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A Brief Review on Dyslipidemia for Pharmacists

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  • General information:
    • Dyslipidemia is defined as a condition in which an individual has elevated cholesterol or lipids in an individual’s blood such as the following:
      • HDL: “Good” cholesterol
      • LDL: “Bad” cholesterol
      • Triglycerides (TGs)
    • LDL cholesterol can form plaques in vessels
    • HDL cholesterol helps remove LDL
    • TGs are formed in fat cells when calories are not burned right away
  • Symptoms:
    • Regarded as a silent disease in which patients are unaware of having it
  • Types and causes:
    • Primary dyslipidemia:
      • Inherited through genetics
    • Secondary dyslipidemia
      • Caused by lifestyle factors such as the following:
        • Obesity
        • Diabetes
        • Hypothyroidism
        • Alcoholism
  • Risk factors:
  • Review of lab values**:
 Total cholesterolHDL  LDLTGs
Desirable< 200> 40 (men) > 50 (women)  < 100< 150
Borderline200 – 239   130-159150-199
High  > 240     160-189  200-499  
Very high      > 190> 500

**All units are in mg/dL

  • Treatment options:
Class and Mechanism of ActionGeneric (Brand) NamesSide EffectsBlack Box WarningsContraindications
Statins: Inhibits the rate-limiting step for cholesterol synthesis by inhibiting HMG-CoA reductase   **first-line**Atorvastatin (Lipitor) Rosuvastatin (Crestor) Simvastatin (Zocor) Pravastatin (Pravachol) Pitavastatin (Livalo) Fluvastatin (Lescol) Lovastatin (Mevacor) Simvastatin + Ezetimibe (Vytorin)  Myalgia Arthralgia Myopathy Diarrhea Cognitive impairmentSkeletal muscle effects  

Hepatotoxicity (increased LFTs)		Pregnancy Breastfeeding  

Use with cyclosporine  

Active liver disease
Bile Acid Sequestrants: Inhibits absorption of bile acids into blood which ultimately aids in reducing LDL  Cholestyramine (Questran) Colesvelam (Welchol) Colestipol (Colestid)  Abdominal pain Cramping Flatulence Constipation Increased TGs Increased LFTs   Esophageal obstruction   Cholestyramine: Biliary obstruction  
Colesvelam: Bowel obstruction and TGs > 500
Fibrates: PPAR-α agonist; inhibits TG synthesis and decreases VLDLGemfibrozil (Lopid) Fenofibrate (Tricor)  Abdominal pain Dyspepsia Increased LFTs  
Upper respiratory tract infection (URTI)  		Risk of myopathy with concurrent statin use   Increased serum creatinine   CholelithiasisLiver disease Renal disease Gallbladder disease  

Use with repaglinide
PCSK-9 Inhibitors: Monoclonal antibodies that decrease LDLAlirocumab (Oraluent) Evolocumab (Repatha)Flu Cold URTI Injection site reaction   Urinary tract infection (UTI)    
2-Azetidinones: Inhibits absorption of cholesterol at the small intestineEzetimibe (Zetia)Myalgia Arthralgia Diarrhea URTI  Skeletal muscle effectsAvoid in patients with hepatic impairment
Fish Oils: Unknown mechanism of action    Omega-3 Acid (Lovaza) Icosapent Ethyl (Vascepa)Dyspepsia Flatulence Burping Increased LDLCaution in those with a fish/shellfish allergy 
Nicotinic acid/Vitamin B3: Decreases synthesis of VLDL, LDL, and TGs  Niacin (Niacor, Niaspan)Flushing Pruritis Nausea Vomiting Diarrhea Cough

Hyperglycemia Hyperuricemia  
Orthostatic hypotension  		Hepatotoxicity  

Rhabdomyolysis with concurrent statin use		Liver disease  

Arterial bleed  

Peptic ulcer disease
High-Intensity Statin Therapy (Lowers LDL on average by > 50%)Moderate-Intensity Statin Therapy (Lowers LDL on average by 30-49%)  
Atorvastatin 40-80 mg Rosuvastatin 20-40 mgAtorvastatin 10-20 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Lovastatin 40 mg
Fluvastatin 40 mg
Pitavastatin 2-4 mg  
  • Additional notes:
    • Statins
      • Patient must contact their doctor for any muscle symptoms or dark urine
      • Simvastatin, lovastatin, and fluvastatin must be taken at bedtime
      • Avoid gemfibrozil, niacin (> 1 gram), and colchicine
      • Simvastatin and lovastatin:
        • Avoid strong CYP3A4 inhibitors such as azoles, erythromycin, clarithromycin, HIV protease inhibitors, cobicistat, nefazodone, cyclosporine, grapefruit juice
    • Bile Acid Sequestrants
      • Take with food and water (colesevelam)
      • Space out with multivitamins
        • At least 4 hours of one another
      • ACC/AHA guidelines do not recommend use if TGs are > 300
    • Fibrates
      • Can increase LDL when TGs are high
      • Patient must contact their doctor for any muscle symptoms, dark urine, abdominal pain, nausea, or vomiting
    • PCSK-9 Inhibitors
      • Store in fridge
      • Prior to administration allow for syringe to warm up to room temperature for 30-45 minutes
        • Inspect for any particles and/or color changes
      • Rotate injection sites
        • Alirocumab and evolocumab: Subcutaneous injections given in the thigh, upper arm, or abdomen (except within 2 inches from belly button)
    • 2-Azetidinones (Zetia):
      • Avoid concurrent use with gemfibrozil
      • Monitor LFTs with concurrent statin or fibrate use
      • Give 2 hours before or 4 hours after bile acid sequestrants
      • Patient must contact their doctor for any muscle symptoms or dark urine
      • Concurrent use with cyclosporine may increase levels of both drugs
    • Nicotinic acid/Vitamin B3
      • Must be taken with food
      • Monitor LFTs
      • Niaspan:
        • IR: Flushing/itching
        • ER: Less flushing than IR; take at bedtime
      • Avoid spicy food and ethanol
      • Take 4-6 hours after bile sequestrant acids
  • Treatment algorithm:
Prevention type  SituationTreatment
        Primary preventionLDL > 190 mg/dLHigh-intensity statin  
Primary preventionAge 40-75LDL 70-189 mg/dLPatients with diabetesModerate-intensity statin, unless 10-year ASCVD risk > 7.5%  
Primary preventionEvaluating 10-year clinical atherosclerotic cardiovascular disease (ASCVD) score  ASCVD risk > 7.5%: high intensity statin
 
ASCVD risk > 5% but <7.5%: moderate-intensity statin  
Secondary preventionPatients with clinical ASCVD< 75 years old: high intensity statin 
> 75 years old: moderate-intensity statin  

We hope this review helped refresh your clinical knowledge on dyslipidemia!

Best of luck,

Sam Tamjidi

RxPharmacist Team

References:

  1. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Accessed October 30, 2020.

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What Pharmacists Need to know about Diabetes

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As per the Centers for Disease Control and Prevention (CDC), 34.2 million people, or 1 in every 10, in the United States have diabetes. Diabetes is 7th on the list of leading causes of death while the total estimated medical costs and costs associated with lost work and wages equates to an estimated $327 billion.

Diabetes, otherwise known as increased sugar levels (hyperglycemia) may be a result of decreased insulin secretion, decreased insulin sensitivity, or both. It can present itself in one of two forms of the following:

  • Type 1
    • Autoimmune destruction of beta cells
    • Loss of insulin production
    • Must use insulin injections
  • Type 2
    • Insulin resistance
    • Decreased insulin production over time
    • Associated with obesity, physical inactivity, family history
  • Signs and symptoms of diabetes include:
Signs and Symptoms of Diabetes
  • Risk factors:
Risk Factors for Diabetes
  • General Screening Criteria:
    • All patients with BMI greater than or equal to 25 kg/m2 + 1 risk factor
    • Children/adolescents with obesity + 1 risk factor
    • 45 years old if no risk factors are present
    • Pregnant women at 24-48 weeks
PrediabetesDiabetes
->Fasting plasma glucose (FPG) 100-125 mg/dL; or
->2-hour glucose after glucose tolerance test 140-199 mg/dL; or
->A1c 5.7-6.4%  		->Symptoms + random plasma glucose > 200 mg/dL; or
->2-hour glucose after glucose tolerance test > 200 mg/dL; or
->FPG > 126 mg/dL; or
->A1c > 6.5%  
  • Glycemic targets (per ADA guidelines):
    • A1c < 7%
    • 80-130 mg/dL pre-prandial plasma glucose
    • < 180 mg/dL post-prandial plasma glucose
    • A1c should be measured quarterly if not at goal
      • Or twice yearly if at goal
      • (A1c – 2) x 30 = average blood glucose
  • Drugs that may increase blood glucose levels:
Drugs that may increase blood glucose levels
  • Non-drug treatment options:
    • Smoking cessation
    • Weight loss
      • 3500 kcal weekly reduction = 1 lb weight loss
      • Waist circumference < 35 inches for females and < 40 inches for males
    • Nutrition
      • Carbs from vegetables, fruits, grains, and dairy
      • Omega-3 fatty acids and fiber
      • Limit saturated fat, cholesterol, and sodium
      • 15 g = 1 serving of carbohydrates
    • Physical activity
      • 150 min/week, moderate intensity
      • No more than 2 consecutive days off
      • Resistance training at least 2x/week
Drug treatments (oral medications)
  • Additional notes on oral drug classes:
    • Biguanides
      • Take with food
      • Use of alcohol increases the risk of lactic acidosis
      • Discontinue before any imaging with iodinated contrast; resume after 48 hrs
    • Meglitinides
      • Take 1-30 minutes before meals
      • If skipping a meal, skip dose as well
    • Sulfonylureas
      • Take with breakfast
        • Exception: Glipizide IR 30 minutes before breakfast
      • Glyburide – avoid in elderly and patients with renal impairment
    • Thiazolidinediones
      • Take with meals
      • May take weeks to take effect
      • Additional warnings:
        • Bladder cancer (pioglitazone only)
        • Risk of macular edema
        • Fracture risk
        • Hepatic failure
        • Resumption of ovulation
    • SGLT-2 Inhibitors
      • Caution when taking with diuretics and NSAIDs (due to risk of hypotension and acute kidney injury)
      • Additional warnings:
        • Genital infections
        • Hypotension
        • Increased LDL
        • Renal insufficiency
        • Ketoacidosis
      • Monitor K+ with Canagliflozin
    • DPP-4 Inhibitors
      • Take in the morning
Drug treatments (injectable medications)

Additional notes on injectable drug classes:

  • GLP-1 Agonists:
    • Exenatide and lixisenatide are administered 60 minutes before a meal
    • All others given without regard to food
  • Amylin Analog
    • Used in treatment of both type I and II diabetes
    • Reduce mealtime insulin by 50%

  • Drug treatments (Insulin)
    • For all insulins:
      • Side effects: weight gain
      • Warnings; hypoglycemia, hypokalemia
      • Never use pens for more than one individual
      • Most are 100 units/mL concentration
      • High risk medications
    • Dosing strategies
      • Basal insulin
        • Long or intermediate acting
        • Mainly affect fasting blood glucose
      • Bolus insulin
        • Rapid or short acting
        • Two purposes:
          • Prandial (mealtime) & correction (acute elevation)
Drug treatments (Insulin medications)
  • Insulins that do not require a prescription:
    • Regular insulin, NPH, and the premixed 70/30 combination
  • Insulin dosing for Type I diabetes:
    • Rapid-acting and basal insulin preferred
    • If using NPH and regular insulin
      • 2/3 NPH, 1/3 regular
    • Initiating basal/bolus insulin:
      • Calculate total daily dose (TDD)
        • 0.6 units/kg/day using TBW
      • Step 2: Divide TDD
        • 50% basal
        • 50% bolus
      • Step 3: Divide the bolus among 3 meals
    • Based on the amount of carbohydrates in a meal, meal-time insulin can be adjusted using rule of 500 (rapid-acting insulin) or rule of 450 (regular insulin)
      • (500 or 450)/TDD = g of carbs covered by 1 unit of insulin
  • Correction factor/dose
    • Factor:
      • Determines how much blood sugar will drop for every 1 unit of insulin. Uses the rule of 1800 (rapid-acting insulin) or rule of 1500 (regular insulin)
        • (1800 or 1500)/TDD = correction factor for 1 unit of insulin
  • Dose:
    • Amount of insulin required to bring blood glucose back to normal: [(blood glucose now) – (target blood glucose)]/   correction factor = correction dose
  • General treatment algorithm for Type II Diabetes:
General treatment algorithm for Type II Diabetes
  • For A1c greater than or equal to 8.5%: Jump straight to dual treatment
  • A1C > 10%: Think insulin
  • Cardiovascular benefit:
    • GLP1 agonists: liraglutide, semaglutide, exenatide
    • SGLT2 inhibitors: empagliflozin, canagliflozin
  • Patient-specific factors
    • Drugs that minimize hypoglycemia:
      • DPP4 inhibitor, GLP1 agonist, SGLT2 or TZD
    • Drugs that promote weight loss:
      • GLP1 agonist or SGLT2 inhibitors
    • Drugs with cost concerns:
      • Sulfonylurea or TZD
  • Combinations to avoid:
    • DPP4 inhibitors + GLP1
    • Sulfonylureas + insulin
  • Insulin dosing for Type II diabetes:
    • Initiate basal insulin after patient fails to reach or maintain goal on multiple oral therapies
    • Starting dose: 0.1-0.2 units/kg/day or 10 units/day
    • Titrate by 10-15% or 2-4 units once or twice weekly until fasting blood glucose at goal
    • If patient reaches fasting blood glucose goal but their A1c is still above goal:
      • Consider the addition of rapid acting mealtime insulin or GLP-1 agonist
  • Insulin administration:
    • Abdomen is the injection site (avoid belly button)
    • May also inject in thighs, buttocks, arms
      • Be consistent with administrations
    • Prime before each dose
    • Rotate sites
  • Hypoglycemia is common with insulin products, thus important to be aware of what to look out for and how to treat it
    • Defined as a blood glucose < 70 mg/dl
    • Symptoms: sweating, pallor, irritable, hunger, lack of coordination, sleepy
      • Beta blockers mask most except hunger and sweating
    • Treatment
      • Consume 15-20 g of glucose/simple carbohydrates
      • Recheck glucose levels after 15 minutes
      • Repeat if needed
      • Eat a small meal/snack to prevent recurrence
    • Glucagon is used only if patient is unconscious
  • Diabetes in pregnancy
    • Gestational diabetes: during pregnancy
      • Risks
        • Macrosomia
        • Hypoglycemia at birth
        • Obesity and type 2 diabetes
      • Management
        • Lifestyle modifications
        • Insulin added if needed (preferred)
        • Metformin and glyburide used
      • Goals:
        • Fasting < 95 mg/dL
        • 1-hour post-meal less than or equal to 140
        • 1-hour post-meal less than or equal to 120

We hope this review helped refresh your clinical knowledge on diabetes. Next up, we will take a look at dyslipidemia.

Best of luck,

Sam Tamjidi

RxPharmacist Team

References:

  1. National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/data/statistics-report/index.html. Accessed October 26, 2020.
  2. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Accessed October 26, 2020.

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A Brief Review on Hypertension for Pharmacists

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With so many organ systems, disease states, and medications to remember, preparation for the NAPLEX may often times seem like a daunting task. While there can be a considerable amount of material to go over for each clinical module, there are certainly some things that deserve more focus than others. This brief review will cover some of the most important information you need to know about hypertension when preparing for your upcoming exam.

General information:

  • Hypertension (HTN) is asymptomatic
  • HTN increases the risk for heart attacks, strokes, and kidney failure
  • Risk factors include the following:
    • High sodium and fat diet, physical inactivity, obesity, tobacco use, excessive alcohol consumption, genetics and family history, age, sex (women more likely than men), and race (African Americans more likely than any other race)
    • Drugs can also increase blood pressure, including the following:
      • Amphetamines, cocaine, pseudoephedrine, immunosuppressants, Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, ethanol, caffeine, serotonin and norepinephrine reuptake inhibitors (SNRIs), oral contraceptives, erythropoietin

Blood pressure categories:

 Ultimate blood pressure goal:

  • 130/80 mmHg

Treatments:

Four preferred drug classes for the following patient subgroups:

  • Non-African American: Thiazide diuretic, CCB, ACE inhibitor or ARB
  • African American: Thiazide diuretic
  • Patients with chronic kidney disease or diabetes with albuminuria ACE inhibitor or ARB
  • Initiate two drugs regimens if blood pressure is > 150/90 mmHg

Additional information:

  • ACE inhibitors, ARBs, Aliskiren
    • Do not use with Entresto
    • Do not use any combination of ACE inhibitors, ARBs, and aliskiren for treatment
  • CCBs
    • CYP3A4 substrates, avoid CYP3A4 inhibitors (eg, grapefruit)
    • Caution with ankle swelling and/or irregular heartbeat
    • Amlodipine and felodipine are the safest to use in patients with HF
  • BBs
    • No longer preferred for HTN treatment
      • Primarily used first-line for heart disease, post myocardial infarction, and HF
    • Use with caution when taking other drugs that decrease HR
    • Mask symptoms of hypoglycemia
  • Diuretics
    • Take doses in the morning or afternoon to avoid frequent urination symptoms at night
    • Provide K+ supplementation to compensate for decreased K+ levels
      • This does not remain true for K+ sparing diuretics
  • Hypertensive emergency
    • Blood pressure > 180/120 mmHg
    • Acute organ damage
    • IV medication used for treatment
      • Clevidipine, nicardipine, diltiazem, verapamil, enalaprilat, esmolol, labetalol, metoprolol tartrate, propranolol, nitroglycerin, nitroprusside, chlorothiazide
    • Goal is to decrease blood pressure by < 25% within first hour
  • Hypertensive urgency
    • Blood pressure > 180/20 mmHg
    • No organ damages
    • Oral medication for treatment
  • Pregnancy
    • Treatment with labetalol, methyldopa or nifedipine XR

Treatments (non-pharmacological):

  • Lifestyle modifications
    • DASH diet, limit salt intake (<1,500 mg/day), exercise, limit alcohol consumption, maintain proper weight (BMI between 18.5 – 24.9)

Be on the look-out for our next review, which will focus on diabetes.

Best of luck,

Sam Tamjidi

RxPharmacist Team

References: Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Accessed October 12, 2020.

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Creating an edge over other PharmD graduates

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It has always been my top-priority goal to gain experiences that would further my personal and professional development which made this position an especially enticing one. Throughout pharmacy school, my unique experiences in diverse work settings and industries helped create a necessary edge over other Doctor of Pharmacy graduates. Although my post-doctoral fellowship was cancelled due to COVID-19, RxPharmacist allowed me to continue to have a productive summer as I developed new skills to become a more marketable Doctor of Pharmacy graduate.

My experience aligned perfectly with my growth mindset as I grew to overcome obstacles that came with completing new projects. Beyond the expected technical skills from content creation and remote communication, I was also exposed to start-up culture and entrepreneurship. My cohort was able to participate in brainstorming sessions on business and marketing strategy that management provided instant feedback on. The mentorship and network development also made it easy for my cohort to connect and support each other in their career trajectory.

Through RxPharmacist, I improved my knowledge of NYS pharmacy law, technical writing, and the test prep start-up industry. I welcome any students and graduates with questions to contact me here: https://www.linkedin.com/in/joan-cheung/

-Joan Cheung

St. John’s University, 2020 PharmD Graduate

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Networking, mentorship, and a preceptor that rocks!

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If you are looking for a great opportunity to jump start your pharmacy career, while gaining valuable firsthand experience and mentorship from an amazing group of people, look no further! The summer graduate internship offered by RxPharmacist is a great program that I would highly encourage to any PharmD student.

When I first joined the team, I was not sure what to expect. I knew that I had a deep interest for medical writing and joining the RxPharmacist team seemed to be the perfect opportunity for post-grad. But, RxPharmacist is so much more than just writing MPJE guides. Being a summer intern afforded me the opportunity to work with amazing pharmacists and other recent graduates. The best part of the program was the mentorship and guidance that I received from my preceptor. While working and studying for your licensure exams FROM HOME, you will also be able to receive the support and guidance you need as you transition from being a student to a true professional!

I would strongly encourage any pharmacist student to consider internship opportunities with RxPharmacist. Not only would you be rewarded as you study for your licensure exams, but you would also be gaining valuable experience and insight to the world of medical writing, marketing, business strategy, and effective networking.

Nnenna I., 2020 RxPharmacist Graduate Summer Intern

Husson University, Class of 2020

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Intern Testimonial- Getting a helping Hand Among COVID-19

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Prior to the completion of pharmacy school there were a lot of questions as to which direction of pharmacy I wanted to pursue. With the many conflicts surrounding job saturation and COVID-19, I was quick to realize it would be in my best interest to become more open-minded towards other career opportunities. Coming across the graduate intern position at RxPharmacist started off as nothing more than curiosity, but now, after completion of the program, I can say with full confidence it was one of the best life decisions I have ever made. 

At RxPharmacist, communication and support is transparent. You work with a team that truly cares about your performance and future career. Not only do they provide constant feedback on your work, but they also create the time to communicate with you to reflect on your resume and cover letter, while assisting you in expanding your professional network. The 10-week program is more than creating a study guide, it’s an opportunity to gain additional insight and hands-on skills that focus on medical writing, entrepreneurship, and marketing. 

The development of your very own study guide will not only aid yourself in passing the MPJE on the first try, but it will also support the pharmacy profession as a whole by helping all other newly graduates succeed as well. I am extremely grateful for the opportunity I had with RxPharmacist and I highly recommend this to anyone seeking experience!

Sam T., 2020 RxPharmacist Graduate Intern

Mercer University, Class of 2020

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Supporting our pharmacy profession: Team Member Testimonial

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My journey with RxPharmacist started with a post on my pharmacy class’s Facebook page asking for help to contribute to their Florida MPJE guide. I reached out and volunteered to help. This experience was very valuable as it helped me develop my writing skills, work within a team with other pharmacy graduates around the State of Florida, and helped me study for the MPJE exam. After I found out I passed the MPJE, there was no way I could take another one.

Little did I know, a year later, I would be moving to Washington, DC. I was researching online for study materials for the DC MPJE, but had little luck in finding materials. That is when I came across RxPharmacist again. I reached out asking if there were any DC MPJE study materials available. Fortunately, I was presented with an opportunity to author a DC MPJE Guide with RxPharmacist. I was already working as a pharmacist and my job was very demanding; however, the RxPharmacist team was very flexible with allowing me to write the guide at my own pace within the time frame requested. This opportunity closely aligned with my goals to help the pharmacy profession and improve my writing skills. Thank you RxPharmacist for another great experience! Best of luck to all current and future pharmacists on your MPJE exams!

Chrissy T., Pharm.D., 2020 Medical Writing Associate

University of Florida College of Pharmacy, Class of 2019

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What is the MPJE and What do I Need to Know?

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WHAT IS THE MPJE?

The Multi-Prudence Jurisdiction Examination (MPJE) is a 120-question computer-based exam that uses adaptive testing response questions. For example, if you keep getting questions wrong then the computer will provide you questions that are statistically deemed “easier.”  It’s important to note that of the 120 questions on this exam, only 100 are used to calculate your final score. The remaining 20 questions are pretest questions that will not count into your MPJE score, but you won’t be able to tell which ones are pretest questions and which ones are not. The total testing time is two hours with NO breaks during the testing session so it’s important to take note of time. 

WHAT IS THE PASSING SCORE?

The passing scaled score is 75 with the minimum score being zero and maximum 100. The exam is divided into three major sections:

  • Pharmacy Practice- 83%
  • Licensure, registration, certification, operational requirements- 15%
  • General Regulatory Processes- 2%

WHAT HAPPENS IF I FAIL?

If you don’t pass the first time you still have 4 more attempts to pass you’re MPJE exam. A maximum of 5 tries per state to pass the MPJE is allowed. Hopefully you won’t fail the first time you take your MPJE but if you do, you need to wait 30 days per state until you can sit for the exam again to re-take. For the NAPLEX, it is a period of 45 days to wait before you can retake the exam again. 

Note that if your eligibility to sit for the NAPLEX or MPJE is going to expire within 10 business days then you won’t be able to pay and sit for the exam so make sure as soon as you get your authorization to test (ATT) letter that you book your appointment as soon as possible. 

IMPORTANT 2019-2020 UPDATES TO MPJE AND NAPLEX

The re-sit fees for the NAPLEX and MPJE are bumped up to $475 and $150 (YIKES that hurts!). If you miss your exam due to an emergency (whatever that means), then you can ask if you can re-sit to take your exam for a reduced fee of $170 for the NAPLEX or $100 for the MPJE. 

SOME MAJOR POINTS TO REMEMBER:

  • All questions are answered in order so there’s no going back
  • Lots of situational questions
  • Online registration costs $250.00 per examination
  • You will need to bring two forms of ID at Pearson Vue
  • At least one picture ID with signature (i.e. Driver’s License)
  • Other can be credit card with signature
  • 120 questions, 100 count towards your score
  • MUST complete 107 questions for examination to be scored
  • If you fail, you must wait 30 days to retake for the MPJE and 45 days for the NAPLEX
  • The MPJE doesn’t distinguish between state and federal laws, but answer each question based on state law
  • Any misconduct or inkling of misconduct is grounds for failure
  • Arrive at least 30 minutes early
  • Ensure to read EVERY SINGLE WORD!
    • They will try to trick you so make sure to answer the question they ask, and lookout for unusual words as triggers. 

BREAKDOWN OF FEES:

Total if you passed the first time: 

$250 MPJE ($150 + $100 application fee)

$575 NAPLEX ($475 + $100 application fee)

$825

Total if you failed but passed the second time: 

$500 MPJE ($250 x 2)

$1,150 NAPLEX ($575 x 2)

$1,650

As you can see, it really adds up if you don’t pass the first time so we hope that you pass the first time! This does not include the stress and wasted time either since you can’t start working until your licensed. We highly recommend reviewing the https://nabp.pharmacy/programs/mpje/ site and reading over the NAPLEX/MPJE registration bulletin. They provide a more specific overview of the exam, scheduling requirements, and a list of core competencies for you to understand. Don’t spend too much time on the core competencies, but more on understanding the laws, as there are many situational type questions.

About RxPharmacist 

RxPharmacist got created out of a calling to help a fellow classmate who failed his board exams, lost his job offer, and almost went homeless in not being able to gain employment as he had to wait 45 days before being able to sit and retake his board exams. Frustrated over the high cost of expensive study guides that were outdated, heavy in content, and weren’t focused on getting to the information needed to pass was the call to action that RxPharmacist has answered.

We are a group of volunteer pharmacists, paid pharmacy students, and mentors to our pharmacy profession driven by fellow pharmacy graduates and pharmacists just like you. We want to make a positive difference and disrupt the pharmacy test-prep industry but we need your help.

If you think you can help join our cause, feel free to shoot us over an email on how we can improve our services and products to help you. Even though this starter guide is basic in nature, we hope it can get you pointed in the right direction so you can start your journey in passing your MPJE board exams. Whether you are a fresh pharmacy graduate or a seasoned pharmacist getting licensed in another state, we’re excited you started your journey with us although it will be short-lived as we hope you will pass the first time! 

We all understand board studying for gaining your pharmacist licensure is not easy. We don’t want the stress and headaches of potential failing you’re MPJE get in the way of the career you want.

What is the MPJE and What do I Need to Know? Read More »

More than just a study guide…

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When I graduated from pharmacy school just a few short months ago, I found myself in the same predicament that most other students find themselves in … what do I do now? I have my degree, I have a year’s worth of rotation experience, but I still have to pass my licensing exams and find a job. I applied to RxPharmacist and was given the opportunity to write the Maryland MPJE Guide. 

When I applied to be an intern for RxPharmacist, I knew that I would be writing a study guide, but I had no idea that I would receive so many other benefits. RxPharmacist thrives off of a spirit of mentorship and connection. I was able to get personalized career advice, resume and CV reviews, and the contact information of other pharmacists who could help me to achieve my goals. The individuals who I have had the pleasure to connect with during my internship truly do give back to the pharmacy profession by assisting new graduates in any way that they can. This experience has really inspired me to give back, as well, since I know what it’s like to be a struggling new pharmacy graduate with many questions, but not so many answers. 

Now that I am at the end of my official internship, I can say with confidence that this experience has provided me with invaluable skills for my future in pharmacy. I am proud to have produced an MPJE guide to help other Maryland graduates like myself to pass their exams on the first try. Furthermore, it has been amazing to have one-on-one career guidance, constructive feedback, and pharmacy advice in a safe space with a trusted pharmacist. I am extremely grateful to have been selected to continue RxPharmacist’s mission of giving back to the profession.

Best of luck to all the new pharmacy graduates!

Lauren A., Pharm.D., 2019 RxPharmacist Intern

Shenandoah University, Class of 2019

More than just a study guide… Read More »

What do our interns say about our program?

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Being an intern for RxPharmacist has been one of the most rewarding opportunities I’ve had so far in my professional career. This internship was an effective and valuable transition between graduating pharmacy school and starting my current medical writing job. Not only is the internship remote (hello Work From Home!), but it is also flexible in the sense that you can learn about various different aspects of medical writing, entrepreneurship, marketing – you name it. I decided to focus on medical writing and marketing. Over the 10 weeks, I improved my medical technical writing, organization, and time management skills. I also learned about the world of start-up businesses and marketing, which was incredibly interesting and new to me. I supported the development of the Texas MPJE guide, which helped me pass my own board exam. Getting paid to pass your board exams seems too good to be true, but it is in fact a reality! Throughout the process, the team provided constant feedback and clear communication which helped me grow personally and professionally. I was also provided multiple networking opportunities, which opened the door to endless possibilities. I highly recommend applying for this internship because it is a great way to enter the “working world” after being in school for so many years. Trust me, the 10 weeks will fly by and you will come out of this internship ready to take on your next job!

-Nancy T., 2019 RxPharmacist Graduate Summer Intern

University of Texas at Austin, Class of 2019

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