PTCB Practice Test

1. Which of the following is the most correct transcription of the prescription directions of
“1 tablet QD”?

a. Take one tablet two times daily.

b. Take one tablet four times daily.
c. Take one tablet daily.
d. Take one tablet three times daily.

2. Which of the following is an error-reducing procedure for writing numbers?

a. Place a terminal period after mg (e.g., 50 mg.).

b. Preface numbers less than one with a zero (e.g., 0.5 mg).
c. Add a zero after whole numbers (e.g., 5.0 mg).
d. Do not add a zero before a number less than one (e.g., .5 mg).

3. If a chemotherapy spill occurs inside the hood, what measure should NOT always be
taken?

a. Double glove, don gown, and put on eye protection.

b. Turn off blower.
c. Leave blower on.
d. Clean liquid spill with absorbent (e.g., gauze).

4. Which of the following is NOT an example of quality assurance in inventory control?

a. denoting high-alert medications

b. using electronic prescription capabilities
c. using bar-code procedures during prescription filling
d. double-checking work

5. Which of the following describes requirements for the stability of sterile products?

a. USP <797>
b. TJC
c. SDS
d. OSHA

6. What test can monitor the use of enoxaparin?

a. INR
b. aPTT
c. RBC
d. antifactor Xa
7. What must a clinician be concerned about regarding the combination of Proscar and
Prozac?

a. drug – drug interaction

b. IV incompatibility
c. schedule IV drugs
d. look-alike, sound-alike drug name pair

8. Which of the following drug combinations is NOT contraindicated?

a. Demerol – Nardil
b. aspirin – Coumadin
c. Zerit – Retrovir
d. Reclast – Actonel

9. What condition does a patient requiring Pancrease likely have?

a. cystic fibrosis
b. asthma
c. renal failure
d. osteoporosis

10. What is the dose of gentamicin 2 mg/kg for a patient weighing 175 lbs?

a. 120 mg
b. 160 mg
c. 180 mg
d. 200 mg

11. A patient is to receive 100 mg/m2 of docetaxel. What is the appropriate dose for a
patient weighing 175 pounds with a body surface area of 1.8m2?

a. 180 mg
b. 360 mg
c. 4400 mg
d. 8,000 mg

12. In a horizontal flow hood, how far should one work inside the hood?

a. 4 inches
b. 6 inches
c. 10 inches
d. 12 inches

13. Crushed or broken tablets of which prescription medication should NOT be handled by
a pharmacy technician who is pregnant?
a. furosemide
b. famotidine
c. finasteride
d. fluoxetine

14. What can direct mixture of calcium gluconate and potassium phosphate solutions for
injection cause?

a. lactated Ringer’s solution

b. emulsion
c. precipitate
d. suspension

15. Which auxiliary label should NOT be applied to a prescription label on Biaxin oral
suspension?

a. Shake well.
b. Refrigerate.
c. Finish the entire course.
d. Take on an empty stomach.

16. Which of the following ingredients of TPN may interact with warfarin?

a. potassium chloride (KCl)

b. multivitamins
c. lipids
d. vitamin K

17. A patient presents you with a prescription for clozapine.

What is NOT true regarding clozapine prescriptions?

a. Registration prior to dispensing or prescribing is required.

b. Patients require frequent monitoring of the absolute neutrophil count (ANC) and white
blood cell (WBC) count.
c. Clozapine is only available through a distribution system.
d. Clozapine is indicated for severe depression.

18. Which herbal preparation is often used for depression?

a. St. John’s wort

b. echinacea
c. saw palmetto
d. valerian

19. Which of the following is NOT an example of a drug and one of its appropriate
monitoring parameters?
a. metoprolol – heart rate
b. filgrastim – triglycerides
c. zoledronic acid – creatinine
d. fluorouracil – WBC

20. How should regular insulin be combined with NPH insulin in the same syringe?

a. Add regular insulin to syringe first, then add NPH.

b. Add NPH to syringe first, then add regular insulin.
c. These cannot be combined in the same syringe.
d. It doesn’t matter which one is added first.

21. How should used fentanyl patches be discarded?

a. mixing in coffee grounds before disposing

b. returning to the pharmacy
c. flushing in the toilet
d. throwing in regular trash

22. Which of the following is NOT something a patient receiving rifampin should be
counseled about?

a. blue-green discoloration of urine

b. permanent discoloration of contact lenses
c. drug–drug interactions
d. decreased effectiveness of birth control pills

23. A patient receives a prescription for oxycodone/acetaminophen 5/325. What is the

maximum number of tablets the patient may take daily?

a. 6
b. 8
c. 10
d. 12

24. Where is medication recall information NOT located?

a. fax from manufacturer

b. letter from wholesaler
c. FDA website
d. DEA website

25. When double-checking a computer entry of a drug versus its National Drug Code (NDC)
number, which part of the NDC should be compared to the drug entry?

a. digits 1 through 5
b. digits 6 through 9
c. digits 10 through 11
d. all 11 digits

26. Which of the DEA numbers listed below would be a valid number for general medical
practitioner Dr. Shannon Brinks?

a. FB2146339
b. SB2146335
c. BS2146333
d. BB2146337

27. Drug ABC is an investigational drug for psoriasis.

What is NOT the physician’s responsibility regarding drug ABC?

a. Obtain signed consent.

b. Obtain study approval from the IRB.
c. Store drug ABC.
d. Provide pharmacy with a signed consent form.

28. How many milliliters of a 10 mg/mL oral solution should be dispensed for a patient
requiring two teaspoonfuls three times daily for seven days?

a. 105 mL
b. 210 mL
c. 315 mL
d. 630 mL

29. A patient requires 20 mEq/L of potassium phosphate.

How many milliliters of a 4.4 mEq/mL concentrated solution should be added to a bag
containing 500 mL?

a. 1 mL
b. 2.3 mL
c. 4.5 mL
d. 23 mL

30. Labels on repackaged medication (e.g., unit dose) must contain all EXCEPT which of the
following?

a. manufacturer lot number

b. expiration date
c. patient’s name
d. drug generic name

31. All prescription labels must contain which of the following?

a. physician telephone number
b. date prescription written
c. name of drug distributor
d. name of drug manufacturer

32. You are filling a prescription for Toprol XL to be taken once daily for one year. The
insurance company requires that a three-month supply be filled. How many refills will the
patient have?

a. 1
b. 3
c. 4
d. 11

33. Which of the following drugs contains acetaminophen?

a. Roxicet
b. Vicoprofen
c. Fiorinal
d. Darvon

34. Which of the following forms is used for the transfer of schedule II medications
between institutions?

a. DEA Form 222

b. DEA Form 41
c. DEA Form 106
d. DEA Form 224

35. Which of the following is the correct combination of a drug and its antidote?

a. aspirin – N-acetylcysteine
b. potassium chloride – vitamin K
c. methotrexate – dexrazoxane
d. midazolam – flumazenil

36. What is an advantage of diphenhydramine oral solution versus diphenhydramine

capsules?

a. no taste
b. faster onset of action
c. easier to transport
d. more convenient

37. Which is of the following NOT something all pharmacies must have?

a. class B balance
b. class A balance
c. mortar and pestle
d. pharmacy weights

38. What is a responsibility specific to an institutional pharmacy technician?

a. Maintain inventory.
b. Prepackage bulk medications.
c. Inspect nursing unit.
d. Assist the pharmacist.

39. If requested, filed prescriptions must be retrievable within how many hours?

a. 24 hours
b. 36 hours
c. 48 hours
d. 72 hours

40. What percentage of dextrose and sodium chloride are in a liter of D5NS?

a. dextrose 5%, sodium chloride 0.9%

b. dextrose 5%, sodium chloride 0.45%
c. dextrose 5%, sodium chloride 0.225%
d. dextrose 5%, no sodium chloride

41. When making IVs, which part of the syringe must never be touched?

a. barrel
b. barrel flange
c. plunger
d. shaft

42. What is the brand name for insulin glargine?

a. Lantus
b. NovoLog
c. Apidra
d. Levemir

43. Which of the following is a C-II?

a. Dolophine
b. Restoril
c. Strattera
d. Suboxone

44. Which of the following agents is an antibacterial?

a. fluconazole
b. nystatin
c. doxycycline
d. acyclovir

45. What is Patanol indicated for?

a. high blood pressure

b. conjunctivitis
c. eye allergies
d. skin allergies

46. Which of the following choices describes a “misbranded” drug?

a. contains unsafe additives

b. differs in strength from what is represented
c. label does not contain directions for use
d. was prepared in unsanitary conditions

47. Which of the following is true about the filling of schedule II drugs?

a. A partial filling is allowed if the remaining

quantity is available within 48 hours.
b. All prescriptions must be handwritten.
c. An emergency filling is not allowable.
d. Faxed prescriptions may be acceptable from long-term care facilities.

48. Of the following NEW orders sent to your pharmacy, which should be filled “stat”?

a. TPN
b. Cardura XL
c. amikacin
d. Lotrimin

49. Which of the following drugs may be delivered via the pneumatic tube system?

a. magnesium citrate
b. gemcitabine
c. pegfilgrastim
d. abciximab

50. You need to repackage 30 pills from a manufacturer bottle with an expiration date of
3/11.
What would be the appropriate expiration date for the repackaged product if the current
date is 3/31/10?
a. 9/10
b. 7/10
c. 6/10
d. 12/10

51. What is the generic name of Seroquel?

a. bupropion
b. olanzapine
c. quetiapine
d. venlafaxine

52. What is the brand name of duloxetine?

a. Abilify
b. Cymbalta
c. Lexapro
d. Zyprexa

53. Which type of laminar flow hood exhausts all air to the outside atmosphere after it
passes through a HEPA filter?

a. type A
b. type B1
c. type B2
d. type B3

54. Which of the following needles has the smallest bore?

a. 16 G
b. 18 G
c. 19 G
d. 21 G

55. Which of the following is true about a drug involved in a FDA class II recall?

a. may cause serious, permanent adverse effects

b. may cause adverse effects that are temporary
c. may not cause adverse effects
d. was contaminated

56. Which types of solutions may contain alcohol?

a. collodion, tincture, syrup

b. tincture, syrup, spirits
c. aromatic waters, liniments, tincture
d. elixir, spirits, tincture
57. What type of dispersion is Silvadene?

a. cream
b. gel
c. ointment
d. paste

58. What condition is quinine approved for?

a. cardiac arrhythmias
b. leg cramps
c. malaria
d. B and C

59. What drug class does Lioresal belong to?

a. antidiabetic
b. diuretic
c. antipsychotic
d. antispasmodic

60. How many pints are in one gallon?

a. 4
b. 6
c. 8
d. 10

61. Convert 1.33 milligrams to micrograms.

a. 13.3 mcg
b. 133 mcg
c. 1330 mcg
d. 13,300 mcg

62. Interpret this set of Roman numerals: MCLXXIV.

a. 664
b. 1164
c. 1174
d. 1574

63. How many tablespoons are in two cups?

a. 4
b. 8
c. 16
d. 32

64. How many micrograms are in one grain?

a. 6.5
b. 650
c. 6500
d. 65,000

65. What is a hermetic container?

a. tamper resistant
b. impermeable to light
c. heat resistant
d. impermeable to air

66. Which of the following drugs is an oral antineoplastic agent for non-small-cell lung
cancer?

a. erlotinib
b. nelarabine
c. vorinostat
d. sorafenib

67. Which corticosteroid is NOT more potent than prednisone?

a. methylprednisolone
b. dexamethasone
c. hydrocortisone
d. prednisolone

68. Which affective disorder is characterized by apprehension and worry?

a. ADHD
b. depression
c. psychosis
d. anxiety

69. Which antiretroviral for human immunodeficiency virus may cause fat redistribution
(lipodystrophy)?

a. nelfinavir
b. lamivudine
c. efavirenz
d. enfuvirtide
70. Which of the following references would be a source of information for a drug from
Canada?

a. Goodman and Gilman’s

b. Remington’s
c. Trissel’s
d. Martindale’s

71. Which of the following is true about Medicare or Medicaid?

a. Medicaid is state-funded health insurance for people ages 65 and older and others with
certain disease states.
b. Medicare is state-funded health insurance for people ages 65 and older and others with
certain disease states.
c. Medicaid is state-administered health insurance for people and families of low income.
d. Medicare is state-administered health insurance for people and families of low income.

72. Which of the following is true about isotretinoin prescriptions?

a. Only a 30-day supply is allowed.

b. All female patients must have a bimonthly pregnancy test.
c. Isotretinoin is indicated for all types of acne.
d. A CBC count must be obtained monthly for anemia.

73. How many milligrams of hydrocortisone should be used in compounding this

prescription?

Rx:
Hydrocortisone 0.5%

Hydrophilic ointment ad 10 g

a. 0.5 mg
b. 5 mg
c. 50 mg
d. 500 mg

74. How many 300 mcg tablets of colchicine may be prepared from 3 gm of colchicine?

a. 100
b. 1000
c. 10,000
d. 1000,000

75. What is NOT true regarding the transfer of a prescription for a controlled substance?

a. “VOID” must be written on the face of the original prescription.

b. The original and transferred prescriptions must be archived for one year.
c. The date of issuance of the original prescription must be written on the transferred
prescription.
d. C-IIs cannot be transferred.

76. Which dosage form of potassium chloride (KCl) would provide the most accurate
delivery of drug to a one-year-old patient?

a. K-Dur
b. K-Lor
c. KCl IV piggyback
d. KCl oral solution

77. Drug A regularly costs $114.00. A drug distributor is offering a discount of 5%. What is
the purchase price of drug A?

a. $57.00
b. $108.30
c. $113.43
d. $119.70

78. How many times must inventory be turned over for a business to have what is
considered a good rate for financial well-being?

a. 6
b. 10
c. 12
d. 15

79. What is true about controlled substances?

a. An institutional DEA number is not required for return of a controlled substance.

b. DEA Form 222 must be completed prior to destruction of the controlled substance.
c. DEA Form 41 must be completed on the day of destruction.
d. DEA Form 41 copy must be submitted to the DEA prior to destruction of controlled
substances.

80. What is NOT true about a group purchasing organization?

a. negotiates with drug manufacturers for discounted drugs

b. purchases discounted drugs for hospitals
c. develops contracts with drug companies
d. assists hospitals, home-health agencies, and nursing homes

81. Who develops the formulary in a hospital?

a. IV room
b. director of the pharmacy
c. TJC
d. P&T committee

82. A hospital P&T committee decides that drug A can be used instead of drug B. What is
this process called?

a. therapeutic substitution
b. therapeutic bioavailability
c. therapeutic equivalency
d. therapeutic equality

83. Which of the following is true about personal protective equipment for IV
compounding?

a. Jewelry is allowed if latex gloves are worn.

b. Use of makeup is allowed if a mask or face shield is worn.
c. Hands do not need to be washed if latex gloves are worn.
d. Compounding gowns are particulate free.

84. Which of the following is true about the legal and regulatory requirements of
medications?

a. The FDA enforces the Controlled Substances Act.

b. The DEA ensures that pharmacy technician requirements are met.
c. The Joint Commission can issue drug recalls.
d. The USP makes requirements for drug labeling.

85. What do the suffixes A-D, XL, and AF mean after the drug names of Imodium A-D,
Procardia XL, and Diprolene AF?

a. as directed, extended release, atrial fibrillation

b. as directed, extended release, antifungal
c. antidiarrheal, extended release, antifungal
d. antidiarrheal, extended release, augmented formula

86. What is NOT true about Radioactive Yellow III materials?

a. Radioactive Yellow III contains the lowest concentration of radiation.

b. Radioactive Yellow III requires a metal shipping container for transportation.
c. A special placard must be placed on any vehicle transporting Radioactive Yellow III
materials.
d. Shipment is regulated by the U.S. DOT.

87. Which of the following is correct about a HEPA filter?

a. HEPA stands for high-efficiency pharmaceutical appliance.

b. Particles greater than three milligrams are prevented from entering the sterile
environment.
c. Cleaning agents can be sprayed on the HEPA filter.
d. The hood should be certified any time the HEPA filter becomes wet.

88. Water is

a. hypertonic
b. osmotic
c. hypotonic
d. isotonic

89. Which of the following is true about compounding equipment?

a. Stainless steel spatulas are used for corrosive ingredients.

b. Digital balances are sensitive to 0.001 mg.
c. Glass mortars and pestles are used for mixing liquid and semisolid ingredients.
d. A volume delivered by a “TD” graduate is inaccurate.

90. Which of the following is true about OBRA 90?

a. requires that all pharmacists perform an MAR

b. requires that pharmacies protect private patient information
c. requires that pharmacies maintain patient profiles
d. requires that patients with disabilities are not discriminated against

Answer Key and Explanations

1. C: According to the Institute for Safe Medication Practices (ISMP), the abbreviation “QD”
should never be used in communicating information to other health professionals.
Abbreviations should be avoided in all prescription writing and medical communication.
Abbreviations have led to many serious medication errors. QD has been mistaken for QID,
and fourfold dosing errors have occurred as a result. In addition, numerals should be spelled
out.

2. B: Many errors have occurred due to the misreading of prescriptions. A terminal period
should not be used after dosing increments, such as mg or mL, due to the possible
misinterpretation of the period as the number 1. Trailing zeros should not be added after
whole numbers due to the risk of a tenfold overdose if the period is poorly written or hard
to see. A zero should be added before a whole number because if the period is not seen, a
tenfold overdose may occur (e.g., 5 mg given instead of 0.5 mg).

3. B: In case of a chemotherapy spill inside a hood, several measures should be taken to

prevent worker and workplace exposure. The worker cleaning up the spill should don
additional protective wear, such as double gloves, eyewear and a gown. If a liquid is spilled,
absorbent gauze or a gauze pillow (from the spill kit) should be placed gently on the spill to
avoid splashing. Powder or solid spills should be cleaned using water-soaked gauze. All items
used to clean up the spill should be disposed of in yellow chemotherapy bags. The blower
should be left on unless the HEPA filter has been contaminated.

4. D: Quality assurance helps guarantee patient safety. Mechanisms to assure patient safety
include storing dangerous and high-alert medications separately from regular stock, bar
coding all procedures associated with prescription filling, and implementation of
computerized physician order entry to minimize poor legibility. All involved with medication
filling should triple check their work.

5. A: United States Pharmacopeia (USP) Chapter 797 is a set of sterile compounding

standards created in order to reduce the risk of patient infection and to protect employees.
Use of USP <797> is required for any institution in which sterile compounding occurs. The
Joint Commission (TJC) is an agency that accredits health-care institutions based on patient
care and safety standards. Safety Data Sheets (SDSs), provided by product sellers, detail
chemical products, potential dangers associated with these chemicals, and measures to be
taken in case of exposure. The Occupational Safety and Health Administration (OSHA) is an
agency that ensures a safe and healthy workplace.

6. D: The low-molecular-weight heparins (LMWHs), including enoxaparin, generally do not

require laboratory monitoring. The international normalized ratio (INR) is used for warfarin
monitoring, and the activated partial thromboplastin time (aPTT) is used for heparin
monitoring. The red blood cell (RBC) count is a measure of red blood cells, and a low value
denotes the presence of anemia (bleeding). If laboratory monitoring of LMWHs is desired
(e.g., for patients who are obese or have renal insufficiency), it is usually via antifactor Xa.

7. D: “Proscar and Prozac” are an example of a look-alike, sound-alike (LASA) drug name pair.
Such drugs have a risk of being mistaken for each other due to similarities in spelling and/or
sound. LASA drugs should not be stored next to each other, and other precautions should be
taken to minimize error. Proscar and Prozac are not controlled substances, are oral agents
(not administered IV), and do not interact with each other.

8. B: Demerol should never be given with monoamine oxidase inhibitors (MAOIs), such as
Nardil, due to the risk of hypertensive crisis and death. Zerit and Retrovir are both
nucleoside reverse transcriptase inhibitors used for the treatment of human
immunodeficiency virus (HIV). This combination should be avoided due to possible
antagonism, rendering treatment ineffective. Reclast and Actonel are both bisphosphonates
used for osteoporosis. Reclast is an IV product taken once yearly, and Actonel is an oral
product taken once weekly. These agents should not be co administered due to the risk of
toxicity. Aspirin and Coumadin are generally not co administered together due to the risk of
bleeding. However, some patients will require this combination due to their clinical
condition. Patients taking both medications should be counseled about signs and symptoms
of bleeding.

9. A: Pancrease is a mixture of enzymes normally produced in the pancreas. Cystic fibrosis is

a condition in which the body does not supply enough of its own pancreatic enzymes. This
does not occur with asthma, renal failure, or osteoporosis.
10. B: First, one must convert pounds to kilograms. Divide 175 lbs by 2.2 kg/lbs to obtain
79.5 kg. Multiply by 2 mg/kg for an answer of 160 mg.

11. A: Body surface area (BSA) is a measurement of the surface of the body using height and
weight and is often used for dosing of certain medications, such as chemotherapy. In this
instance, the answer is 1.8 m2  100 mg/m2 for 180 mg. Weight is unneeded, as it had
already been incorporated into the patient’s BSA.

12. B: One should work at least six inches inside the hood to ensure adequate sterile
compounding and airflow. One should also position hands during compounding in an effort
to avoid blocking airflow.

13. C: Women who are pregnant and handling medications should consider taking
precautions against drug exposure, such as wearing gloves or a mask.
Broken or crushed finasteride should not be handled by a pregnant female due to the risk
for fetal harm. Furosemide, famotidine, and fluoxetine do not carry the same precautions
regarding handling.

14. C: An emulsion is the mixture of one liquid dispersed with another with the aid of a
dispersing agent. An example is fat emulsion used for total parenteral nutrition (TPN).
Lactated Ringer’s solution is used intravenously or for irrigation and contains sodium,
potassium, and calcium salts. A suspension is generally a solid mixed in another vehicle such
as glycerin or water (for example, oral azithromycin suspension). The combination of calcium
gluconate and potassium phosphate can result in a precipitate, which is a potentially
dangerous formation of solid crystals. Caution should be exercised when dosing and
admixing these agents for use in IV preparations, such as for TPN.

15. B: Biaxin oral suspension should be shaken well prior to use, may be taken with or
without food, and the entire course should be finished. Biaxin oral suspension should not be
refrigerated.

16. D: Errors have occurred in which patients receiving warfarin have inadvertently received
vitamin K. Vitamin K is often added to TPN once weekly, and this may be missed in patients
receiving warfarin during the medication profile review. Vitamin K antagonizes the warfarin
anticoagulant activity, rendering it ineffective. TPN generally contains KCl, multivitamins, and
lipids, which do not interact with warfarin.

17. D: Patients, prescribers, and pharmacies must be registered with the Clozaril National
Registry (CNR) prior to the prescription and filling of clozapine, and it is only available
through a distribution system. Clozapine can cause serious agranulocytosis, rendering
patients at risk for infection and death. Thus, patients require frequent monitoring of their
blood counts. Clozapine is indicated for schizophrenia.

18. A: St. John’s wort is often used for depression symptoms and for possible immune
system benefits. Echinacea is also used for immune system support. Saw palmetto is used
for benign prostatic hyperplasia, and valerian is used for its possible sedative effects. None
of these agents are approved by the FDA.

19. B: Metoprolol is used for high blood pressure and tachycardia, so heart rate would be an
appropriate monitoring parameter. Zoledronic
acid may cause renal toxicity, so creatinine would be an appropriate monitoring
parameter. Fluorouracil is an antineoplastic agent and can decrease production
of white blood cells (WBCs), placing patients at risk for infection. WBCs are
monitored during fluorouracil therapy. Filgrastim is used to boost neutrophils,
a type of white blood cell. It does not affect triglycerides appreciably.

20. A: In certain instances, insulins may be mixed in the same syringe. Regular insulin may be
mixed with NPH. Regular insulin should always be drawn up first if mixing with NPH in order
to avoid the inadvertent contamination of regular insulin with NPH insulin.

21. C: Once removed, fentanyl patches should be folded together so that the sticky side
sticks to itself and then flushed down the toilet in order to avoid potential danger to babies,
children, or pets that might be able to access them from the trash. Unless otherwise
specified (like fentanyl patches), unused prescription drugs should be removed from the
bottle and mixed with an undesirable substance, such as cat litter or coffee grounds, sealed
into a disposable container, and then placed in the trash.

22. A: Patients receiving rifampin should be counseled about the possibility of red-orange
discoloration of urine and other body fluids, such as sweat and tears. Use may cause
permanent discoloration of contact lenses. Rifampin has many drug interactions—it can
increase the metabolism of many drugs, rendering them less effective. For example, rifampin
can increase the metabolism of estrogens, making birth control pills less effective. It is very
important that women of childbearing age who receive rifampin be counseled of this risk
and the necessity of a second form of birth control.

23. D: The maximum daily dose of acetaminophen is 4,000 mg, which is 12 tablets of
oxycodone/acetaminophen 5/325 (4,000 mg 325 mg ≈ 12 tablets). Patients should be
counseled about the dangers of liver toxicity associated with acetaminophen use and the
importance of taking the lowest effective dose. Patients should also avoid taking other
agents concomitantly that may contain acetaminophen (e.g., over-the-counter medications).
The Food and Drug Administration (FDA) recommended in 2009 that the maximum daily
dose of acetaminophen be less than 4,000 mg due to the dangers associated with liver
toxicity.

24. D: Pharmacies are notified of medication recalls by manufacturers and wholesalers by

direct mail or fax. Pharmacies can also obtain recall information from the FDA website.

25. B: Digits 6 through 9 are the product code, while the first 5 digits are the manufacturer
code, and the last 2 digits are the packaging code.
26. A: A Drug Enforcement Agency (DEA) number, required for each physician writing
prescriptions for controlled substances, consists of two letters followed by 7 numbers. The
first letter is a classification; for practitioners this letter is most commonly B or F, but may
also be A or M. The second letter is the first letter of the physician’s last name. To verify that
the number is valid, add digits 1, 3, and 5 together. Then add digits 2, 4, and 6 together and
multiply “that sum by 2. Add those 2 quantities together. The result will be a two digit
number, the final digit of which is called the checksum. The checksum will be the seventh
number in the DEA code. In equation form, where F and S are the first and second digits in a
two digit number, respectively, FS = (1st + 3rd + 5th) + 2(2nd + 4th + 6th); (2+4+3) + 2(1+6+3)
= 29; 9 is final number of the DEA code.

27. C: The use of investigational drugs has many requirements in order to protect the
patient. Physicians must have the approval of the institutional investigational review board
(IRB) prior to drug use. Physicians must communicate risks/benefits of the investigational
drug to patients and obtain signed consent. A copy of this consent must be provided to
the pharmacy. The pharmacy is responsible for administrative duties, including dispensing
and storage.

28. B: Two tsp is approximately 10 mL. 10 mL  3 times daily  7 days = 210 mL.

29. B: Because only 500 mL is required, 10 mEq of K-Phos is needed for preparation.
10 mEq  4.4 mEq/mL = 2.3 mL.

30. C: Repackaged medication labels are not required to have patient names. Generic drug
name, drug strength and dose, manufacturer and lot number, and expiration date are
required. Patient names are required on prescription labels.

31. D: Prescription labels must have many components, including date filled, prescription
number, pharmacy address and phone number, name of physician, directions for use, and
manufacturer name. Physician telephone number, date prescription written, and name of
drug distributor are not required on a prescription label.

32. B: As the patient may receive 12 months of Toprol XL, and 3 months will be dispensed
with the first fill, 9 months will remain on the prescription. The patient will have three refills
(a 90-day supply each) remaining on the prescription.

33. A: All the choices are examples of scheduled drugs. Roxicet (C-II) is the combination of
acetaminophen and oxycodone. The suffix “-et” suggests the presence of acetaminophen.
Vicoprofen (C-III) is the combination of hydrocodone and ibuprofen. The suffix “-profen”
suggests the presence of ibuprofen. Fiorinal (C-III) contains butalbital, aspirin, and caffeine.
The suffix “-al” suggests that the product contains aspirin. Darvon (C-IV) is propoxyphene.
Darvocet is the combination of propoxyphene and acetaminophen.

34. A: DEA Form 222 is used to order C-IIs. DEA Form 222 is also required for transfer of C-IIs
between institutions, as one acts as the “supplier” and the other acts as the “requisitioner.”
DEA Form 224 is used to register a pharmacy to be able to stock controlled substances. DEA
Form 41 is used to document the destruction of controlled substances. DEA Form 106 is
used to document theft of controlled substances.

35. D: N-acetylcysteine (Mucomyst) is an antidote used for acetaminophen overdose.

Vitamin K (Mephyton) is used to reverse the anticlotting effect of warfarin. Dexrazoxane
(Zinecard) is used to help protect the heart from toxicity associated with anthracycline
chemotherapy. It is also used for certain types of extravasations. Flumazenil (Romazicon) is
used to reverse the effects of benzodiazepines.

36. B: Solid dosage forms, such as capsules, have no smell or taste, are more convenient,
and easier to transport. Liquid dosage forms, however, have a faster onset of action.

37. A: Pharmacies are required to have certain equipment, including a class A balance,
pharmacy weights, graduated cylinders, and mortars and pestles. Class B balances are
recommended but not required.

38. C: Pharmacy technicians who work in different settings certainly have similar
responsibilities, such as assisting pharmacists, prepackaging bulk medications, and
maintaining inventory. Other mutual responsibilities may include training new employees
and screening telephone calls. Nursing units are specific to institutions such as hospitals,
and nursing inspections for outdated medications are unique to an institutional pharmacy
technician.

39. D: Legally, all prescriptions, DEA forms 41 and 222, and invoices must be retrievable
within 72 hours.

40. A: Dextrose 5% with sodium chloride 0.45% is commonly written as D5½NS. Dextrose 5%
with sodium chloride 0.225% is commonly written as D5¼NS.

41. C: It is usually necessary to touch the syringe barrel and barrel flange when drawing up
medications. One should not touch the syringe plunger, as this could contaminate the
syringe. The shaft is part of the needle.

42. A: NovoLog is insulin aspart, Apidra is insulin glulisine, and Levemir is insulin detemir.

43. A: Dolophine (methadone) is a C-II. Suboxone (buprenorphine) is a C-III. Restoril

(temazepam) is a C-IV. Strattera (atomoxetine) is not a controlled substance.

44. C: Fluconazole and nystatin are antifungal agents. Acyclovir is an antiviral agent.
Doxycycline is an antibacterial agent.

45. C: Patanol (olopatadine) is an antihistamine eyedrop used for eye allergies.

46. C: A misbranded product has untrue or incorrect claims or labeling, including labeling
that doesn’t have appropriate instructions for use or warnings specific to the drug. Choices
A, B, and D are examples of drug adulteration.
47. D: The prescriber must sign a prescription for a C-II. The prescription can be handwritten
or typed on a computer. Patients may receive a partial fill if the remainder is available within
72 hours. Faxed C-II prescriptions are allowable from a long-term care institution. An
emergency filling is allowable as long as the prescription quantity is limited to a specific time
period and the physician provides the pharmacy with a hard copy within 7 days.

48. C: Although parenteral nutrition is very important, TPNs are generally not considered
“stat” because patients can be maintained on IV fluids and electrolytes until TPNs are
available. Cardura XL (doxazosin extended release) is a once-daily agent used for benign
prostatic hyperplasia and does not have an immediate onset. A new order for Cardura XL
would not be considered “stat” in a usual situation. Lotrimin (miconazole) is a topical
antifungal agent, and a new order would not be considered “stat” in a usual situation.
Amikacin is an antibiotic used for serious gram-negative infections and often in patients with
compromised immune systems. Of the choices given, dispensing of a new order for amikacin
would be considered the most pressing.

49. A: Although magnesium citrate may be tubed, it is carbonated and should be allowed to
settle before opening. Many reasons exist why agents should not be tubed. Gemcitabine
(Gemzar) is a chemotherapy agent and should not be tubed due to the danger of leaking and
damaging the entire pneumatic tube system. Pegfilgrastim (Neulasta) should not be tubed
due to the risk of protein denaturing and monetary loss if lost within the system.
Abciximab (ReoPro) is also an agent that could be denatured and rendered inactive if tubed
and is very expensive, making a loss very costly.

50. C: The expiration date of repackaged drugs is 6 months or 25% of the time of the
manufacturer’s expiration date, or whichever is less. The correct answer is 25% of 12
months, or 3 months, making the expiration 6/10.

51. C: Bupropion is Wellbutrin, olanzapine is Zyprexa, quetiapine is Seroquel, and venlafaxine

is Effexor.

52. B: Abilify is aripiprazole, Cymbalta is duloxetine, Lexapro is escitalopram, and Zyprexa is

olanzapine.

53. C: The type A hood exhausts a portion of the air back into the compounding room. The
type B1 hood exhausts most of the air through a HEPA filter and then to the outside. The
type B2 hood exhausts all air to the outside after it passes through a HEPA filter. The type B3
hood recycles air inside the hood and all exhausted air is eliminated to the outside.

54. D: The larger the gauge, the smaller the needle bore.

55. B: An FDA class I recall is the most serious, as the drug in question has a high likelihood
of causing patient injury or death. An FDA class II recall is performed when a drug may cause
injury that is not permanent or is treatable. An FDA class III recall is for drugs that are not
likely to cause patient harm.

56. D: Tinctures, spirits, liniments, elixirs, and collodions may contain alcohol.
57. A: Silvadene is a 1% cream.

58. C: Quinine is only indicated for treatment of malaria. It has been used off label for leg
cramps, but due to the risk of toxicity, it is no longer available over the counter and is not
recommended for leg cramps. Quinidine, used for cardiac arrhythmias, is often mistaken for
quinine.

59. D: Lioresal (baclofen) is an antispasmodic used for muscle spasms.

60. C: 2 pints = 1 quart. 4 quarts = 1 gallon. 8 pints = 1 gallon.

61. C: 1 mg = 1000 mcg. 1.33  1000 = 1330 mcg.

62. C: M = 1000; C = 100; L = 50; XX = 20; IV = 4. Add together for a result of 1174.

63. D: 2 tbsp = 1 fl oz; 8 fl oz = 1 cup; 16 fl oz = 2 cups; 16 fl oz  2 tbsp/fl oz = 32 tbsp

64. D: 1 grain is approximately 65 mg. Converting mg to mcg by multiplying 65 by 1000, the

answer is 65,000 mcg.

65. D: A hermetic container is airtight.

66. A: All drug choices are antineoplastic agents. Nelarabine (Arranon) is an IV agent for T-
cell lymphoblastic leukemia. Vorinostat (Zolinza) is an oral agent for T-cell lymphoma.
Sorafenib (Nexavar)is an oral agent for renal cell carcinoma. Erlotinib (Tarceva) is an oral
agent for non-small-cell lung cancer.

67. C: The anti-inflammatory potency of prednisone is 3.0; the potency of hydrocortisone is

1.5. The potency of prednisolone, methylprednisolone, and dexamethasone are higher than
prednisone at 4.0, 5.0, and 30.0, respectively.

68. D: Attention-deficit hyperactivity disorder (ADHD) is not an affective disorder but is

considered a central nervous system disorder. ADHD is characterized by hyperactivity,
impulsivity, and distractibility. Depression is characterized by worry, mental slowing, and
sadness. Psychosis is characterized by delusions, hallucinations, and ambivalence.

69. A: The protease inhibitors, such as nelfinavir (Viracept), may cause fat redistribution.
Lamivudine (Epivir) is a nucleoside reverse transcriptase inhibitor, efavirenz (Sustiva) is a
nonnucleoside reverse transcriptase inhibitor, and enfuvirtide (Fuzeon) is a fusion inhibitor.

70. D: Goodman and Gilman’s the Pharmacological Basis of Therapeutics is a reference for
drug pharmacology and therapeutics. Remington: The Science and Practice of Pharmacy is a
reference for compounding, and Handbook on Injectable Drugs (“Trissel’s”) is a reference for
IV drug compatibility. Martindale: The Complete Drug Reference contains information about
drugs worldwide.
71. C: Both Medicare and Medicaid are federally funded programs. Medicare provides health
care for people age 65 and older, disabled people younger than 65 years old, and people
with renal failure. Medicaid is state-administered health care for low-income individuals and
families.

72. A: All patients, practitioners, and pharmacies that use isotretinoin must be registered
with iPLEDGE prior to prescribing, dispensing, or administering of isotretinoin. Isotretinoin is
only indicated for severe recalcitrant nodular acne. Female patients must have a monthly
pregnancy test to qualify for isotretinoin prescriptions and should be counseled on the risk
of teratogenicity. Patients should have a baseline triglyceride level, liver function tests, and
complete blood count (CBC) prior to starting therapy and intermittently throughout therapy.
Patients should be counseled on the risk of psychiatric disorders, which have occurred in
patients taking isotretinoin, including severe depression and suicidality.

73. C: 0.5% = 0.005; 10 gm  0.005 = 0.05 g or 50 mg.

74. C: Convert both to milligrams (300 mcg = 0.3 mg; 3 gm = 3,000 mg). Then divide 3,000
mg by 0.3 mg for a result of 10,000 tablets.

75. B: The original and transferred prescriptions must be kept on file for at least two years.

76. C: Both K-Lor and KCL are oral products. K-Lor must be diluted prior to delivery, and a
child is likely to spit out or refuse K-Lor or KCl oral solution medications. K-Dur is a solid
dosage form too large for a child to take. A KCl IV piggyback would provide the most
accurate dose.

77. B: 5% of $114 is calculated by multiplying 114 by 0.05 for a result (discount) of $5.70.
$5.70 subtracted from $114.00 is $108.30.

78. C: The higher the turnover rate, the better the financial health of an institution. Twelve is
considered a turnover rate that is very good. Inventory turnover rate is calculated by total
annual purchases divided by the value of inventory.

79. D: Only institutions with a Drug Enforcement Agency (DEA) number can return controlled
substances. A DEA Form 41 must be completed and submitted to the DEA prior to the
destruction of controlled substances. A copy of this form must be maintained on file for at
least two years. DEA Form 222 is for the purchasing or transferring of controlled substances.

80. B: A group purchasing organization negotiates with drug manufacturers for reduced
medication prices on behalf of health-care institutions and makes contracts with these
companies. The health-care institution purchases medications, not the group purchasing
organization.

81. D: A formulary is a list of medications that has been approved for use in a health-care
institution. The pharmacy and therapeutics (P&T) committee makes the formulary, and its
members include pharmacists, physicians, nurses, and those involved with the purchasing of
pharmaceuticals.
82. A: Therapeutic substitution is the process by which a drug has been deemed to have
similar therapeutic activity and pharmacokinetics to another drug, despite differences in
composition—these drugs may be interchanged. Therapeutic equivalency is when a drug is
considered the same as another drug due to similarities in therapeutic activity and
pharmacokinetics. Bioavailability is the absorption, distribution, metabolism, and elimination
of a drug. Therapeutic equality is not a term used in pharmacy.

83. D: Jewelry should not be worn when compounding due to the risk of contaminating the
sterile field and product. Gloves will not eliminate this risk. Makeup should not be worn due
to the risk of particulate dispersal from the makeup. A mask will not eliminate this risk.
Hands should be washed prior to donning gloves and at routine intervals during
compounding. Compounding gowns are recommended to reduce the release of particulate
matter.

84. D: The DEA enforces the Controlled Substances Act. State boards of pharmacy monitor
pharmacist licensure, technician requirements, and pharmacy permits. The Joint
Commission ensures that institutional pharmacies prepare and dispense unit dose
medications and patient-specific IV medications. The United States Pharmacopeia makes
rules regarding the labeling of medications.

85. D: According to the Institute for Safe Medication Practices (ISMP), drug name suffixes
can lead to confusion and medication error. Errors have occurred, such as the dispensing of
the wrong drug and wrong dose. Extra precautions should be implemented when filling
prescriptions with suffixes in order to ensure that the correct drug and/or dosage form is
being supplied to the patient. Any confusion should be clarified with the prescriber before
dispensing. Imodium A-D is an oral antidiarrheal. Procardia XL is an oral antihypertensive
agent. Diprolene AF is a topical corticosteroid.

86. A: The U.S. Department of Transportation makes regulations regarding the shipping of
hazardous materials, which pertains to radiopharmaceuticals. Radioactive Yellow III material
contains the highest concentration of radiation compared to Radioactive Yellow I and II. A
special metal shipping container is required for transportation, and a special placard must be
placed on any vehicle transporting such an agent.

87. D: HEPA stands for high-efficiency particulate air. It prevents particles greater than three
microns from entering the sterile environment. Cleaning agents, such as 70% alcohol, should
not be sprayed on the filter due to the risk of causing holes. The hood should be certified
anytime the HEPA filter becomes wet.

88. C: Tonicity is the measure of osmotic pressure. A hypertonic solution pulls fluid out of
cells. Three percent sodium chloride is considered hypertonic. A hypotonic solution draws
water into cells, which can cause cells to burst. Water is hypotonic, and plain water (i.e.,
water without additives) MUST NEVER be hung intravenously or peripherally on patients.
Normal saline (0.9%) is isotonic, which does not pull water into or out of cells.

89. C: Rubber spatulas are used for corrosive agents. Digital balances are sensitive to 0.01
mg. Glass mortars and pestles are used for mixing liquid and semisolid agents. TD (“to
deliver”) graduated cylinders deliver the exact amount, while TC (“to contain”) graduated
cylinders do not deliver the exact amount due to the residue left in the cylinder.

90. C: The Omnibus Reconciliation Budget Reconciliation Act of 1990 (OBRA 90) requires that
pharmacists perform drug utilization reviews (DUEs) and maintain patient profiles. A
medication administration record (MAR) is used by the nursing staff to record drug delivery
to patients. The Americans with Disabilities Act (ADA) requires that businesses do not
discriminate against people with disabilities.