PEBC Evaluating Exam – Question set #6
Question 1: JT is taking Olanzapine for psychosis. He comes to the pharmacy complaining about his twisted wrist, feet pointing inwards, and tilted neck. These symptoms are indicative of dystonia. Which of the following is the drug of choice for drug-induced dystonia?
A. Benztropine
B. Propranolol
C. Trihexyphenidyl
D. Tetrabenzene
E. Verapamil
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Answer: A
| Extra Pyramidal Symptoms (EPS) Mnemonic: DAPT | Treatment Mnemonic: Ben’s BAT |
| Dystonia – Continuous spasm + muscle contractions | Benztropine (anticholinergic) |
| Akathisia – Restlessness | Beta blocker (Propranolol) |
| Parkinson’s like Symptoms (TRAP = Tremors, Rigidity, Akinesia, Postural instability) | Anticholinergics (Beztropine, Procyclidine, Trihexyphenidyl) |
| Tardive dyskinesia – Irregular jerky movements – Often involves lower face + distal extremities. – May be chronic. – Can become chronic if continued for a long time. | Tetrabenzene |
Image source: Active Posture
If you want to know more about dystonia, click the link above. Active Posture has written a detailed article on the topic.
Here’s the link to the article.
Note:
The above question is from antipsychotics. Mechanism of action, receptors of drugs (like 5HT1A, etc), and side effects of drugs are important.
Question 2: Which of the following statements describes the primary purpose of conducting a SWOT analysis?
A) Identification of company's vision and goals
B) Evaluation of company's year on year performance
C) Assessment of internal and external variables to plan a road map for success
D) To determine a company’s organizational structure
E) Predict sales to estimate product life cycle
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Answer: C
Question 3: Which of the following are the side effects of Mirtazapine?
A. High Nausea and vomiting
B. High weight gain and high sedation
C. Reduces cholesterol levels
D. Uricosuric effect
E. Pitting edema
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Answer: B
Quick revision:
- Mirtazapine has high sedation and high weight gain due to H1 inhibition.
- Mirtazapine has the least nausea and vomiting due to 5HT3 inhibition
Question 4: Which of the following is not a side effect of Verapamil?
A. Bradycardia
B. Worsening of CHF
C. Constipation
D. Diarrhea
E. Myocardial vasodilation
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Answer: D
Quick revision:
- Verapamil reduces AV conduction, reduces myocardial oxygen demand, and reverses coronary vasospasm
Remember: Constipation is a hallmark side effect of verapamil.
Question 5: A 58-year-old male with type 2 diabetes and metabolic syndrome presents with elevated triglyceride levels despite being on a statin. His physician adds gemfibrozil to his therapy to help manage his lipid profile. During counseling, the patient asks how this new medication works to lower his triglycerides.
Question:
Which of the following best describes the mechanism of action of gemfibrozil?
A. PPAR alpha agonist
B. PPAR gamma antagonist
C. PPAR alpha antagonist
D. Xanthine oxidase inhibitor
E. 5 alpha reductase II inhibitor
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Answer: A
Explanation:
Gemfibrozil is a fibrate that works by activating peroxisome proliferator-activated receptor alpha (PPAR-α). This leads to increased synthesis of lipoprotein lipase, which enhances the breakdown of triglyceride-rich particles, lowering serum triglyceride levels.
Quick revision
Side effects: Gemfibrozil is contraindicated with statins as it may lead to myopathy, Cholelithiasis, and gallstone formation.
Fibrates have the highest triglyceride-lowering effect. Fibrates (Especially fenofibrate) has uricosuric effect. Extremely useful in treating hypertriglyceridemia in diabetic patients and in the prophylaxis of coronary heart disease and cerebrovascular disease.
Question 6: A 69-year-old man with nephrotic syndrome and congestive heart failure is taking phenytoin. He presents with confusion, ataxia, and slurred speech. His total phenytoin level is 6 mcg/mL (therapeutic: 10–20 mcg/mL), but symptoms strongly suggest toxicity.
What is the best explanation for this apparent discrepancy?
A. Phenytoin is water soluble and accumulates in renal failure
B. Increased renal clearance due to proteinuria
C. Unmeasured phenytoin metabolites are neurotoxic
D. Decreased protein binding leads to higher free phenytoin levels
E. Total phenytoin is falsely elevated due to uremia
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Answer: D
Explanation:
In nephrotic syndrome, there’s hypoalbuminemia, which reduces phenytoin’s protein binding. While total levels fall, the free (active) fraction increases, leading to toxicity despite normal or low total levels.
Quick revision
Naproxen is a propionic acid derivative, and it exists in 2 isomeric forms: R and S. The S isomer is more effective than R. Naproxen is the only drug that is marketed as a pure S isomer.
Question 7: JT came to the pharmacy complaining about pain in her ear and fever. Her current symptoms are indicative of Otitis Media. Upon checking JT’s medication history, it was found that JT also experienced gout attacks in the past. Answer the following questions based on the information provided.
Question 7.1: What could be the causative agent for JT’s otitis media?
A. Treponema palladium
B. Bacillus anthracis
C. Helicobacter pylori
D. M. catarrhalis
E. Borrelia burgdorferi
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Answer: D
Quick revision
S. pneumoniae, H. influenzae, and M catarrhalis are the causative agents for otitis media.
Question 7.2: What is the best drug if JT has not taken any antibiotics in more than a year?
A. Amoxicillin + Clavulanate
B. Azithromycin
C. Moxifloxacin
D. Clindamycin
E. Amoxicillin
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Answer: E
Quick revision
Drug of choice: Amoxicillin, Amoxicillin + Clavulanate, Ceftriaxone, Cefuroxime, Azithromycin
Question 8: Which of the following statements about the blood clotting mechanism is correct?
A. Warfarin acts on Extrinsic pathway
B. Heparin acts on extrinsic pathway
C. Warfarin exerts its action through CNS
D. Heparin has receptor mediated action
E. aPTT is monitored for warfarin
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Answer: A
Quick revision
- Heparin acts on intrinsic pathways while Warfarin acts on the extrinsic pathway
Remember the below-mentioned chart. A question is possible from this image.
Question 9: Prolonged q use of which of the following drugs is a risk factor for osteoporosis?
A. Prolong use of Rosuvastatin
B. Long time use of Metformin
C. extended use of Methotrexate
D. Long time use of corticosteroids
E. LABA drugs like Formoterol
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Answer: D
Question 10: Which of the following statements are true when the data represents 99% confidence interval?
A. 99% confidence interval would be narrowe than 95%
B. 99% confidence interval will have a positive skew
C. 99% confidence interval would be wider than 95%
D. 99% confidence interval would have a negative skew
E. 99% confidence interval represents bimodal distribution
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Answer: C
Quick Revision
Question 11: A drug is administered orally at a dose of 100 mg and its AUC (Area Under the Curve) is found to be 50 µg·h/mL. The same drug is administered intravenously at a dose of 50 mg, and its AUC is 150 µg·h/mL. What is the absolute bioavailability of the drug?
A) 16.67%
B) 33.33%
C) 50.00%
D) 66.67%
E) 75.00%
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Answer: A
Use formula for Absolute bioavailability = (AUCoral / AUCiv ) x (Doseiv / Doseoral )
Question 12: A 55-year-old woman with atrial fibrillation is initiated on warfarin therapy. Within 3 days, her INR increases to 5.5, and she reports mild gum bleeding, despite being on a low dose of warfarin. Genetic testing is performed and reveals that she carries the CYP2C9 2/3 genotype along with a VKORC1 polymorphism.
Question:
What is the most likely explanation for the rapid elevation in her INR?
A. Increased metabolism of warfarin
B. Enhanced hepatic clearance
C. Resistance to vitamin K
D. Decreased warfarin metabolism and increased sensitivity
E. Drug interaction with NSAIDs
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Answer: D
Explanation:
The CYP2C9 2/3 alleles result in reduced enzymatic activity, leading to slower metabolism of warfarin, while the VKORC1 polymorphism enhances sensitivity to warfarin. The combination of these genetic factors increases the risk of excessive anticoagulation, even at standard or low doses.
Question 13: DM is a pharmacist working in a community pharmacy. He wants to check the side effects of a particular drug. Which of the following resources should DM check?
A. Cochrane database
B. Natural product database
C. CTC
D. Compendium of Pharmaceutical Speciality (CPS/RxTx)
E. CTMA
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Answer: D
Quick Revision
| Reference | Information |
| Cochrane database | Evidence-based medicine systematic review |
| Natural product database | Natural products and herbs |
| CTC | Tratment options |
| Compendium of Pharmaceutical Speciality (CPS/RxTx) | Prescription drug monographs |
| CTMA | Treatment options |
Question 14: Which of the following is not a healthcare funding source?
A. Federal government
B. Provincial government
C. Charities
D. Employee insurance
E. Mandatory public fees
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Answer: E
Any type of public fee could be a barrier to accessing healthcare.
Question 15: JT is a 29-year-old male who is prescribed Clomiphene to improve his sperm count. Clomiphene is a drug approved to be used for female infertility. Which of the following would best describe the use of Clomiphene in this case?
A. Adapting the prescription
B. Beneficience
C. Prioritizing patient care
D. Off label use
E. Consenting
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Answer: D
Off-label drug use refers to the practice of prescribing a drug for a different purpose than what it was approved for.
Question 16: Which of the following drugs is not required to be taken at night?
A. Fluvastatin
B. Lovastatin
C. Rosuvastatin
D. Pravastatin
E. Simvastatin
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Answer: C
Rosuvastatin and Atorvastatin are high-impact statins and can be taken at any time. Mnemonic: RAtS can be seen any time (R = Rosuvastatin, At = Atorvastatin, and S = Statin)
Fluvastatin, Lovastatin, Simvastatin, and Pravastatin must be taken at night time. Mnemonic: FLoS Per Night. F = Fluvastatin, Lo = Lovastatin, S = Simvastatin, Per = Pravastatin, and Night = to be taken at night.
Question 17: What is the most common gram-positive cocci causing UTI?
A. S. saprophyticus
B. B. pertussis
C. E. coli
D. T. palladium
E. M. catarrhalis
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Answer: A
Remember: E. coli is the most common organism, but the question is asking for gram gram-positive organism.
Question 18: Which of the following is not involved in the metabolism of Acetyl Salicylic Acid?
A. Glycine conjugation
B. Glucuronidation
C. Hydrolysis
D. Glutathione conjugation
E.Hydroxylation
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Answer: D
Names of the phase 2 reactions can be memorized by this mnemonic: ‘Great Students Are Making Good Grades’
Great = Glucuronidation
Students = Sulfation
Are = Acetylation
Making = Methylation
Good = Glutathione Conjugation
Grades = Glycine (Amino Acid) Conjugation
Question 19: A patient with sepsis is on piperacillin-tazobactam administered every 6 hours. Despite achieving peak serum levels well above the MIC, cultures remain positive. You suspect dosing optimization is needed.
Which strategy is most appropriate for time-dependent antibiotics like piperacillin?
A. Increase dose to maximize peak
B. Decrease frequency to reduce toxicity
C. Switch to concentration-dependent drug
D. Extend infusion duration to maintain time above MIC
E. Add vancomycin for synergy
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Answer: D
Explanation:
Piperacillin is a time-dependent β-lactam. Its efficacy is based on how long the drug concentration stays above MIC. Extended infusions help maintain this and improve outcomes.
Question 20: Naltrexone is used for alcohol withdrawal. Which neurotransmitter does Naltrexone reduce in the brain?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. Epinephrine
E. Norepinephrine
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Answer: B
Question 21: Which of the following statements is not true about Medeffect?
A. Accessible to patients and care providers
B. Contains information on drug safety alerts
C. Complete details about the manufacturer or importer
D. Canada vigilance program is a part of medeffect
E. Contains information about recalls
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Answer: C
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