NABP NAPLEX Exam - Topic 8 Question 51 Discussion

Actual exam question for NABP's NAPLEX exam

Question #: 51
Topic #: 8

TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.

While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt's home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.

What would be the most appropriate change to make on her therapy?

AIncrease Simvastatin to 80mg po daily

BKeep Simvastatin at 40mg po daily

CChange Simvastatin 40mg to Atorvastatin 40mg po daily

DChange Simvastatin to Lovastatin 20mg po daily

EDiscontinue Statins.
Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.

Show Suggested Answer

Suggested Answer: C

by Danica at Aug 21, 2022, 04:00 AM

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Myra

4 months ago

I’m not convinced about discontinuing statins altogether.

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Ashton

4 months ago

Keeping Simvastatin at 40mg seems risky with diltiazem.

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Doug

4 months ago

Wait, I thought Lovastatin was okay? This is confusing.

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Pamella

4 months ago

Totally agree, diltiazem and simvastatin don’t mix well!

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Lorrie

4 months ago

I think changing to Atorvastatin is the best move here.

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Tabetha

5 months ago

I feel like discontinuing statins might be too extreme. I remember that atorvastatin is a safer alternative, but I wonder if there's a case for keeping simvastatin at a lower dose.

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Shenika

5 months ago

I practiced a similar question where we had to consider drug interactions. I think the key is to avoid CYP3A4 inhibitors, so changing to atorvastatin seems right.

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Maryann

5 months ago

I'm a bit unsure about the dosing. I thought increasing simvastatin could be an option, but now I see the interaction risk. Is atorvastatin really the best choice here?

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Elbert

5 months ago

I remember studying about drug interactions with statins, especially with diltiazem. I think switching to atorvastatin makes sense since it's not a CYP3A4 substrate.

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Rosalind

5 months ago

I think the key here is to focus on the CSA principles. The question is asking how the firm should respond, so I'll need to review those principles and determine the appropriate action.

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Latosha

5 months ago

Hmm, I'm a bit unsure on this one. I know Workspace ONE is used for mobile device management, but I'm not sure if it's the specific app for viewing assignments. I'll have to think this through carefully.

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Tequila

5 months ago

I think we covered a similar question in class last week. I have a feeling they do prioritize hospital reimbursements over primary care.

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