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10/16/2026

2025 Blood Pressure Guideline: NAPLEX Question of the Day

A patient averages 136/84 mmHg with no diabetes, CKD or CVD. PREVENT 10-year CVD risk is 8%. What is next?

A) Lifestyle only, recheck in 3 to 6 months
B) Use PCE; treat only if ASCVD is 10%+
C) Start medication now plus lifestyle
D) Start an ACE inhibitor plus an ARB

Comment your answer 👇

✅ Answer: C
This is stage 1 hypertension. The 2025 AHA/ACC guideline uses the PREVENT calculator now. If the 10-year risk is 7.5% or higher, start medicine along with lifestyle changes. Below 7.5%, try lifestyle for 3 to 6 months first. The 10% PCE rule is from 2017. ACE inhibitor plus ARB is never recommended.

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10/15/2026

Xanomeline-Trospium Mechanism: FPGEE Question of the Day

A new schizophrenia drug pairs xanomeline with trospium. What is the job of trospium in this combination?

A) Boosts M4 agonism in the brain
B) Blocks dopamine D2 receptors
C) Inhibits CYP2D6 to raise levels
D) Blocks peripheral muscarinic effects

Comment your answer 👇

✅ Answer: D
Xanomeline turns on M1 and M4 muscarinic receptors in the brain. Alone, it also turns them on in the gut and elsewhere. That causes nausea, vomiting and sweating. Trospium is a muscarinic blocker that barely enters the brain. It blocks those side effects in the body and leaves the brain effect alone. Neither drug blocks D2.

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10/14/2026

Opioid conversions in 3 steps 💊 Most students forget step 3.

1️⃣ Add up the 24-hour dose
2️⃣ Convert with the table
Morphine 30 mg oral = Oxycodone 20 mg = Hydromorphone 7.5 mg
3️⃣ Cut 25 to 50% when switching drugs

Example: Oxycodone 20 mg q6h = 80 mg/day
Converts to 30 mg/day of hydromorphone
After the cut: 15 to 22.5 mg/day ✅

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10/13/2026

2026 DEA Rule for Buprenorphine Injections: MPJE Question of the Day

A pharmacy delivers buprenorphine injection to a clinic for one patient. Under the 2026 DEA rule, it must be given within:

A) 14 days of receipt
B) 45 days of receipt
C) 30 days of receipt
D) 72 hours of receipt

Drop your answer below 👇

✅ Answer: B
DEA’s new rule took effect July 9, 2026. A pharmacy can deliver a Schedule III to V injectable for opioid use disorder straight to the prescriber’s clinic. The clinic must give it to the named patient within 45 days of receiving it. The old limit was 14 days. 72 hours is a different rule for treating acute withdrawal.

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10/12/2026

A Category 2 CSP is made only from sterile ingredients. No sterility test is done. What is its max refrigerated BUD?

A) 24 hours
B) 4 days
C) 10 days
D) 45 days

Comment your answer 👇

✅ Answer: C
This is a Category 2 CSP made from sterile ingredients with no sterility test. Its limits are 4 days at room temperature, 10 days in the fridge and 45 days frozen. 24 hours is the Category 1 fridge limit. 45 days is the frozen limit.

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10/09/2026

A patient on apixaban (last dose 4 h ago) has an intracranial bleed. Which US reversal agent is best today?

A) Andexanet alfa bolus plus infusion
B) Idarucizumab 5 g IV
C) Vitamin K 10 mg IV
D) Four-factor PCC (4F-PCC)

Comment your answer 👇

✅ Answer: D
Andexanet was pulled from the US market in December 2025. The FDA said its clot risks outweighed its benefits. That leaves 4F-PCC as the main option for bleeding on apixaban or rivaroxaban. Idarucizumab only reverses dabigatran. Vitamin K only works for warfarin.

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10/07/2026

Serotonin syndrome or NMS? Most students mix them up 🤔

⚡ Serotonin syndrome is FAST
Hours after a new drug. Clonus, high reflexes, dilated pupils, diarrhea.

🧱 NMS is SLOW
1 to 3 days. Lead-pipe rigidity, low reflexes, very high CK.

💊 Treatment
Stop the trigger for both.
SS: cyproheptadine.
NMS: dantrolene or bromocriptine.

Remember: twitchy = serotonin. Stiff = NMS.

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10/06/2026

A woman on a desogestrel combined pill starts suzetrigine for acute post-op pain. What should the pharmacist advise?

A) No action needed, no interaction expected
B) Backup method during use + 28 days after
C) Change dosing to 50 mg every 24 hours
D) Backup method for 7 days only

Comment your answer 👇

✅ Answer: B
Suzetrigine can lower levels of some progestins. Pills with progestins other than levonorgestrel or norethindrone need a backup method. Use it during treatment and for 28 days after the last dose. C is the dose for moderate liver impairment. D is too short.

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10/05/2026

Which faxed Schedule II prescription may serve as the original written prescription under federal law?

A) Oxycodone tabs for outpatient cancer pain
B) Oral hydromorphone, home infusion patient
C) Morphine solution, Medicare hospice patient
D) Fentanyl patch, signed original in 7 days

Drop your answer below 👇

✅ Answer: C
A fax counts as the original in only three cases: hospice patients, LTCF patients, and narcotics compounded for home infusion. For hospice, the prescriber notes "hospice patient" on the Rx. B fails because oral tablets are not infusion. D mixes up the 7-day rule, which only applies to emergency oral CII orders.

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10/04/2026

Can you spot a fake DEA number in 10 seconds? 🔍

Try BS6143250.
1️⃣ Add digits 1, 3, 5 → 6 + 4 + 2 = 12
2️⃣ Add digits 2, 4, 6, then double → 18
3️⃣ 12 + 18 = 30. The last digit is 0, so it matches. Valid ✅

The second letter should match the prescriber's last name.
A valid checksum is not proof, so always check for red flags.

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