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.