Free PTCE practice questions

A patient, Renata Fairburn, presents a new prescription for the macrolide clarithromycin to treat a respiratory infection. Her active profile shows she takes simvastatin 40 mg each evening for hyperlipidaemia. The technician is reviewing the profile before the pharmacist verifies the order. Which interaction concern should the technician flag as the PRIMARY safety issue?

• AClarithromycin inhibits the metabolism of simvastatin, raising the risk of myopathy and rhabdomyolysis.check_circle Correct
• BClarithromycin reduces the absorption of simvastatin, making the statin therapeutically ineffective.
• CClarithromycin and simvastatin compete for renal excretion, causing the antibiotic to accumulate to toxic levels.
• DClarithromycin chelates with simvastatin in the gut, forming an inactive complex that passes unabsorbed.

Why A is correct: Clarithromycin is a strong CYP3A4 inhibitor and simvastatin is a CYP3A4 substrate, so co-administration markedly raises simvastatin levels and the risk of muscle injury, which is the correct primary flag.

Why B is wrong: This is tempting because absorption interactions exist for some drugs, but the clarithromycin-simvastatin interaction is metabolic inhibition that raises, not lowers, statin exposure, so this is wrong.

Why C is wrong: A renal competition mechanism sounds plausible, but the recognised concern is hepatic CYP3A4 inhibition affecting the statin, not antibiotic accumulation, so this misstates the mechanism.

Why D is wrong: Chelation is a real interaction type for tetracyclines and divalent cations, which makes it familiar, but it does not apply to this macrolide and statin pair, so this is incorrect.

A patient, Desmond Achterberg, has been stabilised on warfarin for atrial fibrillation with a target INR of 2 to 3. He tells the technician at pick-up that he has started taking a daily high-dose vitamin K supplement he bought to support bone health. What is the technician's BEST response?

• AReassure him that supplements do not affect prescription medicines and complete the sale.
• BRefer him to the pharmacist, because high-dose vitamin K can reduce warfarin's effect and lower the INR.check_circle Correct
• CTell him to stop the warfarin while taking the supplement and resume it when the bottle is finished.
• DAdvise him to double his warfarin dose to overcome the supplement's effect.

Why A is wrong: This is tempting because supplements are sold over the counter and seem benign, but vitamin K directly antagonises warfarin, so dismissing the interaction is unsafe and wrong.

Why B is correct: Vitamin K is the substrate warfarin blocks, so a high-dose supplement opposes warfarin, can drop the INR below range, and warrants a pharmacist counselling referral, making this the best action.

Why C is wrong: Stopping an anticoagulant sounds like a way to avoid the interaction, but halting warfarin risks clot formation and is outside the technician's scope, so this is wrong.

Why D is wrong: Increasing the dose seems to logically counter the antagonism, but dose changes require prescriber and pharmacist judgement and self-adjustment risks bleeding, so a technician must not advise this.

A patient, Lorcan Pemberton, brings a new prescription for the oral tetracycline doxycycline. While reviewing his profile, the technician sees he regularly takes a calcium-magnesium antacid for reflux and an iron supplement for anaemia. What counselling point about administration should the technician prepare for the pharmacist to reinforce?

• ATake the doxycycline at the same time as the antacid and iron to reduce stomach upset.
• BCrush the doxycycline into the antacid so the medicines are taken together conveniently.
• CSeparate the doxycycline from the antacid and iron by at least two hours to prevent reduced absorption.check_circle Correct
• DStop the antacid and iron entirely for the whole doxycycline course.

Why A is wrong: Co-administration seems sensible for tolerability, but taking them together is precisely what causes chelation and lost efficacy, so this advice is wrong.

Why B is wrong: Combining into one dose appears convenient, yet it maximises the divalent cation chelation that blocks absorption, so this is incorrect.

Why C is correct: Doxycycline chelates with calcium, magnesium, and iron, so spacing the doses by about two hours preserves absorption while keeping the other products, making this the correct counselling point.

Why D is wrong: Stopping the other products avoids the interaction but is unnecessary and may worsen reflux or anaemia, since spacing the doses is sufficient, so this overcorrects.

A technician is entering a new prescription for an injectable opioid into the pharmacy system. The prescriber wrote the dose as ".5 mg" on the order. To reduce the risk of a tenfold dosing error before the entry is verified, how should the technician record the strength?

• AEnter it as "0.5 mg", adding a leading zero before the decimal point.check_circle Correct
• BEnter it exactly as written, ".5 mg", so the record matches the original order character for character.
• CEnter it as "0.50 mg", adding both a leading zero and a trailing zero for clarity.
• DEnter it as ".50 mg", keeping the prescriber's format and adding a trailing zero.

Why A is correct: A leading zero before a bare decimal point makes the decimal far less likely to be overlooked, so "0.5 mg" cannot be misread as "5 mg"; this is the recommended safe practice.

Why B is wrong: Copying the naked decimal is tempting because faithful transcription feels safe, but a missed decimal point makes ".5" read as "5", causing a tenfold overdose, which is precisely the error a leading zero prevents.

Why C is wrong: The leading zero is correct, but the trailing zero is unsafe because if the decimal point is missed "0.50" can be read as "50 mg", a hundredfold error, so trailing zeros are discouraged.

Why D is wrong: This keeps the dangerous naked decimal and adds a trailing zero, combining the two formatting errors that the leading-zero and no-trailing-zero conventions are designed to eliminate.

While restocking, a technician notices that the look-alike medicines hydroxyzine and hydralazine sit next to each other on the shelf and that recent labelling formats them as HYDROXYzine and hydrALAZINE. A new colleague asks what purpose this mixed-case formatting serves. What is the most accurate explanation of the technique?

• AIt marks both products as high-alert medicines that require an independent double check before dispensing.
• BIt applies Tall Man lettering, capitalising the dissimilar letters so visually similar drug names are easier to tell apart.check_circle Correct
• CIt indicates the two products must be separated in inventory because one is a controlled substance.
• DIt signals that the medicines are stored at the same strength and may be substituted for one another.

Why A is wrong: High-alert status is real and may apply to some drugs, but mixed-case lettering is not how high-alert items are flagged; the capitalisation here is solely to distinguish similar names.

Why B is correct: Tall Man lettering capitalises the differing portions of confusingly similar names, drawing the eye to the parts that distinguish them and reducing selection errors between look-alike, sound-alike pairs.

Why C is wrong: Inventory separation is a valid safety strategy, but the capital letters convey name differentiation, not scheduling status, and neither of these antihistamine and antihypertensive agents is controlled.

Why D is wrong: This is wrong and dangerous because the formatting exists to prevent confusion between two different drugs, not to imply they are interchangeable or share a strength.

During final verification, a technician scans the bar code on a stock bottle of warfarin against the bar code on the dispensing label. The system returns a mismatch alert even though the printed drug name on the label appears to match the bottle. What is the technician's most appropriate next step?

• AOverride the alert and continue, since the printed drug name on the label visually matches the stock bottle.
• BReprint the dispensing label so its bar code matches the stock bottle, then rescan to clear the alert.
• CStop, investigate the mismatch, and confirm the correct product and strength before dispensing the order.check_circle Correct
• DSelect a different bottle of the same medicine and scan it, assuming the original bottle's bar code was damaged.

Why A is wrong: Relying on a visual name match is tempting because it looks confirmatory, but it defeats the purpose of bar code verification, which catches mismatches the eye misses such as wrong strength, salt form, or manufacturer.

Why B is wrong: Reprinting to force a match conceals the discrepancy rather than resolving it and could lock in the wrong product, so it removes the safety net the scan provides instead of acting on the warning.

Why C is correct: A bar code mismatch is a hard stop signalling the scanned product does not match the order; investigating and resolving it before proceeding is the action that prevents a wrong-drug or wrong-strength dispensing error.

Why D is wrong: A damaged code is one possibility, but switching bottles without investigating assumes the cause and skips confirming whether the order, strength, or product itself is wrong, which the alert may be flagging.

A technician at Birchwood Pharmacy receives a prescription for Lerato Mokoena: latanoprost 0.005% ophthalmic solution, one drop into each eye every evening, dispensed as a single 2.5 mL bottle. Using the standard estimate that an ophthalmic dropper delivers about 20 drops per millilitre, what days supply should the technician enter for this dispense?

• AAbout 50 days, treating each bottle as delivering one drop per day total.
• BAbout 25 days, based on two drops used each day from roughly 50 drops in the bottle.check_circle Correct
• CAbout 12 days, counting four drops into each eye every evening.
• DAbout 30 days, rounding the bottle to a convenient monthly figure.

Why A is wrong: This counts only one drop daily and ignores that both eyes are dosed, so it doubles the true supply by halving the daily drop count.

Why B is correct: The 2.5 mL bottle yields about 50 drops, and one drop per eye each evening is two drops per day, so 50 divided by 2 gives roughly 25 days.

Why C is wrong: This misreads the directions as four drops per eye; the sig states one drop per eye, so it overstates daily use and understates the supply.

Why D is wrong: Rounding to a calendar month ignores the actual drop maths; 30 days would require fewer than two drops daily, which the sig does not support.

A technician is processing a 30-day prescription for Tobias Renner: insulin glargine U-100, inject 22 units subcutaneously each morning and 14 units each evening. The pharmacy stocks U-100 vials containing 10 mL each. How many vials must be dispensed to cover the full 30 days?

• A1 vial, because a single 10 mL vial lasts the entire month for this patient.
• B3 vials, allowing a full vial for each ten days of the prescription.
• C2 vials, because the 1080 units needed over 30 days exceed the 1000 units in one vial.check_circle Correct
• D4 vials, matching one vial to each weekly injection cycle plus a spare.

Why A is wrong: A 10 mL U-100 vial holds 1000 units, which covers only about 27 days at 36 units daily, so one vial falls short of 30 days.

Why B is wrong: Allocating one vial per ten days assumes 100 units daily, far above the 36 units actually used, so it dispenses far more than needed.

Why C is correct: The patient uses 36 units per day, totalling 1080 units for 30 days; one 10 mL U-100 vial holds 1000 units, so a second vial is required.

Why D is wrong: Tying vials to weeks has no basis in the unit maths; the monthly requirement is 1080 units, which two vials cover comfortably.

A technician must prepare 500 mL of 0.45% sodium chloride solution for an order under Pharmacist Indira Vasquez. The only sodium chloride concentrate on hand is 0.9% sodium chloride, and sterile water for injection is available as the diluent. What volume of the 0.9% stock is needed before bringing the preparation to the final volume?

• A125 mL of the 0.9% stock, then add sterile water to reach 500 mL.
• B300 mL of the 0.9% stock, then add sterile water to reach 500 mL.
• C450 mL of the 0.9% stock, then add sterile water to reach 500 mL.
• D250 mL of the 0.9% stock, then add sterile water to reach 500 mL.check_circle Correct

Why A is wrong: This applies a quarter dilution rather than a half; halving the concentration from 0.9% to 0.45% requires 250 mL of stock, not 125 mL.

Why B is wrong: This figure does not satisfy the dilution equation; 300 mL of 0.9% would yield a final concentration above 0.45% at 500 mL total.

Why C is wrong: This confuses the percentage with a volume; 450 mL of stock gives roughly 0.81% at 500 mL, far stronger than the target.

Why D is correct: Applying C1V1 equals C2V2, 0.9% times V1 equals 0.45% times 500, giving V1 of 250 mL, with sterile water making up the remaining 250 mL.

A patient, Marisol Quintero, presents a written prescription for oxycodone immediate-release 5 mg, quantity 60, signed by Dr Aimee Voss. The patient asks the technician to fill only 20 tablets today because she cannot afford the full quantity, and to receive the balance later. What is the technician's BEST action under federal law?

• ADispense the partial quantity of 20 tablets and supply the remaining 40 tablets within 30 days of the prescription date.check_circle Correct
• BDispense the partial quantity of 20 tablets and supply the balance only within 72 hours, after which the remainder is void.
• CRefuse the partial fill because Schedule II prescriptions must be dispensed in full or returned to the patient.
• DDispense 20 tablets now and add five refills so the patient may collect the remaining tablets as needed.

Why A is correct: Correct: federal law permits partial filling of a Schedule II prescription at the patient's request, and the remaining quantity may be supplied within 30 days of the date the prescription was written.

Why B is wrong: Tempting because the 72-hour limit is a genuine Schedule II partial-fill provision, but under current federal law a partial fill requested by the patient must be completed within 30 days of the written date, so the shorter 72-hour deadline is not the operative rule for this patient-requested partial.

Why C is wrong: Tempting because Schedule II carries no refills, but partial filling at the patient's request is expressly permitted, so an outright refusal is not required.

Why D is wrong: Tempting because refills feel like a way to spread out collection, but Schedule II prescriptions may not be refilled at all, so authorising refills is unlawful.

A prescription for alprazolam 0.5 mg, a Schedule IV medicine, was written on 3 January with an authorisation of five refills. The patient, Devon Hartwell, has used the original fill plus four refills and returns on 10 July seeking the final refill. How should the technician proceed?

• ADispense the final refill, as one authorised refill remains and the order is still within validity.
• BDecline the refill because the prescription has exceeded six months from the date it was written.check_circle Correct
• CDecline the refill because the maximum of five refills has already been exhausted.
• DDispense the refill and transfer the remaining authorisation to another pharmacy on request.

Why A is wrong: Tempting because a fifth refill was authorised, but a Schedule III to V prescription expires six months from the written date, and 10 July is past that limit, so the remaining refill can no longer be used.

Why B is correct: Correct: Schedule III to V prescriptions are valid for a maximum of six months from the issue date, so a prescription written on 3 January cannot be refilled on 10 July regardless of remaining refills.

Why C is wrong: Tempting because five refills is the federal ceiling, but the patient had used only four refills, so the refusal must rest on the six-month expiry rather than an exhausted count.

Why D is wrong: Tempting because transfers of Schedule III to V refills are allowed once, but the prescription has lapsed past six months, so neither a fill nor a transfer of remaining refills is permissible.

A patient, Priya Nandakumar, asks her current pharmacy to transfer the remaining refills of her phenobarbital prescription, a Schedule IV medicine, to a second pharmacy that is not electronically linked by a shared real-time database. The original prescription had three refills authorised, none yet used. How many refills may lawfully be transferred?

• AOnly one refill may be transferred, with the remaining two staying at the original pharmacy.
• BNo refills may be transferred, because Schedule IV prescriptions cannot move between pharmacies.
• CAll three remaining refills may be transferred on a one-time basis to the receiving pharmacy.check_circle Correct
• DAll three refills may be transferred and the receiving pharmacy may then transfer them onward again.

Why A is wrong: Tempting because the transfer itself is a one-time event, but the one-time limit applies to the act of transferring, not the number of refills moved, so all remaining refills go together.

Why B is wrong: Tempting because Schedule II prescriptions cannot have refills transferred, but Schedule III to V refills are transferable, so a blanket refusal misapplies the Schedule II rule.

Why C is correct: Correct: between pharmacies that do not share a real-time online database, the transfer of Schedule III to V refill information is permitted one time only, and all remaining authorised refills transfer in that single transaction.

Why D is wrong: Tempting because the refills do transfer, but for non-linked pharmacies the transfer is allowed only once, so onward re-transfer of the same refills is not permitted.