PTCB Pharmacy Technician (PTCE) — All Questions

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

• a.60 days
• b.30 days✓
• c.15 days
• d.45 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.10 days✓
• c.30 days
• d.7.5 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.3 days
• c.100 days
• d.30 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.Place 2 tablets under the tongue every 6 hours as needed for pain
• b.Take 2 tablets by mouth four times daily on a fixed schedule
• c.Take 2 tablets by mouth every 6 hours as needed for pain✓
• d.Take 2 tablets by mouth every 6 days 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.30 tablets✓
• b.100 tablets
• c.10 tablets
• d.40 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.2.2 mL
• b.33 mL
• c.11 mL✓
• d.22 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.15 mL
• b.3.3 mL
• c.5 mL
• d.7.5 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.25 g✓
• b.10 g
• c.2.5 g
• d.5 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.30 g of the 10% and 30 g of the 2%
• b.15 g of the 10% and 45 g of the 2%
• c.37.5 g of the 10% and 22.5 g of the 2%
• d.22.5 g of the 10% and 37.5 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.400 mL
• c.50 mL
• d.250 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.250 mL/hr
• b.62.5 mL/hr
• c.125 mL/hr✓
• d.100 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.25 gtt/min✓
• c.15 gtt/min
• d.17 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.25 hours
• b.10 hours✓
• c.5 hours
• d.12.5 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.$45.00
• b.$50.00✓
• c.$53.33
• d.$42.50

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

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.$2,400.00
• b.$500.00
• c.$1,500.00
• 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 75
• b.Day 45
• c.Day 68✓
• 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.Reconstruct the DEA number using the check-digit formula and document the calculation
• b.Give the prescription to the pharmacist so the missing element can be resolved with the prescriber before dispensing✓
• c.Enter and fill the prescription, then obtain the DEA number when the patient picks up
• d.Copy the DEA number from an older prescription in the patient's profile onto the hard copy

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

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.Keep this medication in a locked cabinet, away from other household medicines and out of the reach of children
• b.Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed✓
• c.Return any unused doses to the pharmacy so that they can be witnessed and destroyed
• d.Warning: may cause drowsiness; use caution when driving or operating heavy machinery

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

A prescription reads: instill 1 drop into each eye three times daily. One 5 mL bottle is dispensed, and the manufacturer states the bottle delivers 20 drops per mL. Rounded down to whole days, what is the day supply?

• a.8 days
• b.33 days
• c.16 days✓
• d.17 days

The bottle holds 5 mL x 20 drops/mL = 100 drops, and the patient uses 1 drop x 2 eyes x 3 times daily = 6 drops a day, so 100 / 6 = 16.7, reported as 16 whole days. Reading 'each eye' as a single drop per dose leaves 3 drops a day and 100 / 3 = 33 days; doubling the dose to two drops in each eye gives 12 drops a day and 100 / 12 = 8 days. The 17-day figure is the same 16.7 rounded the wrong way, and that rounding is the call worth pausing over, since 16.7 sits closer to 17: a day supply is always rounded down, because on the seventeenth day there is not a full day of drops left.

An inhaler canister is labelled 200 metered actuations. The sig reads: inhale 2 puffs by mouth four times daily. One canister is dispensed. What is the day supply?

• a.100 days
• b.25 days✓
• c.12 days
• d.50 days

The patient uses 2 puffs x 4 times daily = 8 actuations a day, so 200 / 8 = 25 days exactly. Dividing 200 by the 4 daily doses while forgetting that each dose is 2 puffs gives 50 days, and counting only the 2 actuations of a single daily dose gives 200 / 2 = 100 days. Doubling the daily use to 16 actuations gives 200 / 16 = 12.5, reported as 12 days, but nothing in the sig supports 16 puffs a day.

A box of five insulin pens is dispensed. Each pen holds 3 mL of insulin labelled 100 units/mL. The sig reads: inject 35 units subcutaneously twice daily. Rounded down to whole days, what is the day supply?

• a.42 days
• b.7 days
• c.21 days✓
• d.22 days

Each pen holds 3 mL x 100 units/mL = 300 units, so five pens hold 1,500 units; the patient uses 35 x 2 = 70 units a day, and 1,500 / 70 = 21.4, reported as 21 whole days. Treating 100 units/mL as 100 units per pen ignores the 3 mL volume and leaves 500 units, or 500 / 70 = 7 days. Counting only one 35-unit dose a day gives 1,500 / 35 = 42 days. The 22-day figure is that same 21.4 rounded up, and a day supply is rounded down because the final partial day is not a full day of therapy.

A patient is directed to apply 0.5 g of a cream to the affected area three times daily. One 45 g tube is dispensed. What is the day supply?

• a.90 days
• b.10 days
• c.30 days✓
• d.15 days

The patient uses 0.5 g x 3 = 1.5 g a day, so 45 g / 1.5 g per day = 30 days. Treating 1.5 g as the amount per application rather than per day triples the daily use to 4.5 g and gives 45 / 4.5 = 10 days. Counting a single 0.5 g application a day gives 45 / 0.5 = 90 days, and using 3 g a day gives 45 / 3 = 15 days.

A prednisone taper is written with 20 mg tablets: 60 mg daily for 5 days, then 40 mg daily for 5 days, then 20 mg daily for 5 days. What quantity should be dispensed?

• a.60 tablets
• b.18 tablets
• c.6 tablets
• d.30 tablets✓

With 20 mg tablets the three steps are 3, 2 and 1 tablets a day, so the totals are 3 x 5 = 15, 2 x 5 = 10 and 1 x 5 = 5 tablets, giving 15 + 10 + 5 = 30 tablets. The 60-tablet figure is what the same taper needs if 10 mg tablets are used, since the steps would be 6, 4 and 2 a day; the strength written on the prescription decides which applies, and this one says 20 mg. Adding 3 + 2 + 1 without ever multiplying by the 5 days gives 6 tablets, and multiplying that 6 by 3 days instead of 5 gives 18 tablets.

An antineoplastic is ordered at 75 mg/m2 for a patient whose body surface area is documented on the order as 1.6 m2. The vial is labelled 6 mg/mL. What volume contains the ordered dose?

• a.7.8 mL
• b.12.5 mL
• c.20 mL✓
• d.120 mL

The dose is 75 mg/m2 x 1.6 m2 = 120 mg, and 120 mg / 6 mg/mL = 20 mL. The 12.5 mL figure is the most tempting because it uses the right vial concentration but never applies the body surface area, dividing the bare 75 mg by 6 mg/mL. Dividing by 1.6 instead of multiplying gives 46.9 mg and 46.9 / 6 = 7.8 mL, and carrying the milligram number straight across as a volume gives 120 mL, which would only be right if the vial were 1 mg/mL.

A child weighing 33 lb is ordered an antibiotic at 40 mg/kg/day divided every 8 hours. The suspension supplied is 250 mg/5 mL. What volume should be given per dose?

• a.12 mL
• b.6 mL
• c.8.8 mL
• d.4 mL✓

The child weighs 33 lb / 2.2 = 15 kg, so the daily dose is 15 kg x 40 mg/kg = 600 mg; every 8 hours means 3 doses, so each dose is 600 / 3 = 200 mg, and 200 mg / (250 mg per 5 mL, that is 50 mg/mL) = 4 mL. The 6 mL figure is the most tempting because every step is right except the last, splitting the day into two doses of 300 mg. Taking the 33 lb as kilograms gives 33 x 40 = 1,320 mg a day, 440 mg a dose and 8.8 mL, and giving the whole 600 mg at once is 12 mL.

How many milligrams of lidocaine are contained in 20 mL of a 2% (w/v) lidocaine solution?

• a.400 mg✓
• b.20 mg
• c.4,000 mg
• d.40 mg

A percentage strength expressed w/v means grams of drug per 100 mL, so 2% is 2 g per 100 mL, which is 2,000 mg / 100 mL = 20 mg/mL, and 20 mg/mL x 20 mL = 400 mg. Reading the 2 as 2 mg/mL without converting the grams first gives 2 x 20 = 40 mg, and inflating that same conversion tenfold to 200 mg/mL gives 4,000 mg. The 20 mg figure stops at the per-millilitre strength and never multiplies by the 20 mL volume.

An epinephrine solution is labelled with the ratio strength 1:1,000. What concentration does that ratio strength represent?

• a.1,000 mg/mL
• b.10 mg/mL
• c.1 mg/mL✓
• d.0.1 mg/mL

A ratio strength for a solution means grams of drug in that many millilitres, so 1:1,000 is 1 g in 1,000 mL, which is 1,000 mg / 1,000 mL = 1 mg/mL, the same as 0.1% w/v. The 0.1 mg/mL figure is the one worth pausing over, because it is a real epinephrine concentration a technician handles, but it belongs to the 1:10,000 label, where the same 1 g is spread through ten times the volume. Reading the label as 1 g in 100 mL gives 10 mg/mL, and reading it as 1,000 mg in each millilitre gives 1,000 mg/mL.

You must prepare 500 mL of 60% isopropyl alcohol using a 90% and a 40% isopropyl alcohol. What volume of each is required?

• a.250 mL of 90% and 250 mL of 40%
• b.200 mL of 90% and 300 mL of 40%✓
• c.300 mL of 90% and 200 mL of 40%
• d.100 mL of 90% and 400 mL of 40%

By alligation the 90% contributes 60 - 40 = 20 parts and the 40% contributes 90 - 60 = 30 parts, giving 50 parts in all, so the 90% supplies 20/50 x 500 = 200 mL and the 40% supplies 30/50 x 500 = 300 mL. Checking by mass balance, 200 x 0.90 = 180 g plus 300 x 0.40 = 120 g is 300 g of alcohol in 500 mL, which is 60%. Reversing the parts to 300 mL and 200 mL is the commonest error and yields 270 + 80 = 350 g in 500 mL, or 70%. Mixing 250 mL of each averages the two strengths to 65%, and the 1-to-4 split yields 90 + 160 = 250 g in 500 mL, or 50%.

A vial of lyophilised antibiotic powder is reconstituted with 8.6 mL of sterile water and the resulting solution measures 10 mL. What is the powder volume?

• a.1.4 mL✓
• b.18.6 mL
• c.10 mL
• d.8.6 mL

Powder volume is the space the dry drug itself occupies, found as final volume minus diluent volume: 10 mL - 8.6 mL = 1.4 mL. The 8.6 mL figure is the most tempting because that number is the one printed on the reconstitution instructions, but it is the diluent, not the powder. The 10 mL figure is the final volume the label concentration is based on, and adding the two volumes to reach 18.6 mL counts the diluent twice.

An order reads: infuse 1,500 mL of 0.9% sodium chloride over 12 hours using an administration set calibrated at 20 gtt/mL. What is the drip rate in gtt/min?

• a.42 gtt/min✓
• b.31 gtt/min
• c.125 gtt/min
• d.21 gtt/min

The infusion delivers 1,500 mL x 20 gtt/mL = 30,000 drops over 12 x 60 = 720 minutes, so 30,000 / 720 = 41.7, rounded to 42 gtt/min. Checking the other way, 1,500 / 12 = 125 mL/hr and 125 / 60 x 20 = 41.7 gtt/min. The 125 figure is the most tempting because that number really does appear in the working, but it is the hourly volume, not a drip rate. A 15 gtt/mL set would give 125 / 60 x 15 = 31 gtt/min and a 10 gtt/mL set 125 / 60 x 10 = 21 gtt/min, but this order specifies a 20 gtt/mL set.

A 1,000 mL bag is started at 100 mL/hr. After 4 hours the prescriber lowers the rate to 60 mL/hr. How much longer will the bag run?

• a.6 hours
• b.16.7 hours
• c.14 hours
• d.10 hours✓

In the first 4 hours the pump delivered 4 x 100 = 400 mL, leaving 1,000 - 400 = 600 mL, and 600 mL / 60 mL/hr = 10 more hours. The 16.7-hour figure is the most tempting because it applies the new rate correctly but to the whole 1,000 mL, ignoring the 400 mL already infused. Running the remaining 600 mL at the old 100 mL/hr gives 6 hours, and adding the 4 hours already elapsed onto the 10 gives 14 hours, which answers total run time rather than the time still to go.

A plan charges a $10.00 copay plus 20% coinsurance on the balance of the prescription price. The total price of the prescription is $210.00. What does the patient pay?

• a.$52.00
• b.$50.00✓
• c.$42.00
• d.$10.00

The copay comes off first, leaving $210.00 - $10.00 = $200.00; the coinsurance is 20% x $200.00 = $40.00, so the patient owes $40.00 + $10.00 = $50.00. The $52.00 figure is the most tempting because it also adds the copay, but it takes the 20% from the full $210.00 instead of from the balance, charging the patient twice on that first $10.00. Taking 20% of $210.00 and forgetting the copay altogether gives $42.00, and $10.00 assumes the plan absorbs everything above the copay.

A pharmacy acquires a bottle for $80.00 and sells it for $100.00. What are the gross profit and the percentage markup on cost?

• a.$20.00 gross profit and a 25% markup✓
• b.$20.00 gross profit and a 125% markup
• c.$20.00 gross profit and a 20% markup
• d.$100.00 gross profit and a 25% markup

Gross profit is selling price minus cost, $100.00 - $80.00 = $20.00, and markup on cost divides that profit by the cost: $20.00 / $80.00 = 0.25, or 25%. The 20% figure is the hardest to discard, because $20.00 / $100.00 really is 20%, but dividing by the selling price gives the gross margin; this question asks for markup on cost, so the denominator has to be the $80.00. The 125% figure is $100.00 / $80.00, the price as a percentage of cost rather than the increase over it, and the $100.00 profit figure mistakes the whole selling price for the profit and never subtracts what the bottle cost.

A prescription sig reads: ii gtts AU tid. Which set of patient directions is correct?

• a.Instill 2 drops into the left ear three times daily
• b.Instill 2 drops into each eye three times daily
• c.Instill 2 drops into both ears three times daily✓
• d.Instill 2 drops into both ears twice daily

The Roman numeral ii is 2, gtts is drops, AU is auris uterque or both ears, and tid is three times daily. The each-eye version is the trap worth thinking about, because AU and OU differ by one letter and both mean the paired organ; the A stands for auris, the ear, while OU would be oculus uterque, both eyes. AS would be the left ear alone, and twice daily would be written bid.

A prescriber writes 'dispense as written' on a prescription for a brand-name drug that has an AB-rated generic. Which DAW code should be transmitted on the claim?

• a.DAW 1✓
• b.DAW 0
• c.DAW 2
• d.DAW 4

A dispense-as-written instruction from the prescriber on the face of the prescription is DAW 1, which is defined as substitution not allowed by the prescriber. DAW 2 is the closest call, because it also ends with the brand being dispensed, but it records the patient as the source of the request; billing it that way misstates who made the decision and often shifts the extra cost onto the patient. DAW 0 means no product selection was indicated by anyone, and DAW 4 means substitution was allowed but the generic was not in stock.

A claim for a 90-day supply of a maintenance drug is rejected as 'plan limitations exceeded'. The plan covers this drug in 30-day quantities at retail. What is the correct resolution?

• a.Bill the whole 90-day supply as a cash sale
• b.Resubmit the same 90-day claim with a DAW 1 code
• c.Split the 90 tablets into three claims submitted the same day
• d.Rebill the claim for a 30-day quantity and dispense that amount✓

A plan-limitation rejection is a quantity problem, so the fix is to cut the fill back to the quantity the plan actually covers, bill that, and let the patient decide about mail order for the longer supply. Splitting the fill into three same-day claims is the closest wrong answer because it does reach the same 90 days, but the second and third claims reject as refill-too-soon or duplicates, and deliberately structuring claims to defeat a plan limit is a billing offense. A DAW code addresses brand substitution and has no effect on a quantity limit, and moving the patient to cash without telling them takes away a choice that is theirs to make.

A prescription sig reads: 1 tab PO qid ac & hs. Which set of patient directions is correct?

• a.Take 1 tablet by mouth every six hours around the clock with food
• b.Take 1 tablet by mouth after each meal and again at bedtime
• c.Take 1 tablet by mouth four times a day as needed for symptoms
• d.Take 1 tablet by mouth before each meal and at bedtime✓

qid is four times daily, ac is ante cibum or before meals, and hs is hora somni or at bedtime, so the four doses fall before each of the three meals and once at bedtime. Reading the doses as coming after meals swaps ac for pc, post cibum, which moves every dose to the wrong side of the meal and matters for drugs that must be taken on an empty stomach. Doses spaced every six hours around the clock would be written q6h, which detaches them from meals, and nothing in this sig makes the drug an as-needed one.

A prescription reads: hydrocortisone 1% ung, apply to the affected area bid. The shelf holds both a cream and an ointment of that drug and strength. Which product should be pulled?

• a.Either product, because a cream and an ointment of the same strength are interchangeable
• b.The ointment, because ung abbreviates unguentum✓
• c.The lotion, because ung indicates a pourable topical preparation
• d.The cream, because ung marks a water-washable topical base

ung is the abbreviation for unguentum, the Latin word for ointment, so the ointment is the dosage form the prescriber ordered. Treating the cream as equivalent is the tempting error, because both are semisolid topicals of the same drug and strength, but the base changes how the drug is delivered and how long it stays on the skin, and a change of dosage form needs the prescriber's authorisation. A cream would be written crm, and a lotion is a separate pourable dosage form altogether.

Why must the NDC transmitted on a third-party claim match the NDC on the stock bottle actually used to fill the prescription?

• a.A mismatched NDC changes the product's therapeutic equivalence rating and blocks substitution
• b.Federal law requires the dispensing label to print the same NDC that the claim carries
• c.The NDC sets the price the pharmacy paid the wholesaler
• d.The plan pays for the exact package billed and audits compare it to the stock used✓

The NDC on a claim is the pharmacy's statement of whose package, in what size, was dispensed; reimbursement is calculated from that number and an auditor reconciles it against the bottles on the shelf and the purchase invoices, so billing one manufacturer's NDC while dispensing another's produces a recoverable overpayment even when the drug is identical. The labelling answer is the closest wrong one, because the NDC often does print on the dispensing label, but that is pharmacy and state practice rather than what makes the match matter on the claim. Therapeutic equivalence ratings come from the Orange Book, and the NDC identifies a package rather than a price.

A prescriber leaves the substitution line open on a brand-name prescription that has an AB-rated generic, the patient asks for nothing in particular, and the pharmacy dispenses the generic. Which DAW code belongs on the claim?

• a.DAW 3, substitution allowed and the pharmacist selected the brand
• b.DAW 0, no product selection indicated✓
• c.DAW 2, substitution allowed but the patient requested the brand
• d.DAW 1, substitution not allowed by the prescriber

DAW 0 is the code for a claim on which nobody indicated a product selection, which is exactly what a routine generic fill is. The pharmacist-selected code is the closest wrong answer, because a pharmacist did choose the product here, but that code is reserved for the case where the pharmacist dispenses the brand although substitution was allowed. The prescriber code applies only when the prescriber blocks substitution, and the patient code only when the patient asks for the brand and pays the difference.

A prescriber wants to transmit controlled-substance prescriptions to the pharmacy electronically. Under the federal EPCS rules, what must be true of that transmission?

• a.The prescription must be followed by a signed paper copy delivered to the pharmacy within seven days
• b.The prescriber signs each prescription with two-factor authentication in a certified application✓
• c.Office staff may transmit the prescription under the prescriber's shared log-in
• d.Only Schedule III through V prescriptions may be sent electronically

Electronic prescribing of controlled substances is open to every schedule the prescriber may write, but the practitioner has to sign the record inside an application certified for the purpose, using two of the three permitted identity factors. The paper follow-up is the closest wrong answer, because an emergency oral order for a Schedule II drug really does have to be covered by a written prescription within seven days, while a compliant electronic prescription is the legal record on its own. A shared log-in defeats the whole point of the signing credential, which is personal to the prescriber and may not be delegated.21 CFR part 1311

A patient asks a second pharmacy to pick up the remaining refills on an alprazolam prescription. The two pharmacies do not share a real-time online database. What does federal law allow?

• a.The remaining refill information may be transferred one time only✓
• b.The refill information may be transferred as often as refills remain
• c.Transfer is barred for every controlled substance, whatever its schedule
• d.Transfer requires a new prescription from the prescriber

Alprazolam is a Schedule IV drug, and federal rules let the refill information on a Schedule III, IV or V prescription be transferred between pharmacies on a one-time basis. Repeated transfers are the closest wrong answer, because pharmacies that share a real-time online database may indeed transfer up to the number of refills authorised, and this pair does not qualify for that exception. A blanket ban would be right only for Schedule II, which carries no refills at all, and asking the prescriber for a new prescription is always an option but is not what the transfer rule permits.21 CFR 1306.25

A patient leaving the country for a month asks to refill a maintenance drug early, and the claim rejects as refill too soon. What is the correct step?

• a.Contact the plan and request a vacation supply override✓
• b.Change the day supply on the claim until the refill goes through
• c.Resubmit the claim each morning until it pays
• d.Sell the early refill as a cash prescription without telling the plan

Plans build a vacation or extended-travel override into their refill-too-soon edits, and the pharmacy obtains it by calling the help desk with the travel dates. The cash sale is the closest wrong answer, because a patient may legitimately choose to pay cash, but doing it silently costs the patient a benefit they are entitled to and leaves the early supply off the plan's profile. Altering the day supply to force payment is a false claim, and resubmitting an unchanged claim does not move the refill date the plan is measuring against.

A new prescription rejects with the message that the product is not on the plan's formulary. Which step by the technician is most likely to resolve it?

• a.Submit a prior authorisation request, since every non-formulary reject is cleared that way
• b.Substitute a drug from the same class that the plan does cover and bill for it
• c.Send the plan's preferred alternatives to the prescriber and ask for a new prescription✓
• d.Tell the patient the drug is not covered and charge the cash price

A formulary reject is a coverage decision the pharmacy cannot overturn; what it can do is look up what the plan covers in that class and put those options in front of the prescriber, who is the only person able to write the new prescription. Prior authorisation is the closest wrong answer, and some plans do cover a non-formulary drug through an exception request, but that request also has to come from the prescriber with clinical justification and many plans exclude non-formulary products outright. Switching the drug inside the pharmacy dispenses something that was not prescribed, and quoting the cash price without offering a covered route gives the patient nowhere to go.

A claim rejects with 'prior authorisation required'. Which statement describes how that authorisation is actually obtained?

• a.The pharmacist approves it after documenting the need in the profile
• b.The prescriber submits clinical justification to the plan✓
• c.The patient telephones the plan and requests the authorisation
• d.The pharmacy forwards the patient's chart notes to the plan

Prior authorisation is a coverage decision the plan makes on the prescriber's clinical evidence, so the prescriber's office is the only party that can complete it; a technician may start the paperwork, notify the office and track the outcome. The patient's call is the closest wrong answer, because members can and do reach the plan's help desk, but the plan still turns to the prescriber for the clinical information before approving anything. The pharmacy does not hold the chart notes, and no pharmacist has authority over a plan's coverage decisions.

A claim rejects with a message that the patient must first try a preferred agent in the same class before this product will be covered. What is this plan requirement called?

• a.A prior authorisation requirement
• b.Therapeutic interchange by the pharmacy
• c.A step-therapy requirement✓
• d.A quantity limit

Step therapy makes coverage of the requested product conditional on a documented trial of the plan's preferred agent first. Prior authorisation is the closest wrong answer, and the two are often worked through the same help desk, but a prior authorisation asks for clinical justification of this drug while step therapy asks for evidence that a cheaper one was tried and failed. A quantity limit caps how much may be dispensed in a period, and therapeutic interchange is a substitution made under a protocol inside a health system rather than a claim reject.

Which piece of information belongs on the label of a prescription dispensed to a patient but is not required on the manufacturer's stock bottle it was counted from?

• a.The patient's name and the directions for use✓
• b.The product's National Drug Code in 11-digit format
• c.The name and address of the drug's manufacturer
• d.The lot number the manufacturer assigned to the production run

A dispensing label is a patient-specific document: it names the patient and carries the directions the prescriber wrote, and neither can appear on a manufacturer's bulk container that has no patient attached to it. The lot number is the closest wrong answer, because pharmacies do record lot numbers for repackaged products and immunizations, but the manufacturer must print it on the stock bottle while a retail dispensing label is not required to show it. The National Drug Code and the manufacturer's name and address are elements of the manufacturer's own labelling.