Canadian Pharmacy Exams

Pharmacist Evaluating Exam Practice

Volume 2

Dr. Fatima S. Marankan

Phi Publishing
Canadian Pharmacy ExamsTM –Pharmacist Evaluating Exam Practice - Volume 2

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Pharmacy is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are needed. The author and contributors of
Canadian Pharmacy Exams – Pharmacist Evaluating Exam Practice – Volume 2 have checked
with resources believed to be reliable in their efforts to provide information that is complete and
generally in accord with the standards accepted at the time of publication. However, in view of
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Library and Archives Canada Cataloguing in Publication

Phi Publishing
Canadian Pharmacy Exams Pharmacist Evaluating Exam Practice Volume 2/ Author, Dr. Fatima
S. Marankan – 5th Canadian Edition.

About the Author

Dr. Marankan holds a postgraduate degree in pharmacy from the College of Pharmacy at UIC,
USA coupled with extensive experience in pharmacy instruction at the University of British
Columbia, Canada. Dr. Marankan was recently a visiting medical professor. Her academic,
research and teaching achievements have been recognized by the Paul Sang Award at the
University of Illinois at Chicago and the TLEF Award at the University of British Columbia,
Canada. Furthermore, Dr. Marankan was the lead consultant in the development and
implementation of OSCE training in Vancouver, Canada.

Throughout her education and career as pharmacy instructor at the University of British
Columbia, Fatima has gained extensive understanding of the requirements of pharmacy licensing
exams in Canada. This knowledge has guided the development of the Canadian Pharmacy
Exams Series:

Pharmacist Evaluating Exam Practice - Volume 1

Pharmacist Evaluating Exam Practice – Volume 2
Pharmacist MCQ Review
Pharmacist OSCE Workbook
Pharmacy Technician MCQ Review
Pharmacy Technician OSPE Workbook

Thank you to all contributing reviewers!

Preface
The Evaluating Exam (EE) is the first exam towards Canadian pharmacy licensure. The EE has
been designed to evaluate the knowledge of International Pharmacy Graduates seeking licensure.
A candidate for the EE must be prepared to demonstrate knowledge in four key areas:
Biomedical Sciences, Pharmaceutical Sciences, Pharmacy Practice (Clinical Sciences and
Professional Practice Skills) and Behavioural, Social and Administrative Pharmacy Sciences.

Canadian Pharmacy Exams™ - Pharmacist Evaluating Exam Practice is designed as a self-study

tool to help the student seeking pharmacy licensure in Canada test his/her exam readiness,
identify areas of strength and weakness. The book is divided in four key parts listed below and
contains over 660 exam-type questions and answers developed to meet the Evaluating Exam
learning objectives including new EE topic areas according to the Pharmacy Examining Board of
Canada (PEBC®). New PEBC Question Format! New Questions Added!

- 15% Biomedical Sciences

- 25% Pharmaceutical Sciences
- 50% Pharmacy Practice including new EE learning objectives
- 10% Behavioural, Social and Administrative Pharmacy Sciences

Most importantly, answers are supplemented by numerous comments and explanations to ensure
further understanding and learning of new concepts. These comments are truly the keystone of
Canadian Pharmacy Exams™. We trust that each Canadian Pharmacy Exams™ book is a
valuable learning and self-assessment tool towards Canadian Pharmacy licensure. All Canadian
content including pharmacy practice laws and regulations. Canadian Pharmacy Exams™ Series
available at Amazon:

- Pharmacist Evaluating Exam Practice – Vol 1

- Pharmacist Evaluating Exam Practice – Vol 2
- Pharmacist MCQ Review
- Pharmacist OSCE Workbook
- Pharmacy Technician MCQ Review
- Pharmacy Technician OSPE Workbook

Trusted Convenient Comprehensive Canadian Pharmacy Exams™ Online Review for

Pharmacists and Pharmacy Technicians at https://www.cpepreponline.com

FREE Computer-Based Exam Readiness Tests

FREE Pharmacy Resources
FREE One Day Trial

References

- Compendium of Therapeutic Choices, 2019

- Compendium of Pharmaceuticals and Specialties, 2019
- Compendium of Products for Minor Ailments, 2019
- Rx Files, 2017
- Drug Facts and Comparisons, 2017
 - Lehninger Principles of Biochemistry, 2017
- Tietz Fundamental of Clinical Chemistry, 2014
- Essentials of Foye’s Principles of Medicinal Chemistry, 2016
- Martin’s Physical Pharmacy and Pharmaceutical Sciences, 2016

Contents

BIOMEDICAL SCIENCES 7

Questions 7

Answers 45
PHARMACEUTICAL SCIENCES 60

Questions 60

Answers 114

PHARMACY PRACTICE 135

Questions 135

Answers 192

BEHAVIOURAL SOCIAL AND ADMINISTRATIVE 214

PHARMACY SCIENCES

Questions 214

Answers 229

BONUS QUESTIONS 234

NEW QUESTIONS 246

BIOMEDICAL SCIENCES

Questions

1. Which of the following statements concerning haploid cells is NOT accurate?

 A. Contain one set of chromosomes
B. Sperm and ovary are haploid cells
C. They are also called germ cells
D. They are produced during the process of mitosis
E. Haploid cells are produced from diploid cells

2. Metabolic acidosis may be caused by:

A. Aspirin overdose
B. Corticosteroids
C. Diuretics
D. Cushing’s syndrome
E. Vomiting

3. The peptide bond or amide bond which links amino acids to form a protein chain results from
a condensation reaction between:

A. 1 hydroxyl group and 1 carboxyl group

B. 2 carboxyl groups
C. 2 amino groups
D. 1 amino group and 1 carboxyl group
E. 1 hydroxyl and 1 amino group

4. Scurvy is a collagen disease caused by deficiency in:

A. Vitamin C
B. Vitamin D
C. Vitamin A
D. Niacin
E. Thiamin

5. Which of the following statements concerning prions is NOT correct?

A. Misfolded infective proteins

B. Lack DNA
C. Form toxic aggregates in brain
D. Cause many neurodegenerative diseases
E. Alzheimer’s disease is not associated with prions
6. All of the following statements concerning methemoglobin are correct, EXCEPT:

A. Its heme group contains a ferrous iron

B. It does not bind oxygen
C. Can be converted back to hemoglobin by the enzyme methemoglobin reductase
D. G6PD deficiency may increase the levels of methemoglobin
E. May cause blue baby syndrome

7. Coenzymes are:

A. A class of enzymes
B. Enzyme precursors
C. Organic cofactors
D. Small neurotransmitters
E. Metal ions

8. Which of the following is the dietary precursor of Coenzyme A?

A. Pyridoxine
B. Thiamine
C. Pantothenic acid
D. Niacin
E. Riboflavin

9. A cyclic monosaccharide such as glucose has two anomeric forms called alpha and beta. The
two anomers interconvert freely in solution by:

A. Isomerization
B. Mutarotation
C. Bond breakage and ligation
D. Enzyme catalysis
E. Epimerization

10. Which of the following metabolic functions takes place in the smooth endoplasmic
reticulum?

A. Amino acid oxidation

B. Glycolysis
C. DNA transcription
D. Post-translational modification of secretory proteins
E. Lipid and steroid biosynthesis

11. Which of the following statements concerning DNA gyrase is NOT correct?

A. Is a type II topoisomerase
B. Its catalytic activity is ATP independent
C. Prevents DNA supercoiling by unwinding DNA double strand
D. Prevents DNA damage and facilitates DNA replication
E. Ciprofloxacin targets bacterial DNA gyrase

12. Alcoholic patients are commonly deficient in:

A. Folic acid
B. Ascorbic acid
C. Vitamin K
D. Vitamin D
E. Niacin

13. All of the following are connective tissues, EXCEPT:

A. Blood
B. Bone
C. Cardiac muscle
D. Adipose tissue
E. Cartilage

14. Which of the following is NOT a characteristic of epithelial tissues?

 A. They produce glandular secretions
B. They lack blood vessels
C. They detect sensations such as touch, smell and taste
D. They are loosely pack and have significant intercellular material
E. They are attached to a basement membrane

15. Identify the normal range of heart beats per minute at rest.

A. 40 -60
B. 50 -70
C. 60- 80
D. 70 -90
E. 80- 100

16. Which of the following is not a component of heart electrical impulse pathway?

A. SA node
B. Mitotic spindle fiber
C. Bundle of His fiber
D. Bachmann's bundle
E. Purkinje fiber

17. All of the following hormonal disorders are causes of secondary hypertension, EXCEPT:

A. Addison’s disease
B. Hyperaldosteronism
C. Cushing’s disease
D. Pheochromocytoma
E. Hyperparathyroidism

18. Identify the most abundant white blood cells

A. Basophils
B. Neutrophils
 C. Eosinophils
D. Lymphocytes
E. Monocytes

19. Megaloblastic anemia also called macrocytic anemia is NOT caused by:

A. Folic acid deficiency

B. Vitamin B12 deficiency
C. Iron deficiency
D. Alcoholism
E. Celiac disease

20. Which of the following is NOT a symptom of GERD (gastroesophageal reflux disorder)?

A. Dysphagia
B. Nausea
C. Chest pain
D. Bad breath
E. Obesity

21. Patients with celiac disease have hereditary intolerance to gluten. One of the primary
interventions is the avoidance of all of the following food products containing gluten, EXCEPT:

A. Wheat
B. Barley
C. Buckwheat
D. Rye
E. Spelt

22. Zollinger-Ellison syndrome is NOT characterized by:

A. Cancerous tumors called gastrinomas affecting the duodenum, pancreas or bile duct
B. Excessive production of gastrin leading to the secretion of too much gastric acid
C. Significant increase in appetite leading to weight gain
D. Treated commonly with acid reducers to heal the ulcers
E. Symptoms include discomfort in the upper abdomen, diarrhea and GI bleeding
23. Which of the following conditions is NOT associated with increased serum level of IgE?

A. Rhinorrhea
B. Asthma
C. Allergic rhinitis
D. Exposure to allergens
E. Inflammatory disease

24. Proper nutrition determines effective body functions resulting in the prevention of numerous
conditions. Which of the following statements concerning an essential nutrient is NOT correct?

A. Is not produced by the body

B. Is produced by the body in insufficient amount
C. Is produced by the body if lacking in diet
D. Is required for normal body functioning
E. Is a vitamin, dietary mineral, fatty acid or amino acid

25. Which of the following is NOT a characteristic of DNA?

A. Storage of cellular information

B. Used as template to produce mRNAs and ultimately cellular proteins
C. Its replication results in the production of mRNAs
D. Contains deoxynucleotides
E. Is one of the four macromolecules that are essential for life

26. Which of the following secretions are not released in the duodenum?

A. Adrenal gland
B. Parotid gland
C. Stomach
D. Liver
E. Pancreas

27. Which of the following is an exocrine gland?

A. Ovaries
 B. Salivary
C. Thyroid
D. Pituitary
E. Testes

28. All of the following statements concerning melatonin are accurate, EXCEPT:

A. Antioxidant
B. Regulates circadian rhythm
C. Can be used to reduce jet lag
D. Produced by the hypothalamus
E. Used as a supplement to manage insomnia

29. All of the following statements concerning calcitonin are correct, EXCEPT:

A. Inhibits the release of calcium from bones resulting in decreased calcium level in blood
B. Produced by the thyroid gland
C. Belongs to the class of peptide hormones
D. Stimulates osteoclasts and thus bone formation
E. It antagonizes the effects of parathyroid hormone (PTH)

30. All of the following hormones are produced by the adrenal medulla, EXCEPT:

A. Adrenaline
B. Dopamine
C. Cortisol
D. Aldosterone
E. Vasopressin

31. Which of the following steroid hormones contains and aromatic ring?
 A. Progesterone
B. Aldosterone
C. Testosterone
D. Estradiol
E. Cortisol

32. The steroid nucleus called cyclopentanophenanthrene contains:

A. 2 cyclopentane rings and 2 cyclohexane rings

B. 3 cyclopentane rings and 1 cyclohexane ring
C. 1 cyclopentane ring and 3 cyclohexane rings
D. 4 cyclopentane rings
E. 4 cyclohexane rings

33. Arachidonic acid is the primary precursor of eicosanoids and an essential fatty acid. All of
the following are features of arachidonic acid, EXCEPT:

A. Is omega 3
B. Contains 4 conjugated cis-double bonds
C. Its aliphatic chain contains 20 carbon atoms
D. Is a carboxylic acid
E. Key component of cell membrane

34. Ketones produced by diabetic patients are primarily excreted through:

A. Feces
B. Breath
C. Urine
D. Sweat
E. Breast milk

35. Which of the following statements concerning Hashimoto’s disease is NOT correct?

A. Autoimmune disorder and common cause of hypothyroidism

B. Diagnosis is confirmed with blood tests for TSH, T4, and antithyroid autoantibodies
 C. Coomb’s test is useful in its assessment
D. Leads to gradual destruction of the thyroid gland
E. The size of the goiter is not affected

36. Which the following vitamin A derivatives is the active form required for vision?

A. Trans retinol
B. Cis retinol
C. Trans retinal
D. Cis retinal

37. Which of the following is NOT a risk factor for gout?

A. Use of xanthine oxidase inhibitors

B. Thiazide diuretics therapy
C. Foods containing high amounts of purine such as anchovies, organ meats and sardines
D. Vitamin C deficiency
E. Sedentary lifestyle

38. Paget’s disease is a bone disorder characterized by:

A. Large, soft and deformed bone

B. Excessive activation of osteoblasts and osteoclasts
C. May lead to osteoarthritis
D. The most common symptom is bone pain
E. Not a hereditary condition

39. Which of the following mechanisms is NOT implicated in the absorption of ophthalmic
drugs across the cornea?

A. Passive diffusion
B. Osmosis
C. Partition
D. Lipid carrier
 E. Pinocytosis

40. Which of the following is NOT a preventive approach for high blood pressure?

A. Weight loss
B. Stop smoking
C. Excessive alcohol intake
D. Stress management
E. Reduction of salt intake

41. All of the following statements are correct regarding the benefits of digoxin in the treatment
of congestive heart failure, EXCEPT:

A. Decreases the rate of hospitalization

B. Decreases fluid retention
C. Reduces heart rate
D. Reduces mortality
E. Improves quality of life

42. The pathophysiology of emphysema is related to which of the following enzymes?

A. Lysozyme
B. Gyrase
C. Trypsin
D. Pepsin
E. Elastase

43. Which of the following cerebral structures controls vision?

A. Frontal
B. Parietal
C. Occipital
D. Temporal
44. Norepinephrine is degraded by COMT by which of the following reactions?

A. Methylation
B. Carboxylation
C. Deamination
D. Hydroxylation
E. Sulfation

45. Impulses reaching the sympathetic system originate from which of the regions of the spinal
cord?

A. Cervical, Lumbar
B. Thoracic, Cervical
C. Lumbar, Thoracic

46. Nitric oxide is an important signaling molecule with potent vasodilation properties. Which of
the following amino acid is the precursor of nitric oxide?

A. Tyrosine
B. Arginine
C. Tryptophan
D. Lysine
E. Histamine

47. Histamine is produced by:

A. Mast cells, Macrophages

B. Mast cells, Lymphocytes
C. Mast cells, Basophils
D. Masr cells, Kupffer cells
E. Mast cells, Monocytes

48. Which of the following is not a biological effect of histamine?

A. Sedation
B. Inflammatory response
 C. Vasodilation
D. Stimulation of gastric acid secretion
E. Bronchoconstriction

49. Which of the following endorphins action is closely related to that of morphine?

A. Alpha endorphin
B. Beta endorphin
C. Gamma endorphin
D. Sigma endorphin

50. The biological effects of GABAB are mediated by which of the following channels?

A. Cl- channel
B. K+ channel
C. Mg+ channel
D. Ca+ channel
E. PO43- channel

51. Which of the following headaches are associated with nausea and vomiting?

A. Tension headache
B. Migraine headache
C. Cluster headache
D. Stress headache
E. Secondary headache

52. Which of the following statements concerning multiple sclerosis is NOT correct?

A. Autoimmune disorder of the central nervous system

B. Characterized by impaired conduction along axons due to demyelination
C. There is formation of MS plaques where myelin has been destroyed
D. Complete cure can be achieved with the administration of high doses of steroids
E. The most common immune-mediated disorder affecting the central nervous system

53. In skin, sweat glands are found in:

A. Epidermis
 B. Stratum corneum
C. Dermis
D. Subcutaneous layer
E. Hypodermis

54. Which of the following skin growths is a blister containing pus?

A. Papule
B. Pustule
C. Wheal
D. Callus
E. Tag

55. Wrong statement concerning canker sores:

A. Painful red spots, bumps or open sores in the mouth

B. May be caused by vitamin B12, iron or folic acid deficiency
C. May be caused by bacterial infection
D. May be caused by female hormones or stress
E. May be food allergy related

56. All of the following are treatments options for canker sores, EXCEPT:

A. Application of paste made of baking soda and water

B. Brush mouth regularly with sodium lauryl sulfate containing toothpaste
C. Rinsing the mouth with antacid such as Maalox or Mylanta
D. Topical products such as benzocaine
E. Nutritional supplements such as folic acid, vitamin B6 or zinc

57. Psoriasis is a skin condition characterized by itchy or sore patches of thick, red skin with
silvery scales. Psoriasis may be worsened by all, EXCEPT:

A. Infections
B. Stress
C. Dry skin
 D. UV light
E. Smoking

58. All of the following statements concerning cellulitis are correct, EXCEPT:

A. Infection of skin and tissue beneath skin

B. Avoid moisturizers
C. Caused by Streptocccus or Staphylococcus infection
D. Non-contagious
E. Conditions such as eczema, athlete's foot and shingles are risk factors

59. Influenza infection is best classified as:

A. Persistent
B. Latent
C. Acute
D. Chronic
E. Slow

60. The following viral infection may lead to cancer, EXCEPT:

A. Epstein-Barr
B. Hepatitis B
C. Hepatitis C
D. Herpes Simplex Type 2
E. Human Papilloma

61. Yeast is:

A. Eukaryotic organism
B. Prokaryotic organism
C. Bacteria
D. Virus
 E. Fungus

62. Lipopolysaccharide (LPS) is a pyrogenic biomolecule found in Gram-negative bacteria. LPS

is located in:

A. Outer membrane
B. Periplasmic gel
C. Plasma membrane
D. Cytoplasm
E. Flagella

63. Which is of the following bacteria is NOT Gram-negative?

A. Chlamydia pneumoniae
B. Clostridium difficile
C. Brucella canis
D. Helicobacter pylori
E. Neisseria meningitides

64. Which of the following sexually transmitted diseases is Not due to bacterial infection?

A. Gonorrhea
B. Trichomoniasis
C. Syphilis
D. Chlamydia
E. Vaginosis

65. All of the following are mechanisms of transmission of bacillus anthracis, EXCEPT:

A. Contact with animals

B. Inhalation of spore-contaminated dust
C. Skin penetration of spores
 D. Ingestion of contaminated undercooked meat
E. Person to person contact

66. Which of the following statements concerning amylase is NOT accurate?

A. An enzyme secreted by the pancreas

B. It breaks down starch
C. Its level increases in acute pancreatitis
D. Is present in saliva
E. Produced exclusively by humans to aid digestion

67. Which of the following is the most active form of vitamin E?

A. Alpha Tocopherol
B. Beta Tocopherol
C. Gamma Tocopherol
D. Delta Tocopherol

68. What is the end product of protein metabolism?

A. Amino acids
B. Urea
C. Uric Acid
D. Ammonia
E. Carboxylic acid

69. Which of the following cells are precursors of thrombocytes?

A. Mast cells
B. Lymphocytes
C. Monocytes
D. Megakaryocytes
E. Macrophages

70. Methotrexate overdose can be treated with:

 A. Leucovorin
B. Phentolamine
C. Mesna
D. Naloxone
E. Succimer

71. Allopurinol is a drug used to decrease the production of uric acid in patient with gout. Which
of the following is the mechanism of allopurinol?

A. Inhibition of xanthine reductase

B. Inhibition of xanthine decarboxylase
C. Inhibition of xanthine oxidase
D. Inhibition of xanthine aldolase
E. Inhibition of xanthine hydroxylase

72. Tetracycline (TCN) is converted to epiTCN by:

A. Mutarotation
B. Isomerization
C. Rotation
D. Cyclization
E. Condensation

73. Correct statements concerning pyelonephritis:

A. Urinary tract infection (UTI)

B. Caused commonly by E. coli or Enterococcus faecalis
C. Symptoms include abdominal pain and dysuria
D. Use of spermicide could reduce incidence
E. May be prevented by urination after sex and drinking sufficient fluids

74. Acetaminophen overdose is treated with:

A. Flumazenil
B. Deferoxamine
C. Phytonadione
D. Acetylcysteine
 E. Protamine sulfate

75. Which of the following substances is responsible for the toxicity of methanol?

A. Mercapturic acid
B. Formic acid
C. Aspartic acid
D. Glutamic acid
E. Sulfuric acid

76. One of the functions of skin is the regulation of body temperature. Which of the following
glands releases water to the skin surface to help decrease body temperature?

A. Sebaceous
B. Eccrine
C. Ceruminous
D. Lacrimal
E. Mammary

77. The maintenance of normal body temperature is an important biological function. Which of
the following mechanisms is NOT involved in the process of raising body temperature?

A. Shivering
B. Constriction of skin blood vessels
C. Skeletal muscle contraction
D. Profusive perspiration
E. Inactivation of sweat glands

78. Which of the following bones is characterized by high concentration in red bone marrow in
adults?

A. Humerus
B. Sternum
C. Femur
D. Radius
E. Tibia
79. The parietal bone is a cranial bone classified as:

A. Round
B. Irregular
C. Long
D. Short
E. Flat

80. Myasthenia gravis is a neuromuscular condition. All of the following statements concerning
Myasthenia gravis are correct, EXCEPT:

A. Autoimmune reaction
B. Muscle weakness
C. Presence of antibodies that block GABA receptors
D. Impairment of acetylcholine receptors
E. Treated with cholinesterase inhibitors or immunosuppressants

81.A sensory receptor is a sensory nerve ending that responds to a stimulus in the internal or
external environment of an organism. A sensory receptor capable of detecting changes in
hydrogen ions concentration is described as a:

A. Baroreceptor
B. Chemoreceptor
C. Photoreceptor
D. Thermoreceptor
E. Nociceptor

82. Which of the following is the primary location of olfactory receptors in the nasal cavity?

A. Lateral surface of nasal cavity

B. Medial surface of nasal cavity
C. Inner surface of nasal cavity
D. Inferior surface of nasal cavity
E. Superior surface of nasal cavity
83. Some hormones exert their action on neighboring cells based on:

A. Endocrine action
B. Autocrine action
C. Paracrine action
D. Intracrine

84. The regulation of hormonal release is a major homeostatic process. All of the following are
mechanisms of hormonal regulation, EXCEPT:

A. Direct nerve stimulation

B. Feedback inhibition
C. Release of tropic hormones
D. Humoral stimulus
E. Antisense binding

85. Stress has significant impact on biological functions. Which of the following hormones level
is increased by stress?

A. Thyroid stimulating hormone

B. Luteinizing hormone
C. Adrenocorticotropic hormone
D. Growth hormone
E. Melanocyte stimulating hormone

86. Which of the following dietary supplement are needed during the course of DNA
biosynthesis?

A. Iron and Folic acid

B. Vitamin B12 and Iron
C. Folic acid and Calcium
D. Vitamin B12 and Folic acid
E. Iron and Calcium
87. Which of the following hormones has the greatest impact on metabolism?

A. Oxytocin
B. Growth hormone
C. Thyroid stimulating hormone
D. Thyroxine
E. Melatonin

88. All of the following mechanisms describe the activation of B cells, EXCEPT:

A. Antigen recognition
B. Antigen binding
C. Production of cytokines by helper T cells
D. Presentation of MHC proteins
E. Inhibition of B cells coreceptor complex

89. Which of the following antibodies is passed on to nursing infants in breast milk?

A. IgE
B. IgG
C. IgA
D. IgM
E. IgD

90. Lymph is considered a part of the interstitial fluid. Which of the following biomolecules is
NOT found in lymph fluid?
A. Hemoglobin
B. Albumin
C. Triglycerides
D. Lymphocytes
E. Fats

91. Which of the following statements regarding plasma and interstitial fluid is NOT correct?
 A. The interstitial fluid is identical to plasma minus red blood cells
B. The interstitial fluid contains amino acids, sugars, fatty acids, coenzymes, hormones,
neurotransmitters, salts and waste products
C. The composition of interstitial fluid depends upon exchanges between cells in biological
tissues and blood
D. The interstitial fluid has a different composition in different tissues
E. Unlike plasma, the interstitial fluid does not contain albumin.

92. Cardiac output represents the volume of blood being pumped by the heart in the time interval
of one minute. Which of the following equations describes the cardiac output?

A. Cardiac output = Heart Rate – Stroke volume

B. Cardiac output = Heart Rate + Stroke volume
C. Cardiac output = Heart Rate x Stroke volume
D. Cardiac output = Heart Rate/Stroke volume

93. Which of the following blood disorders is characterized by bone marrow suppression?

A. Hemolytic anemia
B. Sickle cell anemia
C. Megaloblastic anemia
D. Aplastic anemia
E. Microcytic anemia

94. The activities of the digestive system are promoted by:

A. Autonomic system
B. Somatic system
C. Sympathetic system
D. Parasympathetic system
E. Adrenergic system

95. Which of the following exocrine glands is located between the temporal bone and the
mandible?
 A. Submaxillary
B. Sublingual
C. Parotid
D. Lacrimal
E. Sebaceous

96. Amylase is a salivary enzyme which initiates primarily the digestion of:

A. Lipids
B. Proteins
C. Lipoproteins
D. Carbohydrates
E. Fibers

97. The pancreas has both endocrine and exocrine functions. It produces several important
hormones including insulin, glucagon, and somatostatin, as well as pancreatic juice containing
digestive enzymes that enhance digestion and ultimately the absorption of nutrients. The
pancreatic duct is linked directly to:

A. Liver
B. Ileum
C. Duodenum
D. Jejunum
E. Stomach

98. Which of the following statements characterizes the biological function of the thymus?
A. Site of T cells production
B. Site of T cells maturation
C. Site of T cells degradation

99. Inflammation often results in swelling of tissues. Which of the following mechanisms
explains this biological effect?

A. High number of invading microorganisms

 B. Increased number of red blood cells
C. Increased number of white blood cells
D. Increased capillaries permeability leading to fluid uptake
E. Production of pus

100. Which of the following body areas is the site of maturation of B lymphocytes?

A. Liver
B. Kidneys
C. Bone marrow
D. Blood
E. Lung

101. All of the following statements characterize antigens, EXCEPT:

A. They stimulate the immune response resulting in the production of antibodies

B. They are large biomolecules such as proteins and polysaccharides
C. They are also called immunoglobulins
D. Bind B cells and T cells
E. Vaccines contain antigens

102. Which of the following hormones are released in the GI tract in response to stomach
acidity?

A. Gastrin
B. Secretin
C. Cholecystokin
D. Substance P
E. Ghrelin

103. Which of the following is the primary location of olfactory receptors in the nasal cavity?

A. Lateral surface of nasal cavity

B. Medial surface of nasal cavity
C. Inner surface of nasal cavity
D. Inferior surface of nasal cavity
E. Superior surface of nasal cavity
104. Which of the following statements concerning lymph nodes is NOT accurate?

A. They contain lymphocytes

B. Filtration and monitoring of the lymph for foreign particles
C. Storage of macrophages
D. Production of red blood cells
E. They are not present in the central nervous system

105. Which of the following statements concerning the absorption of iron salts is NOT correct?
A. Iron is absorbed in the ferrous state by enterocytes in duodenum and upper jejunum
across the divalent metal transporter 1 (DMT1)
B. Iron is primarily absorbed in the ferrous state because ferric iron precipitates in the
duodenum
C. The oxidation of ferric iron to ferrous iron is catalyzed by the enzyme ferrireductase
D. The absorption of iron is promoted by gastric acid and dietary ascorbic acid
E. Iron overload reduces the absorption of iron salts by feedback mechanism

106. Which of the following food products contains the highest concentration of heme bound
iron?

A. 3 ounces beef
B. 3 ounces oysters
C. 3 ounces turkey
D. 3 ounces chicken
E. 3 ounces tuna

107. Iron deficiency is the leading cause of anemia. The absorption of iron is:

A. The greatest for non heme iron

B. The greatest for heme bound iron
C. Antagonized by vitamin C
D. Antacids promote the absorption of iron supplements
E. Occurs primarily in the stomach

108. Beta carotene is a strongly colored red-orange pigment abundant in plants and fruits that
belong to the class of carotenes. Beta carotene is distinguished by having beta-rings at both ends
of the molecule. Beta carotene is a precursor to vitamin A via the action of the intestinal enzyme
beta-carotene monooxygenase. Each molecule of beta carotene is cleaved to produce:

A. 1 molecule of vitamin A
B. 2 molecules of vitamin A
C. 3 molecules of vitamin A
D. 4 molecules of vitamin A
E. 5 molecules of vitamin A

109. Which of the following food products has the highest amount of beta carotene by serving?

A. Sweet potato
B. Carrot
C. Mango
D. Pumpkin
E. Papaya

110. In medicine, parity means:

A. The number of times a woman had twins

B. The number of times a woman had miscarriage
C. The number of times a woman had abortion
D. The number of times a woman has been pregnant
E. The number of times a woman has given birth

111. The limulus test or LAL is used for the detection of endotoxins produced by:
A. Neisseria meningitidis
B. Nocardia brasiliensis
C. Corynebacterium diphtheriae
D. Mycobacterium tuberculosis
E. Streptomyces sudanensis

112. Aneurism is characterized by:

A. Narrowing of blood vessels resulting in increased blood pressure

B. Extensive tissues necrosis and ultimately organ damage
C. Abnormal widening of a portion of an artery due to weak blood vessel wall
D. Blockage of blood vessels due to fat deposits
 E. Abnormal accumulation of interstitial fluid beneath the skin

113. Necrosis is the premature cell death caused by external factors such as infection, toxins, or
trauma. In contrast, apoptosis is naturally occurring cell death. Mycobacterium causes what type
of necrosis?

A. Liquefied necrosis
B. Coagulative necrosis
C. Hemorrhagic necrosis
D. Caseous necrosis
E. Fatty necrosis

114. Neonatal conjunctivitis is an infection contracted by newborns during delivery through the
birth canal from a mother infected with all of the following pathogens, EXCEPT:

A. Neisseria gonorrhea
B. Herpes simplex virus type 2
C. Streptococcus pneumonia
D. Escherichia coli
E. Staphylococcus aureus

115. Peripheral vascular disease (PVD) is another complication of diabetes which contributes to
the development of foot ulcers. PVD is characterized by blockage of arteries resulting in poor
blood flow and nutrients intake, and ultimately impaired wound healing ability. Poor blood flow
leads to all, EXCEPT:

A. Bunion
B. Skin discoloration
C. Swelling of feet
D. Temperature differences throughout feet
E. Detection of pulses in feet

116. Neonatal bacterial meningitis is an inflammation of the meninges due to bacterial infection.
Symptoms include lethargy, seizures, vomiting, irritability, nuchal rigidity, a bulging or full
fontanel as well as cranial nerve abnormalities. Which of the following is NOT a predominant
microorganism in neonatal meningitis?
 A. Neisseria Meningitidis
B. Escherichia coli
C. Listeria monocytogenes
D. Haemophilus influenzae
E. Streptococcus pneumonia

117. Malignant hyperthermia is a life-threatening condition. All of the following anesthetics may
cause malignant hyperthermia, EXCEPT:

A. Halothane
B. Isoflurane
C. Succinylcholine
D. Nitrous oxide
E. Sevoflurane

118. Which of the following statements concerning hyperthermia and fever is NOT correct?

A. Hyperthermia is an elevated body temperature due to failed thermoregulation when the

body produces or absorbs more heat than it can dissipate.
B. Fever is characterized by high temperature caused by an increase in the body
temperature regulatory set-point leading to increased muscle tone, shivering and
alternate feeling of cold and warmth
C. The most common causes of hyperthermia are heat stroke and adverse reactions to drugs
affecting primarily the central nervous system.
D. Fever serves as one of the body's natural defense mechanisms against bacteria and
viruses because they cannot survive at high temperature.
E. Oral, rectal and axillary body temperature measurements are used interchangeably
because they have the same level of accuracy

119. The monofilament test is used during the course of diabetic foot screening. All of the
following statements concerning the monofilament test are correct, EXCEPT:
 A. Non-invasive test
B. Simple and convenient test
C. Foot pulse exam is a substitute to the monofilament test
D. A metal or plastic wire is applied against areas of the feet
E. Enough pressure is applied to bend the wire which helps detect potential loss of
sensation

120. The nasal cavity has a rich blood supply. Which of the following blood vessels supply the
nose?

A. Carotid artery
B. Ethmoidal artery
C. Femoral artery
D. Popliteal artery
E. Subclavian artery

121. The pulse represents the tactile arterial palpation of the heartbeat. The pulse pressure is
determined by the interaction of the stroke volume of the heart, and arteries flexibility and
resistance. Which of the following equations represents the quantification of the pulse?

A. P pulse = P systolic x P diastolic

B. P pulse = P systolic + P diastolic
C. P pulse = P systolic – P diastolic
D. P pulse = P systolic / P diastolic

122. Epistaxis is:

A. Rectal bleeding
B. Nose bleeding
C. Ear bleeding
D. Gastric bleeding
E. Eye bleeding

123. A cell organelle that is a vesicle containing digestive enzymes and is responsible for the
intracellular removal of damaged organelles or pathogens is called:
 A. Mitochondria
B. Lysosome
C. Endoplasmic reticulum
D. Cytoplasm
E. Peroxisome

124. A cell organelle that is a stack of membranes containing chambers and is responsible for the
storage, alteration and packaging of secretory proteins is called:

A. Nucleus
B. Mitochondria
C. Ribosomes
D. Golgi apparatus
E. Centrioles

125. Systemic lupus erythematosus is an autoimmune disorder that mimics various conditions.
The key differentiating feature is its effect on:

A. Heart
B. Lungs
C. Skin
D. Brain
E. Joints

126. Stenosis is characterized by:

A. Inflammation of artery
B. Thinning of artery
C. Hardening of artery
D. Narrowing of artery
E. Widening of artery

127. Which of the following white blood cells are NOT granulocytes?

A. Eosinophils
B. Neutrophils
C. Monocytes
D. Basophils
128. Which of the following white blood cells differentiate to produce macrophages in tissues?

A. Neutrophils
B. Basophils
C. Monocytes
D. Eosinophils
E. Lymphocytes

129. The lymphatic system is part of the circulatory system; it carries a clear fluid called lymph
unidirectionally to the heart. The lymphatic system includes all of the following, EXCEPT:

A. Thymus
B. Thyroid gland
C. Bone marrow
D. Spleen
E. Tonsils

130. All of the following cells are found in the dermis, EXCEPT:

A. Melanocytes
B. Adipocytes
C. Macrophages
D. Fibroblasts

131. Opioid receptors are NOT found in:

A. Brain
B. Spinal cord
C. Intestinal tract
D. Peripheral neurons
E. Heart
132. Which of the following is the primary difference between human cells and bacteria cells?

A. Peptidoglycans
B. Cell wall
C. Integral proteins
D. Plasma membrane
E. Cytosol

133. All of the following are mechanisms of fluoroquinolones resistance, EXCEPT:

A. Topoisomerase IV mutation
B. Drug efflux pump
C. DNA gyrase mutation
D. Cell wall alteration
E. Reduction of intracellular concentration

134. Mycoplasma bacteria are resistant to penicillins and other beta-lactam antibiotics because:

A. They have no cell wall

B. They produce an enzyme that degrades penicillins
C. They lack cell membrane
D. Ribosomes are 70S type
E. They rely on heterotrophic nutrition

135. Ovulation can be monitored by the quantification of:

A. Progesterone and Luteinizing hormone

B. Progesterone and Follicle stimulating hormone
C. Progesterone and estrogen
D. Follicle stimulating hormone and Luteinizing hormone
E. Estrogen and Luteinizing hormone
136. Mantoux test is a diagnostic tool for:

A. Viral meningitis
B. Hansen’s disease
C. Tuberculosis
D. Tinea pedis
E. Lupus erythematosus

137. Which of the following is NOT a type of hernias?

A. Abdominal
B. Ophthalmic
C. Diaphragmatic
D. Anal
E. Pelvic

138. Schick’s test is diagnostic tool for:

A. Traveller’s diarrhea
B. Diphtheria
C. Rabies
D. Yellow fever
E. Scarlet fever

139. Scarlet fever is a bacterial infection caused by which of the following streptococcus
species?

A. Streptococcus pyogenes
B. Streptococcus enterococcus
C. Streptococcus bovis
D. Streptococcus viridans
E. Streptococcus pneumoniae

140. All of the following are symptoms of magnesium deficiency, EXCEPT:

A. Abnormal heart rhythms

B. Impaired muscle contractions
C. Increased appetite
D. Anorexia
 E. Tremors

141. Calcium and magnesium are reabsorbed in the kidneys specifically in:

A. Loop of Henle and collecting duct

B. Distal convoluted tubule and proximal tubule
C. Proximal convoluted tubule and loop of Henle
D. Collecting duct and distal convoluted tubule
E. All areas of kidney

142. Typhus is caused by which of the following bacteria species?

A. Rickettsia
B. Shigella
C. Campylobacter
D. Streptococcus
E. Pseudomonas

143. All of the following enzymes are found in the mitochondria of a typical cell, EXCEPT:

A. Malate reductase
B. Pyruvate dehydrogenase
C. Citrate synthase
D. Succinate dehydrogenase
E. Isocitrate dehydrogenase

144. Which of the following metabolic processes takes place in the rough endoplasmic
reticulum?

A. Lipid biosynthesis
B. Steroid biosynthesis
C. Biosynthesis of intrinsic proteins
D. RNA processing
E. Posttranslational processing of secretory proteins

145. Zymogens are inactive forms of enzymes. Zymogens are the precursors of all of the
following biological substances, EXCEPT:
 A. Cofactors
B. Coagulation factors
C. Proteolytic enzymes
D. Metabolic enzymes
E. Cysteine proteases

146. Phytosterols are fat-like compounds found in vegetables, fruits, legumes and refined
vegetable oils. Phytosterols decrease blood cholesterol by:

A. Inhibiting the primary enzyme involved in cholesterol biosynthesis

B. Competing with cholesterol absorption and uptake in the small intestine
C. Enhancing the metabolism of cholesterol
D. Promoting the clearance of cholesterol
E. Blocking the production of cholesterol precursor

147. Class IIa hyperlipidemia is characterized by:

A. Increased cholesterol, normal triglycerides, increased LDL and normal HDL

B. Normal or slightly increased cholesterol, increased triglycerides, decreased LDL and
decreased HDL
C. Increased or normal cholesterol, increased or normal triglycerides, increased LDL and
normal HDL
D. Increased cholesterol, increased triglycerides, increased LDL and normal HDL
E. Normal or slightly increased cholesterol, increased triglycerides, normal or slightly
decreased LDL and normal or slightly decreased HDL
F. Increased or normal cholesterol, increased triglycerides, decreased LDL and decreased
HDL

148. Which of the following statements regarding the symptoms of hypoglycemia and
ketoacidosis is NOT correct?

A. Hypoglycemia has sudden onset whereas ketoacidosis appears gradually

B. Hypoglycemia is characterized by hunger whereas ketoacidosis is associated with loss of
appetite
C. Fast pulse is a common symptom in hypoglycemia and ketoacidosis
D. Hypoglycemia is a common side effect of antihyperglycemics
E. Ketoacidosis is a feature type 1 diabetes
149. Which of the following calcium preparations is NOT associated with extravasation?

A. Calcium acetate
B. Calcium chloride
C. Calcium gluconate

150. Diabetic peripheral neuropathy (DPN) is a collection of nerve disorders affecting diabetic
patients. All of the following statements regarding DPN are correct, EXCEPT:

A. Up to 50% of patients affected by diabetes will develop DPN within ten years of onset of
the condition
B. DPN is characterized by progressive, painless loss of sensation in hands and feet and is
the primary contributing factor for all foot ulcers
C. DPN appears specifically in patients affected by type II diabetes
D. DPN is a microvascular complication of diabetes
E. The incidence of DPN can be reduced by controlling blood glucose
 Answers
1. D
Haploid cells are produced during the process of meiosis. Diploid cells contain two sets of
chromosomes and produced by mitosis.

2. A
Diuretics, corticosteroids, vomiting, Cushing’s syndrome, Cystic fibrosis, excessive use of
antacids cause metabolic alkalosis. Metabolic acidosis may be also caused by metformin,
diarrhea, alcohol, liver failure, strenuous exercise, ethylene glycol (antifreeze) or methanol
poisoning, and severe dehydration.

3. D

4. A

5. E
Alzheimer’s disease and Parkinson's disease are both prion-like diseases.

6. A
Methemoglobin contains a ferric iron.

7. C
A cofactor is a non-protein chemical compound or metallic ion that is required for an enzyme's
activity. Cofactors can be subclassified as either inorganic ions (calcium, iron, potassium…) or
complex organic molecules called coenzymes; coenzymes are derived from vitamins and other
organic essential nutrients. Examples of coenzyme are biocytin, coenzyme A, lipoate and
tetrahydrofolate.

8. C

9. B
The conversion is achieved without bond breakage.
10. E
A – mitochondria; B –cytosol; C-nucleus; D-Golgi apparatus.

11. B

12. A

13. C

14. D

15. C

16. B
Mitotic spindle fiber is involved in the process of cell division.

17. A
Addison’s disease leads to hypotension instead.

18. B

19. C
Iron deficiency leads to microcytic anemia. Alcoholism may result in folic acid deficiency.
Celiac disease prevents the absorption of nutrients.

20. E
Risk factors of GERD include obesity, pregnancy, smoking, hiatal hernia, and medications such
as antihistamines, calcium channel blockers and antidepressants. Dysphagia refers to difficulty
swallowing.

21. D
Oat is also not recommended for patients with gluten allergy because it is often contaminated
with gluten-containing grains during manufacturing.
22. C
Weight loss is a common symptom

23. A
Rhinorrhea is not always mediated by an allergic response. IgE antibodies are mediators of
allergic reactions.

24. C

25. C
The replication of DNA is the process of copying DNA. The transcription of DNA results in the
production of mRNA.

26. A

27. B
Hypothalamus, pituitary gland, ovaries, testes, parathyroid gland, thyroid gland are endocrine
glands. Sweat glands are also exocrine.

28. D
Melatonin if produced by pineal gland.

29. D
Calcitonin stimulates osteoblasts instead. Osteoblasts are bone forming cells.

30. E

31. D

32. C

33. D
Arachidonic acid is omega 6.
34. B
Which explains the acetone breath of diabetic patients.

35. E
Coomb’s test detects antibodies produced against the thyroid gland.

36. C

37. A
Xanthine oxidase inhibitors such as allopurinol are used in the treatment of gout to prevent the
production of uric acid. Vitamin C and physical activity have preventive effect.

38. E

39. E
The production of tears in eyes makes osmosis possible.

40. C
However, moderate alcohol intake is a preventive approach.

41. D

42. C
Excessive activity of trypsin leads to lung damage.

43. C

44. A

45. C

46. B
Nitric oxide activated the enzyme guanylate cyclase.
47. C

48. A
In contrast histamine enhances wakefulness.

49. B
Beta endorphins are the most potent endorphins and they have high affinity for mu receptors
where morphine binds.

50. B
GABAA is chloride channel.
GABAB is a transmembrane receptor for gamma-aminobutyric acid (GABA) linked via G-
protein to potassium channel.

51. B
Secondary headaches are caused by an underlying disease such as an infection, head
injury, vascular diseases, brain bleed or tumors.

52. D
There is not cure for MS. Steroid are used for symptomatic treatment during attacks.

53. C

54. B

55. C
However viral infection may be the cause.

56. B
Avoid sodium lauryl sulfate containing oral hygiene products as well as spicy and acidic foods

57. D
In fact, it is treated with UV light therapy, pine or coal tar, corticosteroids and
immunosuppressants such as tacrolimus.
58. B
Lubricating skin with moisturizers helps prevent cracking and peeling. Do not apply moisturizer
to open sores.

59. C

60. D

61. A
Yeast is unicellular.

62. A
The outer layer and periplasmic gel are components of the cell wall.

63. B

64. B
Trichomoniasis is parasitic infection.

65. E

66. E
Amylase is found in bacteria, plan and fungi. Acute pancreatitis is inflammation of the pancreas
that occurs suddenly and usually resolves in a few days with treatment.

67. A

68. B

69. D
Mast cells are found primarily in tissues.

70. A
71. C
Allopurinol is used for the prevention of gout attack NOT for acute treatment.

72. B

73. D
The use of spermicide is a risk factor for pyelonephritis. Treatment options include
fluoroquinolones (e.g. ciprofloxacin), beta-lactam antibiotics (e.g. amoxicillin or a
cephalosporin), co-trimoxazole.

74. D

75. B
Mercapturic acid is the end product of acetaminophen detoxification.

76. B
Eccrine and apocrine glands are 2 types of sweat glands.
Sebaceous gland produces oily secretion; ceruminous gland produces cerumen or ear wax;
lacrimal gland produces tears; mammary gland produces breast milk.

77. D

78. B
Femur and tibia are found in the leg whereas humerus and radius are found in the arm.

79. E

80. C
The antibodies produced in Myasthenia gravis block acetylcholine receptors. In more than 50%
of patients affected by myasthenia gravis, the first signs and symptoms involve eye problems,
such as drooping of one or both eyelids (ptosis) or double vision (diplopia).

81. B
Baroreceptors respond to pressure in blood vessels; chemoreceptors respond to chemical stimuli;
hydroreceptors respond to changes in hydration (humidity); mechanoreceptors respond to
mechanical stimuli or stress; nociceptors respond to damage to tissues resulting in pain stimuli;
osmoreceptors respond to the osmolarity of body fluids; photoreceptors respond to light;
proprioceptors provide the sense of position and balance; thermoreceptors respond to
temperature.

82. E

83. C
Endocrine acting hormones are transported by blood and regulate targets far away from their site
of release; autocrine acting hormones regulate the same cells that release them.

84. E
Hormonal stimulus is another mechanism. Antisense binding is a feature of nucleic acids.

85. C

86. D

87. D

88. E
There is activation of B cells coreceptor complex

89. C
IgA mediates innate immunity. IgA is the main immunoglobulin found in mucous secretions,
including tears, saliva, colostrum and secretions from the genitourinary tract, gastrointestinal
tract, prostate and respiratory tract.

90. A

91. A
92. C
93. D

94. D
The adrenergic or sympathetic system has inhibitory effect on digestion.

95. C

96. D

97. C
The part of the pancreas with endocrine function is made up of approximately a million cell
clusters called islets of Langerhans; α cells secrete glucagon which increases blood glucose; β
cells secrete insulin which decreases blood glucose; δ cells secrete somatostatin which regulates
the functions of α and β cells.

98. B

99. D

100. C
B lymphocytes or B cells are antibody producing cells.

101. C
Immunoglobulins are antibodies.

102. B
Secretin is produced by S cells of the duodenum and regulates pH by controlling gastric acid
secretion and buffering with bicarbonate from the pancreas. Gastrin increases the production of
stomach acid. It is primarily released by G cells in the stomach and enhances stomach mobility.
Cholecystokin is synthesized by I-cells in the small intestine and secreted in the duodenum;
cholecystokin stimulates the digestion of fats and proteins by inducing the release of digestive
enzymes and bile from the pancreas and gallbladder, respectively. Chyme refers to partially
digested food.
103. E

104. D
105.C
The conversion of ferric iron to ferrous iron is a reduction not an oxidation.

106. B

107. B
The absorption of heme iron found in meat products ranges from 15% to 35% whereas 2% to
20% of non-heme iron found in plant foods is absorbed. Overall a healthy adult absorbs 10 % to
15 % of dietary iron. The absorption of iron occurs primarily in the duodenum and upper
jejunum.

108. B

109. A
The absorption of beta carotene is enhanced if taken with fats because the molecule is fat soluble.
Carotenoids absorption is restricted to the duodenum.

110. E
Gravidity refers to the number of times a woman has been pregnant regardless of whether the
pregnancies resulted in abortion, miscarriage or live birth.

111. A
The limulus test detects bacterial endotoxin or lipopolysaccharide (LPS), which is a membrane
component of Gram-negative bacteria. Endotoxins are responsible for the clinical symptoms of
bacterial infections including high temperature (they are exogenous pyrogens), high respiration
rate, and low blood pressure; they may lead to endotoxic shock, which may be fatal.
Corynebacterium, Mycobacterium, Nocardia and Streptomyces are Gram positive bacteria.

112. C

113. D
The following patterns of necrosis have been described:
Coagulative necrosis seen in hypoxic (low oxygen) environments, such as in cardiac infarction.
However, a stroke results in liquefied necrosis.
Liquefied necrosis is linked to cellular destruction and pus formation such as in bacterial (e.g.
pneumonia) or, sometimes, fungal infections. However, spirocheatal infections result in
gummatous necrosis such as syphilis.
Hemorrhagic necrosis is due to blockage of the venous drainage of an organ or tissue resulting in
bleeding.
Caseous necrosis is caused primarily by mycobacteria such as in tuberculosis and other
granulomatous disease processes. Granulomas are a form of chronic inflammation due to foreign
bodies, and other chronic stimuli.
Fatty necrosis results from the action of lipases on fatty tissues such as in acute pancreatitis and
breast tissue damage.
Fibrinoid necrosis is linked to immune response mediated vascular damage resulting in fibrin
like deposits.

114. D
Other pathogens include chlamydia trachomatis and streptococcus haemolyticus.

115. A
The detection of pulses in feet is another symptom of poor blood flow. A bunion is a deformation
of the big toe.

116. A
Group B streptococci are also predominant pathogens. Other pathogens include: Enterococci,
nonenterococcal group D streptococci, α-hemolytic streptococci, Haemophilus influenzae type b
and other gram-negative enteric organisms such as Klebsiella sp, Enterobacter sp, Citrobacter
diversus.

117. D
Malignant hyperthermia is usually caused by general anesthetics, specifically volatile
anesthetics, the anticholinergic (neuromuscular blocker) succinylcholine or the depolarizing
muscle relaxants suxamethonium and decamethonium. Non-depolarizing muscle relaxants such
as pancuronium and rocuronium do not cause malignant hyperthermia.

118. E
The normal range of body temperature is 36.5–37.5 °C. Axillary temperature is 1 degree lower
than oral temperature whereas rectal temperature is 1 degree higher than oral temperature.
119. C
The tuning fork test is a substitute to the monofilament test.

120. B
The carotid arteries supply the head and neck. Femoral and popliteal arteries supply lower
extremities. Subclavian artery supplies upper extremities.
Sphenopalatine artery is another artery that supplies the nasal cavity.

121. C
The pulse can be felt at the neck (carotid artery) and wrist (radial artery), behind the knee
(popliteal artery), inside the elbow (brachial artery), and at the ankle joint (posterior tibial artery).

122. B
Common causes include allergies, infections, extreme temperatures and hypertension.

123. B

124. D

125. C
The classic malar rash or butterfly rash on the face. Other sites affected are kidneys.

126. D
Artery stenosis may be caused by atherosclerosis.

127. C
Monocytes and lymphocytes are non-granulocytes.

128. C

129. B
Other components of the lymphatic system are Peyer's patches and skin.
The lymphatic system has the following functions:
ü Removal of interstitial fluid from tissues
ü Transport of white blood cells to and from the lymph nodes into bones
ü Absorption and transport of fatty acids and fats as chyle from the digestive system
ü The lymph transports antigen-presenting cells such as dendritic cells, to the lymph nodes
where an immune response is activated

130. A
The dermis is composed of three major types of cells: fibroblasts, macrophages, and adipocytes.
The epidermis contains keratinocytes, melanocytes, Langerhans cells, Merkel cells and
inflammatory cells. Types of cells found in the hypodermis are fibroblasts, adipocytes, and
macrophages.
131. E
The brain and spinal cord form the central nervous system (CNS). Opioids receptors are also
found in the peripheral sensory neurons and digestive tract.

132. B
For this reason, antibiotics acting on the cell wall have high level of specificity towards bacteria
cells.

133. D
Cell wall alteration is the primary mechanism of resistance of drugs acting on bacteria cell wall
such as penicillins.

134. A
Mycobacteria do not fit the Gram-positive or Gram-positive category. They do not retain the
crystal violet stain instead they are classified as acid-fast Gram-positive. All Mycobacterium
species have a unique cell wall which is thick, hydrophobic and rich in mycolic acids. Common
acid-fast bacteria of medical importance include Mycobacterium tuberculosis, Mycobacterium
leprae and Mycobacterium avium-intracellulare complex.

135. D
Ovulation is controlled by the hypothalamus through the stimulation of the release of the anterior
pituitary gland hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
Progesterone is produced in the ovaries by the corpus luteum, the adrenal glands, and during
pregnancy by the placenta. Progesterone is also stored in adipose fat tissue. Progesterone is a
steroid hormone involved in the menstrual cycle resulting in the thickening of endometrium; it
also supports pregnancy and embryogenesis.
136. C
Mantoux test is also called tuberculin sensitivity test.

137. B
Another type of hernia is intracranial. However, the most common hernias are inguinal hernias
which represent close to 75% of abdominal hernias. An inguinal hernia is a protrusion of a
portion of abdominal cavity through the inguinal canal.

138. B

139. A
Streptococcus pyogenes is also the causative pathogen in streptococcal pharyngitis, rheumatic
fever and necrotizing fasciitis. Penicillin is the drug of choice in the treatment of scarlet fever;
alternative drugs include clindamycin and erythromycin.

140. C
Poor appetite
Other symptoms of magnesium deficiency are nausea, vomiting, fatigue, weakness, numbness,
tingling, muscle cramps, personality changes and coronary spasms.
Magnesium is also used in common laxatives and antacids (e.g., milk of magnesia).

141. C
Magnesium is also reabsorbed in the distal convoluted tubule. Sodium is reabsorbed in all four
locations and the reabsorption of sodium in the collecting duct is modulated by aldosterone.
However, the primary site of sodium reabsorption is in the proximal tube by osmosis. Almost
100 % of glucose is reabsorbed in the proximal tubule via the glucose transporter.

142. A
Typhus is transmitted by body lice, fleas, mites and ticks.

143. A
These enzymes with the exception of malate reductase belong to the citric acid cycle which takes
place in the mitochondria. Malate dehydrogenase or oxidase, succinyl-CoA synthetase, fumarase
are other enzymes found in mitochondria. Cytochrome C is also found tightly attached to
mitochondria. Oxidative phosphorylation and amino acid oxidation are other metabolic processes
that take place in the mitochondria.

144. C
A and B take place in the smooth endoplasmic reticulum; D takes place in the nucleus. Intrinsic
proteins also called integral proteins are proteins found embedded in the plasma membrane; E
takes place in the Golgi apparatus.

145. A
As example, prothrombin is a zymogen. A cofactor is a non-protein chemical compound that is
required by some enzymes for catalysis.

146. B
Phytosterols decrease serum levels of cholesterol and LDL however they have no effect on the
levels of triglycerides and HDL.

147. A
B is hyperlipidemia type I; C is hyperlipidemia type III; D is hyperlipidemia type IIb; E is
hyperlipidemia type IV; F is hyperlipidemia type V.

148. C
Only ketoacidosis leads to fast pulse. The pulse remains normal in hypoglycemia.

149. A
Extravasation refers to severe necrosis, sloughing and abscess formation with IM or
subcutaneous administration.

150. C
DPN is a complication of both type I and type II diabetes.

PHARMACEUTICAL SCIENCES

Questions

1. The following reaction is classified as:

NH4 + OH- NH3 + H2O.
A. Ionization
B. Neutralization
C. Hydrolysis
D. Displacement
E. Isomerization

2. How many molecules of Ca++ and Fe+++ respectively could EDTA chelate?

A. 1 molecule and 1 molecule

B. 2 molecules and 1 molecule
C. 2 molecules and 2 molecules
 D. 1 molecule and 2 molecules

3. Benzodiazepines act as anxiolytics by:

A. Increasing sodium ion influx

B. Potentiating the effect of GABA
C. Potentiating the effect of catecholamines
D. Decreasing chloride ion influx
E. Decreasing potassium ion influx

4. If a noncompetitive inhibitor is used the rate of enzymatic reaction would NOT:

A. Not be affected by the concentration of substrate

B. Increase if the inhibitor is removed
C. Be inversely proportional to the binding affinity of the inhibitor
D. Increase by increasing the concentration of substrate

5. At which of the following ionization rates pH equals pKa?

A. 40% ionization
B. 50% ionization
C. 60% ionization
D. 70 % ionization
E. 80% ionization

6. Which of the following proton pump inhibitors is preferred for risk reduction of NSAID-
associated gastric ulcer?

A. Omeprazole
B. Lansoprazole
C. Esomeprazole
D. Pantoprazole
E. Rabeprazole

7. Acetaminophen could replace ASA (aspirin) as:

 A. Antipyretic and analgesic
B. Anti-inflammatory and antipyretic
C. Anticoagulant and analgesic
D. Anti-inflammatory and antipyretic
E. Anticoagulant and analgesic

8. A collyrium is:

A. Stable emulsion
B. Nasal wash
C. Mouth wash
D. Non-Aqueous suspension
E. Eye wash

9. A piperidine ring is found in which of the following opioid analgesics?

A. Hydrocodone
B. Levorphanol
C. Morphine
D. Fentanyl
E. Methadone

10. Which of the following benzodiazepines is preferred for the treatment of acute agitation,
anxiety and irritability in elderly patients?

A. Alprazolam
B. Clonazepam
C. Oxazepam
D. Lorazepam
E. Diazepam

11. Which of the following can be used in open angle glaucoma but not in closed angle
glaucoma?

A. Pilocarpine
B. Latanoprost
C. Timolol
D. Acetazolamide
E. Epinephrine
12. Which of the following statements concerning tablet coating is NOT correct?

A. Protects the drug from stomach acidity

B. Enhances drug bioavailability
C. Enhances the tablet dissolution rate
D. Protects the drug from moisture.
E. Masks the bitter taste or unpleasant odour of drugs

13. Which of the following antipsychotics has less incidence of sedation?

A. Haloperidol
B. Thioridazine
C. Ziprasidone
D. Chlorpromazine
E. Perphenazine

14. Sulfisoxazole is similar in structure to:

A. PABA
B. Folic acid
C. Folinic acid
D. GABA

15. Vegetarians have usually a deficiency in which of the following vitamins?

A. Vitamin B1
B. Vitamin B2
C. Vitamin B6
D. Vitamin B12

16. Which of the following is a symptom of Vitamin D deficiency?

A. Hypercalcemia
B. Osteomalacia
C. Anorexia
 D. Renal failure
E. Metastatic calcifications

17. Which of the following vegetable oils has the highest concentration of vitamin E?

A. Olive oil
B. Corn oil
C. Sunflower oil
D. Wheat germ oil
E. Peanut oil

18. All of the following statements characterize Sjögren's syndrome, EXCEPT:

A. Destruction of exocrine glands due to immunity

B. Dry mouth and eyes
C. The Schirmer test is used to measure the level of antibodies produced against exocrine
glands
D. Comorbid conditions include rheumatoid arthritis and lupus
E. Women are more likely to be affected

19. All of the following are features of phenothiazine group, EXCEPT:

A. Tricyclic functional group containing two aromatic rings

B. Found in antipsychotics and antihistamines
C. Methylene blue is a derivative of phenothiazine
D. Chloride containing functional group
E. Phenothiazine is an electron donor

20. Which of the following vitamins contain a cobalt atom in their molecular structure?

A. Vitamin D3
B. Vitamin B12
C. Vitamin K
D. Vitamin E
E. Vitamin C

21. All of the following may cause the precipitation of total parenteral nutrition (TPN),
EXCEPT:
 A. Order of mixing the ingredients
B. Amount of electrolytes
C. Amount of amino acids
D. Amount of lipids
E. Purified egg lecithin

22. Which of the following is NOT a side effect of levothyroxine?

A. Weight loss
B. Excessive sweating
C. Tremor
D. Palpitations
E. Sensitivity to heat
F. Insomnia
G. Irritability

23. The following chemical groups are:

NH, CO, CH2

A. Analogs
B. Enantiomers
C. Structural isomers
D. Isosteres
E. Epimers

24. During the process of the formulation of tablets, an abrasion test is used to evaluate all of the
following, EXCEPT:

A. The strength or cohesion of tablets

B. The disintegration rate of tablets
C. The potential loss amount during storage
D. The degradation rate of the active ingredient

25. All of the following ACE inhibitors are prodrugs, EXCEPT:

A. Ramipril
B. Enalapril
 C. Fosinopril
D. Lisinopril
E. Perindopril

26. Which of the following statement concerning anastrozole is NOT correct?

A. Inhibits the enzyme aromatase

B. Anastrozole blocks the production of estrogen
C. Used in the treatment of breast cancer
D. Used in the treatment of prostate cancer
E. Used in the treatment of precocious puberty

27. Enalapril shown below has how many chiral centers?

A. 1
B. 2
C. 3
D. 4
E. 5
28. Which of the following is an antiplatelet?

A. Heparin
B. Ticlopidine
C. Enoxaparin
D. Warfarin

29. The following statements apply to anticoagulants, EXCEPT:

A. Use to treat patient who have unstable angina

B. Used to prevent blood coagulation
C. Used to prevent platelets aggregation
D. Used to treat patient who have had a heart attack

30. The combination between an anticoagulant and an antiplatelet may lead to:

A. Decreased effectiveness of anticoagulant

B. Decreased effectiveness of antiplatelet
C. Increased risk of bleeding
D. No effect because the drugs have different mechanisms of action

31. All are drugs used to treat angina, EXCEPT.

A. Beta blockers
B. CCBs
C. Glycosides
D. Nitrates
E. ACE inhibitors

32. Which of the following CCBs therapy may induce constipation?

A. Felodipine
B. Verapamil
C. Amlodipine
 D. Nicardipine
E. Diltiazem

33. Which of the following pharmacologic effects is NOT associated with glycosides in the
treatment of CHF?

A. Increased AV node refractory period

B. Increased cardiac contraction force
C. Increased ejection velocity
D. Increased heart rate

34. Heparin is a natural anticoagulant produced by:

A. Neutrophils and erythrocytes

B. Basophils and mast cells
C. Lymphocytes and neutrophils
D. Erythrocytes and basophils
E. Lymphocytes and mast cells

35. All of the following are benefits of the use of low molecular weight heparins over heparin,
EXCEPT:

A. Monitoring aPTT is not required

B. Decreased incidence of side effects such as thrombocytopenia and osteoporosis
C. Protamine sulfate is an effective antidote
D. Permits outpatient treatment
E. Convenient subcutaneous administration

36. Identify a phase II reaction that amphetamine (shown below) cannot undergo.

Amphetamine

A. Glucuronidation
B. Acetylation
 C. Hydrolysis
D. Methylation
E. Oxidation

37. Which of the following statements is NOT accurate concerning nephritic syndrome and
nephrotic syndrome?

A. Both are kidney disorders affecting the glomerulus leading to inflammation

B. Hypoalbuminemia, azotemia, hyperlipidemia and edema are some of the side effects
C. Both are characterized by hematuria
D. Diabetes Mellitus is the most common cause of nephrotic syndrome

38. Which of the following statements is NOT accurate concerning osteoarthritis and rheumatoid
arthritis?

A. Both are characterized by inflammation in joints leading to pain, stiffness and swelling
B. In rheumatoid arthritis, the inflammation tends to spread to other parts of the body
resulting in the formation of rheumatoid nodules, dry eyes and dry mouth
C. Both tend to affect joints in a symmetrical pattern
D. The risk of osteoarthritis increases with age and fingers, knees, and hip are primarily
affected
E. Rheumatoid arthritis is an autoimmune condition

39. Which of the following may cause hives?

A. Sumac
B. Sunlight
C. Oak
D. Medications
E. Stress
F. Latex
G. All of the above

41. Chicken pox is caused by:

A. Varicella zoster virus

 B. Herpes simplex virus 1
C. Herpes simplex virus 2
D. Cytomegalovirus
E. Coxsackie virus

42. All of the following are benefits of using DNA primers in PCR, EXCEPT:

A. Specific amplification of a gene of interest

B. Initiation of DNA synthesis
C. Setting the boundaries of the gene to be amplified
D. Quantification of synthesized DNA
E. They are thermostable

43. Which of the following three amino acids will elute first from an ion-exchange column
containing a cation-exchanger at physiological pH?

A. Glutamic acid
B. Arginine
C. Leucine
D. Alanine
E. Tryptophan

44. All are correct statements concerning cytokines, EXCEPT.

A. Cytokines are immune factors

B. Cytokines are used to stimulate the immune system
C. Cytokine are used as therapeutic agents in rheumatoid arthritis
D. Cytokines activate genes that regulate reproduction

45. Which of the following factors is NOT affected by warfarin therapy?

A. Factor VII
B. Factor II
C. Factor IX
D. Factor X
E. Factor XII
46. Which of the following blood coagulation values is NOT affected by warfarin therapy?

A. Bleeding time
B. Prothrombin time
C. Partial thromboplastin time

47. The following CCBs worsen heart failure, EXCEPT:

A. Nifedipine
B. Diltiazem
C. Amlodipine
D. Verapamil

48. Which of the following diuretics is linked to ototoxicity at high dose?

A. Hydrochlorothiazide
B. Furosemide
C. Metolazone
D. Spironolactone
E. Eplerenone

49. Regarding the use of a beta blocker in the management of hyperthyroidism, which of the
following biological effects is TRUE?

A. Aggravates sweating
B. Controls tremor
C. Causes neutropenia
D. Synergistic with iodide
E. Inhibit the activity of thyroid gland

50. A 50-year-old patient comes to the emergency department, a day after he has been
administered an antibiotic for an on-going infection, complaining about palpitations. The ECG
reveals prolonged QT interval. Which one of the following fluoroquinolones most likely caused
this adverse effect?

A. Ciprofloxacin
B. Ofloxacin
C. Moxifloxacin
D. Levofloxacin
E. Norfloxacin

51. What is the implication of INR with a value of 8?

A. Increased risk of bleeding

B. Lower risk of bleeding
C. There is no effect on bleeding
D. Ineffective warfarin therapy

52. Which of the following medications may increase INR?

A. Carbamazepine
B. Rifampin
C. Phenobarbital
D. Amiodarone
E. Oral contraceptives

53. Diabetes insipidus is characterized by all, EXCEPT:

A. Increased risk of kidney malfunction

B. Increased level of vasopressin
C. Polyuria
D. Thirst
E. There is no hyperglycemia

54. Correct statement concerning donepezil therapy.

A. There is immediate improvement in patient symptoms

B. Decreases cognitive impairment
C. Has no effect on cognitive functions
D. Decreases the level of acetylcholine
E. Repairs damaged nerves cells
55. The duration of analgesia is one important factor which differentiates
one opioid from another. Which of the following opioids has the highest potency?

A. Morphine
B. Hydromorphone
C. Meperidine
D. Methadone
E. Fentanyl

56. An agent primarily used to decrease triglycerides is:

A. Lovastatin
B. Neomycin
C. Cholestyramine
D. Niacin
E. Gemfibrozil

57. Gallstones and abdominal pain are side effects of:

A. Colestipol
B. Cholestyramine
C. Lovastatin
D. Nicotinic acid
E. Clofibrate

58. Which of the following drugs would be contraindicated for a patient with a potassium level
of 5.1?

A. Spironolactone
B. Hydrochlorothiazide
C. Acetazolamide
D. Furosemide
E. Torsemide
59. The most life-threatening adverse effect of HMG coenzyme A reductase
inhibitors (statins) is:

A. Hypersensitivity
B. Renal failure
C. Abnormal liver enzymes
D. Myalgia
E. Rhabdomyolysis

60. Which of the following classes of diuretics is calcium-sparing resulting in hypercalcemia?

A. Thiazide
B. Loop
C. Osmotic
D. Carbonic anhydrase inhibitors
E. Potassium-sparing

61. Many stimuli may cause vomiting such as the stimulation of chemoreceptor trigger zone
(CTZ). Which of the following statements concerning CTZ is NOT correct?

A. Stimulated in all forms of vomiting

B. Stimulated by morphine and its analogs
C. Located in the medulla oblongata
D. Located outside the blood-brain barrier
E. Contains dopamine, serotonin, histamine, substance P, opioid,
and acetylcholine receptors

62. The duration of analgesia is one important characteristic which differentiates one opioid from
another. Which of the following opioids has the shortest duration of analgesia?

A. Morphine
B. Hydromorphone
C. Codeine
D. Meperidine
E. Methadone
63. Which of the following drugs antagonizes histamine-1 receptor?

A. Ranitidine
B. Nizatidine
C. Famotidine
D. Fexofenadine
E. Cimetidine

63. Some potential barriers to successful treatment of bacterial abscesses with an aminoglycoside
include:

A. Inactivation of aminoglycosides by an acidic medium

B. Binding of the drug by pus resulting in lack of effectiveness
C. Decreased ability of the drug to penetrate abscesses because of poor vascularity
D. All of the above

64. The drug of choice for methicillin-resistant Staphylococcus aureus is:

A. Oxacillin
B. Cefalexin
C. Vancomycin
D. Piperacillin
E. Cefaclor

65. Scopolamine is an antiemetic with anticholinergic and muscarinic activity. All of the
following statements may be included to a patient counseling session on the use of scopolamine
patch to control nausea and vomiting, EXCEPT:

A. Apply one patch to a clean, dry, hairless area behind the ear
B. The patch should be applied at least 4 hours, up to 12 hours before its effects will be
needed.
C. The patch remains active for up to 24 hours
D. Keep the patch dry to prevent it from falling
E. Common side effects are dry mouth, dizziness and poor visual accommodation

66. A patient with chronic obstructive pulmonary disease (COPD) is being treated with
theophylline by i.v. infusion. What fraction of the steady-state level will be achieved after a time
equal to two (2) elimination half-lives from the beginning of the infusion?

A. 25%
B. 50%
C. 75%
D. 90%
E. 100%

67. The drug of choice for Streptococcus pneumonia (pneumococcus) in a patient without a
history of drug allergies is:

A. Erythromycin
B. Penicillin
C. Vancomycin
D. Ceftriaxone
E. Gentamicin

68. Aminoglycosides are NOT:

A. Bacteriostatic
B. Potentially toxic to the auditory system
C. Potentially nephrotoxic
D. Gram-negative
E. Protein synthesis inhibitors

69. Clindamycin is NOT:

A. Associated with antibiotic-induced diarrhea

B. Active primarily against anaerobes
C. Active primarily against some gram-negative bacteria
D. Used to treat acne
E. A lincosamide

70. Amphotericin B is a very useful agent for treating fungal infections. All of the following are
correct statements regarding amphotericin B, EXCEPT:

A. Binds to ergosterol in the fungal cell membrane

 B. Its analog amphotericin A has also potent antifungal effect
C. Nephrotoxicity may occur
D. Has antiprotozoal effect
E. Typically administered parenterally

71. All of the following are correct statements concerning sulfonamides, EXCEPT:

A. Are competitive antagonists of PABA, and thereby decrease bacterial utilization of para-
aminobenzoic acid in the synthesis of folic acid
B. Are synergistic with trimethoprim, which inhibits dihydrofolate reductase
C. Their action is antagonized by PABA
D. Useful in the management of Stevens–Johnson syndrome
E. Also useful as antifungal and antimalarial agents

72. Various drugs may induce vitamin deficiency as an undesirable side effect. Vitamin B6
(pyridoxine) deficiency may be related to taking:

A. Estrogen-containing oral contraceptives

B. Colchicine
C. Isoniazid
D. Warfarin
E. Clonidine

73. Hepatitis is swelling and inflammation of the liver. Symptoms include dark urine, loss
appetite, jaundice and abdominal pain. Which of the following antibiotics is most closely
associated with the development of hepatitis?

A. Sulfamethoxazole
B. Penicillin G
C. Tetracycline
D. Isoniazid
E. Erythromycin

74. Which of the following antibiotics is most closely associated with the development of renal
and ototoxicity?
 A. Kanamycin
B. Penicillin G
C. Tetracycline
D. Isoniazid
E. Ethambutol

75. Compared to digitoxin, digoxin is or has:

A. Higher binding affinity for plasma proteins

B. Extensively recycled by enterohepatic circulation
C. Prolonged elimination half-life
D. Less completely absorbed orally
E. Extensively metabolized in liver

76. The beneficial effects of digitalis are derived from its effect on myocardial contractility and
on myocardial conduction and excitability. In therapeutic doses, digitalis:

A. Slows atrium contractibility

B. Slows ventricle contractibility
C. Increases ventricle conductivity
D. Increases atrium excitability
E. Decreases ventricular automaticity

77. All are stereoisomers, EXCEPT:

A. Enantiomers
B. Diastereoisomers
C. Z/E isomers
D. Structural isomers
E. Rotamers

78. Hybridoma technology is used to produce:

A. Therapeutic monoclonal antibodies

B. Transgenic animals to test the safety of new drugs
C. Recombinant DNA during the process of cloning
D. Complementary DNA from mRNA
 E. Highly specific polyclonal antibodies

79. Which of the following is NOT a type of cytokine?

A. Interferon Alpha
B. Human Chorionic Gonadotropin
C. Interleukin
D. Colony Stimulating Factor

80. In general protein drugs have a short shelf life compared to small molecule drugs due to their
sensitivity to all, EXCEPT:

A. UV light
B. Temperature
C. pH
D. Shaking
E. Formulation additives
F. Salt

81. A patient with congestive heart failure is receiving digoxin at a daily dose of 0.25 mg orally.
A digoxin concentration in plasma is reported at 1.2 ng/ml after steady-state conditions have
been reached (therapeutic range for plasma digoxin is 0.8-2.0 ng/ml). The patient is showing
declining renal function and his creatinine clearance is now 50% of normal. What would you
recommend with regard to the daily dose of digoxin?

A. Reduce the daily dose by 25% and recheck levels

B. Stop digoxin due to the risk of toxicity in renal failure
C. Reduce the daily dose to 0.125 mg and recheck levels
D. Continue the same daily dose and recheck levels
E. Give 0.25 mg every 72 hours and recheck levels

82.
Assuming a pH of 8.5 and a pKa of 7.9, what is the percentage of unionized drug?
 A. 20%
B. 40%
C. 50%
D. 60%
E. 80%

83. When salicylic acid is added to the therapeutic regimen of a patient receiving valproic acid,
the average steady state concentration (Css) decreased. However, there is no change in seizure
control. The likely explanation is:

A. The patient was already completely cured prior to adding salicylic acid to his therapeutic
regimen
B. Valproic acid has no effect in this case, this patient has transient seizures
C. Stable pharmacologic effect suggests that the concentration of free drug did not change
D. The average steady state concentration is not relevant for drug action
E. The measurement of the steady state concentration is inaccurate

84. Which of the following condition may limit the use of sulfonamides?

A. Seizures
B. Vision disturbances
C. Jaundice
D. Sensitivity to light
E. Diabetes

85. Which of the following laminar flow hoods is NOT suitable for preparing a parenteral
solution of aminophylline?

A. Horizontal
B. Convergent
C. Vertical
86. In the treatment of Parkinson’s disease bromocriptine acts as:

A. Dopamine precursor
B. Dopamine reuptake inhibitor
C. MAO-B inhibitor
D. Dopamine biosynthesis inducer
E. Dopamine agonist

87. MT is a psychotic and obese patient. Which of the following atypical antipsychotics would
be preferred for MT?

A. Clozapine
B. Ziprasidone
C. Olanzapine
D. Quetiapine
E. Risperidone

88. Drug A is metabolized to a single metabolite by the enzyme CYP3A4. The metabolite is
found to be equipotent to drug A. After the administration of a single dose of drug A, the
apparent half-life of both drug A and its metabolite were found to be 8 hrs. However, when
clinical studies were conducted with the metabolite alone, the duration pharmacologic effect of
the metabolite was found to be shorter than that of drug A. Which of the following statements
may explain this observation?

A. The elimination rate of the metabolite is actually slower than drug A

B. The elimination rate of the metabolite is actually faster than drug A
C. The absorption rate of the metabolite is actually slower than drug A
D. The absorption rate of the metabolite is actually faster than drug A
E. Inconclusive due to lack of appropriate data

89. Which of the following drugs decreases the effectiveness of oral contraceptives and is an
antagonist of neurokinin 1 (NK1) receptor?

A. Ritonavir
B. St. John’s Wort
 C. Aprepitant
D. Rifampin
E. Phenytoin

90. Prednisone may produce the following side effects, EXCEPT.

A. Depression
B. Facial puffiness
C. Hypoglycemia
D. Infections
E. Mouth sores

91. Correct statements regarding amantadine:

A. Antiviral against influenza A and influenza B

B. Used in the treatment of Parkinson’s disease
C. Stimulates the release of dopamine
D. Acts as muscarinic antagonist
E. Acts as an inhibitor of Influenza A surface M2 ion channel protein

92. The most commonly recognized side effect of acetaminophen toxicity is:

A. Kidney failure
B. Nausea
C. Blurred vision
D. Hepatic Necrosis.
E. Diarrhea

93. Which of the following metabolic enzymes is induced by alcohol resulting in increased
acetaminophen toxicity?

A. CYP 3A4
B. CYP 2C9
C. CYP 1A2
D. CYP 2E1
E. CYP 3A5
94. JT is 35 years old HIV patient who complains about headaches, irritability, and nightmares.
Which one of the following antiretroviral drugs is most likely causing these symptoms?

A. Efavirenz
B. Indinavir
C. Lamivudine
D. Stavudine
E. Abacavir

95. Regarding its mechanism of action, cromolyn sodium is best described as:

A. Anticholinergic
B. Beta agonist
C. Mast cell stabilizer
D. Glucocorticoid
E. Analgesic

96. What type of clinical study for an Investigational New Drug (IND) involves neither the
investigators nor the patients knowing if the drug or placebo is being given?

A. Single-blind study
B. Double-blind study
C. Placebo-controlled
D. Single-arm
E. Crossover

97. What type of clinical study for a new drug involves each subject receiving all treatment
options?

A. Single-blind
B. Double-blind
C. Single-arm
D. Placebo-controlled
E. Cross-over
98. What type of study for an Investigational New Drug (IND) involves comparison with a
placebo?

A. Single-blind
B. Double-blind
C. Double-arm
D. Single-arm
E. Open-label

99. In clinical trials, the process of informed consent based on the principle of autonomy
involves:

A. Providing all trial related information including expected risks to the patient prior to
enrolment in the study
B. Providing the information in a manner that promotes full understanding
C. Voluntary but informed decision making
D. All of the above

100. Which of the following is most useful in determining the rate of elimination of a drug?

A. Drug concentration in urine

B. Drug concentration in stool
C. Drug concentration in blood
D. Drug concentration in brain
E. Drug concentration in liver

101. In which of the following locations it is most likely to find unaltered drugs?

A. Urine
B. Feces
C. Breast milk
D. Fat tissues
E. Sweat

102. Which of the following is NOT a feature of prolonged release medications?

 A. Less frequent administration
B. Therapeutic effect overnight
C. Lower incidence of side effects
D. Patient compliance
E. More variation in plasma concentration

103. Which of the following is NOT a pharmacokinetic process?

A. Alteration of the drug by P450 enzymes

B. Urinary clearance of drug metabolites
C. Drug diffusion from the GI tract to systemic circulation
D. Induction of vasodilation by a drug
E. Deposition of drug in fat tissues

104. Which of the following statements concerning randomized clinical trials is NOT accurate?

A. They are the most reliable clinical trials

B. A randomized trial features an experimental group and a control group
C. Randomized trials are also called blinded trials
D. Participants are assigned randomly to the trial groups
E. Conscious bias is eliminated by creating trial groups that are similar on average

105. Which of the following statements characterizes a single-arm clinical study?

A. A group receiving a placebo is used as control

B. A group receiving a standard drug is used as control
C. A single group receives the investigational drug to see whether their condition improves
D. Treatment allocations are revealed to participants before the trial

106. In clinical trials the intent to treat analysis is used to enhance the accuracy of results by
decreasing bias. Which of the following statements are correct concerning intent to treat
analysis?

A. Analysis based on initial treatment intent

B. Different from per-protocol analysis
C. Includes patients who did not complete the trial
 D. All of the above

107. A patient come to see you with a prescription for niacin tablets 500 mg tid. Which of the
following is the likely diagnosis?

A. Hypercholesterolemia
B. Coronary insufficiency
C. Gout
D. Anemia
E. Alcoholism

108. While switching a patient from phenytoin capsule to phenytoin suspension there is a marked
reduction in drug blood level. How would you explain this effect?

A. Only metabolism related

B. Only absorption related
C. Only dosage related
D. Absorption and metabolism related
E. Dosage and absorption related

109. Which of the following antipsychotics is used in the treatment of Tourette’s syndrome?

A. Haloperidol
B. Clozapine
C. Thiothixene
D. Olanzapine
E. Quetiapine

110. Which of the following antipsychotics are used in the management of acute agitation?

A. Clozapine
B. Olanzapine
C. Cariprazine
D. Loxapine
E. Quetiapine
111. Which of the following antipsychotics has the highest incidence of extrapyramidal
syndrome (EPS)?

A. Chlorpromazine
B. Thioridazine
C. Haloperidol
D. Ziprasidone
E. Perphenazine

112. Which of the following beta blockers is preferred in the treatment of essential tremors?

A. Atenolol
B. Esmolol
C. Pindolol
D. Propranolol
E. Timolol

113. Which of the following beta blockers has the highest degree of intrasympathomimetic
activity (ISA)?

A. Atenolol
B. Acebutolol
C. Penbutolol
D. Carteolol
E. Pindolol

114. Which of the following TC antidepressants has the highest serotonin reuptake blocking
effect?

A. Clomipramine
B. Doxepin
C. Imipramine
D. Desipramine
E. Nortriptyline

115. Which of the following insulin preparations is compatible when mixed with all types of
insulin?
 A. Lispro
B. Aspart
C. Regular
D. Isophane
E. Lente

116. All of the following statements are correct, EXCEPT:

A. Propylparaben is antimicrobial
B. Sodium bisulfate is an antioxidant
C. EDTA is a chelating agent
D. Lecithin is an antioxidant
E. Lactic acid is antimicrobial

117. The following reaction is classified as:

A. Carboxylation
B. Carbamylation
C. Hydroxylation
D. Acetylation
E. Esterification
118. The calcium channel blocker used to treat unstable angina is:

A. Nifedipine
B. Diltiazem
C. Amlodipine
D. Verapamil
E. Felodipine

120. All of the following statements concerning clofibrate are correct, EXCEPT:

A. Increases lipoprotein lipase activity to promote the conversion of VLDL to LDL

 B. Inhibits cholesterol biosynthesis
C. Lowers serum triglycerides more than cholesterol
D. May induce SIADH
E. Prevents the formation of cholesterol stones in the gallbladder

121. The following symptoms are linked to benzodiazepines withdrawal syndrome, EXCEPT:

A. Sweating
B. Lacrimation
C. Seizures
D. Transient auditory hallucinations
E. Hand tremor

122. Which of the following statements concerning surface tension is NOT correct?

A. Surface tension is due to cohesive forces among the liquid molecules

B. Emulsifying agents enhance the stability of emulsion by decreasing surface tension
C. Surface tension is a property of the surface of a liquid that allows it to resist an external
force
D. Surface tension is low in water compared to other liquids
E. Surface tension decreases as the temperature increases

123. Gentamycin is an aminoglycoside which acts by irreversible inhibition of S30 subunit of

bacterial ribosome. Due to toxicity concerns the use of gentamicin is mostly limited to the
treatment of which of the following infections?

A. Gastrointestinal tract infections

B. Urinary tract infections
C. Respiratory tract infections
D. Eye infections
E. Ear infections

124. Which of the following functional groups has the highest solubility in an acidic
environment?

A. Carboxylic acid
 B. Sulfonamide
C. Phenol
D. Amino group
E. Imine

125. Phenol is characterized by weak acidity. Which of the following statements explain this
property of phenol?

A. Resonance stabilization of the phenoxide anion by the aromatic ring

B. Strong release of proton
C. Poor water solubility
D. Highly basic

126. Some drugs act as non-competitive enzyme inhibitors. In non-competitive inhibition,

increasing the concentration of the enzyme substrate results in:

A. Increased reaction rate

B. Decreased reaction rate
C. Increased concentration of products
D. Decreased concentration of products
E. No effect

127. All of the following statements are accurate concerning the use of beta blockers in the
treatment of angina, EXCEPT:

A. They decrease heart rate and blood pressure

B. They reduce free fatty acids level
C. They prevent angina by decreasing myocardial oxygen demand
D. They have a good safety profile in the treatment of Prinzmentals’s angina
E. They weaken the effects of stress hormones

128. Which of the following drugs is NOT an antiplatelet?

A. Aspirin
B. Clopidogrel
C. Dalteparin
D. Eptifibatide
E. Abciximab
129. Which of the following drugs is first line treatment for urge incontinence?

A. Darifenacin
B. Oxybutynin
C. Estrogen
D. Imipramine
E. Flavoxate

130. Which of the following drugs is first choice in the treatment of acute gout?

A. Indomethacin
B. Colchicine
C. Triamcinolone
D. Allopurinol
E. Probenecid

131. All aseptic manipulations in the laminar airflow hood should be performed at least ___
inches from the outer edge.

A. 3
B. 5
C. 7
D. 9
E. 11

132. If the laminar airflow work bench is turned off, it should be cleaned and allowed to run for
at least ________ prior to use.

A. 15 minutes
B. 30 minutes
C. 45 minutes
D. 60 minutes
E. 90 minutes
133. A laminar air flow hood required to ensure an aseptic environment is:

A. ISO Class 8
B. ISO Class 7
C. ISO Class 6
D. ISO Class 5
E. ISO Class 3

134. What are the minimum and maximum weights for a Class A prescription balance?

A. 100mg to 100g
B. 110mg to 110g
C. 120mg to 120g
D. 130mg to 130g
E. 150 mg to 150 g

135. Thermodynamics is useful in indicating the spontaneity of a biological process. Which of

the following statements concerning a spontaneous biological process is NOT correct?

A. Energy is conversed
B. Energy can be converted from one from to another
C. Input of energy from outside is required
D. Entropy is increased
E. The reaction proceeds toward the state with the least potential energy

136. Enzyme catalysis is characterized by:

A. Increased reaction rate

B. Increased amount of products
C. Increased equilibrium constant
D. Increased activation energy

137. At pH = 4, a strong acid will:

 A. Have decreased rate of dissociation
B. Have the highest rate of ionization
C. Have resistance to neutralization
D. Have strong ionic interactions
E. Low pH has no effect on the ionization of a strong acid

138. Stress has significant impact on biological functions. Which of the following enzymes level
is increased by stress?

A. Thyroid stimulating hormone

B. Adrenocorticotropic hormone
C. Luteinizing hormone
D. Insulin

139. All of the following statements concerning zwitterions are accurate, EXCEPT:

A. Have a single ionization constant

B. The amino acid leucine is a zwitterion
C. Zwitterions are also called amphoteric substances
D. Carry at least one positive and one negative charges
E. Characterized by an isoelectric point

140. Which of the following amino acids have two chiral centers?

A. Threonine and Glycine

B. Glutamine and Isoleucine
C. Isoleucine and Threonine
D. Glutamine and Tryptophan
E. Glycine and Tryptophan

141. Peyer’s patches are lymphoid follicles containing predominantly B lymphocytes. Peyer’s
patches are found in:

A. Intestine
 B. Liver
C. Kidneys
D. Lungs
E. Skin

142. Bulimia and anorexia are both eating disorders. Which of the following statements
concerning bulimia is NOT correct?

A. Bulimia is characterized by binge eating followed by self-induced vomiting

B. People suffering from bulimia are often addicted to laxatives, diuretics or excessive
exercise
C. Bulimia is more likely to affect women than men
D. Bulimia is characterized by significant reduction of appetite
E. Bulimia is often associated with depression and anxiety

143. Gastroesophageal reflux (GERD) is characterized by backward flow of stomach acid and
enzymes in the esophagus. Which of the following are symptoms of GERD?

A. Dysphagia
B. Odynophagia
C. Chest pain
D. Increased salivation
E. All of the above

144. Which of the following conditions is more likely to affect a 7 years old child?

A. COPD
B. Chronic bronchitis
C. Asthma
D. Lung cancer

145. Enzymes have high level of specificity for their substrate. Which of the following is NOT a
substrate property that determines this specificity?

A. Molecular structure
B. Ionization state
C. Stereochemistry
 D. Functional groups
E. Reaction mechanism

146. Which of the following coenzymes is required for amino group transfer in biological
reactions?

A. Biocytin
B. Coenzyme A
C. Pyridoxal phosphate
D. Tetrahydrofolate
E. Lipoate

147. Which of the following statements concerning the biological activity of estriol, estradiol and
estrone is correct?

A. Estriol if more potent than estradiol and estrone

B. Estradiol if more potent than estriol and estrone
C. Estrone if more potent than estradiol and estriol
D. Estriol is as active as estrone and both are more active than estradiol
E. Estrone is as active as estradiol and both are more active than estriol

148. Which of the following mechanisms is not associated with estrogen in the promotion of
blood coagulation?

A. Increasing the level of blood clotting factors

B. Inducing the aggregation of platelets
C. Increasing the level of antithrombin
D. Increasing plasminogen
E. Increasing Von Willebrand Factor

149. Which of the following eicosanoid is characterized by two fused five-membered rings in its
molecular structure?

A. Prostaglandin
B. Thromboxane
C. Leukotriene
 D. Prostacyclin

150. All of the following statements concerning type I diabetes are correct, EXCEPT:

A. Non-insulin dependent
B. Autoimmune disorder
C. Destruction of insulin producing cells
D. Associated with ketoacidosis
E. Has early onset

151. Carpal tunnel syndrome is characterized by pressure on the median nerve that supplies
feeling and movement to the hand. Symptoms include numbness, tingling, weakness, or muscle
damage in the hand and fingers. Carpal tunnel syndrome may be caused by:

A. Diabetes
B. Obesity
C. Alcoholism
D. Rheumatoid arthritis
E. Hypothyroidism
F. All of the above

152. Conjunctivitis or Pink eye is characterized by inflammation or infection of the membrane

lining the eye lids. Conjunctivitis is caused by:

A. Bacteria
B. Allergies
C. Irritants
D. Fungi
E. Chemicals
F. Viruses
G. Parasites
H. Chlamydia
I. All of the above

153. All of the following statements concerning different types of glaucoma are correct,
EXCEPT:
 A. Open angle glaucoma is a chronic condition resulting in increased ocular pressure due to
the build-up of aqueous humor
B. Unlike open angle glaucoma, close angle glaucoma is usually acute; it appears suddenly
resulting in increased ocular pressure
C. Close angle glaucoma requires immediate intervention to avoid vision loss
D. Open angle glaucoma is the most common one
E. Miotic agents are known to increase the risk of open angle glaucoma

154. The following reaction is best described as a:

NaBH4
CH3CH2CH=O CH3CH2CH2OH

A. Oxidation
B. Reduction
C. Condensation
D. Isomerization
E. Halogenation

155. Aspirin is primarily absorbed in which of the following gastrointestinal sites?

A. Stomach
B. Ileum
C. Duodenum
D. Jejunum
E. Colon

156. All of the following are natural gelling agents, EXCEPT:

A. Alginic acid
B. Pectin
C. Carrageenan
D. Polyethylene glycol
E. Gelatin
157. All of the following are typical bases used in the formulation of effervescent tablets,
EXCEPT:

A. Sodium chloride
B. Sodium carbonate
C. Sodium bicarbonate
D. Potassium carbonate
E. Potassium bicarbonate

158. A hydrogel is a network of polymer chains containing water. Hydrogels are used in:

A. Controlled drug delivery systems

B. Topical drug delivery systems
C. Contact lenses
D. Injections
E. Breast implants
F. Wound healing
G. Rectal drug delivery
H. All of the above

159. All of the following are nonionic emulsifying agents, EXCEPT:

A. Cocamide
B. Tween
C. Alkyl polyethylene oxide
D. Polaxamer
E. Cetylpyridine chloride

160. Which of the following phytosterols is found in higher amount in vegetables oils such as
safflower, corn, soy, olive, canola and sunflower?

A. Sitosterol
B. Campesterol
C. Sigmasterol
 D. Brassicasterol
E. Sitostanol

161. The functional group shown below is found in the molecular structure of:

A. Vitamin E
B. Vitamin C
C. Vitamin K
D. Vitamin B2
E. Vitamin B5

162. Which of the following pairs of vitamins contain the functional group shown below in their
molecular structures?

A. Vitamin B3 and Vitamin B9

B. Vitamin B6 and Vitamin B2
C. Vitamin B3 and Vitamin B6
D. Vitamin B9 and Vitamin B2
E. All of the above
163. The functional group shown below is found in the molecular structure of:

A. Vitamin B1
B. Vitamin B7
C. Vitamin B12
D. Vitamin E
E. Vitamin C

164. The metabolism of exposed methyl group in R-CH3 by oxidation catalyzed by P450
enzymes results in the production of the following substances, EXCEPT:

A. Alcohol
B. Aldehyde
C. Carboxylic acid
D. Diol

165. The metabolism of primary amines by monoamine oxidases results in the formation of:

A. Aldehyde
B. Alcohol
C. Ketone
D. Carboxylic acid
E. Epoxide

166. Elixirs are common liquid formulations of drugs. Elixirs are preferred over syrups because
they have better solubility profile for all:

A. Flavoring oils
B. Weak acidic drugs
C. Weak basic drugs
D. Ionic drugs
E. All of the above
167. You are the pharmacist in charge of training a newly hired technician. Which of the
following disinfectants would you recommend for cleaning a laminar flow hood?

A. Acetone
B. Glutaraldehyde
C. Isopropyl alcohol
D. Distilled water

168. Rubbing alcohol is a commonly used germicide. Which of the following is the
concentration of rubbing alcohol?

A. 50 % (v/v)
B. 60 % (v/v)
C. 70 % (v/v)
D. 80 % (v/v)
E. 90 % (v/v)

169. You are compounding a topical preparation which requires a vanishing cream base.
Vanishing cream is best described as:

A. Cold cream
B. Hydrophilic ointment
C. Polyethylene glycol ointment
D. White petrolatum
E. Anhydrous lanolin

170. Which of the following topical formulations may not require an antimicrobial preservative?

A. W/O emulsion
B. O/W emulsion
C. Aqueous gel
D. Saturated sugar solution

171. Which of the following would be the most appropriate sterilization method for ophthalmic
preparations?
 A. Ethylene oxide gas
B. Dry heat for 15 minutes
C. Autoclaving for 15 minutes
D. Filtration using 0.2 um filter
E. Radiation

172. Which of the following suppository of bases dissolves in the rectum instead of melting?

A. Cocoa butter
B. Glycerinated gelatin
C. Palm oil
D. Coconut oil

173. Calculate the absolute bioavailability F for an investigational drug based on the following
data.

Drug formulation Dose AUC (ug/ml/h)

Tablet 150 mg po 45
Suspension (control) 150 mg po 55
IV (control) 50 mg po 40

A. 0.37
B. 0.56
C. 0.82
D. 1.12
E. 1.50

174. Which of the following sulfonamides are preferred in the treatment of rheumatic fever?

A. Sulfadiazine
B. Sulfametoxydiazine
C. Sulfamethoxazole
D. Sulfacetamide
175. Which of the following aminoglycosides is used orally to treat liver encephalopathy?

A. Gentamycin
B. Tobramycin
C. Kanamycin
D. Neomycin
E. Streptomycin

176. Which of the following aminoglycosides has the lowest incidence of hypersensitivity
reactions?

A. Gentamycin
B. Tobramycin
C. Kanamycin
D. Streptomycin
E. Neomycin

177. Which of the following penicillins is provided parenterally only?

A. Penicillin V
B. Dicloxacillin
C. Nafcillin
D. Carbenicillin
E. Piperacillin

178. Jarisch–Herxheimer is a reaction associated with initial treatment of a spirochetal infection

such as syphilis with:

A. A β-lactam antibiotic
B. An Aminoglycoside antibiotic
C. A Sulfonamide antibiotic
D. A Tetracycline antibiotic
E. A cyclic peptide antibiotic

179. Which of the following fluoroquinolones has the highest incidence of CNS related side
effects?

A. Ciprofloxacin
 B. Lomefloxacin
C. Norfloxacin
D. Ofloxacin
E. Moxifloxacin

180. Capsaicin is used as analgesic because it:

A. Depletes and prevents the accumulation of substance P in peripheral sensory neurons

B. Inhibits cyclooxygenases leading to decreased production of prostaglandins
C. Acts centrally as potassium channel opener with weak N-methyl-D-aspartate receptor
antagonistic effect
D. Has partial agonistic properties at cerebral opioids receptors
E. Inhibits presynaptic reuptake of serotonin and noradrenaline, block N-methyl-D-
aspartate receptor and ion channel

181. All of the following antipsychotics contain a piperazine functional group, EXCEPT:

A. Perphenazine
B. Mesoridazine
C. Fluphenazine
D. Prochlorperazine
E. Trifluoperazine

182. Which of the following antipsychotic drugs has the lowest incidence of orthostatic
hypotension?

A. Clozapine
B. Perphenazine
C. Risperidone
D. Olanzapine
E. Quetiapine

183. Which of the following intranasal steroids is used in the treatment of non-allergic AND
allergic rhinitis?

A. Budesonide
B. Mometasone
C. Triamcinolone
 D. Beclomethasone
E. Flunisolide

184. The piperazine functional group is found in which of the following antihistamines?

A. Promethazine
B. Hydroxyzine
C. Clemastine
D. Pheniramine
E. Triprolidine

185. Which of the following antihistamines is NOT an antiemetic?

A. Doxylamine
B. Diphenhydramine
C. Promethazine
D. Dimenhydrinate
E. Cetirizine

186. Which of the following piperidine containing antihistamines is first generation?

A. Azatadine
B. Loratadine
C. Fexofenadine
D. Ketotifen
E. Desloratadine

187. Among the following second-generation antihistamines which one has the highest degree of
sedation?

A. Azelastine
B. Cetirizine
C. Desloratadine
D. Fexofenadine
E. Loratadine
188. All of the following opioids analgesics contain a phenanthrene group, EXCEPT:

A. Codeine
B. Meperidine
C. Levorphanol
D. Morphine
E. Hydrocodone

189. The opioid analgesic with the lowest antitussive potency is:

A. Codeine
B. Levorphanol
C. Oxymorphone
D. Morphine
E. Hydrocodone

190. The opioid analgesic with the highest incidence of dependence is:

A. Meperidine
B. Oxymorphone
C. Hydrocodone
D. Levorphanol
E. Morphine

191. Which of the following analgesics contains a pyrrolidine?

A. Ketorolac
B. Naproxen
C. Ibuprofen
D. Piroxicam
E. Diclofenac
192. Which of the following conditions is NOT treated with propranolol?

A. Pheochromocytoma
B. Migraine prophylaxis
C. Essential tremors
D. Stable congestive heart failure
E. Myocardial infraction

193. All of the following are centrally acting adrenergic blockers, EXCEPT:

A. Clonidine
B. Guanadrel
C. Methyldopa
D. Guanabenz
E. Guanfacine

194. Which of the following diuretics may increase total cholesterol, LDL and triglycerides but
have no effect on HDL?

A. Osmotic
B. Loop
C. Aldosterone antagonists
D. Carbonic anhydrase inhibitors
E. Potassium-sparing

195. All of the following beta blockers decrease HDL and increase LDL, EXCEPT:

A. Nadolol
B. Acebutolol
C. Pindolol
D. Atenolol
E. Metoprolol

196. Clonidine is a centrally acting drugs with numerous indications. Which of the following
conditions in not managed with clonidine?

A. Diabetic diarrhea
B. Gilles de la Tourette syndrome
C. Postherpetic neuralgia
D. Ulcerative colitis
E. Erectile dysfunction

197. Which of the following beta blockers has the shortest duration of action?

A. Acebutolol
B. Carteolol
C. Nadolol
D. Propranolol
E. Atenolol

198. Aliskiren is used as antihypertensive because it acts as:

A. Selective beta receptors blocker

B. Direct renin inhibitor
C. Calcium channel blocker
D. Selective alpha 1 receptor inhibitor
E. Aldosterone receptor blocker

199. Which of the following HMG-CoA reductase inhibitors is not commonly used to manage
hypertriglyceridemia?

A. Fluvastatin
B. Pravastatin
C. Rosuvastatin
D. Simvastatin
E. Atorvastatin

200. Which of the following HMG-CoA reductase inhibitors has the greatest potential of
accumulation in patients with renal impairment due to long half-life?
 A. Lovastatin
B. Rosuvastatin
C. Atorvastatin
D. Fluvastatin
E. Pravastatin

201. Which of the following thiazide diuretics would be preferred in a patient with gout?

A. Metolazone
B. Chlorthalidone
C. Hydrochlorothiazide
D. Indapamide
E. Chlortalidone

202. The metabolism of which of the following pairs of potassium-sparing diuretics produces
active metabolites?

A. Eplerenone and Spironolactone

B. Triamterene and Spironolactone
C. Amiloride and Eplerenone
D. Triamterene and Amiloride

203. Which of the following corticosteroids is the drug of choice for primary and secondary
adrenal cortical insufficiency?

A. Budesonide
B. Dexamethasone
C. Cortisone
D. Prednisone
E. Betamethasone

204. Which of the following corticosteroids has the highest anti-inflammatory potency?

A. Prednisone
B. Hydrocortisone
 C. Prednisone
D. Betamethasone
E. Triamcinolone

205. Which of the following corticosteroids is intermediate acting?

A. Dexamethasone
B. Triamcinolone
C. Cortisol
D. Cortisone
E. Betamethasone

206. All the following statements concerning the mechanism of action of dipyridamole are
correct, EXCEPT:

A. Lengthens abnormally shortened platelet survival time in a dose dependent manner

B. Inhibits red blood cells uptake of adenosine resulting in platelets deactivation
C. Increases the production of thromboxane A2 resulting in the prevention of platelets
activation
D. Inhibits phosphodiesterase enzyme increasing cellular cAMP
E. Increases extracellular concentration of adenosine

207. Which of the following statements concerning protein C are correct?

A. It modulates the extrinsic pathway of coagulation

B. It promotes fibrinolysis and inactivates factors V and VIII
C. Protein S accelerates the anticoagulation effect of protein C
D. The activation of protein C is inhibited by thrombomodulin and endothelial protein C
receptor
E. The non-active form of protein C or zymogen is a vitamin K-dependent glycoprotein

208. All are true statements regarding the intrinsic and extrinsic pathways of coagulation,
EXCEPT:

A. Intrinsic pathway is initiated by the activation of factor XII

B. Extrinsic pathway is activated by the release of tissue thromboplastin
C. The extrinsic pathway takes longer to form a clot than the intrinsic pathway
D. Both converge at a common pathway where thrombin is the primary factor
209. All of the following factors are vitamin K dependent, EXCEPT:

A. Factor II
B. Factor III
C. Factor VII
D. Factor IX
E. Factor X

210. All the following statements concerning heparin are accurate, EXCEPT:

A. It decreases bleeding time

B. It is produced by basophils and mast cells
C. It inhibits the conversion of fibrinogen to fibrin due to factor III dependent deactivation
of thrombin
D. It prevents the formation of stable fibrin due to inhibition of factor XIII
E. It reduces lipoprotein levels by enhancing the release of the enzyme lipase

211. A desired drug concentration of 7.5 mg/L of theophylline is required for a 60 kg patient.
What is the loading dose assuming Vd = 0.5 L/kg, Cl = 0.04 L/kg/hr and t (1/2) = 9.3 hrs?

A. 75 mg
B. 150 mg
C. 225 mg
D. 300 mg
E. 350 mg

212. Which of the following is NOT a phase II reaction substrate?

A. Glucuronic acid
B. Sulfuric acid
C. Acetic acid
D. Amino acids
E. Alcohol

213. A patient is in the hospital and is stable on drug A 0.175 mg IV bid. How much drug A in
mg would you need to give this patient orally, assuming that the bioavailability for oral drug A
tablets is 0.7?

A. 0.12 mg
B. 0.25 mg
C. 0.50 mg
D. 0.70 mg
E. 0.95 mg

214. Using Fick’s law of diffusion, how will drug absorption change if the membrane thickness
is doubled?

A. Double
B. Quadruple
C. Half
D. Quarter
E. No change

215. An antihypertensive has a plasma half-life of 24 hours. If a dose of 40 mg per day is

prescribed, when would you predict that its effect should be near maximal based on blood levels
greater than 90%?

A. 24 hours
B. 36 hours
C. 48 hours
D. 72 hours
E. 96 hours

Answers

1. B

2. A

3. B
4. D
However, if a competitive inhibitor is used then the reaction rate would increase by increasing
the concentration of substrate.

5. B

6. C
Lansoprazole can be an alternative.
7. A

8. E

9. D
A piperidine is also found in paroxetine, risperidone, methylphenidate, raloxifene, minoxidil,
thioridazine, haloperidol and meperidine.

10. C

11. E
Epinephrine decreases aqueous humor production through vasoconstriction of ciliary body blood
vessels which will worsen closed angle glaucoma.

12. C
A and B refer to enteric coating. In general, a coated tablet has a lower rate of dissolution than an
uncoated tablet.

13. A
14. A
Sulfisoxazole is a sulfonamide that acts as dihydropteroate synthetase inhibitor. Its effect is
antagonized by GABA due to structure similarity.

15. D
Vitamin B12 is primarily in meat products.

16. B
Osteomaliacia is the softening of bones. The remaining symptoms are associated with vitamin D
toxicity.
17. D

18. C
The Schirmer test measures the production of tears.

19. D
Phenothiazine contains a sulfur and nitrogen; it is found in many drugs such as chlorpromazine,
thioridazine, and fluphenazine.

Phenothiazine group

20. B
Vitamin B12 is also called cobalamin.

21. E
Purified egg lecithin is used as emulsifier. The amount of glucose also affects the stability of
TPNs.

22. D
Palpitations and angina are signs of overdose.

23. D
Isosteres are useful interchangeably in structure activity relationships (SAR) studies to identify a
drug pharmacophore.

24. D
Ideally a tablet should not lose more than 1% of its weight.

25. D
Captopril is also non-prodrug. Fosinopril is the only phosphate containing ACE inhibitor.
26. D

27. C
Enalapril can have 23 = 8isomers.

28. B
Heparin, enoxaparin (low molecular weight heparin) and warfarin are anticoagulants.

29. C
Antiplatelets (aspirin, clopidogrel, ticlopidine) prevent platelets aggregation not anticoagulants.
Eptifibatide is a peptide and glycoprotein inhibitor that acts as antiplatelet. Other inhibitors of
glycoprotein inhibitors are abciximab (antibody) and tirofiban (small molecule).

30. C
The risk of bleeding may increase due to synergistic (additive) effect of the two drugs.

31. C
Glycosides are used to treat congestive heart failure (CHF).

32. B

33. D
34. B

35. C
Protamine sulfate is an effective antidote of heparin NOT LMW heparins. Low molecular weight
heparins or fractionated heparins include enoxaparin, dalteparin and tinzaparin.

36. D
Methylation requires thiol, phenol or alcohol. Hydrolysis, oxidation, reduction, cyclization and
de-cyclization are phase I reactions.

37. C
Only nephritic syndrome is characterized by hematuria. Hematuria refers to the presence of
blood in urine.
38. C
Rheumatoid arthritis has a symmetrical pattern whereas osteoarthritis can affect a single joint.

39. G
Hives are raised, red, itchy, often fluid-filled patches of skin called wheals or welts that may
appear and disappear at random usually in response to allergic reactions.

41. A
Shingles result from the reactivation of varicella zoster virus and are associated with neuropathic
pain.

42. D
PCR stands for polymerase chain reaction; it is a common biotechnology technique use for gene
amplification.

43. A
A cation-exchanger is negatively charged therefore glutamine acid which is also negatively
charged will be repulsed from the column.

44. D
The regulation of reproduction is one of the biological functions of hormones.

45. E
Warfarin prevents vitamin K-dependent biosynthesis of active forms of the calcium-dependent
clotting factors II, VII, IX and X via the inhibition of the enzyme epoxide reductase. Warfarin
also affects the regulatory factors protein C, protein S, and protein Z.

46. A
Warfarin prolonged prothrombin time and partial thromboplastin time but have no effect on
bleeding time. Hemophilias prolonged partial thromboplastin but have no effect on bleeding time
and prothrombin time. Aspirin prolonged bleeding time and have no effect on prothrombin time
and partial thromboplastin time.

47. C
Among CCBs felodipine and amlodipine are exceptions. Among antiarrhythmics amiodarone
and dofetilide (both are class III) are exceptions.

48. B
Loop diuretics in general.

49. B
Beta blockers act on the adrenergic system to decrease excessive stimulation due to
hyperthyroidism whereas iodide acts directly on the thyroid to decrease its function.

50. C

51. A

52. D
The remaining drugs decrease the effectiveness of warfarin; other drugs known to increase the
effectiveness of warfarin include allopurinol, cimetidine, erythromycin and ketoconazole.

53. B
The level of vasopressin decreases.

54. B
Donepezil is effective after 3 to 6 months. Common side effects include headache, diarrhea and
vomiting.

55. E
Fentanyl is also formulated as patch.

56. E
Neomycin is antibacterial and decreases cholesterol as well.

57. E

58. A
Spironolactone is a potassium sparing diuretic therefore serum potassium will likely rise in
response to the drug. Assuming that normal plasma potassium is in the range of 3.5mmol/l - 5.0
mmol/l, spironolactone will likely lead to dangerous increase of potassium in this patient.

59. E
The side effects listed are all associated with the use of statins. However, the primary concern is
rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of
myoglobin into the bloodstream. Myoglobin is harmful to the kidney and often causes kidney
damage. HMG-CoA reductase is the rate-controlling enzyme of the mevalonate pathway, the
metabolic pathway that produces cholesterol.

60. A

61. A

62. D

63. D
Loratadine and cetirizine are also H1 antagonists.

63. E

64. C

65. C
The patch remains active for 3 days.

66. C
50% of steady state is reached in one half life, and 50% further in another half life or 75% in 2
half lives (50+25+12.5= 87.5% in 3 half lives, 90% in 3.3 half lives, etc.).

67. B

68. A
Aminoglycosides are bactericidal. Bactericidal antibiotics kill microorganisms whereas
basteriostatic antibiotics prevent or slow down their growth.

69. C
Clindamycin is primarily active against gram-positive bacteria.
Pseudomembranous colitis also called antibiotic-associated diarrhea is treated with
metronidazole or vancomycin.

70. B
Amphotericin A has little antifungal activity therefore not useful as therapeutic agent.

71. D
Stevens–Johnson syndrome is a serious reaction induced by sulfonamides. The enzyme
dihydrofolate reductase reduces dihydrofolate to tetrahydrofolate.

72. C

73. D
Isoniazid is used to treat tuberculosis. One of its side effects is the coloration of body secretions.

74. A

75. D
Digitoxin is largely excreted unchanged by kidneys whereas digitoxin is metabolized by the liver
prior to clearance.

76. C
Cardiac glycosides increase atrium and ventricle contractibility, increase atrium and ventricle
conductivity, no effect on atrium excitability, variable effect on ventricle excitability, no effect
on atrium and ventricle automaticity.

77. D

78. A

79. B
hCG (human chorionic gonadotropin) is a hormone produced during pregnancy.
80. F

81. C
If the patient's creatinine clearance is reduced by half, the daily dose should decrease by half or
give the dose at twice the time interval.

82. E
The drug is basic therefore the formula is:
% ionized = 100 / 1 + antilog (pH – pKa) = 20%
Then % unionized = 100 - % ionized = 80%

83. C
A change in free drug concentration affects directly the pharmacologic effect.

84. D
Megaloblastic anemia, thrombocytopenia and sensitivity to light are adverse effects of
sulfonamides.

85. C
A vertical flow hood has higher incidence of contamination however it provides more protection
to the operator against carcinogenic or mutagenic drugs.

86. E
Other dopamine agonists include apomorphine and pergolide useful in the treatment of restless
legs syndrome (RLS) as well.

87. B
Ziprasidone does not cause weight gain.

88. B
Since the metabolite exhibits a half-life identical to drug A after administration of drug A, the
metabolite is probably exhibiting formation rate-limited kinetics. In this situation, the elimination
of the metabolite is actually more rapid than drug A. Thus, when metabolite is given alone, its
duration of action is shorter.

89. C
Aprepitant is an antiemetic. All the drugs listed, and tetracycline decrease the effectiveness of
oral contraceptives based on P450 interactions.

90. C
Prednisone is a corticosteroid. Other side effects are hyperglycemia, immunosuppression,
reactivation of peptic ulcer, hypokalemia, congestive heart failure (CHF), edema, osteoporosis,
headache and cushingoid features.

91. A
Amantadine is not active against influenza B.

92. D
The incidence of hepatic necrosis increases with alcohol intake.

93. D
94. A

95. C
Cromolyn sodium has also anti-inflammatory activity.

96. B

97. E

98. C

99. D

100. C

101. D

102. E
103. D

104. C
Blinding refers to not revealing treatment allocation. Single-blind studies blind patients to
their treatment allocation. Double-blind studies blind both patients and researchers to treatment
allocations.

105. C
D is the definition of open trial.

106. D

107. A
Among antihyperglycemics, niacin has the highest effectiveness in raising HDL and statins have
the highest effectiveness in lowering LDL.
108. E

109. A
Other neuroleptics used to manage Tourette’s syndrome include ziprasidone, risperidone,
fluphenazine and pimozide.

110. B
Cariprazine and brexpiprazole are the newest antipsychotics both approved in 2015.
Cariprazine is used to treat schizophrenia and manic or mixed episodes associated with bipolar I
disorder.
Brexpiprazole is used in the treatment of schizophrenia and as an adjunct for major depressive
disorder.

111. C

112. D

113. E
Atenolol has no ISA. Beta blockers with ISA act as mixed antagonist and agonist; they have less
incidence of drug-induced hypotension.
114. A

115. C

116. D
Lecithin is chelating agent and emulsifier.

117. D
The reaction describes the acetylation of aspirin.

118. D

120. E
In fact, clofibrate increases the risk of cholesterol stones in the gallbladder. VLDL stands for
very low-density lipoproteins whereas LDL stands for low density lipoproteins. SIADH stands
for syndrome of inappropriate secretion of antidiuretic hormone ADH (vasopressin).

121. B
Other symptoms of benzodiazepines withdrawal include insomnia, anxiety, nausea/vomiting and
psychomotor agitation. Seizures occur following abrupt cessation of high doses of
benzodiazepines. Lacrimation, yawning, pupil dilation, rhinorrhea and piloerection are
symptoms of opioids withdrawal.

122. D
Water has a high surface tension due to strong attraction of water molecules to each other
through a network of hydrogen bonds.

123. D

124. D
The remaining functional groups are acidic therefore they will remain uncharged at low pH
which will decrease their solubility in an acidic environment. Other basic functional groups are
guanidine and amidine.

125. A
126. E
In non-competitive inhibition, substrate and inhibitor do not share the same binding site therefore
increasing the amount of substrate has no effect on the effectiveness of the inhibitor.

127. D
Beta blockers should be avoided in coronary arterial spasm (Prinzmental’s angina), calcium
channel blockers are the drugs of choice.

128. C
Dalteparin is an anticoagulant that belongs to the class of low molecular weight heparins
(LMWHs). Eptifibatide and Abciximab (antibody) are glycoprotein IIb/IIIa inhibitors that act as
antiplatelets.
129. B
The remaining drugs are all used in the treatment of urge incontinence. Oxybutynin is
anticholinergic.

130. A
NSAIDs are first choice. Allopurinol and probenecid lower the level of uric acid and are used for
prevention not for acute treatment.

131. C
7 inches represent approximately 15 cm.

132. B
Ideally, a hood should remain on 24 hours.

133. D

134. C

135. C
A spontaneous biological process does not require any input of energy from outside. Input of
energy is needed for non-spontaneous biological processes.

136. A
Enzymes do not affect the equilibrium constant; they increase equally the forward and backward
reactions and activation energy is reduced.

137. A
Since pH = 4 is already acidic (high concentration of H+) the rate of releasing more H+ following
dissociation will decrease.

138. B
Adrenocorticotropic hormone (ACTH) stimulates the production of cortisol and other
glucocorticoids, mineralocorticoid aldosterone, and dehydroepiandrosterone. Cortisol
counteracts insulin, contributes to hyperglycemia by stimulating gluconeogenesis and inhibits the
peripheral use of glucose leading to insulin resistance.

139. A

140. C
Glycine is the only non-chiral amino acid and the smallest. Tryptophan is the largest amino acid.
Methionine and cysteine are sulfur containing.

141. A

142. D
Anorexia is characterized by decreased appetite.

143. E
Dysphagia means difficulty swallowing; odynophagia means painful swallowing.

144. C

145. E

146. C
The dietary precursor of pyridoxal phosphate is vitamin B6.

147. B
The level of estrone does not change with menopause.
148. C
Estrogen decreases the level of antithrombin resulting in enhanced coagulation.
Estrogen also increases HDL, triglycerides, cortisol, sodium and water retention; estrogen
decreases LDL.

149. D

150. A
Type I diabetes is insulin dependent whereas type II diabetes is non-insulin dependent.

151. F

152. I

153. E
Miotic agents or parasympathomimetics such as pilocarpine are used to manage glaucoma; they
increase the outflow of the aqueous humor to reduce intraocular pressure.

154. B

155. A
The acidity in the stomach decreases the ionization of aspirin which is an acidic drug
consequently its absorption is enhanced. Aspirin is also absorbed in the small intestine due to its
large surface area.

156. D
Polyethylene glycol is a synthetic gelling agent. Other natural gelling agents are agar and gum.

157. A
Effervescence is the reaction in water between an acid and a base resulting in the release of
carbon dioxide; carbon dioxide enhances the dissolution of the tablet and neutralizes stomach
acidity to decrease the degradation of acid sensitive drugs. Typical acids used are citric, malic,
tartaric and fumaric.

158. H
159. E
Cetylpyridine chloride is cationic.

160. A

161. C
The functional group is quinone.

162. C
The functional group is pyridine. Vitamin B3 is also called niacin; vitamin B6 is also called
pyridoxine; Vitamin B9 or folic acid contains a pteridine ring. The pteridine ring is a fusion of
pyrimidine and pyrazine rings. Vitamin B2 or riboflavin also contains a pteridine ring.

163. E
The functional group is furan. Vitamin E is phenol containing; vitamin B1 or thiamine contains a
pyrimidine ring; vitamin B7 or biotin contains a thiophene ring; vitamin B12 or cobalamin
contains not only cobalt but also a benzimidazole ring.

164. D
The metabolism by oxidation of double bonds leads to the production of epoxide and diol.

165. A
The metabolism of primary alcohol, secondary alcohol and aldehyde by alcohol dehydrogenase
produces respectively an aldehyde, a ketone and a carboxylic acid.

166. E
Unlike syrup, the alcohol content of elixirs is a good solvent for flavoring oils and unionized
drugs. In addition, their water content will solubilize effectively ionic drugs.

167. C
Ethyl alcohol 70% and isopropyl alcohol 70% are the preferred cleaning agents for a laminar
flow food. Acetone is flammable and toxic. Glutaraldehyde is an oily liquid use to disinfect
medical equipment and as preservative; glutaraldehyde is not volatile and leaves a residual build-
up.

168. C
Alcohol USP and diluted alcohol have respectively the following concentrations 95% (v/v) and
49% (v/v).

169. B

170. D
A saturated sugar solution is typically self-preserved since it does not sustain microbial growth.

171. D
The filter size must be 0.2 to 0.22 um.

172. B
Polyethylene glycol is another base that dissolves.
The melting temperatures of cocoa butter, palm oil, and coconut oil suppository bases are
respectively 30 to 35oC and 33 to 40oC.

173. A
The absolute bioavailability F = AUCtablet / AUCIV
For 150 mg AUCtablet and AUCIV are respectively 45 and 120; therefore F = 45/120 = 0.37.

174. A

175. D
Because Neomycin is poorly absorbed orally, it causes a decrease in intestinal bacteria, thereby
decreasing ammonia production and absorption from the colon.

176. C
Neomycin and streptomycin induce allergic reactions in > 2% of treatments, gentamicin and
amikacin in 0.1 to 2%, and kanamycin in 0.1 to 0.5%.

177. E
Piperacillin is acid unstable; other acid unstable penicillins are penicillin G and ticarcillin.

178. A

179. D
180. A
B refers to NSAIDs; C refers to the non-steroidal analgesic flupirtine; D refers to opioid
analgesics; E refers to the analgesic effect of antidepressants such as amitriptyline.

181. B
Mesoridazine and thioridazine contain a piperidine group.

182. B
Other antipsychotics with low incidence of orthostatic hypotension are thiothixene, fluphenazine,
prochlorperazine, haloperidol and molindone.

183. D
Fluticasone is another option.

184. B
Promethazine contains a phenothiazine group; clemastine contains an ethanolamine group;
pheniramine and triprolidine contain an alkylamine group each.

185. E
Cetirizine is second generation. Antihistamines with antiemetic effect are first generation
including meclizine, hydroxyzine and cyclizine.

186. A
Other second-generation antihistamines are cetirizine and azelastine which contain respectively a
piperazine and phthalazinone groups. Fexofenadine and desloratadine are third-generation.

187. B

188. B
Fentanyl and meperidine are phenylpiperidines whereas methadone and propoxyphene are
diphenylheptanes.

189. C
190. B
Hydromorphone and oxycodone have also high incidence whereas codeine, methadone and
propoxyphene have low incidence.

191. A
Naproxen, ketoprofen, oxaprozin and ibuprofen are propionic acids; piroxicam and meloxicam
are oxicams; diclofenac, indomethacin, sulindac and tolmetin are acetic acids.

192. D

193. B
Guanethidine, guanadrel, reserpine, doxazocin, prazosin and terazosin are peripherally acting
adrenergic blockers

194. B
Thiazide diuretics has the same effect.

195. C
Betaxolol also decreases HDL and increases LDL.

196. E
Erectile dysfunction is one of the common adverse effects of clonidine. Other indications of
clonidine include hypertension, alcohol withdrawal, menopausal flushing, opiate detoxification,
smoking cessation and reductions of allergen-induced inflammation in patients with extrinsic
asthma.

197. D
Acebutolol, 25 to 30 hours; carteolol, 24 hours; nadolol, 17 to 24 hours; propranolol, 8 to 12
hours; timolol, 12hours.

198. B

199. A
Lovastatin is also not the best option for hypertriglyceridemia.
200. E
Pravastatin has a half-life of 77 hours.

201. A
Metolazone and quinethazone have low risk of hyperuricemia.

202. B
The active metabolites of spironolactone and triamterene are respectively canrenone and
hydroxytriamterene sulfate.

203. C
Hydrocortisone may be used as well.

204. D
The anti-inflammatory potency ranking is betamethasone = dexamethasone > triamcinolone =
methylprednisone > prednisone = prednisolone > hydrocortisone > cortisone.

205. B
Cortisone and cortisol (hydrocortisone) are short acting; prednisone and prednisolone are
intermediate acting; dexamethasone and betamethasone are long-acting.

206. C
Dipyridamole is an antiplatelet drug that inhibits the production of thromboxane A2.

207. D
The activation of protein C is promoted by thrombomodulin and endothelial protein C receptor.
Fibrinolysis is the process of blood clot degradation.

208. C
In contrast, the intrinsic pathway takes longer. Factor III accelerates the process of coagulation in
the extrinsic pathway.

209. B
Other non-vitamin K dependent factors are I (fibrinogen), IV (calcium), VIII (antihemophilic
factor), XIII (fibrin stabilizing factor) and PK (prekallikrein, fletcher factor); factor III is
antithrombin; factor II is prothrombin; factor X is Stuart factor.

210. D
Heparin does not affect bleeding time. Heparin also reduces lipoprotein levels by enhancing the
release of the enzyme lipase.

211. C
Dose = 0.5 L/kg x 60 kg x 7.5 mg/L = 225 mg

212. E

213. C
Oral drug A = (0.175 x 2) / 0.7 – 0.50 mg

214. C
The rate of drug absorption is inversely proportional to the thickness of the membrane.

215. E
To have greater than 90% of maximal effect, plasma concentration should be higher than 90%.
Since it takes 3.3 half-lives to get to 90% of steady state, at least 4 half-lives or 4 x 24 hours = 96
hours are required.

PHARMACY PRACTICE
 Questions

1. Which of the following references are best for locating detailed information on approved
drugs?

A. Manufacturer drug monograph

B. Martindale
C. Compendium of Pharmaceuticals and Specialties (CPS)
D. Drug Facts and Comparisons
E. Rx Files

2. Clindamycin auxiliary label may include all, EXCEPT:

A. Take with lot of water to prevent esophagitis

B. Refrigerate the suspension
C. Suspension stored at room temperature expires after 14 days
D. Antibiotic-induced diarrhea may occur
E. If diarrhea occurs, take loperamide

3. All of the following are correct statements concerning the anticancer cyclophosphamide,
EXCEPT:

A. Refrigerate the solution and use within 14 days

B. Used topically to treat eczema
C. Is an immunosuppressant
D. Used to treat severe rheumatoid arthritis, multiple sclerosis and lupus
E. Use of mesna adjuvant decreases cyclophosphamide toxicity

4. Which of the following medications requires monitoring of blood lipids?

A. Raloxifene
B. Aztreonam
C. Oseltamivir
D. Allopurinol
E. Valsartan
5. Which of the following antihypertensives is the drug of choice for a patient who had a heart
attack?
A. Propranolol
B. Clonidine
C. Amlodipine
D. Captopril
E. Losartan

6. Dyspnea is characterized by labored breathing and is a normal symptom of extensive exertion.

Dyspnea may be also caused by all, EXCEPT:

A. Underweight
B. Pregnancy
C. Anemia
D. COPD
E. Congestive heart failure

7. Which of the following abbreviations means “every other day”?

A. qd
B. qh
C. qhs
D. qod
E. qs

8. Which of the following drugs is a narcotic preparation?

A. Methadone
B. Tylenol #2
C. Tylenol #4
D. Morphine
E. Codeine

9. Which of the following drugs must be dispensed with a written prescription only?

A. Diclophen
B. Ritalin
 C. Fiorinal
D. Marinol
E. Dexedrine

10. Clarithromycin suspension label may include:

A. Refrigerate
B. Take with lot of fluids
C. Shake well before using
D. Discoloration of body excretions is likely
E. Store in amber color bottle

11. Which of the following pharmacy terms means “drops”?

A. drs
B. drps
C. dps
D. gtps
E. gtts

12. Which of the following pharmacy terms means “each”?

A. ec
B. aa
C. ec
D. ac
E. cc

13. Which of the following medications is contraindicated in a patient with

untreated complete heart block?

A. Atropine
B. Quinidine
C. Isoproterenol
D. Hydrochlorothiazide
E. Enalapril

14. Which of the following statements describes empty stomach administration?

A. Anytime before a meal

B. 15 minutes before a meal
C. 30 minutes before a meal
D. 30 minutes after a meal
E. 1 hour before a meal

15. Which of the following is NOT an advantage of using blister packaging?

A. Improves patient compliance

B. Increases safe medication use
C. Serves as memory aid
D. Reduces the need for patient counselling
E. Serves as refills reminder

16. Herpes zoster infection is treated with:

A. Darunavir
B. Acyclovir
C. Tipranavir
D. Indinavir
E. Ritonavir

17. All of the following are correct statements concerning Somogyi effect in diabetic patients,
EXCEPT:

A. Also known as post-hypoglycemic hyperglycemia

B. Is associated with a surge of glucagon, cortisol, epinephrine and growth hormone
C. Nocturnal hypoglycemia is not detected in Somogyi effect
 D. Refers to high blood sugar in the morning called “rebound hyperglycemia”
E. Is due to poor diabetes management such as taking too much insulin

18. A physician is in the process of choosing an antibiotic. Which of the following will NOT be
considered?

A. Site of infection
B. Type of microorganism
C. Adverse effects
D. Availability in the closest pharmacy
E. Cost

19. All of the following statements regarding infliximab are accurate, EXCEPT:

A. A chimeric human-mouse monoclonal antibody

B. Administered enterally
C. Used to treat autoimmune disorders such as Crohn’s disease, psoriasis and ulcerative
colitis
D. Antagonizes the effect of tumor necrosis factor alpha (TNF alpha)
E. Acts as immunosuppressant with side effects including increased susceptibility to
infections, lupus and thrombocytopenia

20. What is the meaning of the Latin abbreviation “ac”?

A. Before meals
B. After meals
C. With meals
D. Empty stomach
E. Without regard to food

21. What is the meaning of the Latin abbreviation “qd”?

A. Every hour
B. Every day
C. Every evening
D. Every week
E. Every month
22. What is the meaning of the pharmacy term “s”?

A. Add
B. With
C. Without
D. After
E. Mix

23. Hemorrhoids related counselling may include:

A. Increase dietary fiber intake

B. Use warm bathes
C. Avoid frequent heavy lifting
D. Avoid straining during bowel movements
E. All of the above

24. Which of the following drug requires the auxiliary label “May Discolor Urine Red”?

A. Nitrofurantoin
B. Promethazine
C. Warfarin
D. Chlorpromazine
E. Cimetidine

25. A narcotic preparation contains:

A. One narcotic and one or more non-narcotic medicinal ingredient

B. One narcotic and two or more non-narcotic medicinal ingredients
C. Two narcotics and one or more non-narcotic medicinal ingredient
D. Two narcotics and two or more non-narcotic medicinal ingredients
E. Three narcotics and one or more non-narcotic medicinal ingredients
26. Which of the following drugs is a controlled drug part III?

A. Testosterone
B. Lorazepam
C. Butorphanol
D. Cloxacillin
E. Morphine

27. Which of the following references contains drug monographs?

A. Patient Self-Care
B. Compendium of Pharmaceuticals and Specialties
C. Therapeutic Choices
D. Compendium of Self-Care Products
E. Guide to Drugs in Canada

28. Mood stabilizers are used to treat mood disorders characterized by mood shifts. Which of the
following statements is NOT correct regarding mood stabilizers?

A. Used to treat intense and sustained mood shifts

B. Used in bipolar disorder, schizophrenia and personality disorders
C. Suppress swings between mania and depression
D. They include barbiturates
E. They include anticonvulsants

29. Correct statement regarding donepezil therapy:

A. There is immediate improvement of patient symptoms

B. Decreases cognitive impairment
C. Has no effect on cognitive functions
D. Reverses brain cells damage
E. Decreases the level of acetylcholine
30. Mechanism of donepezil in the treatment of Alzheimer’s disease:

A. Acetylcholine agonist
B. Acetylcholinesterase inhibitor
C. Acetylcholine reuptake inhibitor
D. Dopamine agonist
E. Dopamine reuptake inhibitor

31. All are side effects of clozapine, EXCEPT.

A. Seizures
B. Agranulocytosis
C. Tachycardia
D. Dry mouth
E. Diarrhea

32. Which of the following topical corticosteroids is NOT suitable for application to the face,
jaws and eyelids?

A. Clobetasol 0.05%
B. Hydrocortisone 1%
C. Fluocinolone 0.01%
D. Desonide 0.05%
E. Hydrocortisone 2.5%

33. All are useful treatments for neuropathic pain, EXCEPT.

A. Oxycodone
B. Aspirin
C. Phenytoin
D. Gabapentin
E. Venlafaxine
34. Which of the following describes shingles related neuropathic pain?

A. Acute neuralgia
B. Recurrent neuralgia
C. Chronic neuralgia
D. Trigeminal neuralgia
E. Complex regional pain syndrome type I

35. Which of the following drugs is NOT a first line treatment for postherpetic neuropathic pain?

A. Gabapentin
B. Carbamazepine
C. Amitriptyline
D. Oxycodone

36. A 24 years old patient is currently using phenytoin and carbamazepine to manage her
seizures. She is now pregnant despite the use of oral contraceptives. Which of the following
reasons may explain this lack of contraceptive effectiveness?

A. Lack of compliance
B. Decreased absorption of contraceptives
C. P450 enzymes related drug-drug interaction
D. Increased secretion of fertility hormones
E. Hyper-ovulation

37. Which of the following is the drug of choice for the treatment of Chlamydia urethritis during
pregnancy?

A. Amoxicillin
B. Penicillin V
C. Erythromycin
D. Tetracycline
E. Penicillin G
Case study: Questions 38 to 40

Mrs. JT is a 33-year-old patient who has been recently diagnosed with mycoplasma
pneumonia. JT had a baby girl 3 months ago.

38. Which of the following classes of antibiotics would be preferred for his treatment?

A. Penicillins
B. Macrolides
C. Aminoglycosides
D. Fluoroquinolones
E. Cephalosporins

39. He receives a prescription for a macrolide. Which of the following macrolides is considered
compatible with breastfeeding?

A. Azithromycin
B. Erythromycin
C. Clarithromycin
D. Fidaxomicin

40. Macrolides may produce all of the following effects, EXCEPT:

A. Torsade de pointes
B. Rash
C. Photosensitivity
D. Cholestatic hepatitis
E. Superinfection

41. Flutamide is a nonsteroidal anti-androgen. Therapeutic uses of flutamide include all,

EXCEPT:

A. Male contraception
B. Hirsutism and virilization in women
C. Acne and baldness in both sexes
D. Breast cancer
E. Prostate cancer

42. The use of laxatives may produce all of the following effects, EXCEPT:
 A. Hypernatremia
B. Hyperhydration
C. Spastic colitis with stimulant laxatives
D. Gastrointestinal obstruction with bulk forming agents
E. Hypokalemia

43. In esophagitis, elevation of the head of the bed, decreased alcohol intake, stop smoking, and
consumption of small frequent meals are all useful strategies. Therapeutic options include all of
the following, EXCEPT:

A. Omeprazole
B. Metoclopramide
C. Bethanechol
D. Amitriptyline
E. Cimetidine

44. All of the following are useful advices for a patient suffering from esophagitis, EXCEPT:

A. Elevate the head of the bed

B. Decrease alcohol intake
C. Spicy foods have no effect
D. Avoid smoking
E. Consume small meals frequently rather than few large ones

45. All are pharmacologic options in the treatment of restless leg syndrome (RLS), EXCEPT:

A. Iron replacement
B. Opioids
C. Benzodiazepines
D. Dopamine antagonists
E. Gabapentin

46. Opioids are useful therapeutics in the treatment restless leg syndrome (RLS). Which of the
following opioids would be a safer option?

A. Methadone
 B. Morphine
C. Propoxyphene
D. Oxycodone
E. Hydromorphone

47. All of the following are indications of the drug domperidone, EXCEPT:

A. Antiemetic
B. Treatment of dyspepsia (Dyspepsia is the upper abdominal problem including pain,
feeling of fullness and nausea)
C. Stimulation of chemoreceptor trigger zone
D. Treatment of gastroparesis (delayed gastric emptying)
E. Stimulation of lactation

48. KY is a 24 years old female who is complaining about red, itchy eyes and increased
lacrimation. Allergic conjunctivitis is suspected.
Which of the following medications may be used for her treatment?

A. Ketotifen drops
B. Polyethylene glycol drops
C. Diclofenac drops
D. Ketorolac drops
E. Polysorbate drops

49. Identify the normal level of glycosylated hemoglobin for most diabetics:

A. Lower or equal to 4%
B. Lower or equal to 5%
C. Lower or equal to 7%
D. Lower or equal to 8%
E. Lower or equal to 9%

50. Which of the following oral antihyperglycemics is likely to cause edema, weight gain and
cardiotoxicity?

A. Glyburide
B. Metformin
 C. Pioglitazone
D. Acarbose
E. Miglitol

51. The following drugs cause dysglycemia, EXCEPT.

A. Clozapine
B. Abciximab
C. Phenytoin
D. Prednisone
E. Indinavir

52. All of the following are advantages of insulin pen over standard syringes, EXCEPT.

A. Decrease environmental waste

B. Mixing of different insulins
C. Click helps those with impaired vision
D. Better dosing and usage for the elderly because each dose is premeasured
E. Easy to carry and enhanced compliance due to convenient administration

53. All of the following statements are true concerning nitroglycerin regimen, EXCEPT.

A. For the prevention of angina use 3 SR-tablets daily or 1 patch daily

B. For the relief of angina use a sublingual tablet or spray at onset of an attack. Dose may
be repeated twice in 5 minutes intervals
C. Take on an empty stomach
D. Tablets should be kept in tight amber bottle in a cool, dry place and discarded within 3
months of opening
E. Ointment is used to treat anal fissures

54. All of the following are correct statements concerning levothyroxine, EXCEPT.

A. To avoid side effects, treatment should start with low dose then increase gradually
B. Requires administration on an empty stomach
C. Protect from light
D. Taken as single dose in the morning
E. Maximum beneficial effect within 24 hours
55. Expiry date of benzodiazepines prescription:

A. No specification for prescription expiration

B. 4 months from the date the prescription is written
C. 6 months from the date the prescription is written
D. 1 year from the date the prescription is written
E. 16 months from the date the prescription is written

56. Clindamycin auxiliary label may include all, EXCEPT:

A. Take capsule with lot of water to prevent esophagitis

B. Use vaginal ovules for treatment of bacterial vaginosis
C. Suspension retains potency for 14 days
D. Shake well before use and store in the fridge
E. Suspension has foul taste and odor

57. All of the following statements are true concerning famciclovir in the treatment of shingles,
EXCEPT:

A. Decreases healing time of shingles rash

B. Lessens shingles associated neuropathic pain
C. Reduces the length of outbreaks
D. Eradicates the virus

Case Study: Questions 57 to 60

Mrs. FG’s profile shows:

Age: 54-year-old female
Past medical history: Type 2 diabetes for 4 years
Allergies: No known allergies
Current Medications: glyburide

57. FG comes into the pharmacy to pick up some over the counter medications for her medicine
cabinet. Which of the following medications should NOT be recommended because they may
adversely affect her blood glucose levels?

A. Pseudoephedrine
 B. Acetaminophen
C. Diphenhydramine
D. Dextromethorphan
E. Disulfiram

58. The most common side effect of glyburide is:

A. Lactic acidosis
B. Hypokalemia
C. Pruritus
D. Cough
E. Hypoglycemia

59. FG tells you she has a postprandial blood glucose reading of 10 mmol/L. What is the
meaning of her result?

A. Within normal range - her diabetes appears well controlled

B. High - refer patient to her physician
C. Low - recommend carrying glucose tablets to prevent hypoglycemia
D. High - suggest switching to insulin
E. Low – Call her physician to suggest dose reduction
60. FG has the tendency to take more than average amount of alcohol. Which of the following
statements concerning alcohol would be the least concern of this patient?

A. Alcohol may interact with certain oral hypoglycemic agents

B. Alcohol may impair the body's ability to recover from hypoglycemia
C. Alcohol may cause sexual dysfunction
D. Alcohol may aggravate peripheral neuropathy

61. A 90-year-old patient wishes to purchase the following five products. His profile shows no
known allergies and he is currently using warfarin for 3 years and donepezil for 1 month.

Which of the following should not be sold based on the patient’s profile?

A. Ginkgo biloba
B. Evening primrose oil
C. Vitamin B complex
D. Aloe vera
E. Licorice
62. Which of the following medications may require dose adjustment if being taken by a patient
just starting on levothyroxine for hypothyroidism?

A. Cholestyramine only
B. Insulin only
C. Cholestyramine and Digoxin
D. Insulin and Cholestyramine
E. Digoxin and Insulin

63. Which of the following tests are used in the assessment of Alzheimer’s disease?

A. MMSE
B. CT scan
C. Homocysteine
D. Mini-Cog
E. All of the above

64. The toxicity of some Alzheimer’s drugs is increased by CYP2D6 or CYP3A4 inhibitors such
as paroxetine, erythromycin, prednisone and grapefruit juice and their effectiveness is reduced by
CYP2D6 or CYP3A4 inducers such as carbamazepine, phenytoin, smoking and rifampin. Which
of the following Alzheimer’s drugs is not affected by such interactions?

A. Galantamine only
B. Memantine only
C. Rivastigmine only
D. Memantine and Galantamine
E. Rivastigmine and Galantamine
F. Memantine and Rivastigmine

Case Study: Questions 65 to 66

JR is a 62 years patient who is on warfarin therapy. She is suffering from heart burn
especially at night. JB has already tried antacids and wonders if there is anything else that
would help.

65. Which of the following drugs would NOT be recommended?

A. Alginic acid
B. Aluminum hydroxide
C. Calcium carbonate
 D. Famotidine
E. Cimetidine

66. If she is given cimetidine by mistake which of the following reactions would be expected?

A. Decreased bleeding
B. Increased bleeding
C. Decreased INR
D. Increased warfarin metabolism
E. Decreased warfarin bioavailability

67. Which of the following benzodiazepines is preferred for the management of initial insomnia
due to fast onset and short duration of action?

A. Flurazepam
B. Nitrazepam
C. Temazepam
D. Triazolam
E. Lorazepam

68. A patient asks you what she could do to decrease her risk of osteoporosis. You would suggest
all of the following options, EXCEPT:

A. Elemental calcium 1000 - 1500 mg per day

B. Vitamin D 400 IU daily
C. Regular swimming
D. Regular weightlifting
E. Drinking milk

Case Study: Questions 69 to 70

MA is a 40 years old patient. She is currently using zopiclone 7.5 mg qhs prn
She presents to you the following new prescriptions:
clarithromycin 500 mg bid x 7 days
metronidazole 500 mg bid x 7 days
bismuth subsalicylate ii tabs qid x 7 days

69. According to her profile, how is MA taking zopiclone?

A. 7.5 mg every morning as needed

B. 7.5 mg at every bedtime as needed
C. 7.5 mg every evening as needed
D. 7.5 mg every day as needed
E. 7.5 mg every afternoon as needed

70. What is the most likely diagnosis according to this new prescription drug regimen?

A. Escherichia coli intestinal infection

B. Helicobacter pylori infection induced peptic ulcer
C. Salmonella intestinal infection
D. Intestinal amoebiasis
E. Gardnerella vaginitis

Case Study: Questions 71 to 73

A 38 years old male patient who has been on topical glaucoma therapy for 2 months is
complaining about the side effects of the drug including visual disturbance, increased
lacrimation and irritation. He has also noticed a change in his eye pigmentation and
lengthening of eye lashes.

71. Which of the following drugs has been prescribed?

A. Carbonic anhydrase inhibitor

B. Beta blocker
C. Prostaglandin analogue
D. Cholinergic agonist
E. Alpha agonist

72. The following drugs are all used in the treatment of glaucoma. Which of the following drugs
belongs to the class of prostaglandin-like compounds?
 A. Dorzolamide
B. Echothiophate
C. Latanoprost
D. Brimonidine
E. Pilocarpine

73. Latanoprost is used in the treatment of glaucoma because it:

A. Increases aqueous humor outflow

B. Decreases aqueous humor production
C. Induces pupil constriction
D. Decreases aqueous humor production and increase outflow

74. Ms. Paul is complaining about allergic rhinitis. Which of the following symptoms
characterizes best seasonal allergic rhinitis?

A. Congestion
B. Nasal discharge
C. Red eyes
D. Sore throat
E. Itchy eyes

75. Which of the following body areas is NOT suitable for the application of a nicotine patch?

A. Upper arm
B. Thigh
C. Back
D. Lower rib cage
E. Shoulder

76. A 48 years old patient is using the following medications: spironolactone 100 mg daily and
captopril 25 mg bid. She comes to see you asking for potassium supplements.

A. Provide 100 potassium chloride tablets

B. Advise her to supplement her diet with potassium rich foods such as bananas
C. Instruct her to consult her doctor first as potassium supplements are not needed
D. Advise her to discuss potassium monitoring with her doctor
E. Cal her doctor to discuss switching her prescription to a K-sparring diuretic

77. A young woman travelling to Peru purchases loperamide 2 mg. She asks how to take the
medication. You would advise:

A. One caplet three times daily prophylactically starting on the day of arrival
B. One caplet after each loose bowel movement to a maximum of 6 caplets daily
C. One caplet every 4 hours after diarrhea starts and continue until stools are formed
D. Two caplets at onset of diarrhea, then one after each loose bowel movement, up to a
maximum of 8 caplets daily
E. Two caplets after each loose bowel movement, to a maximum of 4 caplets daily

78. A drug used by one of your regular customers is in the processed of being discontinued.
Which of the following may NOT be an appropriate strategy?

A. Order a large stock as soon as possible

B. Order another drug with same indication
C. Inform his physician
D. Inform the patient
E. Explain to the patient how you intend to remedy the situation

79. A five-month-old child with diarrhea has been on Pedialyte for 4 days. His diarrhea is still
not controlled. What you would recommend?

A. Take him to the physician and continue using Pedialyte

B. Simply continue using Pedialyte, it may take longer to get positive outcome
C. Take him to the physician and discontinue using Pedialyte
D. Increase the frequency of administration of Pedialyte

80. When dealing with a dispensing error, the pharmacy manager should NOT:

A. Inform the patient’s physician

B. Inform the patient and apologize
C. Inform Health Canada
D. Inform the pharmacy staff and offer additional training
E. Inform the pharmacy staff and seek their feedback to prevent that from happening

81. Which of the following would help in the assessment of an asthmatic child therapeutic
regimen?

A. Peak flow meter

B. Nocturnal symptoms
C. Exercise tolerance
 D. Frequency of drug administration
E. All of the above

82. While counseling a patient on the use of psyllium fiber you would NOT include:

A. Take 1 teaspoon full then take 240 ml of water or juice

B. Dissolve 1 teaspoon in 240 ml of water or juice then take immediately
C. For best results follow each dose with 240 ml of liquid
D. Space by at least 2 hours the use of psyllium fiber and the oral administration of other
medications
E. Take with or without food

83. Which of the following drugs is best tolerated in pediatric patients than adults?

A. Acetaminophen
B. Digoxin
C. Theophylline
D. Hydrocortisone
E. Propranolol

84. Which of the following is considered second line medication in smoking cessation?

A. Nortriptyline
B. Varenicline
C. Bupropion
D. Nicotine patch
E. Nicotine spray

85. Which of the following smoking cessation aids may not be recommended in combination
with a nicotine patch?

A. Nicotine gum
B. Nicotine lozenge
C. Nicotine spray
D. Bupropion
E. Varenicline
Prescription Interpretation Problems

Describe how each medication should be used according to the prescription.

86. i gtt ou bid x 7d

87. i appl vag q hs

88. i tab po qid pc

89. iss tsp po tid prn cough

90. iiii gtts ad q4h x5d

91. i supp pr q4h prn nausea

92. i cap po tid ac + hs

93. The glucose tolerance test is a common diabetes diagnosis tool. The levels of blood glucose
are measured at time intervals following a glucose load. Which of the following statements
concerning glucose tolerance test is NOT correct?

A. Compared to glucose tolerance, the time required to reach peak glucose concentration in
blood is often delayed in diabetic patients
B. The rate of glucose metabolism monitored by declining levels in blood is slow in
diabetic patients
C. Diabetes diagnosis requires a 2-hour glucose tolerance test value higher than 7.0 mmol/l
D. The recommended glucose load by WHO is 75 g for all adults
E. Fasting for 8 to 12 hours is required before the test

94. Clomiphene is NOT:

A. Steroid-like ovulation stimulant

B. Selective estrogen receptor modulator
C. Antiestrogenic drug
D. Used to treat infertility
E. Used to treat male hypogonadism
95. What is the duration of PO first course of clomiphene therapeutic regimen?

A. 5 days
B. 2 weeks
C. 3 weeks
D. 4 weeks
E. 5 weeks

96. Cirrhosis is the result of chronic liver disease characterized by liver damage and loss of
function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver
disease. All of the following are complications of cirrhosis, EXCEPT:

A. Jaundice
B. Hemorrhage
C. Increased appetite
D. Ascites
E. Liver cancer

97. Anticonvulsants therapy is associated with decreased levels of:

A. Folic acid
B. Vitamin D
C. Vitamin K
D. Vitamin A
E. Vitamin B2

98. The side effects of the antihyperglycemic metformin include nausea, abdominal pain, bitter
or metallic taste and anorexia. Another side effect is decreased level of:

A. Vitamin B1
B. Vitamin B2
C. Vitamin B3
D. Vitamin B6
E. Vitamin B12

99. Which of the following drugs is the drug of choice for the treatment of dyslipidemia in
pregnant women?

A. Niacin
B. Atorvastatin
C. Gemfibrozil
D. Cholestyramine
E. Ezetimibe

100. Which of the following drugs are first line treatments for uncomplicated hypertension?

A. Beta blockers
B. Angiotensin converting enzyme inhibitors
C. Calcium channel blockers
D. Diuretics
E. Angiotensin II receptor blockers

101. Acne vulgaris is the most common skin disorder in Canada. The management of acne is
primarily pharmacologic. All of the following drugs are used systemically to treat acne,
EXCEPT:

A. Spironolactone
B. Adapalene
C. Isotretinoin
D. Cyproterone
E. Clindamycin

102. Which of the following topical drug formulations is preferred for hairy areas?

A. Lotion
B. Cold cream
C. Gel
D. Cream
E. Ointment

103. Iron deficiency is the leading cause of anemia. Which of the following is the usual daily
target dose of elemental iron in the treatment of anemia associated with iron deficiency?

A. 55 – 70 mg
B. 84 – 90 mg
C. 105 – 200 mg
D. 250 – 300 mg
E. 355 – 400 mg

104. Which of the following is the drug of choice for the treatment for GERD?

A. Antacids
B. H2-receptor antagonists
C. Alginates
D. Proton pump inhibitors
E. Antibiotics

105. Attention deficit hyperactivity disorder (ADHD) is characterized by three hallmark

symptoms: inattention, hyperactivity and impulsivity. Which of the following is a drug of choice
for the treatment of ADHD?

A. Atomoxetine
B. Clonidine
C. Amphetamine
D. Bupropion
E. Guanfacine

106. What are the three parts of the prescription order?

A. Prescriber information, medication information, hospital information

B. Prescriber information, patient information, disease information
C. Prescriber information, patient information, medication information
D. Prescriber information, hospital information, medication information
E. Prescriber information, disease information, medication information

107. When a prescription is being filled at the pharmacy, how can the physicians let the
pharmacist know that they want the brand name medication used instead of the generic version
of the medication?
 A. BAG
B. DAW
C. GNO
D. BNO
E. COP

108. Medications are commonly repackaged into unit doses. All of the following statements
regarding unit dose repackaging are accurate, EXCEPT:

A. All prescriptions are repackaged no matter what

B. Unit dose repackaging of bulk medications is a cost-effective strategy
C. Beneficial when a specific dose is not commercially available
D. Wound dressings repackaged in unit doses improve patients’ compliance
E. Unit dose repackaging improves patients’ safety by eliminating inaccurate dosing

109. Potassium is involved in several biological processes including maintenance of cellular

tonicity, cellular metabolism, contraction of muscles and transmission of nerve impulses. Which
of the following is the normal potassium serum range?

A. 1.7 to 2.2 mEq/l

B. 2.6 to 4.5 mEq/l
C. 3.5 to 5.0 mEq/l
D. 4.4 to 6.0 mEq/l
E. 5.0 to 7.2 mEq/l

110. Which of the following potassium replacement preparations has the highest concentration of
elemental potassium?

A. Potassium gluconate
B. Potassium acetate
C. Potassium chloride
D. Potassium citrate
E. Potassium bicarbonate

111. Which of the following conditions is NOT a contraindication to potassium replacement

therapies?

A. Acute dehydration
B. Azotemia
 C. Addison disease
D. Decreased urine production
E. Hypertension

112. TR has started recently a potassium replacement regimen to offset the loss of potassium
caused by his ongoing hydrochlorothiazide therapy. She is visiting your pharmacy complaining
about potassium related GI discomfort. Which of the following strategies would you help
manage these side effects?

A. Preparation dilution prior to administration

B. Administration with meals
C. Dose reduction
D. All of the above

113. Niacin is a dietary supplement used in the prevention and treatment of Pellagra,
hypercholesterolemia and hypertriglyceridemia. The following niacin formulations are
interchangeable, EXCEPT:

A. Sustained-release tablets
B. Immediate-release tablets
C. Extended-release tablets

114. Flushing is a common side effect of niacin. Flushing usually starts after drug administration
and last 30 to 60 minutes. Which of the following strategies could decrease the incidence of
flushing associated with niacin therapy?

A. Use sustained release tablets

B. Start with low dose then increase slowly
C. Take aspirin 60 minutes prior to niacin administration
D. Take with food or milk
E. All of the above

115. Calcium is an important dietary supplement with numerous physiological functions. Which
of the following conditions is NOT associated with calcium deficiency?

A. Sprue
B. Menopause
C. Pancreatitis
 D. Vitamin D overload
E. Hypoparathyroidism

116. The recommended calcium intake in postmenopausal women not on estrogen replacement
therapy is:

A. 500 mg/day
B. 1000 mg/day
C. 1500 mg/day
D. 2000 mg/day
E. 2500 mg/day

117. Which of the following calcium preparations has the highest concentration of elemental
calcium?

A. Calcium gluconate
B. Calcium carbonate
C. Calcium citrate
D. Calcium lactate
E. Calcium acetate

118. Which of the following is the recommended daily intake of iron in pregnant women during
the last two trimesters?

A. 15 to 30 mg
B. 50 to 75 mg
C. 80 to 100 mg
D. 100 to 125 mg
E. 130 to 145 mg

119. Which of the following low molecular weight heparins (LMWHs) is a drug of choice for the
treatment AND prophylaxis of deep vein thrombosis (DVT)?

A. Dalteparin
B. Tinzaparin
C. Enoxaparin
D. Heparin
120. Which of the following conditions decreases the anticoagulant effect of warfarin?

A. Nephrotic syndrome
B. Hyperthyroidism
C. Hepatitis
D. Steatorrhea
E. Blood dyscrasia

Case Study: Questions 121 to 122

Mrs. Gill is a 52 years old female patient who has been experiencing severe hot flashes
lately. She is considering the use of estrogen for the relief of hot flashes.

121. Which of the following is NOT a type of approved estrogen formulation for menopause?

A. Vaginal ring
B. Topical gel
C. Transdermal Spray
D. Subcutaneous injection
E. Tablet
F. Patch

122. Estradiol transdermal patch should not be applied to:

A. Abdomen
B. Buttocks
C. Breasts
D. Lower back
E. Hip

123. A 3 mg blister of inhaled insulin is approximately equivalent to:

A. 2 units subcutaneously injected regular human insulin

B. 4 units subcutaneously injected regular human insulin
C. 6 units subcutaneously injected regular human insulin
D. 8 units subcutaneously injected regular human insulin
E. 10 units subcutaneously injected regular human insulin

124. Rapid acting insulin lispro may be mixed with:

 A. Aspart
B. Detemir
C. NPH
D. Glulisine
E. Glargine

125. Which of the following substances decrease the hypoglycemic effect of insulin?

A. Alcohol
B. Calcium
C. Lithium
D. Nicotine
E. Anabolic steroids

126. Which of the following nitroglycerin formulations has the longest duration of action?

A. Sublingual tablets
B. Sustained release tablets
C. Topical ointment
D. Translingual spray
E. Transmucosal tablets

127. Which of the following nasal decongestants is associated with rebound congestion?

A. Ciclesonide
B. Oxymethazoline
C. Fluticasone
D. Sodium chloride
E. Azelastine

128. The recommended acetaminophen dosage for a 4 months old child is:

A. 40 mg every 6 hours
B. 40 mg every 4 hours
 C. 60 mg every 6 hours
D. 60 mg every 4 hours
E. 80 mg every 6 hours
F. 80 mg every 4 hours

129. Adjunct treatments to levodopa/carbidopa are:

A. Trihexyphenidyl
B. Pergolide
C. Selegiline
D. Entacapone
E. All of the above

130. Mr. Ali is experiencing Parkinson like symptoms due to long term use of antipsychotics.
Which of the following drugs is NOT effective in the treatment of drug-induced Parkinsonism?

A. Procyclidine
B. Amantadine
C. Levodopa
D. Benztropine
E. Ethopropazine
F. Diphenhydramine

131. Which of the following daily intake of phytosterols has been shown to lower the risk
coronary heart disease by 20% over an individual lifetime?

A. 1 to 2 g
B. 2 to 3 g
C. 3 to 4 g
D. 4 to 5 g
E. 5 to 6 g

132. Ms. Yan takes aspirin enteric coated tablets for analgesia. All of the following would most
likely delay the drug onset of action, EXCEPT:

A. Stress
B. Fatty foods
C. Hot meals
 D. Vigorous exercise
E. Hunger

133. Which of the following supplements reduces the duration and severity of common cold
symptoms if started shortly after onset?

A. Vitamin C
B. Zinc
C. Iron
D. Vitamin A
E. Biotin

134. Which of the following body temperature measurements is preferred for children younger
than 3 years?

A. Oral
B. Axillary
C. Rectal
D. Tympanic

135. Which is of the following body areas is the application site of scopolamine transdermal
patch for the treatment of motion sickness?

A. On the side of the hip

B. On the chest
C. Over the deltoid muscle
D. Behind the ear
E. On the back of the neck

136. What is the approximate lag time for equilibration between maternal blood and fetal tissues?

A. 20 minutes
B. 40 minutes
C. 1 hour
D. 2 hours
E. 3 hours
137. According to current Canadian Diabetes Association (CDA) Clinical Practice Guidelines all
patients with diabetes should have their feet tested for neuropathy at least:

A. Each month
B. Twice a month
C. Each year
D. Twice a year
E. Every two years

138. Which of the following statements is NOT a recommended component of proper diabetes
education?

A. Discuss how proper blood sugar control can cure diabetic neuropathy
B. Discuss the consequences of poor foot care and possible progression from ulceration to
amputation
C. Discuss that managing blood sugar, blood pressure and cholesterol levels can reduce the
risk of developing foot problems
D. Discuss possible complications of diabetes and how to prevent them

139. All of the following population groups have increased risk for diabetes, EXCEPT:

A. Aboriginals
B. Asians
C. Caucasians
D. Africans

140. Poorly controlled diabetes can lead to several complications including foot ulceration.
What percentage of diabetic patients will develop a foot ulcer during the course of their illness?

A. 5%
B. 10%
C. 15%
D. 20%
E. 25%

141. All of the following are risk factors for the development of foot ulcers in patients affected
by diabetes, EXCEPT:

A. Female gender
B. Poor fitting shoes
C. Cigarette smoking
D. Kidney complications from diabetes
E. Limited joint mobility

142 Pharmacists have an important role in the prevention of foot ulcers in diabetic patients.
Which of the following statements is NOT part of patient counseling on appropriate foot
hygiene?

A. Thorough daily foot examination with a mirror. Any swelling, warmth, redness or pain
should be reported to a health professional promptly
B. Avoid bare feet. Wear slippers indoors
C. Do not soak feet for more than 10 minutes to avoid skin softening which may increase
the risk of injuries
D. Apply lotion to heels, soles and between toes to treat dry skin
E. Regular exercise to improve circulation

Case Study: Questions 143 to 145

PJ is a diabetic patient who is visiting your pharmacy to seek counseling about proper
footwear.

143. Which of the following information will NOT be provided to PJ regarding the selection of
shoes?

A. A snug heel fit to avoid frictions

B. A wide heel no higher than one inch
C. Over-the Counter insoles are preferred
D. Shoes should fasten firmly with lace, velcro or a strap
E. Purchase shoes in late afternoon

144. Which of the following information will NOT be provided to PJ regarding the selection and
use of socks?

A. Wearing socks helps decrease frictions within shoes

B. Wear soft cotton socks as they are designed not to apply compression
C. Avoid old socks with holes
D. Avoid socks with damaged seams
 E. Wear socks with bulky seams inside out

145. PJ also requested counselling on when to contact his physician. You informed him to seek
prompt medical help in all of the following situations. EXCEPT:

A. Numbness in feet
B. Dry skin
C. Minor feet injury
D. Warmth on feet or legs
E. Redness or swelling of feet and legs

146. Which of the following is NOT a risk factor for dry skin?

A. Old age
B. Oral contraception
C. Detergents
D. Loose-fitting clothes
E. HIV infection

Case Study: Questions 147 to 148

MB is a 75-years old who is complaining about dry skin. She explains that her condition
worsens during winter months and would like to purchase a moisturizer.

147. Petrolatum is a classic occlusive moisturizer. Which of the following is NOT a feature of
occlusive moisturizers?

A. Reduce the loss of water from skin and help repair skin barrier
B. Penetrate the lipid layer of skin known as stratum corneum
C. Fill spaces between skin scales resulting in smoothness
D. Produce a film that prevents water loss

148. Which of the following moisturizers is a humectant?

A. Vaseline
B. Jojoba oil
C. Beeswax
D. Hyaluronic acid
E. Shea butter
149. KT has been recently diagnosed with type 2 diabetes and is now receiving counselling on
the proper use to a glucose monitor. All of the following factors affect the accuracy of glucose
monitors, EXCEPT:

A. Performing the test at 100C

B. Alcohol intake
C. Strips quality
D. Alternate site testing

150. Which of the following is the maximum adult daily dose of acetaminophen?

A. 2000 mg
B. 3000 mg
C. 4000 mg
D. 5000 mg
E. 6000 mg
151. Migraine headaches cause 10 – 20% of adult headaches. TY is a 45 years old female who is
suspected to suffer from migraine headaches. Which of the following symptoms is NOT
associated with migraine headaches?

A. Unilateral pain affecting one side of the head

B. Aura with blind spots, numbness or visual and sensory changes
C. Frontal pain worsening on sneezing or bending
D. Nausea or vomiting
E. Photophobia

152. Hypertension is one of the top conditions in Canada. The treatment of hypertension
requires a collaborative approach. Which of the following role should not be assigned to a
pharmacy technician in the treatment of hypertension?

A. Identify patient at risk for non- adherence to therapy then refer them to the pharmacist
B. Ensure that the pharmacy carries a variety of blood pressure monitors
C. Counsel hypertensive patients on the selection of appropriate non-prescription drugs
D. Support preventive approaches such as smoking cessation, physical activity and weight
loss
E. Ensuring that the pharmacy carries enough hypertension related educational flyers
153. Gender differences can have a significant impact on communication process depending on
the patient’s cultural belief. Which of the following is the best option when dealing with gender
related issues?

A. Explain to the patient that your gender does not affect his care
B. If possible, match gender with the patient
C. Disregard politely his concerns considering that they are not appropriate
D. Explain politely that such behavior is not acceptable in Canada
E. Suggest that he can always choose another pharmacy

154. Which of the following communication tips will NOT be useful for a pharmacist when
dealing with a patient with limited English-speaking abilities?

A. Speaking slowly, not loudly

B. Using strong body language
C. Using lay language
D. Using close-ended questions
E. Asking questions to test the patient’s understanding

155. Your pharmacy is located in a multicultural community. As a pharmacist, you will

demonstrate cultural awareness when:

A. You take the time to learn about other cultures and beliefs
B. You are sensitive to patients’ behaviors and attitudes
C. You have the capacity to perform a cultural assessment and use the information in
patient care
D. You consciously and deliberately provide culturally sensitive care

156. Which of the following is NOT an advantage of nicotine inhaler?

A. Dose can be adjusted to cope with cravings

B. Satisfies hand to mouth ritual
C. Discreet
D. Oral gratification

Case Study: Questions 157 to 158

Mr. Peter is a 75 years old male patient with type 2 diabetes for 18 years and no known
allergies. His is currently using: Enteric Coated ASA 325 mg daily, nitroglycerin patch 0.2
mg glyburide 10 mg daily and nitroglycerin spray prn

157. Mr. Peter comes to see you because his angina is still not well controlled. He is using
nitroglycerin spray 3 to 4 times daily. Which of the following would be your recommendation?

A. He should see his physician immediately to reevaluate his nitroglycerin therapy

B. Glyburide is decreasing the effectiveness of nitroglycerin
C. Nitroglycerin dose may be repeated many times until relief is achieved
D. He is not taking the drug as required, it is necessary to shake well the container prior to
each use

158. You also realized that Mr. Peter has been using the patch for 24 hours to relieve nocturnal
angina. You advise that he can prevent or lessen the degree of nitrate tolerance from developing
by having a daily nitrate free interval of:

A. 6 hours
B. 8 hours
C. 12 hours
D. 24 hours
E. 36 hours

159. A 39-year-old female patient with no known allergies with a history of insomnia is currently
using the following medications: triazolam 0.5 mg qhs x 2 years, Tylenol #1 - ii prn for
headache. You notice that she has been requesting early refills for triazolam and has received
two prescriptions from walk-in-clinics.

Which of the following would be your primary concerns?

A. Her insomnia is still not controlled

B. Her physician should increase her dosage of triazolam
C. She is probably becoming addicted to triazolam
D. She is suffering from medication resistant insomnia
E. Her physician is too busy for her to get appointments

160. Which of the following is NOT a common benzodiazepines withdrawal symptom?

A. Irritability
B. Increased hand tremor
C. Visual hallucinations
 D. Diarrhea
E. Insomnia

161. A 54 years old patient with known codeine intolerance comes to see you with the following
prescription. He is currently using ibuprofen 400 mg qid

Tylenol #2
Sig: i q4h prn pain
Mitte: 30

After reviewing the patient’s profile, you would:

A. Advise the patient to discontinue ibuprofen while on Tylenol #2

B. Call the doctor and discuss his intolerance to codeine
C. Call the doctor to discuss the potential interaction between Tylenol #2 and ibuprofen
D. Call the doctor to discuss possible substitution to Tylenol #3
E. Fill the prescription as is and counsel the patient to be aware of drowsiness

162. KP is a 67 years old patient who is currently taking the following medications:
zopiclone 7.5 mg hs prn
hydrochlorothiazide 25 mg daily
potassium chloride 600 mg ii bid
digoxin 0.25 mg daily

KP comes to fill a new prescription for verapamil 80 mg q8h. Which of the following would be
an appropriate step?

A. Call his physician to discuss possible verapamil-zoplicone interaction

B. Call his physician to discuss possible verapamil-hydrochlorothiazide interaction
C. Call his physician to discuss possible verapamil-digoxin interaction
D. Dispense as written and counsel the patient on potential new side effects such as
constipation
E. Dispense as written and counsel the patient to take verapamil with food to decrease GI
irritation

163. PA is a 57 years old male patient with a history of sulfonamides and penicillins allergies.
He is currently using naproxen 375 mg bid arthritis
He comes to fill the following prescription for urinary tract infection
Cephalexin 500 mg
Sig: i qid x 7 days

Which of the following would be an appropriate step?

A. Call his physician and recommend changing the prescription to nitrofurantoin

B. Call his physician and recommend changing the prescription to
sulfamethoxazole/trimethoprim
C. Call his physician and recommend changing the duration of treatment to 10 days
D. Fill the prescription as written. Counsel the patient to refrigerate the suspension and
discard after 14 days

164. In clinical trials the intent to treat (ITT) analysis is used to enhance the accuracy of results
by decreasing bias. All of the following statements concerning intent to treat analysis are
accurate, EXCEPT:

A. Analysis based on initial treatment intent

B. Different from per-protocol analysis
C. Includes patients who did not complete the trial
D. Provides unbiased comparisons among the treatment groups
E. Excludes participants who did not adhere to study protocol

165. A patient come to see you with a prescription for niacin tablets 500 mg tid. Which of the
following is the likely diagnosis?

A. Hypercholesterolemia
B. Coronary insufficiency
C. Gout
D. Anemia
E. Alcoholism

166. You are counseling a patient who is complaining about recent incidence of nosebleeds. All
of the following strategies would be included to your counselling session, EXCEPT:

A. Keep your home dry, free of moisture

B. Maintain the temperature between 15oC and 18oC in sleeping areas
C. Limit the use of aspirin
D. Use of saline nasal spray to moisturize your nose
 E. Apply petrolatum jelly inside the nose to prevent dryness

167. A shock is a life-threatening condition characterized by all of the following, EXCEPT:

A. Cool, pale and clammy skin

B. High blood pressure
C. Fast and shallow breathing
D. Thirst, nausea and vomiting
E. Confusion or anxiety

168. You are counseling a patient who is complaining about recurrent urinary tract infections
(UTIs). Which of the following preventive strategies would you include to your counseling
session?

A. Drink at least two liters of water daily

B. Drink cranberry or blueberry juice
C. Avoid vaginal deodorants
D. Empty bladder soon after intercourse
E. All of the above

169. A cataract is a painless and cloudy area in the lens resulting in the reduction of light
reaching the retina. All of the following symptoms are associated with cataracts, EXCEPT:

A. Cloudy, fuzzy and filmy vision

B. Double vision
C. Increased ocular pressure
D. Decreased night vision
E. Spots or halos around light

170. Swimmer’s ear or otitis externa is an inflammation of the ear canal. Which of the following
is NOT a likely cause of Swimmer’s ear?

A. Psoriasis
B. Prolonged use of earplugs or hearing aids
C. Noise
 D. Water in ear
E. Eczema
171. Migraine headaches are unilateral headaches characterized by nausea, vomiting and
sensitivity to light or sound. Which of the following are non-pharmacologic options for the
prevention of migraine headaches?

A. Practice of relaxation techniques

B. Exercise regularly
C. Application of a warm compress on the painful area
D. Adopt a sleeping and eating routine
E. Stay hydrated
F. All of the above

172. Canker sores are painful open sores in the mouth. They are caused by infections, certain
foods, stress and female hormones. Canker sores can be treated by:

A. Rinsing the mouth with an antacid

B. Rinsing the mouth with diluted hydrogen peroxide
C. Applying a paste made of baking soda and water
D. Applying milk of magnesia
E. All of the above

173. Lice are tiny white insects that can live on skin, hair or clothing. Lice spread by close
physical contact or contact with clothing and bedding of an infected person. All of the following
are effective strategies help get rid of lice from clothing and bedding, EXCEPT:

A. Freezing for 6 hours

B. Dry cleaning
C. Washing with hot water
D. Ironing

174. One mg of pancreatin contains 25 USP units of amylase activity, 3.0 USP units of lipase
activity, and 35 USP units of protease activity. If the patient takes 0.1 g daily what is the weekly
amylase activity administered?

A. 2500 units
B. 7500 units
C. 12500 units
D. 17500 units
E. 22500 units
175. A patient is receiving IV Co-trimoxazole (80 mg SMX & 16 mg TMP) 15 ml Q6H. The
physician wants to switch him to liquid formulation. The liquid preparation contains 200 mg
SMX and 40 mg TMP in each 5 ml dose. The volume of liquid required to provide the IV
equivalent dose is:

A. 2 ml
B. 3 ml
C. 4 ml
D. 5 ml
E. 6 ml

176. 50 ml of 95% solution of NaCl is dissolved in 2L dextrose 5%. NaCl = 58g

The mEq of both Na and Cl in 500 ml is:

A. 102 mEq
B. 205 mEq
C. 322 mEq
D. 409 mEq
E. 510 mEq

177. A patient is currently taking 250 mg of anhydrous zinc sulfate. To receive the equivalent
amount of zinc sulfate how many mg of zinc sulfate hexahydrate should the patient take?
ZnSO4 = 161
ZnSO4.6H2O = 269

A. 125.5 mg
B. 200.7 mg
C. 360.2 mg
D. 416.7 mg
E. 508.9 mg

178. A vial contains 5,000,000 units of streptokinase. Following dilution of the powder with 23
ml of sterile water the concentration is 200,000 units/ml. Based on this result what is the amount
of sterile water needed to have a concentration of 250,000 units/ml.

A. 8 ml
B. 10 ml
C. 15 ml
D. 18 ml
E. 20 ml

179. A physician is switching a patient from parenteral azithromycin to enteral. The daily PO
dose equivalent of azithromycin IV 250 mg BID assuming a bioavailability of 52% is:

A. 250 mg
B. 500 mg
C. 750 mg
D. 1000 mg
E. 1250 mg

180. A physician is switching a patient from oral to parenteral morphine administration. The
single dose IM equivalent of morphine PO 36 mg assuming a conversion ratio IM:PO of 1:3 is:

A. 12 mg
B. 25 mg
C. 36 mg
D. 72 mg
E. 108 mg

181. A prescription calls for 1.2 million units of penicillin G IM for the treatment of
streptococcal infection. If the preparation to be dispensed contains 1180 units per mg, how many
milligrams of penicillin G are required?

A. 180 mg
B. 380 mg
C. 590 mg
D. 796 mg
E. 1017 mg

182. A prescription order requires the administration of 60 mg of testosterone. You have

testosterone cypionate in stock. The molecular weights of testosterone cypionate and testosterone
are respectively 412.6g and 288.4g. The dose of testosterone cypionate that would be equivalent
to 60 mg of testosterone is:
 A. 41.2mg
B. 66.4 mg
C. 85.8 mg
D. 98.7 mg
E. 102.5 mg

183. A parenteral formulation contains 50% (w/v) of magnesium sulfate. How many
milliequivalents of magnesium ions are in 2 mL of the magnesium sulfate injection?
Molecular weight of MgSO4·7H2O is 246.48 g.

A. 2.1 mEq
B. 4.1 mEq
C. 6.1 mEq
D. 8.1 mEq
E. 10.1 mEq

184. An infusion order calls for 120 mL 5% D/W IV in 30 min. Assuming a drop factor of 10
drops per milliliter, the flow rate in drops per minute is:

A. 10
B. 20
C. 30
D. 40
E. 50

185. An infusion order calls for 1000 mL 5% D/W q24h IV. Assuming a drop factor of 20 drops
per milliliter, the flow rate in drops per minute is:

A. 12
B. 14
C. 15
D. 17
E. 19

186. A patient has an intravenous infusion of 850 milliliters of 5% D/W infusing at 24 drops per
minute. The drop factor is 20 drops per milliliter. How many milliliters per hour is this patient
receiving?

A. 10.0
 B. 24.0
C. 52.0
D. 72.0
E. 85.0

187. An infusion order calls for 1250 mL 5% D/0.9% NS IV q12h. The drop factor is 60
microdrops per milliliter. The flow rate in microdrops per minute is:

A. 32
B. 56
C. 98
D. 104
E. 120

188.Integrase inhibitors also called integrase strand transfer inhibitors belong to the class of
antiretroviral drugs used in the treatment of HIV infection. They inhibit the action of the viral
enzyme integrase that inserts the viral genome into the DNA of the host cell. Integrase inhibitors
are co-administered with other antiretroviral agents. Which of the following drugs is NOT an
integrase inhibitor?

A. Raltegravir
B. Dolutegravir
C. Atazanavir
D. Elvitegravir
E. Bictegravir

189. Which of the following statements regarding generic drugs is NOT correct?

A. Health Canada mandates that a generic drug is designed to work the same way in the
body as the original brand-name drug
B. Health Canada requires that both brand-name and generic drug companies follow the
same rules for the manufacturing process and for ensuring the quality of their ingredients
 C. Health Canada mandates that generic drugs have similar active ingredient and that they
work the same way in the body as the brand-name drug
D. Health Canada even regulates the non-medicinal ingredients, such as fillers and
preservatives, for both brand-name and generic drugs and they are subject to the same
approval process
E. When a generic drug is approved by Health Canada that means the medicine is as safe
and as effective as the original brand-name drug and they will work the same way

190. "Facsimile transmission" means transmission of the exact visual image of a document by
way of electronic equipment. Prescription drug orders may be transmitted by facsimile by a
prescriber to a pharmacy, provided that all of the following requirements are met, EXCEPT:

A. The prescription must be sent only to pharmacy of the patient's choice with no
intervening person having access to the prescription drug order
B. The prescription must be sent directly from the prescriber's office
C. The prescription must be sent directly from a health institution for a patient of that
institution, or from another location, provided that the pharmacist is confident of the
prescription's legitimacy
D. The prescription may not include the date of issue assuming that a secured fax machine
has been set to automatically record the date of transmission
E. The equipment for the receipt of the facsimile prescription must be located within a
secure area to protect the confidentiality of the prescription information

191. Which of the following statements concerning a faxed prescription is NOT correct?

A. The pharmacist is responsible for verifying the origin of the transmission of the
prescription
B. The pharmacist is responsible for verifying the authenticity of the prescription
C. The prescription must be maintained on permanent quality paper by the pharmacy
D. Facsimile transmission can be accepted only from a practitioner registered to practice in
a Canadian province where the patient has residence
E. Pharmacist-to-pharmacist communication of prescription transfers for other than
narcotics and controlled drugs may be completed by facsimile transmission.
Case Study: Questions 192 to 195
You are counselling a 25 years old female patient who is interested in using Accutane for
the treatment of severe acne. Accutane contains the active ingredient isotretinoin, a
derivate of vitamin A. Accutane is used to treat severe acne resistant to other treatments
including antibiotics. Accutane can cause serious side effects including birth defects and
mental disorders.

192. All of the following statements must be included in your counselling, EXPECT:

A. You must avoid becoming pregnant while on Accutane and at least one month after the
termination of therapy
B. You must have two negative pregnancy tests, one of them must be done in a lab, before
you start taking Accutane
C. You must sign the informed consent form prior to initiating therapy
D. You must have a monthly pregnancy test while on Accutane and one month after you
stop taking the medication
E. Do not have skin smoothing procedures such as waxing and dermabrasion and at least I
month after termination of therapy

193. You should also counsel the patient on the use of effective birth control. Which of the
following statements must be included in your counselling?
You must use effective birth control:

A. For at least one month before starting Accutane

B. While you are on Accutane
C. For at least one month after you stop taking Accutane
D. All of the above

194. In which of the following situations Accutane should not be used?

A. While breast feeding

B. During tetracycline therapy
C. With vitamin A supplements
D. Sensitivity to retinoids
E. All of the above
195. Accutane capsules remain stable for:

A. 6 months
B. 1 year
C. 18 months
D. 2 years
E. 3 years

196. Medication safety is one of the cornerstone activities of the principle of nonmaleficence. In
the event that a medication error does occur, the pharmacy manager can further the principle of
nonmaleficence by encouraging all of the following strategies, EXCEPT:

A. The analysis of what went wrong

B. Finding ways to ensure that the error does not occur again
C. Documenting and sharing the learning from a medication error with the pharmacy staff
D. Punishing the staff involved
E. Training newly hired staff

197. In healthcare, professional integrity involves all of the following, EXCEPT:

A. Exercising the principle of confidentiality
B. Being truthful and honest with patients
C. Telling patients what the best choice for them will be
D. Accepting responsibility for one’s own actions and decisions
E. Practicing within personal limits of knowledge skills and abilities

198. Medication adherence can be generally defined as the extent to which a patient takes
medication as prescribed by the health care provider. Some of the major predictors of poor
adherence to medication include the nature of the condition being treated. Which of the
following conditions is likely to have the highest non-adherence rate?

A. High Blood Pressure

B. Migraine Headaches
C. Community Acquired Pneumonia
D. Peptic Ulcer
E. Rheumatoid Arthritis
199. Which of the following statements concerning Medication reconciliation (MedRec) is NOT
correct?

A. MedRec does not require the involvement of patients to ensure efficiency

B. MedRec helps the reduction of potential adverse drug events
C. MedRec involves a systematic review of all medications a patient is using
D. MedRec should be performed at admission, transfer, and discharge
E. MedRec aims to eliminate undocumented intentional discrepancies and unintentional
discrepancies in drug therapy

200. In order to reduce medication error it is important to have 5 basics rules called “the five
rights of medication administration” always in mind. Which of the following is NOT one of the
five rules?

A. Right patient
B. Right time
C. Right drug
D. Right pharmacy
E. Right dose

201. TJ is the pharmacist on duty at RC Hospital Pharmacy. A patient requiring immediate

asthma medication comes to the pharmacy with a medication order. Which of the following
medication orders the patient has received?

A. Standing order
B. PRN order
C. STAT order
D. Emergency order
E. Investigational order

202. Under the Natural Health Products (NHPs) Regulations, which of the following products
are Natural Health Products?

A. Amino acids
B. Essential fatty acids
C. Probiotics
D. Homeopathic medicines
E. All of the above
203. All Natural Health Products must meet specific labelling requirements, to ensure safe and
informed choices. Information required on NHP labels includes all of the following, EXCEPT:

A. Cost of product
B. Product licence number
C. Quantity of product in the bottle
D. Complete list of medicinal and non-medicinal ingredients
E. Recommended use

204. All of the following are modifiable factors in disease prevention, EXCEPT:

A. Smoking
B. Sedentary lifestyle
C. Genetic
D. Unhealthy diet
E. Unintended pregnancy

205. Screening for health problems in the absence of symptoms is a key strategy in health
promotion and disease prevention. Screening should target the following key areas: neoplastic
diseases, cardiovascular diseases, metabolic, nutritional, environmental disorders, infectious
diseases, vision and hearing disorders, prenatal disorders, congenital disorders, musculoskeletal
disorders as well as mental disorders and substance abuse. To ensure effective patients screening
healthcare professionals should be knowledgeable in which of the following areas?

A. When screening is appropriate

B. What procedures to use
C. How to use the procedures effectively
D. How to interpret and use the results
E. All of the above

206. Immunization is another effective strategy in health promotion and disease prevention. All
of the following are recommended adult immunizations, EXCEPT:
A. Influenza
B. Pneumococcal disease
C. Malaria
D. Tetanus and Diphtheria
E. Measles, Mumps, and Rubella
 F. Hepatitis A and B

207. Pharmacists are encouraged to engage in public education and advocacy in health
promotion and disease prevention within our communities. Which of the following activities
could help improve public education in health promotion and disease prevention?

A. Writing newspaper articles or opinion columns

B. Speaking to school, church, or other community group
C. Advocating changes in public policies or laws
D. Hosting educational webinars
E. All of the above

208. To ensure effective patient counselling skills, the first step for pharmacists is to learn how to
explore the context of the behavioral risk factors in a patient’s life and to begin to understand the
process of empowering patients who desire a change. The following are the 5 A’s model for
patient-centered behavioral change, EXCEPT:

A. Address the behavior at risk first then the patient’s agenda for the visit
B. Assess the patient’s knowledge of the risks and his/her readiness to change
C. Advise the patient
D. Assist the patient’s readiness
E. Arrange follow-up to reinforce the effort and address relapse

209. Which of the following is a key dimension of health?

A. Physical only
B. Social and Physical
C. Social and Mental
D. Physical and Mental
E. Social, Physical and Mental

210. All of the following statements describe an illness behavior, EXCEPT:

A. The pattern of reactions a patient has to their perception of being sick

B. The patient’s willingness to seek care
C. The patients’ compliance to a therapeutic regimen
D. An illness behavior is similar in all patients with a specific disease
E. None of the above
211. All of the following statements illustrate ways in which a person’s culture may affect their
approach to accessing health care, EXCEPT:

A. Differing conceptions of what is considered a disease

B. Compliance to drug therapy
C. Emotional reaction to a diagnosis
D. Acceptance of other forms of treatment such as acupuncture or Ayurveda
E. None of the above

212. Which of the following statements best describes the likely impact of the aging population
on the health care system?

A. Cost of acute care

B. Cost of chronic care
C. Cost of health technologies
D. Cost of pharmaceuticals
E. Cost of preventive care

213. Canadians expect to receive high-quality, accessible and comprehensive health care when
they are ill. They also value effective prevention and promotion services and supports that enable
them to stay healthy. All of the following strategies can help improve the health of Canadian, and
prevent many health problems, EXCEPT:
A. Changing risk factors and conditions that lie inside and within the control of the health
sector
B. Providing population health promotion initiatives and public health services in
communities
C. Ensuring Canadians can access and use appropriate effective clinical prevention services
D. Helping people learn and practise healthy ways of living
E. Using research to build the evidence on what creates good health, identify the causes of
disease and how to influence them

214. Canada’s current health system is mainly focused on diagnosis, treatment and care. To
create healthier populations, and to sustain our publicly funded health system, a better balance
between prevention and treatment must be achieved. All of the following are benefits of health
promotion and disease prevention, EXCEPT:
A. Prevent disabilities
 B. Prevent suffering
C. Prevent the loss of income
D. Prevent premature death
E. Prevent the involvement of private businesses in community health

215. Which of the following factors are determinants of health?

A. Environmental conditions
B. Access to education
C. Economic status
D. Physical activity
E. All of the above

216. Understanding the characteristic of natural history of a disease enables healthcare

professionals achieve all of the following, EXCEPT:

A. Anticipate disease prognosis

B. Identify opportunities for disease prevention
C. Identify strategies for disease control
D. Recommend effective intervention to alter the patient’s genetic factors
E. Assessment the likely disease progression timeframe

217. Which of the following statements describes a secondary intervention targeting a single
patient in the prevention of hepatitis C?

A. Counselling on safe drug use to prevent hepatitis C infection

B. Counselling on safer sex habits to prevent hepatitis C infection
C. Screening for hepatitis C infection if the patient has a history of drug use by injection
D. Recommending hepatitis C infection therapy to an infected patient
E. Counselling an infected patient on hepatitis C transmission prevention strategies

218. All of the following statements describe a primary intervention targeting a community in
the prevention of colorectal cancer, EXCEPT:

A. Organized colonoscopy screening programs in the target community

B. Publicity campaigns alerting the community to the benefits of lifestyle changes such as
high fiber diets
C. Offer subsidies to help people within the target community access physical activity
programs
 D. Ensuring food stores carry a good selection of fruits and vegetables
E. Partnering with community pharmacies to organize educational events

Answers

1. A

2. E
Loperamide will not be effective, instead vancomycin or metronidazole are commonly used.
Antibiotic-induced diarrhea is mostly associated with 3rd generation cephalosporins (ampicillin,
amoxicillin, clindamycin) and fluoroquinolones. The bacteria C. difficile is the leading cause of
antibiotic-induced diarrhea.

3. B
Cyclophosphamide, ifosphamide, chlorambucil and melphalan are alkylating agents.

4. A
Raloxifene is used in the management of post-menopausal symptoms.
Aztreonam is beta lactam antibiotic; oseltamivir is antiviral; allopurinol is antigout that inhibits
the enzyme xanthine oxidase leading to decreased production of uric acid; valsartan is
angiotensin II receptor antagonist.

5. A
Beta blockers are preferred for patients who have had a heart attack.

6. A
Other causes of dyspnea are obesity, pneumonia, cardiac ischemia, pulmonary embolism, asthma
and carbon monoxide poisoning.

7. D
qd means every day; qh means every hour; qhs means every bedtime; qs means sufficient
quantity.

8. B
Methadone, Tylenol#4, morphine and codeine are narcotics.
9. D
A written or verbal prescription is required for the remaining drugs listed.

10. C

11. E

12. B

13. B

14. E
Empty stomach administration requires drug administration 1 hour before OR 2 hours after a
meal.

15. D

16. B
Famciclovir or valacyclovir may be used as well. The other drugs listed are protease inhibitors
used for the treatment of HIV infection.

17. C
C describes Dawn phenomenon

18. D

19. B
Administered by injection.

20. A

21. B
22. C

23. E

24. D
Chlorpromazine and thioridazine color urine red; nitrofurantoin and chloroquine color urine
brown; promethazine and cimetidine color urine blue; warfarin and rifampin color urine orange.

25. B
Fiorinal, Tylenol#2, and Tylenol#3 are narcotic preparations.

26. A
Morphine is a narcotic; Lorazepam is a benzodiazepine, butorphanol is controlled drug part II
and cloxacillin is a schedule F drug.

27. B

28. D
Anticonvulsants such as lamotrigine, gabapentin, carbamazepine, valproic acid are used as mood
stabilizers.

29. B
Donepezil is effective after 3 to 6 months. Common side effects include headache, diarrhea and
vomiting.

30. B
The result is increased level of acetylcholine.

31. E

32. A
Clobetasol 0.05% has very high potency. General guidelines: Very high and high potency
corticosteroids on palms, soles, scalp or thick resistant lesions, low potency on face, jaws,
genitals and skin folds and moderate potency corticosteroids on the rest of the body (large areas).
Very high and high potency corticosteroids are limited to adult use only.
33. B
Carbamazepine is another treatment option.

34. A

35. B
Carbamazepine is first line treatment for Trigeminal Neuralgia (TN) or tic douloureux.

36. C

37. A

38. B
Penicillins are used preferred for the treatment of Streptococcus pneumoniae; 2nd or 3rd
generation cephalosporins are preferred in case of Haemophilus influenzae infection.

39. B
Fidaxomicin has been approved in Canada in 2012 for the treatment of C. Difficile infections

40. C

41. D

42. B
Dehydration is another side effect.

43. C

44. C

45. D
Dopamine agonists and levodopa/carbidopa are other treatment options.
46. A

47. C

48. C
Polysorbate and polyethylene glycol drops are used for dry eyes; diclofenac and ketorolac are
NAISD drops used for ocular abrasion and pain. Sodium cromoglycate drops can be used as
well.

49. C

50. C

51. B
Dysglycemia means abnormal blood glucose level. Other drugs leading to dysglycemia include
interferon alpha and hydrochlorothiazide.

52. B

53. D
Discard within 6 months of opening. Do not exceed 3 tablets in 15 minutes period.
SR tablet is used for the prevention of angina NOT for immediate relief.

54. E
It takes 3 to 4 weeks for maximum effectiveness. Levothyroxine is T4.

55. D

56. D
Shake well before use but to not refrigerate.

57. D

57. A
Pseudoephedrine may lead to increased secretion of insulin due to agonistic effect on the
adrenergic system. Acetaminophen interferes with enzymatic glucose test, NOT blood glucose
level, resulting in false decrease in blood glucose level. Disulfiram inhibits the enzyme
acetylaldehyde dehydrogenase which normally metabolizes alcohol; disulfiram acts as a
deterrent to alcohol ingestion.

58. E

59. A
Postprandial blood glucose refers to blood glucose level following a meal.

60. C

61. A
Garlic, ginger and ginkgo biloba increase the risk of bleeding. In contrast ginseng, green tea, soy
and St. John’s Wort decrease the effectiveness of warfarin.

62. E
Digoxin is adjusted to decrease the risk of hyperthyroidism-like symptoms. Levothyroxine
decreases glycemic control therefore insulin dose adjustment is required. Cholestyramine
decreases the absorption of levothyroxine; dose adjustment is not required however separate
administration by at least 6 hours is recommended.

63. E
MMSE stands for Mini Mental State Examination.

64. F
Urine alkalizers such as carbonic anhydrase inhibitors may also decrease the clearance of
memantine. Donepezil is also affected by P450s interactions.

65. E
To prevent drug-drug interactions.

66. B
Cimetidine decreases warfarin metabolism resulting in increased warfarin bioavailability.
67. D
Triazolam has no hangover therefore there is no effect on daytime alertness.

68. C
Swimming and cycling are not preventive measures for osteoporosis; walking, stairs- climbing,
weightlifting and running are preferred.

69. B

70. B

71. C

72. C
Echothiophate is acetylcholinesterase inhibitor used in chronic glaucoma; dorzolamide is a
carbonic anhydrase inhibitor; brimonidine is alpha 2 adrenergic agonist; timolol is beta
adrenergic antagonist.

73. A

74. E

75. B
Apply the patch to a clean, hairless place on the skin between the neck and the waist. Hip is also
acceptable.

76. C
Spironolactone is K-sparring diuretic.

77. E
78. A

79. A

80. C

81. E

82. A

83. C
The clearance of theophylline is faster in pediatric patients.

84. A

85. E

86
Instill 1 drop in both eyes twice a day for 7 days

87
Insert 1 applicator full vaginally every night at bedtime

88
Take 1 tablet by mouth 4 times a day after meals

89
Take 1 and 1/2 teaspoonful by mouth 3 times a day as needed for cough

90
Instill 4 drops into right ear every 4 hours for 5 days
91
Insert 1 suppository rectally every 4 hours as needed for nausea

92
Take 1 capsule by mouth 3 times daily before meals and at bedtime

93. C
2-hour glucose tolerance test above 11.1 mmol/l is required; 7.0 mmol/l refers to fasting glucose
level. Large doses of salicylates, diuretics, anticonvulsants, and oral contraceptives may affect
the glucose tolerance test.

94. A
Clomiphene is nonsteroidal selective estrogen receptor modulator (SERM).

95. A
PO first course: 50 mg/day; start on 5th day of cycle or anytime for a patient who has had no
recent uterine bleeding. Second course in case of ovulation: repeat first course until conception
or for 3 cycles. Second course if no ovulation: 100 mg/day for 5 days.

96. C
Loss of appetite is common.

97. B

98. E

99. D
Resins (cholestyramine, colestipol) are the only lipid-lowering drugs appropriate for children
older than 2 years and pregnant or lactating women.

100. D

101. B
Adapalene is a topical retinoid used to treat acne. Spironolactone and cyproterone are anti-
androgens used orally treat acne. Isotretinoin is retinoid used orally or topically.
102. C

103. C

104. D

105. C
Stimulants such as amphetamine and methylphenidate are the drugs of choice for the treatment
of ADHD.

106. C

107. B
DAW means dispensed as written.

108. A

109. C

110. C
Here is the order: gluconate < citrate < bicarbonate < acetate < chloride

111. E

112. D

113. C

114. E
The recommended dose of aspirin is 325 mg.

115. D
Other conditions associated with calcium deficiency are vitamin D deficiency, pregnancy,
lactation, chronic diarrhea, steatorrhea, renal failure, alkalosis and hyperphosphatemia.
116. C

117. B
The order is: gluconate < lactate < citrate < acetate < carbonate

118. A

119. C
Dalteparin is used for prophylaxis whereas tinzaparin is used for treatment.
Low molecular weight heparins have greater effect on factor Xa and less antithrombin activity
than heparin. Heparin is not a LMWH.

120. A
B, C, D and E increase the anticoagulant effect of warfarin. It is also important to note that
warfarin appears inactive in breast milk. Other conditions known to decrease the effectiveness of
warfarin include edema, hyperlipidemia and hypothyroidism.

121. D
Estrogen transdermal spray is applied on the inner surface of the forearm.

122. C
Also, do not apply the patch over any skin folds, oily, broken, burned, or irritated skin, or areas
with skin alterations such as birth marks or tattoos, and the waistline or other places where tight
clothing may rub it off.

123. D
1 mg blister is equivalent to 3 units.

124. C
Lispro, Aspart and Glulisine are rapid acting insulins therefore there is no benefits mixing them.
Glargine and Detemir are long acting and should not be mixed with other insulins.
Draw insulin lispro first to avoid clouding. NHP stands for isophane insulin suspension.
125. D
The remaining substances increase the hypoglycemic effect of insulin. Other substances with
similar effect are ACE inhibitors, oral antidiabetics, beta blockers, fibrates, MAO inhibitors,
salicylates, sulfonamides and tetracyclines. Other substances known to decrease the
hypoglycemic effect of insulin include HIV drugs, atypical antipsychotics, oral contraceptives,
corticosteroids, diuretics, phenothiazines and thyroid hormones.

126. C
Sublingual tablets, 30 to 60 minutes; sustained release tablets 3 to 8 hours; topical ointment, 2 to
12 hours; translingual spray, 30 to 60 minutes; transmucosal tablets, 3 to 5 hours.

127. B
Use for no longer than 3 to 4 days to avoid rebound congestion. Azelastine is an antihistamine
used commonly combined with another decongestant.

128. E
3 to 11 months, 80 mg every 6 hours; 1 to 3 years, 80 mg every 4 hours; 3 to 6 years; 120 to 125
mg every 4 to 6 hours; 6 to 12 years, 325 mg every 4 to 6 hours.

129. E

130. C

131. B

132. E
Hunger, cold meals and mild exercise increase gastric emptying; in contrast, A, B, C and D
decrease the rate of gastric emptying which will delay the absorption of aspirin from enteric
coated tablets.

133. B
Vitamin C reduces the duration of the symptoms.

134. C

135. D
136. B

137. C

138. A
Diabetic neuropathy is not curable; however, it can be prevented.

139. C

140. C

141. A
Other risk factors include uncontrolled blood sugar, duration of diabetes, peripheral vascular
disease (PVD), kidney or eye complications from diabetes, older age, diabetic peripheral
neuropathy (DPN), foot deformities, trauma to the feet and poor fitting shoes, foot callus,
previous foot ulcer and male gender.

142. D
Apply lotion to heels and soles not between toes. Other components of diabetic foot hygiene
include washing feet with mild soap in warm water, wearing soft cotton socks that apply some
compression to reduce swelling and have minimal seams.

143. C
Other recommendation include soles should be well cushioned and always buy shoes in the late
afternoon when foot swelling is likely. Over-the-counter insoles should be avoided as they may
cause blisters if they are not the right size.

144. B
Soft cotton socks are specialized socks for diabetic patients that apply some compression to
reduce swelling and have minimal seams.

145. B
Dry skin can be managed effectively by the patient unless it is persistent. Other warning signs
are mild-to-moderate pain in feet and legs, persistent itching in the feet can be a sign of fungal
infection, difficulty walking may be sign of arthritis (Charcot’s joints) or a sign of abnormal
strain or pressure on the foot due to poorly fitting shoes, pain, redness, or swelling around a
toenail could be a sign of an ingrown toenail and calluses or corns developing on the feet.

146. D
Other risk factors for dry skin are tight-fitting clothes, eczema, low humidity in the environment,
HIV infection, diabetes, hypothyroidism, cancer, topical products containing alcohol, statins and
anticholinergic drugs.

147. C
Occlusive moisturizers fill the cracks in dry skin and produce a film that prevents water loss. The
most effective occlusive moisturizer is petrolatum (e.g. Vaseline, Aquafor). Examples include
lanolin, beeswax, mineral oil, and silicones (e.g. dimethicone).

Emollient moisturizers are fatty acids or oils (e.g. jojoba oil, castor oil, coconut oil, palm oil,
shea butter); they fill spaces between skin scales resulting in smoothness, increased flexibility,
and decreased inflammation.

Humectants (e.g. hyaluronic acid, glycerin, propylene glycol, urea, lactic acid, alpha hydroxyl
acid) prevent water loss by binding to water molecules to draw them to the skin.
148. D

149. A
Glucose monitors can be used as low as 50C but not above 400C. Some glucose monitors are
designed to allow alternate site testing.

150. C
4000 mg for aspirin and 1200 mg for ibuprofen.
The common side effect of acetaminophen toxicity is liver damage; the incidence of liver
toxicity increases with alcohol intake.

151. C
Frontal pain worsening on sneezing or bending is associated with sinusitis.

152. C
Patients at risk for non-compliance include senior patients and those requesting refills late.

153. B
154. D
Use open-ended questions. Answers of “yes” or “no” do not tell if the patient truly understood
the information.

155. B
A refers to cultural knowledge; C refers to cultural skill; D refers cultural encounter.

156. C
The nicotine patch is discreet not the inhaler.

157. A
This is a case of ineffective therapeutic regimen.

158. C
12 hours nitrate free period will help avoid drug tolerance.
159. C
Requesting early refills and getting prescriptions from walk-in-clinics are common signs of drug
addiction.

160. D
Diarrhea is a sign of opioids withdrawal.

161. B
Tylenol # 2 contains codeine.

162. C
Verapamil increases significantly the level of digoxin and carbamazepine.

163. A
It is likely that the PA will be allergic to cephalexin.

164. E
ITT analysis requires participants to be included even if they did not fully adhere to the protocol.

165. A
166. A
Humidify your home

167. B
A shock is also characterized by low blood pressure, loss of consciousness and dizziness.

168. E
UTIs include bladder infection (cystitis) and kidney infection (pyelonephritis).

169. C
Increased ocular pressure is a symptom of glaucoma. Cataracts can be prevented with a diet rich
in vitamins E and C, avoidance of steroids as well as good management of high blood pressure
and diabetes.
170. C
Symptoms include itch and feeling of fullness. Swimmer’s ear can be prevented by putting in the
ears few drops of rubbing alcohol or alcohol mixed with equal amount of white vinegar.

171. F
Injections of onabotulinumtoxin A (Botox) about every 12 weeks help prevent migraines in some
adults. Lasmiditan is a new oral tablet approved in October 2019 in the US for the treatment of
migraine with or without aura. Lasmiditan is expected to be approved by Health Canada soon.
Lasmiditan is a highly selective agonist of 5-HT1F receptors.

172. E

173. A
Freezing for 24 hours is required.

174. D
1 mg of pancreatin corresponds to 25 USP units of amylase activity.
100 mg of pancreatin corresponds to 100 × 25 USP units of amylase activity = 2500 units. 2500
units x 7 = 17,500 units.

175. A
Ratio and proportion
200mg / 3 ml = 80 mg/X ml then X= 1.2ml
1.2 ml of the liquid will provide the IV equivalent
176. B
NaCl = 58g therefore 1mEq = 58 mg = 0.058g
In 50 ml of 95% solution, we have 95g / 2 = 47.5 g
In 1 liter, we have 47.5g/2 = 23.75g
23.75 / 0.058 = 409.5 mEq
In 500 ml, we have 409.5 mEq/2 = 205 mEq of Na and Cl

177. D
Anhydrous ZnSO4 represents 60% of ZnSO4.6H2O = 161x100/269
Q1C1 = Q2C2
250 mg x 100% = X mg hydrous zinc sulfate x 60%
X = 416.66 mg about 416.7 mg
178. D
5,000,000 / 200,000 = 25 ml therefore the volumetric contribution of the powder is 2 ml
5,000,000 / 250,000 = 20 ml
Therefore, we need to add 20 ml – 2 ml (contribution of dry powder) =18 ml of sterile water.

179. D
PO daily dose is 1000 mg = twice IV daily

180. A
Single IM dose is 36 mg/3 = 12 mg

181. E
1180 units of penicillin G benzathine are contained in 1 mg.
1 unit is contained in 1/1180 mg.
1,200,000 units are contained in (1,200,000 × 1)/1180 units = 1017 mg.

182. C
288.4 g of testosterone corresponds to 412.6 g of testosterone cypionate.
1 g of testosterone corresponds to 412.6/288.4 g of testosterone cypionate.
60.0 mg or 0.0600 g of testosterone corresponds to (412.6/288.4) × 0.0600 = 0.0858 g or 85.8
mg of testosterone cypionate.

183. D
Amount of magnesium sulfate in 2 mL of 50% magnesium sulfate injection is:

2 ml x 50 g / 100 ml = 1g
Eq wt of MgSO4.7H2O = MW (g)/(valence of specified ion × number of specified ions in one
mole of salt)

For magnesium ion:

The number of equivalents is:
246.48/[2(valence) × 1 (number of ions in the compound)] = 123.24 g/Eq of magnesium ion.
The number of equivalents in 1 g is 1g/ 123.24 g/Eq = 0.008114 Eq.
The number of mEq is:
The mEq wt = Eq wt (g)/1000 = (123.24 g/Eq)/1000 = 0.12324 g.
The number of milliequivalents of magnesium ion in 1g is 1g / 0.12324 g/mEq = 8.114 mEq.

184. D
120 ml x 10 drops per min / 30 minutes = 40 drops/min

185. B
1000 ml x 20 drops per min / 24 hours x 60 = 14 drops/min

186. D
24 drops per min x 60 minutes = 1440 drops in hour
20 drops / 1 ml = 1440 drops / X ml therefore X = 1440 /20 = 72 ml/hr

187. D
1250 ml x 60 udrops per min / 12 hrs x 60 = 104 udrops/min

188. C
Atazanavir is a protease inhibitor. Bictegravir is the newest integrase inhibitor approved in 2018.

.
189. C
Same active ingredient instead of similar active ingredient.

190. D
The prescription must include the date of issue.
A faxed prescription must include the:
a) Date of issue
b) Patient's name and address
c) Name of the drug or ingredient(s) and strength where applicable
d) Quantity of the drug which may be dispensed
e) Dosage instructions for use by the patient which shall include a specific frequency or interval
or maximum daily dose
f) Refill authorization where applicable, which shall include the number of refills and interval
between refills
g) Prescriber's Name, address, telephone number, fax number and signature or unique identifier
(as approved by the Pharmacy Regulatory Authority)
h) Time and date of transmission
i) Name and fax number of the pharmacy intended to receive the transmission
j) Signed certification that:
i. the prescription represents the original of the prescription drug order,
ii. the addressee is the only intended recipient and there are no others, and
iii. the original prescription will be invalidated or retained so that it cannot be re-issued.
191. D
Facsimile transmission can be accepted from a practitioner registered to practice in any Canadian
province.

192. E
Do not have skin smoothing procedures such as waxing and dermabrasion and at least 6 months
after termination of therapy. Another important warning: If you become pregnant during
Accutane therapy, stop taking the drug and contact your doctor immediately.

193. D

194. E
In addition, Accutane should not be used during pregnancy, UV exposure, if the patient has liver
or kidney disease, if the patient has high blood lipids and if the patient is sensitive to
hydrogenated soybean or parabens. Accutane may interact with low-dose contraceptives,
antibiotics, corticosteroids, phenytoin and St. John’s Wort.

195. D

196. D

197. C
A healthcare provider should help patients make their own decisions.

198. A
Symptomless diseases have the highest non-adherence rate.
Note: Some of the major predictors of medication non-adherence are:
Presence of psychological problems, particularly depression
Presence of cognitive impairment
Symptomless diseases
Inadequate follow-up or discharge planning
 Side effects of medications
Patient’s lack of belief in the benefit of treatment
Patient’s lack of insight into the illness
Poor provider-patient relationship
Barriers to care or medications
Cost of medications
Complexity of treatment

199. A
MedRec does require the involvement of patients to ensure accurate and complete information is
communicated.

200. D
Right route of administration is the fifth rule.

201. C
A standing order is dispensed routinely; a PRN order is dispensed as needed; an emergency order
is provided to the physician to be able to respond to an emergency; an investigational order is
dispensed for research purpose.

202. E
Other NHPs are herbal medicines, vitamins, minerals, Traditional medicines such as traditional
Chinese medicines.

203. A
Labelling should also include the product name, any cautionary statements, warnings,
contraindications and possible adverse reactions associated with the product and any special
storage conditions.

204. C

205. E

206. C
There is no vaccine for Malaria

207. E
208. A
Instead, address agenda. Deal first with the patient’s agenda for the visit (new Rx, refill….), and
then introduce the topic of the at-risk behavior; e.g. I would like to talk to you about...

209. E
Social dimension is the capacity to establish and maintain social bonds and to interact
successfully with others. Physical dimension represents collectively the physical symptoms of
the disease. Mental dimension is the emotional impact or the disease.

210. D
Illness behaviour varies from culture to culture and also according to personality.

211. E
All are correct

212. B
An aging population does not increase the cost of individual therapeutics; however due to
polypharmacy (more than 4 prescribed drugs) the overall cost of drug therapy increases in
elderly patients.
213. A
Changing risk factors and conditions that lie outside the health sector should be changed as well
through public education and other effective strategies.
214. E
The statement “private businesses” implies any business NOT private health insurance.
Promoting health and preventing diseases is everyone’s business, all levels of government,
communities, researchers, the non-profit sector and the private sector each have a role to play.
215. E

216. D
A patient genetic makeup is not modifiable

217. C
A and B are primary interventions; D and E are tertiary interventions

218. A
A is a secondary intervention within the target community.
BEHAVIOURAL SOCIAL AND ADMINISTRATIVE PHARM
ACY SCIENCES

Questions

1. Verbal communication is essential in a pharmacy setting. All of the following are attributes of
effective verbal communication, EXCEPT:

A. Accuracy of the message

B. Interrupting to clarify
C. Voice pitch
D. Choice of words
E. Eye contact

2. Which of the following is NOT considered confidential information?

A. Age
B. Credit status
C. Level of education
D. Opinions
E. Facebook profile

3. Nonverbal communication is a very important method of sending messages. This form of

communication is often underestimated. Which of the following is NOT a feature of nonverbal
communication?

A. Personal space
B. Silence
C. Facial expressions
D. Pitch of voice
E. Eye contact

4. All of the following are listed as pharmacy assets, EXCEPT:

A. Account receivables
B. Inventory
C. Cost of leasing
D. Equipment
E. Investments
5. Which of the following financial terms represents the residual claim against pharmacy assets
after all liabilities are paid?

A. Sales
B. Equity
C. Liquidity
D. Inventory
E. Account receivables

6. Which of the following substances is NOT regulated as precursor for illicit drug under the
Precursor Control Regulations of the Controlled Drugs and Substances Act?

A. Ergotamine
B. Ephedra
C. Epinephrine
D. Ephedrine
E. Ergometrine

7. The ethical principle of justice requires that the pharmacist:

A. Respect the patient’s right to make decisions

B. Act with honesty without deception
C. Prevent or remove harm
D. Do good to patients
E. Act with fairness and equality

8. Recently, two pharmacy technicians have been dealing with strong disagreement. Which of
the following is NOT an appropriate strategy to help solve the problem?

A. Pharmacy manager assistance in solving the problem

B. Replace the two technicians involved
C. Provide private counseling on conflict management
D. Transform the problem into learning opportunity
E. Address the problem not individuals involved

9. Prior to dispensing, the pharmacist will require a written prescription for:

 A. Nabilone
B. Tylenol #2
C. Diazepam
D. Butorphanol
E. Testosterone

10. Who is primarily responsible for drug procurement and inventory management in a
pharmacy?

A. Pharmacy technician
B. Pharmacy intern
C. Any pharmacist
D. Pharmacy assistant
E. Pharmacy manager

11. All of the following are required on a drug label, EXCEPT:

A. Name of the prescriber

B. Name of the patient
C. Drug-drug interactions
D. The date the prescription is dispensed
E. Drug strength

12. When dealing with a drug dispensing error, which of the following is the least concern of the
pharmacy manager?

A. Discuss the situation with the staff involved

B. Inform the patient’s physician
C. Increase the frequency of staff training
D. Consider the integration of automation in dispensing
E. Hire new staff

13. The Drug Identification Number (DIN) is a computer-generated number assigned by Health
Canada to a drug prior to being marketed in Canada. The DIN has:

A. 5 digits
B. 6 digits
C. 7 digits
D. 8 digits
E. 9 digits

14. A management style is the overall method of leadership used by the manager. The style of
management in which the pharmacy manager makes all decisions without prior consultation with
staff is called:

A. Consultative
B. Autocratic
C. Bureaucratic
D. Benevolent
E. Dictatorial

15. Which of the following statements concerning NAPRA is NOT correct?

A. Promotes the implementation of pharmacy practice standards across Canada

B. An association of provincial and territorial pharmacy regulatory bodies as well as the
Canadian Forces Pharmacy Services
C. Advocates for the protection of the rights of pharmacists
D. NAPRA’s members primary mandate is to protect the public
E. Provides leadership on national policy issues affecting pharmacy practice

16. All of the following are accurate statements regarding pharmaceutical care, EXCEPT:

A. Pharmaceutical care is a patient-centered drug therapy management involving the

pharmacist and patient’s other healthcare providers
B. The principles of pharmaceutical care are embedded in the concept of Good Pharmacy
Practice
C. The goal of Pharmaceutical Care is to optimize the patient's health-related quality of life
D. Pharmaceutical care is a practice in which patients take full responsibility for their
medication related needs
E. Pharmaceutical care aims to achieve positive clinical outcomes within realistic economic
expenditures

17. The ethical principle of veracity requires that the pharmacist:

 A. Respect the patient’s right to make decisions
B. Act with honesty without deception
C. Do good to patients
D. Act with fairness
E. Prevent or remove harm

18. The ethical principle of autonomy requires that the pharmacist:

A. Respect the patient’s right to make decisions

B. Act with honesty without deception
C. Prevent or remove harm
D. Act with fairness
E. Prevent or remove harm

19. Which of the following financial statements provides information on changes of pharmacy
assets, liquidity, equity and liabilities over a period of time?

A. Income statement
B. Balance sheet
C. Cash flow
D. Return on investment
E. Gross income

20. Which of the following is the primary attribute of effective communication skills?

A. Pitch of voice
B. Personal space
C. Tone of voice
D. Choice of words
E. Listening

21. Which of the following statements describes misbranded drugs?

A. Drugs prepared under unsanitary conditions not conformed to GMPs

B. OTC drugs not packaged in tamper-resistant container
C. Drugs that have a misleading label
D. Expired drugs unsafe for administration
E. Drugs in the process of being recalled
22. Drug monographs also called package inserts provide detailed drug information. Which of
the following is NOT listed in a drug monograph?

A. Drug target validation

B. Formulation
C. Contraindications
D. Chemical structure
E. Pharmacokinetic studies

23. MT visits the pharmacy to request her husband’s profile to submit his life insurance
application. She explains that her husband has provided verbal consent. If the pharmacist
provides the profile without prior consultation with the patient, which of the following bioethics
principles has been violated?

A. Veracity
B. Non-maleficence
C. Beneficence
D. Autonomy
E. Justice

24. A regular customer visits your pharmacy to request a refill for Fiorinal. Which of the
following will be an appropriate action?

A. Refuse to provide a refill and ask her to get a new prescription.

B. Refills are not permitted because the original prescription was verbal
C. Refills are permitted if the prescriber has indicated in writing the number of refills and
dates
D. Provide a refill and call her physician to renew her prescription
E. Provide a refill and ask her to return to the pharmacy with a new prescription within 24
hours

25. Which of the following is NOT a responsibility of the pharmacy technician?

A. Provide counseling on drug adverse effects

B. Receive a prescription
C. Prepare medication for release
D. Transfer a prescription
E. Perform pharmaceutical calculations
26. Which of the following statements concerning the roles of Health Canada are correct?

A. Responsible for helping Canadians maintain and improve their health

B. Regulation and approval of the use of medical devices
C. Provision of supplementary health benefits to eligible First Nations and Inuit
D. Regulation and approval of the use of natural health products
E. All of the above

27. Which of the following is NOT a supplementary health care benefit?

A. Acupuncture
B. Naturopathy
C. Chiropractic
D. Optometry
E. Immunization

28. Which of the following statements regarding the statistical error type I is NOT accurate?

A. Data shows no difference between two experimental treatments but there is actually a
difference
B. p value equal or lower than 0.05 means that type I error is unlikely
C. p (probability) value > 0.05 is the level of significance
D. Statistical error type I is also called alpha error
E. Statistical error type I is also known as false positive error

29. Which of the following is the only vaccine required as a condition of entry under the World
Health Organization's International Health Regulations?

A. Cholera
B. Hepatitis B
C. Yellow fever
D. Malaria
E. Meningitis

30. The Canadian Federal Government provides health care directly to all, EXCEPT:
 A. Military
B. Inmates of Federal prisons
C. Pregnant women
D. First Nations
E. Inuits

31. According to the Personal Information Protection and Electronic Documents Act (PIPEDA),
which of the following statement is NOT correct?

A. The purpose of collecting the information is not necessarily disclosed to the patient
B. Collected information must be stored in a secured place
C. If requested, the patient must have access to her information
D. Collected information must be disclosed without patient’s consent when required by law
E. Personal information must be accurate and updated

32. Under the Special Access Program (SAP) the amount of drug dispensed to a patient is limited
to which of the following treatment durations?

A. 3 months
B. 6 months
C. 9 months
D. 1 year
E. 2 years

33. Drug adverse effects may be reported to the following agencies, ECXEPT:

A. Institute of Safe Medication Practices (ISMP)

B. Health Canada (HC)
C. National Association Pharmacy Regulatory Authorities (NAPRA)

34. A pharmacist has just received a prescription for diazepam. The prescription record must be
kept from the date of dispensing for at least:

A. 6 months
B. 12 months
C. 18 months
D. 2 years
 E. 3 years

35. The transfer of benzodiazepines and other regulated substances prescriptions must be
consistent with appropriate regulations. All of the following statements concerning a prescription
of lorazepam are correct, EXCEPT:

A. The prescription must be written

B. The prescription may be transferred once
C. The prescription refills are permitted if less than one year
D. The prescription can be faxed
E. The prescription part-fills are permitted

36. All of the following statements regarding NAPRA Schedule II drugs are accurate, EXCEPT:

A. A prescription is not required however drugs are available only from the pharmacist
B. They are stored in an area where there is no public access
C. They include vaccines, insulin and ephedrine
D. Aliskiren, Bortezomib and Denosumab are schedule II drugs

37. Which of the following statements characterizes empty stomach administration?

A. Anytime before a meal

B. 30 minutes before a meal
C. 40 minutes before a meal
D. 1 hour after a meal
E. 2 hours after a meal

38. A pharmaceutical company as just submitted an investigational new drug (IND) application
to Health Canada. Which of the following clinical trial phases is post-marketing?

A. Phase I
B. Phase II
C. Phase III
D. Phase IV
E. All of the above
39. Which of the following clinical trial phases refers to the process of pharmacovigilance?

A. Phase 0
B. Phase I
C. Phase II
D. Phase III
E. Phase IV

40. Which of the following statements is NOT correct regarding the standard deviation?

A. It measures the dispersion of data points from the mean

B. The higher the standard deviation, the higher the accuracy of data
C. Unlike the variance, the standard deviation is expressed in the same units as the data
D. A low standard deviation indicates that data points tend to be close to the mean
E. It is a common measure of confidence in statistical conclusions

41. Which of the following statements describes best the “Wilcoxon-Mann-Whitney test”?

A. Continuous probability distribution that describes data that clusters around the mean
B. Statistical significance of the difference between two means
C. Parametric test used to evaluate the true value of a parameter based on a sample
D. Non-parametric test for assessing whether two independent observations come from the
same distribution
E. Compares statistical models in order to identify the model that best fits the population
being investigated

42. Medline is a source of:

A. Only primary information

B. Only secondary information
C. Only tertiary information
D. Primary and secondary information
E. Secondary and tertiary information

43. As a pharmacy manager you are concerned about improving the work performance of a
newly hired pharmacy technician. Which of the following may NOT be an appropriate strategy?
 A. Training
B. Supervision
C. Hiring new staff
D. Proper work assignment
E. Continuing education

44. Which of the following references contain information on natural products?

A. Only Compendium of Therapeutic Choices

B. Only Martindale: The Complete Drug Reference
C. Only Lexi-Comp
D. Compendium of Therapeutic Choices and Lexi-Comp
E. Compendium of Therapeutic Choices and Martindale: The Complete Drug Reference
F. Martindale: The Complete Drug Reference and Lexi-Comp
45. Hepatitis B vaccine belongs to which of the following Health Canada schedules?

A. Schedule N
B. Schedule A
C. Schedule G
D. Schedule F
E. Schedule D

46. Which of the following references provide information on pediatric patients?

A. Micromedex
B. Lexi-Drugs Online
C. CPS
D. All of the above

47. You are about to retrieve some information from a website. Which of the following would
help you assess the website?

A. References provided
B. Website sponsors
C. Last updated
D. Advertisements
E. All of the above
48. Which of the following references would be useful in finding information on a drug half-life?

A. Only Goodman and Gilman’s

B. Goodman and Gilman’s and AHFS Drug Information

C. AHFS Drug Information and Clinical Drug data

D. Clinical Drug data and Goodman and Gilman’s
E. Clinical Drug data and Goodman and Gilman’s and AHFS Drug Information

49. The effectiveness of drug therapy is:

A. Retrospective
B. Prospective
C. Reactive
D. Proactive
E. Defensive

50. You are the manager in a hospital pharmacy. A new pharmaceutical sales representative
visits your pharmacy to introduce himself and to discuss your needs. During your conversation,
he asks what kind of anesthetic the hospital uses regularly. How would you respond?

A. You pretend you don’t have the information

B. You provide the information and ask for a discount on your next order
C. You explain that such information remains the hospital’s property
D. You refer him to the anesthesiology unit

51. The following statements concerning the Drug Identification Number (DIN) are correct,
EXCEPT:

A. It is a computer-generated eight-digit number

B. It uniquely identifies all drug products sold in a dosage form in Canada
C. It is found on the prescription label
D. It is not required for over-the-counter drugs (OTCs)
E. It allows the manufacturer to market the drug in Canada

52. All of the following drug product characteristics are uniquely identified by the Drug
Identification Number (DIN), EXCEPT:

A. Manufacturer
B. Route of administration
C. Formulation
D. Synthesis
E. Product name
F. Strength
G. Active ingredients

53. A narcotic preparation contains:

A. One narcotic and one or more non-narcotic medicinal ingredient

B. One narcotic and two or more non-narcotic medicinal ingredients
C. Two narcotics and one or more non-narcotic medicinal ingredients
D. One or more narcotics
E. Two or more narcotics

54. Which of the following Canada Health Act refers to providing all required treatments to
restore the physical and mental health of residents of Canada?

A. Portability
B. Comprehensiveness
C. Public administration
D. Accessibility
E. Universality

55. Which of the following is NOT a type of pharmacy ownership?

A. Sole proprietorship
B. Incorporation
C. Partnership
D. Franchise
E. Leasing

56. Which of the following financial values measures how quickly a pharmacy converts non-cash
assets to cash assets?
 A. Net income
B. Asset turnover
C. Average inventory
D. Activity ratio
E. Profitability

57. In clinical trials the number need to treat (NNT) refers to the number of patients that must be
treated to benefit one patient. NNT equals:

A. 1/CER
B. 1/EER
C. 1/RRR
D. 1/ARR
E. 1/RR

58. An investigational new drug is tested in 2500 patients. The control group has the same
number of patients. At the end of the trial, 625 patients have improved symptoms compared to
only 500 in the control group. What is the NNT of this study?

A. 20
B. 40
C. 60
D. 80
E. 100

59. Which of the following statements describes sensitivity?

A. Measures the number of people who have the disease and tested negative
B. Measures the number of people who do not have the disease and tested negative
C. Measures the number of people who have the disease and tested positive
D. Measures the number of people who do not have the disease and tested positive

60. In finances which of the following pharmacy assets is NOT considered fixed?

A. Equipment
 B. Intellectual property
C. Investment property
D. Inventories

Answers

1.B
Other attributes of effective verbal communication include listening and personal space

2.E
Information shared publicly is not considered confidential.

3. D
Other features of nonverbal communication include posture, gestures and smiling.

4. C
Other assets include cash, intellectual property and vehicles.

5. B

6. C
Other controlled precursors under the act are: Norephedrine and pseudoephedrine.

7. E

8. B

9. A
Written OR verbal prescription for Tylenol #2, diazepam, butorphanol and testosterone.

10. E
11. C

12. E

13. D

14. B
In consultative management style the pharmacy staff provides views and opinions. Bureaucratic
refers to designing detailed written procedures to be followed.

15. C

16. D
Pharmaceutical care is a practice in which the healthcare provider takes responsibility for a
patient's medication related needs and is held accountable for this commitment.

17. B

18. A

19. C

20. E

21. C
Drugs with false or misleading label are called misbranded. Drugs packaged in non-sterile or
contaminated containers are adulterated.

22. A
Additional information found in a typical drug monograph includes clinical pharmacology,
adverse effects, indications, dose, warnings, precautions, abuse and dependence potential.

23. D
24. A
Fiorinal is a narcotic preparation, refills are not permitted; re-orders require a new written or
verbal prescription.

25. A
All drug related counseling must be provided by a pharmacist.

26. E

27. E

28. A
Type I error or false positive or alpha error. Type II error or false negative or beta error; type I
error is the rejection of a true null hypothesis while a type II error is the non-rejection of a false
null hypothesis.

29. C

30. C

31. A

32. B
SAP provides access to not yet approved drugs and is managed by Health Canada.

33. C
ISMP collects and forwards the reports to Health Canada.

34. D
The record of destruction of targeted substances must be kept also for at least 2 years.

35. A
A verbal prescription is also acceptable.
36. D
The drugs listed are schedule I.
Schedule II drugs include vaccine, insulin, ephedrine, benzyl benzoate and methocarbamol.

37. E
Empty stomach administration requires drug administration 1 hour before OR 2 hours after a
meal

38. D

39. E

40. B

41. D
C refers to Wald test; E refers to F-test.

42. D

43. C

44. F

45. E

46. D

47. E
The purpose of the website should be also considered.

48. E

49. A
50. C

51. D
OTCs approved for sale in Canada are also assigned a DIN.

52. D

53. B

54. B

55. E

56. B
Asset turnover measures how effectively a pharmacy uses its assets to generate sales;
Profitability measures the rate of return on investment. Net income = Gross income – Expenses
including taxes. Average inventory = (Beginning inventory + Ending inventory) divided by 2.

57. D

58. A
NNT = 1/ARR and ARR = EER – CER
ARR = 625/2500 – 500/2500 = 0.05 therefore NNT = 1/0.05 = 20

59. C
B refers to the definition of selectivity

60. D

Bonus Questions
Find Additional Bonus Questions in Volume 1
1. A 42-year-old male HIV patient is on multidrug therapy. One of the drugs in his therapeutic
regimen belongs to the class of HIV drugs that prevent the maturation of virions, produce
favorable long-term suppression of viremia, increase CD4+ lymphocyte counts, reduce disease
progression, decrease opportunistic infections and have low rate of resistance. Which of the
following drugs fits the description?

A. Efavirenz
B. Raltegravir
C. Saquinavir
D. Tenovofir
E. Nevirapine

2. A new antiretroviral drug, BR403, is being evaluated in a comprehensive pre-clinical trial.

Preliminary findings show that the action of BR403 is mediated by its antagonistic effect on
CCR5 receptor thus preventing the entry of HIV virus into host cells. Based on these findings,
which of the following drugs shares the mechanism of the new antiretroviral agent?

A. Maraviroc
B. Indinavir
C. Abacavir
D. Raltegravir
E. Nevirapine

3. Which of the following statements is the least accurate concerning the antihyperglycemic drug
metformin?

A. Adverse effects include lactic acidosis

B. Chronic use increases the risk of vitamin B12 deficiency
C. Inhibits gluconeogenesis
D. Stimulates weight gain
E. Hypoglycemia is unlikely

4. A 28-year-old male diagnosed with acromegaly is receiving treatment with a synthetic

analogue of somatostatin and pegvisomant. Which of following drugs is a synthetic analogue of
somatostatin and used along with pegvisomant to treat acromegaly?

A. Cosyntropin
B. Lanreotide
C. Somatropin
D. Pergolide
E. Serotonin
5. A 44-year-old man presents to the ER with symptoms of hyperglycemia including sweating,
confusion, nervousness, fast heart rate, blurred vision, shortness of breath and fatigue. He was
later diagnosed with type 2 diabetes. You prescribe an antihyperglycemic that mimics the action
of incretins to enhance the secretion of insulin. Which of the following drugs was prescribed?
A. Acarbose
B. Glyburide
C. Exenatide
D. Metformin
E. Rosiglitazone

6. 39-year-old woman, 5’5’’ 192 lbs BMI 33, presents to the clinic for her annual checkup. She
had gestational diabetes during her last pregnancy five years ago. Her blood test results show:
fasting blood glucose FPG 11.5 mmol/L (normal 4.0 to 7.0 mmol/L) and glycated hemoglobin
HbA1C 8.1% (normal 4-6%); microalbuminuria is negative. Her family physician recommends
drug therapy combined with lifestyle changes to normalize her blood glucose. She visits your
pharmacy with a prescription for an antihyperglycemic in the class of sodium-glucose co-
transporter 2 (SGLT2) inhibitors. Which of the following antihyperglycemics has been
prescribed?

A. Pramlintide
B. Dapagliflozin
C. Exenatide
D. Sitagliptin
E. Rosiglitazone

7. A 29-year-old female visits her family physician with complaint of recurrent attacks of
migraine headaches of a pulsating quality and severe intensity, with nausea, photo- and
phonophobia that resolved spontaneously within 12 hours if untreated. The attacks were
preceded by reversible visual disturbances that lasted for 15–30 min. The onset of the symptoms
occurred 5 years earlier. Her medical history, physical and neurological examination did not
suggest any other secondary disorder or head trauma. She was prescribed an abortive drug,
sumatriptan. Which of the following statements describes the primary mechanism of sumatriptan
in the treatment migraine headaches?
A. It is a cholinergic receptor antagonist
B. It is a serotonin receptor agonist
C. It blocks the re-uptake of dopamine
D. It is a beta adrenergic receptor antagonist
E. It inhibits the degradation of catecholamines

8. Which of the following substances used to treat osteoporosis inhibits the interaction between
RANKL and RANK?
 A. Cinacalcet
B. Raloxifene
C. Activated vitamin D
D. Denosumab
E. Teriparatide

9. Pyrantel pamoate is used in the treatment on Ascariasis (roundworm infection). Pyrantel

pamoate exerts its therapeutic effect by which of the following mechanisms?

A. Prevention of cell wall synthesis

B. Inhibition of cell mitotic phase
C. Depolarizing neuromuscular transmission blocker
D. Induction of the production of reactive oxygen species
E. Depletion of cell membrane lipoproteins

10. A 56-year-old pre-diabetic patient presents to her physician for follow-up. She complains of
abdominal cramps, diarrhea and flatulence. She has been diligently following lifestyle changes.
She is also on drug therapy to help prevent the worsening of her condition. Which of the
following drugs is likely to be responsible for her symptoms?

A. Sitagliptin
B. Glyburide
C. Repaglinide
D. Canagliflozin
E. Acarbose

11. A diabetic patient visits his family physician for follow-up. After a 3-month trial of
metformin and lifestyle changes his blood test results are: fasting blood glucose FPG 12.5
mmol/L (normal 4.0 to 7.0 mmol/L) and glycated hemoglobin HbA1C 8.0% (normal 4-6%). His
physician recommends adding a second antihyperglycemic to his therapeutic regimen. The newly
prescribed antihyperglycemic acts on nuclear receptor of peroxisome proliferator activated
receptor gamma (PPAR-gamma) to stimulate carbohydrate and lipid metabolism. Which of the
following antihyperglycemics has been prescribed?

A. Acarbose
B. Glyburide
C. Insulin Lispro
 D. Metformin
E. Pioglitazone

12. Neonatal severe hyperparathyroidism (NSHPT) is a disorder caused by inactivating calcium-

sensing receptor (CASR) mutations that result in life-threatening hypercalcemia and metabolic
bone disease. Cinacalcet is an appropriate therapeutic option for NSHPT. Which of the following
statements describes cinacalcet?

A. Cinacalcet belongs to the class of calcimimetics that mimic the action of cortisol on
tissues
B. Cinacalcet belongs to the class of calcimimetics that mimic the action of carbonate on
tissues
C. Cinacalcet belongs to the class of calcimimetics that mimic the action of calcitonin on
tissues
D. Cinacalcet belongs to the class of calcimimetics that mimic the action of calcium on
tissues
E. Cinacalcet belongs to the class of calcimimetics that mimic the action of corticoprotin on
tissues

13. Mr. Roberts is a 68-year old male with a long history of hypertension and coronary artery
disease (CAD). He was discharged from the hospital few days ago after being admitted for a
Transient Ischemic Attack (TIA) and new onset of Atrial Fibrillation (AF). He presents to your
pharmacy with a new prescription for apixaban for anticoagulation therapy. The therapeutic
effect of apixaban is mediated by the inhibition of:

A. Activated Factor II
B. Activated factor V
C. Activated Factor VII
D. Activated Factor IX
E. Activated Factor X

14. A 57-year-old man with a history of 22 years of smoking presents to the ER with dyspnea,
difficulty breathing, chest pain, weight loss. MRI shows a mass in his left lung and biopsy
reveals malignancy. Surgery was performed followed by chemotherapy with several drugs
including epirubicin. Which of the following statements describes the mechanism of epirubicin?
A. Triazene DNA alkylating agent
B. Antracycline –type DNA intercalating agent
C. Potent folic acid antagonist
D. Purine analog inhibitor of DNA replication
E. Microtubules inhibitor
15. The pharmacokinetic profile of a new anticoagulant R7448 is being evaluated in a phase 1
clinical trial. According to pre-clinical studies, R7448 acts as a direct thrombin inhibitor. Which
of the following drugs has the same mechanism of action?

A. Edoxaban
B. Rivaroxaban
C. Apixaban
D. Dabigatran
E. Warfarin

16. A 69-year-old retired teacher initially complained of urologic symptoms including frequency
of micturition, urinary urgency, and hesitancy with a weak stream. Over the past months, he has
reported occasional hematuria and incontinence. His prostate-specific antigen (PSA) level is 25
ng/mL (normal range: 0.0–4.0 ng/mL) up from 12 ng/mL six months ago. A digital rectal
examination revealed enlarged prostate gland with several palpably discreet nodules; histology
revealed adenocarcinoma representing 55% of biopsied specimen confirming a diagnosis of
prostate cancer. He receives a prescription for an antiandrogen drug. Which of the following
drugs has been prescribed?

A. Anastrozole
B. Megestrol
C. Fulvestrant
D. Leuprolide
E. Flutamide

17. A 57-year-old woman is diagnosed with kidney cancer. Treatment is started with sunitinib a
targeted chemotherapeutic agent. The mechanism of action of sunitinib is mediated by:

A. Inhibition of mammalian target of rapamycin (mTOR)

B. Inhibition of vascular endothelial growth factor receptor (VEGF-R)
C. Inhibition of GTPase RAS protein
D. Inhibition of serine/threonine-specific RAF kinase
E. Inhibition of mitogen-activated protein kinase kinase (MEK)

18. Heparin, also known as unfractionated heparin or full-length heparin is a highly sulfated
glycosaminoglycan used as anticoagulant. Heparin is a naturally occurring anticoagulant
produced by basophils and mast cells. Heparin and its low-molecular-weight derivatives called
low-molecular-weight heparins (LMWHs) are effective at preventing deep vein thrombosis and
pulmonary emboli in patients at risk. Which of the following sets of properties best describes the
differences between heparin (H) and low-molecular-weight heparin (LMWH)?

Duration of Bleeding Thrombocytopenia Monitoring Potent

action Antidote
A H~LMWH H~LMWH H>LMWH H only LMWH
only
B H>LMWH H>LMWH H~LMWH Both H and Both H and
LMWH LMWH
C H~LMWH H<LMWH H<LMWH Both H and H only
LMWH
D H<LMWH H>LMWH H>LMWH H only H only
E H<LMWH H<LMWH H~LMWH LMWH LMWH
only only

19. A 55-year-old woman admitted for postoperative observation receives subcutaneous heparin
treatment to prevent deep venous thrombosis, a major risk factor for pulmonary embolism.
Which of the following statements is correct regarding the mechanism of action of heparin?

A. Heparin enhances the activity of antithrombin

B. Heparin deactivates all serine proteases of the clotting cascade
C. Heparin is a potent direct thrombin inhibitor
D. Heparin stimulates the action of COX-1 enzyme
E. Heparin decreases the expression of glycoproteins IIb/IIIa receptors

20. Ramucirumab is a monoclonal antibody used in combination with other chemotherapeutics to

treat patients with metastatic gastric cancer. Which of the following statements best describes the
mechanism of ramucirumab?
A. Stimulates the proliferation of T-cells by preventing the activation of programmed death-
1 (PD-1) ligand receptor
B. Blocks vascular endothelial growth factor receptor (VEGFR)
C. Competitive inhibitor of histone deacetylase inducing cell cycle arrest or apoptosis
D. Binds vascular endothelial growth factor (VEGF) to prevent its therapeutic effect
 E. Inhibits DNA polymerase resulting in the prevention of cell division

21. Cold chain refers to the process used to maintain optimal conditions, particularly
temperature, during the transport, storage and handling of vaccines. Which of the following
statements concerning the cold chain is NOT accurate?

A. Cold chain begins at the manufacturer and ends with proper storage at the pharmacy
B. Monitoring of vaccines' cold chain is required to ensure potency is maintained
C. Exposure of a vaccine to environmental conditions not recommended for the product is
called a cold chain break

22. Zepatier is an oral fixed-dose combination tablet consisting of elbasvir and grazoprevir for
the treatment of hepatitis C. Both active drugs are direct-acting antivirals (DAAs). Elbasvir and
grazoprevir act synergistically to prevent hepatitis C virus (HCV) from multiplying resulting in a
fast reduction of the levels of HCV in the body. Which of the following statements describes the
mechanism of elbasvir?

A. Inhibitor of viral protease essential for virions assembly

B. Inhibitor of viral protease essential for processing viral polyproteins
C. Inhibitor of viral DNA polymerase
D. Inhibitor of viral entry in hepatocytes
E. Inhibitor of the release of virions

23. Symbicort is a commonly used therapy for asthma. Symbicort contains 200 µg of budesonide
and 6 µg of formoterol per dose. Which of the following statements best describes the indication
of Symbicort in the treatment of asthma?

A. Long-term control only

B. Fast relief of asthma attacks only
C. Prevention of exercise-induced symptoms only
D. Both long-term control and fast relief of asthma attacks
E. Reduction of inflammation only

24. All of the following are benefits of direct-acting antivirals in the treatment of hepatitis C,
EXCEPT:

A. Shorter treatment duration

B. Much higher cure rates
C. Fewer side effects
D. Lower cost
E. Higher selectivity for the virus
 Answers
1. C
Saquinavir belongs to the class of HIV protease inhibitors

2. A
Maraviroc belongs to the class of entry inhibitors used in the treatment of HIV infection.

3. D
In fact, metformin induces weight loss; for that reason, it is a drug of choice for obese diabetic
patients.

4. B
Somatostatin is a hormone that inhibits the secretion of several other hormones, including growth
hormone, thyroid stimulating hormone, cholecystokinin and insulin. Lanreotide mimics the
action of somatostatin to reduce the production of growth hormone in acromegaly.

5. C
Exenatide belongs to the class of incretin mimetics for the treatment of type 2 diabetes; it is a
glucagon-like peptide-1 agonist (GLP-1 agonist). Other GLP-1 agonists include liraglutide and
dulaglutide.

6. B
Dapagliflozin inhibits sodium-glucose co-transporter 2 (SGLT2) which is responsible for at least
90% of the glucose reabsorption in the kidney. Blocking this transporter enhances the clearance
of blood glucose through urine. Other SGLT2 inhibitors (gliflozins) include empagliflozin and
canagliflozin.

7. B

8. D
Denosumab is an antiresorptive drug.

9. C

10. E
Acarbose inhibits alpha-glucosidase and pancreatic amylase needed to digest carbohydrates.
Inhibition of these enzymes reduces the digestion of complex carbohydrates therefore less
glucose is absorbed because carbohydrates are not broken down into glucose molecules.
Acarbose is known to induce the GI symptoms described in the case and is used to manage pre-
diabetes.

11. E

12. D

13. E
Apixaban is an oral, direct, and selective factor Xa (activated factor X) inhibitor.

14. B

15. D

16. E

17. B
Sunitinib is an oral, small-molecule, multi-targeted receptor tyrosine kinase (RTK) inhibitor used
for the treatment of renal cell carcinoma (RCC) and imatinib-resistant gastrointestinal stromal
tumor (GIST). Sunitinib inhibits cellular signaling by targeting multiple RTKs including all
platelet-derived growth factor receptors (PDGF-R) and vascular endothelial growth factor
receptors (VEGF-R).

18. D

19. A

20. B
Ramucirumab belongs to the new class of cancer targeted therapies.

21. A
Cold chain begins at the manufacturer and ends with the administration of the vaccine to the
vaccine recipient.
22. A
Elbasvir is an inhibitor of a viral NS5A protease essential for viral replication and virion
assembly. Grazoprevir is an inhibitor of viral NS3/4A serine proteases, encoded by HCV
genotypes 1 and 4. These enzymes are essential for viral replication and processing of viral
polyproteins into mature proteins. Hepatitis C virus (HCV) is a small single-stranded RNA virus.

23. D
Symbicort is approved by Health Canada for both long-term control and fast relief of asthma
attacks.

24. D

NEW Bonus Questions

Find Additional Bonus Questions in Volume 1
1.In 2018, the proportion of adults Canadian who reported using cannabis daily is:

A. 6%
B. 14%
C. 19%
D. 26%
E. 33%

2.Which of the following statements is an accurate description of cannabis?

A. Therapeutic product containing cannabinoids

B. CBD oil
C. Nabiximols
D. Cannabinoid containing product with DIN
E. Nabilone

3.With the legalization of cannabis in Canada, pharmacists are advised to incorporate screening
for cannabis use disorder into daily practice. Which of the following symptoms is NOT
considered a sign of cannabis use disorder?

A. Poor motivation
B. Respiratory problems
C. Euphoric state
D. Reduced work performance
E. Problematic relationships

4. Cannabis math: What is the estimated THC dose if 1 joint containing 0.5 grams of 12% THC
dried cannabis is smoked? Assume 50% loss by combustion.

A. 5 mg
B. 15 mg
C. 30 mg
D. 60 mg
E. 90 mg
5. With the legalization of cannabis in Canada, pharmacists are advised to incorporate screening
for cannabis use suitability into daily practice. Generally, avoid using cannabis in all of the
following individuals, EXCEPT:

A. Machine operators
B. With a strong family history of schizophrenia
C. With history of alcohol use disorder
D. Pregnant or breastfeeding
E. Allergic to CBD

6. Which of the following statements concerning the common methods of cannabis use is
accurate?

A. Smoked cannabis starts working within 10 min

B. Edibles are likely safer than smoking
C. Oral cannabis starts working at around 1h
D. Vaping is associated with increased risk of respiratory damage
E. Cannabis can be administered topically or rectally

7. All of the following statements concerning cannabis related harm reduction are accurate,
EXCEPT:

A. Avoid driving for several hours after use

B. Alcohol is safe with cannabis
C. Avoid smoking cannabis
D. Keep edibles away from children
E. Delay age of first use as long as possible

8. All of the following are strategies to manage cannabis adverse effects, EXCEPT:

A. Start at low dose, and gradually increase

B. Reduce dose frequency, amount or stop using
C. Choose a strain with higher THC:CBD ratio to reduce sedation
D. Discontinue use if experiencing cannabis use disorder
9. Jim is receiving treatment for lung cancer. He has been dealing with persistent nausea and
vomiting induced by chemotherapy despite being on two antiemetics. Which of the following
products could be recommended to this patient as adjunctive treatment?

A. Nabilone
B. Nabiximols
C. CBD
D. THC/CBD
E. THC

10. Mr. Lenn is a naïve cannabis user who is seeking your counselling. Your counselling will
NOT include which of the following statements?

A. Oral cannabis has slower onset compared to inhaled cannabis

B. Vaped cannabis is as potent as smoked cannabis
C. Inhaled cannabis has shorter duration of action than oral cannabis
D. Smoked cannabis has higher risk of respiratory adverse effect than vaped cannabis
E. He must avoid smoking cannabis

11. You are a hospital pharmacist. A newly admitted patient medical record shows:
36.5 ºC body temperature on admission; Normal range = 35.8ºC to 37.3ºC
The normal range shown is based on:
A. Oral temperature
B. Tympanic temperature
C. Rectal temperature
D. Axillary temperature
E. Standardized formula
12. An adjuvant is a substance such as aluminum salt added to a vaccine. An adjuvant acts to:

A. Increase the release of antigens, stimulate local inflammation to attracts immune cells to
the site, and reduce the physical size of the antigen for more efficient uptake by antigen
processing cells.
B. Slow the release of antigens, reduce local inflammation to attracts immune cells to the
site, and reduce the physical size of the antigen for more efficient uptake by antigen
processing cells.
C. Increase the release of antigens, reduce local inflammation to attracts immune cells to the
site, and enlarge the physical size of the antigen for more efficient uptake by antigen
processing cells.
D. Slow the release of antigens, stimulate local inflammation to attracts immune cells to the
site, and enlarge the physical size of the antigen for more efficient uptake by antigen
processing cells.

13. All of the following statements concerning a vaccine additive are accurate, EXCEPT:

A. Activates viruses or bacteria

B. Stabilizes the vaccine
C. Preserves the vaccine
D. Helps keep the vaccine potent overtime
E. Examples of vaccine additives include albumin, aluminum hydroxide, and aluminum
phosphate

14. All of the following statement concerning herd immunity are accurate, EXCEPT:

A. A large percentage of the population is vaccinated to prevent the spread of certain

infections
B. Individuals not vaccinated are not protected
C. Herd immunity protection is mediated by preventing the spread of the infection in the
population
D. Herd immunity is also called community immunity

15. Which of the following statements best describes passive immunity?

A. Immune response is mediated by antibodies produced by the body’s B-cells as effector

molecules. Both B- and T-cells may be involved in this response.
B. Immune response is mediated the body's immune system to remember an encounter with
a specific antigen and to react more swiftly to the antigen in a later encounter.
 C. Immune response is mediated by antibodies produced by another human being or animal.
Protection is generally limited and diminishes over time.
D. Immune response is mediated by IgM antibodies and stimulated by an encounter with an
antigen for the first time. Immunologic memory is produced.

16. Which of the following statements best describes an immunization record?

A. It consolidates immunization from multiple sources, including any reports of adverse

events, into one confidential record.
B. It is a record of all immunization a person has received. This record is produced in two
forms, professional chart and take-home.
C. It outlines the optimum timing of immunization when primary or secondary
immunization is received after the recommended age.
D. It conveys whether a patient is eligible, due or overdue for a specified vaccine.

Answers

1. A
Prevalence of cannabis use in 2018: 14% of Canadian adults used cannabis in the last 3 months,
6% used daily and 1% were registered for medical use.

2. B
Cannabinoids are all therapeutic products containing cannabinoids; Cannabis is dried cannabis
plant material or cannabis extracts without a DIN such as CBD oil; Prescription cannabinoids are
cannabinoid-containing medications with a DIN such as nabilone or nabiximols.

3. C
Euphoria is not a sign of disorder instead it is a common reaction to cannabis. Another sign of
cannabis use disorder is poor academic performance.

4. C
Amount of THC in 1 joint. 500 mg cannabis x 12% THC = 60 mg
If 50% loss to combustion, then the amount of THC smoke is: 60 mg THC x 50% = 30 mg

5. A
Cannabis should be avoided in individuals younger than 25, with a strong family history of
psychosis, with history of cannabis use disorder or other substance use disorder (e.g., alcohol,
benzodiazepine, opioids), with known allergy to cannabis, THC, CBD or any other cannabinoid.

6. D
Cannabis can be smoked, vaporized, taken orally, sublingually, topically or rectally. Different
routes of administration will result in different pharmacokinetic and pharmacodynamic
properties of the drug.
Inhaled cannabis starts working within 10 min and effects last 2-4h (up to 24h)
Oral cannabis (e.g. oils, edibles) starts working at around 1h and effects last 4-6h (up to 24h)
Vaping and edibles likely safer than smoking. Smoking is associated with increased risk of
respiratory damage. Currently, cannabis edibles are not legally available for purchase.

7. B
Cannabis has additive CNS effects (sedation, dizziness…) with alcohol. Avoid alcohol and
cannabis combination.

8. C
Choose a strain with lower THC:CBD ratio to reduce cognitive side effects. CBD has been
shown to reduce the side effects of THC.
The most common adverse effects of cannabis are:
Euphoria
Sedation
Relaxation
Difficulty speaking
Numbness
Disconnected thoughts
Muscle twitching
Changes in heart rate and blood pressure
Withdrawal symptoms include anxiety, irritability, anger, sleep disturbance, fatigue, cannabis
craving, restlessness
Signs of cannabis use disorder include lack of motivation, poor work/study performance,
problematic relationships

9. A
Of all the cannabinoids, nabilone has the strongest evidence of effectiveness for persistent
chemotherapy induced nausea and vomiting. Off-label indications include AIDS-related
anorexia, palliative pain and neuropathic pain.

10. B
Vaped cannabis is two times more potent than smoked cannabis; smoking destroys the active
ingredients by combustion. There is no evidence that Mr. Lenn is not a good candidate for
cannabis.

11. A
Axillary temperature: Usually 1ºC lower than oral temperature.
Tympanic membrane (ear) temperature: Usually 0.3°C to 0.6°C higher than oral temperature.
Rectal temperature: Usually 1ºC higher than oral temperature.

12. D
An adjuvant increases the body’s immune response to a vaccine.

13. A
A vaccine additive inactivates viruses and bacteria to preserve the vaccine and maintain its
potency overtime.

14. B
Even individuals not vaccinated such as newborns and those with chronic illnesses are offered
some protection because the infection has little opportunity to spread within the community.

15. C
A refers to humoral immunity; B refers to memory or secondary immune response; D refers to
primary immune response.

16. B
A refers to immunization registry; C refers to delayed immunization schedule; D refers to
immunization status.