The more distractors you identify and eliminate, the more you increase your probability of obtaining the best answer. Then select the single best answer. Your first instinct is generally the best choice. Be cautious about not reading multiple possibilities into questions; the questions are straightforward and are not designed to trick you.
3. If you are positive that you do not know the answer, eliminate any distractors and guess intelligently, making the best choice you can of the remaining answers. If you can limit your guess to two possible correct answers, your score will be much better than if you try to guess the correct answer from five possible choices. Proceeding in this fashion over the course of the exam, you can increase your success if you guess consistently. While blind guessing is not recommended, after narrowing possibilities, intelligent guessing is definitely recommended.
4. Pace yourself, but do not rush through the exam. The 4 hours 15 minutes scheduled for the NAPLEX® is more than adequate, and the majority of students have plenty of time to complete the exam. You need to proceed at a reasonable pace and need to answer approximately
45-50 questions per hour to finish comfortably in the time available. There is a timer visible at the corner of the screen with your remaining exam time. If you notice that you have only completed 40 questions in the first hour, you should increase your speed.
5. Some of the math questions may be weighted more heavily and some will take several minutes to answer. Take the time to answer the math questions correctly. Incorrect answers may lead to additional math questions (eg, missing the first milliequivalent question could lead to more milliequivalent questions on your exam). Use the scrap paper provided for your calculations. Be sure to include units as you complete the math questions on your scrap paper.
6. It is important that you remember that you cannot return to a previous question after you have confirmed an answer. There is no need to get upset over a previous question you realize you have missed as you proceed through the exam. Do not get nervous during the exam or panic or you may lose your ability to recall or recognize common information. Remain calm and do the best you can. Best of luck with the test!
James C. Eoff III, PharmD
Executive Associate Dean
University of Tennessee College of Pharmacy
847 Monroe Avenue
Memphis, Tennessee 38163
Email: jeoff@utmem.edu
NAPLEX® stands for the North Amercian Pharmacist Licensure Examination and is a federally registered trademark owned by the National Association of Boards of Pharmacy® (NABP®). This review course is in no way authorized or sponsored by the NABP®. Please check the NABP® website, www.nabp.net, for more complete information.
