NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

Which medication is used specifically in acute care settings and has considerations with CYP3A4 inhibitors?

1. Dexamethasone

2. Midazolam

3. Fentanyl

4. Dobutamine

The correct answer is: Midazolam

Midazolam is the correct answer because it is a medication commonly used in acute care settings for procedures such as sedation, intubation, and anxiolysis due to its rapid onset and short duration of action. Midazolam is metabolized primarily by CYP3A4 enzymes in the liver, and the use of CYP3A4 inhibitors can lead to an increase in midazolam levels, potentially causing excessive sedation and respiratory depression. Therefore, healthcare providers must be cautious when using midazolam in patients also taking CYP3A4 inhibitors to prevent adverse effects. The other options are not specifically used in acute care settings or do not have significant interactions with CYP3A4 inhibitors. Dexamethasone is a corticosteroid commonly used for its anti-inflammatory effects, fentanyl is an opioid analgesic often used in pain management, and dobutamine is a beta-1 adrenergic agonist primarily used for acute heart failure or cardiogenic shock.