How to Study for the NAPLEX (and Pass on Your First Try)

How to Study for the NAPLEX (and Pass on Your First Try)

You know what's funny?

tl;dr pharmacy has existed for nearly 2 years, and I somehow have yet to write a dedicated post on how to study for the NAPLEX. 

I'm emailed about it all the time. I talk about it with my students all the time. I touch on the subject in articles that cover how to study for multiple choice tests.

I've written a post on how to study for the PCOA. I've written a post on studying for the CPJE. I've written on how to memorize drug side effects (and on developing a study system).

But to date, there is no consolidated collection of my thoughts on NAPLEX prep.

The NAPLEX. The North American Pharmacist Licensure Exam.

The ONE test that every single pharmacy student has to pass in order to practice. The test that your pharmacy school is training you for (because your performance is crucial to keeping your school's accreditation in good standing).

 I'm sorry it took me 2 years to write a NAPLEX post. ( Image )

I'm sorry it took me 2 years to write a NAPLEX post. (Image)

Considering that helping pharmacy students is sort of what we "do" around here, I feel like I've done you all a disservice.

My apologies.

Well, that ends today. 

Today, our topic is:

How to Pass the NAPLEX.

Let's dig in.

 

NAPLEX Background 

Similar to my other test reviews, I'm not going to dig too deep in the background. It's all available online (from the people that make the test), and it's better to get that info straight from the horse's mouth.

Plus, I suspect that's not what you're reading this for anyway.

That said, it is worth mentioning a few highlights. 

For starters, let me point you to the NAPLEX page on NABP. This is where you're going to get the most up to date information about registration, cost, and availability. 

Of note, I'd recommend checking out the NAPLEX Registration Bulletin on that page. I'd link it here, but NABP updates it pretty regularly so you're better off clicking the link above and getting the most up to date version. 

Anyway, the registration bulletin is super handy. It's around 50 pages and you should read through all of it. It gives you a complete breakdown of the competencies (i.e. what is tested) as well as some sample questions (you know I love me some sample questions!). 

It also covers some other important requirements, such as what to bring to the test center and what types of IDs are acceptable.

Actually, on that note...

please, Please PLEASE take note of the identification requirements for test day!

NABP is VERY strict about what your ID says compared to what name you used to register for the NAPLEX.  

This personally bit me in the behind, and I had to reschedule my NAPLEX.

Why?

Because I registered for the test as "Brandon Dyson" and my ID reads "Brandon Michael Dyson." 

It turns out that I am not a very smart man. So, learn from my foolishness. Read the registration bulletin and make sure you have acceptable forms of ID that match your registration name. 

 

Types of Questions on the NAPLEX

The NAPLEX is a whopping 250 questions long. Of these, 200 questions are "real" and 50 are "experimental."

The experimental questions are test questions that are evaluated for use in future NAPLEXs. They don't affect your score. They are mixed in throughout the test, and there is no way to know if the question you're looking at is real or experimental. 

So, before you ask, the only way to truly approach the NAPLEX is to assume that all 250 questions are real. There's no way to game the system out of taking the experimental questions. 

Let's talk about the types of questions that are on the NAPLEX...

 No more K-type questions on the NAPLEX!  Image

No more K-type questions on the NAPLEX! Image

First, some good news. They've phased out the K-type questions that are the bane of pharmacy students everywhere! 

But...

They've replaced these K types with questions that are (in my opinion) even harder. Multiple response questions.

Here's a quick breakdown of the types of questions you'll be pitted against (and how to prepare for them) on the NAPLEX.

Multiple Choice

The classic question you're familiar with. You select only the most appropriate answer. This means that only one answer can be right.

The best way to approach these questions is to narrow your options by eliminating answer choices. Use contradicting answers and polarity words (such as "except," "not," "always," and "never") to weed out answer choices. 

We cover a whole bunch of ways to do this in Pharmacy School: The Missing Manual, but the general gist is to whittle your potential answers down to 1 or 2. 

Multiple Response

 Current sitting place for Multiple Response questions ( Image )

Current sitting place for Multiple Response questions (Image)

These are the little devils that have replaced K-type questions. In other words, they have usurped the Iron Throne and have become the most hated type of question in all of The Seven Kingdoms. 

They are the dreaded "Select ALL that apply" questions...and they're annoying AF. 

The only real way to handle these types of questions is to treat each answer choice as a true or false statement. Ignore everything else, and just evaluate each choice individually.

This helps to reduce the "overwhelm" the multiple response questions can bring.

It's true or false, yes or no, black or white. There is no room for "maybe" (at least not if you want to get the question right). 

Constructed Response

These sound hard on the surface, but they are really not that bad. With a constructed response question, you are filling in the blank (by actually typing in your answer).

In practice, the NAPLEX tends to use these for your calculation questions. So you'll have to actually calculate an answer and type it in (instead of picking from one of the multiple choice options).

The (obvious) thing to watch out for is to make sure you enter your answer in the correct format. If the question calls for 2 decimal places, make sure your answer has 2 decimal places. It'd be a real shame to have the right answer but miss the question because you didn't follow directions. 

With that in mind, make sure you brush up on your rounding. If the NAPLEX asks for your answer to be rounded to the nearest whole number, make sure you're doing that correctly. 

Also, double check yourself for typos. Typos are really bad here.

Ordered Response

As the name sort of implies, here you're given a list of options and your job will be to rank them. 

You might be asked to rank corticosteroids from greatest to least potency. Or the strength of a few types of statistical studies. Or the potency of statins. 

There's not really a NAPLEX study hack for these. You just have to know the information. 

Hot Spot

Yay! There's pictures! With Hot Spot questions, you are given a diagram and you are asked to select the correct portion of said diagram that pertains to the question.

These are mostly used with mechanism of action questions. You might get asked where in the clotting cascade rivaroxaban works. Or what part of the HIV life cycle is inhibited by abacavir. Or how to dose vancomycin to ensure CNS penetration

Again, there isn't really a "trick" to these questions. But it's usually basic pharmacology (mechanism of action) being tested. Just know the info, and answer accordingly. 

 

How "Clinical" is the NAPLEX?

You've probably heard that the NAPLEX has been getting more "clinical" over the years. This is true. There are more scenario based questions where you are given a clinical case and asked to interpret questions about it. 

That said, the NAPLEX is still a minimum competency exam. 

I hate the phrase "minimum competency exam." It implies that the NAPLEX is easy. Or that you are somehow inadequate if you don't pass it. Neither of these is true. The NAPLEX is NOT easy, and a lot of really great pharmacists have failed it a time or two.

Don't let your ego convince you that you don't need to study that much. You need to prep for this exam like it's the most important one you'll take in your life (because quite possibly, it is).

The real meaning of "minimum competency" is that the exam is more focused on safety. This means you need to give extra weight to studying contraindications and black box warnings.

The goal of the NAPLEX is to make sure you can practice pharmacy without killing someone. You are more likely to get asked about a rare (but potentially fatal) side effect than you are to get asked about the 4th line of therapy in a patient with refractory hypertension and Stage 4 CKD.

Prioritize your studying accordingly.

Minimum competency also means that the NAPLEX won't ask many questions that are ambiguous or in a clinically gray area. The questions asked won't be open for judgement. They should be black and white, "yes or no" type situations.

Remember that, and remember it well. Especially if you're someone who is prone to talking yourself out of the answers you've picked.

Given enough time, you can make an argument for just about anything on a test. Resist your temptation to do that on the NAPLEX. 

 

How Long Do You Need to Study for the NAPLEX?

This is, of course, a tough question to answer. And my "politician" answer will be...

"It depends."

That said, you're here because you want answers. So let me see what I can do. 

Depending on how intensely you study, I think you can prep for the NAPLEX in 2 - 4 weeks on average. Can you do it in less (or more) time? Yes, but it really just depends on your study style.

Some people (fueled by gallons of coffee) can continue retaining information after 8 solid hours of studying. Others can't. It really requires you to self-evaluate and see where you are.

Personally, I studied closer to 3 - 4 weeks, and I felt over-prepared. This was before the NAPLEX was updated in 2016, so take that with a grain of salt.

In researching this article, Google led me to a surprising number of forums where people claimed to not have studied at all. Many just practiced calculations, passed the NAPLEX, saved the princess, and lived happily ever after. 

In my opinion, that's a hell of a risky proposition. If you have to err on the side of being over or under prepared, which would you rather be?

Outside of the $575 you're spending to take the exam, the NAPLEX is also one of the only things standing between you and a decent income. Waiting 45 days for a second attempt is only costing you money.

Plus if you're doing a residency, most programs require that you pass the NAPLEX so you can complete the "distribution" requirement of their program. Fail the NAPLEX more than once, and you may have a difficult conversation with your residency program director. 

So, my best advice is to study for the NAPLEX for as long as it takes you to feel over-prepared. Best to leave nothing to chance with so much at stake. For most people, this should be achievable in 2 - 4 weeks.

 

Sample NAPLEX Study Calendars

Although not really my style, many students like the structured format of a study schedule to help guide their NAPLEX studying. There are a few nifty ones floating around online (links below).

I was going to create a tl;dr NAPLEX study calendar for this article, but honestly it seemed like I was re-creating the wheel. I don't think I could do a better job of it than RxPrep, and I'm not sure what value I'd be adding to the world if I did.

So, without further ado, here is a guide on how to create a NAPLEX study plan from RxPrep

And here is a sample 7-month study plan from RxPrep.

I would use those as your baseline, and personalize them for your own studying. For myself, I think I would start forgetting material with a 7-month study plan, so I'd condense that calendar into 1 or 2 months if I was taking the NAPLEX again. 

 

NAPLEX Review Guides

So, now that we've got a calendar laid out for us...what should we actually use to study for the NAPLEX?

Should you go for the live review? The book only? The question bank plus the book? Should you use different programs to capitalize on the strengths and weaknesses of each?

You can really stress yourself out wrapping your brain around questions like that.

And if you're not careful, the decision paralysis you feel trying to sort through all of that information can really set you back.

The old adage "Don't let the perfect be the enemy of the good" applies here.

Don't bog yourself down with the (somewhat meaningless) decision on what is the perfect NAPLEX studying program. Just pick one, and move on.

Then, study the shit out of that one resource. 

Truthfully, any of the available NAPLEX study guides are good enough to get you to pass the NAPLEX. So pick the one that best fits your learning style (or the one that your school gave you for free) and go from there.

RxPrep

Personally, I love RxPrep. My personal NAPLEX study system included only RxPrep and a few additional calculation problems (know as the famous SDN 120). I passed on the first attempt. 

The downside of RxPrep is that they are relatively pricey compared to some of the other programs. I was very lucky, and my school gave us full access to RxPrep (and we even got a live lecture from one of the creators).

You can reduce the cost a bit by only getting part of their program (the book, the videos, or the question bank). It's up to you to decide how you best learn (and what you can budget).

Personally, I think I could have done it with just the book and the question bank, but the videos were helpful. In my opinion, the question bank is non-negotiable. I've made no secret of how much I value practice questions in my studying, and RxPrep's massive 3500+ question bank is a major selling feature.

High-Yield Med Reviews

Another very solid option, High-Yield Med Reviews offers basically the same features of RxPrep, but is a bit more affordable.

Also, the CEO of the company is Anthony Busti, MD, PharmD. He's a doctor, a pharmacist, and a nurse. He helped bring us one of my favorite study tools of all time: "Antineoplastic Man" (image is linked in that post), and he also created the awesome literature database EBM Consult. The dude's pretty much a rockstar.

Anyway, if you read my above paragraph on RxPrep, you'll know that I haven't personally used High-Yield Med Reviews to study for the NAPLEX. But, I have used their BCOP study program (and in particular their stats review) and it's good stuff. The stats review in particular is top notch. I'm confident you'll do quite well on the NAPLEX if you prepare using this program. 

UPDATE: The High-Yield Med Review folks read this post and contacted me to offer tl;dr readers a discount on their NAPLEX review products (isn't the internet great?). All you have to do is email customerservice@highyieldmedreviews.com and mention that you're a tl;dr pharmacy reader to ask for your discount.
 
If you're a P4 student, they are offering $50 off any NAPLEX review product. If you're a P3 student looking to prep for classes or rotations, you can get a $50 discount for this year, and then if you buy again next year (for your actual NAPLEX prep), you'll get 50 PERCENT off. These discounts cannot be combined with any other discounts.
 
Their NAPLEX reviews include an online classroom, over 200 lectures, a practice exam, a question bank with over 2000 questions, and a review book. It's literally everything you need to pass. 
 
And in full disclosure, if you email High Yield Med Reviews through the above address to purchase a NAPLEX prep course, tl;dr pharmacy will receive a small portion of your sale as a commission. You get to save money, AND help us out. Thanks for your support! 

Other NAPLEX Review Programs

RxPrep and High-Yield are the only 2 programs I can speak intelligently about. There are, of course, other programs such as Pass NAPLEX Now, and about a half dozen review books from the likes of Kaplan and Lippincott. I'd recommend starting with this review article if you're interested in trying out something else. 

If you have used some other NAPLEX prep service and are willing to give me feedback on it, email me at brandon@tldrpharmacy.com. I'll update this article to make it more comprehensive for readers. Thanks in advance!

 

How to Study for the NAPLEX

And so here we are, finally. After all of that background and study calendars and review guides talk, we get to talk about how to actually study for the friggin NAPLEX. 

What follows are my best general NAPLEX studying tips, as well as the "target areas" that I recommend you spend a little extra time studying.

General NAPLEX Tips 

Take the Break

I know you just wanna get the hell out of the exam room, but when you are given the option for a break (there are potentially a couple offered), do yourself a favor and take it. 

You have up to 6 hours to take the NAPLEX (the optional breaks don't count against your time). Imagine how intensely focused you are during an exam. Imagine doing that to your body for 6 hours. Trust me, you WILL burn out, and you will get sloppy on the second half of your exam.

Better instead to take your break. Walk around, stretch, maybe get a light snack. Take some deep breaths and just try to put your mind literally anywhere else for a few minutes. It'll be worth it.

Be (Potentially) Prepared to Travel

You'd be amazed how fast the exam sites near you can fill up (especially if you're in an area with several pharmacy/nursing/med schools nearby). Try to register as early as you can, but if sites are full, be prepared to travel a little further to the next site. 

Be Prepared for the Exam Room

You, unfortunately, do not have control of the thermostat in the exam room. Make sure to bring a jacket if you get cold easily. Keep in mind that you are NOT allowed to remove anything that goes over your head (like a hoodie) in the exam room, so make sure it's an easily removable jacket. 

Have a Few Marathon Study Sessions

So, you have 6 hours to answer 250 questions (that's less than 90 seconds per question, for those keeping track at home). How much time do you usually spend studying?

If you max out at 1 or 2 hour chunks, you need to practice sitting down and giving laser focus to something for 6 hours (and no, I don't mean binge watching This is Us).

In the age of smart phones and snap chat, our collective attention spans are dwindling. As it gets closer to exam time, schedule yourself a few "marathon" study sessions where you ONLY study for at least 6 hours.

Really own these practice sessions. Turn off your phone, use a browser blocker to block Facebook, Youtube, or whatever else might draw your attention away.

I recommend using some of the available practice banks in RxPrep or High Yield Med Reviews and completing a minimum of 250 questions.

Only 2 or 3 sessions should be enough. You just want to make sure that you know what it feels like to be in a pressure cooker for 6 hours. 

Use the Scratch Paper Provided

The exam center will offer you some scratch paper before going into the exam room. USE THIS. Even if you don't normally use scratch paper during exams.

You may need to sketch out an odds ratio table, or figure out the number needed to treat. Maybe you just need to sort out your thoughts and a quick diagram will help. Maybe you just want to compulsively doodle. 

This is a scenario where it is better to have and not need than to need and not have. If you come across a question where you'd benefit from being able to draw it out, you'll regret not taking the paper. 

Answer Every Question

Unanswered questions are the bane to your NAPLEX score. Unfortunately, you can't skip around during the exam, and once you've submitted your answer it's lost and gone forever. 

You have to keep yourself on pace to finish the entire exam. Of course, blindly guessing on 30 questions in the last 10 minutes isn't going to help your score much more than leaving the answer blank. 

So the take home message here is not to spend too much time on any one question. If you truly don't know the answer to a question when you first look at it, it's unlikely that you're going to have a magical epiphany after staring at it for 4 minutes.

Try your best to narrow down the answer choices and move on. 

Be Prepared for a Ton of Patient Cases

One of the ways the NAPLEX has gotten more "clinical" in the last couple of years is by incorporating more patient cases. Make sure you can (quickly) figure out what the question is asking and answer the question.

The only real way to do this for speed is to practice. But here's a big "pro tip" to help you out.

Do not read the entire case (at first). Instead, just skip to the part at the bottom that has the actual question (hint: it's usually followed by a question mark). 

Many (many) patient case questions will give you a full background of HPI with social history, family history, a set of labs, a list of medications, and so on. Then the question at the bottom will be "Which of the following drugs could be increasing the patient's potassium?"

You don't need an entire patient case to look at a list of drugs and pick one that causes hyperkalemia. You can save yourself a bunch of time (and mental bandwidth) by skipping ahead to the question, seeing what information is needed, and then going back and scanning through the case to find it.

As another bonus, the same clinical scenario is often used for several questions in a row, so don't feel compelled to re-read the entire thing every time. Remember, you're on a strict timer. 

Do Every Practice Question You Can Get Your Grubby Little Mitts On

As I've said (dozens of times on this site), practice questions are a huge part of my prep strategy. They are the only "brass tacks" way to identify what you know (and what you don't).

The key is to go through each question and to know why each answer choice is correct or incorrect. This way, each question actually prepares you for multiple questions that might test the same subject. 

So, yes, I feel like the RxPrep and High Yield question banks are well worth the expense. Ditto for the Pre-NAPLEX.

 Actual picture of you studying your NAPLEX notes ( Image )

Actual picture of you studying your NAPLEX notes (Image)

I know times are tight as a student, but these questions will force you to start remembering what facts are often tested. Plus, you need a lot more mental focus on a practice exam than you do going through your notes.

Reading your notes or a chapter in RxPrep still allows you the mental space to daydream. Your mind can and will wander. That's much less likely on an actual exam, because of the intense concentration needed.

Since the NAPLEX is just a big ole collection of test questions, the best way to prepare is by...you know...doing test questions. 

You Will Never Feel 100% Prepared

Don't push back your test date (outside of family emergencies or other pressing issues). Just take the plunge and knock the exam out. 

Also, it's normal to feel like you failed after taking the exam. Almost everyone does. Just relax and wait. Have a glass of wine and re-watch Pitch Perfect. 

Scores are usually posted on NABP within 2 - 3 business days. You are NOT emailed about when they post, so you'll just have to keep obsessively checking every so often. Fun, right?

 

Specific Areas to Study for the NAPLEX

The NAPLEX is no longer an adaptive test, which is kind of a good thing. The adaptive model basically had a tendency to highlight what you DON'T know, because when you missed a question on a given area (say, HIV), the test would "adapt" by giving you more HIV questions. 

So when you've heard people say that they felt like their entire NAPLEX was HIV or oncology questions, that's why. 

And, that shouldn't happen so much anymore with the new format.

But, there are probably some areas you still need to brush up on. The obvious place to start would be any therapeutic area where you don't feel comfortable. You'll have to self-reflect and assess that for yourself. 

Beyond that, there are some key areas that most students tend to struggle with.

Or, even if you don't struggle with them, they are emphasized so much on the NAPLEX that you need to brush up on them

I'd recommend making sure you are set in all of the following areas.

Brand/Generic

NAPLEX questions usually only include the brand name. If you don't know what the generic is, how are you ever going to answer the question?

You can know every single clinical fact about ticagrelor. But if you don't know that it's Brilinta, you'll miss the NAPLEX question anyway. 

There are a dozen resources on Amazon for the Top 200 (or even Top 500) drugs. Just pick one of those and get to memorizing.

Calculations

Look, pharmacy math isn't hard. If you can cross-multiply, you can be a pharmacist. 

But on the NAPLEX, you have to be able to do those calculations with speed. Remember, you get less than 90 seconds per question. And calculations are "over emphasized" on the NAPLEX (because they're that important).

You need to practice calculations until your brain is numb. 

NAPLEX math questions are often not "one step" problems. You may have to make several calculations to figure out what the question is actually asking for. And the steps are not spelled out for you. You have to figure it out for yourself.

It's already a high-stress environment. Don't make it worse by fumbling through calculations that (should be) easy points. Practice calculations, and practice them often. Practice them by the hundreds.

Remember, the NAPLEX is a minimum competency exam. If you cannot demonstrate basic math skills (used to calculate doses, drip rates, and all sorts of stuff) in the time allowed, you will not pass the test. 

Statistics

Another side effect of the NAPLEX getting more "clinical" is an increased emphasis on biostats and literature evaluation.

Guidelines change. Practice changes. And the only real way for you to keep up (and continue to be a competent pharmacist) is to be able to read and interpret clinical literature.  On top of that, stats is a subject where most students want to burn their notes after they've passed the module. 

Luckily, tl;dr pharmacy has your back. 

Here is our guide on biostats and literature evaluation. (I promise I will get around to writing parts 3 and 4 this year...sorry for the delay everyone!).

My recommendation would be to take the amount of time you think you need to spend on stats preparation, and double it. Yes, stats are THAT emphasized on the NAPLEX. 

At a minimum, make sure you're comfortable with ARR, NNT, OR, RR, and every other fun acronym from your stats class. Also, be able to recognize what kind of statistical test is appropriate for a given type of data.

Again, check out our post above for some help. 

Sterile Compounding and Hazardous Drugs

Didn't think this would show up here, did you?

But guess what, this is now tested on the NAPLEX (as of the updates in 2016). If USP 797 (sterile compounding) and USP 800 (hazardous drugs) are as foreign to you as they were to me when I was a student, you will be missing out on the NAPLEX. 

Don't do that. 

Spend some time learning about beyond use dates, low vs. medium vs. high risk compounding, and how to properly sterilize a hood. For what its worth, RxPrep has a chapter that covers this.

Drugs with a Narrow Therapeutic Index

The logic here is simple. These drugs have a narrow therapeutic index, and therefore are prone to causing toxicity.

I like to call these "drugs that keep pharmacists employed." 

You need to at a minimum be familiar with preventing, identifying, and treating associated toxicities with these drugs. Also, it wouldn't hurt to be rudimentarily familiar with the basics of dosing (at least be able to recognize that 6 grams BID is a bat-shit crazy dose for vancomycin).

Here are some articles that you might find helpful:

Other Clinical Areas You May Be Rusty On

Like I mentioned above, it pays to spend some time focusing on areas where you're uncomfortable (or that are highly emphasized). 

Most students (and most pharmacists for that matter) could use an occasional brush up in the following areas.

  • Antibiotics - At a minimum, know what drugs treat the resistant pathogens (MRSA, Pseudomonas, C. diff, and all of the ESKAPE bugs). 
  • Antifungals - What agent treats what fungus? What relevant drug interactions exist (especially for voriconazole and the other azoles)? I'd also recommend knowing the many formulations (and which are equivalent) for itraconazole and posaconazole. 
  • HIV - Especially the brand names of the combo products and what makes a complete regimen. Also drug interactions with protease inhibitors etc...
  • Oncology - Know the dose limiting toxicities and adverse effects of common chemotherapies. This post should more than cover what you need to know for the NAPLEX. 
  • Anticoagulation - Every drug here has a narrow therapeutic index and it's a high-impact area for pharmacists.
  • Vaccines (sorry, no tl;dr on this topic...yet)

 

Final Thoughts on How to Study for the NAPLEX

One of the ways I prepared for this article was to reach out to some super-smart recent graduates I know. I collected their advice for the NAPLEX. I'd like to leave you today with a screen shot of one of the responses. I think it summarizes the "tl;dr" of this article nicely. 

Good luck! 

Naplex study tips.png
The tl;dr Pharmacy Journal Club: Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease (COMPASS)

The tl;dr Pharmacy Journal Club: Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease (COMPASS)

There's a Fungus Among Us: A Beginner's Guide to Antifungals

There's a Fungus Among Us: A Beginner's Guide to Antifungals