PROMETRIC PRACTICE FOR PARMACIST

1. Actonel Generic Name

What is the generic name for Actonel?
A Alendronate
B Pioglitazone
C Ramipril
D Risedronate
Answer D - The generic name for Actonel is Risedronate. The other medications are listed below.
Alendronate (Fosamax)
Pioglitazone (Actos)
Ramipril (Altace)

2. Chemotherapy Exposure
Because of poor processes and procedures, a pharmacy technician has been exposed unnecessarily to
chemotherapy agents. Which federal organization would have the most oversight over this issue?
A NIH
B OSHA
C IRB
D NCQA
Answer B – OSHA is the Occupational Safety and Health Administration. Their primary objective is to
watch out for the health and welfare of workers.

3. Therapeutic Equivalence
Which of the following statements best describes therapeutic equivalence?
A It refers to two drugs that have identical chemical compositions
B It indicates that a drug is superior to others in terms of efficacy and safety
C Medications that are therapeutically equivalent will have similar drug effects and can be used
interchangeably
D It describes medications that are in the same drug class and have approximately the same cost
Answer C - Therapeutic equivalence is a term used in pharmacology to indicate that two drugs are
essentially equal in terms of their efficacy and safety profiles when used in the same dosage regimen. It
does not consider the cost of the medication. This means that the drugs produce similar therapeutic
effects and have comparable outcomes in treating a particular condition. In practical terms, therapeutic
equivalence suggests that these drugs can be substituted for each other without any significant
differences in clinical effectiveness or safety.

4. Amoxicillin Calculation
A prescriber writes an order for Amoxicillin 0.5 g TID x 7 days. You currently only have 250 mg capsules
available. How many total capsules are needed to fill the entire prescription?
A 45
B 42
C 49
 D 36
Answer B - 250 mg is equivalent to 0.25 g. It will take 2 capsules three times per day for 7 days. That
would be equivalent to 6 capsules per day X 7 days which would equal 42 total capsules.

5. MOA Carvedilol
What is the primary mechanism of action of carvedilol?
A Inhibits beta-1, beta-2, and alpha-1 receptors
B Activates beta-2 receptors
C Activates beta-3 receptors
D Non-selectively inhibits beta receptors
Answer- D - Carvedilol inhibits beta-1, beta-2, and alpha-1 receptors. Inhibition of beta-1 receptors
leads to a reduction in heart rate, contractility, and blood pressure. Beta-2 inhibition can lead to
negative effects in respiratory conditions like asthma and COPD. Alpha receptor inhibition can lead to
vasodilation and a reduction in blood pressure.

6. Saftey of Names, Labels, and Packaging

Years ago, the antidepressant named Brintellix was changed to Trintellix. Which agency would be
responsible for monitoring the safety of names, labels, and packaging?
A VAERS
B CBER
C NCQA
D DMEPA
Answer D – DMEPA is under the umbrella of the Center for Drug Evaluation and Research (CDER) (and
ultimately under the big FDA umbrella). The primary objective of this agency is to review medication
error reports on prescription and over-the-counter drugs.

7. Short Term Prescription

Which medication is typically only used for 1-2 weeks at most?
A Apixaban
B Ciprofloxacin
C Risperidone
D Alendronate
Answer B - Ciprofloxacin is an antibiotic for infection. It is rarely used on a chronic basis. Apixaban
(anticoagulant), risperidone (antipsychotic), and alendronate (osteoporosis medication) are most often
used on a longer-term basis.

8. Route of Administration - Onset of Action

Which route of administration will have the fastest onset of action?
A Oral
B Rectal
C Intravenous
D Transdermal
Answer C - Intravenous administration of medication is the quickest way to get the medication directly
into the bloodstream. The faster the drug gets into the bloodstream, the quicker the onset of action.
9. Medication Class Identification
A patient reports that they cannot afford the price of Protonix. Which of the following would represent
an alternative in the same class of medication?
A Famotidine
B Lisinopril
C Metoprolol
D Omeprazole
Answer A &D -Protonix (pantoprazole) is a proton pump inhibitor frequently used for heartburn.
Omeprazole would be an alternative to this medication and is in the same drug class. Note that
famotidine is an antacid-type medication used for heartburn but inhibits histamine 2 receptors, not
proton pumps. Lisinopril and metoprolol are blood pressure-lowering medications.

10. Supplement in Alcoholism

Patients who have trouble with alcohol addiction will often need this supplement?
A Vitamin A
B Protein
C Ginseng
D Thiamine
Answer D- Thiamine deficiency is a concern in patients with alcohol use disorder.

11. ANDA
A new medication is applying for an ANDA. Which of the following best represents the requirement to
obtain approval?
A The drug must demonstrate bioequivalence with the parent product
B The drug must be proven efficacious in randomized controlled trials
C The drug must be proven safe in randomized controlled trials
D Both B and C
Answer A – An ANDA (abbreviated new drug application) is completed by generic companies and
submitted to the FDA for potential approval. The primary objective of an ANDA is to prove
bioequivalence with the parent (brand) product.

12. Prednisone Class Identification

A patient reports intolerable side effects to prednisone. Which medication is from the same class as
prednisone and would be likely to cause similar side effects?
A Naproxen
B Medrol
C Lyrica
D Prilosec
Answer B -Medrol (methylprednisolone) is a corticosteroid like prednisone and would have a similar
adverse effect profile. Insomnia, mood changes, edema, hypertension, HPA suppression (long term), GI
upset, weight gain, hyperglycemia, and osteoporosis (long term) are all possible adverse effects.

13. Warfarin Interaction

Which medication should be avoided with the use of warfarin?
A Gabapentin
B Zyrtec
C Tylenol
D Ibuprofen
Answer D - Ibuprofen can increase the risk of GI bleed. Starting this medication in a patient already
taking an anticoagulant like warfarin can significantly increase the risk of GI bleeding. This combination
should be avoided if at all possible.

14. Amoxicillin Suspension Calculation

How many mL of Amoxicillin 250 mg/5 mL should be dispensed if the prescription is written for i tbsp PO
BID x 14 days?
A 280 mL
B 420 mL
C 140 mL
D 560 mL
Answer B - 1 tablespoon (tbsp) is 15 mL and we are dosing it twice per day. The patient will take 30 mL
per day X 14 days so the correct answer should be 420 mL.

15. Digoxin Dosing

A prescription comes in for digoxin 0.125 mg QD, what is the equivalent dose in mcg?
A 12.5 mcg
B 0.000125 mcg
C 1.25 mcg
D 125 mcg
Answer D - 1 mg is equivalent to 1,000 mcg. Because this is true, you would take 0.125 X 1,000 to get
125 mcg.

16. Oral Dosage Form - Diabetes Medication

A patient is requesting a diabetes medication that is not an injection. Which of the following
medications would be given as an oral dosage form?
A Basaglar
B dulaglutide
C Byetta
D Jardiance
Answer D - Jardiance is an SGLT-2 inhibitor used in the management of diabetes (and may also help with
heart failure). This medication is an oral medication. Byetta and dulaglutide are both GLP-1 agonists and
require an injection. Basaglar is a long-acting insulin and is a biosimilar agent to Lantus (insulin glargine).
This medication would also require an injection.

17. Medicare and MTM

Which of the following Medicare components covers the Medication Therapy Management benefit?
A Part B
B Part A
C Part D
D Part B or D may cover the MTM benefit
Answer C – The MTM benefit is covered under Medicare Part D which is the prescription drug benefit
program.

18. FDA Agencies

Which agency is not run by or part of the FDA?
A ISMP
B CBER
C DMEPA
D CDER
Answer A – ISMP is a nonprofit organization that is focused on medication error prevention and
ultimately the safe use of medications. ISMP will share information with the FDA to help them better
identify safety and error concerns.

19. REMS
In the creation of a REMS program, which of the following is true?
A The FDA sets up the program and pharmaceutical manufacturer agrees to the requirements
B Once set up, a REMS program is required forever as long as the medication is still being marketed and
sold
C A medication guide must be given to the patient
D The program is designed to minimize excessive costs to the patient
Answer – The manufacturer sets up the program and the FDA approves it. It is reevaluated periodically
and may be eliminated or revised if new evidence on safety is available. Medication guides being given
to the patient are required. The REMS program goal is to reduce the risk of serious adverse effects or
reactions.

20. Furosemide Adverse Effects

Which is a boxed warning on furosemide?
A Fetal toxicity
B Fluid/electrolyte loss
C Hyperkalemia
D Weight loss
Answer C -Furosemide is a diuretic that can cause significant fluid loss as well as electrolyte depletion.
Hypokalemia is the most common electrolyte deficiency caused by furosemide.

21. Cyanide Safety Legislation

Which legislation/program was created in response to an individual causing cyanide poisoning by
replacing acetaminophen with cyanide pills?
A Orphan Drug Act
B MedWatch
C DSHEA
D Tamper Resistant Packaging
Answer D – The Tamper Resistant Packaging Regulation of 1982 made it a crime to tamper with
packaged consumer products. It also influenced manufacturers to create packaging for their drugs so
patients knew if the package had been opened already. This was brought about after an individual was
placing cyanide in Tylenol containers.

22. OTC and Legend Legislation

What piece of legislation set up two categories of drugs (legend and over-the-counter)?
A Durham Humphrey
B Kefauver Harris
C Orphan Drug Act
D Prescription Drug Marketing Act
Answer A – The Durham Humphrey Amendment was set up to create two categories of medicines. The
Amendment set up a category of drugs that cannot be safely used without medical supervision and sale
is restricted to prescription (legend or prescription drugs). In addition, this legislation set up a category
of drugs that could be reasonably used without provider supervision (over-the-counter or OTC’s).

23. FDA Role

Which of the following tasks would not typically be associated with the FDA’s role?
A Approval of REMS programs
B Developing and creating compounding standards
C Determining whether a drug requires a boxed warning
D Issuing an alert on a medication safety-related issue
Answer – The FDA doesn’t typically develop and create compounding standards. This would be more of
a task related to USP. The FDA may regulate pharmacies that do these activities, but they don’t actually
create the standards that need to be followed.

24. Recalls
A drug manufacturer has announced that there was an error in production and a different excipient was
put into tablets of metoprolol. This excipient is FDA-approved as safe for human consumption and there
is no anticipated risk to patients. What type of recall would this be?
A Class 1
B Class 2
C Class 3
D Too little information to determine
Answer C – In a class 3 recall, exposure to the product is unlikely to cause harm to patients taking the
medication or using the device. A class one recall is the highest level recall that does run the risk of
serious harm to patients.

25. Saw Palmetto Indication

A patient asks you about taking saw palmetto extract. What is the most common indication that a
patient would use this for?
A Hypertension
B Stroke prevention
C Heartburn
D BPH
Answer D - Saw palmetto is commonly marketed for its utility in BPH despite limited evidence
supporting its use.

26. CMR
Which of the following statements is true regarding a CMR?
A Follow up annual CMR’s can be done by pharmacy technicians, but the initial CMR must be done by a
pharmacist
B Performing a CMR via telehealth is acceptable under most situations
C The medication action plan only provides a list of medication
D None of the above are true
Answer – Telehealth is an acceptable way to do CMRs under most circumstances. Pharmacy technicians
cannot perform and bill CMRs. However, they may be incorporated into some data gathering and data
entry tasks. The medication action plan is the document that helps a patient stay on track with their
goals of care.

27. Liraglutide Boxed Warning

Which is a boxed warning on liraglutide?
A Carcinogenic
B Lactic acidosis
C Thyroid C-cell tumors
D Weight loss
Answer C - Per the FDA: Studies were done in mice and in rats to look for any evidence that liraglutide
might cause cancer in animals. Results of the studies showed that liraglutide caused malignant tumors of
the thyroid gland, especially at doses that were 8 times higher than what humans would receive.
Because of this, the FDA issued a warning for specific types of thyroid tumors.

28. Drug Interaction PDE-5 Inhibitors

As you review Mr. Steven's medication list, you realize that he has many PRN medications. Which one
would be of the highest concern with regard to drug interactions with tadalafil?
A Calcium carbonate (Tums) for GERD
B Nitroglycerin for chest pain
C Ibuprofen for pain
D Diphenhydramine for sleep
Answer - There is a drug interaction with systemic nitrate/nitroglycerin products; advise patients about
the potential interaction and the risk of low blood pressure/hypotension.

29. Oral Contraceptives and Adverse Effect Risk

Ms. Jones has asked about the risks with regard to her birth control. She informs you that she is taking
Loestrin which is a combination of estrogen and progestin. You inform her that it can increase the risk of
blood clots. Which part of her history would increase the risk of a blood clot?
A 1-2 glasses of wine per week
B She runs marathons a few times per year
C She is currently taking rifampin
D She is a smoker
Answer D - Smoking and older age are two major risk factors that will increase the risk for blood clots
associated with oral contraceptives. Rifampin may interact with estrogen and progestin combination
products, but it would be more likely to reduce drug concentrations and not increase clot risk.

30. Lamotrigine Warning

Mr. Thomas was prescribed lamotrigine by their neurologist. They can't recall what side effects are
associated with this medication. What adverse effect carries a boxed warning?
A Edema
B Rash
C Hyperkalemia
D Weight gain
Answer - Lamotrigine is well known to cause a rash and this can be very serious and lead to Stevens-
Johnson Syndrome. It carries a boxed warning from the FDA regarding this risk. Higher dosages without
slow titration can increase this risk. Valproic acid in combination with lamotrigine can also increase this
risk.