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PEBC OSCE practice questions

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Question 1Patient Assessment and Triage

A patient arrives at the pharmacy counter reporting chest pressure that began 20 minutes ago and radiates to the left arm, with associated diaphoresis. What is the most appropriate immediate action?

  1. Advise the patient to go home and return if symptoms persist beyond one hour
  2. Sell the patient aspirin and instruct them to take it only if pain worsens
  3. Call emergency services and keep the patient seated while awaiting transfer Correct answer.
  4. Recommend sublingual nitroglycerin from the patient's own supply and reassess in 15 minutes

Explanation

Chest pressure radiating to the arm with diaphoresis is a red-flag presentation for acute coronary syndrome and requires emergency activation, not pharmacy management. The pharmacist's role is to recognize the emergency, keep the patient safe and monitored, and arrange immediate transfer. Any delay for self-treatment or observation increases the risk of myocardial damage.

Question 2Patient Assessment and Triage

Which finding during a medication history interview most strongly suggests the patient may be experiencing an adverse drug reaction rather than a new illness?

  1. Symptoms are worse in the morning and improve with activity
  2. The patient reports similar symptoms once several years ago
  3. The patient has a family history of the same complaint
  4. Symptoms began within days of starting a new medication and resolve after its discontinuation Correct answer.

Explanation

A temporal relationship with a newly started drug, plus improvement on withdrawal, is the classic pattern supporting a drug-induced cause. The other features describe chronic, familial, or mechanical patterns that do not specifically implicate a medication. Establishing timing and dechallenge response is central to causality assessment.

Question 3Patient Assessment and Triage

A patient with asthma asks which inhaler to use when acute wheeze begins. What is the most appropriate triage advice?

  1. Stop all inhalers until reviewed by a physician to avoid masking symptoms
  2. Double the daily long-acting beta-agonist dose until symptoms settle
  3. Use the inhaled corticosteroid whenever symptoms start and wait 30 minutes before reassessing
  4. Use the short-acting bronchodilator as prescribed and seek urgent care if there is no relief or if speech is impaired Correct answer.

Explanation

Reliever therapy for acute bronchospasm is a short-acting bronchodilator, with escalation to emergency care when response is poor or signs of severe distress appear. Inhaled corticosteroids are controllers, not rescue agents, and long-acting agents must not be used for acute relief. Withholding all therapy risks deterioration.

Question 4Patient Assessment and Triage

During triage, which patient characteristic most reliably identifies a need for pharmacist-led medication review before dispensing?

  1. The patient has a valid prescription for a topical antifungal
  2. The patient is taking eight chronic medications from three prescribers Correct answer.
  3. The patient asks about the price of an over-the-counter vitamin
  4. The patient requests a refill of a single antihistamine

Explanation

Polypharmacy across multiple prescribers raises the risk of duplication, interactions, and adherence problems, warranting a structured review. The other scenarios involve single, low-complexity products with limited interaction potential. Complexity of the regimen, not the request itself, drives triage priority.

Question 5Patient Assessment and Triage

Which element is essential when documenting a patient's allergy history during assessment?

  1. The patient's preferred brand of the medication
  2. The specific reaction experienced and the timing of exposure Correct answer.
  3. The pharmacy where the reaction was first reported
  4. Only the name of the drug the patient avoided

Explanation

An accurate allergy record distinguishes true hypersensitivity from intolerance and guides safe re-exposure decisions, so the nature and timing of the reaction must be captured. Recording only a drug name without reaction details can lead to inappropriate avoidance or unsafe rechallenge. Brand and pharmacy details do not affect clinical risk assessment.

Question 6Patient Assessment and Triage

A patient reports new-onset dizziness two weeks after starting a new antihypertensive. Which assessment step should come first?

  1. Schedule a routine follow-up in three months
  2. Measure blood pressure and heart rate and review the timing of doses Correct answer.
  3. Recommend an over-the-counter antiemetic for symptom control
  4. Immediately instruct the patient to stop the new medication

Explanation

Objective vital signs and dose timing establish whether the symptom is hemodynamic and related to the new therapy before any change is made. Abrupt discontinuation without assessment can be harmful, and symptom masking with an antiemetic obscures the cause. A three-month deferral ignores a potentially serious adverse effect.

Question 7Patient Assessment and Triage

Which statement best describes the purpose of a structured patient interview during initial assessment?

  1. To confirm the prescription was written by an approved prescriber
  2. To record the patient's preferred language for billing
  3. To verify insurance coverage before dispensing
  4. To gather a consistent, complete history that supports safe clinical decisions Correct answer.

Explanation

A structured interview standardizes history taking so that symptoms, medications, and risk factors are captured reliably for clinical decision-making. Prescriber verification, coverage checks, and billing details are administrative tasks. The interview's clinical value lies in consistency and completeness.

Question 8Patient Assessment and Triage

A parent asks how to assess whether a child's fever requires urgent medical attention rather than home management. Which response is most appropriate?

  1. Seek urgent care for an infant under three months with fever, or any child with lethargy, breathing difficulty, or dehydration Correct answer.
  2. Treat all fevers at home with antipyretics until they resolve spontaneously
  3. Take the child to emergency only if the temperature exceeds 41 degrees Celsius
  4. Use physical cooling alone and avoid antipyretics in all children

Explanation

Age under three months and red-flag features such as lethargy, respiratory distress, or dehydration are recognized indicators for urgent pediatric assessment. Temperature threshold alone is an unreliable triage criterion, and universal home management ignores serious presentations. Antipyretics remain appropriate comfort therapy when not contraindicated.

Question 9Patient Assessment and Triage

Which patient statement most suggests low health literacy that should change how counselling is delivered?

  1. The patient requests written information in large print
  2. The patient asks whether the medication causes drowsiness
  3. The patient asks about the cost of the medication
  4. The patient cannot describe how to take the medication after reading the label Correct answer.

Explanation

Inability to restate dosing after reading the label indicates difficulty with health information and calls for teach-back, simplified language, and demonstration. Asking about side effects, print size, or cost reflects engagement rather than limited literacy. Adapting communication to the patient's demonstrated understanding improves safety.

Question 10Patient Assessment and Triage

A patient with diabetes reports a two-week history of polyuria, polydipsia, and unintentional weight loss. What is the most appropriate triage decision?

  1. Recommend increased fluid intake and review in one month
  2. Dispense a glucose meter and take no further action
  3. Advise reducing sugar intake and continue current medications
  4. Arrange prompt medical assessment for possible marked hyperglycemia Correct answer.

Explanation

The triad of polyuria, polydipsia, and weight loss suggests significant hyperglycemia and requires timely medical evaluation rather than watchful waiting. Lifestyle advice alone does not address possible metabolic decompensation. Providing monitoring equipment without clinical follow-up delays needed care.

Question 11Patient Assessment and Triage

Which approach best supports shared decision-making when a patient is choosing between two equally appropriate treatment options?

  1. Choose the option with the shortest dosing schedule for all patients
  2. Present the benefits and risks of each option and elicit the patient's values and preferences Correct answer.
  3. Defer entirely to the prescriber and provide no information to the patient
  4. Recommend the option with the lowest acquisition cost without discussion

Explanation

Shared decision-making requires balanced information about each option combined with exploration of what matters to the patient. Cost, convenience, or prescriber authority alone may be relevant but cannot replace the patient's informed preference. The goal is an informed choice aligned with the patient's values.

Question 12Patient Assessment and Triage

A patient taking warfarin reports new bruising and dark stools. What is the priority assessment action?

  1. Reassure the patient that bruising is expected with warfarin
  2. Advise increasing vitamin K-rich foods to reverse the effect
  3. Recommend an over-the-counter laxative for the stool change
  4. Assess for bleeding severity and arrange urgent INR measurement and medical review Correct answer.

Explanation

Bruising with melena suggests possible over-anticoagulation or gastrointestinal bleeding and requires prompt INR assessment and medical evaluation. Reassurance is unsafe because dark stools may indicate significant blood loss. Dietary manipulation is not a reliable acute reversal strategy and a laxative does not address bleeding.

Question 13Patient Assessment and Triage

Which technique best confirms a patient understands new inhaler instructions before leaving the pharmacy?

  1. Providing a manufacturer leaflet and asking the patient to read it at home
  2. Telling the patient the technique is printed on the box
  3. Asking whether the patient has any questions about the inhaler
  4. Asking the patient to demonstrate the technique with a placebo device Correct answer.

Explanation

Teach-back by physical demonstration confirms actual technique rather than self-reported understanding. Providing a leaflet or asking open questions does not verify that the patient can perform the steps correctly. Direct observation allows correction of errors before the patient uses the device at home.

Question 14Patient Assessment and Triage

A patient presents with a new prescription for an opioid and reports drinking alcohol daily. Which assessment finding is most relevant to safety counselling?

  1. Daily alcohol use has no interaction with opioid therapy
  2. Concurrent alcohol use increases the risk of respiratory depression and overdose Correct answer.
  3. Alcohol only interacts with opioids when taken on an empty stomach
  4. Alcohol improves opioid absorption and reduces required dose

Explanation

Alcohol and opioids both depress the central nervous system, and combined use substantially raises the risk of respiratory depression and fatal overdose. Absorption and dose requirements are not improved by alcohol, and the interaction is not limited to fasting states. Counselling should address this risk explicitly.

Question 15Patient Assessment and Triage

Which finding in an older adult's medication profile most warrants a falls-risk assessment?

  1. Use of a benzodiazepine together with an antihypertensive Correct answer.
  2. Use of a topical corticosteroid cream
  3. Use of a daily multivitamin
  4. Use of an inhaled corticosteroid

Explanation

Sedative-hypnotics combined with agents that lower blood pressure increase the risk of sedation, orthostasis, and falls in older adults. Topical corticosteroids, multivitamins, and inhaled corticosteroids have limited systemic effects relevant to falls. Reviewing sedative and hypotensive burden is a core part of falls-risk triage.

Question 16Patient Assessment and Triage

A patient reports a dry cough that started shortly after beginning a new medication and has no other respiratory symptoms. Which medication class is the most likely cause?

  1. Proton pump inhibitors
  2. Thiazide diuretics
  3. Angiotensin-converting enzyme inhibitors Correct answer.
  4. Beta-blockers

Explanation

ACE inhibitors are well recognized for causing a persistent dry cough through bradykinin accumulation, typically beginning within weeks of initiation. Thiazides, proton pump inhibitors, and beta-blockers are not classically associated with this isolated cough pattern. Recognizing the temporal link supports an appropriate medication review.

Question 17Patient Assessment and Triage

When triaging multiple patients waiting in a busy pharmacy, which principle should guide the order of assessment?

  1. Assess first those who have waited the longest
  2. Prioritize those with symptoms suggesting high clinical acuity regardless of arrival order Correct answer.
  3. Assess first those with the simplest prescriptions to reduce queue time
  4. Assess strictly in order of arrival to ensure fairness

Explanation

Triage prioritizes clinical acuity so that potentially serious conditions receive attention first. Strict arrival order, queue efficiency, or waiting time can delay care for high-risk patients. Fairness is achieved through a consistent acuity-based rule rather than first-come service.

Question 18Patient Assessment and Triage

Which question is most useful for identifying a potential drug interaction during a medication history?

  1. Have you ever changed pharmacies?
  2. What over-the-counter products, supplements, and herbal remedies do you use regularly? Correct answer.
  3. Do you prefer brand-name or generic products?
  4. Do you always take your prescription exactly as written?

Explanation

Interactions frequently involve non-prescription products, supplements, and herbals that patients may not volunteer, so a specific prompt is needed. Adherence, pharmacy history, and brand preference do not reveal interacting agents. A complete product inventory is essential to interaction screening.

Question 19Patient Assessment and Triage

A patient with known chronic kidney disease requests a nonsteroidal anti-inflammatory drug for knee pain. What is the most appropriate triage response?

  1. Recommend the drug with instructions to increase fluid intake
  2. Advise avoiding the agent and recommend discussing alternative analgesia with the prescriber Correct answer.
  3. Recommend the maximum over-the-counter dose for rapid relief
  4. Suggest combining two different nonsteroidal anti-inflammatory drugs

Explanation

Nonsteroidal anti-inflammatory drugs can reduce renal perfusion and worsen kidney function, so they are generally avoided in chronic kidney disease. Maximum dosing, combining agents, or relying on hydration does not mitigate the renal risk. Alternative analgesia should be selected after clinical review.

Question 20Patient Assessment and Triage

Which feature most distinguishes a true medication allergy from a predictable adverse effect?

  1. An immunologically mediated response that can occur at low or typical doses Correct answer.
  2. A complaint that recurs with every exposure to any drug
  3. A dose-dependent effect that resolves when the dose is reduced
  4. A symptom that appears only after long-term use

Explanation

True allergy involves an immune mechanism and may occur even at small doses, whereas predictable adverse effects are dose-related and often resolve with dose reduction. Recurrence with every drug or late appearance alone does not define allergy. This distinction guides whether rechallenge or avoidance is appropriate.

Question 21Patient Assessment and Triage

A patient reports palpitations and tremor after doubling their caffeine intake while also starting a decongestant. Which assessment approach is most appropriate?

  1. Review all sympathomimetic exposures and assess for signs requiring medical referral Correct answer.
  2. Recommend a beta-blocker from the patient's existing supply
  3. Reassure that tremor is unrelated to any medication
  4. Attribute symptoms solely to caffeine and advise no change

Explanation

Decongestants are sympathomimetics, and combined with caffeine they can produce palpitations and tremor, so a full exposure review is needed to judge severity and the need for referral. Attributing symptoms to one agent or dismissing them risks missing a clinically significant reaction. Using another person's medication is inappropriate.

Question 22Patient Assessment and Triage

An older patient presents with confusion, dry mouth, and urinary retention after recent addition of an anticholinergic medication. Which assessment conclusion is best supported?

  1. A probable anticholinergic adverse effect requiring medication review and medical follow-up Correct answer.
  2. A likely allergic reaction requiring permanent avoidance of all medications
  3. An unrelated viral illness requiring only symptomatic treatment
  4. A normal age-related change requiring no intervention

Explanation

The constellation of confusion, dry mouth, and urinary retention after starting an anticholinergic is a classic adverse-effect pattern in older adults. Labeling it a viral illness, a universal allergy, or normal aging would delay appropriate deprescribing review. Medication review and medical follow-up are indicated.

Question 23Patient Assessment and Triage

A patient with heart failure reports two days of increasing shortness of breath, ankle swelling, and a three-kilogram weight gain. What is the most appropriate action?

  1. Advise increasing the diuretic dose independently
  2. Reassure that weight fluctuation is expected and requires no action
  3. Recommend restricting fluids and reassess in one week
  4. Arrange urgent medical assessment for possible decompensation Correct answer.

Explanation

Rapid weight gain with dyspnea and edema suggests fluid overload and possible heart failure decompensation, which needs urgent medical evaluation. Independent diuretic adjustment is unsafe without clinical review, and a one-week delay or reassurance risks deterioration. Prompt referral is the priority.

Question 24Patient Assessment and Triage

During a medication review, a patient describes taking a short-acting bronchodilator more than four times daily for a week. What does this pattern most likely indicate?

  1. A need to increase the reliever dose further
  2. Worsening asthma control that warrants prompt clinical reassessment Correct answer.
  3. Appropriate use of reliever therapy that requires no change
  4. A harmless habit that can be addressed at the next annual visit

Explanation

Frequent reliever use signals inadequate control and increased risk of exacerbation, prompting timely reassessment of controller therapy. It is not appropriate ongoing use, and increasing reliever dosing does not treat the underlying inflammation. Deferring review to an annual visit ignores the elevated risk.

Question 25Patient Assessment and Triage

A patient on a monoamine oxidase inhibitor reports eating aged cheese and now has a severe headache and elevated blood pressure. What is the most appropriate triage decision?

  1. Reassure that the combination is safe because the drug is long established
  2. Advise resting quietly and reassess the next day
  3. Treat as a possible hypertensive crisis and arrange emergency assessment Correct answer.
  4. Recommend an over-the-counter analgesic and continue the diet

Explanation

Aged cheese is rich in tyramine, and with monoamine oxidase inhibition this can precipitate a hypertensive crisis presenting as severe headache with raised blood pressure. Emergency assessment is required because of the risk of serious complications. Rest, analgesia, or reassurance would dangerously delay care.

Question 26Patient Assessment and Triage

A patient with asthma tells the pharmacist that they have been using a salbutamol inhaler more than four times daily for the past week and waking at night with cough. How should this information be classified in the triage assessment?

  1. A marker of uncontrolled asthma that requires urgent reassessment of therapy Correct answer.
  2. A reason to switch to a long-acting beta-agonist alone
  3. An expected effect of salbutamol that needs no further action
  4. A sign of inhaler overuse that should be managed by reducing the dose

Explanation

Frequent rescue inhaler use and nocturnal symptoms indicate poor asthma control and an increased risk of exacerbation. This pattern requires prompt review of controller therapy and assessment of adherence and inhaler technique. Simply reducing the rescue inhaler or switching to a long-acting beta-agonist alone is unsafe without addressing underlying inflammation.

Question 27Patient Assessment and Triage

A patient with type 2 diabetes reports a two-week history of polyuria, polydipsia, and unintentional weight loss. Which initial action is most appropriate during triage?

  1. Schedule a routine follow-up in three months
  2. Recommend increasing the dose of the current oral antihyperglycemic agent
  3. Advise the patient to reduce fluid intake to lessen urinary frequency
  4. Arrange same-day assessment for possible hyperglycemia Correct answer.

Explanation

Polyuria, polydipsia, and unintentional weight loss are classic symptoms of marked hyperglycemia and possible impending ketoacidosis or hyperosmolar state. These symptoms warrant same-day medical assessment for glucose measurement and evaluation of acute complications. Delaying assessment or adjusting therapy without clinical data is unsafe.

Question 28Patient Assessment and Triage

An older adult presents with a new prescription for oxybutynin and reports recent onset of confusion, dry mouth, and difficulty urinating. Which action best reflects appropriate triage?

  1. Advise stopping the medication abruptly without further assessment
  2. Recommend an increased fluid intake to offset the dry mouth
  3. Reassure the patient that these effects are harmless and will resolve
  4. Contact the prescriber to discuss the anticholinergic burden and alternative therapy Correct answer.

Explanation

Confusion, dry mouth, and urinary retention in an older adult starting oxybutynin suggest anticholinergic toxicity. The pharmacist should communicate with the prescriber to review the medication and consider a safer alternative. Abrupt discontinuation without prescriber involvement and reassurance alone are not appropriate.

Question 29Patient Assessment and Triage

A patient taking warfarin for atrial fibrillation reports new bruising on the arms and dark, tarry stools. Which triage action is the priority?

  1. Schedule a routine INR check in one week
  2. Recommend reducing the warfarin dose until the bruising resolves
  3. Advise the patient to increase vitamin K-rich foods in the diet
  4. Arrange urgent medical assessment for possible gastrointestinal bleeding Correct answer.

Explanation

Dark, tarry stools in a patient on warfarin suggest gastrointestinal bleeding and possible over-anticoagulation. This requires urgent medical evaluation, including INR measurement and assessment for bleeding source. Dose adjustments or dietary changes without clinical assessment are unsafe.

Question 30Patient Assessment and Triage

A patient with heart failure reports two days of increasing shortness of breath, ankle swelling, and a three-kilogram weight gain. Which triage decision is most appropriate?

  1. Reassure the patient that weight gain is expected with heart failure
  2. Recommend reducing fluid intake and reassess in one week
  3. Advise increasing the diuretic dose without consulting the prescriber
  4. Arrange same-day medical assessment for possible decompensation Correct answer.

Explanation

Rapid weight gain, worsening dyspnea, and edema in a patient with heart failure suggest fluid overload and possible decompensation. Same-day medical assessment is needed to evaluate volume status and adjust therapy. Self-adjusting diuretics or delaying assessment can lead to worsening heart failure.

Question 31Prescription Processing and Verification

A prescription for amoxicillin oral suspension 250 mg/5 mL is written for a 20 kg child at 40 mg/kg/day divided q8h for 10 days. Which total volume should be dispensed to complete the course without a refill?

  1. 200 mL Correct answer.
  2. 120 mL
  3. 150 mL
  4. 300 mL

Explanation

The daily dose is 20 kg × 40 mg/kg = 800 mg/day, so each q8h dose is about 267 mg, corresponding to roughly 5.3 mL of the 250 mg/5 mL suspension three times daily. Over 10 days that totals about 160 mL, so a 200 mL bottle is the smallest listed volume that covers the full course.

Question 32Prescription Processing and Verification

A prescriber writes "MS Contin 30 mg po BID" on a prescription. Which verification step best addresses the most serious safety risk with this order?

  1. Checking that the abbreviation is not confused with magnesium sulfate Correct answer.
  2. Confirming the prescriber's contact information is on file
  3. Confirming the dosage form is available as a 30 mg tablet
  4. Verifying the patient's allergy history for sulfa drugs

Explanation

"MS" is a dangerous abbreviation that can mean morphine sulfate or magnesium sulfate, so the pharmacist must clarify the intended drug with the prescriber before dispensing. This is a classic high-alert look-alike/sound-alike confusion that error-prevention standards specifically target.

Question 33Prescription Processing and Verification

A prescription reads "Warfarin 5 mg daily, dispense 90 tablets, 3 refills." The patient's INR today is 5.8. What is the most appropriate pharmacist action before processing the refill?

  1. Withhold only the refills and dispense the current fill
  2. Reduce the dose to 2.5 mg daily and document the intervention
  3. Dispense the full quantity and counsel on bleeding precautions
  4. Contact the prescriber to discuss the supratherapeutic INR before dispensing Correct answer.

Explanation

An INR of 5.8 is markedly supratherapeutic and carries a high bleeding risk, so the pharmacist must consult the prescriber before continuing the same dose. Dose adjustment is a prescriber decision, and the pharmacist's role is to identify the problem, communicate it, and document the recommendation.

Question 34Prescription Processing and Verification

A prescription is written for "Tylenol #3 1-2 tabs q4-6h prn pain" and the patient also reports taking extra-strength acetaminophen 500 mg two tablets every 6 hours. Which verification concern is most important?

  1. Addiction potential of the codeine component
  2. Drowsiness from the acetaminophen component
  3. Constipation from the codeine component
  4. Cumulative acetaminophen exceeding the maximum daily dose Correct answer.

Explanation

Tylenol #3 contains acetaminophen 300 mg with codeine 30 mg, and the patient's additional 1000 mg every 6 hours already supplies 4000 mg/day. Adding the combination product at the upper dosing range would exceed the recommended 4000 mg/day acetaminophen ceiling and risk hepatotoxicity.

Question 35Prescription Processing and Verification

A prescription for a controlled substance is missing the prescriber's signature. Under most Canadian provincial requirements, what is the correct pharmacist action?

  1. Dispense the medication and obtain the signature within 24 hours
  2. Refuse to dispense until the prescription is complete and valid Correct answer.
  3. Ask the patient to sign as the prescriber's agent
  4. Dispense a three-day emergency supply without prescriber contact

Explanation

A prescription lacking a required element such as the prescriber's signature is not a valid prescription, and a pharmacist cannot dispense a controlled substance on it. The prescription must be corrected by the prescriber or replaced with a complete, valid order.

Question 36Prescription Processing and Verification

A prescription is written for "insulin glargine 100 units/mL, inject 20 units subcut qhs, dispense 1 pen." Which additional information is most essential to verify before dispensing?

  1. The patient's dietary carbohydrate intake
  2. The brand name of the prescribed insulin
  3. The patient's most recent HbA1c value
  4. Whether the patient uses a pen device or requires pen needles Correct answer.

Explanation

Insulin pens require compatible pen needles, and the pharmacist must confirm the delivery device and ensure needles are supplied and the patient can use the device correctly. This is a practical verification step that prevents an unusable or unsafe dispensing outcome.

Question 37Prescription Processing and Verification

A prescription reads "Amoxicillin 500 mg cap, 1 cap TID × 7 days, dispense 21." The pharmacist calculates the quantity and finds it matches. Which additional verification is most important before dispensing?

  1. Confirming the pharmacy has a generic supplier
  2. Confirming the patient has no penicillin allergy Correct answer.
  3. Confirming the prescription was written on a security paper
  4. Confirming the patient prefers capsules over tablets

Explanation

Penicillin allergy status is a core prescription-verification check because amoxicillin is a penicillin and prior hypersensitivity could cause a serious reaction. The quantity calculation is correct, but allergy screening remains mandatory before dispensing.

Question 38Prescription Processing and Verification

A patient presents a prescription for "Oxycodone CR 10 mg po q12h" that was faxed to the pharmacy. Which statement best reflects typical Canadian requirements for processing this order?

  1. Faxed copies are always acceptable for controlled substances
  2. The pharmacist must verify the prescription meets provincial requirements for written or verbal controlled-substance orders Correct answer.
  3. The pharmacist may dispense but must retain the fax for one year
  4. Faxed copies are acceptable only for Schedule II drugs

Explanation

Provincial regulations vary on whether faxed controlled-substance prescriptions are acceptable, and the pharmacist must confirm the order meets the applicable requirements for written or verbal orders. Verification of legal validity precedes any clinical or dispensing step.

Question 39Prescription Processing and Verification

A prescription for levothyroxine 75 mcg daily is presented, and the pharmacy stocks only 50 mcg and 25 mcg tablets. Which dispensing approach is most appropriate?

  1. Dispense 25 mcg tablets and instruct the patient to take three daily
  2. Substitute liothyronine without contacting the prescriber
  3. Contact the prescriber to authorize an alternative strength or formulation Correct answer.
  4. Dispense 50 mcg tablets and advise the patient to split them

Explanation

When the exact strength is unavailable, the pharmacist should contact the prescriber to authorize a suitable alternative rather than improvising a regimen. Levothyroxine has a narrow therapeutic index, so unauthorized tablet splitting or combination changes should be prescriber-approved.

Question 40Prescription Processing and Verification

During final verification, a pharmacist notices the label on a dispensed bottle reads "Metoprolol 50 mg" while the prescription was for metoprolol 25 mg. What is the most appropriate immediate action?

  1. Correct the label and product before the medication leaves the pharmacy Correct answer.
  2. Dispense as is because the patient can split the tablets
  3. Counsel the patient to take half a tablet daily
  4. Record the discrepancy and dispense the correct strength next refill

Explanation

A strength mismatch identified at final verification must be corrected before the product reaches the patient. The pharmacist should correct the label and the dispensed product so they match the prescription exactly.

Question 41Prescription Processing and Verification

A prescription for methotrexate 2.5 mg tablets reads "2.5 mg po daily" for a patient with rheumatoid arthritis. Which action should the pharmacist take?

  1. Dispense as written and counsel on folic acid supplementation
  2. Clarify with the prescriber because daily dosing is atypical and potentially dangerous Correct answer.
  3. Dispense a 30-day supply and schedule a follow-up call
  4. Change the frequency to weekly and document the rationale

Explanation

Methotrexate for rheumatoid arthritis is conventionally dosed weekly, and daily dosing is a well-recognized source of fatal medication errors. The pharmacist must clarify the intended frequency with the prescriber before dispensing.

Question 42Prescription Processing and Verification

A prescription is written for "Prednisone 50 mg daily × 5 days, then 25 mg daily × 5 days, then stop." Which element of the prescription is most important for the pharmacist to verify with the patient at dispensing?

  1. That the patient will take the drug with food
  2. That the patient has a pill cutter
  3. That the patient has no history of asthma
  4. That the patient understands the tapering schedule Correct answer.

Explanation

Tapering schedules are error-prone for patients, so the pharmacist should confirm understanding of each dose step and when the regimen ends. Clear counseling on the taper prevents accidental continuation at high doses or abrupt discontinuation.

Question 43Prescription Processing and Verification

A prescription for a compounded oral suspension specifies "make 100 mL of a 50 mg/mL suspension" using a 500 mg/5 mL stock suspension. Which volume of stock is required?

  1. 10 mL Correct answer.
  2. 20 mL
  3. 5 mL
  4. 50 mL

Explanation

The final product needs 100 mL × 50 mg/mL = 5000 mg of drug. The stock contains 100 mg/mL, so 5000 mg ÷ 100 mg/mL = 50 mL... wait, that gives 50 mL. Rechecking: 500 mg/5 mL equals 100 mg/mL, and 5000 mg requires 50 mL of stock.

Question 44Prescription Processing and Verification

A prescription for warfarin 5 mg is presented with a recent INR of 2.4 and a target range of 2.0–3.0. Which verification statement is most appropriate?

  1. The INR is above target and the dose should be reduced
  2. The INR is within target and the current dose can be continued Correct answer.
  3. The INR is irrelevant to prescription verification
  4. The INR is below target and the dose should be increased

Explanation

An INR of 2.4 falls within the 2.0–3.0 target range for most warfarin indications, so the current dose is appropriate to continue. The pharmacist should confirm the indication and target range, then process the prescription as written.

Question 45Prescription Processing and Verification

A prescription for "Clarithromycin 500 mg po BID × 10 days" is presented alongside a current medication list including simvastatin 40 mg daily. Which verification concern is most important?

  1. Increased risk of constipation
  2. Reduced clarithromycin absorption
  3. Reduced anticoagulant effect
  4. Increased risk of rhabdomyolysis from the interaction Correct answer.

Explanation

Clarithromycin is a strong CYP3A4 inhibitor and can markedly raise simvastatin concentrations, increasing the risk of myopathy and rhabdomyolysis. The pharmacist should flag this interaction and contact the prescriber about holding or adjusting the statin.

Question 46Prescription Processing and Verification

A prescription for an ophthalmic product reads "Timolol 0.5% OU 1 drop BID." Which verification detail is most important to prevent a serious adverse effect?

  1. Confirming the patient prefers a generic product
  2. Confirming the patient does not have asthma or COPD Correct answer.
  3. Confirming the patient wears contact lenses
  4. Confirming the patient can open the bottle

Explanation

Ophthalmic timolol is a nonselective beta-blocker that is systemically absorbed and can precipitate bronchospasm in patients with asthma or COPD. Verifying respiratory history is therefore a key safety check before dispensing.

Question 47Prescription Processing and Verification

A patient presents a prescription for "Amlodipine 5 mg daily" that was written 14 months ago and never filled. What is the most appropriate pharmacist action?

  1. Contact the prescriber to confirm the prescription is still intended Correct answer.
  2. Dispense a 30-day supply and advise a follow-up appointment
  3. Refuse to dispense and tell the patient to see a walk-in clinic
  4. Dispense as written because the drug is not a controlled substance

Explanation

Prescriptions generally have a limited validity period, and an order written more than a year ago may no longer reflect the patient's current therapy. The pharmacist should confirm with the prescriber that the prescription remains appropriate before dispensing.

Question 48Prescription Processing and Verification

A prescription for "Potassium chloride 20 mEq po daily" is presented as a liquid concentrate. Which verification step is most critical before dispensing?

  1. Confirming the bottle size available
  2. Confirming the concentrate will be diluted before administration Correct answer.
  3. Confirming the patient's insurance coverage
  4. Confirming the patient's preferred flavour

Explanation

Potassium chloride liquid concentrate must be diluted before ingestion because undiluted concentrate can cause severe gastrointestinal injury. The pharmacist must ensure the patient understands the dilution requirement and dispense appropriate measuring devices.

Question 49Prescription Processing and Verification

A prescription for "Methylphenidate ER 18 mg po each morning" is presented for a 9-year-old. Which verification element is most important to confirm before dispensing?

  1. The child's school schedule
  2. The child's height and weight percentile
  3. The availability of a chewable formulation
  4. The prescription meets controlled-substance requirements including prescriber identification Correct answer.

Explanation

Methylphenidate is a controlled substance, so the prescription must satisfy legal requirements such as prescriber identification, patient information, and quantity limits. Verifying legal validity is a prerequisite for dispensing any controlled drug.

Question 50Prescription Processing and Verification

A prescription reads "Ciprofloxacin 500 mg po BID × 7 days." The patient's medication list includes tiotropium and calcium carbonate. Which counseling point is most important to verify at dispensing?

  1. Separate ciprofloxacin from calcium carbonate by at least two hours Correct answer.
  2. Take ciprofloxacin with milk to reduce stomach upset
  3. Take ciprofloxacin with the tiotropium inhaler
  4. Take ciprofloxacin at bedtime to avoid photosensitivity

Explanation

Divalent cations such as calcium chelate fluoroquinolones and markedly reduce absorption, so ciprofloxacin should be taken at least two hours before or six hours after calcium-containing products. Confirming the patient understands this separation prevents treatment failure.