Question 1: Which of the following parameters is the most important factor to boost a pharmacy’s sales and profit?
A. Business location
B. Well trained staff
C. Customer loyalty
D. Underpaid employees
E. Under staffed business
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Answer: C
Acquiring new customers is the most expensive part of keeping or increasing a pharmacy’s profit. Option D – paying employees below minimum wage is both illegal and unethical. The remaining options should be considered at the time of starting the business.
Question 2: What are accounts receivable?
A. Liability as customer has received the service or goods but did not pay for it
B. Asset has the pharmacy has received the goods but has not yet paid for it
C. Salaries of the staff who works at the pharmacy
D. Customer has paid for the medicines but not received by the customer
E. Asset as the pharmacy has delivered the goods/services but not yet paid by the customer
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Answer: E
Accounts receivable are a part of assets. It simply means medicines/services sold on credit where the customer did not pay right away but will pay after a predetermined period (7 days, 10 days or any time).
Total current assets = Cash + accounts receivable + Inventory + prepaid expenses.
TIP: If a pharmacy has to pay someone, then it is a liability. The opposite of that is an asset (meaning the pharmacy has to receive payment).
Question 3: Which of the following drugs causes retinopathy?
A. Captopril
B. Hyroxychloroquine
C. Benzafibrate
D. Glimiperide
E. Misoprostol
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Answer: B
Quick revision for Hydroxychloroquine
| Use | Retinopathy and QT prolongation arethe most important side effects. Eye exam before starting the drug and annually is recommended |
| Side effects | Retinopathy and QT prolongation are the most important side effects. Eye exam before starting the drug and annually is recommended |
| Pregnancy | Safe to use |
Question 4: JT, a 66-year-old female, comes to the pharmacy with symptoms of a gout attack. JT has been taking anti-hypertensive medicines for more than a year. Currently, JT is taking Hydrochlorothiazide. JT is asking for the pharmacist’s recommendation for a painkiller to help with the symptoms of gout. Which of the following is the best option for JT?
A. Refer to doctor as because of JT's medication profile
B. Recommend Naproxen for pain
C. Recommend Indomethacin because of JT's age
D. Refer to a doctor because JT is a female
E. Do not recommend Colchicine as it is less than 36 hours
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Answer: A
Hydrochlorothiazide increases uric acid levels. High uric acid levels is associated with gout attacks. This patient has to be checked by a doctor to recommend a drug to lower uric acid levels, manage gout symptoms, and to change hydrochlorothiazide with another antihypertensive drug that does not increase uric acid levels. Losartan is one such drug with a uricosuric effect.
The other options may seem right, but if you choose them, you are hurting the patient, as the patient has high uric acid levels. No other options in the list deal with the actual problem of high uric acid levels. Hence, option A is the right answer.
Question 5: JT is a 29-year-old female who smokes 4 cigarettes in a day. She does not have epilepsy or psychosis. She recently underwent a lower jaw surgery for cosmetic enhancement. What is the best recommendation for JT for her to quit smoking?
A. Nicotine gum
B. Buspirone
C. Vernaciline
D. Nicotine patch
E. Nicotine lozenges
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Answer: D
- For 10 or fewer cigarettes, nondrug measures like Cognitive behavioral therapy is the first choice.
- For more than 10 cigarettes, Nicotine replacement therapy is the first choice. If NRT fails, go with prescription drugs
- Here, the answer is a Nicotine patch, as CBT is not given as an option, and JT underwent jaw surgery. So she cannot be recommended gum or lozenges
Question 6: A 41-year-old woman presents with dizziness and palpitations. She is on fluoxetine, ondansetron (post-surgery), and azithromycin (for URI). ECG reveals a QT interval of 520 ms. Which of her medications is most likely contributing to her condition?
A. Ondansetron
B. Fluoxetine
C. Azithromycin
D. All of the above
E. None of the above
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Answer: D
Explanation:
All three drugs prolong the QT interval and together can cause torsades de pointes. Co-administration increases the additive risk.
Question 7: What is the purpose of adding carbidopa to levodopa therapy?
A. Carbidopa inhibits peripheral uptake of dopamine
B. Carbidopa inhibits the metabolism of levodopa in CNS
C. inhibits peripheral conversion of levodopa to dopamine
D. reduces the number of lewy bodies in CNS
E. Resolves the symptoms through levodopa independent mechanism
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Answer: C
Quick revision
- Levodopa is a prodrug that is converted to dopamine by dopa decarboxylase
- Side effects:
- Wearing off, on-off, and dyskinesia
- Visual and auditory hallucinations
- Nausea, vomiting, and gastric upset
- Peripheral conversion of levodopa to dopamine causes nausea, vomiting, cardiac arrhythmias, and hypotension
- Precautions and contraindications:
- Vit B6 increases the peripheral conversion of levodopa to dopamine
- Levodopa + MAO inhibitors cause hypertensive crises. So do not combine
- Levodopa should be taken on an empty stomach
Question 8: What is the mechanism of action of Memantine?
A. NMDA receptor antagonist
B. Dopa decarboxylase inhibitor
C. COMT inhibitor
D. MAO ihbitor
E. Norepinephrnie Dopamine Reuptake Inhibitor
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Answer: A
Memantine is used as an adjuvant drug to treat dementia. It has limited use due to hepatotoxicity.
The 2 drugs in dementia that cause the most hepatotoxicity are Tolcapone and Memantine. Tolcapone is withdrawn and is no longer used due to hepatotoxicity.
Question 9: JT is a 42-year-old male who comes to the pharmacy to pick up a new prescription for Atorvastatin for hyperlipidemia. JT smokes 5 cigarettes per day and drinks a glass full of grapefruit juice every morning and evening since he was 18. JT is also taking medicines for hypertension. Answer the following questions based on the information provided.
Question 9.1: What is the pharmacist’s concern with the new prescription?
A. Dispense the prescription as there is no issue
B. Smoking reduces the efficacy of Atorvastatin
C. Atorvastatin is not the right drug considering JT's relatively young age
D. Interaction of Atorvastatin with grapefruit juice
E. Atorvastatin should not be given to a patient with hypertension
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Answer: D
CYP3A4 metabolizes Simvastatin, Atorvastatin, and Lovastatin and has the highest interaction with grapefruit juice.
Mnemonic 1: Add SALT to grapefruit juice. SALT = Simvastatin, Atorvastatin, and Lovastatin, T = to grapefruit juice
Mnemonic 2 (For those who speak Hindi): ‘Juice piyega SAL bhar pachayega’
Quick revision Tips:
- Atorvastatin (CYP3A4) and Rosuvastatin (CYP2C9) are high-impact statins. They have a long half-life and can be taken at any time. Other statins should be taken at night
- Pravastatin’s metabolizing enzyme is not known, and hence has the least interaction
Question 9.2: What is the pharmacist’s recommendation?
A. Ask the doctor to change Atorvastatin to Pravastatin
B. Ask JT to quit smoking right away
C. Recommend DASH diet to JT to control cholesterol levels
D. Ask doctor to change Atorvastatin to Rosuvastatin
E. Recommend Fluvastatin in place of Atorvastatin
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Answer: A
The obvious answer to this question would be to ask JT not to drink grapefruit juice. But that is not given in the option. Out of all the given options, changing Atorvastatin to Pravastatin is the best answer
Question 9.3: Which drug is the reason for JT’s dizziness when he stands up after sitting for some time? This symptom is indicative of postural hypotension.
A. Atorvastatin
B. Hydrochlorthiazide
C. Losartan
D. Propranolol
E. Furosemide
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Answer: C
Revision tip for the Pharmacy evaluation exam
Which drugs cause orthostatic or postural hypotension?
– ACE inhibitors – drugs ending in -pril. Example – Captopril
– ARB – drugs ending in -sartan. Example – Losartan
– Alpha 1 antagonists – drugs ending in -sin. Example – Prazosin
– Alpha 2 agonist – Methyldopa
– Vasodilators – Hydralazine and Nitrates
– Dihydropyridine Calcium channel blockers. – Drugs ending in -dipine. Example Nifedipine
Question 10: A patient is taking St John’s wort and Tacrolimus. What is the pharmacist’s recommendation?
A. St John's wart increases the effect of Tacrolimus
B. St John's wart reduces the effect of Tacrolimus
C. There is no interaction between the 2 drugs mentioned
D. Tacrolimus increases the effect of St John's wart
E. Tacrolimus decreses the effect of St John's wart
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Answer: B
St John’s wort is an inducer of CYP3A4 and P-Gp, while Tacrolimus is a substrate of CYP3A4 and P-Gp.
Question 11: A patient is prescribed dexamethasone 25 mg. The dose has to be reduced by 5 mg every week. How many tablets of dexamethasone 5 mg should be dispensed?
A. 105
B. 95
C. 120
D. 15
E. 16
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Answer: A
Week 1: Dose = 25 mg. So 5 (5 tab x 5 mg = 25 mg) tablets per day. So for 1 week = 5 x 7 = 35 tablets
Week 2: Dose = 20 mg. so 4 (4 tab x 5 mg = 20 mg) tablets per day. So for 1 week = 4 x 7 = 28 tablets
Week 3: Dose = 15 mg. so 3 (3 tab x 5 mg = 15 mg) tablets per day. So for 1 week = 3 x 7 = 21 tablets
Week 4: Dose = 10 mg. so 2 (2 tab x 5 mg = 10 mg) tablets per day. So for 1 week = 2 x 7 = 14 tablets
Week 5: Dose = 5 mg. so 1 (1 tab x 5 mg = 5 mg) tablets per day. So for 1 week = 1 x 7 = 7 tablets
Total tablets to be dispensed = 35 + 28 + 21 + 14 + 7 = 105 tablets
This type of dose tapering calculation is important.
Question 12: A 3-year-old child weighing 10 kg is diagnosed with acute otitis media. The physician prescribes amoxicillin at a dose of 40 mg/kg/day, to be given in two equally divided doses. The pharmacy dispenses amoxicillin suspension with a concentration of 40 mg/mL. How many millilitres (mL) of the suspension should be given per dose?
A. 2.5 mL
B. 5 mL
C. 10 mL
D. 15 mL
E. 20 mL
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Answer: B
Explanation:
Suspension = 40 mg/mL → Volume per dose = 200 mg ÷ 40 mg/mL = 5 mL
Total daily dose = 40 mg/kg × 10 kg = 400 mg/day
Divided into 2 doses = 400 mg ÷ 2 = 200 mg per dose
Question 13: A new cholesterol-lowering drug has been studied in a clinical trial involving patients at high risk of cardiovascular events. The study found that 10% of patients in the placebo group experienced a heart attack, compared to 6% in the treatment group over a 5-year period. The clinical pharmacist wants to calculate how many patients would need to be treated with this drug to prevent one additional heart attack. Which of the following formulas should the pharmacist use to calculate the Number Needed to Treat (NNT)?
A. NNT = 1/ARR
B. NNT = ([CER - EER]/CER) x 100
C. NNT = (1/ARR) x 100
D. NNT = CER - EER
E. NNT = Number of exposed subjects/number of unexposed subjects
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Answer: A
Question 14: A drug degrades according to first-order kinetics. If the initial concentration of the drug is 250 mg/L and the degradation rate constant (k) is 0.04 day⁻¹, what is the time required for the concentration to decrease to 90% of its initial value?
A. 1.1 days
B. 3.1 days
C. 2.9 days
D. 2.22 days
E. 2.6 days
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Answer: E
Put the values in equation t90 = 0.105/Kel
Question 15: If the absolute risk reduction (ARR) of a new drug is 0.1, what is the number needed to treat (NNT)?
A. 18
B. 6
C. 10.5
D. 12
E. 10
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Answer: E
Put the values in equation NTT = 1/ARR
Question 16: A 59-year-old male with a history of asthma and a recent myocardial infarction is being evaluated for beta-blocker therapy as part of his secondary prevention plan.
Question:
Which beta-blocker would be the most appropriate choice in this patient?
A. Propranolol
B. Nadolol
C. Metoprolol
D. Timolol
E. Sotalol
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Answer: C
Explanation:
Metoprolol is a cardioselective beta-1 blocker, making it a safer choice in asthmatic patients compared to non-selective beta-blockers like propranolol or nadolol, which can precipitate bronchospasm.
Question 17: A 67-year-old woman with chronic kidney disease (eGFR: 25 mL/min) is started on a standard dose of imipenem for a complicated urinary tract infection. Two days later, she develops new-onset seizures.
Question:
Which of the following best explains the cause of her seizures?
A. Imipenem-induced hyponatremia
B. Renal retention of imipenem
C. Drug allergy
D. Coexisting electrolyte disorder
E. Cerebral metastasis
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Answer: B
Explanation:
Imipenem can lower the seizure threshold, particularly in patients with renal dysfunction where drug clearance is impaired. Dose adjustment based on renal function is essential.
PEBC evaluating exam practice questions – Question Set #3
Also read this post. It has more questions with answers, mnemonics, and some quick revision notes.
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PEBC Evaluating exam sample questions pdf link.
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