52 Medications & Pharmacology Practice Questions & Answers

1. 1. A refill request comes in for Synthroid. Which generic ingredient should the technician pull from the shelf?

   • A.Methimazole tablets
   • B.Levothyroxine sodium✓ Answer
   • C.Liothyronine sodium
   • D.Propylthiouracil tablets

   Synthroid is the brand name for levothyroxine sodium, a synthetic T4 thyroid hormone given to replace hormone in hypothyroidism. Liothyronine is synthetic T3, while methimazole and propylthiouracil do the opposite job — they suppress an overactive thyroid.

   Ref QB-9THF4MSource: FDA-approved labeling, Synthroid (levothyroxine sodium); PTCE Content OutlineReport a problem with this question

2. 2. A patient asks which brand-name product corresponds to the metformin tablets on her profile. Which answer is correct?

   • A.Glucotrol, the glipizide brand product
   • B.Januvia, the sitagliptin brand product
   • C.Amaryl, the glimepiride brand tablet product
   • D.Glucophage, the metformin brand product✓ Answer

   Glucophage is the brand name for metformin, a biguanide that lowers hepatic glucose production in type 2 diabetes. Glucotrol (glipizide) and Amaryl (glimepiride) are sulfonylureas that stimulate insulin release, and Januvia (sitagliptin) is a DPP-4 inhibitor — different classes entirely.

   Ref QB-QAZXBJSource: FDA-approved labeling, Glucophage (metformin hydrochloride); PTCE Content OutlineReport a problem with this question

3. 3. A pharmacy stocks omeprazole, pantoprazole, and esomeprazole. The shared '-prazole' stem tells the technician these agents belong to which class?

   • A.Proton pump inhibitors, which block gastric acid secretion✓ Answer
   • B.Antacids, which chemically neutralize acid already present
   • C.Prokinetic agents, which speed gastric emptying and transit
   • D.Histamine-2 blockers, which act on parietal cell receptors

   The '-prazole' stem is reserved for proton pump inhibitors, which irreversibly inhibit the H+/K+-ATPase pump on the gastric parietal cell and so shut down acid production at its source. H2 blockers carry the '-tidine' stem instead, and antacids neutralize acid that has already been secreted rather than preventing its release.

   Ref QB-8T65XJSource: FDA proton pump inhibitor class labeling; PTCE Content OutlineReport a problem with this question

4. 4. Metoprolol and atenolol carry the '-olol' stem, and carvedilol the related '-ilol' stem. Which statement about this class is accurate?

   • A.They are beta-blockers and may worsen bronchospasm in asthma patients✓ Answer
   • B.They are alpha-1 blockers and are used mainly for prostate symptoms
   • C.They are calcium channel blockers and commonly cause ankle edema
   • D.They are ARBs and are chosen when a cough develops on another agent

   The '-olol' stem (and the related '-ilol' and '-alol' stems) marks beta-adrenergic blocking agents. Because beta-2 receptors in the airways also mediate bronchodilation, non-selective and high-dose beta-blockers can provoke bronchoconstriction, which is why an asthma history on the profile is a recognized drug–disease concern to flag for the pharmacist. Alpha-1 blockers end in '-osin' (tamsulosin, doxazosin), calcium channel blockers in '-dipine' (amlodipine), and ARBs in '-sartan' (losartan), so none of those classes fits these drugs.

   Ref QB-PANM6HSource: FDA beta-blocker class labeling (metoprolol, atenolol, carvedilol); PTCE Content OutlineReport a problem with this question

5. 5. A patient profile lists losartan (Cozaar). The '-sartan' stem places this drug in which class, and what does it treat?

   • A.Angiotensin-converting enzyme inhibitor used for hyperlipidemia
   • B.Dihydropyridine calcium channel blocker used to prevent migraine
   • C.Loop diuretic used to relieve edema in heart failure patients
   • D.Angiotensin II receptor blocker used to treat hypertension✓ Answer

   Drugs ending in '-sartan' are angiotensin II receptor blockers; they occupy the AT1 receptor so angiotensin II cannot cause vasoconstriction, lowering blood pressure. ACE inhibitors ('-pril') act one step earlier in the same pathway and treat the same condition, which is why the two are a classic therapeutic-duplication pair rather than a lipid or migraine therapy.

   Ref QB-7TTSRHSource: FDA-approved labeling, Cozaar (losartan potassium); PTCE Content OutlineReport a problem with this question

6. 6. Lorazepam, diazepam, and clonazepam share the '-azepam' stem. Which class do they belong to?

   • A.Antipsychotics, agents that block central dopamine receptors
   • B.Barbiturates, older sedatives identified by the '-barbital' ending
   • C.Benzodiazepines, sedative agents that enhance GABA activity✓ Answer
   • D.Muscle relaxants, agents that act at the neuromuscular junction

   The '-azepam' and '-azolam' stems identify benzodiazepines, which bind an allosteric site on the GABA-A receptor and increase chloride conductance, producing sedation, anxiolysis, and muscle relaxation. Barbiturates are a separate older class recognized by the '-barbital' ending.

   Ref QB-NAAAZFSource: FDA benzodiazepine class labeling (boxed warning, 2020); PTCE Content OutlineReport a problem with this question

7. 7. A patient having an acute gout flare asks whether the allopurinol on his profile will stop the attack. What is allopurinol's role?

   • A.It dissolves existing joint crystals within hours of a dose
   • B.It relieves an acute flare by blocking prostaglandin production
   • C.It works as a rescue analgesic taken only when a joint hurts
   • D.It lowers uric acid production to prevent future flares✓ Answer

   Allopurinol is a xanthine oxidase inhibitor taken daily to reduce uric acid formation, so it is prophylactic maintenance therapy for chronic gout. It has no analgesic or anti-inflammatory action and can even precipitate a flare when first started, so acute attacks are managed with other agents chosen by the prescriber.

   Ref QB-6TFFKGSource: FDA-approved labeling, allopurinol (Zyloprim) — not effective in acute gouty attacks; PTCE Content OutlineReport a problem with this question

8. 8. A patient with asthma has both an albuterol HFA inhaler and a fluticasone/salmeterol inhaler. Which product is used first when sudden wheezing starts?

   • A.The fluticasone/salmeterol inhaler, taken as two extra maintenance puffs
   • B.The albuterol inhaler, because a short-acting beta-2 agonist works quickly✓ Answer
   • C.Either inhaler, since both relieve bronchospasm within a few minutes
   • D.The fluticasone/salmeterol inhaler, because it opens airways fastest

   Albuterol is a short-acting beta-2 agonist and is the rescue inhaler: it relaxes bronchial smooth muscle within minutes. Fluticasone/salmeterol is a controller combining an inhaled corticosteroid with a long-acting beta-2 agonist, and its labeling states it is not for relieving acute symptoms, so substituting it in an attack delays effective treatment.

   Ref QB-VASM7RSource: FDA-approved labeling, albuterol HFA and Advair (fluticasone/salmeterol) — not for acute symptoms; PTCE Content OutlineReport a problem with this question

9. 9. Two weeks after starting lisinopril, a patient reports a persistent dry, tickling cough with no fever. This cough is most consistent with which explanation?

   • A.A known class effect of ACE inhibitors related to bradykinin✓ Answer
   • B.A common side effect of statins caused by muscle inflammation
   • C.An expected effect of beta-blockers due to airway constriction
   • D.A typical reaction to diuretics caused by fluid in the lungs

   ACE inhibitors block the enzyme that degrades bradykinin, so bradykinin accumulates in the airway and provokes a dry, non-productive cough in a minority of patients, usually within weeks of starting. It is a class effect, not an infection, and the technician documents the complaint and refers the patient to the pharmacist.

   Ref QB-DTXSSRSource: FDA ACE inhibitor class labeling (lisinopril) — persistent nonproductive cough; PTCE Content OutlineReport a problem with this question

10. 10. A patient taking atorvastatin reports new, unexplained aching and weakness in both thighs. Which adverse effect does this most suggest?

    • A.Hypokalemia from a loop diuretic, which causes cramping and weakness
    • B.Tendon inflammation, a labeled warning for fluoroquinolone antibiotics
    • C.Statin-associated myopathy, which can progress to rhabdomyolysis✓ Answer
    • D.Peripheral neuropathy, a known effect of long-term metformin use

    Statin labeling warns of myopathy presenting as unexplained muscle pain, tenderness, or weakness, which can advance to rhabdomyolysis with myoglobin release and kidney injury. Because that progression is potentially serious, the report is documented and sent to the pharmacist rather than dismissed as ordinary soreness.

    Ref QB-5937BMSource: FDA statin class labeling — myopathy and rhabdomyolysis warning; PTCE Content OutlineReport a problem with this question

11. 11. A patient is picking up a fluticasone inhaler used twice daily for asthma control. Which counseling point belongs on the label?

    • A.Rinse the mouth with water after each dose✓ Answer
    • B.Take the dose with a full glass of water and remain upright
    • C.Hold the breath for a full minute after each inhaled dose
    • D.Shake well and use only when sudden shortness of breath occurs

    Inhaled corticosteroid deposited in the mouth and throat suppresses local immunity and allows Candida to overgrow, producing oropharyngeal thrush and hoarseness. Rinsing and spitting after each dose removes that residue, and a valved spacer further reduces oropharyngeal deposition.

    Ref QB-MRVZQKSource: FDA-approved labeling, fluticasone propionate inhalation (rinse mouth after use); PTCE Content OutlineReport a problem with this question

12. 12. A patient stabilized on warfarin says she is starting a diet with large daily servings of kale and spinach. What is the concern?

    • A.Vitamin K in those greens opposes warfarin, so intake should stay consistent✓ Answer
    • B.Fiber in those greens binds warfarin, so doses must be taken at night
    • C.Vitamin C in those greens raises warfarin levels and the bleeding risk
    • D.Iron in those greens chelates warfarin and blocks its absorption fully

    Warfarin works by interfering with vitamin K–dependent clotting factor synthesis, so a sudden increase in dietary vitamin K from leafy greens counteracts the drug and lowers the INR. Patients are not told to avoid greens entirely; they are told to keep intake steady from week to week so the dose stays matched to the diet.

    Ref QB-69EHGNSource: FDA-approved labeling, warfarin sodium (Coumadin) — vitamin K intake consistency; PTCE Content OutlineReport a problem with this question

13. 13. A doxycycline prescription is filled for a patient who also takes calcium carbonate antacids and a ferrous sulfate tablet. Which counseling point applies?

    • A.Take all three products together so the stomach is protected from irritation
    • B.Stop the antacid and the iron until the antibiotic course is finished
    • C.Take the doxycycline with milk to prevent nausea from the antibiotic
    • D.Separate the doxycycline from the calcium and iron by several hours✓ Answer

    Tetracyclines and fluoroquinolones form insoluble chelates with di- and trivalent cations such as calcium, iron, magnesium, and aluminum, which sharply reduces antibiotic absorption and can cause treatment failure. Spacing the doses by several hours preserves absorption without forcing the patient to abandon either therapy.

    Ref QB-NR8CWMSource: FDA-approved labeling, doxycycline — absorption impaired by antacids and iron; PTCE Content OutlineReport a problem with this question

14. 14. A patient who uses sublingual nitroglycerin for angina has a new sildenafil prescription on his profile. Why is this pairing flagged?

    • A.The combination triggers a rapid rise in blood pressure and headache
    • B.The combination reduces how much nitroglycerin is absorbed under the tongue
    • C.The combination increases the risk of bleeding from the stomach lining
    • D.The combination can cause a life-threatening drop in blood pressure✓ Answer

    Nitrates and PDE-5 inhibitors both raise cyclic GMP in vascular smooth muscle, and together they produce additive vasodilation that can cause profound, refractory hypotension. Sildenafil labeling therefore lists organic nitrates in any form as a contraindication, so the profile must go to the pharmacist before dispensing.

    Ref QB-39CHYHSource: FDA-approved labeling, Viagra (sildenafil) — contraindicated with organic nitrates; PTCE Content OutlineReport a problem with this question

15. 15. A profile shows prescription naproxen taken twice daily, and the patient is buying a bottle of ibuprofen 200 mg for a headache. What issue does this raise?

    • A.No issue arises, because one is a prescription and one is over the counter
    • B.A therapeutic duplication arises, since both are NSAIDs and raise bleed risk✓ Answer
    • C.No issue arises, because the two agents act on different pain pathways
    • D.An interaction arises, because ibuprofen makes naproxen far less effective

    Ibuprofen and naproxen are both non-selective NSAIDs, so taking them together is same-class therapeutic duplication that multiplies cyclooxygenase inhibition without adding analgesia. NSAID labeling carries a boxed warning for gastrointestinal bleeding and ulceration, so the technician flags the overlap for the pharmacist before the sale.

    Ref QB-JR6CDHSource: FDA NSAID class labeling — boxed warning for GI bleeding; PTCE Content OutlineReport a problem with this question

16. 16. A patient's allergy field records anaphylaxis to amoxicillin, and a new cefuroxime prescription is entered. What should the technician do?

    • A.Cancel the prescription and tell the patient to call the prescriber back
    • B.Flag the profile for the pharmacist, as cephalosporins may cross-react✓ Answer
    • C.Process the prescription, since cephalosporins never cross-react at all
    • D.Change the drug to azithromycin, which is the standard substitute here

    Cephalosporins share a beta-lactam ring with penicillins, and their labeling directs caution because cross-sensitivity reactions occur, particularly where the side chains are similar. Judging whether a documented anaphylaxis permits a cephalosporin is a clinical decision, so the technician documents the allergy and routes the order to the pharmacist rather than changing or cancelling the drug.

    Ref QB-49QU5KSource: FDA cephalosporin class labeling — penicillin cross-sensitivity precaution; PTCE Content OutlineReport a problem with this question

17. 17. A caregiver asks whether metoprolol succinate ER tablets may be crushed into applesauce for easier swallowing. What is the correct response?

    • A.Crushing is unsafe: it breaks the release mechanism and dumps the dose✓ Answer
    • B.Crushing is allowed only for the evening dose of a twice-daily regimen
    • C.Crushing is fine if the whole dose is swallowed within a few minutes
    • D.Crushing is fine, because the coating only masks an unpleasant taste

    Modified-release designations such as ER, XR, XL, SR, CR, DR, and LA, as well as enteric coatings, depend on an intact matrix or film to meter the drug out over hours or to protect it from stomach acid. Crushing or chewing defeats that control and releases a full day's dose at once, risking toxicity, so the pharmacist must be asked for a suitable alternative dosage form.

    Ref QB-KRHPJJSource: FDA-approved labeling, Toprol-XL (metoprolol succinate extended-release); PTCE Content OutlineReport a problem with this question

18. 18. A prescription reads 'ciprofloxacin otic suspension, 4 gtt in the left ear twice daily.' The patient asks about using the same bottle in the eye. Which statement is correct?

    • A.An otic drop may be placed in the eye when the drug name matches
    • B.An otic drop never goes in the eye, though an eye drop may go in the ear✓ Answer
    • C.An otic drop and an eye drop are interchangeable at the same strength
    • D.An otic drop may be placed in the eye after dilution with sterile saline

    Ophthalmic products must be manufactured sterile and buffered to tolerate ocular tissue, so they meet a higher standard than otic products and can be used in the ear when a prescriber directs it. Otic preparations are not required to meet that ophthalmic standard, and placing one in the eye risks irritation and infection, which makes this a well-known route error to catch at data entry.

    Ref QB-99GHZRSource: FDA labeling for ophthalmic versus otic preparations (sterility requirements); PTCE Content OutlineReport a problem with this question

19. 19. A shipment label instructs 'Store in a refrigerator.' Under the USP storage definitions, which temperature range does that specify?

    • A.20 to 25 °C (68 to 77 °F), described as controlled room temperature
    • B.−25 to −10 °C (−13 to 14 °F), the range USP defines as a freezer
    • C.8 to 15 °C (46 to 59 °F), the range that USP describes as cool
    • D.2 to 8 °C (36 to 46 °F), the range USP defines for a refrigerator✓ Answer

    USP General Chapter <659> defines a refrigerator as a cold place maintained thermostatically between 2 and 8 °C (36 to 46 °F). Storing a refrigerated product warmer risks loss of potency, while letting it freeze can denature proteins such as insulin or vaccine antigens, so the monitored refrigerator range protects stability in both directions.

    Ref QB-RRACERSource: USP General Chapter <659> Packaging and Storage Requirements (storage temperature definitions)Report a problem with this question

20. 20. A patient wants her sublingual nitroglycerin tablets moved into a weekly plastic pill organizer with cotton added. What should she be told?

    • A.Keep the tablets in the refrigerator inside a clear plastic vial
    • B.Keep the tablets in the original glass container without cotton✓ Answer
    • C.Keep the tablets in the organizer as long as it closes tightly
    • D.Keep the tablets in the organizer, but change the cotton every week

    Sublingual nitroglycerin is volatile and sensitive to light, moisture, and air, so its labeling requires the original amber glass container with the cap tightly closed and no cotton, paper, or other drug stored with it. Cotton absorbs the active drug and plastic organizers let it escape, both of which can leave a patient with tablets that no longer relieve angina.

    Ref QB-ESYAHASource: FDA-approved labeling, Nitrostat (nitroglycerin sublingual tablets) — storage in original container; PTCE Content OutlineReport a problem with this question

21. 21. A technician reconstitutes an amoxicillin oral suspension whose package insert states the mixed product is stable for 14 days when refrigerated. What must be done at that point?

    • A.Keep the manufacturer's printed expiration date and store at room temperature
    • B.Label the bottle with a 14-day discard date and direct the patient to refrigerate it✓ Answer
    • C.Write a discard date of 28 days, the standard for all reconstituted antibiotics
    • D.Write a discard date one year ahead, matching the dry powder's dating

    Once water is added, the antibiotic begins to hydrolyze and the long expiration date printed for the dry powder no longer applies. The discard date comes from the manufacturer's package insert for the reconstituted product and is written on the bottle at the time of mixing, together with the storage condition the insert specifies — here refrigeration for the stated 14 days.

    Ref QB-X96G4BSource: FDA-approved labeling, amoxicillin for oral suspension (storage after reconstitution); PTCE Content OutlineReport a problem with this question

22. 22. A shelf label is printed as 'hydrOXYzine' beside 'hydrALAZINE.' Why are parts of these names capitalized?

    • A.The capitals mark the drugs that require refrigeration on that shelf
    • B.The capitals flag drugs that must be dispensed in unit-dose packaging
    • C.The capitals highlight the letters that differ in a look-alike pair✓ Answer
    • D.The capitals identify products that are stocked behind the counter

    This is Tall Man lettering, an error-prevention technique that capitalizes the dissimilar portion of two look-alike or sound-alike names so the eye is forced to the part that differs. Hydroxyzine is an antihistamine and hydralazine is a vasodilator, so the visual break, together with separated shelf placement and barcode scanning, guards against a wrong-drug selection.

    Ref QB-FSBNPBSource: ISMP List of Confused Drug Names with Tall Man Letters; PTCE Content OutlineReport a problem with this question

23. 23. Which USAN suffix identifies an angiotensin II receptor blocker (ARB) such as losartan or valsartan?

    • A.-pril
    • B.-sartan✓ Answer
    • C.-olol
    • D.-dipine

    The USAN stem '-sartan' marks angiotensin II receptor blockers, which lower blood pressure by blocking angiotensin II at its receptor rather than blocking its formation. '-olol' marks beta-blockers, '-dipine' marks dihydropyridine calcium channel blockers, and '-pril' marks ACE inhibitors.

    Ref QB-Y9HT9CSource: USAN stem list (-sartan = angiotensin II receptor antagonists); PTCE 2026 Content Outline, Knowledge Area 1.1Report a problem with this question

24. 24. A prescription written for Eliquis is filled with the generic product. Which drug name should appear on the label?

    • A.dabigatran
    • B.edoxaban
    • C.rivaroxaban
    • D.apixaban✓ Answer

    Eliquis is the brand name for apixaban, a direct factor Xa inhibitor anticoagulant. The distractors are other oral anticoagulants with their own brands: edoxaban is Savaysa, dabigatran is Pradaxa, and rivaroxaban is Xarelto, so matching the exact brand-generic pair is the tested skill.

    Ref QB-CS9N68Source: FDA Orange Book / Eliquis (apixaban) FDA label; PTCE 2026 Content Outline, Knowledge Area 1.1Report a problem with this question

25. 25. Which generic medication corresponds to the brand name Zoloft?

    • A.escitalopram
    • B.sertraline✓ Answer
    • C.fluoxetine
    • D.duloxetine

    Zoloft is the brand name for sertraline, an SSRI antidepressant. The distractors belong to other brands in the same therapeutic space: escitalopram is Lexapro, fluoxetine is Prozac, and duloxetine is the SNRI Cymbalta, which is why they are commonly confused.

    Ref QB-V9FTR8Source: FDA label: Zoloft (sertraline hydrochloride); PTCE 2026 Content Outline, Knowledge Area 1.1Report a problem with this question

26. 26. Amlodipine, nifedipine, and felodipine all share the '-dipine' stem. To which drug class do they belong?

    • A.Beta-adrenergic blocker
    • B.Thiazide-type diuretic
    • C.Calcium channel blocker✓ Answer
    • D.Alpha-adrenergic blocker

    The '-dipine' stem marks dihydropyridine calcium channel blockers, which relax vascular smooth muscle by blocking calcium entry into cells, lowering blood pressure. Beta-blockers end in '-olol', alpha-blockers for blood pressure include '-zosin' drugs, and thiazides are a chemically distinct diuretic class.

    Ref QB-DSMYB9Source: USAN stem list (-dipine = dihydropyridine calcium channel blockers); PTCE 2026 Content Outline, Knowledge Area 1.1Report a problem with this question

27. 27. Which diabetes medication is an SGLT2 inhibitor that lowers blood glucose by increasing glucose excretion in the urine?

    • A.sitagliptin
    • B.empagliflozin✓ Answer
    • C.glimepiride
    • D.semaglutide

    The '-gliflozin' stem marks SGLT2 inhibitors like empagliflozin (Jardiance), which block glucose reabsorption in the kidney so excess glucose leaves in the urine. Sitagliptin ('-gliptin') is a DPP-4 inhibitor, semaglutide ('-tide') is a GLP-1 receptor agonist, and glimepiride is a sulfonylurea.

    Ref QB-W9T5X9Source: USAN stem -gliflozin; FDA label: Jardiance (empagliflozin); PTCE 2026 Content Outline, Knowledge Area 1.1Report a problem with this question

28. 28. While reviewing a patient's profile and purchases, which combination should the technician flag to the pharmacist as a therapeutic duplication?

    • A.Metformin and sitagliptin tablets
    • B.Hydrocodone/APAP and OTC Tylenol✓ Answer
    • C.Lisinopril and hydrochlorothiazide
    • D.Albuterol and fluticasone inhalers

    Hydrocodone/APAP already contains acetaminophen, so adding OTC Tylenol duplicates the same ingredient and can push the patient past the safe daily acetaminophen limit, risking liver injury. The other pairs combine drugs with different mechanisms that are commonly and intentionally prescribed together.

    Ref QB-ASJYT5Source: FDA acetaminophen safety labeling (hidden duplication, daily maximum); PTCE 2026 Content Outline, Knowledge Area 1.2Report a problem with this question

29. 29. One patient's profile lists active prescriptions for both Coumadin and warfarin tablets. What is the issue the technician should surface?

    • A.It is a drug-drug interaction risk
    • B.It is duplicate therapy of the same drug✓ Answer
    • C.It is a brand-generic strength mismatch
    • D.It is an insurance billing conflict only

    Coumadin is the brand name of warfarin, and an A-rated generic is bioequivalent to its brand, so the two entries are the same therapy dispensed twice — a duplication that could double the anticoagulant dose and cause serious bleeding. They are not two different interacting drugs, and the problem is clinical, not merely billing.

    Ref QB-T9R5E6Source: FDA Orange Book: A-rated therapeutic equivalence (brand + generic = same therapy); PTCE 2026 Content Outline, Knowledge Area 1.2Report a problem with this question

30. 30. A patient stabilized on warfarin drops off a new prescription for metronidazole. What effect of the combination should be flagged for the pharmacist?

    • A.A lowered INR with risk of clotting
    • B.A disulfiram-like flushing reaction
    • C.A raised INR with risk of bleeding✓ Answer
    • D.Reduced absorption of the antibiotic

    Metronidazole inhibits CYP2C9, the enzyme that clears warfarin, so warfarin levels and the INR rise and bleeding risk increases — pharmacists typically arrange closer INR monitoring or a dose change. The disulfiram-like reaction is a real metronidazole warning, but it involves alcohol, not warfarin.

    Ref QB-HUYF2ESource: FDA Coumadin (warfarin) label, Drug Interactions (CYP2C9 inhibitors incl. metronidazole raise INR); PTCE 2026 Content Outline, Knowledge Area 1.3Report a problem with this question

31. 31. Prescriptions for oxycodone and alprazolam arrive for the same patient. Which life-threatening risk carries an FDA boxed warning for this combination?

    • A.Serotonin syndrome with high fever
    • B.Hypertensive crisis with headache
    • C.Deep sedation and slowed breathing✓ Answer
    • D.Rhabdomyolysis with kidney damage

    Opioids and benzodiazepines both depress the central nervous system, and taken together they can cause profound sedation, respiratory depression, coma, and death — the reason the FDA added a boxed warning to both classes in 2016. Serotonin syndrome involves serotonergic drugs, hypertensive crisis involves MAOIs, and rhabdomyolysis is a statin-interaction concern.

    Ref QB-ZBTAFDSource: FDA Drug Safety Communication (2016) boxed warning: opioids + benzodiazepines; PTCE 2026 Content Outline, Knowledge Area 1.3Report a problem with this question

32. 32. A patient taking doxycycline buys calcium carbonate antacids. What happens if the two are taken at the same time?

    • A.The pairing can cause tendon rupture
    • B.They are safe when taken with dairy milk
    • C.The antacid raises doxycycline levels
    • D.Calcium binds the drug, blocking uptake✓ Answer

    Tetracyclines like doxycycline chelate with multivalent cations — calcium, magnesium, aluminum, iron — forming complexes the gut cannot absorb, so antibiotic levels drop and the infection may not be treated; doses should be separated by several hours. Dairy contains calcium and causes the same problem, and tendon rupture is a fluoroquinolone warning, not a tetracycline one.

    Ref QB-GUM5VCSource: FDA doxycycline label, Drug Interactions (chelation with antacids/divalent cations); PTCE 2026 Content Outline, Knowledge Area 1.3Report a problem with this question

33. 33. A patient using oral contraceptives wants to start the supplement St. John's Wort. Why must the pharmacist be alerted?

    • A.It adds estrogen-like activity of its own
    • B.It binds the hormones in the intestine
    • C.It speeds hormone breakdown, cutting efficacy✓ Answer
    • D.It slows hormone breakdown, causing toxicity

    St. John's Wort induces CYP3A4, the enzyme that metabolizes contraceptive hormones, so hormone levels fall and breakthrough bleeding or unintended pregnancy can result. The same induction mechanism reduces levels of many other drugs, including warfarin — the opposite of the inhibition-and-toxicity pattern in the distractor.

    Ref QB-YBFY9CSource: NIH/FDA guidance: St. John's Wort CYP3A4 induction reduces oral contraceptive levels; PTCE 2026 Content Outline, Knowledge Area 1.3Report a problem with this question

34. 34. Which administration instruction is correct for once-weekly alendronate (Fosamax)?

    • A.Take with milk to protect the stomach lining
    • B.Take at breakfast, then lie down 30 minutes
    • C.Take at bedtime with a snack to avoid nausea
    • D.Take with water and stay upright 30 minutes✓ Answer

    Alendronate must be taken first thing in the morning on an empty stomach with a full glass of plain water, and the patient must stay upright for at least 30 minutes, because the tablet can severely irritate the esophagus if it lingers there. Food, milk, and other beverages drastically reduce its already-low absorption, and lying down raises the esophagitis risk.

    Ref QB-FU9TPBSource: FDA Fosamax (alendronate) label, Dosage and Administration; PTCE 2026 Content Outline, Knowledge Area 1.4Report a problem with this question

35. 35. Why is a patient told to rinse the mouth with water after each dose from a fluticasone inhaler?

    • A.To prevent oral candidiasis (thrush)✓ Answer
    • B.To improve the drug's lung absorption
    • C.To keep the inhaler valve from clogging
    • D.To prevent staining of tooth enamel

    Inhaled corticosteroids that deposit in the mouth and throat suppress local immunity and let Candida overgrow, causing oral thrush; rinsing and spitting after each use washes away the residue before it can act. Rinsing has nothing to do with lung absorption, tooth staining, or device maintenance.

    Ref QB-XB4N4BSource: FDA Flovent (fluticasone propionate) label: rinse mouth after use to reduce oropharyngeal candidiasis; PTCE 2026 Content Outline, Knowledge Area 1.4Report a problem with this question

36. 36. A child weighing 22 kg is prescribed cephalexin 25 mg/kg/day divided every 12 hours. How many milligrams are in each dose?

    • A.1,100 mg
    • B.275 mg✓ Answer
    • C.550 mg
    • D.137.5 mg

    The daily amount is 25 mg/kg x 22 kg = 550 mg per day; dosing every 12 hours means 2 doses per day, so 550 mg / 2 = 275 mg per dose. Choosing 550 mg forgets to divide the daily total, and 137.5 mg divides by 4 as if dosing were every 6 hours.

    Ref QB-EUWFHASource: Weight-based dose calculation (mg/kg/day divided by doses per day); PTCE 2026 Content Outline, Knowledge Area 1.4 (calculation-flagged)Report a problem with this question

37. 37. Which opioid side effect persists for the whole course of therapy because tolerance to it does not develop?

    • A.Constipation✓ Answer
    • B.Sleepiness
    • C.Mild nausea
    • D.Mild itching

    Opioids slow gut motility through receptors in the intestine, and unlike sedation, nausea, and itching — which usually fade as the body adapts — no tolerance develops to this effect, so constipation continues as long as the opioid is taken and often needs a scheduled laxative. That is why opioid-induced constipation is managed proactively rather than waited out.

    Ref QB-WBRAX9Source: Opioid class labeling: opioid-induced constipation persists (no tolerance develops); PTCE 2026 Content Outline, Knowledge Area 1.5Report a problem with this question

38. 38. Which precaution belongs in the counseling notes for a patient starting doxycycline?

    • A.Lie down right after taking each dose
    • B.Use sun protection while on this drug✓ Answer
    • C.Avoid exercise to prevent tendon injury
    • D.Avoid leafy green vegetables entirely

    Tetracyclines cause photosensitivity: the drug makes skin react to UV light, so exaggerated sunburn can occur after brief exposure, and patients should use sunscreen and protective clothing. Leafy greens matter for warfarin, tendon injury is a fluoroquinolone warning, and lying down after a dose is exactly wrong — doxycycline can cause esophageal irritation if taken right before reclining.

    Ref QB-DUJ5C9Source: FDA doxycycline label: photosensitivity warning; PTCE 2026 Content Outline, Knowledge Area 1.5Report a problem with this question

39. 39. At drop-off, a patient mentions they broke out in hives the last time they took cephalexin. What should the technician do?

    • A.Record the allergy and alert the pharmacist✓ Answer
    • B.Suggest an antihistamine before each dose
    • C.Reassure them hives are a minor side effect
    • D.Refuse to fill any beta-lactam prescription

    Hives suggest a true allergic reaction, so the technician's role is to document the new allergy in the patient record and route it to the pharmacist, who alone can assess the reaction and decide how to proceed. Reassuring the patient or recommending an antihistamine is counseling outside the technician's scope, and the fill/no-fill decision belongs to the pharmacist, not the technician.

    Ref QB-VBDYR8Source: PTCB technician scope of practice: allergy/reaction reports must be routed to the pharmacist; PTCE 2026 Content Outline, Knowledge Area 1.5Report a problem with this question

40. 40. Tamsulosin (Flomax) is most commonly dispensed to treat which condition?

    • A.High blood pressure
    • B.Erectile dysfunction
    • C.An enlarged prostate✓ Answer
    • D.An overactive bladder

    Tamsulosin is an alpha-1A blocker selective for receptors in the prostate and bladder neck, relaxing that smooth muscle to relieve the urinary symptoms of benign prostatic hyperplasia (BPH). Its selectivity means it has little effect on blood pressure, which distinguishes it from older alpha-blockers like doxazosin that also treat hypertension.

    Ref QB-6K9MFNSource: FDA Flomax (tamsulosin) label: indication = benign prostatic hyperplasia; PTCE 2026 Content Outline, Knowledge Area 1.6Report a problem with this question

41. 41. Allopurinol is taken every day on a long-term basis for which purpose?

    • A.Rebuilding lost bone in osteoporosis
    • B.Preventing gout by lowering uric acid✓ Answer
    • C.Treating rheumatoid joint inflammation
    • D.Relieving pain during an acute gout attack

    Allopurinol inhibits xanthine oxidase, the enzyme that produces uric acid, so taken daily it lowers urate levels and prevents the crystal formation that triggers gout flares. It does not relieve the pain of an attack already underway — starting or adjusting it during a flare can even worsen the flare — which is the classic misconception the acute-attack pain-relief option tests.

    Ref QB-P3FS2PSource: FDA Zyloprim (allopurinol) label: xanthine oxidase inhibitor for gout management/prophylaxis, not acute attacks; PTCE 2026 Content Outline, Knowledge Area 1.6Report a problem with this question

42. 42. Under USP standards, once a multi-dose vial of an injectable is first punctured, what beyond-use date normally applies?

    • A.28 days✓ Answer
    • B.14 days
    • C.6 months
    • D.24 hours

    USP assigns multi-dose vials a 28-day beyond-use date after first puncture unless the manufacturer's labeling specifies otherwise, because the preservative in a multi-dose vial can only suppress microbial growth for a limited time once the seal is broken. Single-dose vials, by contrast, contain no preservative and are discarded after one use.

    Ref QB-5KW9AMSource: USP General Chapter <797>: multi-dose vial BUD = 28 days after first puncture unless labeled otherwise; PTCE 2026 Content Outline, Knowledge Area 1.7Report a problem with this question

43. 43. How does a beyond-use date (BUD) differ from the manufacturer's expiration date printed on the package?

    • A.A BUD is assigned by the drug wholesaler
    • B.A BUD is always longer than the expiration
    • C.A BUD applies only to controlled substances
    • D.A BUD starts when a product is opened or mixed✓ Answer

    The expiration date is set by the manufacturer for the unopened product under labeled storage, while the beyond-use date is assigned by the pharmacy once a product is opened, reconstituted, repackaged, or compounded — and it is almost always shorter, never longer, than the remaining expiration dating, because stability and sterility degrade after the original container is breached.

    Ref QB-N34FVMSource: USP General Chapters <795>/<797>: beyond-use date definition vs manufacturer expiration date; PTCE 2026 Content Outline, Knowledge Area 1.7Report a problem with this question

44. 44. Per USP, 'refrigerated' storage for products such as unopened insulin means which temperature range?

    • A.8°C to 15°C (46°F to 59°F)
    • B.20°C to 25°C (68°F to 77°F)
    • C.-25°C to -10°C (-13°F to 14°F)
    • D.2°C to 8°C (36°F to 46°F)✓ Answer

    USP defines refrigerated (cold) storage as 2°C to 8°C (36°F to 46°F), the range required for unopened insulin, most vaccines, and many reconstituted suspensions. The distractors are the other USP definitions: -25°C to -10°C is frozen, 8°C to 15°C is cool, and 20°C to 25°C is controlled room temperature.

    Ref QB-4KJX4KSource: USP General Chapter <659> Packaging and Storage Requirements: cold/refrigerated = 2-8°C (36-46°F); PTCE 2026 Content Outline, Knowledge Area 1.8Report a problem with this question

45. 45. Under federal requirements, how must Schedule II medications be stored in a pharmacy?

    • A.Only in a refrigerated locked container
    • B.In a locked cabinet or dispersed in stock✓ Answer
    • C.On an open shelf sorted alphabetically
    • D.In a separate room with video monitoring

    Federal regulation gives pharmacies two options for Schedule II controls: keep them in a securely locked, substantially constructed cabinet, or disperse them throughout the noncontrolled stock so they cannot be located and stolen quickly. Neither refrigeration, cameras, nor a separate room is a federal storage requirement, and open alphabetical shelving provides none of the required security.

    Ref QB-M3R4QKSource: 21 CFR 1301.75(b): controlled substances in a securely locked cabinet or dispersed through noncontrolled stock; PTCE 2026 Content Outline, Knowledge Area 1.8Report a problem with this question

46. 46. A patient buying a high-dose biotin supplement (10 mg daily) mentions she has a thyroid blood test next week. Why should the technician alert the pharmacist?

    • A.Biotin can cause real thyroid gland damage
    • B.Biotin can raise liver enzymes on the test
    • C.Biotin can falsely skew immunoassay results✓ Answer
    • D.Biotin can raise the patient's serum potassium

    Many laboratory immunoassays use biotin-streptavidin binding, so high blood biotin levels from supplements interfere with the assay itself and can give falsely high or falsely low results. The FDA safety communication cites falsely low troponin, and thyroid tests (TSH, free T4) are also affected, which can lead to a wrong diagnosis. This is a drug-dietary supplement and drug-laboratory interaction. The technician recognizes it and refers it to the pharmacist, who advises the patient to tell the prescriber and lab about the biotin. Biotin does not damage the thyroid, raise potassium, or raise liver enzymes; the problem is test interference, not a real change in the body.

    Ref QB-3K7MXHSource: FDA Safety Communication: Biotin (Vitamin B7) Interference with Lab Tests (Nov 2017, updated Nov 2019); PTCE Content Outline 1.3 (drug-dietary supplement, drug-laboratory interactions)Report a problem with this question

47. 47. A patient taking metformin is scheduled for a CT scan with iodinated contrast. Which lab value does the care team check to decide whether metformin must be held around the scan?

    • A.Kidney function (eGFR)✓ Answer
    • B.Glucose control (A1c)
    • C.Liver enzymes (ALT)
    • D.Serum potassium (K+)

    Metformin is eliminated by the kidneys, and iodinated contrast can cause acute kidney injury. If kidney function drops, metformin accumulates and the risk of lactic acidosis rises. FDA-approved metformin labeling therefore says to stop metformin at the time of, or before, an iodinated contrast procedure in patients with an eGFR of 30-60 mL/min/1.73 m2 (and in other risk groups), recheck eGFR 48 hours afterward, and restart only if kidney function is stable. A1c and potassium do not decide this hold, and although a history of liver disease is one of the label's risk groups, the lab value the decision rests on is eGFR, not ALT. The technician's role is to recognize the flag and refer it to the pharmacist.

    Ref QB-K3DSHJSource: FDA Drug Safety Communication on metformin and kidney function (April 2016); Glucophage (metformin) prescribing information, Dosage and Administration: discontinuation for iodinated contrast imaging procedures; Warnings: lactic acidosisReport a problem with this question

48. 48. A patient whose profile shows lithium carbonate is buying ibuprofen 200 mg to take several times a day for back pain. What concern makes this a pharmacist referral?

    • A.The pair often causes low blood sugar
    • B.NSAIDs can lower lithium blood levels
    • C.NSAIDs can raise lithium blood levels✓ Answer
    • D.Lithium blocks ibuprofen's pain relief

    NSAIDs such as ibuprofen reduce kidney prostaglandin activity, which lowers renal clearance of lithium. Serum lithium concentrations then rise, and because toxic lithium levels are close to therapeutic ones, the patient can develop lithium toxicity (tremor, confusion, vomiting). Lithium labeling therefore warns that NSAIDs require closer monitoring of serum lithium levels. The effect is an increase, not a decrease, and the pair does not block pain relief or cause hypoglycemia. The pharmacist, not the technician, decides on an alternative or on monitoring.

    Ref QB-AKPX5TSource: Lithium carbonate prescribing information, Drug Interactions: NSAIDs decrease renal lithium clearance and increase serum lithium concentrations; PTCE Content Outline 1.3Report a problem with this question

49. 49. A box of varicella vaccine (Varivax) arrives at a pharmacy that gives immunizations. Per the CDC Vaccine Storage and Handling Toolkit, where must it be stored?

    • A.Room temperature, 20 °C to 25 °C
    • B.Refrigerator, between 2 °C and 8 °C
    • C.Freezer, between -50 °C and -15 °C✓ Answer
    • D.Freezer, between -90 °C and -60 °C

    Varicella vaccine is a live, attenuated vaccine that loses potency when it gets warm, so the CDC lists it, along with MMRV, as a frozen vaccine kept in a vaccine freezer between -50 °C and -15 °C (-58 °F to +5 °F). The 2-8 °C refrigerator range is for most other vaccines; the manufacturer allows Varivax in a refrigerator only for a limited time, not as routine storage. The -90 °C to -60 °C ultra-cold range applies to certain other products, and room temperature is for the diluent, not the vaccine powder.

    Ref QB-T3V4RTSource: CDC Vaccine Storage and Handling Toolkit, Frozen Vaccines (varicella, MMRV: -50 °C to -15 °C); Varivax prescribing information, Section 16 How Supplied/Storage and HandlingReport a problem with this question

50. 50. At the start of the workday, the data logger shows the vaccine refrigerator reached 12 °C overnight; it now reads 5 °C. What should the technician do first with the vaccines inside?

    • A.Keep using them since the unit is back in range
    • B.Move them into the freezer to cool them down
    • C.Mark them Do Not Use and keep them at 2-8 °C✓ Answer
    • D.Discard them all as pharmaceutical waste

    An overnight reading of 12 °C is a temperature excursion above the 2-8 °C range. The CDC Toolkit says to label the affected vaccines 'DO NOT USE,' keep them stored under proper conditions, notify the supervisor or vaccine coordinator, and document the event (time, temperatures, duration, lot numbers). Then the manufacturer or immunization program is contacted to decide whether the doses are still viable. Discarding on your own wastes vaccine that may still be usable. Freezing damages refrigerated vaccines. Continuing to use them before a viability decision risks giving patients ineffective doses.

    Ref QB-9N9SYRSource: CDC Vaccine Storage and Handling Toolkit, Temperature Excursions (label 'Do Not Use', store under proper conditions, notify, document, contact manufacturer/immunization program)Report a problem with this question

51. 51. A NovoLog (insulin aspart) vial is first punctured on October 3. Its labeling allows an opened vial to be used for 28 days. Which discard date should be written on the vial?

    • A.October 31✓ Answer
    • B.November 3
    • C.October 17
    • D.November 14

    The in-use period starts on the day the vial is first opened, so the discard date is October 3 + 28 days = October 31 (3 + 28 = 31, and October has 31 days). November 3 comes from adding one calendar month (31 days) instead of 28 days. October 17 uses a 14-day period that applies to some other insulin products. November 14 uses a 42-day period that belongs to a different product. Every insulin has its own in-use period, so the technician marks the open date and applies the number from that product's labeling, not one rule for all insulins.

    Ref QB-R54MDRSource: NovoLog (insulin aspart) prescribing information, Section 16.2 Recommended Storage (opened 10 mL vial: use within 28 days); PTCE Content Outline 1.7 (insulin stability, calculation-based)Report a problem with this question

52. 52. A patient picking up Enbrel (etanercept) prefilled syringes asks how to keep them at home until use. Which instruction matches the product labeling?

    • A.Freeze until needed, then thaw before injecting
    • B.Store in the fridge door, out of the carton
    • C.Refrigerate, and shake well before each injection
    • D.Refrigerate in the carton; do not freeze or shake✓ Answer

    Etanercept is a protein biologic. Freezing or vigorous shaking can denature the protein or make it clump, so it no longer works. Its labeling says to store it refrigerated at 2-8 °C in the original carton to protect it from light, and not to freeze or shake it. Taking it out of the carton removes that light protection. The fridge door is not a recommended spot because its temperature swings each time the door opens. The pharmacist covers any labeled room-temperature allowance during counseling.

    Ref QB-ANM46TSource: Enbrel (etanercept) prescribing information, Section 16 Storage and Handling, and Instructions for Use (refrigerate 2-8 °C in original carton to protect from light; do not freeze; do not shake); PTCE Content Outline 1.7/1.8Report a problem with this question

Practice questions based on the PTCB exam content outline. Not affiliated with the PTCB, and not medical advice. About the PTCE →