I received a score in the triple digits, and I want to ease the minds of anyone studying currently.
-I was an average student with below-average motivation at times during didactic courses, but very attentive during rotations and I worked retail throughout school
-I studied from RxPrep for a while but didn't get serious until 3 weeks prior to the test, and purchased the quiz banks 2 weeks prior for practice
-I studied many hours a day, writing summarized notes on sections and studying that, but realized I was running out of time once I got through the HIV section
-I did not take the Pre-Naplex, but my RxPrep quizzes ranged from very low scores of 30-50% and up to 90% after reading the chapters one time. I did about half the quiz bank
I did not finish the RxPrep book. Once I realized I was taking too long summarizing chapters, I began summarizing the big disease state chapters such as HTN, DLD, and DM, then I read over other big names like heart failure, osteoporosis, RA/OA, etc. After that I skimmed what I could, and felt that getting the "gist" of a chapter and drugs for these diseases was enough for what I saw of them on the exam. I spent a long time learning HIV and ID but got very few and simple questions on that. Throughout my studies, I would review the math in RxPrep and the 120 SDN questions, focusing on speed an accuracy. I went through both twice, and timed myself and checked my accuracy on the second round. I felt this was the most important thing to focus on and I believe my test supported this.
The night before the exam, I got a good night's rest and that morning I had a big breakfast and some coffee. I woke up with enough time to hit on the big points such as drug interactions and brand names. When I got to the testing site I was a bit nervous but knew that the exam was not an impossible feat and most people passed the first time, so I was pretty calm taking the test. I knew how to do every math question on the exam, but still checked each answer multiple times in different ways to ensure I got the points I knew I could get. Therapeutics asked some questions I knew before I started studying, some questions I knew specifically from studying, and some I probably could have studied more and got the answer. There were a few I knew or really should have known but during the heat of the moment I just messed up on. I took the 10 minute break half way through and didn't feel the questions "amped up" on the second half, and in fact my exam ended with very simple therapeutics questions and a few tougher math problems. I paced myself well and ended with 15 minutes to spare. Afterwards, I felt I should have done well enough to pass, because although I guessed completely or partly on many, there were still a lot I knew outright and I was confident on every math question. Of course, this worried me as I have been reading that feeling like you failed is the key to success!
After my experience with the exam I can't be sure if our interpretation of the CAT system is completely accurate. For one, I received a simple math question type about 3 times, once back-to-back with almost nothing in the question changed. This made me very worried, so each time I received that question type I did it over and over different ways. There is no way I did it wrong, and the multiple choice selection was right there both times. I wouldn't let the CAT system get to you much, it's probably not perfect and worrying about it will only slow you down.
Exam Taking Tips:
-Stay calm and pace yourself. I shot for 45 questions in the first hour, and if there was a question I wasn't sure on I went with what seemed most likely and went on
-Don't look at the cases unless the question specifically references the case. Many "case" questions might as well be standalone questions. If a question DOES reference the patient or the case, make sure you look at everything on the chart at least once so you don't miss a crucial lab value or note.
-Double or even triple check your math, and make sure you have the SAME UNITS and DECIMAL PLACES as the question states. This is likely where many can lose easy points.
Study Tips:
-TAKE BREAKS! Don't study for 5 hours straight. Study for 45-60min, take a 10-15 minute break, and repeat
-STUDY ACTIVELY! I rewrote and simplified notes and highlighted when I went over again. Some people like flash cards, others read aloud or have study partners. You can also take quizzes to test yourself, the RxPrep bank is good for this. Quizlet has some good brand/generic name flash cards which I used and found helpful.
-Focus on math (including biostats) first and review it every couple days to stay sharp on all equations and methods
-Focus on the big disease states we see all the time: DM, HTN, DLD, HF, etc, as well as Drug-Drug Interactions (esp. big drugs and PSPORCS & GPACMAN), Drugs in Pregnancy, Immunizations, and Natural Products. Essentially, study for the things you'll most likely see in practice, then branch out and review frequently.
-For each disease state chapter, I feel the hierarchy of importance would be:
1) Brand/Generic Names (including combinations!) - I used online flashcards and focused on bolded drugs in RxPrep, and unbolded ones I had seen a few times prior
2) Drug Classes
3) Indications/Contraindications
4) Standout SE's and BBW's
5) Standout DDI (especially big ones like amiodarone, phenytoin, lithium, digoxin, NSAIDS, etc - Rxprep has an excellent chapter for this)
6) Counseling
7) MoA
8) Pathology of Disease
9) Pearls
A lot of questions will be referencing drugs by brand name, class, or indication, so without knowing this you can't begin answering questions. From there the focus is mostly safety and counseling with some therapeutic decisions. This is reflected in the test blueprint posted by NABP.
For math, you really need to practice a lot. I felt RxPrep's quiz bank offered a great deal of math and biostats practice questions to supplement the book and the 120 questions. There were a few techniques and tricks I picked up on when practicing, and I'll share that here:
1) Rxprep's equations for MEq and MOsm were either wrong or unsimplified. For simplicity of memorization and application:
mmol = mg/MW
MEq = mmol x valence
MOsm = mmol x particles
These problems get complicated when you're asked for the mmol or MEq of a component within a compound. SDN question #26 and #82-84 help to clarify this.
2) Learn and use dimensional analysis. This helps you make sure you are in the correct units and provides a very simple way for you to check your work. It's not always the best technique for every problem, but in many it makes sure you are getting the correct answer.
3) Read the question FIRST and ensure your final units match the question's. Before starting the problem, I drew a line and put the final units for the question afterward ( ______mg/mL) and put either "WHOLE" or "0.0x" or "o.x" afterward to ensure I was answering the question with a whole number, to the nearest hundredth, or nearest tenth, etc. Make sure you're rounding correctly!
4) Learn some shortcuts. For me one of the biggest time savers was realizing 1% = 10mg/mL, and vice versa. Especially for drip rate questions, being able to go from % to mL and back quickly is very helpful (or at least much more helpful than 1% = 1g/100mL). This is also great for alligations, where you can convert, say, 150mg/10mL --> 15mg/mL --> 1.5% in seconds and set up your problem quickly.
5) For all dilutions, either with a straight diluent or a lesser concentrated solution, use alligation. This will give you more practice for the more complicated alligation problems and I find I prefer doing this to c1 x v1 = c2 x v2 for straight dilution. RxPrep shows a great way to do these kinds of problems, and the 120 q's have many good practice problems for alligation. I particularly like #78.
6) Memorize all the equations in RxPrep save for the massive BEE equations. If you have the 2013 version, I understand the 2014 version has more PK such as VD and clearance. You definitely want to know your half-life equation and understand half life, and to be safe, learning VD, Clearance, Ke, and AUC is simple as they all interwork.
7) Study Bio-statistics. I thought I knew the equations and found the RxPrep quiz bank sets on this topic to be a good wake-up call and really solidified these concepts for me
8) Double (Triple?!) Check! Don't let these points pass you by. Barring mistakes, these are the most certain and heaviest points you can get on the exam. There are only so many ways these questions can be asked, and some are fill-in-the-blank. Do NOT mess these up.
Overall, I think this test is exaggerated many times over for what it is. I think most people could make a passing score with a few days of math review, but of course the stakes are high and it's not worth the risk of retaking. If you have the time anyway, study what you can with your goal of being a better pharmacist for your intended practice setting. If you study like that and brush up on your math, there's no reason to stress too much over the NAPLEX. I know I didn't believe it before, but those that said it wasn't so bad were right. If you know the math, you're going to know some of the other questions just from school, rotations, or work. You can bridge the gap with RxPrep, and at least for the math practice the quiz bank is very helpful, while the other quizzes make sure you're at least retaining some therapeutics info.
Good luck to those still studying.