Free PTCB Practice Test

Which drug is the generic equivalent of Lipitor?

• Simvastatin
• Atorvastatin (correct answer)
• Rosuvastatin
• Pravastatin

Lipitor is the brand name for atorvastatin, an HMG-CoA reductase inhibitor (statin) used to lower cholesterol. The distractors are also statins, but they pair with different brands: simvastatin is Zocor, rosuvastatin is Crestor, and pravastatin is Pravachol. Knowing exact brand-generic pairs prevents dispensing errors within the same drug class.

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Lisinopril belongs to which drug class?

• Beta blocker
• Calcium channel blocker
• ACE inhibitor (correct answer)
• Angiotensin II receptor blocker

Lisinopril ends in the suffix -pril, which identifies angiotensin-converting enzyme (ACE) inhibitors used for hypertension and heart failure. Angiotensin II receptor blockers (ARBs) are the tempting distractor because they act on the same pathway, but ARB generic names end in -sartan, such as losartan and valsartan.

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A patient taking an ACE inhibitor is most likely to report which common side effect?

• A persistent dry cough (correct answer)
• Persistent constipation
• Gradual weight gain
• Noticeable hair loss

ACE inhibitors such as lisinopril and enalapril commonly cause a persistent, nonproductive dry cough due to bradykinin accumulation in the airways. Patients bothered by the cough are often switched to an ARB, which works on the same system without this effect. Constipation is more typical of verapamil or opioid therapy, not ACE inhibitors.

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Which administration instruction is appropriate for levothyroxine (Synthroid)?

• Take it with a high-fiber breakfast each morning
• Take it at bedtime together with an antacid
• Take it at the same time as a calcium supplement
• Take it on an empty stomach before breakfast (correct answer)

Levothyroxine is best absorbed on an empty stomach, so patients are told to take it with water 30 to 60 minutes before breakfast at a consistent time each day. The distractors all reduce absorption: food, fiber, calcium, iron, and antacids can bind the drug or interfere with uptake, leading to poorly controlled thyroid levels.

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Metformin is the generic name for which brand-name product?

• Glucotrol
• Glucophage (correct answer)
• Glyset
• Glucovance

Glucophage is the brand name for metformin, a first-line oral medication for type 2 diabetes. The distractors sound similar because many diabetes brands begin with 'Glu-': Glucotrol is glipizide, Glyset is miglitol, and Glucovance is a glyburide-metformin combination. These similar names make careful product selection essential.

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Which side effect is most commonly reported when a patient first starts metformin?

• Diarrhea and stomach upset (correct answer)
• A persistent dry cough
• Swelling in the ankles
• Constant ringing in the ears

Gastrointestinal effects such as diarrhea, nausea, and stomach upset are the most common complaints when starting metformin, which is why patients are counseled to take it with food. A dry cough is characteristic of ACE inhibitors, and ankle swelling is associated with calcium channel blockers like amlodipine, not metformin.

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A patient taking warfarin should keep intake of which food group consistent from day to day?

• Fresh citrus fruits
• Low-fat dairy products
• Green leafy vegetables (correct answer)
• Red meat and poultry

Green leafy vegetables such as spinach and kale are rich in vitamin K, which works against warfarin's anticoagulant effect. Patients do not need to avoid these foods entirely, but sudden changes in intake can swing the INR out of range. Dairy and red meat do not meaningfully affect warfarin, and citrus is a concern with certain statins, not warfarin.

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Which laboratory test is used to monitor warfarin therapy?

• Hemoglobin A1c
• INR (correct answer)
• TSH
• Serum creatinine

The international normalized ratio (INR) measures how long blood takes to clot and is the standard test for adjusting warfarin doses; many patients target an INR of 2 to 3. Hemoglobin A1c monitors long-term blood sugar control in diabetes, and TSH monitors thyroid therapy, so neither reflects anticoagulation status.

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How should unopened insulin vials be stored in the pharmacy?

• In the freezer
• At controlled room temperature away from direct light
• On the filling counter for quick access
• In the refrigerator at 36°F to 46°F (2°C to 8°C) (correct answer)

Unopened insulin must be refrigerated at 36°F to 46°F (2°C to 8°C) to remain potent until its labeled expiration date. Freezing destroys insulin and it must never be dispensed if it has been frozen. Room temperature storage is acceptable only for the vial or pen a patient is actively using, and even then most products must be discarded after about 28 days.

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Sublingual nitroglycerin tablets should be dispensed in which container?

• The manufacturer's original glass container (correct answer)
• A standard amber plastic prescription vial
• A weekly pill organizer with labeled compartments
• Any tightly closed container in the refrigerator

Sublingual nitroglycerin is volatile and loses potency when exposed to light, air, moisture, and plastic, so it must stay in the manufacturer's original tightly capped glass container. Repackaging it into a standard plastic vial, the routine practice for most tablets, is the tempting error here, but doing so can leave a patient with an ineffective drug during chest pain.

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Hydroxyzine is most often confused with which look-alike/sound-alike medication?

• Hydrocodone
• Hydrochlorothiazide
• Hydralazine (correct answer)
• Hydrocortisone

Hydroxyzine, an antihistamine, and hydralazine, a blood pressure medication, form a classic look-alike/sound-alike pair on the ISMP confused drug names list. The other options also start with 'hydr-' but differ enough in spelling and use that they are not the recognized paired risk for hydroxyzine.

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Tramadol is most often confused with which look-alike/sound-alike medication?

• Tamsulosin
• Trazodone (correct answer)
• Triamterene
• Tizanidine

Tramadol, an opioid analgesic, and trazodone, an antidepressant commonly used for sleep, are a well-known confused drug name pair on the ISMP list. Selecting the wrong one could give a patient an opioid instead of a sleep aid or vice versa. The other options do not closely resemble tramadol in spelling.

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A patient taking atorvastatin should be told to promptly report which symptom because it may signal a serious adverse effect?

• A mild intermittent headache
• Occasional heartburn after large meals
• A runny nose during allergy season
• Unexplained muscle pain or weakness (correct answer)

Statins can rarely cause serious muscle breakdown (rhabdomyolysis), which can damage the kidneys, so unexplained muscle pain, tenderness, or weakness should be reported right away. Mild headache and heartburn are common, generally benign complaints with many medications and do not signal the characteristic statin danger the way muscle symptoms do.

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Why should patients taking simvastatin avoid drinking large quantities of grapefruit juice?

• Grapefruit juice raises simvastatin levels and can cause muscle toxicity (correct answer)
• Grapefruit juice speeds simvastatin metabolism, lowering the drug's effect
• Grapefruit juice delays tablet dissolution, so the dose takes longer to work
• Grapefruit juice binds simvastatin in the gut, reducing the amount absorbed

Grapefruit juice inhibits intestinal CYP3A4, the enzyme that breaks down simvastatin, so blood levels rise and the risk of muscle toxicity, including rhabdomyolysis, increases. Every distractor describes the drug working less well or more slowly, but the danger runs in the opposite direction: the interaction puts more simvastatin in the body, not less.

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A patient taking an MAOI antidepressant such as phenelzine must avoid aged cheeses and cured meats to prevent which reaction?

• Serotonin syndrome
• Severe hypoglycemia
• A hypertensive crisis (correct answer)
• An anaphylactic reaction

Aged and fermented foods contain tyramine, which MAOIs prevent the body from breaking down; the resulting buildup can trigger a sudden, dangerous spike in blood pressure known as a hypertensive crisis. Serotonin syndrome is the tempting distractor because it is also linked to MAOIs, but it results from combining serotonergic drugs, not from eating tyramine-rich foods.

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Why should doses of tetracycline be separated from calcium-containing antacids and dairy products?

• Calcium increases tetracycline levels and causes toxicity
• Calcium binds tetracycline in the gut and reduces its absorption (correct answer)
• The combination causes severe drowsiness
• The combination permanently stains adult teeth

Calcium, magnesium, aluminum, and iron form insoluble complexes with tetracycline in the gastrointestinal tract, a process called chelation, so less antibiotic is absorbed and the infection may not be treated effectively. The first option reverses the direction of the interaction; the problem is too little drug reaching the bloodstream, not too much.

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Generic drug names ending in -olol, such as metoprolol and atenolol, generally belong to which drug class?

• Beta blockers (correct answer)
• ACE inhibitors
• Proton pump inhibitors
• Statins

The suffix -olol identifies beta blockers, which slow heart rate and lower blood pressure. Recognizing class suffixes is a fast accuracy check during order entry: each of the other classes listed has its own characteristic generic-name ending, and none of them uses -olol.

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Losartan is the generic name for which brand-name product?

• Diovan
• Avapro
• Benicar
• Cozaar (correct answer)

Cozaar is the brand name for losartan, an angiotensin II receptor blocker (ARB) used for hypertension. The distractors are other ARBs, which makes them tempting: Diovan is valsartan, Avapro is irbesartan, and Benicar is olmesartan. Same-class drugs are not interchangeable without a new prescription.

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Omeprazole belongs to which drug class?

• H2-receptor antagonist
• Antacid
• Proton pump inhibitor (correct answer)
• Prokinetic agent

Omeprazole (Prilosec) is a proton pump inhibitor (PPI), identified by the -prazole suffix, and it reduces stomach acid production for conditions such as GERD and ulcers. H2 blockers like famotidine also reduce acid and are the tempting distractor, but they work at a different receptor and their generic names end in -tidine.

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Which drug is the generic equivalent of Zoloft?

• Escitalopram
• Sertraline (correct answer)
• Fluoxetine
• Paroxetine

Zoloft is the brand name for sertraline, a selective serotonin reuptake inhibitor (SSRI) used for depression and anxiety disorders. The distractors are all SSRIs as well, which is what makes them plausible: escitalopram is Lexapro, fluoxetine is Prozac, and paroxetine is Paxil.

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Alprazolam is the generic name for which brand-name benzodiazepine?

• Xanax (correct answer)
• Ativan
• Klonopin
• Valium

Alprazolam is marketed as Xanax, a Schedule IV benzodiazepine used for anxiety and panic disorder. The other choices are benzodiazepine brands paired with different generics: Ativan is lorazepam, Klonopin is clonazepam, and Valium is diazepam. Confusing agents within this class is a common source of dispensing errors.

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An albuterol inhaler is primarily used for which purpose?

• Long-term daily control of airway inflammation
• Prevention of seasonal allergy symptoms
• Quick relief of acute bronchospasm (correct answer)
• Treatment of respiratory infections

Albuterol is a short-acting beta agonist 'rescue' inhaler that rapidly relaxes airway muscles during an acute asthma or bronchospasm episode. Long-term control is the tempting distractor, but that role belongs to maintenance therapies such as inhaled corticosteroids; relying on albuterol alone for daily control signals poorly managed asthma.

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Patients using a fluticasone (Flovent) inhaler should be counseled to do what after each use?

• Lie down and rest for 10 to 15 minutes
• Rinse the mouth with water and spit (correct answer)
• Drink a large glass of milk
• Use an over-the-counter nasal decongestant

Fluticasone is an inhaled corticosteroid, and steroid particles left in the mouth and throat can cause oral thrush (a candida yeast infection). Rinsing with water and spitting after each use washes the residue away. The other options do not remove drug from the oral cavity and provide no protection against this well-known adverse effect.

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Digoxin has a narrow therapeutic index. Which combination of symptoms may indicate digoxin toxicity?

• Dry mouth, thirst, and constipation
• Weight gain and swelling of the legs
• Increased appetite and trouble sleeping
• Nausea, vomiting, and visual disturbances (correct answer)

Classic signs of digoxin toxicity include nausea, vomiting, loss of appetite, and visual changes such as blurred or yellow-green vision, along with dangerous heart rhythm disturbances. Because the toxic level sits close to the therapeutic level, these warning signs matter. Weight gain and swelling suggest worsening heart failure rather than drug toxicity.

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Patients taking metronidazole should be warned to avoid which substance during therapy and for several days afterward?

• Alcohol (correct answer)
• Dairy products
• Green leafy vegetables
• Caffeine

Combining metronidazole (Flagyl) with alcohol can cause a disulfiram-like reaction with flushing, throbbing headache, nausea, vomiting, and rapid heartbeat, so alcohol should be avoided during treatment and for about three days after the last dose. Dairy restriction is the tempting distractor because it applies to tetracyclines, not metronidazole.

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Which opioid side effect typically persists for as long as therapy continues rather than improving with time?

• Drowsiness
• Nausea
• Constipation (correct answer)
• Itching

Tolerance develops to most opioid side effects, including drowsiness and nausea, within days to weeks, but constipation continues for the entire duration of therapy because opioid receptors in the gut keep slowing intestinal movement. This is why patients on chronic opioids are often counseled about a bowel regimen from the start of treatment.

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Which side effect is most commonly associated with diphenhydramine (Benadryl)?

• Diarrhea
• Drowsiness (correct answer)
• High blood pressure
• Ringing in the ears

Diphenhydramine is a first-generation antihistamine that crosses into the brain and causes marked drowsiness, which is why it also appears in OTC sleep aids and why patients are warned about driving. Second-generation antihistamines such as loratadine were developed specifically to reduce this sedation. Diarrhea is not typical; the drug's anticholinergic effects more often cause dry mouth and constipation.

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Neurontin is the brand name for which generic drug?

• Pregabalin
• Levetiracetam
• Lamotrigine
• Gabapentin (correct answer)

Neurontin is the brand name for gabapentin, used for nerve pain and seizures. Pregabalin is the tempting distractor because it is a closely related drug, but its brand name is Lyrica. Levetiracetam is Keppra and lamotrigine is Lamictal, both antiseizure medications with different uses and dosing.

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Hydrochlorothiazide therapy is most likely to cause which electrolyte abnormality?

• Low potassium (hypokalemia) (correct answer)
• High potassium (hyperkalemia)
• High sodium (hypernatremia)
• Low blood sugar (hypoglycemia)

Thiazide diuretics such as hydrochlorothiazide increase urinary excretion of potassium, so patients can develop hypokalemia, which may cause muscle cramps and dangerous heart rhythms. Prescribers often monitor potassium levels or add a supplement during thiazide therapy, and the other laboratory changes listed are not characteristic effects of this drug class.

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Because spironolactone is a potassium-sparing diuretic, patients taking it are at increased risk for which condition?

• Hypokalemia
• Hypoglycemia
• Hyperkalemia (correct answer)
• Hypernatremia

Spironolactone (Aldactone) causes the kidneys to retain potassium while excreting sodium and water, so potassium levels can climb too high (hyperkalemia), especially when combined with ACE inhibitors, ARBs, or potassium supplements. Patients should also be cautious with potassium-containing salt substitutes, and periodic laboratory monitoring is common.

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Which common side effect should patients starting amlodipine (Norvasc) be told about?

• A persistent dry cough
• Swelling of the ankles and feet (correct answer)
• Severe watery diarrhea
• Gradual hearing loss in both ears

Amlodipine is a dihydropyridine calcium channel blocker, and peripheral edema, swelling of the ankles and feet, is one of its most common dose-related side effects. The dry cough distractor is tempting because both drug types treat blood pressure, but cough is the signature complaint of ACE inhibitors, not calcium channel blockers.

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Which statement about metoprolol products is correct?

• Metoprolol tartrate is the once-daily extended-release form
• Metoprolol succinate is the immediate-release form sold as Lopressor
• The two salt forms may always be interchanged without contacting the prescriber
• Metoprolol succinate is the extended-release form sold as Toprol-XL (correct answer)

Metoprolol succinate (Toprol-XL) is the extended-release salt taken once daily, while metoprolol tartrate (Lopressor) is immediate-release and usually taken twice daily. Because the salts differ in release characteristics and dosing frequency, they are not interchangeable without prescriber authorization, making the substitution option a dangerous assumption.

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After reconstitution, most amoxicillin oral suspensions should be discarded after how many days?

• 14 days (correct answer)
• 28 days
• 60 days
• 90 days

Once water is added, amoxicillin suspension is chemically stable for only 14 days, so the pharmacy labels a 14-day beyond-use date and refrigeration is recommended to preserve stability and improve taste. The 28-day distractor is tempting because it matches the room-temperature limit for many opened insulin products, but it does not apply to reconstituted amoxicillin.

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Which vaccine must be stored in a freezer rather than a refrigerator?

• Inactivated influenza vaccine
• Hepatitis B vaccine
• Varicella (Varivax) vaccine (correct answer)
• Tdap vaccine

Varicella vaccine must be kept frozen between -58°F and +5°F (-50°C and -15°C) to remain potent, and doses stored incorrectly may have to be discarded. Influenza, hepatitis B, and Tdap vaccines are all refrigerated at 36°F to 46°F and must never be frozen, so mixing up these storage requirements ruins product in either direction.

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Ondansetron, the generic for Zofran, is primarily used for which purpose?

• Relieving heartburn and reflux
• Preventing nausea and vomiting (correct answer)
• Treating traveler's diarrhea
• Reducing fever and body aches

Ondansetron is a 5-HT3 antagonist antiemetic that blocks serotonin signals responsible for triggering nausea and vomiting, commonly from chemotherapy, surgery, or acute illness. Although all the distractors involve symptom relief, none involves the vomiting pathway; heartburn, for example, is treated with acid reducers such as PPIs or H2 blockers.

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A patient picking up a course of oral prednisone should receive which counseling point?

• Stop taking it immediately once you feel better
• Take it on an empty stomach at bedtime each night
• Double the next dose whenever a dose is missed
• Take it with food and do not stop it abruptly (correct answer)

Prednisone can irritate the stomach, so taking it with food is advised, and after prolonged therapy the dose must be tapered because the body's own steroid production is suppressed; stopping suddenly can cause adrenal insufficiency. The first option is the dangerous opposite of correct practice, and doubling doses is never routine advice for corticosteroids.

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On the ISMP error-prone abbreviations list, how should insulin doses be written instead of using the abbreviation 'U'?

• The abbreviation IU
• The word 'units' spelled out (correct answer)
• A superscript letter u
• The letter U followed by a period

The abbreviation 'U' can be misread as a zero or a four, turning 10 U of insulin into 100 or 104 units, a potentially fatal overdose, so the word 'units' must be written out. 'IU' is the tempting distractor, but it appears on the same error-prone list because it can be misread as 'IV' or the number 10.

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Why does ISMP recommend against using the abbreviation 'QD' for once-daily dosing?

• It is Latin and considered unprofessional in charts
• It takes too long to write on paper prescriptions
• It may only be used in hospital inpatient settings
• It can be misread as QID (four times daily) (correct answer)

A sloppily written QD is easily mistaken for QID, quadrupling the daily dose, or for OD, sending an oral dose to the eye, so ISMP directs prescribers to write the word 'daily' instead. The issue is misinterpretation risk, not the use of Latin itself; many safe abbreviations also derive from Latin.

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A prescriber writes an order for 'warfarin 1.0 mg.' Why is this format dangerous?

• A missed decimal point turns the order into 10 mg (correct answer)
• Warfarin is not manufactured in a 1 mg tablet strength
• Trailing zeros make the prescription legally invalid
• Warfarin can never be safely dosed at only 1 mg

A trailing zero after a decimal point is on the ISMP do-not-use list because a faint or missed decimal turns 1.0 mg into 10 mg, and with a high-alert drug like warfarin a tenfold overdose can cause life-threatening bleeding. The dose should simply be written as 1 mg. Warfarin is in fact made in a 1 mg tablet, and the order is not legally invalid; it is unsafe, which is why the format should be clarified and avoided.

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Under ISMP safe-writing rules, which is the correct way to write a half-milligram dose?

• .5 mg
• 0.50 mg
• .50 mg
• 0.5 mg (correct answer)

A leading zero is always required before a decimal point ('0.5 mg') because a bare '.5 mg' can be misread as 5 mg if the decimal is overlooked. Trailing zeros are prohibited for the mirror-image reason: '0.50 mg' or '.50 mg' invites a misread as 50 mg. The safe format therefore uses a leading zero and no trailing zero.

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What is the purpose of tall man lettering, such as DOPamine and DOBUTamine?

• To flag medications that require refrigerated storage
• To highlight the differing letters in similar drug names (correct answer)
• To show which part of the drug name is the active ingredient
• To identify controlled substances on the shelf

Tall man lettering capitalizes the portions of similar drug names that differ, helping staff visually distinguish confusable pairs like DOPamine and DOBUTamine during product selection and order entry. It carries no meaning about storage, chemistry, or controlled status; it is purely a visual error-prevention technique promoted by ISMP and FDA.

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Which medication appears on the ISMP list of high-alert medications for community pharmacy?

• Insulin (correct answer)
• Amoxicillin
• Omeprazole
• Loratadine

High-alert medications are drugs that carry a heightened risk of causing significant patient harm when used in error, and all insulin products are on the ISMP community pharmacy list along with opioids, anticoagulants, and oral chemotherapy. Amoxicillin, omeprazole, and loratadine can certainly be involved in errors, but mistakes with them are far less likely to be catastrophic.

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A patient experiences a serious adverse reaction to a prescription drug. Which FDA program accepts voluntary reports of serious adverse drug events and product quality problems?

• VAERS
• OSHA
• MedWatch (correct answer)
• REMS

MedWatch is the FDA's safety information and adverse event reporting program for drugs, biologics, and medical devices, and it also accepts reports of product quality problems. OSHA addresses workplace safety, REMS is a risk-management framework for specific drugs rather than a reporting program, and VAERS is a separate reporting system with its own distinct scope.

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An adverse event that occurs after a vaccination should be reported to which program?

• MedWatch
• ISMP MERP
• The DEA
• VAERS (correct answer)

The Vaccine Adverse Event Reporting System (VAERS), co-managed by the FDA and CDC, is the national program for reporting adverse events that follow immunization. ISMP MERP collects medication error reports rather than vaccine reactions, and the DEA regulates controlled substances, not vaccine safety surveillance.

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After a serious medication error reaches a patient, the pharmacy conducts a root cause analysis. What is the primary goal of this process?

• To determine which employee should be disciplined or retrained
• To find and fix the system weaknesses that allowed the error (correct answer)
• To satisfy the pharmacy's liability insurance carrier
• To calculate the total financial cost of the error

Root cause analysis is a retrospective, systems-focused review that asks why an error was possible, examining workflow, staffing, labeling, and technology rather than blaming individuals. A punitive focus is the tempting distractor, but blame-centered cultures discourage error reporting, which ultimately makes patients less safe.

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How does failure mode and effects analysis (FMEA) differ from root cause analysis?

• FMEA looks for potential failure points before an error occurs (correct answer)
• FMEA is performed only after a serious patient harm event
• FMEA focuses on assigning blame to individual employees
• FMEA may only be conducted by FDA investigators

FMEA is a prospective tool: a team maps a process, such as launching a new compounding service, and asks what could go wrong at each step so safeguards can be built in ahead of time. Root cause analysis, by contrast, is retrospective and happens after an event. Neither method is about individual blame, and both are conducted by the organization itself.

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Alcohol-based hand sanitizers are NOT reliably effective against which organism, making handwashing with soap and water necessary after contact?

• Influenza A virus
• Methicillin-resistant Staphylococcus aureus
• Clostridioides difficile spores (correct answer)
• Escherichia coli

C. difficile forms hardy spores that alcohol does not destroy; the mechanical action of washing with soap and running water is needed to physically remove them from the hands. Alcohol-based rubs remain effective against most common bacteria and enveloped viruses, including influenza, which is why they are acceptable for routine hand hygiene in other situations.

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According to CDC guidance, hands should be lathered and scrubbed with soap and water for at least how long?

• 5 seconds
• 10 seconds
• 60 seconds
• 20 seconds (correct answer)

The CDC recommends scrubbing all surfaces of the hands, including between fingers and under nails, for at least 20 seconds before rinsing. Shorter contact times remove fewer microorganisms and are a common shortcut that undermines infection control. A full minute is not required for routine handwashing, though sterile compounding procedures involve longer, more thorough hand and forearm cleansing.

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Scanning the NDC barcode on the stock bottle during prescription filling primarily prevents which type of error?

• Selecting the wrong drug or strength from the shelf (correct answer)
• Billing the wrong insurance plan
• Handing the prescription to the wrong patient at pickup
• Miscounting the number of tablets

Barcode verification compares the scanned stock bottle's NDC against the product entered on the prescription, catching wrong-drug and wrong-strength selections before the medication is counted and labeled. Wrong-patient errors at pickup are prevented by verifying two patient identifiers at the register, not by barcode scanning during filling.

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A technician catches a wrong-strength error during the final check before the prescription is sold. This event is best described as what?

• A sentinel event
• A near miss (correct answer)
• An adverse drug reaction
• A side effect

A near miss (close call) is an error that is caught and corrected before it reaches the patient. It should still be documented and reported internally because near misses reveal weaknesses that could cause a future harmful error. A sentinel event is the tempting distractor, but that term describes a serious event that actually reaches a patient and causes death or major harm.

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Before releasing a prescription at the register, which two patient identifiers should be verified?

• First name and phone number
• Street address and prescription number
• Full name and date of birth (correct answer)
• Last name and insurance ID number

Verifying the patient's full name plus date of birth is the standard two-identifier check because the combination is unlikely to match two different people, unlike a first name or shared household address. Asking the patient to state the identifiers, rather than confirming a yes/no question, further reduces the chance of releasing medication to the wrong person.

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A patient asks the pharmacy technician whether a new prescription is safe to take with an OTC pain reliever. What should the technician do?

• Answer the question using the package insert
• Recommend acetaminophen as the safest choice
• Suggest the patient look it up online
• Refer the question to the pharmacist (correct answer)

Questions about drug interactions, safety, and product selection are counseling, which under OBRA-90 and state pharmacy practice acts must be handled by the pharmacist. Reading from a package insert may feel helpful, but interpreting clinical information for a specific patient is still counseling and falls outside the technician's scope of practice.

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During a monthly shelf check, a technician finds a bottle of expired tablets. What should be done with it?

• Leave it on the shelf with a clear warning sticker
• Remove it and quarantine it away from dispensing stock (correct answer)
• Dispense it only if it expired less than one month ago
• Donate it promptly to a local free clinic

Expired stock must be physically removed and stored in a clearly designated quarantine area so it cannot be accidentally dispensed while awaiting return to a reverse distributor or destruction. Dispensing recently expired drug is never acceptable because potency and safety are no longer assured, and donating expired medication simply transfers that risk to another patient.

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Which strategy helps prevent errors involving look-alike/sound-alike drug pairs stored in the pharmacy?

• Physically separating the products and using shelf warning labels (correct answer)
• Storing them directly next to each other so staff see both names
• Relying on experienced staff to remember the difference
• Keeping both products in the same bin to save space

Separating confusable products on the shelf and adding auxiliary shelf alerts or tall man letter labels forces an extra moment of attention and physically reduces grab-the-wrong-bottle errors. Reliance on memory is the tempting distractor because experienced staff feel confident, but human vigilance alone fails under workload and distraction, which is why system-based safeguards are preferred.

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Why is concentrated potassium chloride injection subject to strict storage restrictions in health systems?

• It is classified as a controlled substance
• It requires strict protection from light
• Accidental IV push of the concentrate can be fatal (correct answer)
• It degrades within a few hours at room temperature

Undiluted concentrated potassium chloride given intravenously can stop the heart, so it is a high-alert medication that is removed from patient care areas and stored securely in the pharmacy, where it is diluted before use. It is not a controlled substance; the restriction exists because of clinical danger, not abuse potential or stability concerns.

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Under USP <800>, a technician counting or repackaging a hazardous drug such as an oral chemotherapy agent should do what?

• Handle the tablets with bare hands and wash afterward
• Count the tablets quickly to limit exposure time
• Store the drug with regular stock to avoid confusion
• Use dedicated equipment and wear chemotherapy-rated gloves (correct answer)

USP <800> requires that hazardous drugs be handled with tested chemotherapy gloves and counted on dedicated equipment that is decontaminated after use, because drug residue can transfer to other products and expose staff. Speed does not reduce contact exposure, and hazardous drugs must be stored separately from regular stock, not mixed with it.

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Which agent is used to disinfect the work surfaces of an ISO Class 5 laminar airflow workbench before sterile compounding?

• Sterile 70% isopropyl alcohol (correct answer)
• Full-strength household bleach
• 3% hydrogen peroxide from the OTC aisle
• Warm soapy water alone

Sterile 70% isopropyl alcohol is the standard agent for disinfecting the hood's work surfaces before compounding and for wiping vial stoppers and ampule necks, and it must be allowed to dry so it can act. Household bleach and retail peroxide are not sterile agents intended for the primary engineering control, and soap alone cleans but does not adequately disinfect.

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Which workplace practice reduces the likelihood of order-entry errors?

• Encouraging multitasking during prescription data entry
• Answering phone calls while typing prescriptions
• Establishing interruption-free zones for order entry (correct answer)
• Setting higher hourly filling quotas

Distraction is a leading contributor to data-entry mistakes, so designating interruption-free zones or times for entering and verifying prescriptions lets staff give full attention to critical tasks. Multitasking feels efficient, which makes it the tempting choice, but dividing attention between the phone and the keyboard measurably increases wrong-drug, wrong-dose, and wrong-patient entries.

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A technician realizes that a patient who has already left the pharmacy received another patient's medication. What is the FIRST step?

• Wait to see whether the patient calls to complain
• Notify the pharmacist so the patient can be contacted (correct answer)
• Quietly correct the record in the computer system
• Complete an incident report at the end of the week

Patient safety comes first: the pharmacist must be told immediately so the patient can be reached before taking the wrong drug, and the pharmacist can assess clinical risk and direct next steps. Documentation and record correction follow, but they never precede stopping potential harm, and concealing or delaying disclosure of an error is a serious professional violation.

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Which of the following is one of the classic 'five rights' of safe medication use?

• Right price
• Right pharmacy
• Right manufacturer
• Right route (correct answer)

The five rights are the right patient, right drug, right dose, right route, and right time, and each dispensing check should confirm all five. Price, pharmacy location, and manufacturer may matter for billing and stocking, but they are not part of this core safety checklist; a generic from a different manufacturer is still the right drug if product and strength match.

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The sig '1 tab PO BID' directs the patient to take:

• One tablet by mouth once daily
• Two tablets by mouth once daily
• One tablet by mouth twice daily (correct answer)
• One tablet under the tongue twice daily

PO means by mouth and BID means twice daily, so the patient takes one tablet by mouth two times each day. The sublingual distractor is tempting because SL and PO are both route abbreviations, but PO specifically means swallowed by mouth. Misreading BID as the number of tablets rather than the frequency is a classic order-entry mistake.

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The sig 'ii gtts OU q6h' directs the patient to instill:

• Two drops in both eyes every 6 hours (correct answer)
• Two drops in the right eye every 6 hours
• Two drops in both ears every 6 hours
• One drop in each eye six times daily

Roman numeral ii means two, gtts means drops, OU means both eyes, and q6h means every 6 hours. OD (right eye) and AU (both ears) are the confusable distractors; in fact, these organ abbreviations are so easily misread that ISMP recommends writing out 'each eye' or 'each ear,' though technicians must still be able to interpret them on incoming prescriptions.

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In the sig '1 tab po ac,' the abbreviation 'ac' instructs the patient to take the dose:

• After meals
• Before meals (correct answer)
• At bedtime
• As needed

The abbreviation 'ac' comes from the Latin ante cibum, meaning before meals, and is common on prescriptions for drugs like sulfonylureas that work best taken before eating. The tempting reverse answer, after meals, is abbreviated 'pc' (post cibum), while 'hs' means at bedtime and 'prn' means as needed.

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A prescription for 30 tablets carries the sig '1 tab PO TID.' How many days will the supply last?

• 30 days
• 15 days
• 7 days
• 10 days (correct answer)

TID means three times daily, so the patient uses 3 tablets per day. Days supply equals quantity divided by daily use: 30 tablets ÷ 3 tablets per day = 10 days. The 30-day distractor comes from overlooking the frequency, and 15 days would result from misreading TID as BID (twice daily).

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Amoxicillin 250 mg/5 mL suspension is prescribed as 500 mg three times daily for 10 days. What total quantity should be dispensed?

• 150 mL
• 300 mL (correct answer)
• 200 mL
• 250 mL

Each 500 mg dose requires 10 mL because the concentration is 250 mg per 5 mL. Three doses daily uses 3 × 10 mL = 30 mL per day, and over 10 days the total is 30 × 10 = 300 mL. The 150 mL distractor results from forgetting to double the 5 mL for the 500 mg dose, an easy concentration error.

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A patient injects 40 units of U-100 insulin daily from a 10 mL vial. What is the days supply?

• 25 days (correct answer)
• 30 days
• 20 days
• 40 days

U-100 insulin contains 100 units per mL, so a 10 mL vial holds 10 × 100 = 1,000 units. Dividing by daily use gives 1,000 ÷ 40 = 25 days. The 30-day distractor is tempting because so many prescriptions are billed for 30 days, but the arithmetic here supports only 25; billing insulin for more days than the vial provides causes claim and refill problems.

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A prescription reads 'Instill 1 drop into the right eye twice daily.' Using 20 drops per mL, what is the days supply of a 5 mL bottle?

• 25 days
• 40 days
• 50 days (correct answer)
• 100 days

A 5 mL bottle at 20 drops per mL contains 5 × 20 = 100 drops. The patient uses 1 drop twice daily, or 2 drops per day, so 100 ÷ 2 = 50 days. The 100-day distractor comes from forgetting the twice-daily frequency, and 25 days would result from incorrectly assuming both eyes are being treated.

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A liquid medication is dosed as 2 teaspoonfuls twice daily for 10 days. How many milliliters should be dispensed?

• 100 mL
• 400 mL
• 150 mL
• 200 mL (correct answer)

One teaspoonful equals 5 mL, so each dose is 2 × 5 mL = 10 mL. Twice-daily dosing uses 10 × 2 = 20 mL per day, and 20 × 10 days = 200 mL. The 100 mL distractor comes from treating the whole two-teaspoonful dose as only 5 mL, and 400 mL comes from treating each teaspoonful as 10 mL, which doubles the correct total.

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A patient weighs 176 pounds. What is this weight in kilograms?

• 88 kg
• 80 kg (correct answer)
• 76 kg
• 96 kg

Pounds are converted to kilograms by dividing by 2.2: 176 ÷ 2.2 = 80 kg. The 88 kg distractor is the classic error of dividing by 2 instead of 2.2, which overstates the patient's weight and would inflate any weight-based dose calculated from it.

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A drug is dosed at 10 mg/kg/day. What is the correct daily dose for a child weighing 22 pounds?

• 220 mg
• 44 mg
• 100 mg (correct answer)
• 110 mg

First convert pounds to kilograms: 22 ÷ 2.2 = 10 kg. Then multiply by the dose: 10 kg × 10 mg/kg = 100 mg per day. The 220 mg distractor comes from multiplying by the weight in pounds without converting, a doubling error that is especially dangerous in pediatric dosing.

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How many grams of hydrocortisone are contained in 100 g of hydrocortisone 1% ointment?

• 1 g (correct answer)
• 0.1 g
• 10 g
• 0.01 g

A 1% weight-in-weight preparation contains 1 g of active drug in every 100 g of product, so 100 g of ointment contains exactly 1 g of hydrocortisone. The 10 g distractor would represent a 10% preparation, and 0.1 g would be 0.1%; percentage strength always expresses parts of drug per 100 parts of product.

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Epinephrine 1:1000 solution contains how much epinephrine per milliliter?

• 1 g/mL
• 0.1 mg/mL
• 10 mg/mL
• 1 mg/mL (correct answer)

A ratio strength of 1:1000 means 1 g of drug in 1,000 mL of solution. Converting, 1 g = 1,000 mg, so 1,000 mg ÷ 1,000 mL = 1 mg/mL. Confusing ratio strengths has caused fatal epinephrine errors, which is why labeling now emphasizes the mg/mL expression instead of ratios.

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In a 10-digit NDC formatted 5-4-2, what does the first segment identify?

• The package size
• The labeler (manufacturer or distributor) (correct answer)
• The product strength and dosage form
• The lot number

The NDC's three segments identify, in order, the labeler (the manufacturer or distributor, assigned by the FDA), the product (drug, strength, and dosage form), and the package size. The lot number is the tempting distractor because it also appears on the bottle, but it is assigned per production batch and is not part of the NDC at all.

Which DAW code is entered when the prescriber writes 'Brand Medically Necessary' on the prescription?

• DAW 1 (correct answer)
• DAW 0
• DAW 2
• DAW 5

DAW 1 indicates that the prescriber requires the brand-name product and substitution is not allowed; handwritten instructions such as 'Brand Medically Necessary' or 'Dispense as Written' trigger this code. Entering any other DAW code misrepresents who made the brand decision and can cause claim rejections and audit findings.

A prescriber allows substitution, but the patient insists on receiving the brand-name product. Which DAW code applies?

• DAW 0
• DAW 1
• DAW 2 (correct answer)
• DAW 3

DAW 2 documents that substitution was permitted but the patient requested the brand-name drug, which often means the patient pays a higher copay or the difference in price. Coding the claim with any other DAW value misstates who asked for the brand and can lead to claim rejections and audit findings.

Which DAW code indicates that no product selection was specified and generic substitution is permitted?

• DAW 9
• DAW 7
• DAW 1
• DAW 0 (correct answer)

DAW 0 is the default code meaning the prescriber made no brand requirement and the pharmacy may dispense a generic; it is the code on the vast majority of claims. DAW 7 is the tempting distractor, but it means substitution is prohibited by state law for that product, a very different situation from an unrestricted prescription.

The Roman numeral 'viii' on a prescription represents what quantity?

• 8 (correct answer)
• 6
• 13
• 12

In Roman numerals, v equals 5 and each i equals 1, so viii equals 5 + 1 + 1 + 1 = 8. Reading vi as 6 but then miscounting the i's, or confusing viii with xiii (13), leads to wrong quantities. Prescribers often use Roman numerals for controlled substance quantities because they are harder to alter.

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After counting amoxicillin capsules on a counting tray, what should the technician do before using that tray for other medications?

• Nothing, because counting trays do not retain drug residue
• Rinse the tray with water only at the end of the day
• Clean the tray and spatula to remove penicillin residue (correct answer)
• Turn the tray over and count on the reverse side

Powder residue from penicillin products clings to trays and spatulas and can contaminate the next drug counted, potentially triggering a reaction in a penicillin-allergic patient. The equipment must be cleaned immediately after use, and many pharmacies keep dedicated trays for penicillins, sulfonamides, and hazardous drugs. Waiting until the end of the day leaves every intervening count contaminated.

Which graduated cylinder should be selected to measure 27 mL of a liquid most accurately?

• A 100 mL graduate
• A 30 mL graduate (correct answer)
• A 250 mL graduate
• A 10 mL graduate filled three times

Accuracy is best when the volume fills most of the graduate, so the smallest cylinder that holds the entire quantity, here the 30 mL graduate, is correct, with the reading taken at the bottom of the meniscus at eye level. Larger graduates make small volumes hard to read precisely, and splitting the measurement across multiple fills compounds measurement error with each pour.

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Under federal law, how many refills are permitted on a prescription for a Schedule II controlled substance?

• Up to five within six months
• One, if authorized by the prescriber
• None (correct answer)
• Unlimited refills for one year

Federal law prohibits any refills on Schedule II prescriptions; the patient must obtain a new prescription each time. The refill allowances described in the other options exist elsewhere in pharmacy practice, but none of them applies to Schedule II drugs such as oxycodone and methylphenidate.

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Under federal law, prescriptions for Schedule III and IV controlled substances may be refilled how many times?

• Up to 5 times within 6 months of the date issued (correct answer)
• Up to 5 times within 12 months of the date issued
• Up to 6 times within 6 months of the date issued
• They may not be refilled at all

The Controlled Substances Act allows Schedule III and IV prescriptions to be refilled a maximum of 5 times within 6 months of the issue date, whichever limit is reached first. The 12-month distractor borrows the typical validity period of non-controlled prescriptions, and 6 refills in 6 months exceeds what the statute permits.

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Which DEA form, or its electronic equivalent through CSOS, must a pharmacy use to order Schedule II substances from a wholesaler?

• DEA Form 224
• DEA Form 222 (correct answer)
• DEA Form 106
• DEA Form 41

DEA Form 222, or an electronic order placed through the Controlled Substance Ordering System (CSOS), is required for every purchase or transfer of Schedule I or II substances, and executed forms must be kept on file for two years. The other DEA forms listed serve different administrative purposes and cannot be used to order controlled substances.

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A newly opened community pharmacy must submit which DEA form to register to dispense controlled substances?

• DEA Form 222
• DEA Form 41
• DEA Form 106
• DEA Form 224 (correct answer)

DEA Form 224 is the application for registration that authorizes a retail pharmacy to dispense controlled substances, and the registration must be renewed every three years. Registration always comes first: every other controlled-substance activity a pharmacy performs presumes it already holds a valid DEA registration.

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The theft or significant loss of controlled substances must be reported to the DEA using which form?

• DEA Form 106 (correct answer)
• DEA Form 41
• DEA Form 222
• DEA Form 363

DEA Form 106 is the report of theft or significant loss of controlled substances, filed after the pharmacy makes its initial notification to the DEA. Form 363 applies to narcotic treatment programs, and the other forms listed have no role in reporting a theft or loss.

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Which FDA recall classification indicates a reasonable probability that using the product will cause serious adverse health consequences or death?

• Class III
• Class II
• Class I (correct answer)
• Market withdrawal

Class I is the most serious recall category, reserved for products with a reasonable probability of causing serious harm or death, such as a wrong drug in the bottle or a life-saving product that fails. Class II involves temporary or reversible harm, and Class III involves unlikely harm. The numbering feels backward to many students, which makes Class III the tempting wrong answer.

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The iPLEDGE REMS program is required for patients receiving which medication?

• Clozapine
• Isotretinoin (correct answer)
• Thalidomide
• Warfarin

iPLEDGE is the REMS for isotretinoin, an acne drug that causes severe birth defects; the program requires registration, pregnancy testing, and contraception commitments before dispensing. Thalidomide is tempting because it also carries its own teratogenicity REMS, and warfarin, though high-risk, has no REMS. Clozapine once had a REMS as well, but the FDA eliminated that program in 2025.

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Using the DEA checksum, what must the seventh digit be for a DEA number that begins AB123456?

• 9
• 6
• 1
• 3 (correct answer)

Add the first, third, and fifth digits: 1 + 3 + 5 = 9. Add the second, fourth, and sixth digits and double the result: (2 + 4 + 6) × 2 = 24. The sum is 9 + 24 = 33, and the last digit of that sum, 3, must be the check digit. Choosing 9 reflects stopping after the first step, the most common checksum mistake.

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Under the Combat Methamphetamine Epidemic Act, a purchaser may buy no more than how much pseudoephedrine base in a 30-day period from a retail pharmacy?

• 3.6 g
• 9 g (correct answer)
• 7.5 g
• 24 g

Federal law limits retail pseudoephedrine purchases to 9 g of base per 30 days, in addition to a 3.6 g daily sales limit, and requires the product to be kept behind the counter with a logbook of sales. The 3.6 g distractor is the daily limit, not the monthly one, and 7.5 g is the separate 30-day limit that applies to mail-order sales.

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Federal law requires a pharmacy to take a complete inventory of all controlled substances at least how often?

• Every 2 years (correct answer)
• Every year
• Every 5 years
• Every 6 months

The Controlled Substances Act requires a biennial inventory, meaning a full count of all controlled substances on hand at least every 2 years, with Schedule II drugs counted exactly and Schedule III-V drugs allowed an estimated count for open containers of 1,000 units or fewer. Some states impose stricter, more frequent requirements, but the federal minimum is every 2 years.

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When a pharmacy registrant destroys controlled substances, which DEA form documents the destruction?

• DEA Form 222
• DEA Form 106
• DEA Form 41 (correct answer)
• DEA Form 224

DEA Form 41 is the registrant's record of controlled substances destroyed, and DEA rules require that the drugs be rendered 'non-retrievable' so they cannot be diverted or used. Destruction is a planned, witnessed, and documented event, which is what separates Form 41 from the forms covering other types of inventory removal.

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