PCOA Practice Questions

An organization should develop which of the following documents first? A. Vision and mission statement B. Strategic and business plan C. Budget projection D. Situation analysis

A. Vision and mission statement The vision and mission statement serve as the initial framework from which the strategic and future business plans are derived. Budget projections and other analyses are performed once an organization's vision and mission are well established.

What is a function of surfactants in suspension preparations? A. Wetting agent B. Improve solubility C. Improve stability D. Improve palatability

A. Wetting agent The surfactant tends to lower the surface tension between solid surfaces and liquids, thus improving the wetting ability.

Which of the following are characteristics of stratification? (Mark all that apply.) A. Is conducted before randomization B. Ensures equal distribution of subject characteristics between groups C. Requires larger number of subjects D. Can be used in parallel or crossover studies

A, B, C, D. Stratification ensures equal distribution of selected subject characteristics between groups. It requires a larger number of patients and can be used in both parallel and crossover study designs. Stratification is performed before randomization.

Which of the following statements are true regarding medication access? (Mark all that apply.) A. Pharmacoeconomic data are used by health care companies, government agencies, and other entities to pay for or manage prescriptions B. Each therapeutic class of medications typically has multiple available products. Multiple brandname products as well as multiple generic medications may be available C. Because of the cost of purchasing and keeping medications on hand in the hospital, decisions must be made about which medications to purchase and stock D. Health insurance companies use pharmacoeconomic data to keep patients from getting the medications that they really need

A, B, C.

Which of the following are essential vehicles for practitioners in keeping up to date with new literature? (Mark all that apply.) A. Review articles B. Clinical practice guidelines C. Attendance at continuing education courses D. Case reports

A, B, C. Important vehicles for practitioners relative to keeping up to date with new literature include review articles, clinical practice guidelines, and attendance at continuing education events. Case reports are generally not an important method for keeping up to date with new literature.

Which of the following statements is part of Mankiw's 10 Principles of Economics? (Mark all that apply.) A. People face trade-offs B. People respond to incentives C. Prices tend to fall when the government prints too much money D. Society faces a short-run trade-off between inflation and unemployment

A, B, D. For C, prices generally rise when too much money is in circulation.

In which of the following ways do pharmacy leaders typically influence health system operations? (Mark all that apply.) A. Physicians' prescribing habits B. Supply chain expense C. Admission denials D. Information technology

A, B, D. Pharmacy leaders work with prescribers to effectively manage drug supply expenses and use information technology systems. They do not have direct involvement with denying patient admissions. (C)

Which of the following treatments is no longer used to decontaminate the gastrointestinal tract for an acute poisoning in an alert adult? (Mark all that apply.) A. Ipecac syrup B. Saline cathartics (laxatives) C. Activated charcoal D. Whole bowel irrigation

A, B. Ipecac syrup and cathartics are no longer routinely used to treat ingestions. Activated charcoal and whole bowel irrigation are used when indicated.

Which of the following are descriptive statistics commonly used in characterizing data from observational studies? (Mark all that apply.) A. Arithmetic mean B. Normality C. Mode D. Range

A, C, D. Arithmetic mean, mode, and range are descriptive statistics. Normality is used in inferential statistics and is the exception.

Which of the following are critical steps in practicing evidenced-based medicine? (Mark all that apply.) A. Search the literature for relevant clinical articles B. Regularly converse with colleagues on their approach to a clinical problem C. Evaluate and critically appraise the clinical studies for validity and usefulness D. Formulate a clear clinical question relative to a particular patient problem

A, C, D. Regularly conversing with colleagues on their approach to a clinical problem is not a part of practicing evidence-based medicine. Critical steps in practicing evidence-based medicine include searching the literature for relevant clinical articles, evaluating and critically appraising the clinical studies for validity and usefulness, and formulating a clear clinical question relative to a particular patient problem.

The acceptance of a specific benefit-to-risk ratio (mark all that apply) A. depends on the treated disease. B. depends on the shelf life of the drug. C. depends on the treated patient population. D. depends on the frequency and severity of adverse drug reactions.

A, C, D. The benefit-to-risk ratio balances the potential harm and the potential desired therapeutic outcome of a drug therapy.

Which of the following vitamins should be given to prevent Wernicke-Korsakoff syndrome in patients with alcoholism? A. Thiamine B. Niacin C. Pyridoxine D. Folic acid

A. Thiamine Thiamine (vitamin B1) is given to prevent Wernicke-Korsakoff syndrome in patients with a history of alcohol abuse. Niacin and folic-acid deficiency can occur in patients with alcohol abuse, but they are not routinely supplemented unless there are signs of deficiency (e.g., pellagra, macrocytic anemia). Pyridoxine is used to prevent isoniazidinduced neuropathies.

Which of the following agents is the most appropriate first-line option for treating hyperlipidemia in most cases? A. Atorvastatin B. Niacin C. Ezetimibe D. Fenofibrate

A. Atorvastatin Atorvastatin or other statin drugs have become the dominant first-line agents for hyperlipidemia. Ezetimibe is a second-line agent that is either added to statin therapy or added as an alternative to statins in patients who cannot tolerate those drugs. Niacin and fenofibrate have fallen out of favor in most cases because of adverse effects and a lack of long-term benefits.

Which of the following price measures reflects all rebates paid by manufacturers to wholesalers and retail pharmacies, but does not include rebates paid by manufacturers to pharmacy benefit managers, Medicaid, or other third-party payers? A. Average manufacturer price B. Wholesale acquisition cost C. Average wholesale price D. List price

A. Average manufacturer price The average manufacturer price (AMP) is the average price paid by wholesalers to manufacturers or by retail pharmacies that buy directly from manufacturers for drugs distributed through such pharmacies. It reflects all rebates paid by manufacturers to wholesalers and retail pharmacies, but does not include rebates paid by manufacturers to pharmacy benefit managers, Medicaid, or other third-party payers.

Individuals with a hormone-sensitive tumor should not receive which of the following agents? A. DHEA B. Saw palmetto C. St. John's wort D. Vitamin E

A. DHEA DHEA is metabolized to testosterone and estradiol, which stimulate prostate and certain types of breast cancer, respectively. Saw palmetto contains fatty acids and sterols that do not affect hormone concentrations. Vitamin E was not found to decrease the occurrence of cancer. St. John's wort does not affect tumor cells.

In general, what key word would not allow you to ask an open-ended question during a patient interview? A. Do B. How C. When D. What

A. Do A question beginning with "do" can be answered with a "yes" or a "no."

What are the two main forms of managed care? A. HMOs and PPOs B. HMOs and ACOs C. PPOs and ACOs D. MTMS and ACOs

A. HMOs and PPOs HMOs and PPOs are the two main managed care categories, whereas MTMS is an example of pharmaceutical services. An HMO is a managed care insurance plan where the payer is accountable for both the cost and the quality of care within a closed system. A PPO, which is mainly concerned about reducing the cost of care, creates a larger but still restrictive network of physicians who agree to a contracted rate before care delivery.

Which of the following describes the comparison of costs per QALY gained? A. Incremental cost-effectiveness ratio B. Cost-benefit analysis C. Health utility D. Sensitivity analysis

A. Incremental cost-effectiveness ratio Constructing an incremental cost-effectiveness ratio allows one to determine the cost of each QALY when comparing treatment options. A cost-benefit analysis is an overarching type of model within which one might create an incremental costeffectiveness ratio. Health utility is a measure used to determine QALYs, and sensitivity analysis may be used when conducting a cost-effectiveness analysis as a way to see how varying the inputs leads to different interpretations of results.

Which of the following strategies can be used with patients at the pharmacy to increase openness between the pharmacist and the patient? A. Listen, acknowledge, wonder B. Recognize, question, reflect C. Listen, acknowledge, reflect D. Listen, question, reflect

A. Listen, acknowledge, wonder This is the correct combination of strategies that are used at the pharmacy to increase openness between the pharmacist and the patient.

The rate of dissolution of drugs into the surrounding media is expressed by the A. Noyes-Whitney equation. B. Michaelis-Menten equation. C. Stokes equation. D. Henderson-Hasselbalch equation.

A. Noyes-Whitney equation. The Noyes-Whitney equation explains the rate of dissolution of drugs into the surrounding media.

Which of the following clinical study design characteristics is consistent with a case report? A. Observational B. Prospective C. Randomized D. Controlled

A. Observational Case reports are always observational. Prospective designs, randomization, and controls are all study design characteristics commonly used with randomized controlled trials and are not associated with case reports.

Which of these glands is both endocrine and exocrine in function? A. Pancreas B. Thymus gland C. Adrenal gland D. Pituitary gland

A. Pancreas The pancreas is both endocrine (secreting insulin) and exocrine (secreting digestive enzymes) in function.

Of the five components of the medication use process, which area has been shown to have the highest rate of medication errors associated with it? A. Prescribing and ordering B. Administering C. Dispensing D. Monitoring

A. Prescribing and ordering Prescribing and ordering has the highest rate of medication errors. This problem can be associated with errors related to transcription and illegible handwriting.

Which of the following is not a component of the normal bacterial growth curve? A. Release phase B. Stationary phase C. Logarithmic phase D. Lag phase

A. Release phase Bacteria follow a four-phase growth curve: 1) lag phase 2) logarithmic phase 3) stationary phase 4) decline phase.

Which is a false statement regarding serum creatinine? A. SCr measures low in body builders and in consumers of a protein-rich diet B. Normal SCr level ranges between 0.7 and 1.5 mg/dL C. Cimetidine, spironolactone, and ACE inhibitors may cause an increase in SCr D. SCr is related to muscle metabolism

A. SCr measures low in body builders and in consumers of a protein-rich diet The serum creatinine level is high in body builders and in consumers of a protein-rich diet. Answers B, C, and D are correct.

When conducting an FMEA, determining the RPN is important. What does the RPN measure? A. Severity, occurrence, and detection B. Location, detection, and severity C. Severity, detection, and negligence D. None of the above

A. Severity, occurrence, and detection FMEA RPN (Risk Priority Number) is a numerical assessment of the risk priority level of a failure mode in an FMEA analysis. An RPN is calculated by determining a severity rating, an occurrence rating, and a detection rating.

In 1945, 1,000 women worked in a factory painting radium dials on watches. A study compared the incidence of bone cancer in these women, up to 1975, with the incidence of bone cancer in 1,000 women who worked as telephone operators in 1945. Twenty of the radium dial painters and 4 of the telephone operators developed bone cancer between 1945 and 1975. This study is an example of A. a cohort study. B. an experimental study. C. a cross-sectional study. D. a case control study.

A. a cohort study. Cohort studies compare the risk of developing a disease between those who are exposed to a risk factor and those who are not exposed. Subjects were not assigned to a treatment, and patients were followed through time for the development of bone cancer. Patients were identified by their exposure to radium by painting watch dials and compared to people who were not exposed to radium but had a risk of developing bone cancer.

In the compounding of suppositories, the density factor represents the ratio A. between the weight of the drug and the weight of the base replaced by the drug. B. between the weight of the drug and the weight of the base. C. between the weight of the drug and the weight of the medicated suppository. D. between the weight of the drug and the weight of a blank

A. between the weight of the drug and the weight of the base replaced by the drug. The density factor is used to determine the amount of suppository base replaced by the presence of the drug.

Which drug will undergo N-demethylation in vivo?

B. Drug B has an N-methyl group, so it is a candidate for N-demethylation.

A city contains 100,000 people (52,000 males and 48,000 females), and 2,000 people die per year (1,100 males and 900 females). What is the crude mortality rate? A. 21.2 per 1,000 B. 20 per 1,000 C. 18.8 per 1,000 D. 18.8 per 10,000

B. 20 per 1,000 Crude mortality is 2,000 people divided by 100,000 people. Thus, 20 people die per 1,000. Don't overthink it.

The first fasting lipid panel should be obtained at what age and how often if no risk factors are present? A. 20 years old and every 2 years B. 20 years old and every 5 years C. 25 years old and every 2 years D. 25 years old and every 5 years

B. 20 years old and every 5 years The first fasting lipid panel, along with other risk assessment, should be obtained at 20 years of age and every 5 years if no risk factors are present.

A patient has been taking 250 mg of valproic acid three times per day for 2 weeks (half-life 16 hours), and a trough concentration drawn is 23 mcg/mL. What dose would come closest to achieving a target steady-state trough concentration of 60 mcg/mL? A. 250 mg four times per day B. 750 mg three times per day C. 500 mg three times per day D. 750 mg four times per day

B. 750 mg three times per day Use the ratio between the dose and the steadystate trough concentration.

Which of the following blood tests is most appropriate to monitor when patients receive medications known to cause hepatic injury? A. Hematocrit B. AST and ALT C. Creatinine D. INR

B. AST and ALT AST and ALT are common markers of drug induced hepatocellular damage. Creatinine is used to assess renal function. Hematocrit is used to assess bleeding and anemias. INR is used to assess blood coagulation and can be increased in liver failure, but it is less commonly used for monitoring drug-induced hepatocellular damage.

A patient's asthma is not well controlled with inhaled albuterol prn. Which of the following is the most appropriate escalation in therapy at this time? A. Change inhaled albuterol to scheduled dosing every 6 hours B. Add a low-dose inhaled corticosteroid C. Add a long-acting inhaled β2-agonist D. Add an oral corticosteroid

B. Add a low-dose inhaled corticosteroid In the standard stepwise approach to asthma treatment, the recommended treatment in patients not controlled with a prn SABA is to add a lowdose ICS. Adding a LABA or an oral corticosteroid are recommended in various later steps after adding an ICS. Scheduled albuterol is not generally recommended.

In addition to directly causing vasoconstriction, angiotensin II stimulates the release of what substance from the adrenal cortex? A. Dopamine B. Aldosterone C. Vasopressin D. Angiotensin-converting enzyme

B. Aldosterone Aldosterone is responsible for sodium and water retention. Retention of sodium and water increases blood volume, thus increasing vascular resistance.

Which of the following is not an immunosuppressive drug used in transplant patients? A. FK506 B. Antihistamine C. Azathioprine D. Cyclosporine

B. Antihistamine Antihistamine is a type of allergy medication.

Which of the following drugs is indicated for the initial management of muscarinic symptoms from an organophosphate poisoning? A. Sodium bicarbonate B. Atropine C. Succimer D. Pralidoxime

B. Atropine Atropine is used to treat the organophosphateinduced muscarinic symptoms (miosis; nausea and vomiting; diarrhea; urination; bradycardia; excessive bronchial, lacrimal, dermal, nasal, and salivary secretions). Pralidoxime is used with atropine to resolve severe organophosphate symptoms (such as those from exposure to nerve agents), including nicotinic symptoms of muscle weakness and cramps, fasciculations, and tachycardia and CNS symptoms such as coma and seizures. Succimer is used for lead poisoning. Sodium bicarbonate has several uses including the treatment of tricyclic antidepressant toxicity. Neither succimer nor sodium bicarbonate has a role for the muscarinic effects.

Which of the following cell lines is most important relative to specific defense against bacteria? A. Natural killer cells B. B-lymphocytes C. Helper T-lymphocytes D. Cytotoxic T-lymphocytes

B. B-lymphocytes B-lymphocytes (B cells) are largely responsible for antibody- mediated immunity T-lymphocytes are responsible for cell-mediated immunity. Natural killer cells are part of nonspecific immunity in humans.

When considered collectively, what is the single most important factor affecting population health at the individual level? A. Quality of health care facilities B. Behavioral decisions C. Socioeconomic status D. Insurance status

B. Behavioral decisions

Which of the following best describes a validation study? A. Original research not previously reported B. Confirmation of original research by an independent group C. Laboratory research supporting a clinical trial D. Recommendation by a clinical expert

B. Confirmation of original research by an independent group Validation studies duplicate (to some degree) an original study that shows benefit to determine if the benefit can be reproduced, thereby suggesting a true beneficial effect.

What patient-centeredness dimension refers to coming to a treatment decision that takes into account not only the health care provider's wishes but also the wishes and barriers of the patient? A. Doctor-as-person B. Therapeutic alliance C. Patient-as-person D. Sharing of power and responsibility

B. Therapeutic alliance Therapeutic alliance involves making a treatment decision that includes the wishes and barriers of the patient.

Which of the following statements correctly describes cohort studies? A. They are often retrospective B. They are conducted to evaluate rare risk factors C. They are done when disease is rare D. All cohort studies are prospective

B. They are conducted to evaluate rare risk factors Cohort studies are conducted when the risk factors are rare. They can be retrospective or prospective.

Which statement is false? A. Phenazopyridine causes orange-red urine B. Tylenol causes white urine C. Acetazolamide causes false-positive protein in the urine D. Amitriptyline causes blue-green urine

B. Tylenol causes white urine Tylenol does not cause white urine. Statements A, C, and D are correct.

Which of these distribution models allows for the drug to be dispensed without pharmacist verification? A. Inpatient centralized model B. Floor-stock distribution model C. Unit-dose distribution model D. Inpatient decentralized model

B. Floor-stock distribution model Floor-stock distribution models will consist of items that have a low-risk safety profile. Such models are also effective for providing low-risk sensitive items to a patient care area.

Which of the following genetic variations is important to the risk of hypersensitivity reactions after abacavir therapy? A. MGMT B. HLA-B*5701 C. CYP2C19 D. TPMT

B. HLA-B*5701 HLA-B*5701 is a genetic variant that is associated with the risk for hypersensitivity reactions after abacavir therapy.

Generally, what key word should be used to ask an open-ended question? A. Can B. How C. Will D. Did

B. How A question beginning with "how" cannot be answered with a "yes" or a "no."

Which of the following analgesia agents is most appropriate for treating neuropathic pain? A. Morphine B. Pregabalin C. Celecoxib D. Fentanyl

B. Pregabalin Pregabalin is one of the primary drugs used for neuropathic pain. Morphine and fentanyl are opiates used for other types of acute and chronic pain (e.g., somatic, visceral, musculoskeletal). Celecoxib is an NSAID agent used for inflammatory and musculoskeletal pain.

The synthesis of proteins in the cytoplasm of the cell requires several metabolic elements. Which of the following is not required to synthesize a new protein chain? A. Transfer RNA B. Recombinant DNA C. Ribosome proteins D. Messenger RNA

B. Recombinant DNA Protein synthesis in the cytoplasm requires tRNA, and mRNA and takes place on the ribosome.

Which of the following is not considered an effective way to bring about medication safety in an organization? A. Eliminate the use of dangerous abbreviations B. Restrict the use of high-risk drugs C. Implement medication safety technology D. Improve the communication process between all involved in the medication use process, including family members

B. Restrict the use of high-risk drugs Restricting the use of high-risk drugs is not an appropriate action to improve medication safety. Creating a high-alert drug list with specific actions to take when medications on the list are used is a more appropriate action.

Antigen-presenting cells such as macrophages present antigen in the context of MHC class II molecules to A. neutrophils. B. T cells. C. B-cells. D. eosinophils.

B. T cells. T helper cells recognize antigen peptides in the context of MHC class II through interaction with T-cell receptors.

Which of the following statements is not true? A. The coefficient of determination ranges from 0 to 1 B. The correlation coefficient ranges from 0 to 1 C. The sign of the correlation coefficient is the same as the sign of the slope of the regression equation D. The absolute value of the correlation coefficient equals the square root of the coefficient of determination

B. The correlation coefficient ranges from 0 to 1 The value of the correlation coefficient ranges from -1 to 1.

Subjective information in the SOAP notes includes A. laboratory test results. B. medication taken by the patient. C. vital signs and physical findings. D. blood pressure measurement.

B. medication taken by the patient. Subjective information in the SOAP notes includes the information reported by the patient. Medication taken by the patient will be part of the subjective notes.

Trends for inpatient drug spending are mainly A. lower than retail drug spending. B. outpacing levels of reimbursement. C. stable and not changing. D. decreasing to lower levels.

B. outpacing levels of reimbursement. Drug spending is increasing at a rate faster than the rate of reimbursement, which is, in many cases, decreasing.

Which of the following agents is most appropriate to treat hypertension and also prevent renal dysfunction (i.e., provide renal protection) in patients with diabetes? A. Hydrochlorothiazide B. Metoprolol C. Lisinopril D. Amlodipine

C. Lisinopril Lisinopril is an ACEI. ACEIs and ARBs treat hypertension and provide renal protection in patients with diabetes. Hydrochlorothiazide (diuretic), metoprolol (β-blocker), and amlodipine (CCB) are also antihypertensive agents, but they do not provide additional renal protection in patients with diabetes.

Which of the following is true regarding sample size in randomized controlled trials? A. Increased sample size reduces statistical power B. Increased sample size is needed for a crossover design versus a parallel design C. Decreased sample size is needed when the expected difference in outcome between groups is large D. Decreased sample size is needed where large variability exists in the study outcome being measured

C. Decreased sample size is needed when the expected difference in outcome between groups is large. Increased sample size increases statistical power and is needed when there is large variability in the study outcome being measured. Decreased sample size is needed for a crossover study design because patients are serving as their own controls.

Screening for prostate cancer in men with average risk of prostate cancer and a high PSA level annually is acceptable as long as they have a life expectancy of how many years? A. 2 B. 5 C. 10 D. 15

C. 10 Per the U.S. Preventive Services Task Force recommendations for screening for prostate cancer in men with average risk of prostate cancer and a high PSA level, annually is acceptable as long as they have a life expectancy of 10 years.

A prevalence study conducted from January 1 to December 31, 2017, on a population of 125,000 identified 500 cases of a disease. The incidence rate of this disease is 2 per 1,000. What percentage of the cases was newly diagnosed in 2017? A. 5% B. 50% C. 2% D. Answer cannot be calculated from this data set

C. 2% Of 125,000 people, there were a total of 500 cases. An incidence rate of 2 per 1,000 means 250 new cases per 125,000 people. Thus, 50% are new cases.

Which of the following statements is not true about statistical hypotheses? A. The null hypothesis is a statement presumed to be true in the study population B. The alternative hypothesis is typically the same as the research hypothesis C. A statistical test can prove or reject a null hypothesis D. A statistical test has to have a null hypothesis

C. A statistical test can prove or reject a null hypothesis When hypothesis testing does not reject the null hypothesis, it does not mean proof of the null hypothesis. Hypothesis testing indicates only whether the available data support or do not support the null hypothesis.

Which medication class does not potentially cause a false high glucose level? A. Loop diuretics B. Corticosteroids C. ACE inhibitors D. Isoniazid

C. ACE inhibitors A false high glucose level is associated with loop diuretics, corticosteroids, and isoniazid but not with ACE inhibitors.

Which of the following is a neurotransmitter that is released from the axon terminal of the neuromuscular junction? A. Estrogen B. Substance P C. Acetylcholine D. GABA

C. Acetylcholine Acetylcholine is the neurotransmitter in the axon terminal of the neuromuscular junction. GABA is a neurotransmitter, but it is mostly localized to the brain. Estrogen and substance P are hormones.

The intervertebral disc is located in which of the following regions of the body? A. Stomach B. Sternum C. Bony spine D. Epidermis of the skin

C. Bony spine Intervertebral discs are a component of the bony spine. The sternum is also a component of the skeleton, but it is located in the chest and is a component of the rib structure.

With respect to statutory law, which of the following is ordered correctly from most powerful to least powerful (e.g., descending order of authority)? A. Statute, ordinance, regulation, constitution, treaty or international agreement B. Ordinance, regulation, statute, treaty or international agreement, constitution C. Constitution, treaty or international agreement, statute, regulation, ordinance D. Regulation, constitution, treaty or international agreement, ordinance, statute

C. Constitution, treaty or international agreement, statute, regulation, ordinance In descending order of authority: 1) Constitution 2) treaty or international agreement 3) statute 4) regulation 5) ordinance.

Which of the following best describes assertive behavior? A. Talking over others B. Arguing your point to prove you are right regardless of how it affects others C. Directly expressing ideas, opinions, and desires D. Interrupting when others make illogical points

C. Directly expressing ideas, opinions, and desires Assertive behavior is not aggressive or disrespectful of others.

Which of the following statements is not true regarding green tea? A. The major dose-limiting ingredient of green tea extract appears to be caffeine B. Human studies demonstrate that 8-16 cups of green tea per day are safe and well tolerated C. Human data suggest that green tea extract is associated with significant liver injury D. Green tea is associated with lower systolic blood pressure, total cholesterol, and LDL-C in humans

C. Human data suggest that green tea extract is associated with significant liver injury In 2008, the Dietary Supplements Information Expert Committee (DSI EC) of the United States Pharmacopeial Convention systematically reviewed 216 case reports on green tea products, including 34 reports concerning liver damage, in response to concerns over hepatotoxicity related to green tea extract (GTE)-containing weight-loss products. The data suggest that liver-related adverse effects after GTE intake are rare.

A patient in your pharmacy thinks she may be pregnant and plans to purchase one of the digital testing devices today. Which of the following counseling points is not correct? A. For improved accuracy, test 1 week after a missed period B. If you don't believe the test results, a blood test would be more accurate C. It is best to use a urine sample taken before bedtime D. This test measures hCG levels in the urine

C. It is best to use a urine sample taken before bedtime The first urine of the morning should be sampled for improved accuracy because it contains a higher concentration of hCG.

Which of the following is the most appropriate initial therapy for a patient with chronic obstructive pulmonary disease in addition to a prn short-acting inhaled β2-agonist? A. Inhaled corticosteroid B. Theophylline C. Long-acting inhaled anticholinergic D. Short-acting inhaled anticholinergic

C. Long-acting inhaled anticholinergic A long-acting anticholinergic (or a LABA) should be started with a prn SABA. Short-acting anticholinergics have been replaced by long-acting agents. Theophylline and ICS are reserved for more refractory patients.

What mechanism is most commonly responsible for causing Down syndrome? A. Translocation of the Philadelphia chromosome (9 and 22) B. Deletion of a portion of the short arm of chromosome 5 C. Nondisjunction during meiotic segregation D. Robertsonian translocation of chromosome 21

C. Nondisjunction during meiotic segregation Most commonly, Down syndrome occurs as an error during cell division. Other causes, although less likely, are mosaicism and Robertsonian translocation of chromosomes 21 and 14.

Before a prescription is dispensed, a medication label must be prepared. Which of the following is not a required element? A. Quantity dispensed B. Directions for use C. Patient's date of birth D. Date

C. Patient's date of birth The date of birth is not required for a prescription. The quantity, directions for use, and date are all required elements of a prescription.

Which of the following drugs with a narrow therapeutic index is most likely to cause severe rashes and CNS changes? A. Aminoglycoside antibiotics B. Digoxin C. Phenytoin D. Warfarin

C. Phenytoin Phenytoin can cause a number of adverse effects including skin rashes (sometimes severe) and CNS changes when serum levels are supratherapeutic. Aminoglycosides -> Nephrotoxicity Warfarin -> Bleeding Digoxin -> Arrhythmias

Gaseous oxygen and carbon dioxide are exchanged in which level of the respiratory system? A. Trachea B. Bronchi C. Pulmonary alveoli D. Larynx

C. Pulmonary alveoli The pulmonary alveoli are the smallest air-filled part of the lung and are the site of gas exchange between the lungs and the blood.

MGMT promoter status is predictive of which of the following clinical responses to drug therapy? A. Improved tumor response in hormone-expressing breast tumors B. Improved response in non-small cell lung cancer when gefitinib is given C. Response to alkylating agents in patients with brain tumors D. Response to warfarin therapy in patients with variants in VKORC1

C. Response to alkylating agents in patients with brain tumors MGMT promoter status is predictive of the response to alkylating agents in patients who have brain tumors.

John is a 53-year-old male with diabetes who is not responding to standard oral antidiabetic medications and must use insulin to control his blood glucose levels. He is expected to self-administer his medications. Which route of administration would you choose for his insulin administration? A. Intravenous B. Intramuscular C. Subcutaneous D. Oral

C. Subcutaneous The subcutaneous route is best because the oral route has already failed. Intravenous and intramuscular routes are probably impractical for self-administration.

Which of the following kidney structures serves as the excretory function by producing ultrafiltrate? A. Hilus B. Renal pelvis C. Tubular nephron D. Renal cortex

C. Tubular nephron The tubular nephron is the functional unit of the kidney producing urine and removing waste from the blood.

Which of the following is best described as preference weights that help decision makers understand value of or desirability for particular health states? A. Patient-reported outcome B. Quality-adjusted life-year C. Utility D. Time trade-off

C. Utility Utility describes the relative value that an individual perceives to gain from achieving certain levels of health. Patient-reported outcomes is an overarching term for results of interventions that are not interpreted by a provider yet still measure the effect of a therapy. A QALY is how one measures the quality of a year lived based on a particular treatment's likely outcomes. Time trade-off is a popular way to determine health utility.

Penny, a 45-year-old female, appears in the emergency department of the local hospital experiencing a panic attack after a car wreck in which the other driver experienced some trauma. Your choice for therapy is A. an intravenous bolus dose of an antianxiety drug. B. an intravenous infusion of an antianxiety drug. C. an intramuscular injection of an antianxiety drug. D. a subcutaneous dose of an antianxiety drug.

C. an intramuscular injection of an antianxiety drug. An intramuscular injection of an antianxiety drug is the best choice because it gives rather quick relief but also has some action for several hours.

Thrombus formation in the venous side of the circulatory system is most commonly attributable to A. vessel endothelium injury. B. increased blood flow. C. decreased blood flow. D. disseminated intravascular coagulation.

C. decreased blood flow. On the venous side, blood pressure is lower (as compared to arterial blood) and most thrombi are formed because of decreased blood flow. Thrombus formation is due to three factors known as Virchow's triad: injury or abnormality of the endothelial wall of the vessel, decreased blood flow, and changes in the normal process of coagulation.

Drug A is a full agonist for a specific receptor system; drug B is a competitive antagonist for the same receptor system. If increasing doses of drug B are co-administered with drug A, drug B will A. increase the apparent Emax of drug A. B. reduce the apparent Emax of drug A. C. increase the apparent EC50 of drug A. D. reduce the apparent EC50 of drug A.

C. increase the apparent EC50 of drug A. Antagonists increase the apparent EC50 of a drug by shifting the effect versus concentration curve to the right.

Vitamin D deficiency is related to A. overexposure to the sun. B. deactivation of cholecalciferol in the liver. C. increased skin pigmentation. D. lack of sunscreen use.

C. increased skin pigmentation. Increased skin pigmentation decreases penetration of UVB rays through the skin, so activation of vitamin D is reduced. Insufficient exposure to sunlight and sunscreen use have been associated with vitamin D deficiency. Cholecalciferol is activated (not deactivated) in the liver.

The large-scale study of the structure and function of proteins is A. genomics. B. bioinformatics. C. proteomics. D. biostatistics.

C. proteomics. Proteomics is defined as the large-scale study of the structure and function of proteins.

Which of the following would be an example of one defined alcoholic beverage? A. 1 glass of wine B. 1 whisky sour C. 2 oz of 80-proof whisky D. 12 oz of beer

D. 12 oz of beer One defined alcoholic beverage is equivalent to - 12 oz of beer - 5 oz of wine - 1.5 oz of 80-proof distilled spirits.

Which of the following situations is least likely to pose a conflict of interest? A. A pharmacist recommends his son-in-law for employment B. A pharmacist who serves on a hospital's pharmacy and therapeutics committee owns a considerable amount of stock in a pharmaceutical company C. A pharmacy store manager whose annual bonus is tied to total sales considers introducing a line of dietary supplements for which there is little documentation of therapeutic value D. A pharmacist whose retirement investments are all in mutual funds serves as the pharmacy purchasing officer for a large hospital

D. A pharmacist whose retirement investments are all in mutual funds serves as the pharmacy purchasing officer for a large hospital From among the choices presented, the one that represents the least potential conflict of interest is that of a pharmacy purchasing officer who does not own stocks in the companies whose products are under consideration for purchase.

Which of the following agents is most appropriate to treat hypertension and also provide heart rate control in a patient with atrial fibrillation? A. Spironolactone B. Amlodipine C. Valsartan D. Atenolol

D. Atenolol Atenolol is a β-blocker agent that provides heart rate control (i.e., lowers heart rate) in addition to blood pressure control. Spironolactone is a diuretic primarily used in CHF but can be used for hypertension. It does not control heart rate. Amlodipine (CCB) and valsartan (ARB) are antihypertensive agents but neither provides heart rate control.

When the availability of a drug is scarce, which of the following is the best ethical course of action for a pharmacist? A. Distribute the drug on a first-come, first-served basis until the supply is exhausted B. Keep all the supply for distribution to the pharmacist's own customers or patients C. Place the needs of the broader community ahead of the needs of the pharmacist's own patients D. Balance the needs of society and individual patients in making decisions regarding allocation of the drug

D. Balance the needs of society and individual patients in making decisions regarding allocation of the drug From an ethical viewpoint, both the needs of a pharmacist's individual patients and the needs of the broader community should be considered.

Which of the following is most commonly a first-line agent for treating congestive heart failure? A. Hydralazine B. Digoxin C. Diltiazem D. Carvedilol

D. Carvedilol Carvedilol is a β- and alpha-blocking agent commonly used for CHF. Hydralazine can be used in CHF (especially in African American patients) but is not a first-line agent. Similarly, digoxin can be used in CHF but is not a first-line agent. Diltiazem is not used in CHF because of negative inotropic effects.

The Dietary Supplement and Health Education Act (DSHEA) does not allow for which of the following types of claims? A. Health claims B. Structure or function claims C. Nutrient content claims D. Disease claims

D. Disease claims The DSHEA specifically prohibits product labeling that refers to the treatment, cure, or diagnosis of "disease."

A patient is interested in an OTC nasal corticosteroid spray for her seasonal allergies. Which of the following is an important counseling point regarding the drawbacks of this medication? A. It can cause sedation B. It can cause anticholinergic effects such as dry mouth C. It can be used for a maximum of 72 hours only D. Effects will not occur immediately

D. Effects will not occur immediately A primary drawback of nasal corticosteroids is that they have a long onset of action (from days to weeks). Patients may get frustrated if they expect an immediate effect. They do not cause sedation or anticholinergic effects like first-generation antihistamines. The 72-hour limitation on therapy is for direct nasal decongestants such as oxymetazoline.

Renin is a substance secreted in response to decreases in renal arteriolar pressure or blood flow. What part of the kidney is responsible for secreting renin? A. Peritubular capillary endothelial cells B. Mesangial cells C. Lacis cells D. Juxtaglomerular cells

D. Juxtaglomerular cells Juxtaglomerular cells are responsible for secreting renin. Renin converts angiotensinogen to angiotensin I.

Which of the following substances released by endothelial cells is a potent vasodilator? A. Endothelin B. Vasopressin C. Dopamine D. Nitric oxide

D. Nitric oxide Nitric oxide is a potent vasodilator released by the endothelial cells in response to changes in blood pressure.

According to USP Chapter <795>, for which of the following preparations would a beyond-use date of 6 months at room temperature be most appropriate? A. Water-containing oral preparations B. Water-containing, topical semisolid formulations C. Water-containing, topical liquid formulations D. Non-water-containing (nonaqueous) solid formulations

D. Non-water-containing (nonaqueous) solid formulations Usually, solid formulations are more stable than other types of formulations. According to USP Chapter <795>, in the absence of stability data, nonaqueous preparations may be given a 6-month BUD.

Which of the following statements best describes an organization that functions within a just culture? A. An organization that deals only with errors attributed to system failures B. An organization that looks to terminate all employees involved in errors resulting in patient harm C. An organization that functions with the intent that all errors are self-correcting D. None of the above

D. None of the above A just culture looks for the root cause of an error. In a just culture, the evaluation process seeks out system failures, but if a human resource issue is identified, appropriate actions are taken.

Which core element of medication therapy management is fulfilled by providing each patient with a complete list of the medications he or she is taking, including directions for use, indications, and prescriber? A. Medication action plan B. Medication therapy review C. Documentation and follow-up D. Personal medication record

D. Personal medication record The personal medication record is the core element of medication therapy management that is satisfied by providing the patient with a complete list of his or her medications.

A patient is taking digoxin 0.125 mg per day with a measured steady state of 1.7 ng/mL drawn 5 hours after his last digoxin dose. His heart rate is 81 beats per minute at this time. The desired steady-state concentration is 1.0 ng/mL. What is the most appropriate course of action? A. Stop dosing, wait for the concentration to fall to 1 ng/mL, and restart dosing at 0.125 mg every other day B. Decrease the dose to 0.125 mg every other day C. Check the patient's renal function D. Redraw the level later in the dosing interval

D. Redraw the level later in the dosing interval Digoxin has a significant distribution phase (two-compartment model), but the therapeutic range is based on digoxin trough concentrations. If a level is drawn less than 8 hours after administration of the dose, then the digoxin concentration will be falsely elevated. The patient's heart rate is 81 bpm, which also does not suggest the dose is too high. In this case, redraw an appropriate trough level.

What agency generally regulates traditional pharmacy compounding? A. FDA B. USP C. PCAB D. State boards of pharmacy

D. State boards of pharmacy The regulation of pharmacy compounding is generally regulated by individual state boards of pharmacy. This is true for pharmacies operating as traditional pharmacies (i.e., compounding is performed for specific patients, pursuant to a valid prescription). Pharmacies operating outside of this scope may be subject to FDA jurisdiction.

Which of the following types of fish may be at increased risk of containing methylmercury? A. Salmon B. Tuna C. Trout D. Swordfish

D. Swordfish In addition to swordfish, methylmercury contamination is common in shark, king mackerel, and tilefish.

To promote a culture of safety, a health care organization should create an environment that A. is protective of patient information regarding possible medication errors. B. identifies which individual is responsible for the error. C. allows the pharmacy department to be solely responsible for addressing medication safety issues. D. promotes a nonpunitive environment in which safety information is freely shared.

D. promotes a nonpunitive environment in which safety information is freely shared. To promote a culture of safety, an organization must promote an environment in which safety information is freely communicated and employees are not punished for participating.

Individuals who receive HMG-CoA reductase inhibitors for high cholesterol and experience myalgia may be depleted of which of the following? A. Vitamin A B. Vitamin K C. Selenium D. Ubiquinone

D. Ubiquinone Ubiquinone is a metabolite of the mevalonate pathway that generates cholesterol. Statins block a step in this pathway that decreases cholesterol concentrations and also decreases ubiquinone (CoQ10) concentrations.

Which of the following is not part of the epidemiologic triad? A. Host B. Environment C. Agent D. Vector

D. Vector The epidemiologic triad consists of the host, the agent, and the environment.

Which of the following vitamins is found in green, leafy vegetables and can counteract the effect of warfarin? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K

D. Vitamin K Vitamin K is found in green, leafy vegetables and can counteract warfarin. Warfarin inhibits the vitamin K-dependent clotting factors, so providing more vitamin K counters that effect. Vitamins A, D, and E are the other fat-soluble vitamins, but they do not interact with warfarin as does vitamin K.

Which of the following Web sites contains 1,422 guidelines published from 2011 to 2017 worldwide? A. http://www.medmatrix.org B. https://www.cdc.gov C. http://www.myguidelines.org D. https://www.guideline.gov

D. https://www.guideline.gov This is a DUMB question.

What is the purpose of the Poison Prevention Packaging Act of 1970? A. Protect the privacy and security of individual health information B. Require that certain household products, including oral prescription drugs, be packaged in child-resistant containers C. Control the sale of those drugs that have been found to have a potential for abuse and addiction D. Serve as a checks and balances system for the U.S. government

Require that certain household products, including oral prescription drugs, be packaged in child-resistant containers