PTCE Pharmacy Technician Certification (CPhT) Exam Question and Answers

Multiple-dose vials (MDVs)containpreservativesto inhibit microbial growth. These vials are designed formultiple withdrawalsover time, increasing the risk of contamination. Preservatives, such asbenzyl alcohol or phenol, help prevent bacterial or fungal contamination after repeated needle insertions.

A. stability and compatibility→ Incorrect. Preservatives do not inhibit drug stability; they prevent microbial contamination.

B. sorption and leaching→ Incorrect. Sorption (adsorption/absorption of drugs onto container surfaces) and leaching (release of chemicals from containers) are unrelated to preservatives.

D. synergistic reactions→ Incorrect. Synergistic reactions refer to drug interactions, not contamination prevention.

Incorrect Answer Choices:Pharmacy Technician References:

PTCB PTCE Exam Content Outline (Sterile and Non-Sterile Compounding)

USP <797> Guidelines for Sterile Compounding

American Society of Health-System Pharmacists (ASHP) Guidelines on Multiple-Dose Vials

Mosby’s Pharmacy Technician Exam Review

Mycophenolate is an immunosuppressant that can cause severe birth defects, requiring a REMS program to ensure patient safety.

📌Reference:FDA REMS Drug List, PTCE Study Guide.

Experiencingphotosensitivity(increased sensitivity to sunlight) as a result of takingciprofloxacinis an example of anadverse drug reaction (ADR). Thisunexpectedandundesirableeffect occurs in some individuals due tofluoroquinolones causing cellular damage from UV exposure.

A. Intended effect→ Incorrect; the intended effect of ciprofloxacin isbacterial infection treatment, not photosensitivity.

C. Synergistic effect→ Incorrect; asynergistic effectoccurs whentwo drugs work togetherto produce a greater effect, which is not the case here.

D. Anaphylactic reaction→ Incorrect;anaphylaxisis asevere allergic reactionwithrespiratory distress, hypotension, and swelling, not photosensitivity.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Medication Safety & Side Effects)

Lexicomp Drug Monograph for Ciprofloxacin

FDA Fluoroquinolone Safety Warnings

Comprehensive and Detailed Step-by-Step Explanation:

Anear miss(also called aclose call) occurs whenan error is detected and corrected before it reaches the patient.Since the incorrect strength was caught before dispensing, this is classified as a near miss.

📌Explanation of Answer Choices:✅A. Near miss→Correct.The error wasidentified before reaching the patient, preventing harm.❌B. Adverse drug reaction→ Incorrect.An ADR occurs when a patient experiences an unintended effect from a properly administered drug.❌C. Drug allergy→ Incorrect.An allergic reaction involves the immune system (e.g., rash, anaphylaxis), not a dispensing mistake.❌D. Sentinel event→ Incorrect.Sentinel events involve severe patient harm or death (e.g., wrong drug leading to death).

📌Reference:

ISMP Guidelines on Error Reporting

PTCB Exam: Medication Safety & Risk Management

Pharmacy technicians in certain states may initiate the transfer of non-controlled prescriptions under pharmacist supervision.

Controlled substance transfers MUST be done by pharmacists.

📌Reference:State Board of Pharmacy Regulations.

Risperidone (Risperdal oral solution)is anatypical antipsychoticused to treatschizophrenia, bipolar disorder, and autism-related irritability.

Itsoral liquid formulationmust be storedin the refrigerator (between 2°C and 8°C or 36°F to 46°F)to maintain stability.

If left at room temperature for an extended period, theactive ingredients can degrade, reducing the medication's effectiveness.

Storage Considerations for Other Medications:

Gabapentin (Neurontin liquid formulation):Must be refrigerated.✅

Sertraline (Zoloft oral solution):Stored at room temperature.❌

Aripiprazole (Abilify liquid formulation):Stored at room temperature.❌

📌Reference:Manufacturer’s storage guidelines,USP Chapter <797>for compounded sterile preparations.

Therapy duration (length of treatment)must be specified, especially forantibiotics, to ensureappropriate treatment completion and prevent antibiotic resistance.

Typical duration for amoxicillin:

7–10 days for infections

5 days for strep throat

📌Reference:CDC Antibiotic Prescribing Guidelines, PTCE Prescription Requirements.

Comprehensive and Detailed Step-by-Step Explanation:

The FDA Orange BookprovidesTherapeutic Equivalence (TE) codesto indicate whether a generic drug isequivalentto a brand-name drug.

📌Explanation of Answer Choices:✅B. The Orange Book→Correct.Liststherapeutic equivalence (TE) codesfor FDA-approved generics.❌A. Remington→ Incorrect.Pharmacy reference book, not used for TE codes.❌C. SDSs→ Incorrect.Used for chemical safety, not drug equivalence.❌D. Package insert→ Incorrect.Does not contain TE codes.

📌Reference:

FDA Orange Book

PTCB Exam: Therapeutic Equivalence

Lot numbers are required for drug recalls and tracking purposes.

Prescription numbers are pharmacy-specific and not on manufacturer packaging.

📌Reference:FDA Drug Labeling Requirements, USP Manufacturing Guidelines.

TheFDA classifies recalls into three levels, withClass III being the least severe:

Class I Recall→Most severe→ Issued when a drugmay cause serious harm or death.

Class II Recall→Moderate severity→ The drug may causetemporary or medically reversible adverse effects.

Class III Recall→Least severe→ The productis unlikely to cause harm but violates FDA regulations(e.g., labeling errors, minor packaging issues).

A. Is issued when there is a reasonable probability that the product will cause serious adverse health consequences or death.❌→Incorrect

Describes a Class I recall, not Class III.

B. Is initiated by the FDA if a manufacturer has violated the adulteration provisions of the Food, Drug, and Cosmetic Act (FDCA).❌→Incorrect

FDA action due to adulteration typically leads to Class I or Class II recalls, depending on severity.

C. Occurs when a product may cause temporary or medically reversible adverse health consequences.❌→Incorrect

Describes a Class II recall, not Class III.

FDA Drug Recall Guidelines– Defines Class I, II, and III recalls.

PTCB PTCE Exam Content Outline– Covers recall classifications and pharmacy responsibilities.

FDA Enforcement Report– Lists real-world examples of Class III recalls (e.g.,mislabeling, incorrect expiration dates).

Why Not the Other Options?Key References:

Aricept (Donepezil) is a cholinesterase inhibitorused for treatingmild, moderate, or severe Alzheimer's disease dementia.

Itworks by increasing acetylcholine levels in the brain, improving memory and cognitive function.

FDA-approved for all stages of Alzheimer’s disease.

B. Azilect❌→Used for Parkinson’s disease, not Alzheimer's.

Azilect (Rasagiline) is a monoamine oxidase-B (MAO-B) inhibitorthat helps manage Parkinson’s symptoms but is not indicated for dementia.

C. Ambien❌→Used for insomnia, not Alzheimer's dementia.

Ambien (Zolpidem) is a sedative-hypnotic for sleep disordersand does not treat cognitive decline.

D. Atacand❌→Used for hypertension, not dementia.

Atacand (Candesartan) is an angiotensin receptor blocker (ARB) used to treat high blood pressure and heart failure.

FDA Approved Uses for Donepezil (Aricept)– Confirms its indication for all stages of Alzheimer’s disease.

Alzheimer’s Association Treatment Guidelines– Listscholinesterase inhibitors as first-line therapy for dementia.

PTCB PTCE Exam Content Outline– Covers pharmacologic treatments for cognitive disorders.

Why Not the Other Options?Key References:

Comprehensive and Detailed Step-by-Step Explanation:

Colchicine (Colcrys, Mitigare)is used to treatacute gout flaresbyreducing inflammation caused by uric acid crystalsin the joints.

📌Explanation of Answer Choices:✅B. Gout flares→Correct.Colchicine is ananti-inflammatory drug specific to gout.❌A. Hyperlipidemia→ Incorrect.Statins are used for hyperlipidemia.❌C. Hypothyroidism→ Incorrect.Levothyroxine is used for hypothyroidism.❌D. Peripheral neuropathy→ Incorrect.Gabapentin or pregabalin are used for nerve pain.

📌Reference:

American College of Rheumatology (ACR) Gout Treatment Guidelines

PTCB Exam: Pharmacology for Technicians

Lorazepam oral concentrate is a high-potency liquid formulation often dispensed in 2 mg/mL. Due to its strength and risk of dosing errors, it must be dispensed with a calibrated oral syringe for accurate dosing, especially in pediatric or geriatric patients.

From Pharmacy Technician Certification Exam Review:

“Concentrated oral liquids should always be dispensed with calibrated measuring devices to prevent overdose or underdose.”

Other options:

Enoxaparin – subcutaneous injection

Albuterol/ipratropium – inhalation

Polyethylene glycol 3350 – powder mixed with water (no syringe required)

Comprehensive and Detailed Step-by-Step Explanation:

Amedication erroroccurs when a patientreceives the wrong drug, dose, or administration method, which can result inadverse effects.High-risk medicationsinclude:

Injectable insulins(risk of hypoglycemia, coma).

Antineoplastic (chemotherapy) agents(toxic at incorrect doses).

Oral anticoagulants (e.g., warfarin, apixaban)(can causefatal bleeding).

📌Explanation of Answer Choices:✅A. Topical creams→Correct.While topical medicationscan cause localized irritation or allergies, theyrarely cause systemic toxicitywhen used improperly.❌B. Injectable insulins→ Incorrect.Can cause life-threatening hypoglycemia.❌C. Antineoplastic agents→ Incorrect.High risk of toxicity and organ damage.❌D. Oral anticoagulants→ Incorrect.Incorrect dosing can lead to fatal bleeding.

📌Reference:

ISMP List of High-Alert Medications

FDA Guidelines on Medication Errors

PTCB Exam: Medication Safety & Risk Management

Lyrica (pregabalin) is an anticonvulsant that causes drowsiness, dizziness, and sedation.

It is commonly prescribed for nerve pain, epilepsy, and fibromyalgia.

📌Reference:FDA Pregabalin Drug Label, PTCE Medication Safety Guide.

Schedule III & IV drugs can be refilled up to 5 times within 6 months from the date written.

After 6 months or 5 refills, a new prescription is required.

📌Reference:DEA Controlled Substance Act (21 CFR 1306).

Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug (NSAID) available in:

Oral tablets

Injectable IM/IV formsIt’s commonly used for short-term pain relief.

The others:

Dobutamine – IV only (used in cardiac settings)

Benzonatate – Oral capsules only (cough suppressant)

Cefazolin – Injectable only (no oral form; used in perioperative antibiotic prophylaxis)

From Mosby’s Pharmacy Technician:

“Ketorolac is one of the few NSAIDs that comes in both oral and parenteral forms, making it useful for step-down therapy in pain management.”

Withdrawal occurs when a drug-dependent individual stops taking the drug abruptly, leading to physiological symptoms.

Example:Opioid withdrawal can cause nausea, sweating, and tremors.

Withdrawal differs from addiction, which involvescompulsive drug-seeking behavior.

📌Reference:DEA Controlled Substance Abuse Guide, PTCE MedicationSafety Guidelines.

Comprehensive and Detailed Step-by-Step Explanation:

Hand hygiene is the single most effective way to prevent infection.Washing hands withsoap and water for at least 30 secondsremoves bacteria, viruses, and contaminants.

📌Explanation of Answer Choices:✅D. Wash hands for 30 seconds→Correct.Best method toreduce the spread of infection.❌A. Wear powdered latex gloves→ Incorrect.Powdered gloves can increase contamination risk.❌B. Clean counting trays after use→ Incorrect.Important, but handwashing is more effective.❌C. Put on shoe covers→ Incorrect.Useful in sterile environments, but not as effective as handwashing.

📌Reference:

CDC Hand Hygiene Guidelines

USP <797>: Infection Control in Pharmacies

Risperdal Consta (risperidone long-acting injection) is an antipsychotic medication used to treat schizophrenia and bipolar disorder. It is supplied as a powder that must be reconstituted with a diluent before administration as an intramuscular (IM) injection.

According to the manufacturer’s storage guidelines:

Refrigeration Requirement:Risperdal Consta should be stored in a refrigerator (36°F to 46°F or 2°C to 8°C) to maintain stability.

Room Temperature Stability:If removed from refrigeration, Risperdal Consta can remain stable at room temperature (≤77°F or 25°C)for up to 14 days. After this period, the product should not be used if it has not been administered.

This stability information is critical for pharmacy technicians handling the medication, as it ensures proper storage and prevents medication degradation, which can affect efficacy and safety.

Risperdal Consta (Janssen Pharmaceuticals) Prescribing Information– Official manufacturer guidelines.

PTCB PTCE Exam Content Outline – Medication Storage and Stability– Covers best practices for proper drug storage and handling.

United States Pharmacopeia (USP) Standards– Guidelines on temperature control for pharmaceutical products.

Pharmacy Technician References:This information is essential for pharmacy technicians preparing Risperdal Consta for dispensing or administration, ensuring compliance with manufacturer and regulatory guidelines.

Lisinopril is anangiotensin-converting enzyme (ACE) inhibitor, commonly used forhypertension (high blood pressure)andheart failure. A well-known side effect of ACE inhibitors is apersistent dry, hacking cough.

The cough is caused bybradykinin accumulation, which occurs due to ACE inhibition.

This coughdoes not respond to cough suppressantsand can be bothersome for patients.

If the cough is severe, thepharmacist may recommend switching to an angiotensin II receptor blocker (ARB) such as losartan, which does not cause this side effect.

B. Purchase fexofenadine for seasonal allergies❌→ No significant interaction between lisinopril and fexofenadine.

C. Mention that they have lowered their cholesterol❌→ Cholesterol levels do not affect lisinopril’s mechanism of action.

D. Report that their blood pressure has been normal lately❌→ This is expected with effective treatment and does not require pharmacist intervention unless the patient wants to discontinue the medication.

PTCB PTCE Exam Content Outline– Covers drug interactions, side effects, and patient counseling.

American Heart Association (AHA) Guidelines– Lists ACE inhibitor side effects, including dry cough.

FDA Lisinopril Medication Guide– Mentions dry cough as a common adverse effect requiring pharmacist consultation.

Why is the Cough Significant?Why Not the Other Options?Key References:

The abbreviation"PO"means"by mouth" (per os).

The abbreviation"ac"stands for"before meals" (ante cibum).

The phrase"daily for 14 days"indicates that the patient should take the medication once a day for a total of 14 days.

Thus, the correct label instructions should be:"Take one capsule by mouth before a meal once daily for 14 days."

PTCB PTCE Exam Content Outline – Prescription Interpretation– Covers standard medical abbreviations.

ISMP (Institute for Safe Medication Practices) List of Common Pharmacy Abbreviations– Defines "PO" (by mouth) and "ac" (before meals).

USP Medication Labeling Standards– Ensures clear and accurate patient instructions.

Pharmacy Technician References:

Risk Evaluation and Mitigation Strategies (REMS)areFDA-required programsto ensure that thebenefits of certain medications outweigh their risks. REMS programsrestrict prescribing, dispensing, and monitoringdue to the potential for serious side effects or misuse.

Suboxoneis used foropioid dependenceand containsbuprenorphine, apartial opioid agonist, which can causeaddiction, misuse, and respiratory depressionif used improperly.

REMS Requirements for Suboxone:

Prescriber Certification:Only specially certified providers can prescribe Suboxone.

Patient Education:Patients must be informed about the risks of misuse, overdose, and dependence.

Limited Dispensing:Pharmacists must ensure prescriptions meet REMS criteria before dispensing.

A. Xarelto (Rivaroxaban).→ Incorrect. While Xarelto is an anticoagulant, it isnot under REMS.

C. Warfarin.→ Incorrect. Warfarin requires monitoring butdoes not have a REMS program.

D. Haloperidol.→ Incorrect. Haloperidol is an antipsychotic, but itdoes not have a REMS program.

FDA REMS Program List (www.accessdata.fda.gov).

Suboxone REMS Guidelines (www.suboxonerems.com).

PTCB PTCE Exam Content Outline – REMS and Medication Safety.

Mosby’s Pharmacy Technician: Principles and Practice – REMS Regulations.

Why Is Suboxone (Buprenorphine/Naloxone) Under REMS?Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

Comprehensive and Detailed Step-by-Step Explanation:

To find how muchmentholis needed:

(0.25100)×600g=1.5g=1500mg\left( \frac{0.25}{100} \right) \times 600 g = 1.5 g = 1500 mg(1000.25​)×600g=1.5g=1500mg

📌Explanation of Answer Choices:✅C. 1500 mg→Correct.0.25% of 600 g = 1500 mg.❌A. 15 mg→ Incorrect.Calculation error.❌B. 150 mg→ Incorrect.Incorrect decimal placement.❌D. 15 g→ Incorrect.Overestimated.

📌Reference:

USP <795>: Pharmaceutical Compounding – Nonsterile Preparations

PTCB Exam: Pharmaceutical Calculations

Formula: Dose ÷ Concentration = Volume (mL)

30 mg ÷ 20 mg/mL = 1.5 mL

📌Reference:PTCB Calculation Guide, Pharmacy Dosage Conversions.

Root-Cause Analysis (RCA)is asystematic processused inhealthcare and pharmacy settingstoidentify the underlying factors that contributed to an error or safety event. RCA helps pharmacy staff determinewhy a problem occurredand implement corrective actions toprevent future occurrences.

Identify the problem or event.

Gather and analyze data.

Determine the root cause(s).

Develop and implement corrective actions.

Monitor for improvement and prevention of recurrence.

A. Determine which medication should be dispensed→ Incorrect; RCA is focused onerror investigation, not routine dispensing decisions.

B. Decipher prescriber handwriting during order entry→ Incorrect; this is not the purpose of RCA, though poor handwriting may be identified as a contributing factor in an error.

C. Increase pharmacy revenue and inventory turnover→ Incorrect; RCA is aboutpatient safety and error prevention, not financial performance.

Steps in Root-Cause Analysis (RCA):Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) RCA Guidelines

FDA Medication Error Prevention Strategies

PTCB PTCE Exam Content Outline (Quality Assurance & Medication Safety)

Comprehensive and Detailed Step-by-Step Explanation:

The FDA requires patient package inserts (PPIs) for certain medications, including oral contraceptives like norethindrone/ethinyl estradiol.

📌Explanation of Answer Choices:

✅B. Norethindrone/Ethinyl Estradiol → Correct. Oral contraceptives must include a PPI with risk information.

❌A. Sulfamethoxazole/Trimethoprim → Incorrect. Does not require a package insert.

❌C. Triamterene/HCTZ → Incorrect. A diuretic, no required PPI.

❌D. Emtricitabine/Tenofovir Disoproxil → Incorrect. A PPI is required only for certain formulations.

📌Reference:

FDA Patient Information Leaflet Requirements

Briviact (brivaracetam) and Vimpat (lacosamide) are both anticonvulsantsused to treat epilepsy.

Therapeutic duplication alertswarn ofmultiple drugs treating the same condition, increasing the risk of side effects.

📌Reference:ISMP Medication Safety Guidelines, PTCE Exam Study Guide.

Comprehensive and Detailed Step-by-Step Explanation:

Retin-A (Tretinoin)is atopical retinoidused foracne treatmentandshould be stored with other topical medicationsatroom temperature (68-77°F or 20-25°C).

📌Explanation of Answer Choices:✅D. Topical preparations→Correct.Retin-A is atopical medicationand should be stored accordingly.❌A. Liquid preparations→ Incorrect.Retin-A is not an oral liquid.❌B. Chemotherapy drugs→ Incorrect.Tretinoin is not classified as chemotherapy.❌C. Refrigerated drugs→ Incorrect.Retin-A should not be refrigerated.

📌Reference:

USP <1079>: Storage of Pharmaceuticals

Manufacturer’s Storage Guidelines for Retin-A

Norethindrone is a synthetic progestin hormone found in oral contraceptives.

Hormones and chemotherapy drugs must be disposed of as hazardous pharmaceutical waste per EPA and USP <800> guidelines.

📌Reference:EPA Hazardous Drug Disposal Regulations, USP <800> Hazardous Drug List.

Breaking Down the SIG Code:"Sig: 1 tab PO q.i.d. p.c. & h.s."

Abbreviation

Meaning

1 tab

Take one tablet

PO

By mouth (oral route)

q.i.d.

Four times daily

p.c.

After meals (post cibum)

h.s.

At bedtime (hora somni)

"Take one tablet by mouth four times daily after meals and at bedtime."✅

(A) Take one tablet by mouth five times daily with meals and at bedtime.❌Incorrect – "q.i.d." means four times daily, not five.

(B) Take one tablet by mouth four times daily without meals and at bedtime with a snack.❌Incorrect – "p.c." meansafter meals, not without meals.

(C) Take one tablet by mouth four times daily before meals and at bedtime.❌Incorrect – "p.c." meansafter meals, not before.

(D) Take one tablet by mouth four times daily after meals and at bedtime.✅Correct – Matches the SIG interpretation.

ISMP List of Common SIG Codes and Abbreviations:https://www.ismp.org

PTCB Exam Content Outline – Prescription Interpretation & SIG Code Reading

Putting It Together:Analysis of Answer Choices:References for Pharmacy Technicians:

DEA requires allcontrolled substance prescriptionsto include thedate of issueas per21 CFR 1306.05(a).

Other required elements:

Patient’s full name and address

Drug name, strength, dosage form, quantity

Directions for use

Prescriber’s name, address,DEA number, and signature

📌Reference:DEA Controlled Substance Act;21 CFR 1306.05.

Cleaning counting trays removes medication residue to prevent cross-contamination, especially with penicillin or sulfa drugs.

📌Reference:ISMP Pharmacy Cleaning and Contamination Prevention Guidelines.

TheU.S. Food and Drug Administration (FDA)requires aMedication Guide (MedGuide)to be provided when dispensing certain medications that have significant safety concerns.Zyprexa (Olanzapine), anatypical antipsychotic, requires aMedication Guidedue to serious risks such as:

Increased mortality in elderly patients with dementia-related psychosis

Metabolic side effects(e.g., weight gain, hyperglycemia, and dyslipidemia)

Neuroleptic malignant syndrome (NMS)

A. Zafirlukast→ Incorrect; while used forasthma(leukotriene receptor antagonist), it doesnot require a Medication Guide.

B. Zestril (Lisinopril)→ Incorrect; anACE inhibitorfor hypertension, it doesnot require a Medication Guide.

C. Zinc→ Incorrect; adietary supplementthat does not require a Medication Guide.

Other Answer Choices Explained:References:

FDA Medication Guide Requirements for Olanzapine (Zyprexa)

PTCB PTCE Exam Content Outline (Medication Safety & Patient Counseling)

Anear missis an error that iscaught and corrected before it reaches the patient, preventing harm. In this case, the pharmacistidentified that ampicillin was incorrectly entered as amoxicillinandcorrected the error before dispensing, meaning the patient never received the wrong medication.

B. Dispensing error→ Incorrect; adispensing erroroccursonly if the incorrect drug is given to the patient. Since the error was caught before dispensing, it is classified as anear miss.

C. Adverse event→ Incorrect; anadverse eventis aharmful effectexperienced by the patient, which did not happen here.

D. Unauthorized drug→ Incorrect; anunauthorized drugrefers to a drugdispensed without a valid prescription, which is not the case here.

Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) Medication Safety Guidelines

FDA Medication Error Reporting and Prevention Guidelines

PTCB PTCE Exam Content Outline (Quality Assurance & Medication Safety – Error Prevention)

1 oz = 30 mL

4 oz × 30 mL = 120 mL

📌Reference:PTCE Pharmacy Conversions Guide.

Comprehensive and Detailed Step-by-Step Explanation:

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Cyanocobalamin (Vitamin B12)is used to treatpernicious anemia, a condition caused byVitamin B12 deficiencydue to the body’s inability to absorb it properly.

Pernicious anemiais an autoimmune disorder where the stomach does not produceintrinsic factor, a protein needed for Vitamin B12 absorption.

Symptoms includefatigue, weakness, neurological issues (numbness, tingling), and megaloblastic anemia.

Cyanocobalamin is given viaIM injection or high-dose oral supplementation.

(A) Pernicious anemia✅Correct – Cyanocobalamin is the primary treatment.

(B) Alcohol withdrawal❌Incorrect – Thiamine (Vitamin B1) is used for alcohol withdrawal, not cyanocobalamin.

(C) Hypothyroidism❌Incorrect – Treated withlevothyroxine (Synthroid), not Vitamin B12.

(D) Narrow-angle glaucoma❌Incorrect – Treated withtimolol, acetazolamide, or surgery, not cyanocobalamin.

Cyanocobalamin Prescribing Information (NIH): https://medlineplus.gov/druginfo/meds/a607038.html

PTCB Exam Content Outline – Disease States & Medications

Key Facts About Cyanocobalamin & Pernicious Anemia:Analysis of Answer Choices:References for Pharmacy Technicians:

Comprehensive and Detailed Step-by-Step Explanation:

Acetaminophen (Tylenol)is metabolized by theliver.Excessive doses or concurrentalcohol useincreases the risk ofliver damage (hepatotoxicity).

📌Explanation of Answer Choices:✅D. Alcoholic beverages→Correct. Alcohol and acetaminophen together can causesevere liver damage.❌A. Citrus fruits→ Incorrect. Citrus does not interfere withacetaminophen metabolism.❌B. Leafy greens→ Incorrect. Leafy greens affectwarfarin, notacetaminophen.❌C. Dairy products→ Incorrect. Dairy does not interact withacetaminophen.

📌Reference:

FDA Acetaminophen Warnings

PTCB Medication Safety Guidelines

According toUSP <800>andOSHA guidelines, exposure control forhazardous drugs (HDs)must begin as soon as the drugenters the facilityto ensure proper handling, storage, and administration safety. This includes:

Receiving:

Hazardous drugs must beunpacked in a designated areathat isseparate from regular medications.

They shouldnot be opened in sterile or positive-pressure areasto prevent contamination.

Storage:

HDs must be stored in anegative-pressure room with proper ventilation.

They must be placed indesignated binsto reduce exposure risks.

Handling and Compounding:

Usepersonal protective equipment (PPE)such as gloves, gowns, and masks when handling hazardous drugs.

Use abiological safety cabinet (BSC) or compounding aseptic containment isolator (CACI)when preparing hazardous drugs.

A. Is dispensed→ Incorrect;control measures must start earlier, before dispensing.

C. Is compounded→ Incorrect; safety measures beginbefore compounding, when the drug arrives at the pharmacy.

D. Is placed on the pharmacy shelf→ Incorrect;exposure control measuresbegin before storage, duringreceiving and handling.

Other Answer Choices Explained:References:

USP <800> Hazardous Drug Handling Guidelines

OSHA Hazardous Drug Safety Standards

NIOSH (National Institute for Occupational Safety and Health) Hazardous Drug List

PTCB PTCE Exam Content Outline (Medication Safety & Hazardous Drug Handling)

Percocet (oxycodone/acetaminophen) and Tylenol (acetaminophen)should be avoided together becauseboth contain acetaminophen.

High doses of acetaminophen (>4,000 mg/day in adults)can causesevere liver toxicity, leading to acute liver failure.

Acetaminophen is metabolized by theliver enzyme CYP2E1, producingtoxic metabolitesthat, in excess, overwhelm the liver’s ability to detoxify them.

Why Other Options Are Incorrect:

Motrin (ibuprofen) + Ativan (lorazepam):No liver toxicity risk.✅

Motrin (ibuprofen) + Tylenol (acetaminophen):Not inherently dangerous but can causeGI bleedingandkidney damagewith long-term use.

Percocet (oxycodone/acetaminophen) + Ativan (lorazepam):Risk ofCNS depression, butnotliver toxicity.

📌Reference:FDA Acetaminophen Safety Guidelines,CDC Liver Toxicity Warnings.

HCTZ (hydrochlorothiazide) is a diuretic, but the abbreviation can be confused with hydrocortisone (a corticosteroid).

To prevent errors, ISMP recommends writing out "hydrochlorothiazide" instead of using "HCTZ."

📌Reference:ISMP Do Not Use List, PTCE Medication Safety Guidelines.

Pantoprazole (Protonix)is aproton pump inhibitor (PPI)that isonly available by prescriptionfor treatingGERD, Zollinger-Ellison syndrome, and peptic ulcers.

Omeprazole (Prilosec), Lansoprazole (Prevacid), and Esomeprazole (Nexium)are availableOTC and by prescriptionin different strengths.

Prescription PPIsare typically higher strength than OTC versions.

📌Reference:FDA Drug Approvals for OTC and Prescription PPIs.

TheInstitute for Safe Medication Practices (ISMP)maintains a list oferror-prone abbreviationsthat shouldnot be usedin medication orders to prevent misinterpretation and medication errors.

Analysis of the Answer Choices:Abbreviation

Meaning

ISMP Recommendation

U

Units

❌Do NOT use→ Can be mistaken for "0" or "4" (e.g., 10U could be misread as 100).Use"unit"instead.

AD

Right ear

❌Do NOT use→ Can be confused with "OD" (right eye).Use"right ear"instead.

AU

Both ears

❌Do NOT use→ Can be confused with "OU" (both eyes).Use"both ears"instead.

gtt

Drop

✅Accepted→ Common and not considered error-prone.

Since"gtt" for drop is not on ISMP's "Do Not Use" list, it is the correct answer.

ISMP List of Error-Prone Abbreviations– Confirms that "U," "AD," and "AU" should not be used in prescriptions.

Joint Commission "Do Not Use" List– Prohibits "U" and similar abbreviations to prevent dosing errors.

PTCB PTCE Exam Content Outline– Covers error prevention strategies, including abbreviation safety.

Key References:

Step 1: Convert pounds to kilograms

1 kg = 2.2 lbs

132 lbs ÷ 2.2 = 60 kg

Step 2: Calculate total dose

5 mg/kg × 60 kg = 300 mg

Thus, the correct answer isC. 660 mg.

📌Reference:PTCE Calculation Guide, Pediatric Dosage Calculations.

Comprehensive and Detailed Step-by-Step Explanation:

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Explanation of Answer Choices:✅C. 20→Correct.2 tablets per day × 10 days = 20 tablets.❌A. 5→ Incorrect. Under-dose.❌B. 10→ Incorrect. Under-dose.❌D. 40→ Incorrect. Over-dose.

📌Reference:

USP <795> Pharmaceutical Calculations

PTCB Exam: Dosing Conversions

According to theCDC Hand Hygiene Guidelines,alcohol-based hand sanitizershould be used:

Before and after direct patient contact(if hands are not visibly dirty).

Before and after wearing gloves(if no contamination is visible).

Before handling medication or sterile supplies.

A. Are about to touch a contaminated surface❌→Incorrect

Hand sanitizer should not be used before touching a contaminated surface.Instead, gloves should be worn, and hand hygiene should be performedaftertouching a contaminated surface.

B. Have just performed an aseptic task❌→Incorrect

Before aseptic tasks (e.g., preparing IV medications), soap and water or hand sanitizer is used.Afterward, contamination risk determines if sanitization is needed.

C. Are about to remove their gloves❌→Incorrect

Gloves do not completely prevent contamination; hand hygiene should be performedafterremoving gloves, not before.

CDC Guidelines for Hand Hygiene in Healthcare Settings– Recommends hand sanitizer use after patient contact.

USP <797> Sterile Compounding Guidelines– Reinforces aseptic hand hygiene practices.

PTCB PTCE Exam Content Outline– Covers infection control and proper use of hand hygiene techniques.

Why Not the Other Options?Key References:

In the providedcompounded prescription, the antifungal agent isnystatin.

Nystatin is a polyene antifungalthat works by binding toergosterolin fungal cell membranes, causing leakage of cellular contents and fungal cell death.

It iscommonly used for fungal infections, particularlycutaneous or mucosal Candida infections(e.g., diaper rash, oral thrush).

A. Cholestyramine.→ Incorrect. Cholestyramine is abile acid sequestrantused to lowercholesteroland treatdiarrhea(often in combination with other ingredients for skin irritation or wounds).

B. Hydrocortisone.→ Incorrect. Hydrocortisone is acorticosteroidused to reduceinflammation and itching, but it does not kill fungi.

C. Zinc oxide.→ Incorrect. Zinc oxide is askin protectantused fordiaper rash and minor burns, but it is not an antifungal.

Lexicomp Drug Database – Nystatin Mechanism of Action.

FDA Drug Label for Nystatin – Antifungal Properties.

PTCB PTCE Exam Content Outline – Compounded Preparations and Active Ingredients.

Mosby’s Pharmacy Technician: Principles and Practice – Dermatologic Compounding.

Why Is Nystatin an Antifungal?Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:Conclusion:Pharmacy technicians must befamiliar with drug classificationsto correctly identify active ingredients incompounded prescriptions.Nystatin is the only antifungal agentin the provided formulation.

To determine the correct volume of amoxicillin suspension per dose, use the given concentration and dose.

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

Formula to calculate volume needed:Volume (mL)=Prescribed dose (mg)Concentration (mg/mL)\text{Volume (mL)} = \frac{\text{Prescribed dose (mg)}}{\text{Concentration (mg/mL)}}Volume (mL)=Concentration (mg/mL)Prescribed dose (mg)​

Step 1: Identify Given InformationStep 2: Calculate150 mg250 mg/5 mL=150×5250=750250=3 mL\frac{150 \text{ mg}}{250 \text{ mg/5 mL}} = \frac{150 \times 5}{250} = \frac{750}{250} = 3 \text{ mL}250 mg/5 mL150 mg​=250150×5​=250750​=3 mL

Thus, the patient should take3 mL per dose.

B. 4 mL→ Incorrect; this would correspond to a different strength.

C. 5 mL→ Incorrect; this would deliver250 mg, which is incorrect.

D. 6 mL→ Incorrect; this would deliver300 mg, exceeding the prescribed dose.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations – Dosage & Volume Calculations)

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

Amlodipine (Norvasc)is acalcium channel blocker (CCB)used to treathypertension and angina. A common side effect of amlodipine isdizziness, which occurs due to itsvasodilatory effects, leading tolowered blood pressureandpotential orthostatic hypotension.

B. Photosensitivity→ Incorrect;photosensitivityis more commonly associated with drugs such astetracyclines, sulfonamides, and fluoroquinolones, not amlodipine.

C. Agitation→ Incorrect; amlodipine does not typically causeCNS agitation.

D. Insomnia→ Incorrect;amlodipine does not significantly affect sleep patterns.

Peripheraledema

Flushing

Fatigue

Other Answer Choices Explained:Additional Side Effects of Amlodipine:References:

PTCB PTCE Exam Content Outline (Pharmacology for Technicians – Cardiovascular System Drugs)

Lexicomp Drug Monograph for Amlodipine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

Risedronate (Actonel) is a bisphosphonate used for osteoporosis.

It can causehypocalcemia (low calcium levels)byinhibiting bone resorption.

Patients must take it witha full glass of water and remain upright for 30 minutesto preventesophageal irritation.

📌Reference:FDA Bisphosphonate Warnings, PTCB Drug Counseling Guidelines.

Nurtec ODT (Rimegepant)is anorally disintegrating tablet (ODT)used for theacute treatment of migraines. Since it is designed to dissolve quickly in the mouth,it is highly sensitive to moisture. Exposure to moisture can cause the tablets to degrade, dissolve prematurely, or lose potency.

Storage Requirement:

Must be kept in the original blister packaging until usetoprevent moisture exposure.

Should not be stored in pill organizers or opened ahead of time.

B. Light→ Incorrect; Nurtec ODT isnot highly photosensitive.

C. Heat→ Incorrect; while heat can degrade many medications,moisture is the primary concernfor ODT formulations.

D. Cold→ Incorrect; refrigeration isnot required, and cold storage does not affect the drug’s stability.

Other Answer Choices Explained:References:

FDA Drug Label for Nurtec ODT (Rimegepant) – Storage and Handling Instructions

USP <795> Nonsterile Compounding & Drug Stability Guidelines

PTCB PTCE Exam Content Outline (Medication Storage & Handling)

Lipitor is the brand name forAtorvastatin, aHMG-CoA reductase inhibitor (statin)used to lower cholesterol and reduce the risk of cardiovascular disease.

(A) Provastatin❌Incorrect –Misspelled, should bePravastatin(Pravachol).

(B) Fluvastatin❌Incorrect – Fluvastatin (Lescol) is another statin, but not the generic for Lipitor.

(C) Simvastatin❌Incorrect – Simvastatin (Zocor) is a statin but not the generic for Lipitor.

(D) Atorvastatin✅Correct – The generic name for Lipitor.

Analysis of Answer Choices:Statins & Their Brand Names:Generic Name

Brand Name

Atorvastatin

Lipitor✅

Simvastatin

Zocor

Pravastatin

Pravachol

Fluvastatin

Lescol

Rosuvastatin

Crestor

Lovastatin

Mevacor

Lipitor Prescribing Information: https://www.pfizer.com/products/product-detail/lipitor

PTCB Exam Content Outline – Generic & Brand Name Drug Recognition

Pharmacology for Pharmacy Technicians, 3rd Edition – Perspective on Statin Medications

References for Pharmacy Technicians:

5-FU (Fluorouracil) is a chemotherapy drugused forcolon, breast, and skin cancers.

It is apyrimidine analogthatprevents cancer cell DNA replication.

Why Other Options Are Incorrect:

A. Fluocinonide?❌Topical corticosteroid for skin conditions.

B. Fluoxetine (Prozac)?❌SSRI antidepressant.

C. Fluocinolone?❌Topical corticosteroid.

📌Reference:National Cancer Institute Chemotherapy Guide, PTCB Oncology Medications.

PerUSP standards, a drug with an expiration date ofMarch 2025is consideredvalid until the last day of the month, which isMarch 31, 2025. This applies unless otherwise specified by the manufacturer.

If a drug is labeledMM/YYYY, itremains valid until the last day of that month.

If a drug is labeled with aspecific day (MM/DD/YYYY), itexpires at the end of that day.

A. February 28, 2025→ Incorrect; the expiration is at the end ofMarch, not February.

B. March 1, 2025→ Incorrect; the drug is stillusable until March 31.

D. March 1, 2026→ Incorrect; the drugexpires in March 2025, not 2026.

Expiration Date Rules:Other Answer Choices Explained:References:

USP <797> Pharmaceutical Compounding – Expiration and Beyond-Use Dating (BUD) Guidelines

FDA Drug Expiration Date Regulations

PTCB PTCE Exam Content Outline (Pharmaceutical Storage & Stability)

Comprehensive and Detailed Step-by-Step Explanation:

If a prescriber fails to include a quantity on a prescription, it is considered a prescribing error. Pharmacists and pharmacy technicians must contact the prescriber for clarification.

📌Explanation of Answer Choices:

✅D. Prescribing → Correct. The prescriber made the error by omitting critical information.

❌A. Administration → Incorrect. This refers to errors in how the patient takes the medication.

❌B. Dispensing → Incorrect. This refers to pharmacy errors in filling the prescription.

❌C. Dosage → Incorrect. A dosage error occurs when the wrong dose is prescribed or administered.

📌Reference:

ISMP Medication Error Guidelines

PTCB Exam: Types of Medication Errors

USP <800> mandates that personal protective equipment (PPE) be worn when handling hazardous drug spillsto protect againstinhalation, skin absorption, or accidental ingestion.

Full PPE includes gloves, gowns, eye protection, and respiratory protection when necessary.

📌Reference:USP <800> Hazardous Drug Handling Guidelines.

Cytotoxic agents are drugs that kill or damage cells, particularly rapidly dividing cells. They are primarily used in the treatment of cancer (chemotherapy) because cancer cells multiply quickly. These medications interfere with cell division (mitosis), leading to cell death.

According to Mosby’s Pharmacy Technician: Principles and Practice:

“Cytotoxic drugs are most commonly used in oncology. Their use requires special handling and storage protocols to protect healthcare workers and patients.”

Additional Notes:

Diabetes treatments involve insulin or oral antidiabetics, not cytotoxics.

Rosacea and allergies are treated with antimicrobials and antihistamines/steroids, respectively.

Repatha (evolocumab) is a PCSK9 inhibitor used for lowering LDL cholesterol. One of its common side effects includes musculoskeletal pain, such as muscle aches and cramps. According to the FDA package insert for Repatha, clinical trials observed arthralgia, myalgia, and back pain as notable adverse events.

In contrast:

Requip (ropinirole) may cause dizziness or nausea.

Restasis (cyclosporine ophthalmic) causes eye irritation.

Restoril (temazepam) is associated with sedation.

Comprehensive and Detailed Step-by-Step Explanation:

TheDEA (Drug Enforcement Administration) mandates that controlled substance records must be kept for at least 2 years.

📌Explanation of Answer Choices:✅B. 2 years→Correct.TheControlled Substances Act (CSA) requires pharmacies to maintain records for at least 2 years.❌A. 1 year→ Incorrect.Too short.❌C. 5 years→ Incorrect.Some states require longer retention, but federal law states 2 years.❌D. 7 years→ Incorrect.Not required by federal law.

📌Reference:

DEA Controlled Substances Act (21 CFR § 1304.04)

PTCB Exam: Pharmacy Law & Regulations

Tall Man letteringis amedication safety strategyrecommended by theFDA, ISMP (Institute for Safe Medication Practices), and The Joint Commissiontoprevent medication errorscaused bylook-alike, sound-alike (LASA) drug names.

Thedistinctive portionsof similar drug names are written inuppercase lettersto highlight differences.

Helps pharmacists, technicians, and healthcare professionals distinguish medications that areeasily confuseddue to similar names.

Reduces the risk ofprescription misinterpretationandmedication errorsin pharmacy settings.

How Tall Man Lettering Works:Examples of Tall Man Lettering (ISMP and FDA-Approved List):Regular Name

Tall Man Lettering Version

prednisone

predniSONE

prednisolone

prednisoLONE

hydroxyzine

hydrOXYzine

hydralazine

hydrALAzine

dobutamine

dobutAMINE

dopamine

dopaMINE

A. Highlights the similarities in drug names.→ Incorrect. Tall Man lettering highlightsdifferences, not similarities, toprevent confusion.

B. Ensures all trade names will be capitalized.→ Incorrect. Tall Man lettering applies toboth brand and generic names, but it is used specifically for drugs with look-alike names.

D. Keeps the pharmacy inventory in alphabetic order.→ Incorrect. Inventory order is based onstandard drug names, not Tall Man lettering.

Institute for Safe Medication Practices (ISMP) – Official Tall Man Lettering List.

FDA and The Joint Commission Medication Safety Guidelines.

PTCB PTCE Exam Content Outline – Medication Safety Strategies.

USP <797> and ISMP Guidelines on Look-Alike, Sound-Alike Medications.

Mosby’s Pharmacy Technician: Principles and Practice – Error Prevention Strategies.

Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:Conclusion:Tall Man lettering is anessential tool for pharmacy techniciansto helpreduce medication errorsby drawing attention todifferencesbetweensimilar drug names, ensuringsafer dispensing and administrationof medications.

Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that increases the risk of serious bleeding.

High-alert medications have anarrow therapeutic indexand requirespecial monitoring.

📌Reference:ISMP High-Alert Medication List, FDA Eliquis Safety Warnings.

Naproxen (Aleve, Naprosyn) is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.

📌Reference:FDA NSAID Safety Guidelines.

Stock rotation ensures medications with earlier expiration dates are used first by placing them in the front of the shelf, and medications with later expiration dates behind. This practice is part of the FEFO (First Expired, First Out) system.

From Mosby’s Pharmacy Technician: Principles and Practice:

“Stock rotation using the FEFO method ensures medication integrity and minimizes waste due to expiration.”

This differs from:

A – relates to ordering, not shelf arrangement

B – refers to product recall or removal

C – defines inventory turnover, not physical placement

TheNational Drug Code (NDC)is a10- or 11-digit numberthat uniquely identifies drugs in the U.S.

NDC format:

First set of numbers (Labeler Code):Identifies the manufacturer.

Middle set of numbers (Product Code):Identifies the specificdrug, strength, and dosage form(important for accurate product selection).

Last set of numbers (Package Code):Identifies the package size and type.

Why Other Options Are Incorrect:

A. Identification of therapeutic class?❌NDC codes do not indicate a drug’s therapeutic class.

B. Locating expired medication?❌Expiration dates are printed separately on the packaging.

C. Proper storage of the medication?❌Storage requirements are determined by themanufacturer’s label, not the NDC.

📌Reference:FDA NDC Directory Guidelines, PTCE Exam Study Guide.

Insurance requires accurate “days supply” calculations.If a30-daysupply is incorrectly entered as a90-daysupply, the system will reject early refills.

📌Reference:PTCE Pharmacy Billing and Reimbursement Guidelines.

Pseudoephedrineis regulated under theCombat Methamphetamine Epidemic Act (CMEA)of 2005 due to its potential use in methamphetamine production.

It is availableover-the-counter (OTC) but behind the pharmacy counter, and its sale requires:

Proof of ID

Purchase limits (3.6 g per day, 9 g per month)

A log of purchases maintained by the pharmacy

Loratadine, acetaminophen, and naproxendo not have federal restrictions like pseudoephedrine.

📌Reference:U.S.Combat Methamphetamine Epidemic Act (CMEA)of 2005.

A spacer is a non-prescription medical devicethat enhances the delivery of medication from anMDI (metered dose inhaler).

Since the patient never picked it up and it isnot a controlled or perishable item, the pharmacy canreturn it to dispensing stock for resale.

Why Other Options Are Incorrect:

A. Damaged stock?❌Only if the spacer was opened, broken, or contaminated.

B. The manufacturer?❌Not necessary unless it is defective.

C. The study sponsor?❌Applies only to clinical trial supplies.

📌Reference:ISMP Safe Handling of Medical Devices, PTCE Study Guide.