Pharmacotherapy
1. Which of the following anti-diabetic agents is most likely to cause hypoglycemia?
A. Glyburide
B. Sitagliptin
C. Metformin
D. Pioglitazone
Correct Answer: A. Glyburide
Explanation:
A. Glyburide ✔️ — Correct. Glyburide is a sulfonylurea that increases insulin secretion regardless of glucose levels, which increases the risk of hypoglycemia.
B. Sitagliptin ❌ — A DPP-4 inhibitor; it enhances insulin release in a glucose-dependent manner, making hypoglycemia rare.
C. Metformin ❌ — A biguanide that decreases hepatic glucose production; it doesn’t increase insulin secretion and is not associated with hypoglycemia.
D. Pioglitazone ❌ — A thiazolidinedione (TZD); improves insulin sensitivity, but rarely causes hypoglycemia when used alone.
A nurse scans a patient’s wristband and the medication barcode before administering insulin. This process is an example of:
A. Medication Administration Record (MAR)
B. Barcode Medication Administration (BCMA)
C. Computerized Provider Order Entry (CPOE)
D. Drug Utilization Review (DUR)
Correct Answer: B. Barcode Medication Administration (BCMA)
Explanation:
A. MAR ❌ — The MAR is used to document medication administration, not to verify patient identity at the point of care.
B. BCMA ✔️ — Correct. BCMA uses barcode scanning to ensure the right patient, right drug, right dose, right route, and right time.
C. CPOE ❌ — Used by prescribers to enter medication orders
D. DUR ❌ — A pharmacist-led review of medication appropriateness, not a bedside administration step.
Which of the following orders should be processed and dispensed as STAT?
A. Montelukast for asthma
B. Vancomycin for septic shock
C. Calcium carbonate for osteoporosis
D. Metformin for type 2 diabetes mellitus
Correct Answer: B. Vancomycin for septic shock
Explanation:
A. Montelukast ❌ — Maintenance medication; not for acute management.
B. Vancomycin ✔️ — Correct. In septic shock, rapid initiation of empiric antibiotics is essential to reduce mortality.
C. Calcium carbonate ❌ — For chronic supplementation; not urgent.
D. Metformin ❌ — Maintenance therapy; not for acute glucose control in hospitalized patients.
16. Which is the most appropriate reference for obtaining detailed information about a drug’s chemical structure, molecular data, and dosage forms?
A. DrugBank
B. DailyMed
C. Medscape
D. ClinicalTrials.gov
Correct Answer: A. DrugBank
Explanation:
A. DrugBank ✔️ — Correct. Provides comprehensive chemical, molecular, pharmacological, and pharmaceutical details.
B. DailyMed ❌ — Focuses on FDA-approved labeling, not deep chemical analysis.
C. Medscape ❌ — Offers general clinical overviews, not extensive formulation details.
D. ClinicalTrials.gov ❌ — Lists registered clinical studies, not detailed drug data.
Amoxicillin 45 mg/kg/dose every 12 hours is prescribed for a 20-kg child. The oral suspension is available as 250 mg/5 mL. How many milliliters should be given per dose?
A. 2 mL
B. 3 mL
C. 4 mL
D. 9 mL
Correct Answer: D. 9 mL
Explanation:
Dose = 45 mg/kg × 20 kg = 900 mg/day
Since dosing is every 12 hours → 450 mg per dose
Concentration = 250 mg / 5 mL = 50 mg/mL
Volume = 450 mg ÷ 50 mg/mL = 9 mL per dose
2. A 45-year-old patient presents with persistent symptoms of gastroesophageal reflux disease (GERD) despite lifestyle modifications and initial once-daily proton pump inhibitor (PPI) therapy. Which of the following is the most appropriate next step in pharmacologic management?
A. Antacids after meals
B. H2-receptor blockers 2 hours after meals
C. PPI twice daily 30 minutes before meals
D. PPI once daily before meals for breakthrough symptoms
Correct Answer: C. PPI twice daily 30 minutes before meals
Explanation:
A. Antacids ❌ — Provide temporary relief only; not recommended for long-term control of GERD.
B. H2-blockers ❌ — Less effective than PPIs in managing moderate-to-severe GERD or erosive esophagitis.
C. PPI twice daily ✔️ — Correct. PPIs are the most effective treatment for GERD. Twice-daily dosing is indicated for patients with severe or refractory symptoms.
D. PPI once daily ❌ — May be insufficient in severe GERD or with nocturnal symptoms.
What is the primary safety benefit of Automated Dispensing Machines (ADMs)?
A. Prevent drug interactions
B. Improve inventory cost control
C. Increase accuracy and reduce medication errors
D. Eliminate the need for pharmacists
Correct Answer: C. Increase accuracy and reduce medication errors
Explanation:
A. Prevent drug interactions ❌ — This is a function of clinical decision support, not ADMs.
B. Improve inventory cost control ❌ — ADMs can aid in inventory management, but that’s not their primary safety advantage.
C. Increase accuracy & reduce med errors ✔️ — Correct. ADMs reduce selection errors and improve accountability in medication distribution.
D. Eliminate pharmacists ❌ — ADMs support, but do not replace, clinical pharmacist responsibilities.
A pharmacist notes that warfarin, which had been held during hospitalization for elevated INR, was not resumed in the discharge medication list despite resolution of INR. This is an example of:
A. Medication error report
B. Medication reconciliation at discharge
C. Drug interaction review
D. Adverse drug event report
Correct Answer: B. Medication reconciliation at discharge
Explanation:
A. Medication error ❌ — Not a dispensing or administration error; it’s an omission at transition of care.
B. Medication reconciliation ✔️ — Correct. Ensures all intended medications are accurately documented and continued or discontinued appropriately at discharge.
C. Drug interaction review ❌ — No interaction assessment is involved here.
D. Adverse drug event ❌ — No adverse clinical effect occurred from the omission at the time of discovery.
Which Boolean operator narrows a database search by requiring that both search terms appear in the results?
A. OR
B. AND
C. NOT
D. WITH
Correct Answer: B. AND
Explanation:
A. OR ❌ — Expands search results by including either term.
B. AND ✔️ — Correct. Narrows results by retrieving only entries containing both terms.
C. NOT ❌ — Excludes records containing a specific term.
D. WITH ❌ — Not recognized as a Boolean operator in most databases.
A provider orders 500 mL of D5W containing bupivacaine 0.125%. The pharmacy has bupivacaine 0.5% vials. How many milliliters of the 0.5% solution are required?
A. 1.25 mL
B. 12.5 mL
C. 125 mL
D. 250 mL
Correct Answer: C. 125 mL
Explanation:
Desired conc. = 0.125% = 1.25 mg/mL
Total drug needed = 500 mL × 1.25 mg/mL = 625 mg
Stock conc. = 0.5% = 5 mg/mL
Volume needed = 625 mg ÷ 5 mg/mL = 125 mL
3. A patient with asthma reports daily symptoms and three nocturnal awakenings per month. What is the asthma severity classification?
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Correct Answer: C. Moderate persistent
Explanation:
A. Mild intermittent ❌ — ≤2 days/week symptoms and ≤2 nocturnal awakenings/month.
B. Mild persistent ❌ — >2 days/week symptoms but not daily.
C. Moderate persistent ✔️ — Correct. Daily symptoms and 3–4 night awakenings/month.
D. Severe persistent ❌ — Symptoms throughout the day with frequent nocturnal awakenings.
Which statement best defines high-alert medications?
A. Medications used only in intensive care units
B. Drugs requiring therapeutic drug level monitoring
C. Medications with a high risk of causing significant harm if used in error
D. Drugs with short half-life
Correct Answer: C. Medications with a high risk of causing significant harm if used in error
Explanation:
A. ICU use ❌ — High-alert drugs are not limited to the ICU.
B. Monitoring requirement ❌ — Not all high-alert drugs require level monitoring.
C. High harm risk ✔️ — Correct. Examples: insulin, anticoagulants, chemotherapy agents, concentrated electrolytes.
D. Short half-life ❌ — Pharmacokinetics do not define high-alert status.
According to ASHP and USP guidelines, which elements must be included on a unit dose label?
A. Medication name, lot number, patient name
B. Medication name, strength, route, expiry date, lot number
C. Medication name, patient name, dose, date
D. Medication name, dosage form, frequency, route
Correct Answer: B. Medication name, strength, route, expiry date, lot number
Explanation:
A. Missing strength and expiry date ❌
B. ✔️ Correct. Required: drug name, strength, route, lot number, and expiration date to ensure accurate identification and traceability.
C. Patient name is not required for non-patient-specific unit dose stock ❌
D. Missing lot number and expiry date ❌
A pharmacy resident searches PubMed using “GERD AND Aspirin.” This search technique is an example of:
A. MeSH mapping
B. Boolean operator
C. Truncation
D. Wildcard search
Correct Answer: B. Boolean operator
Explanation:
A. MeSH mapping ❌ — Uses standardized subject headings, not logical connectors.
B. Boolean operator ✔️ — Correct. "AND" is a Boolean operator that combines search terms for specificity.
C. Truncation ❌ — Uses symbols (e.g., *) to capture multiple word endings.
D. Wildcard ❌ — Substitutes for unknown letters within a word.
A patient is to receive 150 mg of a drug in 500 mL D5W at a rate of 0.15 mg/min. What infusion rate in mL/hr should be set?
A. 10 mL/hr
B. 15 mL/hr
C. 20 mL/hr
D. 30 mL/hr
Correct Answer: D. 30 mL/hr
Explanation:
0.15 mg/min × 60 min = 9 mg/hr
Concentration = 150 mg / 500 mL = 0.3 mg/mL
Rate = 9 mg ÷ 0.3 mg/mL = 30 mL/hr
4. A 66-year-old patient is diagnosed with acute DVT. Which regimen is guideline-recommended for initial treatment?
A. Rivaroxaban 20 mg once daily
B. Warfarin 10 mg on day 1, then 5 mg daily
C. Apixaban 10 mg BID for 7 days, then 5 mg BID
D. Dabigatran 150 mg BID
Correct Answer: C. Apixaban 10 mg BID for 7 days, then 5 mg BID
Explanation:
A. Rivaroxaban 20 mg OD ❌ — Maintenance dose; initial therapy requires 15 mg BID for 21 days.
B. Warfarin ❌ — Requires bridging with parenteral anticoagulant for ≥5 days and INR monitoring.
C. Apixaban ✔️ — Correct. Direct oral anticoagulant; approved for use without heparin bridging.
D. Dabigatran ❌ — Requires prior 5–10 days of parenteral anticoagulation.
What is meant by independent double-checking of high-alert medications?
A. One pharmacist verifies their own work
B. Two pharmacists verify independently
C. A nurse verifies the order with the pharmacist
D. The same pharmacist reviews the order twice
Correct Answer: B. Two pharmacists verify independently
Explanation:
A. One pharmacist ❌ — Self-checking increases confirmation bias risk.
B. Two pharmacists ✔️ — Correct. Independent verification by two individuals helps prevent serious medication errors.
C. Nurse + pharmacist ❌ — Not considered “independent” by formal safety standards.
D. Same pharmacist twice ❌ — Still subject to the same oversight bias.
During IV admixture preparation, a sterile vial is accidentally dropped onto the cleanroom floor. According to ASHP standards, what is the appropriate action?
A. Use it after wiping with alcohol
B. Discard and replace with a new vial
C. Check for cracks and use if intact
D. Wipe with dry gauze and use
Correct Answer: B. Discard and replace with a new vial
Explanation:
A. Alcohol wipe ❌ — Does not guarantee sterility after the container is dropped.
B. ✔️ Correct. Dropped containers are considered to have compromised sterility and must be discarded.
C. Visual inspection is insufficient to ensure sterility ❌
D. Dry gauze does not address contamination ❌
Insulin-induced hypoglycemia is an example of which type of adverse drug reaction (ADR)?
A. Type A
B. Type B
C. Type C
D. Type D
Correct Answer: A. Type A
Explanation:
A. Type A ✔️ — Correct. Predictable and dose-dependent, related to the drug’s pharmacologic action.
B. Type B ❌ — Unpredictable, idiosyncratic, or allergic reactions.
C. Type C ❌ — Associated with chronic drug use.
D. Type D ❌ — Delayed onset reactions, such as teratogenicity or carcinogenicity.
Dobutamine 5 mcg/kg/min is ordered for a 70 kg patient. Stock solution: 1 g in 250 mL NS. What is the correct infusion rate in mL/hr?
A. 5.25 mL/hr
B. 21 mL/hr
C. 35 mL/hr
D. 52.5 mL/hr
Correct Answer: A. 5.25 mL/hr
Explanation:
Dose = 5 mcg/kg/min × 70 kg = 350 mcg/min
Per hour = 350 × 60 = 21,000 mcg/hr = 21 mg/hr
Concentration = 1000 mg / 250 mL = 4 mg/mL
Rate = 21 mg ÷ 4 mg/mL = 5.25 mL/hr
5. A patient is initiated on darbepoetin alfa for anemia of CKD. When should hemoglobin be rechecked to guide dose adjustment?
A. 2–4 weeks
B. 6–8 weeks
C. Weekly
D. Daily
Correct Answer: A. 2–4 weeks
Explanation:
A. 2–4 weeks ✔️ — Correct. ESA efficacy should be assessed in this interval; dose adjustments based on response.
B. 6–8 weeks ❌ — Too delayed for initial adjustment.
C. Weekly ❌ — Unnecessary; Hgb changes gradually.
D. Daily ❌ — Clinically inappropriate; not evidence-based.
Denosumab has a boxed warning for severe hypocalcemia in patients with CKD. What is the safest system-based intervention before dispensing?
A. Monitor all patients on denosumab
B. Place a hard stop in the dispensing system if no calcium result is available
C. Educate patients to take calcium supplements
D. Switch all patients to an alternative therapy
Correct Answer: B. Place a hard stop in the dispensing system if no calcium result is available
Explanation:
A. Monitor ❌ — Ongoing monitoring is important but less effective than a pre-dispense block.
B. Hard stop ✔️ — Correct. This prevents dispensing until a recent calcium level is documented, reducing risk of harm.
C. Educate ❌ — Education alone cannot ensure labs are checked.
D. Switch therapy ❌ — Not necessary unless clinically indicated.
Which of the following drug combinations requires a Y-site compatibility check before co-administration?
A. Calcium gluconate + potassium phosphate
B. Magnesium sulfate + normal saline
C. Furosemide + dextrose 5%
D. Heparin + normal saline
Correct Answer: A. Calcium gluconate + potassium phosphate
Explanation:
A. ✔️ Correct. Calcium and phosphate can precipitate in IV lines, potentially causing embolism; compatibility must be verified before mixing or Y-site administration.
B. Compatible; commonly administered together ❌
C. No major Y-site incompatibility ❌
D. Compatible; heparin flushes are routinely prepared in NS ❌
A patient requests information on vaccines required for international travel. Which is the best resource?
A. World Health Organization (WHO)
B. Centers for Disease Control and Prevention (CDC)
C. Saudi Food and Drug Authority (SFDA)
D. Orange Book
Correct Answer: B. Centers for Disease Control and Prevention (CDC)
Explanation:
A. WHO ❌ — Provides global recommendations but less individualized.
B. CDC ✔️ — Correct. Offers up-to-date, country-specific vaccine and health guidance for travelers.
C. SFDA ❌ — Regulates pharmaceuticals in Saudi Arabia; not a travel vaccine source.
D. Orange Book ❌ — Addresses bioequivalence of drug products; unrelated to vaccines.
A pharmacist receives a prescription for a custom compounded oral suspension with a concentration of 1.5% w/v. The prescribed volume is 200 mL. The active drug is supplied as 300 mg tablets.
How many tablets are required to prepare the suspension?
A) 8 tablets
B) 10 tablets
C) 5 tablets
D) 20 tablets
Correct Answer: B
Step 1 – Calculate total amount of drug needed
1.5% w/v means 1.5 g per 100 mL.
So, 3.0 g of active drug is needed.
Step 2 – Convert grams to milligrams
3.0 g×1000=3000 mg
Step 3 – Calculate number of tablets
Number of tablets=3000 mg/ 300mg =10 tablets