Question 1
A newly diagnosed patient with diabetes is brought to the ER. The patient also has schizophrenia, hypertension, and a few other conditions. Which of the following drugs can potentially increase creatinine clearance (CrCl) to more than 180 mL/min?
A) Metformin
B) Lurasidone
C) Lithium
D) Clozapine
E) Atenolol
Correct Answer: C) Lithium
Explanation: Lithium can cause nephrogenic diabetes insipidus, leading to increased creatinine clearance (CrCl > 180 mL/min). This effect is due to lithium’s interference with kidney function, specifically its impact on water and sodium balance.
Question 2
Which of the following is NOT a function of NAPRA (National Association of Pharmacy Regulatory Authorities)?
A) Developing national standards for pharmacy practice
B) Regulating provincial pharmacy licensing
C) Overseeing national pharmacy exams
D) Protecting public safety by establishing pharmacy standards
E) Regulating drug prices (PMPRB)
Correct Answer: E) Regulating drug prices (PMPRB)
Explanation: The Patented Medicine Prices Review Board (PMPRB) regulates drug prices in Canada, not NAPRA. NAPRA focuses on pharmacy standards, public safety, and professional regulation.
Question 3
What is the mechanism of action of galantamine in the treatment of Alzheimer’s disease?
A) Selective serotonin reuptake inhibition
B) Inhibition of glutamate receptors
C) Inhibition of acetylcholinesterase and modulation of nicotinic receptors
D) Dopamine receptor blockade
E) Antagonism of GABA receptors
Correct Answer: C) Inhibition of acetylcholinesterase and modulation of nicotinic receptors
Explanation: Galantamine is an acetylcholinesterase inhibitor and a nicotinic receptor modulator, which enhances cholinergic function by increasing acetylcholine levels in the brain, used in Alzheimer’s disease.
Question 4
What is the mechanism of action of atomoxetine in the treatment of attention-deficit hyperactivity disorder (ADHD)?
A) Selective norepinephrine reuptake inhibition
B) Dopamine receptor agonist
C) Acetylcholinesterase inhibition
D) Gamma-aminobutyric acid (GABA) receptor modulation
E) Monoamine oxidase inhibition
Correct Answer: A) Selective norepinephrine reuptake inhibition
Explanation: Atomoxetine works by selectively inhibiting the norepinephrine transporter, increasing norepinephrine levels in the synaptic cleft, which improves attention and behavior in patients with ADHD.
Question 5
A community health survey was conducted in a town with a population of 50,000 people. The survey found that 1,200 individuals currently have hypertension. What is the prevalence of hypertension in this town?
A) 0.24%
B) 2.4%
C) 24%
D) 4%
E) 12%
Correct Answer: B) 2.4%
Explanation: Prevalence is calculated as the number of existing cases (1,200) divided by the total population (50,000), multiplied by 100.
Prevalence = (1,200 / 50,000) × 100 = 2.4%.
Question 6
A patient requires a total of 40 units of insulin per day, consisting of 70% intermediate-acting insulin and 30% rapid-acting insulin. How many units of intermediate-acting insulin and rapid-acting insulin will the patient need to mix for each dose?
A) 28 units of intermediate-acting, 12 units of rapid-acting
B) 30 units of intermediate-acting, 10 units of rapid-acting
C) 20 units of intermediate-acting, 20 units of rapid-acting
D) 25 units of intermediate-acting, 15 units of rapid-acting
E) 35 units of intermediate-acting, 5 units of rapid-acting
Correct Answer: A) 28 units of intermediate-acting, 12 units of rapid-acting
Explanation: 70% of 40 units = 28 units of intermediate-acting insulin, and 30% of 40 units = 12 units of rapid-acting insulin.
Question 7
A pharmacist is asked to prepare a 3:1000 cream from nifedipine 5 mg tablets. The final weight of the cream should be 270 grams. How many nifedipine 5 mg tablets are required to prepare the cream?
A) 162 tablets
B) 81 tablets
C) 54 tablets
D) 108 tablets
E) 64 tablets
Correct Answer: C) 54 tablets
Explanation:
Step 1: 3:1000 means 3 grams of nifedipine in 1000 grams of cream.
Step 2: To prepare 270 grams of cream, you need (3/1000) × 270 = 0.81 grams of nifedipine.
Step 3: 0.81 grams = 810 mg, so you need 810 mg of nifedipine.
Step 4: Since each tablet is 5 mg, you’ll need 810/5 = 162 tablets.
Question 8
Which of the following is the most common symptom of tinea pedis (athlete’s foot)?
A) Muscle cramps
B) Red, scaly, itchy skin between the toes
C) Blisters on the hands
D) Nail thickening
E) Scalp itching
Correct Answer: B) Red, scaly, itchy skin between the toes
Explanation: Tinea pedis (athlete’s foot) is characterized by itchy, scaly, and red skin, most commonly found between the toes.
Question 9
Which of the following is considered the first-line treatment for head lice in a pregnant woman?
A) Permethrin 1% lotion
B) Lindane shampoo
C) Ivermectin lotion
D) Malathion lotion
E) Spinosad suspension
Correct Answer: A) Permethrin 1% lotion
Explanation: Permethrin 1% lotion is considered the first-line treatment for head lice and is safe for use during pregnancy.
Question 10
Which cells in the stomach are responsible for secreting gastric acid (HCl)?
A) Chief cells
B) Parietal cells
C) G cells
D) D cells
E) Mucous cells
Correct Answer: B) Parietal cells
Explanation: Parietal cells are responsible for secreting gastric acid (HCl), which aids in digestion.
Question 11
Which of the following is a long-acting beta-agonist (LABA) used in the long-term management of asthma?
A) Albuterol
B) Salmeterol
C) Ipratropium
D) Theophylline
E) Montelukast
Correct Answer: B) Salmeterol
Explanation: Salmeterol is a long-acting beta-agonist (LABA) used in the long-term management of asthma, usually in combination with inhaled corticosteroids.
Question 12
Which class of drugs is typically used as first-line therapy in the long-term management of chronic obstructive pulmonary disease (COPD)?
A) Beta-blockers
B) Inhaled corticosteroids
C) Long-acting muscarinic antagonists (LAMA)
D) Leukotriene receptor antagonists
E) Systemic corticosteroids
Correct Answer: C) Long-acting muscarinic antagonists (LAMA)
Explanation: LAMA drugs, such as tiotropium, are commonly used as first-line therapy in the long-term management of COPD to improve airflow and reduce exacerbations.
Question 13
In a patient with severe COPD, when is long-term oxygen therapy (LTOT) indicated?
A) PaO2 ≤ 60 mmHg
B) SpO2 < 95%
C) PaO2 ≤ 55 mmHg or SpO2 < 88%
D) PaCO2 > 50 mmHg
E) PaO2 > 75 mmHg
Correct Answer: C) PaO2 ≤ 55 mmHg or SpO2 < 88%
Explanation: Long-term oxygen therapy (LTOT) is indicated in patients with COPD when PaO2 ≤ 55 mmHg or SpO2 < 88% to improve survival and reduce complications.
Question 14
Which of the following is characteristic of Heart Failure with Preserved Ejection Fraction (HFpEF)?
A) Reduced ejection fraction <40%
B) Increased diastolic dysfunction
C) Increased systolic dysfunction
D) Decreased ventricular filling pressure
E) Right ventricular hypertrophy only
Correct Answer: B) Increased diastolic dysfunction
Explanation: HFpEF is primarily characterized by diastolic dysfunction, where the heart has trouble relaxing and filling with blood, despite having a preserved ejection fraction (≥50%).
Question 15
A 65-year-old male presents to the emergency department with paroxysmal atrial fibrillation. His symptoms include palpitations, shortness of breath, and dizziness. His episodes typically last less than 24 hours and resolve on their own. His history includes hypertension and chronic kidney disease. Which of the following is the most appropriate first-line management of paroxysmal atrial fibrillation for this patient?
A) Digoxin
B) Warfarin
C) Beta-blockers
D) Amiodarone
E) Aspirin
Correct Answer: C) Beta-blockers
Explanation: In patients with paroxysmal atrial fibrillation, beta-blockers are often the first-line treatment for controlling rate. They help manage the symptoms and reduce the frequency of episodes, particularly in patients with co-existing hypertension.
Question 16
A physician has had their registration cancelled for prescribing narcotics. Which of the following medications can they still prescribe?
A) Naloxone
B) Naltrexone
C) Buprenorphine + Naloxone (Suboxone)
D) Methadone
E) All of the above
Correct Answer: A) Naloxone
Explanation: A physician with cancelled registration for narcotic prescriptions can still prescribe Naloxone, as it is an opioid antagonist used in opioid overdose situations. However, other narcotics and opioid-related treatments like methadone or Suboxone require special registration.
Question 17
Which of the following is a primary function of Health Canada?
A) Regulating the pharmaceutical industry’s pricing
B) Monitoring and assessing the safety of food and drugs
C) Licensing healthcare professionals
D) Conducting audits on hospital safety protocols
E) Overseeing national public health insurance
Correct Answer: B) Monitoring and assessing the safety of food and drugs
Explanation: Health Canada is responsible for ensuring the safety and effectiveness of food, drugs, and health products in Canada, along with other regulatory activities in healthcare.
Question 18
A pharmacy technician receives a call from a prescriber’s office for a verbal prescription. What should the technician do?
A) Accept and process the prescription
B) Transfer the call to a pharmacist to take the prescription
C) Ask the prescriber to fax the prescription
D) Decline the prescription since it’s verbal
E) Accept the prescription but confirm details with the pharmacist afterward
Correct Answer: A) Accept and process the prescription
Explanation: Pharmacy technicians are authorized to take verbal prescriptions, except for narcotics. Since the prescription is for a non-narcotic medication, the technician can accept and process the prescription independently.
Question 19
Given the formula Css = R0 / (K × Vd), if a patient is receiving a drug infusion at a rate of 15 mg/hour, with a clearance rate (K) of 0.5 L/hour and a volume of distribution (Vd) of 40 L, what will the steady-state concentration (Css) of the drug be?
A) 0.75 mg/L
B) 1.25 mg/L
C) 1.5 mg/L
D) 2 mg/L
E) 3 mg/L
Correct Answer: B) 1.25 mg/L
Explanation: Using the formula Css = R0 / (K × Vd), plug in the values:
Css = 15 mg/hour / (0.5 L/hour × 40 L) = 1.25 mg/L.
Question 20
What is the standard filter size for sterilizing solutions in pharmaceuticals?
A) 0.1 microns
B) 0.22 microns
C) 0.5 microns
D) 1 micron
E) 0.05 microns
Correct Answer: B) 0.22 microns
Explanation: A 0.22-micron filter is typically used for sterilizing solutions to remove bacteria and other microorganisms in sterile compounding.
Question 21
What is the mechanism of action of Lopinavir?
A) Serine protease inhibitor
B) Viral protease inhibitor
C) Reverse transcriptase inhibitor
D) Fusion inhibitor
E) Integrase inhibitor
Correct Answer: B) Viral protease inhibitor
Explanation: Lopinavir is a viral protease inhibitor, used in the treatment of HIV to block the protease enzyme, which is essential for viral replication.
Question 22
Which is the active form of Ibuprofen?
A) R-Ibuprofen
B) S-Ibuprofen
C) Both R and S forms
D) Neither R nor S forms
E) The active form depends on the patient’s metabolism
Correct Answer: B) S-Ibuprofen
Explanation: The S-enantiomer of ibuprofen is the active form. Ibuprofen exists as a racemic mixture where the S-isomer provides the therapeutic effects, such as anti-inflammatory and analgesic actions.
Question 23
A patient receiving tamoxifen for breast cancer reports concerns about experiencing nausea and vomiting due to chemotherapy. Which of the following is the most appropriate response regarding the nauseating effects of tamoxifen?
A) Prescribe ondansetron for anticipatory nausea
B) Use lorazepam to prevent anticipatory nausea
C) No anticipatory measures are required as tamoxifen is least nauseating
D) Prescribe metoclopramide to reduce nausea
E) Switch tamoxifen to another anti-cancer drug
Correct Answer: C) No anticipatory measures are required as tamoxifen is least nauseating
Explanation: Tamoxifen is generally well-tolerated and has minimal nauseating effects compared to chemotherapy agents. Therefore, no anticipatory measures for nausea and vomiting are typically required when using tamoxifen.
Question 24
If an allosteric inhibitor binds irreversibly to an enzyme, what type of bond is most likely formed?
A) Hydrogen bond
B) Ionic bond
C) Covalent bond
D) Van der Waals forces
E) Hydrophobic interactions
Correct Answer: C) Covalent bond
Explanation: An irreversible allosteric inhibitor forms a covalent bond with the enzyme, leading to permanent inhibition and preventing further activity.
Question 25
How does serotonin influence Gs and Gi receptors to affect ion channels?
A) By increasing ATP synthesis
B) By increasing cAMP via adenylate cyclase, leading to the phosphorylation of ion channels
C) By inhibiting cAMP synthesis and preventing ion channel activation
D) By directly opening ion channels without second messengers
E) By blocking adenylate cyclase and decreasing ATP availability
Correct Answer: B) By increasing cAMP via adenylate cyclase, leading to the phosphorylation of ion channels
Explanation: Serotonin binds to Gs and Gi receptors, activating adenylate cyclase which converts ATP to cAMP. This cAMP activates protein kinases that phosphorylate ion channels, leading to their opening.
Question 26
A patient with hyperthyroidism presents with nasal congestion. Which of the following treatments is the most appropriate for this patient considering their condition?
A) Pseudoephedrine
B) H1 Antihistamines
C) H2 Blockers
D) Oxymetazoline nasal spray
E) Phenylephrine tablets
Correct Answer: C) H2 Blockers
Explanation: In patients with hyperthyroidism, H2 blockers (such as ranitidine or famotidine) are preferred to relieve nasal congestion, as other decongestants (like pseudoephedrine) may exacerbate cardiovascular symptoms like tachycardia.
Question 27
A patient with type 2 diabetes is experiencing insulin resistance. Which of the following medications can improve insulin sensitivity and is commonly considered a first-line option in type 2 diabetes management?
A) Sulfonylureas
B) Insulin
C) Metformin
D) Acarbose
E) Thiazolidinediones
Correct Answer: C) Metformin
Explanation: Metformin is commonly used as a first-line treatment for type 2 diabetes because it improves insulin sensitivity in peripheral tissues, helping to manage insulin resistance and lower blood sugar without increasing insulin secretion.
Question 28
A 70-year-old man visits his doctor for routine lab work. His results show elevated serum parathyroid hormone (PTH) levels. The physician explains that this is common in older adults due to changes in the body’s renal function. Which of the following is most likely to increase with age in this patient?
A) Total body water
B) Bone mass
C) Parathyroid hormone
D) Hair growth
E) Renal clearance
Correct Answer: C) Parathyroid hormone
Explanation: Serum parathyroid hormone (PTH) increases with age, particularly due to declining renal function, which affects the body’s ability to manage calcium and phosphorus levels.
Question 29
A mother brings her 6-month-old baby to the pediatrician, concerned about a red rash in the diaper area that hasn’t improved with regular diaper changes. The pediatrician diagnoses the baby with diaper rash and recommends a mild corticosteroid. Which of the following would be the most appropriate treatment?
A) 0.025% Hydrocortisone
B) 0.5% Hydrocortisone
C) 0.05% Betamethasone
D) 0.05% Acetamide
E) 1% Hydrocortisone
Correct Answer: B) 0.5% Hydrocortisone
Explanation: Hydrocortisone 0.5% is a mild corticosteroid suitable for diaper rash treatment. Stronger corticosteroids like betamethasone can be too potent for the sensitive skin of infants and may cause adverse effects.
Question 30
A 60-year-old woman is diagnosed with open-angle glaucoma. Her ophthalmologist prescribes dorzolamide to manage her intraocular pressure. She asks how the medication works. Which of the following best explains the mechanism of action of dorzolamide?
A) Decreases production of aqueous humor
B) Increases outflow of aqueous humor
C) Blocks sympathetic stimulation of the ciliary body
D) Enhances reabsorption of aqueous humor
E) Dilates the pupil to increase drainage
Correct Answer: A) Decreases production of aqueous humor
Explanation: Dorzolamide is a carbonic anhydrase inhibitor that works by decreasing the production of aqueous humor in the eye, thus lowering intraocular pressure (IOP), which is crucial in managing glaucoma.
Question 31
A patient is learning about the anatomy of the eye. The physician explains the layers of the eye and asks the patient to identify the outermost and innermost layers. Which of the following correctly describes these layers?
A) Cornea and optic nerve
B) Sclera and retina
C) Conjunctiva and iris
D) Choroid and vitreous body
E) Lens and fovea
Correct Answer: B) Sclera and retina
Explanation: The sclera is the outermost layer of the eye, often referred to as the “white of the eye.” The retina is the innermost layer, responsible for receiving light and sending visual signals to the brain via the optic nerve.
Question 32
A 35-year-old woman is started on isoniazid therapy for latent tuberculosis. The physician advises her to take pyridoxine (vitamin B6) supplements. What is the most likely reason for this recommendation?
A) To prevent hepatic toxicity
B) To prevent peripheral neuropathy
C) To prevent drug-induced lupus
D) To prevent skin rashes
E) To enhance isoniazid absorption
Correct Answer: B) To prevent peripheral neuropathy
Explanation: Isoniazid can cause peripheral neuropathy, which is related to vitamin B6 (pyridoxine) deficiency. Pyridoxine supplementation helps prevent this side effect. While isoniazid can also cause hepatic toxicity and drug-induced lupus, pyridoxine specifically addresses the risk of neuropathy.
Question 33
A 28-year-old woman is prescribed a combined oral contraceptive (OCP) containing drospirenone. What should her healthcare provider monitor after the first cycle of using this contraceptive?
A) Blood glucose levels
B) Blood pressure
C) Potassium (K) levels
D) Liver enzymes
E) Hemoglobin levels
Correct Answer: C) Potassium (K) levels
Explanation: Drospirenone, a progestin with anti-mineralocorticoid activity, can increase the risk of hyperkalemia. Therefore, potassium levels should be monitored, especially after the first cycle of therapy, to detect any electrolyte imbalances.
Question 34
A pharmacist assistant at a community pharmacy is assisting with new prescriptions. Which of the following tasks is the assistant not permitted to perform?
A) Enter a new prescription into the software
B) Check the authenticity of a prescription
C) Assist with stock management
D) Direct the patient to a pharmacist for OTC recommendations
E) Label prescription bottles for filling
Correct Answer: B) Check the authenticity of a prescription
Explanation: Pharmacist assistants are allowed to perform administrative tasks such as entering new prescriptions into the system or assisting with stock management, but they cannot perform clinical tasks like checking prescription authenticity, taking oral prescriptions, or providing advice about medications.
Question 35
A woman with a history of anorexia nervosa and recent jaw surgery wants to quit smoking. Which of the following smoking cessation options is the most appropriate for her?
A) Nicotine gum
B) Nicotine lozenges
C) Bupropion
D) Nicotine patches
E) Varenicline
Correct Answer: D) Nicotine patches
Explanation: Nicotine patches are the best option for this woman because they bypass the oral route, making them suitable after jaw surgery. Other options like gum or lozenges could be problematic due to her surgery, and medications like bupropion or varenicline may have contraindications or side effects that are concerning, especially with her history of anorexia nervosa.
Question 36
A 35-year-old man presents with acute hepatitis after returning from a trip to a developing country. His doctor suspects he contracted the illness from contaminated food or water. Which of the following is the most likely cause of his acute hepatitis?
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
Correct Answer: A) Hepatitis A
Explanation: Hepatitis A is the most common cause of acute hepatitis, typically transmitted through contaminated food or water. While hepatitis B and C can also cause acute hepatitis, hepatitis A is more often associated with foodborne outbreaks.
Question 37
During a muscle contraction, calcium is required for the process to occur. Where does the calcium involved in smooth muscle contraction come from?
A) Only extracellular calcium
B) Only the sarcoplasmic reticulum
C) Both extracellular calcium and the sarcoplasmic reticulum
D) The nucleus and the mitochondria
E) The Golgi apparatus
Correct Answer: C) Both extracellular calcium and the sarcoplasmic reticulum
Explanation: The calcium needed for muscle contraction is sourced from both the sarcoplasmic reticulum (S.R.) and extracellular calcium that enters through calcium channels in the smooth muscle cells.
Question 38
A patient taking metformin for type 2 diabetes presents with symptoms of anemia. The lab results show a high mean corpuscular volume (MCV), indicating macrocytic anemia. What is the most likely cause of this patient’s anemia?
A) Iron deficiency
B) Folate deficiency
C) Vitamin B12 deficiency
D) Sickle cell disease
E) Hemolytic anemia
Correct Answer: C) Vitamin B12 deficiency
Explanation: Long-term use of metformin can lead to vitamin B12 deficiency, which causes macrocytic anemia (elevated MCV). Monitoring of vitamin B12 levels is recommended in patients taking metformin.
Question 39
Which of the following is necessary for the absorption of vitamin B12 in the gastrointestinal tract?
A) Folate
B) Vitamin D
C) Intrinsic factor
D) Calcium
E) Iron
Correct Answer: C) Intrinsic factor
Explanation: Intrinsic factor is a glycoprotein produced by the stomach that is essential for the absorption of vitamin B12 in the small intestine. Without intrinsic factor, vitamin B12 cannot be properly absorbed, leading to deficiency.
Question 40
A clinical study on the efficacy of a new medication had a significant difference in sample size between the control group and the treatment group. How might this difference in sample size affect the study?
A) It improves the study’s precision
B) It decreases the likelihood of random errors
C) It can introduce bias and affect the study’s validity
D) It increases the generalizability of the study
E) It has no impact on the study’s results
Correct Answer: C) It can introduce bias and affect the study’s validity
Explanation: A difference in sample size between study groups can lead to bias and affect the validity of the study results, potentially skewing the outcome and reducing the reliability of the findings.
Question 41
A 55-year-old man is being treated with isoniazid for latent tuberculosis. His doctor advises him to take pyridoxine (Vitamin B6) alongside isoniazid. What is the reason for this recommendation?
A) To prevent hepatotoxicity
B) To enhance the efficacy of isoniazid
C) To prevent peripheral neuropathy
D) To reduce gastrointestinal upset
E) To treat latent tuberculosis more effectively
Correct Answer: C) To prevent peripheral neuropathy
Explanation: Isoniazid can deplete pyridoxine (Vitamin B6), leading to peripheral neuropathy. Concurrent pyridoxine supplementation helps minimize this risk.
Question 42
A 65-year-old man with benign prostatic hyperplasia (BPH) is prescribed terazosin and finasteride. He asks whether taking these two medications together is necessary or considered excessive therapy. Which of the following is the most appropriate response?
A) This is an example of polypharmacy and should be avoided
B) This is considered duplicate therapy and should be changed
C) This combination is appropriate management for BPH
D) Testosterone should be added to enhance effectiveness
E) Finasteride and testosterone should be combined for better outcomes
Correct Answer: C) This combination is appropriate management for BPH
Explanation: Terazosin (an alpha-1 blocker) and finasteride (a 5-alpha-reductase inhibitor) work synergistically to manage BPH symptoms. Testosterone is contraindicated with finasteride due to its opposing effects on androgen levels, making option D incorrect.
Question 43
A 10-year-old girl presents with ear pain and discharge after spending a weekend swimming in a pool. The doctor suspects an infection. What is the most likely diagnosis for this patient?
A) Otitis media
B) Swimmer’s ear (otitis externa)
C) Impacted cerumen
D) Eustachian tube dysfunction
E) Sinusitis
Correct Answer: B) Swimmer’s ear (otitis externa)
Explanation: Otitis externa (also known as swimmer’s ear) is a common ear infection associated with prolonged water exposure, such as swimming. It causes ear pain and discharge and is typically treated with topical antibiotics or ear drops.