# Free PTCE Practice Test: 90 Questions with Explanations Free · No account · No card Take an original 90-question PTCE practice test weighted to the 2026 PTCB outline. Every answer includes an explanation and its actual source citation. Use the optional 110-minute timer, review domain scores, and retake with a fresh question set. These are original study questions, not actual PTCB exam items. Unlimited Practice Guide is not affiliated with PTCB. ## 2026 PTCE domain weights - **Medications:** 35% - **Federal Requirements:** 18.75% - **Patient Safety & QA:** 23.75% - **Order Entry & Processing:** 22.5% ## Complete question set ## Question 1 What does the sig code 'SL' mean? - A. By mouth - B. Under the tongue - C. Topically - D. By injection **Correct answer:** Under the tongue **Explanation:** SL (sublingual) means under the tongue. Medications given this way are absorbed quickly through the blood vessels under the tongue, bypassing the digestive system. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Unscored practice question_ ## Question 2 What is the brand name for glipizide? - A. Copaxone - B. Glucotrol - C. Amaryl - D. Diabeta **Correct answer:** Glucotrol **Explanation:** glipizide is marketed under the brand name Glucotrol. It is classified as a Sulfonylurea. **Source citation:** `FDA Orange Book - Approved Drug Products with Therapeutic Equivalence Evaluations` _Scored practice question_ ## Question 3 What does USP <797> address? - A. Sterile compounding standards - B. Non-sterile compounding standards - C. Prescription labeling requirements - D. Hazardous drug handling **Correct answer:** Sterile compounding standards **Explanation:** USP <797> establishes standards for sterile compounding, including personnel qualifications, training, facility design, environmental monitoring, equipment maintenance, aseptic technique, beyond-use dating, and quality assurance for compounded sterile preparations (CSPs). **Source citation:** `USP <797> - Pharmaceutical Compounding — Sterile Preparations` _Scored practice question_ ## Question 4 A prescription reads 'Take 1 tablet QD'. Why should this sig be clarified with the prescriber? - A. QD requires a specific time of day - B. QD is on the ISMP 'Do Not Use' list and can be confused with QID - C. QD is only used for controlled substances - D. QD is not a valid abbreviation **Correct answer:** QD is on the ISMP 'Do Not Use' list and can be confused with QID **Explanation:** QD (once daily) is on the ISMP 'Do Not Use' list because it can be confused with QID (four times daily), potentially leading to a 4x overdose. The sig should be clarified and written as 'daily' or 'once daily' instead. **Source citation:** `ISMP List of Error-Prone Abbreviations - Patient Safety` _Scored practice question_ ## Question 5 What does the sig code 'BID' mean? - A. Twice daily - B. Four times daily - C. Once daily - D. Three times daily **Correct answer:** Twice daily **Explanation:** BID (bis in die) means twice daily. The patient should take the medication two times per day, typically morning and evening. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 6 Which drug is commonly confused with hydroxyzine due to similar spelling? - A. hydrocortisone - B. hydrocodone - C. hydroxychloroquine - D. hydralazine **Correct answer:** hydralazine **Explanation:** Hydroxyzine (antihistamine) and hydralazine (antihypertensive) are commonly confused due to similar spelling. Dispensing the wrong drug could lead to serious patient harm. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 7 Clonidine is on the LASA list because it can be confused with which benzodiazepine? - A. Diazepam - B. Alprazolam - C. Lorazepam - D. Clonazepam **Correct answer:** Clonazepam **Explanation:** Clonidine (antihypertensive) and clonazepam (benzodiazepine for seizures/anxiety) have similar spellings. A patient needing blood pressure control who receives clonazepam could experience excessive sedation without blood pressure benefit. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 8 Celebrex is commonly confused with which SSRI antidepressant? - A. Cymbalta - B. Celexa - C. Lexapro - D. Zoloft **Correct answer:** Celexa **Explanation:** Celebrex (celecoxib, an NSAID for pain/inflammation) and Celexa (citalopram, an SSRI for depression) are LASA drugs with similar brand names. Dispensing errors between these could cause significant patient harm. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 9 Which of the following abbreviations is on the ISMP 'Do Not Use' list? - A. U (for units) - B. BID - C. PO - D. TAB **Correct answer:** U (for units) **Explanation:** U (for units) is on the ISMP 'Do Not Use' list because it can be mistaken for '0' or '4', leading to dangerous dosing errors. Write out 'units' instead. **Source citation:** `ISMP List of Error-Prone Abbreviations` _Scored practice question_ ## Question 10 Which of the following is NOT required in a DSCSA Transaction Statement (TS)? - A. The entity did not knowingly ship a suspect or illegitimate product - B. The entity is authorized to distribute the product - C. The entity received the product from an authorized trading partner - D. The wholesale acquisition cost of the product **Correct answer:** The wholesale acquisition cost of the product **Explanation:** The Transaction Statement does not require pricing information. It must include statements that the entity is authorized, received from an authorized trading partner, received proper documentation, and did not knowingly ship suspect/illegitimate products. **Source citation:** `21 U.S.C. § 360eee(27) - Transaction Statement Requirements` _Scored practice question_ ## Question 11 A drug distributor fills a Schedule II order placed via DEA Form 222. After shipping the controlled substances, the distributor retains Copy 1 but fails to forward Copy 2 to the DEA. What regulatory violation occurred? - A. No violation — the purchasing pharmacy is responsible for forwarding Copy 2 to the DEA - B. All three copies must be retained by the purchasing pharmacy - C. No copies go to the DEA — both copies remain with the distributor - D. After filling the order, the supplier must forward Copy 2 to the DEA to maintain the chain-of-custody record for C-II substances **Correct answer:** After filling the order, the supplier must forward Copy 2 to the DEA to maintain the chain-of-custody record for C-II substances **Explanation:** Under paper DEA Form 222: the purchaser (pharmacy) fills out the form and sends Copies 1 and 2 to the supplier (distributor). Copy 3 is retained by the purchaser. After filling the order, the supplier retains Copy 1 and must forward Copy 2 to the DEA. Failure to submit Copy 2 to the DEA breaks the mandatory chain-of-custody tracking for C-II substances. **Source citation:** `21 CFR § 1305.13 — Procedure for filling DEA Form 222` _Unscored practice question_ ## Question 12 What is an 'illegitimate product' under DSCSA? - A. A product sold without a valid prescription - B. A product that has been recalled by the FDA - C. A product not covered by insurance - D. A product confirmed to be counterfeit, diverted, stolen, intentionally adulterated, or the subject of a fraudulent transaction **Correct answer:** A product confirmed to be counterfeit, diverted, stolen, intentionally adulterated, or the subject of a fraudulent transaction **Explanation:** An illegitimate product is a product that has been confirmed (after investigation) to be counterfeit, diverted, stolen, intentionally adulterated, or the subject of a fraudulent transaction. It must be quarantined, disposed of, and reported to the FDA and trading partners within 24 hours. **Source citation:** `21 U.S.C. § 360eee(8) - Illegitimate Product Definition` _Unscored practice question_ ## Question 13 A pharmacy receives an order for 'potassium chloride 40 mEq IV push.' The technician begins to prepare a syringe for direct IV injection. What must be stopped? - A. IV push potassium chloride can cause fatal cardiac arrest — it MUST be diluted and administered as a slow infusion, never by IV push - B. Only oral potassium is available - C. The dose is too low for IV push - D. The order just needs a different syringe size **Correct answer:** IV push potassium chloride can cause fatal cardiac arrest — it MUST be diluted and administered as a slow infusion, never by IV push **Explanation:** Undiluted IV push potassium chloride is an ISMP high-alert medication that has caused multiple patient deaths from fatal cardiac arrhythmia. KCl must always be diluted in IV fluid and administered as a controlled-rate infusion. Most institutions have removed concentrated KCl from floor stock to prevent this error. **Source citation:** `ISMP High-Alert Medications; Joint Commission National Patient Safety Goals` _Scored practice question_ ## Question 14 What does 'QPM' mean in prescription directions? - A. Every 4 hours - B. As needed - C. Every evening - D. Every morning **Correct answer:** Every evening **Explanation:** QPM means every evening. The medication should be taken once daily in the evening. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 15 A prescription is received from Dr. Hernandez with DEA number BH6187377. Is this DEA number valid? - A. Invalid - B. Valid **Correct answer:** Valid **Explanation:** This DEA number is VALID. Verification: 1. Add 1st, 3rd, 5th digits: 6 + 8 + 3 = 17 2. Add 2nd, 4th, 6th digits: 1 + 7 + 7 = 15, then multiply by 2 = 30 3. Total: 17 + 30 = 47 4. Last digit of total (7) matches check digit (7) ✓ 5. Second letter "H" matches first letter of "Hernandez" ✓ **Source citation:** `21 CFR § 1306.05 - DEA Registration Numbers - Federal Requirements` _Scored practice question_ ## Question 16 A solution contains 500 mg of drug in 50 mL. What is the concentration in mg/mL? - A. 10.0 mg/mL - B. 12.0 mg/mL - C. 15.0 mg/mL - D. 8.0 mg/mL **Correct answer:** 10.0 mg/mL **Explanation:** Concentration = Mass ÷ Volume To find concentration, divide mass by volume: 500 mg ÷ 50 mL = 10.0 mg/mL **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Question 17 What is an 'authorized trading partner' under DSCSA? - A. Any entity that sells prescription drugs - B. Only entities approved by the FDA - C. Only chain pharmacy organizations - D. A manufacturer, wholesale distributor, dispenser, or repackager that holds valid licensure or registration **Correct answer:** A manufacturer, wholesale distributor, dispenser, or repackager that holds valid licensure or registration **Explanation:** An authorized trading partner is a manufacturer, wholesale distributor, dispenser, or repackager with valid federal and state licensure or registration. Trading partners must only transact with authorized entities to maintain supply chain integrity. **Source citation:** `21 U.S.C. § 360eee(2) - Authorized Trading Partner Definition` _Scored practice question_ ## Question 18 What does the sig code 'GTT' mean? - A. Capsule - B. Gram - C. Tablet - D. Drop **Correct answer:** Drop **Explanation:** GTT (gutta) means drop. This is commonly used for eye drops, ear drops, and oral liquid medications dosed by drops. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 19 How should unopened insulin be stored? - A. At room temperature only - B. Refrigerated (36°F to 46°F) - C. Frozen until ready to use - D. In direct sunlight **Correct answer:** Refrigerated (36°F to 46°F) **Explanation:** Unopened insulin should be refrigerated at 36°F to 46°F (2°C to 8°C). Once opened or in use, most insulins can be kept at room temperature for 28 days. Never freeze insulin. **Source citation:** `USP Chapter <797> and Manufacturer Guidelines - Patient Safety` _Scored practice question_ ## Question 20 Which of the following products would require DSCSA transaction documentation? - A. A medical device - B. A dietary supplement - C. A prescription drug product being transferred between authorized trading partners - D. A bottle of aspirin sold OTC **Correct answer:** A prescription drug product being transferred between authorized trading partners **Explanation:** DSCSA applies to prescription drug products (as defined under the FDCA) being transferred between authorized trading partners. OTC drugs, dietary supplements, and medical devices are not covered by DSCSA tracing requirements. **Source citation:** `21 U.S.C. § 360eee(15) - DSCSA Product Scope` _Scored practice question_ ## Question 21 What does the sig code 'SOL' mean? - A. Solid - B. Solution - C. Sublingual - D. Soluble **Correct answer:** Solution **Explanation:** SOL means solution. A solution is a liquid dosage form where the medication is completely dissolved in the solvent. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 22 How would you translate '1 TAB SL PRN chest pain' for a patient? - A. Take one tablet by mouth as needed for chest pain - B. Dissolve one tablet in water as needed for chest pain - C. Apply one tablet topically as needed for chest pain - D. Place one tablet under the tongue as needed for chest pain **Correct answer:** Place one tablet under the tongue as needed for chest pain **Explanation:** 1 TAB SL PRN chest pain means: Place one tablet (1 TAB) under the tongue (SL) as needed (PRN) for chest pain. Nitroglycerin is commonly given this way. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 23 What does the sig code 'TOP' mean? - A. Applied to the skin - B. By mouth - C. Under the tongue - D. By injection **Correct answer:** Applied to the skin **Explanation:** TOP (topical) means applied to the skin or a specific external area. Creams, ointments, and patches are common topical dosage forms. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Unscored practice question_ ## Question 24 What is the Thalomid REMS program (formerly S.T.E.P.S.) designed to prevent? - A. Kidney failure - B. Liver toxicity - C. Severe birth defects caused by thalidomide - D. Cardiac arrest **Correct answer:** Severe birth defects caused by thalidomide **Explanation:** The Thalomid REMS (Risk Evaluation and Mitigation Strategy for thalidomide) is designed to prevent severe birth defects (phocomelia). Thalidomide is a potent teratogen, and the REMS includes strict pregnancy prevention measures, prescriber and pharmacy certification, and patient enrollment. **Source citation:** `FDA Thalomid REMS - 21 U.S.C. § 355-1` _Scored practice question_ ## Question 25 What is the role of the 'designated person' under USP <797>? - A. The person who orders supplies - B. A pharmacist or other qualified person responsible for overseeing sterile compounding operations, training, and quality assurance - C. The person who delivers compounded products to patients - D. The security guard for the cleanroom **Correct answer:** A pharmacist or other qualified person responsible for overseeing sterile compounding operations, training, and quality assurance **Explanation:** The designated person under USP <797> is a pharmacist (or other qualified individual) responsible for overseeing all sterile compounding operations. Responsibilities include personnel training and competency assessment, facility maintenance, environmental monitoring, and quality assurance. **Source citation:** `USP <797> - Designated Person Responsibilities` _Scored practice question_ ## Question 26 Under DSCSA, which products are exempt from serialization and tracing requirements? - A. Only compounded medications - B. Blood and blood components, radioactive drugs, imaging drugs, certain IV products, and medical gases - C. All generic medications - D. All OTC medications **Correct answer:** Blood and blood components, radioactive drugs, imaging drugs, certain IV products, and medical gases **Explanation:** DSCSA exempts certain products from serialization and tracing requirements, including blood and blood components, radioactive drugs, imaging drugs, certain IV products, medical gases, and homeopathic drugs. These products have other regulatory oversight mechanisms. **Source citation:** `21 U.S.C. § 360eee(15) - Product Exemptions Under DSCSA` _Scored practice question_ ## Question 27 A prescription for vinblastine should be verified to avoid confusion with which similar drug? - A. hydroxyzine - B. vincristine - C. metronidazole - D. clonidine **Correct answer:** vincristine **Explanation:** vinblastine and vincristine are look-alike/sound-alike (LASA) drugs. Similar names; both are chemotherapy agents with FATAL dose differences. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 28 Which LASA drug pair involves medications where one is for BPH and the other is for osteoporosis? - A. Proscar and Prolia - B. Flomax and Fosamax - C. Avodart and Actonel - D. Rapaflo and Reclast **Correct answer:** Flomax and Fosamax **Explanation:** Flomax (tamsulosin, for BPH/enlarged prostate) and Fosamax (alendronate, for osteoporosis) are commonly confused. A man receiving Fosamax for his BPH would not get symptom relief and could experience unnecessary side effects. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 29 Janumet belongs to which drug class? - A. DPP-4 Inhibitor/Biguanide - B. Second-Generation Cephalosporin - C. Erythropoiesis-Stimulating Agent - D. HMG-CoA Reductase Inhibitor (Statin) **Correct answer:** DPP-4 Inhibitor/Biguanide **Explanation:** Janumet (sitagliptin/metformin) is classified as a DPP-4 Inhibitor/Biguanide. **Source citation:** `FDA Drug Classification System` _Scored practice question_ ## Question 30 A prescription reads 'Take 1 tablet QOD'. How should this be clarified for the patient label? - A. Take one tablet four times daily - B. Take one tablet as needed - C. Take one tablet every other day - D. Take one tablet once daily **Correct answer:** Take one tablet every other day **Explanation:** QOD means every other day, but it is on the ISMP 'Do Not Use' list because it can be confused with QD (daily) or QID (four times daily). The label should clearly state 'every other day' to prevent errors. **Source citation:** `ISMP List of Error-Prone Abbreviations - Patient Safety` _Scored practice question_ ## Question 31 How long can an opened insulin pen be used when stored at room temperature? - A. 7 days - B. 28 days (for most insulins) - C. 14 days - D. 90 days **Correct answer:** 28 days (for most insulins) **Explanation:** Most opened insulin pens can be kept at room temperature for up to 28 days. After 28 days, the insulin should be discarded even if there is product remaining, as potency decreases over time. **Source citation:** `Manufacturer Guidelines for Insulin Storage - Patient Safety` _Scored practice question_ ## Question 32 Which of the following is NOT a requirement for a valid controlled substance prescription? - A. Patient's full name and address - B. Date of issue - C. Patient's social security number - D. Prescriber's DEA number **Correct answer:** Patient's social security number **Explanation:** A valid controlled substance prescription requires the patient's full name and address, the prescriber's name, address, and DEA registration number, the date of issue, and the drug name, strength, dosage form, and quantity. A patient's social security number is NOT required. **Source citation:** `21 CFR § 1306.05 - Manner of issuance of prescriptions` _Scored practice question_ ## Question 33 A pharmacy dispenses warfarin 5mg tablets. The patient is also taking aspirin 325mg daily, but the DUR alert for drug interaction was overridden without pharmacist review. What error occurred? - A. A significant drug-drug interaction alert was bypassed — concurrent use of warfarin and aspirin significantly increases bleeding risk and requires pharmacist clinical review - B. Only the prescriber handles drug interactions - C. No error — warfarin and aspirin are commonly used together - D. Aspirin is not a real concern with warfarin **Correct answer:** A significant drug-drug interaction alert was bypassed — concurrent use of warfarin and aspirin significantly increases bleeding risk and requires pharmacist clinical review **Explanation:** Warfarin (anticoagulant) combined with aspirin (antiplatelet) significantly increases bleeding risk. While sometimes intentionally prescribed together, DUR alerts for this interaction must ALWAYS be reviewed by a pharmacist who can assess clinical appropriateness. Technicians should never override clinical alerts. **Source citation:** `OBRA 90 — Prospective Drug Utilization Review; 42 U.S.C. § 1396r-8` _Scored practice question_ ## Question 34 A pharmacy technician discovers a discrepancy in the controlled substance inventory. Who must be notified? - A. Only the pharmacist-in-charge - B. The pharmacist-in-charge and store manager - C. The pharmacist-in-charge and DEA (if significant loss) - D. Only the DEA **Correct answer:** The pharmacist-in-charge and DEA (if significant loss) **Explanation:** Any discrepancy in controlled substance inventory must be immediately reported to the pharmacist-in-charge. If the discrepancy indicates theft or significant loss, a DEA Form 106 must be filed with the DEA within one business day of discovery. **Source citation:** `21 CFR § 1301.76 - Other security controls for practitioners` _Scored practice question_ ## Question 35 How long must a pharmacy retain records for Schedule II controlled substances? - A. 3 years - B. 1 year - C. 2 years - D. 5 years **Correct answer:** 2 years **Explanation:** Under DEA regulations, all records relating to controlled substances must be maintained for a minimum of 2 years from the date of the record. This includes invoices, DEA Form 222s, prescriptions, and inventory records. **Source citation:** `21 CFR § 1304.04 - Maintenance of records and inventories` _Scored practice question_ ## Question 36 How frequently must ANC be monitored for patients on clozapine during the first 6 months of therapy? - A. Daily - B. Monthly - C. Biweekly - D. Weekly **Correct answer:** Weekly **Explanation:** During the first 6 months of clozapine therapy, the ANC must be monitored weekly. After 6 months with acceptable ANC levels, monitoring may be reduced to every 2 weeks, and after 12 months, to monthly. **Source citation:** `Clozapine REMS Monitoring Schedule` _Scored practice question_ ## Question 37 Why are tramadol and trazodone considered look-alike/sound-alike drugs? - A. They have similar spelling and can be confused, but have completely different uses - B. They have the same mechanism of action - C. They are in the same drug class - D. They are both controlled substances **Correct answer:** They have similar spelling and can be confused, but have completely different uses **Explanation:** Tramadol (pain reliever) and trazodone (antidepressant/sleep aid) have similar spelling and are frequently confused. A patient needing pain relief who receives trazodone may not get adequate pain control and could experience unwanted sedation. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Unscored practice question_ ## Question 38 A prescription sig reads 'i tab PO BID pc.' The technician labels it 'Take 1 tablet by mouth twice daily before meals.' What is incorrect? - A. The route is wrong - B. 'pc' means after meals (post cibum), not before meals — 'ac' means before meals (ante cibum) - C. BID is wrong — it should be TID - D. The quantity is wrong **Correct answer:** 'pc' means after meals (post cibum), not before meals — 'ac' means before meals (ante cibum) **Explanation:** The abbreviation 'pc' stands for 'post cibum' meaning after meals, while 'ac' stands for 'ante cibum' meaning before meals. Confusing these can affect drug absorption and efficacy. Some medications require food for absorption or to reduce GI side effects. **Source citation:** `ISMP Error-Prone Abbreviations; USP Labeling Standards` _Scored practice question_ ## Question 39 What is the generic name for Proscar? - A. dutasteride - B. finasteride - C. ziprasidone - D. fluticasone **Correct answer:** finasteride **Explanation:** Proscar is the brand name for finasteride. It is classified as a 5-Alpha Reductase Inhibitor. **Source citation:** `FDA Orange Book - Approved Drug Products with Therapeutic Equivalence Evaluations` _Scored practice question_ ## Question 40 Which medication class is particularly sensitive to light and moisture exposure? - A. Calcium channel blockers - B. ACE inhibitors - C. Proton pump inhibitors - D. Nitroglycerin and other nitrates **Correct answer:** Nitroglycerin and other nitrates **Explanation:** Nitroglycerin and other nitrates are highly sensitive to light, moisture, and heat. They should be stored in original containers, replaced regularly, and patients should be counseled about proper storage to ensure medication effectiveness. **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 41 Thorazine requires which special storage condition? - A. No special storage required - B. Protection from light - C. Refrigeration - D. Freezing **Correct answer:** Protection from light **Explanation:** Thorazine (chlorpromazine) is light-sensitive. Protect from light; may discolor if exposed **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 42 Which entities are considered 'trading partners' under the Drug Supply Chain Security Act (DSCSA)? - A. Pharmacies and patients - B. Only DEA-registered entities - C. Only manufacturers and pharmacies - D. Manufacturers, wholesale distributors, dispensers, and repackagers **Correct answer:** Manufacturers, wholesale distributors, dispensers, and repackagers **Explanation:** Under DSCSA, trading partners include manufacturers, wholesale distributors, dispensers (pharmacies), and repackagers. Each must maintain transaction documentation and verify product authenticity. **Source citation:** `21 U.S.C. § 360eee(23) - Definition of trading partner` _Scored practice question_ ## Question 43 Lasix requires which special storage condition? - A. No special storage required - B. Refrigeration - C. Freezing - D. Protection from light **Correct answer:** Protection from light **Explanation:** Lasix (furosemide) is light-sensitive. Protect from light; oral solution is particularly sensitive **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 44 How would you translate 'Apply TOP BID AAA' for a patient? - A. Apply by mouth twice daily as directed - B. Apply topically twice daily to affected area - C. Apply topically once daily to affected area - D. Apply topically three times daily to affected area **Correct answer:** Apply topically twice daily to affected area **Explanation:** Apply TOP BID AAA means: Apply topically (TOP) twice daily (BID) to affected area (AAA). **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 45 A pharmacy technician unpacks a shipment containing cyclophosphamide vials wearing only nitrile exam gloves. Per USP <800>, what is the safety violation? - A. Must wear two pairs of chemotherapy-tested gloves when receiving hazardous drugs, even for unpacking, per USP <800> - B. Only needs to wash hands after unpacking - C. Only needs a face mask - D. No violation — receiving doesn't require special PPE **Correct answer:** Must wear two pairs of chemotherapy-tested gloves when receiving hazardous drugs, even for unpacking, per USP <800> **Explanation:** USP <800> requires that personnel receiving hazardous drugs wear at minimum two pairs of chemotherapy-tested gloves (ASTM D6978). Even though the drugs are in sealed containers, breakage or external contamination can occur during shipping. Additional PPE may be required if damage is suspected. **Source citation:** `USP <800> Hazardous Drugs — Handling in Healthcare Settings` _Unscored practice question_ ## Question 46 What does 'NKA' or 'NKDA' mean in a patient profile? - A. New known allergies - B. No known allergies / No known drug allergies - C. Needs known allergens - D. Not known at this time **Correct answer:** No known allergies / No known drug allergies **Explanation:** NKA means no known allergies, and NKDA means no known drug allergies. This is documented in the patient profile after allergy screening. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 47 Can the FDA modify or remove a REMS after it has been approved? - A. Yes, the FDA can modify, strengthen, or release a REMS based on new safety data and REMS assessments - B. Only the manufacturer can modify a REMS - C. REMS can only be removed by Congressional action - D. No, once approved, a REMS is permanent **Correct answer:** Yes, the FDA can modify, strengthen, or release a REMS based on new safety data and REMS assessments **Explanation:** The FDA can modify, strengthen, or release (remove) a REMS based on new safety data, REMS assessment results, and changes in risk-benefit profile. If the REMS is no longer necessary to ensure benefits outweigh risks, the FDA can release the manufacturer from the REMS requirement. **Source citation:** `21 U.S.C. § 355-1(g)(4) - REMS Modification Authority` _Scored practice question_ ## Question 48 What is the proper storage for Xalatan? - A. No special storage required - B. Freeze until ready to use - C. Room temperature only - D. Refrigerate (36°F to 46°F) **Correct answer:** Refrigerate (36°F to 46°F) **Explanation:** Xalatan (latanoprost) requires refrigeration. Refrigerate unopened; once opened, may be stored at room temp for up to 6 weeks **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 49 The FDA Purple Book is to biologics as the Orange Book is to small-molecule drugs. What does a 'interchangeable' designation in the Purple Book mean? - A. The biosimilar has identical structure to the reference biologic - B. The biosimilar is covered by all insurance plans that cover the reference product - C. The biosimilar may be substituted for the reference product without prescriber intervention - D. The biosimilar has the same brand name as the reference product **Correct answer:** The biosimilar may be substituted for the reference product without prescriber intervention **Explanation:** An 'interchangeable' biosimilar in the Purple Book may be substituted for the reference biologic at the pharmacy level without the prescriber's prior intervention (similar to generic substitution for small molecules). A regular biosimilar designation means it is highly similar but not yet designated as interchangeable. **Source citation:** `42 U.S.C. § 262(k) - Biosimilar Approval Pathway and Interchangeability` _Scored practice question_ ## Question 50 A prescriber writes an emergency prescription for a Schedule II controlled substance by telephone. The written prescription must be received by the pharmacy within how many days? - A. 14 days - B. 30 days - C. 3 days - D. 7 days **Correct answer:** 7 days **Explanation:** In emergency situations, a pharmacist may dispense a Schedule II controlled substance upon oral authorization from a prescriber. The prescriber must then deliver a written, signed prescription to the pharmacy within 7 days. **Source citation:** `21 CFR § 1306.11(d) - Oral/telephoned prescriptions for Schedule II` _Scored practice question_ ## Question 51 Suzetrigine (Journavx), FDA-approved in January 2025, represents a novel analgesic class because it: - A. Is a centrally-acting SNRI approved specifically for pain without antidepressant effects - B. Is a selective COX-3 inhibitor with fewer GI side effects than NSAIDs - C. Is the first non-opioid, non-NSAID selective Nav1.8 sodium channel inhibitor for moderate-to-severe acute pain - D. Is a kappa-opioid agonist with limited CNS penetration and minimal abuse potential **Correct answer:** Is the first non-opioid, non-NSAID selective Nav1.8 sodium channel inhibitor for moderate-to-severe acute pain **Explanation:** Suzetrigine (Journavx) was approved by the FDA in January 2025 as the first new class of analgesic in over 20 years. It selectively inhibits Nav1.8 sodium channels, which are preferentially expressed in peripheral pain-sensing neurons. Unlike opioids, it acts peripherally and does not demonstrate the CNS depression, opioid-mediated respiratory depression, or addiction risk associated with mu-opioid agonists. It is not scheduled as a controlled substance by the DEA. It is indicated for moderate-to-severe acute pain in adults. **Source citation:** `FDA NDA 217186 (Journavx, 2025) - Novel Drug Approval; Non-opioid analgesic` _Scored practice question_ ## Question 52 A patient is prescribed 200 mg daily in 2 divided doses. How many mg per dose? - A. 75 mg - B. 150 mg - C. 175 mg - D. 100 mg **Correct answer:** 100 mg **Explanation:** Dose per Administration = Daily Dose ÷ Doses per Day Dose per administration = Daily dose ÷ Number of doses 200 mg ÷ 2 = 100 mg per dose **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Question 53 Under USP <800>, can unit-dose oral solid hazardous drugs (e.g., tablets/capsules) be handled without a C-PEC? - A. Yes, without any restrictions - B. No, all hazardous drugs require a C-PEC - C. Yes, if they remain in their original manufacturer's packaging and are not cut, crushed, or manipulated - D. Only if the pharmacist approves **Correct answer:** Yes, if they remain in their original manufacturer's packaging and are not cut, crushed, or manipulated **Explanation:** Intact oral solid hazardous drugs in their original manufacturer's packaging do not require a C-PEC for dispensing. However, if tablets need to be cut, crushed, or otherwise manipulated, appropriate containment precautions (including a C-PEC or ventilated containment device) are required. **Source citation:** `USP <800> - Handling Oral Solid Hazardous Drugs` _Scored practice question_ ## Question 54 What is the purpose of environmental monitoring in a cleanroom? - A. To verify that the air quality, surface cleanliness, and microbial levels meet required standards for sterile compounding - B. To monitor the room temperature for employee comfort - C. To monitor security cameras - D. To track inventory levels **Correct answer:** To verify that the air quality, surface cleanliness, and microbial levels meet required standards for sterile compounding **Explanation:** Environmental monitoring verifies that the cleanroom maintains the required ISO air quality classifications. It includes viable (microbial) air and surface sampling, non-viable particle counting, temperature and humidity monitoring, and pressure differential verification. **Source citation:** `USP <797> - Environmental Monitoring Program` _Scored practice question_ ## Question 55 Under the iPLEDGE REMS, how often must female patients of childbearing potential have a pregnancy test? - A. Every 6 months - B. Monthly, with two negative tests before starting and monthly tests during therapy - C. Once before starting therapy - D. Only at the end of therapy **Correct answer:** Monthly, with two negative tests before starting and monthly tests during therapy **Explanation:** Female patients of childbearing potential must have two negative pregnancy tests before starting isotretinoin (one at qualification, one immediately before starting) and monthly pregnancy tests during therapy. The prescription window is limited to 7 days. **Source citation:** `iPLEDGE REMS Program Requirements` _Scored practice question_ ## Question 56 A patient presents a prescription for 'semaglutide injection' for weight management. Which brand name should be dispensed for this indication, and how does it differ from Ozempic? - A. Wegovy (2.4 mg weekly maintenance dose) — Wegovy is the FDA-approved semaglutide product specifically indicated for chronic weight management in adults - B. Ozempic (0.5 mg, 1 mg, or 2 mg doses) — Ozempic is FDA-approved for both T2DM and chronic weight management - C. Either product may be dispensed interchangeably because they contain the same active ingredient at the same strengths - D. Rybelsus (oral semaglutide tablet) — the only semaglutide formulation approved for weight loss **Correct answer:** Wegovy (2.4 mg weekly maintenance dose) — Wegovy is the FDA-approved semaglutide product specifically indicated for chronic weight management in adults **Explanation:** Semaglutide is marketed under two different brand names for different indications: Ozempic (0.5 mg, 1 mg, 2 mg weekly SQ injection) is approved only for type 2 diabetes management; Wegovy (0.25 mg titrated up to 2.4 mg weekly SQ injection) is approved specifically for chronic weight management (BMI ≥30 or ≥27 with weight-related comorbidity). They are NOT interchangeable — the doses and pens are different. Dispensing Ozempic for weight loss is off-label and may not be covered by insurance. Rybelsus is an oral tablet approved only for T2DM. **Source citation:** `FDA NDA 209637 (Ozempic, 2017); FDA NDA 215256 (Wegovy, 2021) - Semaglutide Prescribing Information` _Scored practice question_ ## Question 57 What is a 'product identifier' under DSCSA? - A. The brand name of the drug - B. The pharmacy's license number - C. A standardized graphic that includes the NDC, serial number, lot number, and expiration date encoded in a 2D data matrix barcode - D. The DEA registration number **Correct answer:** A standardized graphic that includes the NDC, serial number, lot number, and expiration date encoded in a 2D data matrix barcode **Explanation:** A product identifier is a standardized graphic (2D data matrix barcode) on or affixed to each package and homogeneous case that includes the product's NDC, serial number, lot number, and expiration date in both human-readable and machine-readable format. **Source citation:** `21 U.S.C. § 360eee(14) - Product Identifier Definition` _Unscored practice question_ ## Question 58 Which of the following drugs does NOT typically require a REMS with ETASU? - A. Clozapine (Clozaril) - B. Amoxicillin (Amoxil) - C. Isotretinoin (Accutane) - D. Thalidomide (Thalomid) **Correct answer:** Amoxicillin (Amoxil) **Explanation:** Amoxicillin is a commonly prescribed antibiotic that does not require a REMS. Isotretinoin (iPLEDGE), clozapine (Clozapine REMS), and thalidomide (Thalomid REMS) all require REMS with ETASU due to their serious safety risks. **Source citation:** `FDA REMS Database - Approved REMS Programs` _Unscored practice question_ ## Question 59 Nipride requires which special storage condition? - A. Freezing - B. Refrigeration - C. No special storage required - D. Protection from light **Correct answer:** Protection from light **Explanation:** Nipride (sodium nitroprusside) is light-sensitive. Protect from light; wrap IV bag in aluminum foil **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 60 A drug is dosed every 8 hours at normal CrCl. When CrCl drops to 50 mL/min (40% of normal), the interval is extended proportionally. What is the new dosing interval? - A. 26 hours - B. 16 hours - C. 20 hours - D. 32 hours **Correct answer:** 20 hours **Explanation:** New interval = Normal interval ÷ (CrCl fraction) New interval = 8 ÷ (40 ÷ 100) = 20 hours **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Question 61 A TPN order includes 500 mL of a 20% lipid emulsion. A 20% lipid emulsion provides 2 kcal/mL. How many kcal from fat are provided? - A. 950 kcal - B. 1200 kcal - C. 1100 kcal - D. 1000 kcal **Correct answer:** 1000 kcal **Explanation:** Fat kcal = Lipid Volume (mL) × 2 kcal/mL (for 20%) kcal from fat = Volume (mL) × 2 kcal/mL 500 mL × 2 = 1000 kcal Note: 10% lipid = 1.1 kcal/mL; 20% lipid = 2 kcal/mL; 30% lipid = 3 kcal/mL **Source citation:** `Pharmacy Calculations - Standard Practice` _Unscored practice question_ ## Question 62 Which drug is commonly confused with methotrexate due to similar spelling? - A. metformin - B. hydroxyzine - C. clonidine - D. metolazone **Correct answer:** metolazone **Explanation:** methotrexate and metolazone are on the ISMP confused drug names list (similar spelling; one is for cancer/arthritis, the other is a diuretic). Always verify the correct drug before dispensing. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 63 What should be used instead of 'IU' for international units? - A. 'IUs' - B. Just 'U' - C. Write out 'international units' - D. 'Int. U' **Correct answer:** Write out 'international units' **Explanation:** IU (international units) can be mistaken for IV (intravenous) or the number 10. Write out 'international units' or use 'units' when appropriate. **Source citation:** `ISMP List of Error-Prone Abbreviations` _Scored practice question_ ## Question 64 What does the sig code 'IV' mean? - A. By mouth - B. Into the muscle - C. Under the skin - D. Into the vein **Correct answer:** Into the vein **Explanation:** IV (intravenous) means into the vein. This route provides the fastest onset of action as medication enters the bloodstream directly. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 65 Which drug is commonly confused with prednisone due to similar names? - A. metronidazole - B. prednisolone - C. clonazepam - D. hydroxyzine **Correct answer:** prednisolone **Explanation:** prednisone and prednisolone are on the ISMP confused drug names list (similar names; both are corticosteroids but have different formulations). Always verify the correct drug before dispensing. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 66 What does 'NR' or 'NRF' mean on a prescription? - A. Next refill - B. Normal refill - C. No refills - D. New refill **Correct answer:** No refills **Explanation:** NR or NRF means no refills. The prescription cannot be refilled and a new prescription is required for more medication. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 67 Latuda belongs to which drug class? - A. Macrolide Antibiotic - B. First-Generation Cephalosporin - C. Atypical Antipsychotic - D. DPP-4 Inhibitor/Biguanide **Correct answer:** Atypical Antipsychotic **Explanation:** Latuda (lurasidone) is classified as a Atypical Antipsychotic. **Source citation:** `FDA Drug Classification System` _Scored practice question_ ## Question 68 A technician is filling a prescription for hydrOXYzine 25mg for anxiety. The shelf label reads 'hydrALAZINE 25mg.' The technician selects the bottle. What error is about to occur? - A. Wrong quantity being dispensed - B. LASA drug mix-up — hydroxyzine (antihistamine) confused with hydralazine (antihypertensive) - C. Expired medication selected - D. Wrong dosage form selected **Correct answer:** LASA drug mix-up — hydroxyzine (antihistamine) confused with hydralazine (antihypertensive) **Explanation:** Hydroxyzine and hydralazine are a classic LASA (Look-Alike/Sound-Alike) pair. Hydroxyzine is an antihistamine/anxiolytic while hydralazine is an antihypertensive. Dispensing the wrong drug could cause dangerous hypotension. Tall Man lettering (hydrOXYzine vs hydrALAZINE) is required by ISMP to help prevent this error. **Source citation:** `ISMP List of Confused Drug Names; FDA Tall Man Lettering Recommendations` _Scored practice question_ ## Question 69 Why must sodium nitroprusside (Nipride) IV bags be wrapped in aluminum foil? - A. To prevent contamination - B. To identify it as a high-alert medication - C. To keep it cold - D. To protect it from light degradation **Correct answer:** To protect it from light degradation **Explanation:** Sodium nitroprusside is extremely light-sensitive and will degrade rapidly when exposed to light. IV bags must be wrapped in aluminum foil or opaque material during infusion to maintain potency and prevent toxic breakdown products. **Source citation:** `USP Chapter <797> and Manufacturer Guidelines - Patient Safety` _Scored practice question_ ## Question 70 What is the generic name for Herceptin? - A. trastuzumab - B. suzetrigine - C. NPH insulin - D. rituximab **Correct answer:** trastuzumab **Explanation:** Herceptin is the brand name for trastuzumab. It is classified as a Monoclonal Antibody. **Source citation:** `FDA Orange Book - Approved Drug Products with Therapeutic Equivalence Evaluations` _Scored practice question_ ## Question 71 Which of these medications requires refrigeration after reconstitution? - A. Atorvastatin tablets - B. Omeprazole capsules - C. Amoxicillin suspension - D. Ibuprofen tablets **Correct answer:** Amoxicillin suspension **Explanation:** Amoxicillin suspension must be refrigerated after reconstitution and discarded after 14 days. This helps maintain potency and prevent bacterial growth in the liquid formulation. **Source citation:** `Manufacturer Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 72 Which drug is commonly confused with tramadol due to similar spelling? - A. hydralazine - B. trazodone - C. metformin - D. clonidine **Correct answer:** trazodone **Explanation:** tramadol and trazodone are on the ISMP confused drug names list (similar spelling; one is a pain reliever, the other is an antidepressant). Always verify the correct drug before dispensing. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 73 What does the sig code 'TAB' mean? - A. Capsule - B. Suspension - C. Tablet - D. Solution **Correct answer:** Tablet **Explanation:** TAB means tablet. Tablets are solid dosage forms that may be scored for splitting or coated for various purposes. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Unscored practice question_ ## Question 74 Advair Diskus belongs to which drug class? - A. Fluoroquinolone Antibiotic - B. Antiplatelet Agent - C. Corticosteroid/LABA Combination - D. Benzodiazepine **Correct answer:** Corticosteroid/LABA Combination **Explanation:** Advair Diskus (fluticasone/salmeterol) is classified as a Corticosteroid/LABA Combination. **Source citation:** `FDA Drug Classification System` _Scored practice question_ ## Question 75 A prescription is received from Dr. Gonzalez with DEA number FG4087356. Is this DEA number valid? - A. Invalid - B. Valid **Correct answer:** Invalid **Explanation:** This DEA number is INVALID. Verification: 1. Add 1st, 3rd, 5th digits: 4 + 8 + 3 = 15 2. Add 2nd, 4th, 6th digits: 0 + 7 + 5 = 12, then multiply by 2 = 24 3. Total: 15 + 24 = 39 4. Last digit of total (9) does NOT match check digit (6) ✗ The check digit should be 9, but the DEA number shows 6. **Source citation:** `21 CFR § 1306.05 - DEA Registration Numbers - Federal Requirements` _Scored practice question_ ## Question 76 Lasix belongs to which drug class? - A. Loop Diuretic - B. Direct Oral Anticoagulant - C. DPP-4 Inhibitor - D. Corticosteroid/LABA Combination **Correct answer:** Loop Diuretic **Explanation:** Lasix (furosemide) is classified as a Loop Diuretic. **Source citation:** `FDA Drug Classification System` _Scored practice question_ ## Question 77 You have 15% stock solution and need to prepare 500 mL of 4% solution. How many mL of stock solution are needed? - A. 143 mL - B. 123 mL - C. 133 mL - D. 153 mL **Correct answer:** 133 mL **Explanation:** V1 = (C2 × V2) ÷ C1 Using C1V1 = C2V2: V1 = (C2 × V2) ÷ C1 V1 = (4% × 500 mL) ÷ 15% V1 = 133 mL of stock solution needed **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Question 78 Which drug is commonly confused with Celebrex due to similar brand names? - A. hydroxyzine - B. Celexa - C. clonazepam - D. metformin **Correct answer:** Celexa **Explanation:** Celebrex and Celexa are on the ISMP confused drug names list (similar brand names; one is an NSAID, the other is an SSRI). Always verify the correct drug before dispensing. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 79 A prescription reads: Take 2 tablet(s) in the morning and 1 tablet(s) at bedtime. Dispense 120 tablets. What is the days supply? - A. 50 days - B. 40 days - C. 35 days - D. 45 days **Correct answer:** 40 days **Explanation:** Days Supply = Quantity ÷ (AM Dose + PM Dose) Daily usage = 2 (AM) + 1 (PM) = tablets/day Days supply = 120 ÷ tablets/day = 40 days **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Question 80 What PPE is required when handling hazardous drugs under USP <800>? - A. Chemotherapy-tested gloves (double gloving), protective gown, eye/face protection, and respiratory protection as needed - B. A lab coat and standard gloves - C. No special PPE is required - D. Standard pharmacy gloves only **Correct answer:** Chemotherapy-tested gloves (double gloving), protective gown, eye/face protection, and respiratory protection as needed **Explanation:** USP <800> requires chemotherapy-tested gloves (ASTM D6978 rated, double gloving recommended), a protective gown (back-closing, long sleeves, elastic cuffs), eye/face protection, and respiratory protection (N95 or higher) when indicated for handling hazardous drugs. **Source citation:** `USP <800> - PPE Requirements for Hazardous Drugs` _Scored practice question_ ## Question 81 Nitroglycerin tablets (Nitrostat) require which special storage condition? - A. Refrigeration - B. Stored lying flat - C. Protection from light in original brown glass container - D. Frozen storage **Correct answer:** Protection from light in original brown glass container **Explanation:** Nitroglycerin is light-sensitive and volatile. It must be stored in its original brown glass container, protected from light and moisture. Patients should replace nitroglycerin every 6 months after opening. **Source citation:** `USP Storage Guidelines - Patient Safety` _Scored practice question_ ## Question 82 What does the sig code 'PRN' mean? - A. As needed - B. At bedtime - C. Before meals - D. Every day **Correct answer:** As needed **Explanation:** PRN (pro re nata) means 'as needed.' The patient takes the medication only when symptoms occur, not on a fixed schedule. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 83 What does USP <795> address? - A. Non-sterile compounding standards - B. Sterile compounding standards - C. Hazardous drug handling - D. Drug storage requirements **Correct answer:** Non-sterile compounding standards **Explanation:** USP <795> establishes standards for non-sterile compounding, including personnel training, facility requirements, equipment, component selection, compounding process, quality control, and beyond-use dating for non-sterile preparations. **Source citation:** `USP <795> - Pharmaceutical Compounding — Nonsterile Preparations` _Scored practice question_ ## Question 84 A prescription for metformin should be verified to avoid confusion with which similar-sounding drug? - A. methotrexate - B. metoprolol - C. metronidazole - D. methylphenidate **Correct answer:** metronidazole **Explanation:** Metformin (diabetes medication) and metronidazole (antibiotic) are on the ISMP confused drug names list. A patient receiving the wrong drug would not get appropriate treatment for their condition. **Source citation:** `ISMP List of Confused Drug Names - Patient Safety` _Scored practice question_ ## Question 85 How often should chemotherapy gloves be changed when compounding hazardous drugs under USP <800>? - A. Once per shift - B. Only when visibly soiled - C. Every 30 minutes or immediately if torn, punctured, or contaminated - D. Every 4 hours **Correct answer:** Every 30 minutes or immediately if torn, punctured, or contaminated **Explanation:** Chemotherapy gloves should be changed every 30 minutes during continuous compounding of hazardous drugs, or immediately if torn, punctured, or contaminated. Some glove types may allow longer wear times per manufacturer specifications. **Source citation:** `USP <800> - Glove Change Frequency` _Scored practice question_ ## Question 86 What does the sig code 'QID' mean? - A. Four times daily - B. Three times daily - C. Twice daily - D. Once daily **Correct answer:** Four times daily **Explanation:** QID (quater in die) means four times daily. The medication should be taken four times per day, typically at evenly spaced intervals. **Source citation:** `Standard Pharmacy Abbreviations - Order Entry` _Scored practice question_ ## Question 87 A prescription reads 'Instill 1 gtt OD TID'. How should this be clarified on the patient label? - A. Instill 1 drop in the left eye three times daily - B. Instill 1 drop in the right eye three times daily - C. Instill 1 drop in both eyes three times daily - D. Instill 1 drop in the right ear three times daily **Correct answer:** Instill 1 drop in the right eye three times daily **Explanation:** OD means right eye (oculus dexter), but it is on the ISMP 'Do Not Use' list because it can be confused with OS (left eye) or AD (right ear). The patient label should clearly state 'right eye' to prevent administration errors. **Source citation:** `ISMP List of Error-Prone Abbreviations - Patient Safety` _Scored practice question_ ## Question 88 Under USP <800>, how must hazardous drug waste be disposed of? - A. In designated, properly labeled hazardous drug waste containers, and disposed of through an approved hazardous waste program - B. By incineration in the pharmacy - C. In regular trash bins - D. By flushing down the drain **Correct answer:** In designated, properly labeled hazardous drug waste containers, and disposed of through an approved hazardous waste program **Explanation:** Hazardous drug waste must be placed in designated, properly labeled, leak-proof containers and disposed of through an EPA-approved hazardous waste program. This includes contaminated PPE, empty vials, unused drugs, and cleaning materials from spills. **Source citation:** `USP <800> - Hazardous Waste Disposal; EPA/RCRA Regulations` _Scored practice question_ ## Question 89 Tirzepatide (Mounjaro, Zepbound) represents a novel drug class approved by the FDA in 2022–2023. Which mechanism best describes tirzepatide's action? - A. Dual agonist at both GLP-1 and GIP receptors, producing greater weight loss than GLP-1 agonists alone - B. SGLT-2 inhibitor that reduces renal glucose reabsorption - C. Selective GLP-1 receptor agonist only (same class as semaglutide) - D. DPP-4 inhibitor that increases endogenous incretin levels **Correct answer:** Dual agonist at both GLP-1 and GIP receptors, producing greater weight loss than GLP-1 agonists alone **Explanation:** Tirzepatide (Mounjaro, approved May 2022 for T2DM; Zepbound, approved November 2023 for obesity) is the first dual GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor agonist. This dual mechanism produces greater reductions in HbA1c and body weight compared to GLP-1 agonists alone (e.g., semaglutide). It differs from DPP-4 inhibitors, which indirectly raise GLP-1 levels, and from SGLT-2 inhibitors, which work via renal glucose excretion. **Source citation:** `FDA NDA 215866 (Mounjaro, 2022); FDA NDA 217806 (Zepbound, 2023) - Novel Drug Approvals` _Scored practice question_ ## Question 90 Acetaminophen max pediatric daily dose is the lesser of 75 mg/kg/day or 4000 mg. A child weighs 50 kg, taking 15 mg/kg/dose every 6 hours. What is the daily dose? - A. 3750 mg/day - B. 2500 mg/day - C. 3000 mg/day - D. 4000 mg/day **Correct answer:** 3000 mg/day **Explanation:** Daily = min(mg/kg × weight × doses, 4000) Doses/day = 4 (q6h) Daily = 15 × 50 × 4 = possible daily dose (cap at 4000 mg) = 3000 mg/day **Source citation:** `Pharmacy Calculations - Standard Practice` _Scored practice question_ ## Frequently asked questions ### Is this PTCE practice test free? Yes. All 90 questions and explanations are free. No account or payment card is required. ### How long is the real PTCE? The PTCE has 90 questions (80 scored and 10 unscored) and a time limit of 1 hour 50 minutes. ### Are these real PTCE questions? No. These are original practice questions written to the public 2026 PTCB content outline. Unlimited Practice Guide is not affiliated with PTCB. ### What should I use after this? PTCB recommends its official Pre-PTCE as a final readiness check after studying with the PTCE Practice Bank. 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