1. Which of the following cannot be refilled under any circumstances? a. Metoprolol b. Methylphenidate c. Mitomycin d. Hydroxyurea View Answer 1. (b) Methylphenidate is a controlled class II drug. It is indicated for treatment of attention deficit hyperactivity disorder (ADHD). It cannot be refilled under any circumstances. close 2. Valproic acid syrup is available as 250 mg/5 cc. If a patient were taking 1000 mg in the morning and 750 mg in the evening, how many cc of syrup would you dispense for a 30-day supply ? a. 1500 cc b. 1050 cc c. 500 cc d. 480 cc View Answer 2 (b)1050cc. In this type of calculation first find out number of cc required for 1 day. Morning dose Drug ml of solution 250 mg present 5 cc of solution 1000 mg ? 1000 x 5cc / 250 = 20 cc of solution. Evening dose Drug ml of solution 250 mg present in 5 cc of solution 750 mg ? 750 x 5cc / 250 = 15 cc of solution. For a 30 day supply of Valproic acid (20 cc (am) + 15 cc (pm) ) x 30 = 1050cc. close 3. If a patient were taking Glyburide for his type II diabetes, and a physician prescribed him Chlorpropamide, a pharmacy technician would: a. Fill the prescription. b. Notify a pharmacist about the duplication of therapy. c. Notify a pharmacist about the drug-food interaction. d. All of the above. View Answer 3. (b)Glyburide and Chlorpropamide are oral sulfonylurea agents indicated for treatment of diabetes. Pharmacy technician will notify the pharmacist about duplication of therapy. close 4. All of the following drugs should be carefully prescribed with aspirin EXCEPT: a. Enoxaparin b. Coumadin c. Heparin d. Metoclopramide View Answer 4. (d)Aspirin is a blood thinning agent indicated for prevention of heart stroke. It should be carefully prescribed with other blood thinning agents because of risks of bleeding. Lovenox (Enoxaparin), Coumadin (Warfarin), Heparin, Plavix (Clopidogrel), Ticlid (Ticlopidine), Depakene (Valproic acid), Persantine (Dipyridamole), Mandol (Cefamandole), Cefotan (Cefotetan), Cefobid (Cefoperazone) and Moxam (Moxalactam) are agents that increase bleeding tendency in patients and should be carefully prescribed with other blood thinning agents. close 5. An overdose of Coumadin can be treated by administering: a. Vitamin K b. Acetylcysteine c. Mesna d. Protamine sulfate View Answer 5. (a)The overdose of Coumadin can be treated by administration of Vitamin K1 (Mephyton). close 6. Prochlorperazine can be classified as an: a. Anti-emetic b. Anti-depressant c. Anti-anxiety d. Anti-hypertensive View Answer 6. (a)Compazine (Prochlorperazine) is indicated for treatment of nausea and vomiting and therefore is classified as an anti-emetic (agent that prevent nausea and vomiting). close 7. A patient is taking Amoxicillin 500 mg by mouth three times a day for 7 days. How many capsules of 500 mg of Amoxicillin will you dispense for the whole supply? a. 42 b. 21 c. 7 d. 30 View Answer 7. (b). close 8. The cost for 100 tablets of Olanzapine is $420.00. The percentage mark up on the prescription is 15. What will be the retail cost for 30 tablets of the above drug ? a. $200 b. $145 c. $300 d. $450 View Answer 8. (b)The cost of 100 tablets of Olanzapine is $420 and therefore the cost of one tablet of Olanzapine would be $420/100 = $ 4.20. The % mark-up on the prescription is 15% Cost of prescription mark up on rx $ 100 $ 15 $ 4.20 ? 15 x 4.20 / 100 = $ 0.63, therefore dispensing cost of each prescription would be $ 4.20 + $ 0.63 = $ 4.83 The cost of 30 tablets would be $ 4.83 x 30 = $145. close 9. How much quantity of 3% Salicylic acid powder is required to mix with a talc powder to prepare a 0.20%, 500 grams of Salicylic acid? a. 50 gm b. 33 gm c. 480 gm d. 57 gm View Answer 9. (b)33 grams. For calculations of this type the allegation method is very useful. We want to prepare 500 gm of 0.2 % salicylic acid by mixing talc (0 %) powder with 3 % of Salicylic acid powder. 3 % salicy 0.2 (3 % sali) 0.2 % 0 % talc (no salicy) 2.8 (0% sali) Total 3.0 (0.2 % sali) We want to find out how many grams of 3 % salicylic acid required Total parts of 0.2% sali Parts of 3 % sali 3 parts 0.2 parts 500 ? 500 x 0.2 / 3 = 33 grams of 3% salicylic acid required. close 10. Clopidogrel is classified as an: a. Anti-hypertensive. b. Inhibitor of platelets' aggregation. c. Anti-diabetic. d. Anti-Parkinson's. View Answer 10. (b)Plavix (Clopidogrel) is a blood thinning agent. Agents of this class generally act by inhibiting aggregation of platelets which is thought to be the primary mechanism of blood clotting. It is indicated for prevention of heart stroke in patients with CHF. close 11. All of the following drugs can be indicated for the treatment of asthma EXCEPT: a. Ipratropium b. Metoprolol c. Albuterol d. Zafirlukast View Answer 11. (b)Asthma is characterized by increased responsiveness of trachea and bronchi to various stimuli and narrowing of airways. It is associated with shortness of breath, chest tightness, wheezing and coughing. The Beta-2 receptors stimulation generally dilates the bronchial smooth muscles and helps in controlling asthma. Beta-2 receptors blockers generally constrict the smooth muscles of bronchi and may even aggregate asthma. Metoprolol is a Beta-1 and Beta-2 receptor blockers indicated for treatment of hypertension and should be carefully prescribed in patient with asthma. Other choices such as Accolate and Atrovent are indicated for treatment of asthma. close 12. A prescription for MS Contin 30 mg was written as follows: Manan Care Rx Mr. Shroff 1/1/01 Ms Contin 30 mg sig- 1 po tid x 30 day # 60 Dr. Bhatia 1/1/02 Refill-0 MHS DEA # AB2354760 What would be the dispense quantity for the above prescription? a. 90 b. 60 c. 30 d. 10 View Answer 12. (b)The prescription of CII controlled drugs should be dispensed with specific quantity mentioned on prescription by physician. MS-contin is a controlled II drug and therefore correct dispensing quantity would be 60. close 13. A patient requests a refill for Diazepam 10mg. Upon reviewing his profile, a pharmacy technician reveals that the prescription for the requested drug has been refilled 5 times. The pharmacy technician will: a. Refill the prescription since it has been written for prn times. b. Cannot refill. Notify a pharmacist. c. Asks the patient to provide a valid DEA 222 order form. d. Refuse to fill since the strength of the requested medication is commercially unavailable. View Answer 13. (b)Prescription of controlled drugs III, IV and V cannot be refilled more than 5 times. A patient must bring a new prescription after this allowable refill is executed. Prescriptions older than 6 months require a new prescription to fill. close 14. Which of the following auxiliary labels is required when dispensing Otocort otic solution? a. Take with food. b. Do not consume alcoholic beverages. c. For ear use only. d. Shake well before using. View Answer 14. (c)Otocort otic solution is intended for ear use only. It should not be applied to eyes and therefore the auxiliary label "For ear use only" is required. close 15. All of the following drugs are colony and erythrocytes stimulating agents EXCEPT: a. Filgrastim. b. Epoetin. c. Tamsulosin. d. Sargramostim. View Answer 15. (c)Tamsulosin is the generic name of Flomax. It is indicated for treatment of B.P.H. All of the rest of the choices are colony stimulator agents. They generally help in stimulation of erythrocyte and granulocytes. close 16. Lanoxin pediatric solution is available in 0.05 mg/ml. If a patient is taking 0.25 mg of Lanoxin per day, what will be the dispense quantity of the drug in a cc for a 30-day supply? a. 25 cc b. 50 cc c. 100 cc d. 150 cc View Answer 16. (d)150 cc. Lanoxin is available in 0.05 mg/ml. Patient is taking 0.25 mg per day. Drug ml of solution 0.05 mg 1 ml 0.25 mg ? 0.25 x 1 / 0.05 = 5ml for 30 days supply = 30 x 5cc = 150cc close 17.Which of the following drugs is classified as a controlled substance? a. Cipro b. Vibramycin c. Lyrica d. Antara View Answer 17.(c) Lyrica (Pregabalin) is classified as a Schedule V controlled substance.It is indicated for: 1. Management of neuropathic pain associated with diabetic peripheral neuropathy 2. Management of postherpetic neuralgia 3. Adjunctive therapy for adult patients with partial onset seizures 4. Management of fibromyalgia 5. Management of neuropathic pain associated with spinal cord injury close 18. A prescription for Cymbalta can be filled by selecting: a. Lidocaine b. Tramadol c. Duloxetine d. Diclofenac View Answer 18.(c) A prescription for Cymbalta can be filled by selecting Duloxetine. It is indicated for treatment of depression. close 19.What is the principal side effect of Acarbose (Precose)? a. Hyperglycemia b. Bloating and diarrhea c. Severe constipation d. Bleeding View Answer 19.(b) Acarbose (Precose) is an oral alpha-glucosidase inhibitor for use in the management of type 2 diabetes mellitus. It delays the digestion of ingested carbohydrates, thereby resulting in a smaller rise in blood glucose concentration following meals. As a consequence of plasma glucose reduction, Precose reduces levels of glycosylated hemoglobin in patients with type 2 diabetes mellitus. The recommended starting dosage of Acarbose (Precose) is 25 mg given orally three times daily at the start (with the first bite) of each main meal . However, some patients may benefit from more gradual dose titration to minimize gastrointestinal side effects. This may be achieved by initiating treatment at 25 mg once per day and subsequently increasing the frequency of administration to achieve 25 mg t.i.d. Hypoglycemia, gas, bloating and diarrhea are commonly reported side effects of Acarbose (Precose). close 20. “Prescription” means: I. An order given individually for the person for whom prescribed, directly from the practitioner, or the practitioner’s agent, to a pharmacist. II. A chart order written for an inpatient specifying drugs which he or she is to take home upon discharge. III. A chart order written for an inpatient for use while he or she is an inpatient. a. I only b. I and II only c. II and III only d. All View Answer 20. Answer: (b). 1. "Prescription" means: (a). An order given individually for the person for whom prescribed, directly from the practitioner, or the practitioner's agent, to a pharmacist or indirectly by means of an order signed by the practitioner or an electronic transmission from the practitioner to a pharmacist. (b). A chart order written for an inpatient specifying drugs which he or she is to take home upon discharge. 2. "Prescription" does not include a chart order written for an inpatient for use while he or she is an inpatient. close A pharmacy technician may NOT perform which of the following tasks? I. Accept an original prescription drug order by telephone. II. Perform patient counseling. III. Sign any federally-required controlled substance or inventory form. a. I only b. I and II only c. II and III only d. All View Answer Answer: (d). All listed tasks cannot be performed by a pharmacy technician. The pharmacist in charge or the retail drug outlet shall determine the duties of pharmacy technicians based upon the needs of the drug outlet. At time of employment the pharmacist in charge shall provide the technician with a description of the tasks that the technician may perform. Pharmacy technicians are limited to performing tasks in the preparation of prescription legend drugs and nonjudgmental support services. Permissible duties include the dispensing of drugs under the direct supervision of a pharmacist. Pharmacy technicians may also have access to a facsimile machine or computer used to receive original prescription drug orders via facsimile. A pharmacy technician may not perform any of the following tasks: A. Accept an original prescription drug order by telephone; B. Clinically evaluate a patient profile relative to drugs that have or will be dispensed; C. Perform patient counseling or suggesting over-the-counter or prescription products to a patient; D. Make decisions that require the education and professional training of a pharmacist; or E. Sign any federally-required controlled substance or inventory form. close 22. All of the following vaccines can be stored in a refrigerator EXCEPT: a. Influenza b. Hep B c. Rotavirus d. HZV View Answer 22. Answer:(d). CDC Vaccine Storage Recommendations List: Vaccines Require To Be Stored In Referigerator (2 to 8 degrees C): 1. HepA 2. HepB 3. HepA-HepB 4. Hib (Haemophilus influenzae type b) 5. Hib-HepB 6. HPV (Human papilloma virus) 7. Influenza 8. Meningococcal-combinations 9. MMRa* (Measles, mumps, rubella) 10. Pneumococcal 11. Rotavirus 12. Any diphtheria/tetanus toxoid, pertussis combination Vaccines Require To Be Stored In Freezer (-50 to -15 degrees C): 1. VAR Varicella 2. HZV (Herpes Zoster Vaccine) 3. MMRa (Measles, mumps, rubella) 4. MMRV (Measles, mumps, rubella, varicella) * Can be stored in freezer or referigerator. close 23. In a near future, which of the following nasal corticosteroids will be available OTC? a. Nasacort AQ b. Nasonex c. Omnaris d. Flonase e. Vancenase AQ View Answer 23. Answer: (d), Flonase. The U.S. Food and Drug Administration (FDA) has approved Flonase Allergy Relief (fluticasone propionate 50 mcg spray)as an over-the-counter (OTC) treatment for temporary relief of the symptoms of hay fever or upper respiratory allergies. Flonase Allergy Relief is the first and only over-the-counter nasal spray indicated for relief of all nasal and eye-related allergy symptoms3,4 including runny nose, sneezing, itchy nose, nasal congestion and itchy and watery eyes.Flonase Allergy Relief will be available at full prescription strength and to provide 24-hour non-drowsy allergy relief. close 24. Which of the following information about the Ebola virus is/are TRUE? I. There's no cure or vaccine for Ebola. II. Ebola wreaks life-threatening havoc within the body by attacking multiple organ systems at the same time. III. Experts stress that early and intense medical care can greatly improve a person's chances of survival. a. I only b. I and II only c. II and III only d. All View Answer 24. Answer: (d), All. The Ebola virus currently raging in West Africa has a well-earned reputation as one of the world's most deadly illnesses. But experts stress that early and intense medical care can greatly improve a person's chances of survival. There's no cure or vaccine for Ebola, which wreaks life-threatening havoc within the body by attacking multiple organ systems at the same time. Instead, doctors must fall back on the basics of "good meticulous intensive care," supporting the patient and targeting treatment toward the organs that are under attack by the virus. The virus is particularly tough to combat because once it gets into the human body, it attacks so many different tissues. In contrast, most viruses tend to target one specific organ. For example, influenza goes after the respiratory system. Ebola attacks every organ system, including the heart, lungs, brain, liver and kidneys. It even attacks a person's blood, thinning it and causing Ebola's trademark bleeding from multiple orifices. close 25. Which of the following information about Cardioviva is/are TRUE? I. It is a natural, over-the-counter probiotic supplement. II. It is clinically proven to support healthy knee cartilage in adults. III. The probiotic strain in Cardioviva is Lactobacillus acidophilus. a. I only b. I and II only c. III only d. II and III only e. All View Answer 25. (a) I only, Cardioviva is a natural, over-the-counter probiotic supplement. The probiotic strain in Cardioviva is Lactobacillus reuteri. It is clinically proven to support healthy Cholesterol levels in adults. The suggested dose is one 100 mg capsule twice daily with meals. Gas and bloating are commonly reported side effects of Cardioviva. close 26. Which of the following information is/are TRUE about Ebola Hemorrhagic Fever? I. It is a viral hemorrhagic fevers. II. It is a severe, often fatal disease in humans and nonhuman primates. III. It is caused by infection with a virus of the family Filoviridae. a. I only b. I and II only c. III only d. II and III only e. All View Answer 26. Answer:(d), All. Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees). Ebola HF is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection occurs, symptoms usually begin abruptly. The first Ebolavirus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically. There are five identified subspecies of Ebolavirus. Four of the five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d'Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans. close 27. Which of the following statements are TRUE about S.T.E.P.S. Programs? I. All prescriptions prescribed under these programs must be filled within 3 days. II. Prescribe no more than 4 weeks (28 days) of therapy, with no automatic refills. III. All prescribers must register in the S.T.E.P.S. Prescriber Registry via the Prescriber Registration Card that is located in every S.T.E.P.S. folder. a. I only b. I and II only c. II and III only d. All View Answer 27. Answer:II and III only. 1. S.T.E.P.S. stands for System for Thalidomide Education and Prescribing Safety, a proprietary education and restrictive distribution program for Thalomid (Thalidomide). The S.T.E.P.S. program was developed because of the toxicity associated with fetal exposure to Thalomid (Thalidomide) and to minimize the chance of fetal exposure to Thalomid (Thalidomide). 2. Thalidomide in combination with Dexamethasone is indicated for the treatment of patients with newly diagnosed multiple myeloma and Erythema Nodosum Leprosum. 3. All prescribers must register in the S.T.E.P.S. Prescriber Registry via the Prescriber Registration Card that is located in every S.T.E.P.S. folder. 4. Only licensed prescribers may register. They should complete, sign, and return the Prescriber Registration Card. Prescriptions cannot be issued by telephone under this program. 5. Prescribers shall not prescribe more than 4 weeks (28 days) of therapy with no automatic refills. A patient shall be informed that all prescriptions must be filled within 7 days (NOT 3 days). close 28. FDA has recently approved Contrave (Naltrexone hydrochloride and Bupropion hydrochloride extended-release tablets). Contrave is indicated for the treatment of: a. Management of smoking cessation. b. Treatment of seizure. c. Management of chronic weight reduction. d. Treatment of atypical depression. e. Management of an opioid abuse. View Answer 28. Answer: Management of chronic weight reduction. The U.S. Food and Drug Administration today approved Contrave (Naltrexone hydrochloride and Bupropion hydrochloride extendedrelease tablets) as treatment option for chronic weight management in addition to a reducedcalorie diet and physical activity. The drug is approved for use in adults with a body mass index (BMI) of 30 or greater (obesity) or adults with a BMI of 27 or greater (overweight) who have at least one weight-related condition such as high blood pressure (hypertension), type 2 diabetes, or high cholesterol (dyslipidemia). The most common adverse reactions reported with Contrave include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea. close 29. Which of the following active ingredients found in Fosamax Plus D? a. Vitamin D1 b. Vitamin D2 c. Vitamin D3 d. Vitamin D4 View Answer 29. Vitamin D3. Alendronate sodium is a bisphosphonate that acts as a specific inhibitor of osteoclast mediated bone resorption. Bisphosphonates are synthetic analogs of pyrophosphate that bind to the hydroxyapatite found in bone. Fosamax Plus D contains Alendronate sodium, a bisphosphonate, and Cholecalciferol (vitamin D3). Cholecalciferol (vitamin D3) is a secosterol that is the natural precursor of the calciumregulating hormone calcitriol (1,25 dihydroxyvitamin D3). It is indicated for the treatment of osteoporosis in postmenopausal women and to increase bone mass in men with osteoporosis. The recommended dosage is one 70 mg Alendronate/2800 international units vitamin D3 or one 70 mg Alendronate/5600 international units vitamin D3 tablet once weekly. Important Administration Instructions: 1. Take the drug at least one-half hour before the first food, beverage, or medication of the day with plain water only. Other beverages (including mineral water), food, and some medications are likely to reduce the absorption of Alendronate. Waiting less than 30 minutes, or taking Fosamax Plus D with food, beverages (other than plain water) or other medications will lessen the effect of Alendronate by decreasing its absorption into the body. 2. Take Fosamax Plus D upon arising for the day. To facilitate delivery to the stomach and thus reduce the potential for esophageal irritation, a Fosamax Plus D tablet should be swallowed with a full glass of water (6-8 ounces). 3. Patients should not lie down for at least 30 minutes and until after their first food of the day. 4. Fosamax Plus D should not be taken at bedtime or before arising for the day. Failure to follow these instructions may increase the risk of esophageal adverse experiences. Asthenia, diarrhea, abdominal pain, edema, leg cramps and rash are commonly reported side effects of Fosamax Plus D. close 30. What is an elemental calcium amount in Actonel With Calcium? a. 1250 mg b. 500 mg c. 650 mg d. 1000 mg View Answer 30. (b) 500 mg. Risedronate (Actonel) With Calcium is a co-package product containing Risedronate sodium tablets, 35 mg for once weekly dosing and calcium carbonate tablets, USP (1250 mg, equivalent to 500 mg elemental calcium) for daily dosing for the remaining 6 days of the week. Each package contains a 28-day course of therapy. Risedronate (Actonel) is a pyridinyl bisphosphonate that inhibits osteoclast-mediated bone resorption and modulates bone metabolism. It is indicated for the treatment and prevention of osteoporosis in postmenopausal women. Risedronate (Actonel) should be taken at least 30 minutes before the first food or drink of the day other than water. Risedronate (Actonel) should not be taken at the same time as other medications, including calcium. To facilitate delivery to the stomach, Risedronate (Actonel) should be swallowed while the patient is in an upright position and with a full glass of plain water (6 to 8 oz). Patients should not lie down for 30 minutes after taking the medication. Risedronate (Actonel) is not recommended for use in patients with severe renal impairment (creatinine clearance < 30 mL/min). No dosage adjustment is necessary in patients with a creatinine clearance ≥ 30 mL/min or in the elderly. One 1250 mg calcium carbonate tablet (500 mg elemental calcium) orally, taken with food daily on each of the remaining six days (Days 2 through 7 of the 7-day treatment cycle). Arthralgia, myalgia and nausea are commonly reported side effects of Risedronate (Actonel). close 31. Zetia is indicated for the treatment of: a. Hyperlipidemia b. Depression c. Diabetes mellitus d. Gout View Answer 31. Hyperlipidemia. Ezetimibe (Zetia), administered alone, is indicated as adjunctive therapy to diet for the reduction of elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and nonhigh- density lipoprotein cholesterol (non-HDL-C) in patients with primary (heterozygous familial and nonfamilial) hyperlipidemia. The combination of Ezetimibe (Zetia) and Atorvastatin or Simvastatin is indicated for the reduction of elevated total-C and LDL-C levels in patients with Homozygous Familial Hypercholesterolemia (HoFH). It is also indicated as adjunctive therapy to diet for the reduction of elevated sitosterol and campesterol levels in patients with homozygous familial sitosterolemia. The recommended dose of Ezetimibe (Zetia) is 10 mg once daily with or without food. Liver enzyme abnormalities, rhabdomyolysis and myopathy are commonly reported side effects of Zetia. close 32. The prescription for Eplerenone can be filled by selecting which of the following? a. Proscar b. Zyflo c. Inspra d. Augmentin View Answer 32. Answer: Eplerenone (Inspra) is a blocker of aldosterone binding at the mineralocorticoid receptor. It is available for oral administration contains 25 mg or 50 mg of Eplerenone (Inspra). It is indicated for the treatment of Congestive Heart Failure Post-Myocardial Infarction and Hypertension. Treatment should be initiated at 25 mg once daily and titrated to the recommended dose of 50 mg once daily, preferably within 4 weeks as tolerated by the patient. Eplerenone (Inspra) may be administered with or without food. Serum potassium should be measured before initiating Eplerenone (Inspra) therapy, within the first week, and at one month after the start of treatment or dose adjustment. Serum potassium should be assessed periodically thereafter. For hypertensive patients receiving moderate CYP3A4 inhibitors (e.g., erythromycin, saquinavir, verapamil, and fluconazole), the starting dose of Eplerenone (Inspra) should be reduced to 25 mg once daily. In all patients taking Eplerenone (Inspra) who start taking a moderate CYP3A4 inhibitor, check serum potassium and serum creatinine in 3-7 days. Hyperkalemia, dizziness, diarrhea and abdominal pain are reported side effects of Eplerenone (Inspra). close 33. Amiodarone is indicated for the treatment of: a. Hypertension b. Arrhythmia c. Depression d. Hyperthyroidism e. Seizure View Answer 33. Answer:b. Amiodarone (Cordarone) is a member of a class of antiarrhythmic drugs with predominantly Class III (Vaughan Williams' classification) effects, available for oral administration as pink, scored tablets containing 200 mg of Amiodarone hydrochloride. Amiodarone (Cordarone) contains 37.3% iodine by weight. Therefore, it shall be carefully prescribed to patients suffering from hypo-hyper-thyroidism. Because of its life-threatening side effects and the substantial management difficulties associated with its use, Amiodarone (Cordarone) is indicated only for the treatment of the following documented, life-threatening recurrent ventricular arrhythmias when these have not responded to documented adequate doses of other available antiarrhythmics or when alternative agents could not be tolerated. 1. Recurrent ventricular fibrillation. 2. Recurrent hemodynamically unstable ventricular tachycardia. Loading doses of 800 to 1,600 mg/day are required for 1 to 3 weeks (occasionally longer) until initial therapeutic response occurs. Administration of Amiodarone (Cordarone) in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs. If side effects become excessive, the dose should be reduced. When adequate arrhythmia control is achieved, or if side effects become prominent, Amiodarone (Cordarone) dose should be reduced to 600 to 800 mg/day for one month and then to the maintenance dose, usually 400 mg/day. Since grapefruit juice is known to inhibit CYP3A4-mediated metabolism of oral amiodarone in the intestinal mucosa, resulting in increased plasma levels of Amiodarone, grapefruit juice should not be taken during treatment with oral Amiodarone. Since amiodarone is a substrate for CYP3A4 and CYP2C8, drugs/substances that inhibit CYP3A4 may decrease the metabolism and increase serum concentrations of Amiodarone. Hepatic injury, hypothyroidism, hyperthyroidism, tremor, poor coordination and pulmonary fibrosis are commonly reported side effects of Amiodarone (Cordarone). close 34. Which of the following is the first combination pill approved to treat chronic HCV genotype 1 infection? a. Vitekta b. Tybost c. Movantik d. Harvoni e. Contrave View Answer 34. Answer: (d). Ledipasvir and Sofosbuvir (Harvoni) . Ledipasvir and Sofosbuvir (Harvoni) is the first combination pill approved to treat chronic HCV genotype 1 infection. It is also the first approved regimen that does not require administration with interferon or ribavirin, two FDAapproved drugs also used to treat HCV infection. Ledipasvir and Sofosbuvir (Harvoni) is a once-daily NS5A inhibitor and nucleotide analog polymerase inhibitor fixed-dose combination for the treatment of chronic hepatitis C genotype 1 infection. Both drugs in Harvoni interfere with the enzymes needed by HCV to multiply. Sofosbuvir is a previously approved HCV drug marketed under the brand name Sovaldi. Harvoni also contains a new drug called ledipasvir. Ledipasvir and Sofosbuvir (Harvoni) is the third drug approved by the FDA in the past year to treat chronic HCV infection. The FDA approved Simeprevir (Olysio) in November 2013 and Sofosbuvir (Sovaldi) in December 2013. The most common side effects reported in clinical trial participants were fatigue and headache. close 35. The active ingredient found in Tavist ND is/are: I. Clemastine II. Pseudoephedrine III. Loratadine a. I only b. III only c. I and II only d. II and III only e. All View Answer 35. Answer:(b), Loratadine. Normally, the active ingredient found in Tavist is Clemastine. It is indicated for the treatment of seasonal and perennial allergic rhinitis; and chronic idiopathic urticaria. The recommended dose is 1.34 mg orally twice a day. Dosage may be increased as required, but not to exceed 2.68 mg orally 3 times a day. Sedation, sleepiness, dizziness, disturbed coordination, epigastric distress, thickening of bronchial secretions are commonly reported side effects of Clemastine (Tavist). The active ingredient found in Tavist ND is 10 mg Loratadine. close 36. A pharmacy technician receives a new prescription. The prescription reads: Exenatide 2mg SC once a week for type II diabetes x 30 days. Refill: 5 times Which of the following is the most appropriate action by a pharmacy technician? a. Fill it by selecting Simponi. b. Fill it by selecting Byetta. c. Fill it by selecting Bydureon. d. Fill it by selecting Fosamax. e. Fill it by selecting Combivir. View Answer 36. Answer:(c). The active ingredient found in Bydureon is Exenatide indicated for the treatment of type II diabetes mellitus. It is an incretin mimetic agent. Incretins, such as glucagon-like peptide-1 (GLP-1), enhance glucose-dependent insulin secretion and exhibit other antihyperglycemic actions following their release into the circulation from the gut. Bydureon is a GLP-1 receptor agonist that enhances glucose-dependent insulin secretion by the pancreatic betacell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying. Bydureon is an extended-release formulation of Exenatide, administered as an injection once every 7 days (weekly). It is also available under the trade name Byetta. Byetta is an immediate release solution of Exenatide administered by SC route. Byetta should be initiated at 5 mcg administered twice daily at any time within the 60-minute period before the morning and evening meals (or before the two main meals of the day, approximately 6 hours or more apart). Nausea, vomiting, diarrhea, dyspepsia, injection site reactions, constipation and hypoglycemia are commonly reported side effects of Bydureon. close 37. Coricidin HBP Night is contraindicated to use in patients suffering from: I. Hypertension II. Glaucoma III. BPH a. I only b. I and II only c. II and III only d. All View Answer 37. Answer: (c) II and III only. All Coricidin HBP (High Blood Pressure) products are free of decongestants and therefore they can safely be used in patients suffering from high blood pressure. The active ingredients found in Coricidin HBP Night are 500mg Acetaminophen, 10mg Dextromethorphan Hydrobromide and 2mg Chlorpheniramine. The active ingredients found in Coricidin HBP Day are 10mg Dextromethorphan Hydrobromide and 200mg Guaifenesin. It is indicated for the symptomatic relief of cold and cough, runny nose and sneezing, and bronchial irritation. Since Coricidin HBP Night contains anti-histamine (Chlorpheniramine), it shall be carefully prescribed to patients suffering from glaucoma or BPH. The recommended dose is 1 tablet every 6 hours, not more than 4 tablets in 24 hours. Nausea, vomiting, sedation, drowsiness, dizziness and blurred vision are commonly reported side effects of the drug. close 38. The prescription for Esomeprazole can be filled by selecting: a. Prilosec b. Tagamet c. Protonix d. Axid e. Nexium View Answer 38. Answer: (e) Esomeprazole (Nexium). Esomeprazole (Nexium) is the S-Isomer of Omeprazole (Prilosec). It is classified as a Proton Pump Inhibitor (PPI). It is indicated for the treatment of duodenal ulcer, gastric ulcer, Zollinger Ellison Syndrome and GERD. The OTC version of Esomeprazole (Nexium) 24 HR is also commonly known as “Purple Pill”. It is supplied in delayed-release capsules and in packets for a delayed-release oral suspension. Each delayed-release capsule contains 20 mg, or 40 mg of Esomeprazole (Nexium). Each packet of Esomeprazole (Nexium) for delayed-release oral suspension contains 2.5 mg, 5 mg, 10 mg, 20 mg, or 40 mg of Esomeprazole (Nexium), in the form of the same enteric-coated granules used in Esomeprazole (Nexium) delayed-release capsules. The recommended dose is 20 to 40 mg once daily for 4 to 8 weeks. Diarrhea, nausea, flatulence, abdominal pain, constipation, and dry mouth are commonly reported side effects of Esomeprazole (Nexium). close 39. Which of the following is commonly known as “Z-Drug”? a. Omeprazole b. Olanzapine c. Zolpidem d. Nizatidine e. Doxylamine View Answer 39. Answer: (c) The Z-drugs, which include Eszopiclone (Lunesta), Zolpidem (Ambien), and Zaleplon (Sonata), are benzodiazepine receptor agonists. That means they work in a similar way to the benzodiazepine drugs inside the brain. They are GABA agonists meaning they somewhat mimic the action of gamma-Aminobutyric acid, the inhibitory neurotransmitter and thereby induce sleepiness. These drugs are sometimes referred to as non-benzodiazepine hypnotics or just nonbenzodiazepines. That’s a dumb name, if you ask us. Too unspecific and vague, especially if you are not in the context of sleep medicine. Further, even within sleep medicine, there are compounds that are non-benzodiazepine hypnotics that would not be considered part of this class: antihistamines and Ramelteon, for instance. One problem is that the chemists don’t have a category that these drugs all fall into which is narrow enough to signify what medical practitioners are talking about. These drugs are in the categories pyrazolopyrimidines, imidazopyridines or cyclopyrrones, but they are not all in the same category. Therefore, we prefer the term Z-drugs. The generic names for these drugs all contain the letter Z, and it is as good a name as any. close 40. Interferons are proteins produced by tumor cells or host cells that are infected with viruses, bacteria and other unknown nucleic acids. Interferons that are obtained from lymphocytes are generally classified as: a. Alpha-interferon b. Beta-interferon c. Gamma-interferon d. Delta-interferon e. Sigma-interferon View Answer 40. Answer: (c) Interferons are proteins produced by tumor cells or host cells that are infected with viruses, bacteria and other unknown nucleic acids. Interferons also activate other cells that serve as part of the immune system and destroy invading pathogens. Interferons are classed as: alpha (from white cells), beta (from fibroblasts) and gamma (from lymphocytes). Interferons enhance the immune system in many ways so can be used to treat different conditions involving the immune system. Interferons used therapeutically are manufactured using recombinant DNA technology. Interferon alphas are used to treat viral infections (chronic hepatitis, human papillomavirus) and treating cancer (hairy cell leukemia, AIDS related - Kaposi sarcoma, malignant melanoma). Interferon betas are used to treat or slow down the progression of multiple sclerosis. Interferon gamma is used to treat chronic granulomatous disease. close 41. For I.V light sensitive drugs, Amber Bags offer a fast, cost effective solution. They effectively filter out ___% of the rays in the ultraviolet spectrum, providing the required safety. View Answer 41. Answer: 96.7%. Ultraviolet light can cause oxidation, hydrolysis and loss of potency to sensitive meds in solution. This loss can be greatly minimised by protecting from light. Amber glass protection is expensive, foil wrapping is cumbersome and time consuming. Amber Bags offer a fast, cost effective solution. They effectively filter out 96.7% of the rays in the ultraviolet spectrum, providing the required safety. close 42. According to ADA 2015 guidelines, the value of A1C% 10 reflects the mean plasma glucose level: a. 126 mg/dl b. 183 mg/dl c. 240 mg/dl d. 269 mg/dl e. 298 mg/dl View Answer 42. Answer: (c) 240 mg/dl. Below is the chart that describes the correlation between A1C% and blood glucose concentration in mg/dl. close 43. Which of the following is/are considered Diabetes Risk Factor(s)? a. Physical inactivity. b. Women who delivered a baby greater than 9 lb. c. First-degree relative with diabetes. d. High-risk race/ethnicity e. Hypertension ≥ 140/90 mm Hg A. a, c, d and e only B. b only C. All D. a, c and d only E. e only View Answer 43. Answer: (C) All. Diabetes Risk Factors: 1. Physical inactivity. 2. First-degree relative with diabetes. 3. Women who delivered a baby >9 lb or were diagnosed with GDM. 4. High-risk race/ethnicity. 5. A1C ≥5.7%, Impaired Glucose Tolerance (IGT), or Impaired Fasting Glucose (IFG) on previous testing. 6. Hypertension (≥140/90 mm Hg or on therapy). 7. HDL-C <35 mg/dL ± TG >250 mg/dL. close 44. The terms "prescription" and "drug order" do not include an order for medication requiring a prescription to be dispensed, which is provided for the immediate administration to the ultimate user or recipient. True or False View Answer 44. Answer: True. The terms "prescription" and "drug order" do not include an order for medication requiring a prescription to be dispensed, which is provided for the immediate administration to the ultimate user or recipient. close 45. Mifepristone is indicated for the treatment of: a. Diabetes b. Thyroid c. Pregnancy Termination d. Hypertension e. ADHD View Answer 45. Answer: Mifepristone (Mifeprex) is a synthetic steroid with antiprogestational effects. Mifepristone (Mifeprex) is indicated for the medical termination of intrauterine pregnancy through 49 days' pregnancy. For purposes of this treatment, pregnancy is dated from the first day of the last menstrual period in a presumed 28 day cycle with ovulation occurring at mid-cycle. The duration of pregnancy may be determined from menstrual history and by clinical examination. Ultrasonographic scan should be used if the duration of pregnancy is uncertain, or if ectopic pregnancy is suspected. Any intrauterine device (“IUD”) should be removed before treatment with Mifepristone (Mifeprex) begins. Patients taking Mifepristone (Mifeprex) must take 400 μg of Misoprostol two days after taking Mifepristone (Mifeprex) unless a complete abortion has already been confirmed before that time. Day One: Mifeprex Administration Patients must read the MEDICATION GUIDE and read and sign the PATIENT AGREEMENT before Mifeprex is administered. Three 200 mg tablets (600 mg) of Mifeprex are taken in a single oral dose. Day Three: Misoprostol Administration The patient returns to the health care provider two days after ingesting Mifeprex. Unless abortion has occurred and has been confirmed by clinical examination or ultrasonographic scan, the patient takes two 200 μg tablets (400 μg) of misoprostol orally. During the period immediately following the administration of Misoprostol, the patient may need medication for cramps or gastrointestinal symptoms. The patient should be given instructions on what to do if significant discomfort, excessive vaginal bleeding or other adverse reactions occur and should be given a phone number to call if she has questions following the administration of the Misoprostol. In addition, the name and phone number of the physician who will be handling emergencies should be provided to the patient. Day 14: Post-Treatment Examination Patients will return for a follow-up visit approximately 14 days after the administration of Mifeprex. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred. Pregnancy termination by surgery is recommended in cases when Mifepristone (Mifeprex) and misoprostol fail to cause termination of intrauterine pregnancy. Serious and sometimes fatal infections and bleeding occur very rarely following spontaneous, surgical, and medical abortions, including following Mifepristone (Mifeprex) use. Ensure that the patient knows whom to call and what to do, including going to an Emergency Room if none of the provided contacts are reachable, if she experiences sustained fever, severe abdominal pain, prolonged heavy bleeding, or syncope, or if she experiences abdominal pain or discomfort or general malaise (including weakness, nausea, vomiting or diarrhea) more than 24 hours after taking Misoprostol. close 46. The cryogenic vessel shall be properly labeled and color coded according to the medical gas contained in the vessel. Which of the following color-code is used for medical oxygen? a. Yellow b. Green c. Gray d. Brown View Answer 46. Answer: Green. As used in this section, "cryogenic vessel" means an insulated metal container in the form of a cylinder or other design used to hold gases that have been liquefied by extreme reductions in temperature. (C). Each cryogenic vessel subject to this section shall meet the following requirements: (1). The vessel shall be properly labeled according to the medical gas contained in the vessel. (2). The vessel shall be color coded as follows: (a). Air - yellow; (b). Carbon dioxide - gray; (c). Cyclopropane - orange; (d). Helium - brown; (e). Nitrogen - black; (f). Nitrous oxide - blue; (g). Oxygen - green. The colors specified in this division shall not be used for any medical gas other than those specified in this division. close 47. Using the NARxCHECK, a pharmacist is receiving a scaled score of 650 for a particular patient. Which of the following statements based on this scaled score is TRUE? a. Very low risk for misuse b. low risk for misuse c. moderate risk for misuse d. High risk for misuse View Answer 47. Answer: High risk for misuse, [https://www.nabp.net]. NARXCHECK is an automatic prescription drug abuse assessment and management tool for health care providers. Once integrated into the facility's system, NARxCHECK automatically queries the state PMP database to generate a report that includes a score for three different drug classes: narcotics, sedatives, and stimulants. These three-digit scores (000-999) help practitioners to decide whether or not they need to review a patient history before prescribing additional medications. The score is easy to read using the following guidelines: 1. Less than 200 = Be confident - low risk for misuse. 2. 200 - 500 = Be curious - moderate risk for misuse. 3. Greater than 500 = Be cautious - higher risk for misuse. close 48. Levetiracetam is indicated for the treatment of: a. Diabetes b. Hypertension c. Seizure d. Parkinson’s e. Depression View Answer 48(c). Levetiracetam (Spritam) is indicated for the treatment of partial onset seizures, myoclonic seizures and primary generalized tonic-clonic seizures in adults and children with epilepsy. Spritam utilizes Aprecia's proprietary ZipDose® Technology platform, a groundbreaking advance that uses three-dimensional printing (3DP) to produce a porous formulation that rapidly disintegrates with a sip of liquid.1 While 3DP has been used previously to manufacture medical devices, this approval marks the first time a drug product manufactured with this technology has been approved by the FDA. ZipDose Technology enables the delivery of a high drug load, up to 1,000 mg in a single dose. As a result, Spritam enhances the patient experience - administration of even the largest strengths of Levetiracetam (Spritam) with just a sip of liquid. In addition, with Spritam there is no measuring required as each dose is individually packaged, making it easy to carry this treatment on the go. The recommended daily dose is 1000 to 3000 mg per day. Sleepiness, weakness, dizziness, infection, tiredness, acting aggressive, nasal congestion, decreased appetite, and irritability are commonly reported side effects of Levetiracetam (Spritam). Levetiracetam is also available under the trade names Keppra and Elepsia.