CSLB General Building (B) — All Questions

Which brand name corresponds to the generic drug atorvastatin?

• a.Zocor
• b.Crestor
• c.Lipitor✓
• d.Pravachol

Atorvastatin is marketed under the brand name Lipitor. Zocor is simvastatin, Crestor is rosuvastatin, and Pravachol is pravastatin; all four are statins, which is why the names are easily confused.

A patient brings in a prescription written for Synthroid. What is the generic name of this medication?

• a.Levothyroxine✓
• b.Liothyronine
• c.Methimazole
• d.Propylthiouracil

Synthroid is the brand name for levothyroxine, a synthetic T4 thyroid hormone. Liothyronine is synthetic T3 (Cytomel), while methimazole and propylthiouracil are antithyroid agents used for hyperthyroidism, not replacement therapy.

Prinivil and Zestril are brand names for which generic drug?

• a.Enalapril
• b.Ramipril
• c.Losartan
• d.Lisinopril✓

Lisinopril is sold as both Prinivil and Zestril. Enalapril (Vasotec) and ramipril (Altace) are different ACE inhibitors, and losartan (Cozaar) is an angiotensin II receptor blocker rather than an ACE inhibitor.

Which generic medication is sold under the brand name Glucophage?

• a.Glipizide
• b.Metformin✓
• c.Glyburide
• d.Pioglitazone

Glucophage is the brand name for metformin. Glipizide (Glucotrol) and glyburide (DiaBeta) are sulfonylureas, and pioglitazone (Actos) is a thiazolidinedione; all lower blood glucose but by different mechanisms.

A patient picks up a refill for Norvasc 5 mg tablets. Which generic name should appear on the label?

• a.Amlodipine✓
• b.Atenolol
• c.Nifedipine
• d.Diltiazem

Norvasc is amlodipine, a dihydropyridine calcium channel blocker. Atenolol (Tenormin) is a beta blocker, while nifedipine (Procardia) and diltiazem (Cardizem) are other calcium channel blockers sold under different brand names.

Omeprazole is marketed under which brand name?

• a.Protonix
• b.Nexium
• c.Prevacid
• d.Prilosec✓

Omeprazole is sold as Prilosec. Protonix is pantoprazole, Nexium is esomeprazole, and Prevacid is lansoprazole; all four are proton pump inhibitors with similar-sounding generic endings.

What is the generic name of Zoloft?

• a.Fluoxetine
• b.Sertraline✓
• c.Paroxetine
• d.Citalopram

Zoloft is the brand name for sertraline. Fluoxetine is Prozac, paroxetine is Paxil, and citalopram is Celexa; all are selective serotonin reuptake inhibitors used for depression and anxiety disorders.

Gabapentin is dispensed under which of the following brand names?

• a.Lyrica
• b.Keppra
• c.Neurontin✓
• d.Topamax

Gabapentin is marketed as Neurontin. Lyrica is pregabalin, Keppra is levetiracetam, and Topamax is topiramate; all are anticonvulsants, and pregabalin is structurally the closest relative to gabapentin.

Which generic diuretic corresponds to the brand name Lasix?

• a.Bumetanide
• b.Hydrochlorothiazide
• c.Spironolactone
• d.Furosemide✓

Lasix is furosemide. Bumetanide (Bumex) is another loop diuretic, hydrochlorothiazide is a thiazide, and spironolactone (Aldactone) is a potassium-sparing aldosterone antagonist.

A generic drug name ending in the suffix '-sartan' indicates that the medication belongs to which class?

• a.Angiotensin II receptor blockers✓
• b.ACE inhibitors
• c.Beta blockers
• d.Calcium channel blockers

The '-sartan' stem identifies angiotensin II receptor blockers such as losartan and valsartan. ACE inhibitors end in '-pril', beta blockers end in '-olol', and dihydropyridine calcium channel blockers end in '-dipine'.

Alprazolam (Xanax) is a benzodiazepine. Under federal law, benzodiazepines such as alprazolam are placed in which DEA schedule?

• a.Schedule II
• b.Schedule IV✓
• c.Schedule III
• d.Schedule V

Benzodiazepines, including alprazolam, are Schedule IV controlled substances. Schedule II includes drugs such as oxycodone and amphetamine, Schedule III includes products such as ketamine and some anabolic steroids, and Schedule V includes low-dose codeine cough preparations.21 CFR 1308 (DEA schedules)

Pantoprazole belongs to which drug class?

• a.H2 receptor antagonist
• b.Antacid
• c.Proton pump inhibitor✓
• d.Prostaglandin analog

Pantoprazole is a proton pump inhibitor; the '-prazole' stem marks this class, which blocks the gastric H+/K+ ATPase. H2 receptor antagonists include famotidine, antacids are products such as calcium carbonate, and misoprostol is the prostaglandin analog used for gastric protection.

Metformin is classified as which type of antidiabetic agent?

• a.Biguanide✓
• b.Sulfonylurea
• c.Thiazolidinedione
• d.DPP-4 inhibitor

Metformin is the only biguanide in common use; it lowers hepatic glucose production and improves insulin sensitivity. Sulfonylureas such as glipizide stimulate insulin release, thiazolidinediones such as pioglitazone act on PPAR-gamma receptors, and DPP-4 inhibitors such as sitagliptin end in '-gliptin'.

Azithromycin belongs to which class of antibiotics?

• a.Fluoroquinolone
• b.Tetracycline
• c.Macrolide✓
• d.Cephalosporin

Azithromycin is a macrolide, along with erythromycin and clarithromycin. Fluoroquinolones end in '-floxacin', tetracyclines end in '-cycline', and cephalosporins usually begin with 'cef-' or 'ceph-'.

Which of the following medications is a loop diuretic?

• a.Hydrochlorothiazide
• b.Furosemide✓
• c.Spironolactone
• d.Chlorthalidone

Furosemide acts on the ascending loop of Henle and is classified as a loop diuretic. Hydrochlorothiazide and chlorthalidone are thiazide-type diuretics acting on the distal tubule, and spironolactone is a potassium-sparing agent.

In the FDA Orange Book, an 'AB' therapeutic equivalence code means that the product:

• a.Has been approved for the same indications but was never compared with the brand
• b.May be dispensed only with written permission from the prescriber
• c.Contains a different active ingredient that produces a similar effect
• d.Has demonstrated bioequivalence and may be substituted for the reference listed drug✓

An AB code means actual or potential bioequivalence problems have been resolved with adequate in vivo or in vitro data, so the product is therapeutically equivalent to the reference listed drug and can be substituted. It does not mean the ingredient differs, and no special prescriber permission is required beyond ordinary state substitution rules.FDA

A product carries a 'BX' code in the Orange Book. What does this indicate?

• a.The product is fully bioequivalent to the reference listed drug
• b.The product is available only as a brand name
• c.Available data are insufficient to establish therapeutic equivalence✓
• d.The product has been withdrawn from the market for safety reasons

Codes beginning with B indicate products the FDA does not consider therapeutically equivalent, and BX specifically means the data are insufficient to determine equivalence, so automatic substitution is not appropriate. AB is the code for demonstrated equivalence, and market withdrawal is handled through separate FDA actions, not the equivalence code.FDA

Which medication is generally considered a narrow-therapeutic-index drug for which switching between manufacturers warrants extra caution and monitoring?

• a.Warfarin✓
• b.Amoxicillin
• c.Ibuprofen
• d.Loratadine

Warfarin has a narrow therapeutic index, so small changes in blood level can cause bleeding or clotting and INR monitoring is needed after any product change. Amoxicillin, ibuprofen, and loratadine have wide margins between effective and toxic doses and are not narrow-therapeutic-index agents.

Montelukast is most commonly prescribed for which condition?

• a.Hypertension
• b.Gastroesophageal reflux disease
• c.Hypothyroidism
• d.Asthma maintenance and allergic rhinitis✓

Montelukast is a leukotriene receptor antagonist used for long-term asthma control and for allergic rhinitis; it is not a rescue inhaler. Hypertension is treated with agents such as lisinopril, reflux with proton pump inhibitors, and hypothyroidism with levothyroxine.

Tamsulosin is indicated primarily for the treatment of:

• a.Overactive bladder
• b.Benign prostatic hyperplasia✓
• c.Erectile dysfunction
• d.Urinary tract infection

Tamsulosin is an alpha-1 blocker that relaxes smooth muscle in the prostate and bladder neck, improving urine flow in benign prostatic hyperplasia. Overactive bladder is treated with antimuscarinics such as oxybutynin, erectile dysfunction with agents such as sildenafil, and urinary infections with antibiotics.

A patient is discharged after coronary stent placement with a prescription for clopidogrel (Plavix). What is the purpose of this medication?

• a.To lower LDL cholesterol
• b.To control blood glucose
• c.To lower heart rate and blood pressure
• d.To inhibit platelet aggregation and prevent clot formation✓

Clopidogrel is an antiplatelet agent that blocks the P2Y12 ADP receptor, reducing the risk of stent thrombosis, myocardial infarction, and stroke. LDL lowering is the role of statins, glucose control belongs to antidiabetic agents, and heart rate and blood pressure reduction is the role of beta blockers.

A patient newly diagnosed with hypothyroidism presents a prescription. Which medication is expected?

• a.Methimazole
• b.Levothyroxine✓
• c.Metformin
• d.Prednisone

Hypothyroidism is treated by replacing the missing hormone with levothyroxine. Methimazole suppresses thyroid hormone production and is used for hyperthyroidism, metformin treats type 2 diabetes, and prednisone is a corticosteroid used for inflammation.

Which of the following products should NOT be crushed before administration?

• a.Immediate-release lisinopril tablet
• b.Chewable montelukast tablet
• c.Enteric-coated aspirin tablet✓
• d.Scored metoprolol tartrate tablet

The enteric coating on aspirin is designed to keep the tablet intact until it passes the stomach, so crushing destroys that protection and increases gastric irritation. Immediate-release and scored tablets may generally be split or crushed, and chewable tablets are meant to be broken down in the mouth.

How should a sublingual nitroglycerin tablet be administered during an episode of chest pain?

• a.Placed under the tongue and allowed to dissolve without swallowing✓
• b.Swallowed whole with a full glass of water
• c.Chewed thoroughly and then swallowed
• d.Dissolved in juice and taken by mouth

Sublingual tablets dissolve under the tongue so the drug is absorbed directly into the bloodstream through the oral mucosa, giving rapid onset and bypassing first-pass liver metabolism. Swallowing, chewing, or dissolving the tablet in liquid sends it through the digestive tract and destroys that advantage.

A patient is dispensed otic drops for an ear infection. Which counseling point is correct?

• a.The drops may be used in either the ear or the eye if needed
• b.The drops are for the ear only and must never be instilled in the eye✓
• c.The drops must be refrigerated and instilled cold
• d.The drops should be diluted with water before each use

Otic products are not manufactured to be sterile and isotonic for ocular use, so instilling them in the eye can cause pain and injury; ophthalmic drops, by contrast, may be used in the ear. Otic drops are normally stored at room temperature, warmed slightly in the hand if cold, and are never diluted by the patient.

Insulin glargine (Lantus) is administered by which route?

• a.Intravenous
• b.Intramuscular
• c.Intradermal
• d.Subcutaneous✓

Insulin glargine is injected into subcutaneous fat, where its slow, steady absorption produces basal coverage over about 24 hours. Intravenous administration would produce an immediate, unpredictable drop in glucose and is reserved for regular insulin, while intramuscular and intradermal routes are not used for insulin therapy.

A patient taking lisinopril reports a persistent dry, tickling cough that started a few weeks after beginning therapy. What is the most likely explanation?

• a.Dry cough is a recognized ACE inhibitor effect related to bradykinin accumulation✓
• b.The cough indicates an allergic reaction requiring epinephrine
• c.The cough is a sign that the dose is too low
• d.Lisinopril does not cause cough, so the symptom is unrelated

ACE inhibitors block breakdown of bradykinin in the respiratory tract, and the resulting dry, nonproductive cough is a well-known reason patients are switched to an ARB such as losartan. It is not an anaphylactic reaction, and the cough is dose-independent rather than a sign of underdosing.

Which symptom should a patient starting atorvastatin be told to report promptly to the prescriber?

• a.Mild sweet taste in the mouth
• b.Occasional sneezing
• c.Unexplained muscle pain, tenderness, or weakness✓
• d.Increased appetite

Statins can cause myopathy, and in rare cases rhabdomyolysis, so new unexplained muscle pain or weakness needs prompt evaluation and possible creatine kinase testing. A sweet taste, sneezing, and increased appetite are not characteristic statin adverse effects.

A patient is starting a course of metronidazole. Which counseling point is most important?

• a.Avoid alcohol during therapy and for several days after the last dose✓
• b.Take each dose on a completely empty stomach
• c.Expect the urine to turn bright blue
• d.Double the next dose if one is missed

Metronidazole combined with alcohol can produce a disulfiram-like reaction with flushing, nausea, vomiting, and palpitations, so alcohol is avoided during and shortly after therapy. The drug may be taken with food to reduce stomach upset, it can darken urine rather than turn it blue, and doses are never doubled after a missed dose.

A patient stabilized on warfarin asks whether it is acceptable to take ibuprofen for back pain. What is the appropriate response?

• a.Ibuprofen has no interaction with warfarin and may be taken freely
• b.Ibuprofen raises bleeding risk with warfarin; the patient should check with the prescriber first✓
• c.Ibuprofen decreases warfarin's effect, so the warfarin dose must be doubled
• d.Ibuprofen may be taken only if the warfarin dose is skipped that day

NSAIDs such as ibuprofen irritate the gastrointestinal lining and inhibit platelet function, which adds to warfarin's anticoagulant effect and increases bleeding risk, so the prescriber should be consulted and acetaminophen is often preferred. The interaction increases rather than decreases bleeding risk, and patients should never adjust or skip warfarin doses on their own.

How should unopened vials of insulin glargine be stored in the pharmacy?

• a.In the freezer at -10 °C
• b.At room temperature only, discarded after 7 days
• c.In the refrigerator at 2-8 °C, protected from freezing✓
• d.In a warming cabinet at 30-35 °C

Unopened insulin is stored in the refrigerator at 2-8 °C, where it remains stable until the manufacturer's expiration date. Freezing denatures insulin and makes the vial unusable, and prolonged storage at warm temperatures shortens potency well before the labeled expiration.

'Controlled room temperature' on a manufacturer's storage label corresponds to which temperature range?

• a.2-8 °C
• b.8-15 °C
• c.15-20 °C
• d.20-25 °C✓

Controlled room temperature is defined as 20-25 °C, with brief excursions permitted between 15 and 30 °C. The 2-8 °C range describes refrigeration, while 8-15 °C corresponds to a cool storage area and 15-20 °C falls below the controlled room temperature range.USP

What is the correct storage instruction for sublingual nitroglycerin tablets?

• a.Transfer the tablets to a weekly pill organizer for convenience
• b.Keep them in the original glass container, tightly closed and protected from light and moisture✓
• c.Store the bottle in the refrigerator at 2-8 °C
• d.Keep the bottle open on the bathroom shelf for quick access

Nitroglycerin is volatile and moisture sensitive, so it must remain in its original tightly closed amber glass container to preserve potency. Pill organizers, refrigeration, and humid bathroom storage all allow loss of drug or moisture damage, which can leave the patient without an effective dose during chest pain.

Latanoprost ophthalmic solution is dispensed to a patient with glaucoma. What are the correct storage directions?

• a.Refrigerate the unopened bottle at 2-8 °C; once opened it may be kept at room temperature for up to 6 weeks✓
• b.Freeze the bottle until the first dose is due
• c.Store at room temperature indefinitely with no expiration limit after opening
• d.Keep the bottle in direct sunlight to maintain clarity

Unopened latanoprost requires refrigeration at 2-8 °C, and after the bottle is opened it may be stored at room temperature for up to 6 weeks. Freezing is never appropriate for ophthalmic solutions, an opened bottle does have a limited beyond-use period, and light exposure degrades the drug.

A prescription is entered for hydroxyzine 25 mg. Which medication is most likely to be selected in error because of a classic look-alike/sound-alike name pair?

• a.Hydrocortisone
• b.Hydrochlorothiazide
• c.Hydralazine✓
• d.Hydrocodone

Hydroxyzine and hydralazine are a well-documented look-alike/sound-alike pair; one is an antihistamine and the other an antihypertensive vasodilator, so a mix-up can cause serious harm. Hydrocortisone is a corticosteroid, hydrochlorothiazide a thiazide diuretic, and hydrocodone an opioid, none of which form this classic confusion pair.

Which of the following is classified as a high-alert medication?

• a.Loratadine 10 mg tablets
• b.Acetaminophen 325 mg tablets
• c.Docusate sodium 100 mg capsules
• d.Concentrated potassium chloride injection✓

Concentrated potassium chloride for injection is a high-alert medication because an undiluted dose can cause fatal cardiac arrhythmia; other high-alert classes include insulin, anticoagulants, opioids, and neuromuscular blockers. Loratadine, acetaminophen at standard strength, and docusate carry a much lower risk of catastrophic harm when an error occurs.

Product labels print certain drug names as buPROPion and busPIRone. What is the purpose of this formatting?

• a.Tall man lettering highlights the differing letters to reduce name selection errors✓
• b.Capital letters indicate the drug is a controlled substance
• c.Capital letters mark the product as requiring refrigeration
• d.The uppercase portion shows the manufacturer's abbreviation

Tall man lettering capitalizes the dissimilar portion of look-alike drug names so staff notice the difference during selection and dispensing. It carries no meaning about controlled substance status, storage requirements, or the manufacturer.

A prescription is written for clonidine to treat hypertension. Which sound-alike medication could be dispensed in error?

• a.Clopidogrel
• b.Clindamycin
• c.Clonazepam✓
• d.Colchicine

Clonidine and clonazepam are a recognized sound-alike pair; clonazepam is a benzodiazepine, so dispensing it instead of an antihypertensive could cause sedation and leave blood pressure untreated. Clopidogrel is an antiplatelet drug, clindamycin an antibiotic, and colchicine a gout agent, and none of these names is close enough to be the classic confusion partner.

A prescription reads: amoxicillin 400 mg/5 mL suspension, give 200 mg by mouth twice daily. How many mL should be given per dose?

• a.1.25 mL
• b.2.5 mL✓
• c.5 mL
• d.10 mL

Since 400 mg is contained in 5 mL, 200 mg is half that amount, or 2.5 mL per dose. The 5 mL volume would deliver 400 mg, 10 mL would deliver 800 mg, and 1.25 mL would supply only 100 mg.

An insulin product is labeled 100 units/mL. A patient is instructed to inject 18 units. What volume corresponds to this dose?

• a.0.018 mL
• b.1.8 mL
• c.0.9 mL
• d.0.18 mL✓

At a concentration of 100 units/mL, each unit equals 0.01 mL, so 18 units equals 0.18 mL. A volume of 1.8 mL would contain 180 units, 0.9 mL would contain 90 units, and 0.018 mL would contain only 1.8 units.

Which drug is placed in Schedule II (C-II), the schedule with an accepted medical use but the highest abuse potential of any prescribable controlled substance?

• a.Alprazolam
• b.Hydromorphone✓
• c.Pregabalin
• d.Ketamine

Hydromorphone is a C-II opioid; other common C-II agents include oxycodone, fentanyl, methylphenidate, and amphetamine. Alprazolam is C-IV, pregabalin is C-V, and ketamine is C-III, so all three carry a lower federally assigned abuse potential. Schedule II drugs have accepted medical use but the greatest abuse and dependence risk among drugs that may still be prescribed.21 CFR 1308 (DEA schedules)

Under the Controlled Substances Act, which statement correctly describes Schedule I substances such as heroin and LSD?

• a.They have a low abuse potential and may be sold over the counter.
• b.They may be dispensed by prescription but never refilled.
• c.They may be dispensed with up to 5 refills in 6 months.
• d.They have a high abuse potential and no currently accepted medical use in the United States, so they cannot be prescribed.✓

The defining feature of Schedule I is a high potential for abuse combined with no currently accepted medical use in the United States, which is why these substances are not dispensed on an outpatient prescription. Over-the-counter sale is impossible for any Schedule I substance, and the no-refill rule describes Schedule II, while the 5-refills-in-6-months rule describes Schedules III and IV. Schedule I products are limited to registered research and other DEA-authorized activity.21 CFR 1308 (DEA schedules)

What is DEA Form 222 (or its electronic CSOS equivalent) used for?

• a.Ordering or transferring Schedule II controlled substances between DEA registrants✓
• b.Reporting a theft of controlled substances to the DEA
• c.Documenting the destruction of expired controlled substances
• d.Registering a new pharmacy with the DEA

DEA Form 222, or an electronic order placed through the Controlled Substance Ordering System (CSOS), is required for every purchase or transfer of a Schedule II substance between registrants. Schedules III through V may be ordered on an ordinary invoice and do not require Form 222, although the invoice must still be retained. Theft reporting uses Form 106, destruction uses Form 41, and initial pharmacy registration uses Form 224.21 CFR 1305 (DEA Form 222 / CSOS)

A pharmacy destroys a quantity of expired Schedule II tablets on site. Which DEA form documents this disposal?

• a.DEA Form 224
• b.DEA Form 106
• c.DEA Form 41✓
• d.DEA Form 222

DEA Form 41 is the registrant's record of controlled substances that have been destroyed, and it must be retained with the pharmacy's controlled substance records. Form 106 is reserved for theft or significant loss, Form 222 is for ordering Schedule II drugs, and Form 224 is the pharmacy's DEA registration application. Destruction records are kept for at least 2 years under federal law; some states are stricter.21 CFR 1307 (DEA Form 41 destruction)

During a routine count the pharmacy discovers that a sealed bottle of oxycodone is missing and suspects diversion. Which action does federal law require?

• a.Record the shortage on the next biennial inventory only
• b.Notify the DEA and submit DEA Form 106 for the theft or significant loss✓
• c.Complete DEA Form 41 to document the missing product
• d.Submit a new DEA Form 222 to replace the lost stock

A theft or significant loss of controlled substances must be reported to the DEA, and Form 106 is the report used to document the circumstances and quantities involved. Form 41 records product that was intentionally destroyed, not product that disappeared, and Form 222 only orders Schedule II stock. Simply noting the discrepancy at the next inventory does not satisfy the reporting duty; state boards often require notification as well.DEA

How often must a DEA registrant take a complete inventory of all controlled substances on hand?

• a.Every 2 years✓
• b.Every 12 months
• c.Every 6 months
• d.Every 5 years

Federal law requires a biennial inventory, meaning a complete count of controlled substances on hand at least every 2 years, in addition to the initial inventory taken when the registrant begins handling controlled substances. Annual, semiannual, and five-year cycles are not the federal standard, although some states require inventories more often. Schedule II records must be kept separate from all other records and all controlled substance records must be readily retrievable and kept at least 2 years; this is a federal minimum and some states are stricter.21 CFR 1304 (controlled substance records)

A patient presents a written prescription for a Schedule IV benzodiazepine. What is the federal refill limit?

• a.No refills are permitted
• b.Unlimited refills for 12 months from the date written
• c.Up to 3 refills within 12 months of the date written
• d.Up to 5 refills within 6 months of the date written✓

Schedule III and Schedule IV prescriptions may be refilled a maximum of 5 times and only within 6 months of the date the prescription was written, whichever limit is reached first. The no-refill option describes Schedule II, which may not be refilled at all, and neither unlimited refills for a year nor a 3-refill cap matches the federal rule for C-III and C-IV. This is a federal minimum; some states are stricter.21 CFR 1306 (controlled substance prescriptions)

A manufacturer recalls a sterile injectable after finding particulate matter that could cause fatal embolism. How does the FDA classify this recall?

• a.Class III
• b.Class II
• c.Class I✓
• d.Class IV

A Class I recall applies when there is a reasonable probability that use of the product will cause serious adverse health consequences or death, which fits a contaminant capable of causing a fatal event. Class II covers products that may cause temporary or medically reversible harm, and Class III covers products unlikely to cause any adverse health consequence, such as a minor labeling defect. There is no Class IV in the FDA recall classification system.21 CFR 7 (FDA recall classification)

Which statement best describes a Risk Evaluation and Mitigation Strategy (REMS)?

• a.A DEA program that limits how much of a controlled substance a pharmacy may order each month
• b.An FDA-required safety program that may mandate prescriber certification, patient enrollment, pharmacy certification, or laboratory monitoring before a drug is dispensed✓
• c.A USP standard that sets beyond-use dates for compounded preparations
• d.A manufacturer's voluntary coupon program that lowers patient copays for specialty drugs

A REMS is imposed by the FDA when a drug's serious safety risks require controls beyond standard labeling, and its elements can include certifying prescribers and pharmacies, enrolling patients in a registry, and documenting laboratory results before dispensing. Familiar examples are iPLEDGE for isotretinoin, absolute neutrophil count monitoring for clozapine, and the restricted program for thalidomide. Ordering quotas are a DEA function, beyond-use dating is set by USP compounding standards, and copay assistance has no regulatory safety role.FDA REMS (FDAAA 2007)

Which standard governs compounded sterile preparations, including ISO-classified air, garbing, and assignment of beyond-use dates?

• a.USP <795>
• b.USP <800>
• c.USP <797>✓
• d.21 CFR 1304

USP <797> sets the practice standards for compounded sterile preparations, covering ISO-classified engineering controls, personnel hand hygiene and garbing, environmental monitoring, and beyond-use dating. USP <795> applies to nonsterile compounding such as creams and oral suspensions, while USP <800> addresses handling of hazardous drugs regardless of whether the preparation is sterile. 21 CFR 1304 concerns controlled substance recordkeeping and has nothing to do with compounding technique.USP <797>

A technician will compound a chemotherapy agent in a negative-pressure containment room while wearing a chemotherapy-rated gown and two pairs of chemotherapy-rated gloves. Which standard drives these requirements?

• a.USP <800>✓
• b.USP <795>
• c.USP <797>
• d.Drug Supply Chain Security Act (DSCSA)

USP <800> governs the receipt, storage, compounding, and disposal of hazardous drugs in order to protect personnel, patients, and the environment, and it specifies containment engineering controls such as negative pressure rooms plus chemotherapy-rated PPE. Drugs subject to <800> are identified from the NIOSH hazardous drug list. USP <795> and <797> address nonsterile and sterile compounding quality rather than worker exposure, and the DSCSA deals with tracing product through the supply chain.USP <800>

Which action by a pharmacy technician violates the HIPAA Privacy Rule?

• a.Submitting a claim with the patient's medication details to the patient's insurer
• b.Faxing a refill history to the prescribing physician who is managing the patient's therapy
• c.Providing patient records to the pharmacist for an internal medication error review
• d.Telling the patient's neighbor which medications the patient picked up that morning✓

Protected health information may be used or disclosed without separate patient authorization for treatment, payment, and health care operations, and disclosures must be limited to the minimum necessary for the purpose. Billing the insurer is payment, faxing the prescriber is treatment, and an internal error review is health care operations, so all three are permitted. Disclosing a patient's medications to a neighbor serves none of these purposes and is a privacy violation.HIPAA Privacy Rule (45 CFR 164)

Under the Combat Methamphetamine Epidemic Act, what is the federal daily purchase limit of pseudoephedrine base for a single buyer?

• a.9 g
• b.2.4 g
• c.3.6 g✓
• d.7.5 g

The CMEA caps a single purchaser at 3.6 g of pseudoephedrine base per day and 9 g in a 30-day period, so 9 g is the monthly limit rather than the daily one and 2.4 g and 7.5 g are not federal thresholds. Products must be kept behind the counter or in a locked case, and the buyer must show photo identification and sign a written or electronic logbook that is retained for 2 years. These are federal minimums; some states are stricter and require a prescription.Combat Methamphetamine Epidemic Act (CMEA)

A prescriber writes an order for an oral liquid antipsychotic as "1.0 mg by mouth at bedtime." Why is this way of writing the dose considered unsafe?

• a.If the decimal point is missed or lost, 1.0 mg is read as 10 mg, a ten-fold overdose✓
• b.Doses below 10 mg must always be expressed in mcg
• c.A decimal point is never permitted in an order for a liquid medication
• d.The trailing zero shows the dose was rounded and is therefore only an estimate

A trailing zero adds no clinical information but creates real danger: if the decimal point is faint or lost in transmission, 1.0 mg is read as 10 mg. The safe convention is the opposite pair of rules: never use a trailing zero (write 1 mg), but always use a leading zero for doses under one (write 0.5 mg, not .5 mg). Small doses are not converted to mcg simply for being small, decimal points are allowed in liquid orders, and a trailing zero says nothing about rounding.

A handwritten order reads "Humulin R 8U subcutaneously before meals." Which correction should be made before the order is processed?

• a.Abbreviate "subcutaneously" to "SQ"
• b.Rewrite the dose as "8.0 units"
• c.Have "U" spelled out as "units," because U can be misread as a zero or a four✓
• d.Replace "before meals" with "QD"

The symbol U is one of the most dangerous abbreviations in practice: 8U can be read as 80 or 84, turning an 8 unit insulin dose into a potentially fatal one. The word units must be written out in full. SQ is itself an error-prone abbreviation, 8.0 units introduces a hazardous trailing zero, and QD is on every do-not-use list because it is confused with QOD and QID.

While filling a prescription, a technician scans the barcode on the stock bottle and the dispensing system rejects the scan. What is the correct next action?

• a.Key the NDC in manually and continue filling
• b.Stop, set the bottle aside, and confirm that the product truly matches the prescription label before going any further✓
• c.Rescan repeatedly until the system finally accepts the bottle
• d.Skip the scan and rely on the pharmacist to catch any problem at final check

A rejected scan is the system telling the technician that the product in hand is not the product on the label, so the fill must stop until the discrepancy is resolved. Manual entry, repeated rescanning, and skipping the scan all defeat the purpose of barcode verification, which is an independent electronic check that does not depend on the eyes of the person filling. Relying on the final check alone removes one layer of protection instead of adding one.FDA

A pediatric order is written for 15 mg/kg per dose for a child who weighs 18 kg. The label produced by the system reads "2,700 mg per dose." What should the technician conclude?

• a.The label is correct, because 18 kg multiplied by 15 mg/kg equals 2,700 mg
• b.The label is correct but the dose should be rounded up to 2,750 mg for easier measuring
• c.The dose must be recalculated using the child's weight in pounds
• d.The label shows a ten-fold overdose; the correct dose is 270 mg per dose✓

18 kg x 15 mg/kg = 270 mg per dose, so 2,700 mg is exactly ten times the intended amount and the label must be stopped and given to the pharmacist. Accepting 2,700 mg repeats the decimal error, and rounding it to 2,750 mg only makes an overdose easier to measure. Weight-based pediatric doses are calculated in kg, so converting to pounds would inflate the dose further.

Technicians are taught to read each prescription three times during the fill process. At which three points should those readings occur?

• a.When the stock bottle is taken off the shelf, when the drug is counted or measured, and when the bottle is returned to the shelf✓
• b.At drop-off, at the register, and at pickup
• c.Three times in succession immediately before counting the tablets
• d.Once by the technician and twice by the pharmacist at final verification

The three readings are spaced across the physical steps of the fill — selection, counting, and return to stock — so that a wrong-drug or wrong-strength selection is caught at a different moment each time. Reading three times in a row uses the same glance and the same assumption, so it catches almost nothing. Drop-off and pickup are separate service steps rather than fill checks, and the technique is a technician self-check, not a substitute for the pharmacist's verification.

Insulin, heparin, warfarin, opioids and concentrated potassium chloride are all classified as high-alert medications. What does that classification mean?

• a.Errors happen far more frequently with these drugs than with other medications
• b.They are the most expensive products carried in the pharmacy
• c.They may be dispensed only in unit-dose packaging
• d.An error involving them is far more likely to cause severe or fatal harm, even though errors are not necessarily more frequent✓

High-alert status is about the consequence of an error, not its frequency: these drugs have a narrow margin between a therapeutic dose and a lethal one, so a single mistake can kill. That is why they warrant an independent double check, physical separation, and standardized concentrations. Cost, packaging format and error frequency are not what put a drug on a high-alert list.

A heparin infusion is prepared by adding 25,000 units of heparin to a 250 mL bag of diluent. Which final concentration should appear on the label?

• a.10 units/mL
• b.25 units/mL
• c.100 units/mL✓
• d.1,000 units/mL

25,000 units divided by 250 mL equals 100 units/mL, and because heparin is a high-alert drug this figure should be confirmed by an independent double check before the bag is released. 10 units/mL and 25 units/mL understate the concentration, while 1,000 units/mL is a ten-fold overstatement that would lead a nurse to infuse far too little or far too much heparin for the ordered rate.

An order calls for potassium chloride 20 mEq to be added to 100 mL of diluent. The stock vial is labeled 2 mEq/mL. What volume should be withdrawn?

• a.2 mL
• b.10 mL✓
• c.20 mL
• d.40 mL

20 mEq divided by 2 mEq/mL equals 10 mL, which is then added to the 100 mL bag. Withdrawing 2 mL or 20 mL would deliver 4 mEq or 40 mEq, and 40 mL would give 80 mEq — four times the order. Concentrated potassium chloride is a high-alert product that must always be diluted before administration and never dispensed as an undiluted vial to a patient care area.

A prescription reads "insulin glargine 14 units subcutaneously at bedtime," but the label that printed reads "inject 14 mL subcutaneously at bedtime." What should the technician do?

• a.Stop the fill and alert the pharmacist, because the unit of measure was changed from units to mL and would produce a massive overdose✓
• b.Dispense it, since 14 mL of U-100 insulin equals 14 units
• c.Correct the label to read 14 mL and add an auxiliary label about measuring carefully
• d.Dispense it with an insulin syringe so the patient can convert the dose

Insulin is dosed in units, and 14 mL of U-100 insulin would contain 1,400 units — roughly a hundred times the intended dose — so the fill must stop and the pharmacist must correct the entry. The claim that 14 mL equals 14 units is false, keeping the mL wording preserves the error, and no auxiliary label or syringe choice can make a wrong unit of measure safe.

One shelf label in a pharmacy reads "hydrOXYzine" and another, stored some distance away, reads "hydrALAZINE." What is the purpose of writing the names this way?

• a.It marks the product as a controlled substance
• b.It shows that only the brand-name product may be dispensed
• c.It identifies the part of the name that must be typed on the patient label
• d.It highlights the letters that differ between two similar names so the products are less likely to be confused✓

TALL man lettering capitalizes the dissimilar portion of two confusable names so the eye is pulled to the difference rather than to the shared beginning. Controlled substance status is shown by the schedule and storage requirements, not by capitalization, and TALL man lettering says nothing about brand versus generic. The patient label uses ordinary lettering; the capitalization is a shelf and screen aid for staff.

A pharmacy stocks both clonazePAM and cloNIDine. Which storage practice best reduces the risk of pulling the wrong product?

• a.Shelve them side by side in alphabetical order so both can be seen at once
• b.Store both bottles in the refrigerator
• c.Separate them physically on different shelves and place a shelf alert at each location✓
• d.Keep only one of the two products in stock at any given time

Physical separation plus a shelf alert breaks the automatic reach-and-grab that causes look-alike errors, because the technician must move to a different location and read a warning before selecting. Strict alphabetical shelving is what places these two names next to each other in the first place, neither product requires refrigeration, and refusing to stock one of them would leave patients without a legitimately prescribed drug.

Which pair of medications is most likely to be involved in a look-alike/sound-alike selection error?

• a.amoxicillin and metformin
• b.predniSONE and predniSOLONE✓
• c.lisinopril and warfarin
• d.ibuprofen and cetirizine

predniSONE and predniSOLONE differ by only a few letters near the end of a long shared stem, sit next to each other alphabetically, and are stocked in similar strengths, which is the classic recipe for a wrong-drug selection. The other pairs share neither spelling, sound nor shelf position, so a technician reaching for one is unlikely to grab the other.

A patient's profile lists busPIRone 10 mg three times daily, but the bottle a technician pulled from the shelf is buPROPion 100 mg. Why was this error likely, and what would have prevented it?

• a.The two drugs belong to the same therapeutic class; checking the class would have prevented it
• b.The two drugs share a labeler code; comparing manufacturers would have prevented it
• c.The two drugs have identical strengths; comparing strengths would have prevented it
• d.The two names look and sound alike; scanning the barcode and reading the full name with its TALL man lettering before counting would have prevented it✓

busPIRone and buPROPion share their first three letters and a similar rhythm, which is why they appear on look-alike/sound-alike lists; a barcode scan plus a deliberate reading of the capitalized portion catches the substitution before any tablets are counted. They are not in the same therapeutic class, they do not necessarily come from the same labeler, and their strengths in this scenario are 10 mg and 100 mg rather than identical.

A stock bottle carries the NDC 00093-0058-01. In the 11-digit 5-4-2 format, what does the middle segment identify?

• a.The specific drug product, meaning its active ingredient, strength and dosage form✓
• b.The manufacturer or labeler that markets the product
• c.The package size and type
• d.The controlled substance schedule

The three segments run labeler, product and package: the first five digits identify the company, the middle four identify the drug together with its strength and dosage form, and the last two identify the package size. So a change in strength from 10 mg to 20 mg changes the middle segment. Controlled substance schedule is not encoded anywhere in the NDC.FDA

Two bottles from the same manufacturer carry NDC numbers that are identical except for the final two digits. What does this most likely mean?

• a.One is the brand product and the other is its generic
• b.The two bottles contain different strengths of the drug
• c.The bottles hold the same drug, strength and dosage form but in different package sizes✓
• d.One of the two bottles has passed its expiration date

Only the package segment differs, so the products are identical in ingredient, strength and dosage form and vary only in package size — for example a 100 count bottle versus a 500 count bottle. A brand-to-generic change would alter the labeler segment, a change in strength would alter the product segment, and expiration dating is printed separately and is never part of the NDC.

Which practice best confirms that the stock bottle in hand is the exact product called for by the prescription label?

• a.Compare only the drug name printed on the label with the name on the bottle
• b.Compare the full 11-digit NDC on the stock bottle with the NDC on the prescription label, segment by segment✓
• c.Compare the lot number on the bottle with the prescription number
• d.Compare the manufacturer's logo on the bottle with the image shown in the dispensing software

Matching all 11 digits verifies manufacturer, drug, strength, dosage form and package size in a single check, which is why the NDC is the anchor for both manual and barcode verification. Reading the name alone misses strength and dosage form errors, the lot number and prescription number are unrelated fields, and a logo confirms only the company.

At the pickup window a patient asks the technician whether her new antibiotic will interfere with her birth control pill. What should the technician do?

• a.Read the interaction section of the package insert aloud to the patient
• b.Suggest that the patient look it up on the manufacturer's website
• c.Answer using the interaction screen in the dispensing software
• d.Refer the question to the pharmacist, who is responsible for patient counseling✓

Interpreting a drug interaction for a specific patient is clinical judgment and counseling, which is the pharmacist's role; the technician's correct response is a prompt, courteous hand-off. Reading the insert aloud or repeating what the software screen says is still giving clinical advice, and sending the patient to a website leaves the question unanswered by the professional standing right there.

While entering a prescription for cephalexin, a technician sees a system alert that the patient has a documented penicillin allergy. What is the appropriate action?

• a.Leave the alert unresolved and notify the pharmacist so it can be clinically evaluated✓
• b.Override the alert, since cephalexin is not a penicillin
• c.Remove the allergy from the profile if the patient says the reaction was mild
• d.Cancel the prescription and tell the patient to contact the prescriber

Deciding whether a documented allergy contraindicates a related antibiotic is a clinical judgment reserved for the pharmacist, so the technician's job is to preserve the alert and escalate it. Overriding it, editing the allergy history based on a casual patient comment, or cancelling the prescription outright all substitute the technician's judgment for the pharmacist's and can delay needed therapy.

Which step must be performed by the pharmacist before a completed prescription is released to the patient?

• a.Counting or measuring the medication
• b.Applying the auxiliary labels to the container
• c.The final clinical and product verification of the finished prescription✓
• d.Scanning the barcode on the stock bottle

Final verification is where a licensed pharmacist confirms that the right drug, strength, quantity and directions match the prescription and that the therapy is appropriate for that patient, and it cannot be delegated to a technician. Counting, labeling and barcode scanning are all technical tasks a technician performs, and none of them substitutes for the pharmacist's clinical review.

A prescriber's office telephones the pharmacy to give a new prescription. In most states, what should the technician do?

• a.Take the order, enter it, and have the pharmacist verify the entry afterward
• b.Transfer the call to the pharmacist, because accepting a new verbal prescription is outside the technician's scope in most states✓
• c.Take the order only if it is not a controlled substance and the caller is a nurse
• d.Ask the caller to repeat the order twice and document it as a written prescription

Receiving a new oral prescription requires professional judgment about the drug, dose and directions as they are spoken, so most state boards restrict it to the pharmacist and the correct action is to hand off the call. Entering it first and verifying later means the error has already been recorded, a nurse relaying an order does not change the technician's scope, and repeating an order does not convert a verbal prescription into a written one.

In what sequence should personnel garb before entering the buffer area to prepare sterile compounded products?

• a.Gown, shoe covers, hair cover, mask, hand hygiene, sterile gloves
• b.Hand hygiene, sterile gloves, gown, mask, hair cover, shoe covers
• c.Mask, gown, shoe covers, hair cover, hand hygiene, sterile gloves
• d.Shoe covers, hair and beard cover, mask, hand hygiene, gown, sterile gloves✓

Garbing moves from the dirtiest items to the cleanest — feet, then head, then face — with hand hygiene performed after the head and face coverings are in place and immediately before the gown and sterile gloves. All jewelry, watches and artificial or extended nails must be removed before this sequence begins. The other sequences put gloves or gown on before hand hygiene or before the head coverings, which contaminates what has already been donned.USP <797>

While compounding in a horizontal laminar airflow workbench, a technician sets a stack of supplies between the HEPA filter and an open vial. Why is this unsafe?

• a.It interrupts first air, so the critical site no longer receives unobstructed HEPA-filtered air and may become contaminated✓
• b.It raises the temperature inside the hood above the permitted range
• c.It triggers the hood's pressure differential alarm
• d.It blocks the technician's view of the syringe graduations

First air is the clean air leaving the HEPA filter before it touches anything, and any object placed upstream of a critical site creates turbulence and a shadow of unfiltered air over that site. Work should be performed at least 6 inches inside the hood with nothing between the filter and the vial or needle. Temperature limits, alarms and sightlines are not the reason the practice is prohibited.USP <797>

Immediately before puncturing a vial inside the hood, what should the technician do to the rubber septum?

• a.Wipe it with a dry gauze pad
• b.Rinse it with sterile water and puncture it right away
• c.Wipe it with sterile 70% isopropyl alcohol and allow it to air-dry before puncturing✓
• d.Hold it briefly over a flame to sterilize the surface

Sterile 70% isopropyl alcohol needs contact time to kill surface organisms, so the septum must be wiped in one direction and then allowed to dry rather than being punctured while still wet. A dry gauze pad only moves contamination around, sterile water has no antimicrobial action, and open flame is never used in a laminar airflow hood.

A technician is assigned to prepare an intravenous dose of a hazardous antineoplastic drug. Which combination of personal protective equipment and engineering control is required?

• a.One pair of examination gloves and a cloth lab coat, working in a horizontal laminar airflow bench
• b.Two pairs of chemotherapy-rated gloves and a disposable low-permeability gown, working in a negative-pressure containment device✓
• c.Sterile gloves and a surgical mask only, working at an open bench with a portable fume extractor
• d.Chemotherapy gloves with no gown, working in a positive-pressure clean bench

Hazardous drug compounding requires double chemotherapy-rated gloves and a closed-front, low-permeability disposable gown inside a containment primary engineering control that keeps airflow moving inward and vents appropriately, protecting the preparer as well as the preparation. A horizontal or positive-pressure clean bench blows air outward toward the operator, and examination gloves, cloth coats or a mask alone provide no barrier against hazardous drug residue.USP <800>

A technician pulls the wrong strength of a medication but notices the mistake and corrects it before the pharmacist's final check, so the patient is never affected. Under a just-culture approach, what should happen next?

• a.Nothing, because no patient was harmed
• b.The technician should receive formal discipline for the mistake
• c.It should be reported only if the same technician repeats the mistake
• d.The near miss should be documented and reported internally so the underlying system weakness can be analyzed and corrected✓

Near misses are free lessons: reporting one lets the pharmacy run a root cause analysis and fix the shelf layout, label design or workflow that made the error possible before a patient is harmed. A just culture separates honest system-driven error from reckless behavior, so punishing the report or waiting for a repeat simply teaches staff to stay silent and leaves the hazard in place.

A patient develops a severe rash days after starting a newly dispensed sulfonamide antibiotic, and the pharmacist decides to report it to the FDA. Which program should be used?

• a.MedWatch, the FDA program for adverse events and product quality problems involving drugs and other medical products✓
• b.VAERS, which collects reports of adverse events following vaccination
• c.A DEA Form 106, used to report loss or theft of controlled substances
• d.The manufacturer's product recall notification system

MedWatch is the FDA's voluntary reporting pathway for suspected adverse drug reactions, medication errors and product defects, and reports from pharmacies help detect safety signals that clinical trials missed. VAERS is reserved for events after vaccines, DEA Form 106 covers controlled substance loss or theft, and a recall notification moves product off the shelf but is not a way to report a patient reaction.FDA

Metformin 500 mg, sig: 1 tablet by mouth twice daily. Quantity dispensed: 60 tablets. What is the day supply?

• a.15 days
• b.30 days✓
• c.45 days
• d.60 days

The patient takes 1 tablet x 2 times daily = 2 tablets per day. 60 tablets / 2 tablets per day = 30 days. The tempting error is answering 60 days by treating the dispensed quantity as if it were one tablet per day.

Amoxicillin 250 mg/5 mL oral suspension, sig: 1 teaspoonful by mouth three times daily. One 150 mL bottle is dispensed. What is the day supply?

• a.5 days
• b.7.5 days
• c.10 days✓
• d.30 days

One teaspoonful = 5 mL, and 5 mL x 3 doses = 15 mL per day. 150 mL / 15 mL per day = 10 days. Answering 30 days comes from dividing 150 mL by a single 5 mL dose and forgetting that the patient takes three doses each day.

Insulin glargine 100 units/mL is dispensed as one 10 mL vial. The sig reads: inject 30 units subcutaneously at bedtime. Rounded down to whole days, what is the day supply?

• a.33 days✓
• b.30 days
• c.3 days
• d.100 days

A 10 mL vial at 100 units/mL contains 10 x 100 = 1000 units. 1000 units / 30 units per day = 33.3, which is reported as 33 days. Answering 3 days comes from using 100 units as the total vial content instead of 1000 units.

A prescription is written with the sig: ii tabs PO q6h PRN pain. Which set of patient directions is correct?

• a.Take 2 tablets by mouth every 6 days as needed for pain
• b.Take 2 tablets by mouth four times daily on a fixed schedule
• c.Place 2 tablets under the tongue every 6 hours as needed for pain
• d.Take 2 tablets by mouth every 6 hours as needed for pain✓

ii = two, PO = by mouth, q6h = every 6 hours, PRN = as needed. Nothing in the sig makes the dose scheduled rather than as-needed, and PO is by mouth, not sublingual (SL). The most tempting distractor drops PRN and converts q6h into a fixed four-times-daily schedule.

A prednisone taper is ordered using 10 mg tablets: 40 mg daily for 3 days, then 30 mg daily for 3 days, then 20 mg daily for 3 days, then 10 mg daily for 3 days. What quantity should be dispensed?

• a.10 tablets
• b.30 tablets✓
• c.40 tablets
• d.100 tablets

With 10 mg tablets the daily tablet counts are 4, 3, 2 and 1. Each step runs 3 days: (4 x 3) + (3 x 3) + (2 x 3) + (1 x 3) = 12 + 9 + 6 + 3 = 30 tablets. Answering 10 tablets comes from adding 4 + 3 + 2 + 1 and forgetting to multiply each step by its 3 days.

A 22 kg child is ordered cefdinir 10 mg/kg per dose every 8 hours. The suspension supplied is 100 mg/5 mL. What volume should be given per dose?

• a.11 mL✓
• b.2.2 mL
• c.22 mL
• d.33 mL

The dose is 22 kg x 10 mg/kg = 220 mg. At 100 mg/5 mL the concentration is 20 mg/mL, so 220 mg / 20 mg/mL = 11 mL per dose. Answering 2.2 mL comes from dividing 220 mg by 100 mg and forgetting that each 100 mg occupies 5 mL.

An order calls for 375 mg of an antibiotic. The stock solution is labeled 250 mg/5 mL. How many mL should be measured?

• a.3.3 mL
• b.5 mL
• c.7.5 mL✓
• d.15 mL

Set up the proportion 250 mg / 5 mL = 375 mg / x, so x = (375 x 5) / 250 = 1875 / 250 = 7.5 mL. Answering 3.3 mL comes from inverting the proportion and calculating (250 x 5) / 375.

How many grams of dextrose are contained in a 500 mL bag of D5W?

• a.2.5 g
• b.5 g
• c.10 g
• d.25 g✓

D5W is 5% weight/volume, which means 5 g of dextrose per 100 mL. For 500 mL: 5 g/100 mL x 500 mL = 25 g. Answering 5 g comes from reading the 5% as 5 g per bag regardless of volume.

You must prepare 60 g of a 5% hydrocortisone ointment using a 10% ointment and a 2% ointment. How much of each is required?

• a.37.5 g of the 10% and 22.5 g of the 2%
• b.22.5 g of the 10% and 37.5 g of the 2%✓
• c.30 g of the 10% and 30 g of the 2%
• d.15 g of the 10% and 45 g of the 2%

By alligation, the 10% gets 5 - 2 = 3 parts and the 2% gets 10 - 5 = 5 parts, for 8 total parts. 60 g / 8 = 7.5 g per part, so 3 x 7.5 = 22.5 g of the 10% and 5 x 7.5 = 37.5 g of the 2%. The classic error is assigning the parts to the wrong strength, which reverses the two answers.

How many mL of a 50% stock solution are needed to prepare 500 mL of a 10% solution?

• a.100 mL✓
• b.50 mL
• c.250 mL
• d.400 mL

Using C1V1 = C2V2: 50% x V1 = 10% x 500 mL, so V1 = 5000 / 50 = 100 mL of stock, then qs to 500 mL with diluent. Answering 400 mL is the volume of diluent added, not the volume of stock solution required.

An order reads: infuse 1000 mL of 0.9% sodium chloride over 8 hours. What is the flow rate in mL/hr?

• a.62.5 mL/hr
• b.100 mL/hr
• c.125 mL/hr✓
• d.250 mL/hr

Flow rate = total volume / total time = 1000 mL / 8 hr = 125 mL/hr. Answering 62.5 mL/hr comes from dividing by 16 instead of 8, a common slip when the order is misread as a two-bag total.

1000 mL is to infuse over 10 hours using an administration set calibrated at 15 gtt/mL. What is the drip rate in gtt/min?

• a.10 gtt/min
• b.15 gtt/min
• c.17 gtt/min
• d.25 gtt/min✓

1000 mL / 10 hr = 100 mL/hr, and 100 mL/hr / 60 min = 1.67 mL/min. Multiplying by the drop factor: 1.67 mL/min x 15 gtt/mL = 25 gtt/min. Answering 17 gtt/min comes from using a 10 gtt/mL set instead of the 15 gtt/mL set that was specified.

A 500 mL IV bag is running at 50 mL/hr. How long will the bag last?

• a.5 hours
• b.10 hours✓
• c.12.5 hours
• d.25 hours

Infusion time = volume / rate = 500 mL / 50 mL/hr = 10 hours. Answering 25 hours comes from dividing by 20 mL/hr, and answering 5 hours comes from dividing only half the bag by the rate.

A pharmacy acquires a product for $40.00 and applies a 25% markup on cost. What is the selling price?

• a.$42.50
• b.$45.00
• c.$50.00✓
• d.$53.33

Markup on cost = $40.00 x 0.25 = $10.00, so the selling price is $40.00 + $10.00 = $50.00. Answering $53.33 comes from treating 25% as a margin on the selling price ($40.00 / 0.75) instead of a markup on cost.

A drug has an AWP of $120.00 per 100 tablets. A plan reimburses AWP minus 15% plus a $3.50 dispensing fee. What is the total reimbursement for a 30 tablet prescription?

• a.$34.10✓
• b.$30.60
• c.$36.00
• d.$39.50

AWP for 30 tablets = $120.00 x (30/100) = $36.00. Subtract 15%: $36.00 x 0.85 = $30.60. Add the dispensing fee: $30.60 + $3.50 = $34.10. Answering $39.50 comes from adding the dispensing fee to $36.00 and skipping the 15% discount.

A pharmacy holds a capitated contract paying $6.00 per member per month for 500 enrolled members. What does the pharmacy receive for the month if 900 prescriptions are filled?

• a.$500.00
• b.$1,500.00
• c.$2,400.00
• d.$3,000.00✓

Capitation pays per enrolled member, not per prescription: $6.00 x 500 members = $3,000.00 for the month. The number of prescriptions filled does not change the payment, so calculations built on the 900 prescriptions lead to the wrong answers.

A prescription for 1 tablet daily is filled with 90 tablets on day 1. The plan will not pay for a refill until 75% of the day supply has elapsed. On which day is the refill first payable?

• a.Day 45
• b.Day 68✓
• c.Day 75
• d.Day 90

90 tablets at 1 tablet daily is a 90 day supply, and 75% of 90 days = 67.5 days. Since a partial day does not count, the refill is first payable on day 68. Answering day 75 comes from reading the 75% as 75 days rather than as a percentage of the 90 day supply.

A new written prescription for a Schedule II controlled substance is complete except that the prescriber's DEA number is not on the form. What should the technician do?

• a.Copy the DEA number from an older prescription in the patient's profile onto the hard copy
• b.Enter and fill the prescription, then obtain the DEA number when the patient picks up
• c.Give the prescription to the pharmacist so the missing element can be resolved with the prescriber before dispensing✓
• d.Reconstruct the DEA number using the check-digit formula and document the calculation

A prescription for a controlled substance must carry the required elements, including the prescriber's DEA number, before it can be dispensed. A technician may not supply, guess, or reconstruct a missing element; the correct action is to route the prescription to the pharmacist, who resolves it with the prescriber. Using the check-digit formula only tests whether a number is plausible and cannot create a valid one.21 CFR 1306 (controlled substance prescriptions)

A product carries the 11-digit NDC 00093-3109-56. What does the middle four-digit segment identify?

• a.The specific drug, its strength, and its dosage form✓
• b.The labeler, meaning the manufacturer or distributor
• c.The package size and package type
• d.The lot number assigned during manufacturing

An 11-digit NDC is written in a 5-4-2 format: the first segment is the labeler code, the middle four digits are the product code (drug, strength, and dosage form), and the last two digits are the package code. The lot number is a separate manufacturing identifier and is never part of the NDC.FDA

Which statement is federally required on the label of a dispensed prescription for a Schedule III controlled substance?

• a.Store in a locked cabinet away from other household medications
• b.May cause drowsiness; use caution when operating machinery
• c.Return all unused doses to the pharmacy for destruction
• d.Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed✓

Federal law requires the transfer warning on the label of any dispensed Schedule II, III or IV prescription. The drowsiness statement is a clinically useful auxiliary label but is not the federally mandated warning, and the storage and return statements are counseling points rather than label requirements.21 CFR 1306 (controlled substance prescriptions)

Under federal packaging law, which dispensed product may routinely be supplied in a non-child-resistant container without any request from the patient or prescriber?

• a.Amoxicillin 250 mg/5 mL oral suspension
• b.Sublingual nitroglycerin 0.4 mg tablets✓
• c.Lisinopril 10 mg tablets
• d.Ibuprofen 600 mg tablets

Sublingual nitroglycerin is a listed exemption from child-resistant packaging because a patient having chest pain must be able to open the container immediately. The other three products require child-resistant packaging unless the patient or prescriber specifically requests otherwise, and a patient waiver may be kept on file for that request.Poison Prevention Packaging Act