1 QE Therapeutic Neurological and Respiratory Disease MOCK 2 Test QA Nov 2014

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Neurological Drugs & Respiratory Drugs
MOCK TEST
1) JP is 35 year old female presented her doctor with undesirable

symptoms for the past 6 months such as throbbing, pulling,
creeping, watering down through her leg and unpleasant
sensations in her legs specially occurring in evening and in sleep
at night. This causing her to restless and wakes up several times
in night. Based on signs and symptoms JP doctor diagnosed her
condition as restless leg syndrome and prescribed pramipexole
0.125 mg hs.
All of the non pharmacological measures recommended, except?
A) hot baths, stretching, moderate exercise
B) playing cards, video games, and crossword puzzles
C) gambling and hyper sexuality
D) walking and stretching exercise
E) avoid alcohol, caffeine, and smoking
Ans. C
Tips: dopamine agonist pramipexole can be associated with
compulsive behavior such as pathological gambling and
hypersexuality side effects.
2) If doctor prescribed a non ergotamine selective dopamine

agonist, pramipexole 0.125 mg hs daily. What is incorrect?
A) Pramipexole is taken 2 hours before the onset of symptoms
and increase every 2-3 days to effectiveness
B) For evening symptoms dose can be taken late afternoon.
C)dopamine agonist are associated with nauseas, sedation and
light headedness
D) pramipexole and ropinirole is used for treatment for
intermittent symptoms of restless leg syndrome.
E) pramipexole and ropinirole is more frequently associated
sudden onset of sleep attack at higher doses.
Tips Inc Copyright 2000-2014 Prevent Piracy & Report Piracy 1

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Ans. D
Tips: levodopa/carbidopa is used to treat intermittent restless
leg syndrome
3) If JPs doctor considers prescribing gabapentin to treat restless

leg syndrome in the event of intolerability to dopamine agonist
or RLS symptoms augmentation. What is incorrect about
gabapentin?
A) gabapentin major side effects include drowsiness and gait in
elderly
B) gabapentin has NO evidence of use in restless leg syndrome
treatment
C) gabapentin is effective to treat painful restless leg syndrome
D) gabapentin is no interactions with oral contraceptive pills
E) gabapentin are taken two hours apart from antacids
Ans. B
4) KT is a 30 year old female with active lifestyle. Past few

months she has been complaining severe numbness in her right
leg that causing her collapse, balance problems and unsteady
when walking. Her neurological symptoms were steadily
progressive. However her cognitive, visual and emotional
response are normal. After several laboratory test such as
rheumatic factor, C-reactive protein, antinuclear antibody and
complete neurological exam. Her condition was diagnosed as
multiple sclerosis. To improve symptoms like stretching exercise
to manage spasticity and gait disturbances by non
pharmacological measure of multiple sclerosis. Which of
healthcare professional may collaborate?
A) physiotherapist
B) dietician

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C) nurse practitioner
D) chiropractor
E) psychiatrist
Ans. A
5) Although there is no known cure for multiple sclerosis

however there are several disease modifying therapies has been
show to reduce the rate or relapse, number severity, and
duration of attacks of multiple scelrosis. What are treatment
options are multiple sclerosis?
a) interferons beta
B) glatiramer
C) Mitoxantrone
D)Natalizumab
E) All of the above
Ans. E
Tips: other therapies also include fingolimod and adjuntive
therapies include fampridine and emerging therapies include
teriflunomide, lequinimod.
6) JD is a 65 yo patient with type 2 diabetes. His current CrCl <30

ml/min. Patient reports severe burning, pin feeling and
numbness in his limbs. Doctor considering to prescribed What is
the DOC for neuropathic pain?
A) Nortriptyline
B) Gabapentin
C) Pregabalin
D) Carbmazepine
E) Duloxetine
Ans. A

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7) JD doctor prescribed carbamazepine 100 mg daily. After few

weeks JD returns to your pharmacy says he has some relief of his
signs and symptoms but with more side effects that are
bothering the patient. Which of the following symptoms are not
dose dependent?
A-Skin Rash
B-Dizziness
C-visual disturbances
D-GI upset
Ans-A
Tips: Carbamazepine idiosyncratic ADR is rash, require
discontinuing and talking to doctor. A patient with allergic
amitriptyline should not take carbamazepine because these two
drugs are structurally same class.
8) Which of the following antidepressants is most effective in

the treatment of post herpetic neuralgia, and diabetic
neuropathic pain?
a. Amitriptyline
b. Fluoxetine
c. Paroxetine
d. Citalopram
Ans: A
TC page 143
Tips: Amitriptyline is used in post herpetic, diabetic neuropathic
pains, however it not used in trigeminal neuralgia pain
Amitriptyline dose 10 to 25 mg QHS daily at weekly intervals
until pain relief or side effects.

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9) Which of the following DOES NOT have any value in the

treatment of symptoms of trigeminal neuralgia.
A) Carbamazepine
B) Capsaicin
C) Meloxicam
D) Duloxetine
E) Pregabalin
Ans: C
TC page 139. NSAIDs, and acetaminophen are NOT effective for
the treatment of neuralgia.
10) MK is a 22 year old female has 6 month history of pulse type

head ache, pain is unilateral lasting anywhere from few hours to
to one to two days. Other symptoms include nausea and
vomiting. MK has active lifestyle. All of the following can
increase here severity of her headache? except
A) bicycling B) known dietary trigger c)light D) application of ice
E)noisy room
Ans. D

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11) MK doctor prescribed a prescription for sumatriptan 100 mg
tablets for migraine attack. Appropriate information to provide to
the patient includes which of the following?
a) If the sumatriptan does not relieve the headache within four

hours, ergotamine may be used.
b) If no relief is achieved in two hours, sumatriptan may be
repeated.
c) If the headache is relieved but another headache occurs eight
hours later, sumatriptan may be used for the second headache.
d) The maximum dosage in any 24hour period is six tablets.
e) If relief is not achieved, no other medication can be used for 24
hours.
Ans: C
12) Which of the following is indicators migraine therapy

working?
A) Degree of pain relief
B) Onset of pain relief
C) Ability to continue or return to daily activities
D) Headache dairy
E) All of the above
Ans. E
13) MK doctor changed her prescription to rizatriptan wafer

What is true about rizatriptan wafer?
A) it absorb bucally
B) dissolve on tongue and swallow saliva.
C) Dissolve with glass of water and swallow
D) it is used in patient nausea and vomiting
E) Rizatriptan can be used for break through pain
Ans. B

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14) MD is a 40-year-old woman who has recently been

diagnosed with panic disorder. She describes to you the very
frightening episodes she has experienced over the last six
months. She was convinced she had a serious heart problem,
but has been assured by her doctor that she is physically
healthy. She is obviously very anxious, fidgeting with her purse,
looking around to see who may also be in the pharmacy. Upon
questioning, you found out that she has been having trouble
concentrating and sleeping and that she is very worried about
having another attack. MDs physician prescribed lorazepam 0.5
mg tid. Repeat 5 times. What is correct?
A) Prescription is NOT valid
B) Prescriptions is forged
C) Prescription should not contain repeats
D) Prescription is valid
E) The prescription is NOT allowed
Ans: D
Tips: Benzodiazepine can be refilled. Benzodiazepine refills do not

require intervals to be specified. Control substance part 1 doctor
has to specify intervals of repeats and repeats allowed only for
written prescriptions.

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15) Which of the following is indicator or fraudulent
prescription?
A) Prescription is washed with acetone to remove original
handwriting
B) Prescription altered for number of tablets like 10 altered to
100. In verbal prescription ask prescriber to spell out quantity
C) Fictitious patient and stolen pad, computer generated pad
D) Adding other control substances to existing prescription
E) All of the above
Ans: E
16) If pharmacist suspect prescription forged?

A) Inform physician/prescriber
B) Report to local law enforcement
C) Inform other local pharmacies or update in narcotic
monitoring system.
D) All of the above
Ans: D
17) JK is 53-year-old lady came to the pharmacy with a

prescription for Wellbutrin 150 mg SR. Her profile shows that
she was on Wellbutrin 150mg XL. The pharmacist asked the
patient whether she is aware of any changes that her doctor
made for her therapy, and she replied that nothing her doctor
told her about that. The best action the pharmacist should do is:
A. Dispense Wellbutrin 150mg SR since there is no difference
between the two
B. Dispense Wellbutrin XL as in her profile
C. Call the doctor to see if he has intended to change XL to SR
D. Give the generic bupropion SR
E. None of the above
Ans: (C)

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Tips: Wellbutrin XL is once a day and Wellbutrin SR is twice a day
but could be given once a day, so the best option is to call the
doctor that the.
18) JKs doctor call pharmacy to change prescription to

Wellbutrin SR 150 mg bid. However technician prints
prescription label. Wellbutrin SR 150 mg take two tablet
daily. What is pharmacist changes you recommend?
A) Wellbutrin SR 150 maximum single dose should not
exceed 150 mg
B) Wellbutrin SR 150 mg should not exceed 300 mg daily
C) Wellbutrin SR 150 mg single dose 150 mg and doses
8 hr apart. Take one tablet twice daily.
D) Wellbutrin SR 150 mg is once a day
E) Wellbutrin XL 150 mg is twice daily
Ans. C
Tips:
19) MK is a 70 years old patient uses salbutamol inhaler and

Ipratropium inhaler for his COPD. He still has cough and sputum
indicating that his COPD is not under control. Next step for his
doctor to initiate is:
(A) Give antibiotics to treat his infection
(B) Add antibiotic and replace ipratropium by Tiotropium
(C) Add long acting Tiotropium
(D) Add theophylline
(E) None of the above
Ans: (B)
TIPS: Antibiotics are used as adjuncts.

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20) MK is COPD is not under control. His doctor wants to do
assessment for his COPD to assess his condition during an
exacerbation. Best monitoring parameters to assess his
condition is:
(A) Respirometer and histamine test challenge
(B) Peak flow meter
(C) Arterial blood gas determination
(D) X-ray to the chest
Ans: (C)
TIPS: Arterial blood gas determination is the gold standard to
assess oxygenation and ventilation during exacerbation.
Reference: Therapeutic Choices 5th edition Page 662
21) MP is 77 year old female presents to the emergency department with

dyspnea, fever to 103, hypotension and mental status changes. Initial
evaluation demonstrates a left lower lobe infiltrate. Additional studies show
blood pressure of 90/60, respiratory rate of 34, and pulse of 110. Laboratory
parameters include WBC of 2.3, and BUN of 33, with creatinine of 1.3. Pulse
oximetry reveals 88% on room air, which comes up to 99% on 4 liters. Based
upon the above presentation, which of the following is the most appropriate
course of action? (CURB 65)
A) Discharge the patient on oral azithromycin

B) Admit the patient to the general medical ward and begin
intravenous doxycycline and azithromycin
C) Admit the patient to the intensive care unit, and begin fluid
resuscitation, and intravenous ampicillin-sulbactam and
levofloxacin.
D. Admit the patient to the intensive care unit and initiate
mechanical ventilation, pressors, and intravenous piperacillin-
tazobactam

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ANSWER: C
Tips: This patient clearly has severe CAP, and according to current
recommendations, meets criteria for ICU admission for CAP. Specifically, the
leukopenia, hypoxia, hypotension, and mild uremia all indicate the need for
closer monitoring. Initial treatment for CAP requiring ICU admission includes
empiric therapy with a beta-lactam + either azithromycin or a
fluoroquinolone. If pseudomonas is suspected, an antipseudomonal,
antipneumococcal beta-lactam is indicated, in addition to a quinolone. Other
regimens may be used as well.
22) After MPs discharge from hospital. His doctor prescribed him
tiotropium (Spiriva), but he still has some signs and symptoms of
COPD during the day although he is complaint with using his
medication. Best therapy as an add on is/are:
I) Add ipratropium to Spiriva for 8 to 10 days
II) Add salbutamol to Spiriva
III. Add inhaled corticosteroid to Spiriva
A) I only B) III only C) I and II D) II and III E) I,
II, III
Ans: (C)
Tips: Salbutamol helps and adding ipratropium for 8-10 days
when starting Spiriva, until Spiriva reaches its maximum benefit.

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23) MPs doctor wants to do assessment for his COPD to assess
his condition during an exacerbation. Best monitoring
parameters to assess his condition is:
(A) Respirometer and histamine test challenge
(B) Peak flow meter
(C) Arterial blood gas determination
(D) X-ray to the chest
Answer: (C)
Tips: Peak flow meter or (Spirometer for hospital) for asthma
diagnosis and home monitoring. Arterial blood gas
determination is the gold standard to assess oxygenation and
ventilation during exacerbation. Reference: Therapeutic Choices
6th edition Page 707.
However Spirometer is the gold standard for diagnosis of COPD.
TC page 700 and 699.
24) RKP is 3-year old boy with moderate persistent asthma was
started on a budesonide dry powdered inhaler two weeks ago.
The patient stopped taking the medication because he did not
feel an improvement in symptoms. Which of the following
counseling points should the pharmacist review with the
patient?
a) The patient is too young to use a dry powdered inhaler
appropriately
b) Budesonide should be used only as needed before exercising
c) One way to measure improvement is by using a peak flow
meter daily
d) A spacer should be used with the dry powdered inhaler
Ans . A
TIPS: Goal of therapy of asthma in infants and children is to
maintain normal measures of expiratory airflow, such as peak
flows or pulmonary function studies. REF(TC, 4th edition, 420)

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25) In the assessment of asthmatic condition of the a child, what

factor is useful?
a) peak flow meter > 5 year age
b) days missed from school
c) Nocturnal symptoms
d) Exercise tolerance
E) All of the above
ANS.E
TIPS: History of nocturnal symptoms with awakening in the early
morning is a critical component to assess. Peak flow rates in
children are insensitive indicator of airflow limitation, there may
be significant air flow limitation in the presence of normal peak
flow rate. REF (AT & TC, 4th edition, 421)
26) What is the best dosage form for inhalation drugs, in

children age <5 year age?
A) MDI + aerochamber+ face mask
B) Turbuhaler
C) Diskus
D) handihaler
E) Nebulizer
Ans-A

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27) What is incorrect about long-term use of inhaled
corticosteroids?
A) Inhaled corticosteroids can slow growth in kids
B) Decrease in height is permanent.
C) The effect on height is dose-related but it seems to occur even
with low doses of beclomethasone, budesonide, or flunisolide.
D) Oral fungal infection
E) Inhaled corticosteroids can cause weight loss
Ans: E
Tips: Growth suppression by glucocorticoids occurs due to
suppression of pituitary hypothalamus axis.
The higher local or topical side effects of corticosteroids are
associated with very high potent betamethasone, triamcilanone.
These are Not applied on face.
28) What is NOT correct about long-term use of oral steroids?

A) Increase risk of osteoporosis and fractures
B) Suggest osteoporosis monitoring
C) Increase fracture risk in seniors
D) Increase risk of cataract
E) Gastritis
Ans: E
Tips; gastritis is inflammatory condition, thus it should not cause
by steroids.
TC page 1055 and 675

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29) KT is 28-year old woman, is being treated for generalized
seizures (simple partial). Presents with prescription of
carbamazepine. Her medical history includes: No allergies and no
other medical conditions. Which medication causes tolerance?
a) Carbamazepine
b) Valproic acid
c) Phenytoin
d) Clobazam
Ans: D
Tips: Phenobarbital and primidone also have tolerance.
30) A patient comes into the pharmacy and falls down; he had a
‘seizure”. What is to be done?
A) Call 911 and see if his wife has coverage
B) Try to keep his mouth open to prevent chalk up.
C) Give chewable tablets of phenytoin
D) Call doctor to get prescription of carbamazepine
E) Call his family to inform his condition
Ans. B

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31) MD, a 21 year old, presents with a purpuric skin rash. She
wonders if she is having another flare-up of her eczema, but this
rash looks different. Her patient record is as follows: Allergies:
penicillin, History: eczema x 2.5 years, epilepsy x 1 month. Current
medications: betamethasone (Betnovate) Cr 0.05% bid prn x 2.5
years, ethinyl estradiol/ levonorgestrel (Min-Ovral) x 10 months.
Lamotrigine 75mg daily.
What is the most probable cause of her skin rash?
A. An acute flare-up of her eczema
B. Skin rash is major side effect of lamotrigine
C. A reaction to oral contraceptives
D. An interaction between ethinyl estradiol/ levonorgestrel (Min-
Ovral) and phenytoin
Ans.: B
32) Which of the following antiepileptic drugs skin rash effect

can trigger when the drugs initially taken high dose?
A) Phenytoin B) carbamazepine C) Valproic acid D)
Lamotrigine E) Topiramate
Ans. D
33) Which of the following side effect of lamotrigine. Patient

should be informed to contact doctor immediately?
a) Liver toxicity B) Weight gain C) dizziness D) skin
rash e) Fever
Ans. D

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34) Florence is a 72-year-old patient suffering from acute
pneumonia and COPD. He is allergic to penicillin. He is currently
taking Aminophylline infusion by i.v. drip at a rate of 40mg/h,
ceftazidime 1g IVPB q8h, Gentamicin 100 mg IVPB q12h and
albuterol 5% nebulizer solution q4h prn. The culture and
sensitivity report for the sputum specimen indicates the following
minimum inhibitory concentration (MICs):
Ceftazidime ≤ 8 mcg/ml
Mezlocillin ≤ 8 mcg/ml
Gentamicin = 4 mcg/ml
Tobramycin ≤ 0.5 mcg/ml
Ciprofloxacin = 8 mcg/ml
Based on these results, a rational therapeutic decision would be
to:
a. Continue existing regimens without change
b. Continue ceftazidime only
c. Continue gentamicin; change ceftazidime to mezlocillin
d. Change gentamicin to tobramycin; continue ceftazidime
e. Change ceftazidime to mezlocillin; discontinue gentamicin
Ans. D
35) Which is the most common organism for community

acquired pneumonia?
A) Streptococcus pneumonia
B) Micoplasma pneumonia
C) S. aureus
D) E. coli
E) Pseudomonas aeruginosa
Ans. A

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36) CS is a 68-yo male who presented to the ER this morning at
0200 hours with a 2-day history of productive cough with fever.
He also complained of shortness of breath. He decided to seek
medical treatment because the chest pain and other symptoms
were preventing restful sleep. It was decided to admit CS to the
hospital with a diagnosis of community-acquired pneumonia.
The following antibiotic regimen was ordered:
Ceftriaxone 1 g IV q 12 h and clarithromycin 500 mg po q 12 h.
What comment would you make during rounds this morning
regarding the dosing of the antibiotics?
I) The ceftriaxone and clarithromycin doses must be reduces
based on CS’s estimated renal function.
II)These antibiotics should be given at least 1 hour apart.
III-Ceftriaxone can be given q 24 h for the treatment of
community acquired pneumonia.
A. I only B) III only c)I and II only d)II and III only e) I, II and III
Ans: B
Tips: Ceftriaxone has long half thus, it is used once daily (q24h)
37) JS is a 78-yo male who was admitted to the hospital

yesterday from an area nursing home with fever, chills,
vomiting, and severe flank pain. Which of the following would
NOT need to be adjusted in a patient with decreased renal
function?
A. Ampicillin
B. Ceftazimide
C. Ceftriaxone
D. Ticarcillin and clavulanate potassium
E. Piperacillin and tazobactam
Ans-C

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Tips: Cefoperazone have only hepatic clearance. For renal
disease patient moxifloxacin and ceftriaxone do not require dose
adjustments.
38) Which is the most common organism for community

acquired pneumonia?
A. Legionalla pneumoniae
B. Staphulococcus pneuminae
C. Streptococcus pneumoniae
D. H. influenza
E. M. catharrhalis
Ans: C
Tips: S. pneumoniae (50% of all cases of CAP that needs hospital
admission).
39) PJK is 35 year old female. She has been customer of your
pharmacy and brings prescription a new albuterol inhaler, and asks
how he can tell if he has doses left in his albuterol inhaler. He says
he had a bad asthma attack recently and had plenty of albuterol on
hand, but it has crossed his mind that he would be big trouble if his
Albuterol inhaler were ever empty? The pharmacist advices
patient!
A) Pt the inhaler in water for the "float test"
B) Have extra available, and to be sure to write down the date of
his refill to have at least a rough idea of how much of this reliever
medication is left
C) Shake inhaler if you hear sound of powder in, there should be
sufficient medication
D) If you get dry mist after inhalation that means still there is
medication
E) None of the above
Ans: B

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40) PJK in short-acting beta agonist (SABA) salbutamol inhaler

PRN and inhaled corticosteroid budosenide bid for asthma. He
has frequent exacerbation and frequently hospitalized due to
asthma exacerbation. The doctor prescribed leukatriene
inhibitor montelukast. What benefits would the patient
experience with new medication?
I) Decreased use of short acting beta agonist
II) Decreased hospitalization
III) Decrease frequent attacks
A) I only B) III onlyC) I and II D) II and III E) I,II,III
Ans. E
41) PJK is continuing use of ventolin inhaler 1 puff qid and

fluticasone inhaler 1 puff BID. How does LABA benefit in
patient asthma is NOT controlled?
A) Minimized exercise induced asthma
B) synergistic effects with steroids
C) Decrease the use of SABA
D) Helps in nigh time symptoms
E) All of the above
Ans. E
42) Which of the LABA has quick onset of action?

A) salbutamol
B) Formeterol
C) Salmeterol
D) Albuterol
E) all of the above
Ans. B
Tips: formeterol onset is 3 min and duration 12 hours.

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43) Venlafaxine was omitted for 10 days for a 78 year old

patient. The order was inadvertently crossed off from
medication administration records and subsequently not
transcribed on transfer to chronic care. Patient experienced all
of the following, except?
A) nausea and vomiting
B)Delirium
C) Flu like symptoms
D)Insomnia
E)Tremors
Ans: E&B
Tips: SSRI or SNRI withdrawal or discontinued symptoms: flu like
symptoms. However no tremors and cognitive symptoms.

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44) A nurse had an order to administer a 200 mg depot injection
of zuclopenthixol decanoate. She had no previous experience
with the drug and misunderstood the vial’s label. Instead of
giving the patient his usual dose of 1ml of a 200mg/ml solution,
she interpreted the entire vial to contain 200mg. Five times the
normal dose was given (the vial was only half full). The patient
may experienced the following?
A) unpleasant extra pyramidal symptoms
B) suicidal symptoms
C) disorientation
D) Insomnia
E)none of the above
ANS: A
45) Which of the following can be crushed and chewed?

A) Dutasteride
B) Ibandronate
C) Duloxetine
D) Divalproex
E) ASA 80 mg
ANS:E

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46) JM is 75 year old diagnosed with Alzheimer’s disease and
diastolic dysfunction, his current medication include donepezil
10mg QD, furosemide 40mg QD, verapamil SR QD. Jims father
and mother both have had suffered Alzheimer in their old age.
Symptoms of Alzheimer’s disease, all EXCEPT:
a) Slurred speech
B)Delay cognitive functions detritions
C)Fatigue
D)Dementia
E) Loss of memory
Ans: C
Tips: Fatigue and reversing cognitive functions are NOT a goal of
therapy for dementia.
SAPF = Stress, Anxiety, Psychosis and Fatigue are except for
dementia symptoms.
47) All of the following are the risk factor of Alzheimer’s disease,
EXCEPT
a) Female gender
B)Family history
C) Age
D) Emotional stress
E)None of the above
Ans: D

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48) The doctor prescribes a combination treatment of SSRI +

benzodiazepines for which there is a risk for a pharmacokinetic
interaction. Which of the following is the best course of action?
A) Recommend avoiding the combination due to the narrow
safety margin of SSRI
B) Recommend avoiding the combination due to narrow safety
of margin of benzodiazepines
C) Dispense the combination and monitor for increased side
effects of SSRI
D) Dispense the combination and monitor for increased side
effects of benzodiazepines
Ans: D
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49) A 25 year old student is taking paroxetine daily for the
treatment of depression for the past 3 months. Currently doctor
diagnosed patient as maniac. What is appropriate to do?
A) Continue paroxetine and start lithium
B) Discontinue paroxetine and start lithium
C) Continue paroxetine and add haloperidol and lithium
D) Discontinue paroxetine and add haloperidol
E) Increase dose of lithium
Ans: B

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50) KP is a 27 year old man using salbutamol and fluticasone

inhalers for asthma. Having dry cough. He asks pharmacist, why
all OTC cough suppressants like dextromethorphan (DM) should
be avoided?
A) DM may hide early symptoms of asthma attack
B) DM interact with corticosteroids making both ineffective
C) All people asthma should consult with physician as soon as
respiratory symptoms develops
D) codeine is more safe and effective for people with asthma
Ans: A

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******
51) KK, is a 43-year-old male, presents to your pharmacy
requesting something for his “ulcer.” On questioning him, you
learn that: 1) he has had “stomach pains: that have been getting
progressively worse over the month; 2) he does not take any
NSAIDs/ASA; 3) his pain does not rise towards the neck
(heartburn); 4) he has not alarm features; and 5) he never has
been diagnosed with an ulcer. He smokes 3 to 4 cigarettes a day
and usually has 2 glasses of wine with dinner. Based on the
evidence, what would be an appropriate next step to manage
KK?
a) Stop the cigarettes and the wine
b) Try an alginate-containing product
c) Suggest he see his family doctor for possible H. pylori testing.
d) Go to the Emergency room to be assessed for a possible
peptic ulcer
Ans: C
52) PKis a 58-year-old female with moderate persistent low back

pain. She is currently taking acetaminophen 300 mg/codeine 30
mg, 4 to 6 tablets per day and senna, 2 tablets per day for
constipation. Her pain score is 6/10. She doesn’t like the
inconvenience of taking so many pills and would like to reduce
her pill burden. Her physician would like to switch her to a pain
patch for more consistent pain control.
Which of the following would be the most appropriate
for PK?
I) Buprenorphine transdermal system
II) Fentanyl transdermal system
III) acetaminophen + codeine + caffeine PRN
Ans: E

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53) Which of the following is/are appropriate counselling

point(s) for transdermal administration of opioids?
I) Advise patients to avoid exposure to external heat sources as
they can increase the release of buprenorphine or fentanyl and
may result in an overdose.
II) Advise patients to avoid strenuous exercises as they may
increase absorption of buprenorphine or fentanyl and may result
in an overdose.
III) Advise patients to contact their physician or pharmacist if
they develop a high fever as fever can increase release of
buprenorphine or fentanyl and may result in an overdose
Ans: A
54) MP is a 50 year old male participating in your pharmacy

cardiovascular risk assessment clinic. He has history of
hypertension or diabetes and has never smoked. He has no
recent blood work on file. A fasting lipid panel is ordered to
assess his cardiovascular risk. Which of the following lab tests
should be completed at baseline in the event the patient is
started on a statin?
I) AST/ALT
II) Creatine kinase
III) Electrolytes
Ans: A

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55) MP is a 22-year-old woman, otherwise healthy, presents
with a 6-month history of episodes of unresponsiveness
accompanied by lip smacking lasting 1 to 2 minutes and
occurring 2 to 3 times per month. She takes no medications She
is in a monogamous relationship with a male sexual partner
and only occasionally uses contraception. A routine EEG
shows left temporal epileptiform activity and MRI of the brain
shows left mesial temporal sclerosis. Which of the following
drugs have decreased the effectiveness of oral contraceptive
pills?
i. Gabapentin
ii. Lamotrigine
iii. Topiramate
a) I only
b) III only
c) I and II
d) II and III
e) I, II III
Ans. B
56) Which of the following drugs are associated with

hirsutism side effects?
A) Phenytoin
B) Carbamazepine
C) valproic acid
D) Topiramate
E) Lamotrigine
Ans: A
Answer: B: Hirsutism is a common side effect of
phenytoin and is not correlated with serum phenytoin
concentration. Ataxia and sedation are
concentration-dependent side effects.
Drugs that cause hirsutism include: phenytoin, androgen,
finasteride, OCP, prednisone.

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57) After her phenytoin therapy has been optimized, MP

returns to the clinic just before her wedding and requests
an oral contraceptive. Which of the following statements
regarding oral contraceptives and phenytoin is most
correct?
A. There is no potential drug-drug interaction
B. Phenytoin inhibits the metabolism of phenytoin and may
increase their side effects.
C. Oral contraceptives inhibit the metabolism of phenytoin
and may increase its side effects.
D. Phenytoin induces the metabolism of oral contraceptives
and may decrease their efficacy.
E. Oral contraceptives induce the metabolism of phenytoin
and may decrease its efficacy.
Answer: D: Phenytoin is an enzyme inducer. It may
increase the metabolism of oral contraceptives and reduce
their efficacy. Patients should be advised to consider
alternative methods of contraception to avoid unplanned
pregnancy.
58) Doctor doubled dose of phenytoin, when to

measure steady state concentration?
A) After 1 day
B) After 1 week
C) After 1 month
D) After 2 week
E) After 3 week
Ans: B
Tips: On average at phenytoin dose of:
300 mg/day takes approx. 5 to 7 days to Css

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Example. Patient receiving phenytoin 300 mg capsule daily.
The Css is 9.2 mcg/ml. If doctor increased dose to 400 mg
daily. What will be Css.
Cnew = (D new/Dold) x C old then increase 15 to 33%
C new = (400 mg/300 mg) x 9.2 mcg

= 12.3 mcg/ml
For 15% is 1.15 x 12.5 = 14.1 mcg/ml
For 33% = 16.4 mcg/ml
Then range is 14.1 mcg/mL to 16.4 mcg/mL
59) A 21-year-old obese woman who is otherwise healthy

reports a 5-year history of Generalized-onset seizures are most
effectively treated with broad-spectrum antiepileptic drugs. Her
current medications include Alesse 28, 1 tablet daily as directed
(has not had this filled regularly), vitamin C 500 mg po od, and
vitamin B complex 50 1 tab po daily.
What is the drug of choice for generalized onset seizures?
A) Lamotrigine
B) valproic acid
C-Carbamazepine
D-Phenytoin
E-Topiramate
Ans: B
60) All of the following drug have least drug interactions with
Alesse 28?
I) Valproic acid II) Gabapentin III) Lamotrigine
A) I only B-III only C-I and II D) II and III E) I, II, III
Ans: C

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61) Which of the following laboratory test is monitored for

valporoic acid?
A) Renal function tests
B) Liver function tests
C) Fabrile seizure
D) Neuroleptic malignant syndrome
Ans: B
62) A patient brings a prescription of divalproex 250 mg bid. In

the patient profile patient was using valproic acid for the past 3
years. What is appropriate to do?
A) this could be drug non compliance
B) call doctor to confirm if dr want to change medication
C) valproic acid and divalproex are drug with same indication so
dispense
D)Check dosage if it is same as divalproex than can be dispensed
E) ask patient if he is aware his medication has been changed
and what did the doctor tell you about this.
Ans: E

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63) A 60 yo person on Li2CO 3 600 mg q8h for maniac depression,
have continuous vomiting and watery diarrhea for a last 1 week?
Looking for some OTC antidiarrheal? If patient is taking
mistakenly every 1 h, what is the serious symptoms is observed?
A) Bradycardia
B) Sweating
C) Confusion
D) Diarrhea
E) Course tremors
Ans: E
Tips: Course tremors are lithium toxicity symptoms where as
fine tremors is side effects.
64) A resident of a long-term care facility was admitted to

hospital with behavioral challenges. The patient condition
stabilized on olanzapine 10 mg qid. After discharge from
hospital, the resident required readmission a short time later
because of over sedation and falls. What is reason for second
time admission?
A) due to side effect of olanzapine
B)neuroleptic malignant syndrome
C)overdose of olanzapine
D)because patient is old
E)not sure what is going on
Ans: C

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65) An elderly patient had a prescription of lorazepam 1 mg as
needed for escalation of aggressive, agitated behavior. About 30
min after administration of a dose of the lorazepam, the patient
was given clonazepam. Which of the following should be
monitored? Except?
A) Disorientation
B) Difficulty in walking
C) Fall
D) Insomnia
E) Sedation
Ans: D
Tips: side effects can occurs in 3 days of start using
benzodiazepine.
66) A.M. is an 18-year old male who was admitted to the

hospital after having his first psychotic break. A.M.’s parents
has noticed that he was acting strangely for the last few
months. His grades in school had dropped; he was not
interested in hanging out with his friends anymore; and he had
been fired from his part-time job. Most of A.M.’s time was
spent alone in the basement staring blankly at the TV. When it
appeared that A.M. was not responding to external stimuli, his
parents brought him to the emergency department worried
that something is wrong with their son. A.M.’s social
withdrawal, as well as his loss of academic and occupational
functioning is most consistent with:
a) prodromal phase of schizophrenia
b) depression
c) acute phase of schizophrenia
d) residual phase of schizophrenia
Ans: A

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67) As part of the initial screening of the above patient, it would

be important to include :
a. complete blood count and electrolytes
b. urine drug screen
c. urine culture
d. thyroid function test
Ans: A
Tips: CBC, electrolytes, routine urine analysis if clinically
indicated.
68)The most appropriate choice of medication treatment for

A.M would be:
a) clozapine
b) olanzapine
c) perphenazine
d) chlorpromazine
Ans: B
69) Second-generation anti-psychotics as a class offer the

following advantage:
a) high D2 blockade
b) dopamine blockade specific to the nigrostriatal and
mesocortical areas
c) Low ratio of D2:5HT2 blockade
d) Rapid dissociation from the serotonin receptor
Ans: C

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70) The efficacy of second-generation antipsychotics as
compared to conventional antipsychotics can be summarized as:
a) equally effective for positive symptoms and negative
symptoms, less effective for cognitive symptoms and mood
symptoms
b) equally effective for positive, negative, cognitive and mood
symptoms
c) equally effective for positive symptoms, more effective for
mood and cognitive symptoms and less effective for negative
symptoms
d) equally effective for positive symptoms, more effective for
negative, cognitive and mood symptoms
Ans: D
71) Which of the following second-generation agents is most

likely to cause prolactin elevation?
a) Risperidone
b) Olanzapine
c) Quetiapine
d) Clozapine
Ans: A
72) The propensity of second generation agents to cause weight

gain can be ordered as follows:
a) clozapine>Risperidone>Quetiapine>olanzapine
b) olanzapine>clozapine>Risperidone>Quetiapine
c) risperidone>Quetiapine>olanzapine>clozapine
d) clozapine>Olanzapine>Quetiapine>Risperidone
Ans: D

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73) RJ a 34 year old patient who has been getting his
prescriptions filled at your pharmacy for a long time. He has
been taking paroxetine 40 mg per day for two years for the
treatment of obsessive-compulsive disorder, with good results.
He used to have obsessions of doubt, leading to compulsive
checking, which virtually incapacitated him. He wasn’t able to
leave the house for fear that the stove has been left on, or that
the door wasn’t locked. He has talked to his psychiatrist about
stopping the medication and he asks for your opinion.
Which of the following is correct?
a. he will not relapse after discontinuation since he took the
medication for two years
b. he must stay on medication for at least five years to reduce
the risk of relapse
c. he has been on medication too long already
d. he may or may not relapse if the medication is stopped.
Ans: D
74) RJ after a discussion with his physician, decides to stop the

paroxetine. Which of the following would represent the best
advice for him?
a. taper down the dose of paroxetine slowly
b. stop the paroxetine at once and take prn doses of diazepam if
required
c. stop the paroxetine at once and monitor symptoms
d. substitute paroxetine with fluoxetine for two weeks then stop
Ans: A

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75) One year after stopping the paroxetine, RJ notices the return
of some of his symptoms. He is reluctant to take medication
again because he does not want to have to take medications for
the rest of his life.
Which of the following statements is correct with respect to
treatment of OCD?
a) cognitive-behavioral therapy has not been shown to be
effective
b) cognitive-behavioral therapy is as effective as
pharmacotherapy
c) pharmacotherapy is much more effective than cognitive-
behavioural therapy
d) cognitive-behavioral therapy should be tried before
pharmacotherapy is offered
Ans: D
***************
76) JDs doctor would like to start her on combination

pharmacotherapy with an anxiolytic and an antidepressant.
Which of the following SSRIs would be most likely to have a
pharmacokinetic interaction with a benzodiazepine?
a) Citalopram
b) Fluvoxamine
c) Paroxetine
d) Sertraline
Ans:B
************

PharmacyPREP.com
77) You implement a plan to monitor the therapeutic outcomes
of Ms L’s pharmacotherapy. Which of the following best
describes the goals of treatment for panic disorder?
a) reduce the number of panic attacks and the degree of
anticipatory anxiety
b. reduce the number of symptoms experienced during a panic
attack
c. reduce the time it takes for symptoms to peak during a panic
attack
d. reduce the number of panic attacks
Ans: A
***********
78) A 44 year old patient with epilepsy, he is using valproic acid
500mg TID, for past 6 months He has good response however he
is experiencing some side effect like stomach upset. The
pharmacist should advise the patient:
I ) Talk to doctor to reduce the dose
II) Talk to doctor to switch him to liquid form
III) Talk to doctor to give him another medication in the same
class (divalproex)
A-I only B-III only C) I and II D) II and III E) I, II, III
Ans: B
TIPS: Changing the dosage form will not reduce the side effect.
However usually, if there is a good response to any medication
with side effect, it is better to keep within the same class.

PharmacyPREP.com
79) Folic acid deficiency will affect which of the following
antiepileptic drugs?
I) carbamazepine
II) valproic acid
III) phenytoin
A) I only B) III only C) I and II D) II and III E) I, II, III
Ans: B
TIPS: Drugs that cause macrocytosis and altered folate
metabolism including (antineoplastic and zidovudine, phenytoin,
primidone, MTX, triamterene, trimethoprim, and oral
contraceptives) REF. (TC, 4th edition, 838).
80) A patient came to emergence poisoned with

diphenhydramine, amitriptyline, imipramine. What are the
symptoms?
a. dry mouth
b. tinnitus
c. constipation
d. sedation
e. all of the above
Ans: E
TIPS:TCAs SEs are antcholenergic, anthitamenergic, orthostatic
hypotension, lowered seizure threshold, and sexual dysfunction.
REF (TC, 4th edition, 49).

PharmacyPREP.com
81) A woman phoned the pharmacist and told him that her
husband has swallowed 30 tabs of acetaminophen 325 mg. What
is the proper advice?
a) He will be ok
b) Induce emesis-using ipecac
c) Call the poison center to ask for advice
d) Take him to the emergency department
Ans: C
TIPS: In adults hepatotoxicity may occur after ingestion of a
single oral dose more than 7.5 g. For treatment consider
consultation with a toxic poison center. REF (CPS,2003,
acetaminophen).
**********
82) A patient came to his family physician experiencing severe

Elbow pain after severe contact with anther soccer player. There
is swelling also in his ankle. He treated his ankle at the time of
incidence with ice packs, for 24 hrs, however the pain is still
persistent. patient has peptic ulcer. What will you recommend?
I) Cold compress
II) NSAIDs rubs
III) Ibuprofen
A) I only B) III only C-I and II only D) II and III only E)I, II, III
Ans : C

PharmacyPREP.com
83) Which of the following agents is preferred when used to
heal an NSAID-induced ulcer if the NSAID must be continued.
a. sucralfate
b. misoprostol
c. proton pump inhibitor
d. H2 receptor antagonist
Ans C
TIPS: At risk patients for peptic ulcer from NSAIDs therapy may
be offered gastric protective therapy with standard doses of PPI.
REF(TC,4th edition,502).
*************
84) MP is a 78 year old female who had difficulty sleeping over

the past several days and some leg cramping and rigidity in the
early of hours of morning. Her medical history include angina,
chronic constipation and Parkinson's disease. Currently she is
using levodopa/carbidopa 100/25 1 tablets 8 am 12 noon 4 pm
and 8 pm. Amantadine 100 mg qd, ASA 81 mg, Nitrodur 0.6 mg
qam, bisacodyl PRN.
Which of the following most likely explanation for MP symptoms?
A) anticholinergic side effects of amantadine
B) On-off fluctuation
C) Wearing off effect
D) Extra pyramidal side effects
E) levodopa induced urinary incontinence
Ans: C

PharmacyPREP.com
85) Which of the following you suggest to improve MP
symptoms?
A) Decrease the dose of levodopa/carbidopa
B) Switch to controlled release levodopa/carbidopa
C) Switch to amantadine
D) decrease the frequency of levodopa/carbidopa
E)Discontinue levodopa and add entacapone
Ans: B
KM is a 66-year-old female who visits your pharmacy. She arrives

at your pharmacy to refill her prescriptions. She is currently taking
levodopa/carbidopa 100/25 five times daily, bromocriptine 5 mg
qid, and selegiline 5 mg q 12 h. KM tells you that she has been
well, except for some difficulty sleeping.
86) What should you recommend to KM?

a) Ensure that selegiline is taken early in the day
b) Ensure that the last dose of levodopa is taken to no later than 6
pm
c) Suggest that you could recommend that her physician switch
from bromocriptine to ropinirole
d) Ensure that she avoids foods with high tyramine content, such
as red wine and smoked meats.
Ans-A
87) KM turns one month later with a new complaint. She tells you
that she has noticed that she is often light-headed when she arises
from sitting or lying down. What might be causing this problem
for KM?
a) Progression of PD
b) Levodopa therapy

PharmacyPREP.com
c) Bromocriptine therapy
d) All of the above
Ans-D
88) Which of the following is a reasonable strategy for dealing

with KM’s problem?
a) The use of a salt substitute
b) Fluid restriction
c) Fludrocortisone therapy
d) All of the above
Ans-A
89) Which of the following medications is/are approved for

postherpetic neuralgia (PHN)?
a. Gabapentin
b. Amitriptyline
c. Lidocaine patch 5%
d. All of the above
Ans : D
TC page 141, Lidocaine 5% topical gel and transdermal patch
90). Which of the following agents is indicated for the treatment of

trigeminal neuralgia?
a. Topiramate
b. Gabapentin
c. Carbamazepine
d. Phenytoin
Ans. C
TC page 139
91) Which of the following antidepressants is most effective in the

treatment of neuropathic pain?
a. Amitriptyline
b. Fluoxetine
c. Paroxetine

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d. citalopram
Ans: A
TC page 143
Tips: Amitriptyline is used in postherpetic, diabetic neuropathic
pains, however it not used in trigeminal neuroglia pain
Amitriptyline dose 10-25 mg QHS daily at weekly intervals until
pain relief or side effects.
92) A patient using phenytoin for the six months, reports had
swollen gum, which of the following is the appropriate
recommendation.
A-Mouth hygiene
B) Refer to dentist
C) Recommend oral mouth hygiene
D-Recommend toothpaste
93) Mr DL is 69 year old male who is being treated for chronic

cancer pain with 15 mg of SR morphine at 6 AM and 6 PM. He is
complaining significant break through pain which wakes him up at
about 4 AM and another pain 3 PM which requires rescue doses of
immediate release morphine. His pain is well controlled
throughout the rest of the day. How should morphine regimen
should change:
A-Reduce the dose interval of SR morphine to q 8 h
B-No need to change, as rescue doses continue to be taken as
needed
C-Increase the dose of immediate release morphine
D-Increase dose of SR morphine to 30 mg q 12 hours.
11-D
Comments: use immediate release product with SR formulation for
break through pains. The opioid potency or dose can be increased
if pain continues or becomes moderate to severe. Doses should be
prescribed on schedule basis rather than PRN to prevent
reoccurrence of pain. An agent with quick onset of action should
also be prescribed as needed for breakthrough pain.

PharmacyPREP.com
TC p 132
95) Which of the following counselling is important

when a patient who has been given opioid for the
first time:
A-Double of dose if needed
B-Do not drink alcohol while taking this medication
C-Take medication with full glass of water
D-Do not takes this medication with any other medication
12-B
96) Which of the following is most accurate description of

breakthrough pain;
A-pain that is not responsive to medications
B-Pain that interrupts sleep
C-Pain that spikes upward in intensity
D-Pain experienced by cancer patients
13-C
97) JP is a 59-year-old male who is taking levodopa/benserazide

100/25 qid, selegiline 2.5 mg daily He has taken this medication
at this dose for 3 months and has had little rigidity and posture.
Which of the following is true?
a) Levodopa/carbidopa is more effective than
levodopa/benserazide, so JP should be switched to
levodopa/carbidopa
b) Benserazide is administered with levodopa for the purpose of
reducing the adverse effects of levodopa and decreasing
levodopa
c) The lack of response to this agent means that JP does not have
PD
d) None of the above
Ans-B

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98) Which of the following is not a consequence of autonomic
dysfunction in PD?
a) Urinary incontinence
b) Excessive sweating
c) Sleep disturbances
d) Sexual dysfunction
Ans-C
99) JP return to pharmacy with new prescription of citalopram 50

mg daily for the treatment of depression symptoms. What is the
pharmacist concern?
A) drug and drug interaction
B) drug and food interaction
C) Age of patient
D) QT prolongation concern
E) no concern
100) JP reports excessive sweating, and hypertension is occurring

from the past few days? What is the reason?
A) hypertension crisis
B) serotonin syndrome
C) Neuroleptic malignance
D) Drug side effects
E) Parkinson's disease symptoms
18) KM is a 75 yo women, frequently forgets daily activities such

housekeeping, names of relative and friends... Doctor diagnosed
Alzheimer's. What is goal of therapy?
A) Delay the time to transfer nursing home facility
B) Decrease mortality
C) Decrease cognitive functions damage
D) Decrease the time for pharmacotherapy
E) Increase medication compliance

PharmacyPREP.com
Ans: C
Tips: Decrease cognitive functions damage this delays
progression of disease and prevent getting into severe form of
dementia. Lab test to confirm cognitive MME, MoCA.
19) MJ is 70 year old man. Has been on anti-Parkinson's

medications levodopa/carbidopa tid. and Furosemide for the
treatment of hypertension. He also uses arthritis medications
Acetaminophen 650 mg q6h and vitamin B 12 injections. Recently
he has been diagnosed for urinary incontinence. What is the
cause of urinary incontinence?
A) Levodopa/carbidopa
B) Furosemide
C) Acetaminophen
D) Vitamin B 12 injection
Ans: A
TC page 879 6th ed. Drugs that may cause or aggravate urinary
retention should be avoided in urinary incontinence.

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1) JP is 35 year old female presented her doctor with undesirable

2) If doctor prescribed a non ergotamine selective dopamine

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3) If JPs doctor considers prescribing gabapentin to treat restless

4) KT is a 30 year old female with active lifestyle. Past few

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5) Although there is no known cure for multiple sclerosis

6) JD is a 65 yo patient with type 2 diabetes. His current CrCl <30

Tips Inc Copyright 2000-2014 Prevent Piracy & Report Piracy 3

7) JD doctor prescribed carbamazepine 100 mg daily. After few

8) Which of the following antidepressants is most effective in

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9) Which of the following DOES NOT have any value in the

10) MK is a 22 year old female has 6 month history of pulse type

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a) If the sumatriptan does not relieve the headache within four

12) Which of the following is indicators migraine therapy

13) MK doctor changed her prescription to rizatriptan wafer

Tips Inc Copyright 2000-2014 Prevent Piracy & Report Piracy 6

14) MD is a 40-year-old woman who has recently been

Tips: Benzodiazepine can be refilled. Benzodiazepine refills do not

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16) If pharmacist suspect prescription forged?

17) JK is 53-year-old lady came to the pharmacy with a

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18) JKs doctor call pharmacy to change prescription to

19) MK is a 70 years old patient uses salbutamol inhaler and

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21) MP is 77 year old female presents to the emergency department with

A) Discharge the patient on oral azithromycin

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25) In the assessment of asthmatic condition of the a child, what

26) What is the best dosage form for inhalation drugs, in

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28) What is NOT correct about long-term use of oral steroids?

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32) Which of the following antiepileptic drugs skin rash effect

33) Which of the following side effect of lamotrigine. Patient

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35) Which is the most common organism for community

Tips Inc Copyright 2000-2014 Prevent Piracy & Report Piracy 17

37) JS is a 78-yo male who was admitted to the hospital

Tips Inc Copyright 2000-2014 Prevent Piracy & Report Piracy 18

38) Which is the most common organism for community

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40) PJK in short-acting beta agonist (SABA) salbutamol inhaler

41) PJK is continuing use of ventolin inhaler 1 puff qid and

42) Which of the LABA has quick onset of action?

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43) Venlafaxine was omitted for 10 days for a 78 year old

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45) Which of the following can be crushed and chewed?

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48) The doctor prescribes a combination treatment of SSRI +

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50) KP is a 27 year old man using salbutamol and fluticasone

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