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ExCPT practice questions

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Question 1Pharmacology

Metformin belongs to which class of antidiabetic medications?

  1. Biguanide Correct answer.
  2. Sulfonylurea
  3. SGLT2 inhibitor
  4. DPP-4 inhibitor

Explanation

Metformin is a biguanide that reduces hepatic glucose production and improves peripheral insulin sensitivity. It is commonly used as first-line therapy for type 2 diabetes. The other classes listed work through different mechanisms, such as stimulating insulin release or increasing urinary glucose excretion.

Question 2Pharmacology

Which route of administration generally produces the most rapid onset of systemic drug effect?

  1. Oral tablet
  2. Transdermal patch
  3. Intravenous injection Correct answer.
  4. Subcutaneous injection

Explanation

Intravenous administration places drug directly into the bloodstream, bypassing absorption and producing essentially immediate systemic availability. Oral and subcutaneous routes require absorption first, and transdermal delivery is deliberately slow.

Question 3Pharmacology

Constipation is a predictable adverse effect of which medication class?

  1. Thiazide diuretics
  2. Beta-2 agonists
  3. Opioid analgesics Correct answer.
  4. Loop diuretics

Explanation

Opioids reduce gut motility by acting on mu receptors in the enteric nervous system, so constipation occurs in most patients and does not reliably resolve with continued use. Sedation and respiratory depression are other characteristic opioid effects.

Question 4Pharmacology

Which brand name corresponds to atorvastatin?

  1. Lipitor Correct answer.
  2. Crestor
  3. Zocor
  4. Pravachol

Explanation

Lipitor is the brand name for atorvastatin, an HMG-CoA reductase inhibitor used to lower LDL cholesterol. Recognizing brand-generic pairs helps prevent duplication when a patient reports taking medications by either name.

Question 5Pharmacology

Which abbreviation on a prescription means the medication is to be taken by mouth?

  1. PR
  2. IM
  3. SL
  4. PO Correct answer.

Explanation

PO stands for the Latin per os, meaning by mouth, and is the most common route abbreviation seen on outpatient prescriptions. Misreading route abbreviations can lead to administration errors, so each abbreviation must be interpreted precisely.

Question 6Pharmacology

Which medication is a beta-lactam antibiotic?

  1. Ciprofloxacin
  2. Doxycycline
  3. Azithromycin
  4. Amoxicillin Correct answer.

Explanation

Amoxicillin is an aminopenicillin and therefore contains the beta-lactam ring that inhibits bacterial cell wall synthesis. Patients with penicillin allergy may react to other beta-lactams, so this class distinction matters clinically.

Question 7Pharmacology

Cyanocobalamin is used to treat a deficiency of which vitamin?

  1. Vitamin A
  2. Vitamin K
  3. Vitamin C
  4. Vitamin B12 Correct answer.

Explanation

Cyanocobalamin is a synthetic form of vitamin B12 used to treat pernicious anemia and other B12 deficiency states. B12 is needed for normal nerve function and red blood cell formation.

Question 8Pharmacology

Which agent is classified as a first-generation antihistamine?

  1. Pseudoephedrine
  2. Diphenhydramine Correct answer.
  3. Dextromethorphan
  4. Guaifenesin

Explanation

Diphenhydramine blocks histamine H1 receptors and is a classic first-generation antihistamine, used for allergic symptoms and as a sleep aid. It is often combined with other cold ingredients, so identifying each component prevents therapeutic duplication.

Question 9Pharmacology

Which laboratory test is used to monitor warfarin therapy?

  1. Activated partial thromboplastin time
  2. Platelet count
  3. INR Correct answer.
  4. Serum creatinine

Explanation

Warfarin inhibits vitamin K-dependent clotting factors, and the INR reflects that pathway's activity, so it is the standard monitoring test. A therapeutic INR is typically between 2 and 3 for most indications.

Question 10Pharmacology

Which medication requires periodic serum level monitoring because of a narrow therapeutic index?

  1. Acetaminophen
  2. Lisinopril
  3. Digoxin Correct answer.
  4. Amoxicillin

Explanation

Digoxin has a narrow window between therapeutic and toxic concentrations, so serum levels are checked to avoid toxicity such as nausea, visual changes, and arrhythmias. Levels are especially important when renal function declines or interacting drugs are added.

Question 11Pharmacology

A drug's half-life is best defined as the time required for which of the following?

  1. The drug to be completely eliminated from the body
  2. Peak plasma concentration to be reached
  3. Plasma concentration to decrease by 50 percent Correct answer.
  4. The entire dose to be absorbed

Explanation

Half-life describes how quickly plasma concentration falls and is used to estimate dosing interval and time to steady state. Roughly four to five half-lives are needed to reach steady state with repeated dosing.

Question 12Pharmacology

Which medication is a proton pump inhibitor?

  1. Ranitidine
  2. Famotidine
  3. Sucralfate
  4. Omeprazole Correct answer.

Explanation

Omeprazole irreversibly blocks the gastric proton pump in parietal cells, producing strong and long-lasting acid suppression. It is used for GERD, peptic ulcer disease, and H. pylori regimens.

Question 13Pharmacology

Combining an MAO inhibitor with aged cheese or cured meats can precipitate which reaction?

  1. Hypertensive crisis Correct answer.
  2. Severe hypoglycemia
  3. Profound bradycardia
  4. Acute liver failure

Explanation

MAO inhibitors block the breakdown of tyramine, so tyramine-rich foods can trigger a large release of norepinephrine and a hypertensive crisis. Patients on these drugs need counseling on avoiding aged cheese, cured meats, and certain fermented products.

Question 14Pharmacology

Which instruction is correct for administering sublingual nitroglycerin tablets?

  1. Place the tablet under the tongue and let it dissolve Correct answer.
  2. Chew the tablet and then swallow it
  3. Swallow the tablet with a full glass of water
  4. Crush the tablet and mix it into food

Explanation

Sublingual absorption through the rich venous plexus under the tongue delivers nitroglycerin directly to circulation and avoids first-pass hepatic metabolism. Swallowing the dose greatly reduces its effectiveness.

Question 15Pharmacology

Which agent is the specific antidote for acetaminophen overdose?

  1. Naloxone
  2. Flumazenil
  3. Protamine sulfate
  4. Acetylcysteine Correct answer.

Explanation

Acetylcysteine restores glutathione stores so the toxic metabolite NAPQI can be detoxified, and it is most effective when given early after ingestion. Activated charcoal may also be used if the patient presents soon enough.

Question 16Pharmacology

A persistent dry cough in a patient taking an ACE inhibitor is most likely caused by which mechanism?

  1. Excess histamine release
  2. Sodium retention in the lungs
  3. Reduced bradykinin breakdown Correct answer.
  4. Direct irritation of the esophagus

Explanation

ACE is the same enzyme that degrades bradykinin, so inhibition allows bradykinin to accumulate and irritate the airways, producing a dry cough. Switching to an angiotensin receptor blocker usually resolves the cough.

Question 17Pharmacology

Albuterol belongs to which pharmacologic class?

  1. Long-acting muscarinic antagonist
  2. Leukotriene receptor antagonist
  3. Short-acting beta-2 agonist Correct answer.
  4. Inhaled corticosteroid

Explanation

Albuterol stimulates beta-2 receptors in airway smooth muscle, producing rapid bronchodilation for acute symptom relief. Because its effect is short, it is used as a rescue inhaler rather than for maintenance control.

Question 18Pharmacology

The generic name of a medication is best described as which of the following?

  1. The name protected by patent for one company
  2. The official nonproprietary name of the drug Correct answer.
  3. The name chosen by the manufacturer for marketing
  4. The chemical name used only in laboratory research

Explanation

The generic name is the nonproprietary name assigned to a drug's active ingredient and is used by all manufacturers, which is why products from different companies share it. The brand name is proprietary and belongs to a specific manufacturer.

Question 19Pharmacology

Sedation is a common adverse effect of which medication?

  1. Diphenhydramine Correct answer.
  2. Loperamide
  3. Albuterol
  4. Metformin

Explanation

First-generation antihistamines such as diphenhydramine cross the blood-brain barrier and block central histamine receptors, causing drowsiness. Patients should be warned about driving and about additive sedation with alcohol or other depressants.

Question 20Pharmacology

Which supplement can reduce the anticoagulant effect of warfarin?

  1. Vitamin K Correct answer.
  2. Calcium carbonate
  3. Vitamin C
  4. Ferrous sulfate

Explanation

Vitamin K is the cofactor for synthesis of the clotting factors that warfarin inhibits, so supplemental vitamin K can lower the INR and blunt anticoagulation. Patients should keep dietary and supplemental vitamin K intake consistent and report changes.

Question 21Pharmacology

Which medication is a direct factor Xa inhibitor used as an oral anticoagulant?

  1. Warfarin
  2. Apixaban Correct answer.
  3. Clopidogrel
  4. Unfractionated heparin

Explanation

Apixaban directly inhibits factor Xa, blocking the conversion of prothrombin to thrombin and reducing clot formation. It belongs to the direct oral anticoagulant group, which requires no routine INR monitoring.

Question 22Pharmacology

Which statement correctly describes a prodrug?

  1. It permanently blocks its receptor
  2. It must be converted in the body to become active Correct answer.
  3. It is excreted unchanged in the urine
  4. It is fully active as administered

Explanation

A prodrug is pharmacologically inactive or much less active until metabolism converts it into the active compound, as with codeine converting to morphine. This design can improve absorption, stability, or targeting of the active drug.

Question 23Pharmacology

Which age-related change most often requires reduced starting doses in older adults?

  1. Reduced renal clearance Correct answer.
  2. Faster hepatic metabolism
  3. Higher total body water
  4. Increased gastric acid secretion

Explanation

Glomerular filtration rate declines with age, so renally eliminated drugs accumulate and can reach toxic concentrations at standard doses. Lower initial doses and slower titration are used for drugs such as aminoglycosides and digoxin.

Question 24Pharmacology

Which statement best describes a competitive antagonist?

  1. It produces an effect only in the absence of agonist
  2. It activates the receptor more strongly than the agonist
  3. It binds irreversibly and permanently blocks the receptor
  4. It binds reversibly and can be overcome by more agonist Correct answer.

Explanation

A competitive antagonist occupies the same site as the agonist without activating the receptor, and because binding is reversible, raising the agonist concentration can restore the response. This shifts the agonist dose-response curve to the right.

Question 25Pharmacology

Which medication is a strong CYP3A4 inhibitor that can raise the levels of statins metabolized by this enzyme?

  1. Phenytoin
  2. Rifampin
  3. Clarithromycin Correct answer.
  4. Carbamazepine

Explanation

Clarithromycin inhibits CYP3A4, so statins such as simvastatin and atorvastatin are metabolized more slowly and muscle toxicity risk rises. Enzyme inducers act in the opposite direction and can reduce statin efficacy.

Question 26Pharmacy Law and Ethics

Under federal law, how many refills are permitted on a prescription for a Schedule II controlled substance?

  1. No refills are permitted Correct answer.
  2. Up to three refills are permitted
  3. Up to five refills within six months are permitted
  4. One refill is permitted

Explanation

Federal regulations prohibit refilling a Schedule II prescription, so any additional quantity requires a new prescription from the prescriber. The five-refills-in-six-months rule applies only to Schedule III through V.

Question 27Pharmacy Law and Ethics

A pharmacy technician looks up a coworker's prescription profile out of curiosity. Which HIPAA principle does this violate?

  1. The accounting of disclosures rule
  2. The marketing restriction
  3. The notice of privacy practices requirement
  4. The minimum necessary standard Correct answer.

Explanation

The minimum necessary standard limits use and disclosure of protected health information to what is needed to accomplish the intended purpose. Accessing a record without a work-related need fails that test and is a privacy violation.

Question 28Pharmacy Law and Ethics

Which DEA form does a pharmacy use to order Schedule II controlled substances from a wholesaler?

  1. DEA Form 222 Correct answer.
  2. DEA Form 224
  3. DEA Form 41
  4. DEA Form 106

Explanation

DEA Form 222, or its electronic equivalent through the CSOS system, is the order document required for distributing Schedule II controlled substances between registrants. A separate order is needed for each supplier.

Question 29Pharmacy Law and Ethics

A technician discovers that a bottle of oxycodone tablets is missing from the safe. Which DEA form is used to report the loss?

  1. DEA Form 41
  2. DEA Form 106 Correct answer.
  3. DEA Form 224
  4. DEA Form 222

Explanation

Theft or significant loss of controlled substances must be reported to the DEA in writing on Form 106 within one business day of discovery. The registrant must also notify state authorities when required and complete the related records.

Question 30Pharmacy Law and Ethics

Which federal law requires most oral prescription medications to be dispensed in child-resistant containers unless the prescriber or patient requests otherwise?

  1. Poison Prevention Packaging Act Correct answer.
  2. Durham-Humphrey Amendment
  3. Combat Methamphetamine Epidemic Act
  4. Kefauver-Harris Amendment

Explanation

The Poison Prevention Packaging Act requires child-resistant packaging for most oral prescription drugs, with a limited exception when the prescriber or the patient requests non-complying packaging. The other laws address prescription status, premarket approval, and pseudoephedrine sales.

Question 31Pharmacy Law and Ethics

Which element is required on the label of a dispensed prescription?

  1. The pharmacy's wholesale cost
  2. The prescriber's home address
  3. The directions for use Correct answer.
  4. The patient's diagnosis

Explanation

Federal and state labeling rules require the directions for use along with items such as the patient name, drug name and strength, quantity, and pharmacy information. Diagnosis, a prescriber's home address, and acquisition cost are not required label elements.

Question 32Pharmacy Law and Ethics

How often must a registered pharmacy take a full inventory of its controlled substances under federal rules?

  1. Every year
  2. Every two years Correct answer.
  3. Every five years
  4. Every six months

Explanation

Federal regulations require a biennial inventory, meaning one every two years, of all controlled substances on hand; a newly registered pharmacy takes an initial inventory on the date it begins business. Some states impose additional or more frequent requirements.

Question 33Pharmacy Law and Ethics

A prescriber telephones an emergency oral order for a Schedule II drug. Within what period must a written or electronic prescription be delivered to the pharmacy?

  1. 72 hours
  2. 7 days Correct answer.
  3. 48 hours
  4. 24 hours

Explanation

For an emergency oral Schedule II order, the prescriber must deliver a written or electronic prescription within seven days, and the quantity is limited to what is needed for the emergency period. The pharmacist documents the emergency and attempts to verify the prescriber's authority.

Question 34Pharmacy Law and Ethics

A prescription for 60 tablets of a Schedule II drug is partially filled with 20 tablets on the day it is written. By what date must the remaining 40 tablets be supplied under federal rules?

  1. Within 90 days of the partial fill
  2. Within 30 days of the prescription date Correct answer.
  3. There is no time limit for a partial fill
  4. Within 60 days of the prescription date

Explanation

For a partial fill of a Schedule II prescription, the remaining quantity must be dispensed within 30 days of the date the prescription was written. A 60-day window is available only for patients in a long-term care facility or who are terminally ill.

Question 35Pharmacy Law and Ethics

Under the Combat Methamphetamine Epidemic Act, what is the maximum daily amount of pseudoephedrine a retail customer may purchase?

  1. 7.5 grams
  2. 3.6 grams Correct answer.
  3. 1.2 grams
  4. 9 grams

Explanation

CMEA limits retail pseudoephedrine sales to 3.6 grams per day and 9 grams in any 30-day period. Purchasers must also present photo identification and sign a written or electronic logbook.

Question 36Pharmacy Law and Ethics

How long must a pharmacy retain controlled substance prescription records under federal law?

  1. One year
  2. Two years Correct answer.
  3. Five years
  4. Six months

Explanation

Federal regulations require that records and inventories for controlled substances be maintained for at least two years and be available for inspection. State boards may require longer retention periods.

Question 37Pharmacy Law and Ethics

What is the maximum number of refills allowed for a prescription for a Schedule III controlled substance?

  1. Five refills within six months Correct answer.
  2. No refills are allowed
  3. One refill within 30 days
  4. Three refills within one year of issuance

Explanation

Schedule III through V prescriptions may be refilled up to five times, and no refill may be dispensed more than six months after the date the prescription was issued. Schedule II prescriptions cannot be refilled at all.

Question 38Pharmacy Law and Ethics

A technician finds an expired bottle of amoxicillin suspension on the dispensing shelf. What is the correct action?

  1. Remove it and quarantine it Correct answer.
  2. Leave it until month end
  3. Dispense it if the patient agrees
  4. Relabel it with today's date

Explanation

Expired products must be pulled from active stock immediately and segregated for return to a reverse distributor or for destruction. Dispensing an expired product is a safety and legal violation regardless of patient consent.

Question 39Pharmacy Law and Ethics

A caller claiming to be a patient's employer asks the technician to confirm whether the patient filled a prescription. What is the best response?

  1. Read the prescription label to the caller
  2. Confirm that the person is a patient of the pharmacy
  3. Decline to confirm any patient information Correct answer.
  4. Ask the caller to hold while you pull the profile

Explanation

Protected health information includes the fact that someone is a patient or has received a prescription, and it may not be disclosed without authorization. The technician should decline and follow the pharmacy's policy for third-party inquiries.

Question 40Pharmacy Law and Ethics

How often must a pharmacy's DEA registration be renewed?

  1. Every two years
  2. Every year
  3. Every three years Correct answer.
  4. Every five years

Explanation

DEA registrations are issued for a three-year period and must be renewed before expiration to maintain authority to handle controlled substances. A separate registration is required for each location where controlled substances are stored.

Question 41Pharmacy Law and Ethics

A new patient presents a cash prescription for a large quantity of oxycodone written by a prescriber 200 miles away. What does the pharmacist's corresponding responsibility require?

  1. Dispense it because the prescriber's DEA number is valid
  2. Dispense it only after the patient signs a waiver
  3. Report the prescriber to the DEA before dispensing
  4. Resolve the red flags before dispensing Correct answer.

Explanation

A pharmacist shares responsibility for the legitimacy of a controlled substance prescription and must resolve red flags before dispensing, documenting the resolution. The pharmacist may refuse to fill when concerns cannot be resolved.

Question 42Pharmacy Law and Ethics

Under the Omnibus Budget Reconciliation Act of 1990, what must a pharmacist offer to do when dispensing a prescription?

  1. Substitute a generic drug
  2. Provide a free refill
  3. Counsel the patient about the medication Correct answer.
  4. Report every prescription to the state Medicaid agency

Explanation

OBRA '90 requires pharmacists to offer counseling to patients receiving Medicaid, and most states extend the requirement to all patients. The law also requires a prospective drug utilization review before dispensing.

Question 43Pharmacy Law and Ethics

Under the Drug Supply Chain Security Act, a pharmacy may accept a prescription drug product for dispensing only if the package does what?

  1. Carries a verifiable product identifier Correct answer.
  2. Arrives with a paper invoice signed by the wholesaler
  3. Is listed in the Orange Book as therapeutically equivalent
  4. Is shipped directly from the manufacturer

Explanation

DSCSA requires an interoperable, serialized system in which trading partners exchange transaction data and packages carry a product identifier that can be verified at the package level. Suspect or illegitimate product must be quarantined and investigated.

Question 44Pharmacy Law and Ethics

Which USP general chapter sets the standards for compounding sterile preparations in a pharmacy?

  1. USP <800>
  2. USP <797> Correct answer.
  3. USP <795>
  4. USP <1160>

Explanation

USP <797> covers sterile compounding, including facility requirements, environmental monitoring, and beyond-use dating for sterile preparations. USP <795> covers nonsterile compounding and USP <800> covers hazardous drugs.

Question 45Pharmacy Law and Ethics

Which program does the FDA use to collect reports of serious adverse events and product problems from health professionals?

  1. The MedWatch program Correct answer.
  2. The REMS program
  3. The Orange Book
  4. The ARCOS system

Explanation

MedWatch is the FDA's reporting program for serious adverse events, product quality problems, and medication errors involving drugs, biologics, and devices. Reporting is voluntary for most health professionals and mandatory for manufacturers.

Question 46Pharmacy Law and Ethics

A pharmacy's registrant wants a technician to sign DEA Form 222 orders on the pharmacy's behalf. What must be done first?

  1. Notify the DEA field office before the first order
  2. Obtain a waiver from the state board of pharmacy
  3. Execute a power of attorney and keep it on file Correct answer.
  4. Have the agent obtain a separate DEA registration

Explanation

A registrant may authorize one or more individuals to sign Form 222 by executing a power of attorney for each person. The power of attorney is kept with the executed order forms and remains valid until revoked.

Question 47Pharmacy Law and Ethics

When must a pharmacy provide its Notice of Privacy Practices to a patient?

  1. Within 30 days after the first prescription is filled
  2. Only when a privacy complaint is filed
  3. Only when the patient requests a copy
  4. No later than the first date of service Correct answer.

Explanation

HIPAA requires a covered entity to provide its Notice of Privacy Practices no later than the first date of service and to make a good-faith effort to obtain the patient's written acknowledgment. The notice may also be posted and made available electronically.

Question 48Pharmacy Law and Ethics

A manufacturer's representative offers a pharmacy technician event tickets in exchange for recommending the company's product to patients. What is the most appropriate response?

  1. Accept but disclose the gift only if a patient asks
  2. Accept, because the representative made the offer
  3. Decline the offer and report it Correct answer.
  4. Accept, because the recommendation is only a suggestion

Explanation

Gifts tied to product selection create a conflict of interest and may violate employer policy, state law, and federal anti-kickback rules. The technician should decline the offer and report it so the pharmacy can address the conduct.

Question 49Pharmacy Law and Ethics

A technician realizes after the patient leaves that a prescription was dispensed with the wrong strength. What should the technician do first?

  1. Correct the record in the system without telling anyone
  2. Wait to see whether the patient reports a problem
  3. Document the error and continue the shift quietly
  4. Notify the supervising pharmacist immediately Correct answer.

Explanation

An error that reaches a patient must be reported to the pharmacist right away so the patient can be contacted and harm minimized. The event is then documented through the pharmacy's quality and error-reporting process.

Question 50Pharmacy Law and Ethics

Which item must appear on a prescription for a Schedule II controlled substance?

  1. The wholesaler's invoice number
  2. The patient's diagnosis code
  3. The prescriber's DEA registration number Correct answer.
  4. The pharmacy's DEA number

Explanation

A Schedule II prescription must include the prescriber's DEA registration number along with the patient's name and address, the drug, strength, quantity, and directions. Diagnosis codes and wholesaler information are not required components.