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PTCB MTM practice questions

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Question 1Medications and Medical Concepts

Which inhaled medication is the preferred rapid reliever for acute asthma symptoms?

  1. Montelukast
  2. Albuterol Correct answer.
  3. Fluticasone
  4. Tiotropium

Explanation

Short-acting beta-2 agonists such as albuterol relax bronchial smooth muscle within minutes and are the standard rescue therapy for acute bronchospasm. Inhaled corticosteroids, leukotriene modifiers, and long-acting anticholinergics are controllers used for maintenance, not rapid relief.

Question 2Medications and Medical Concepts

A patient taking lisinopril develops a persistent dry cough. Which mechanism best explains this adverse effect?

  1. Bradykinin accumulation Correct answer.
  2. Beta-2 receptor blockade
  3. Prostaglandin inhibition
  4. Histamine release

Explanation

ACE inhibitors block the enzyme that degrades bradykinin, so bradykinin accumulates in the respiratory tract and triggers cough. This is a class effect that typically resolves after switching to an ARB.

Question 3Medications and Medical Concepts

Metformin is contraindicated in patients whose estimated glomerular filtration rate falls below which value?

  1. 60 mL/min/1.73 m2
  2. 15 mL/min/1.73 m2
  3. 45 mL/min/1.73 m2
  4. 30 mL/min/1.73 m2 Correct answer.

Explanation

Metformin is contraindicated at an eGFR below 30 mL/min/1.73 m2 because reduced clearance raises the risk of lactic acidosis. Between 30 and 45, starting the drug is generally discouraged and the dose may need to be limited.

Question 4Medications and Medical Concepts

How should levothyroxine be administered for best absorption?

  1. With the morning meal
  2. Together with calcium
  3. On an empty stomach Correct answer.
  4. At bedtime with a snack

Explanation

Levothyroxine absorption is reduced by food, calcium, iron, and other medications, so it is taken on an empty stomach, typically 30 to 60 minutes before breakfast. Consistent timing maintains stable thyroid hormone levels.

Question 5Medications and Medical Concepts

Which statin has the greatest increase in serum concentration when taken with grapefruit juice?

  1. Rosuvastatin
  2. Pravastatin
  3. Fluvastatin
  4. Simvastatin Correct answer.

Explanation

Simvastatin is extensively metabolized by CYP3A4, and grapefruit juice inhibits intestinal CYP3A4, raising simvastatin levels and myopathy risk. Rosuvastatin and pravastatin are minimally dependent on CYP3A4 metabolism.

Question 6Medications and Medical Concepts

Which therapy is used to reverse warfarin anticoagulation in a patient with major bleeding?

  1. Andexanet alfa for apixaban
  2. Idarucizumab for dabigatran
  3. Protamine sulfate infusion
  4. Vitamin K with PCC Correct answer.

Explanation

Major warfarin-associated bleeding is managed with vitamin K plus a prothrombin complex concentrate to rapidly restore clotting factors. Vitamin K alone acts too slowly for an emergency.

Question 7Medications and Medical Concepts

Approximately how long does it typically take for an SSRI to produce its full antidepressant effect?

  1. 24 to 48 hours
  2. 3 to 6 months
  3. 3 to 5 days
  4. 2 to 4 weeks Correct answer.

Explanation

SSRIs require several weeks of continuous therapy for full therapeutic benefit because adaptive changes in serotonin signaling develop gradually. Patients should be counseled not to expect immediate improvement.

Question 8Medications and Medical Concepts

Which adverse effect is most characteristic of fluoroquinolone antibiotics such as ciprofloxacin?

  1. Tendon rupture Correct answer.
  2. Pulmonary fibrosis
  3. Aplastic anemia
  4. Nephrogenic diabetes insipidus

Explanation

Fluoroquinolones carry a boxed warning for tendinitis and tendon rupture, especially in older adults and those using corticosteroids. Patients should report tendon pain and stop the drug.

Question 9Medications and Medical Concepts

A patient taking phenelzine eats aged cheese and develops a severe headache with a markedly elevated blood pressure. Which reaction is occurring?

  1. Hypoglycemia
  2. Hypertensive crisis Correct answer.
  3. Serotonin syndrome
  4. Hypothyroid storm

Explanation

MAO inhibitors prevent breakdown of dietary tyramine, which acts as an indirect sympathomimetic and can precipitate a hypertensive crisis. Aged cheese, cured meats, and tap beer are classic tyramine sources.

Question 10Medications and Medical Concepts

What is the maximum recommended daily dose of acetaminophen for a healthy adult?

  1. 4 g Correct answer.
  2. 2 g
  3. 8 g
  4. 6 g

Explanation

The generally accepted maximum adult dose of acetaminophen is 4 g per day from all sources to limit hepatotoxicity risk. Lower limits are advised for patients with liver disease, heavy alcohol use, or low body weight.

Question 11Medications and Medical Concepts

How should alendronate be taken to maximize absorption and reduce esophageal injury?

  1. At bedtime with a small snack
  2. Chewed and swallowed without water
  3. With breakfast together with calcium
  4. With water, upright for 30 min Correct answer.

Explanation

Bisphosphonates are poorly absorbed and can injure the esophagus, so they are taken with a full glass of plain water on an empty stomach while remaining upright for at least 30 minutes. Food, calcium, and other beverages reduce absorption.

Question 12Medications and Medical Concepts

A patient known to be a CYP2C19 poor metabolizer receives clopidogrel after coronary stent placement. Which concern is most relevant?

  1. Increased bleeding from higher drug levels
  2. Hyperkalemia from renal impairment
  3. No clinically significant effect
  4. Reduced antiplatelet effectiveness Correct answer.

Explanation

Clopidogrel is a prodrug requiring CYP2C19 activation, so poor metabolizers form less active metabolite and have diminished platelet inhibition. Alternative antiplatelet therapy such as prasugrel or ticagrelor may be considered.

Question 13Medications and Medical Concepts

Which symptom is most consistent with hypoglycemia?

  1. Shakiness and sweating Correct answer.
  2. Polyuria and thirst
  3. Constipation
  4. Persistent bradycardia

Explanation

Hypoglycemia triggers an adrenergic response producing tremor, diaphoresis, palpitations, and anxiety, along with neuroglycopenic symptoms such as confusion. Immediate fast-acting carbohydrate is the treatment.

Question 14Medications and Medical Concepts

Which over-the-counter decongestant should be used cautiously in a patient with uncontrolled hypertension?

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

Explanation

Pseudoephedrine is an alpha-adrenergic agonist that causes vasoconstriction and can raise blood pressure and heart rate. It should be avoided or used cautiously in uncontrolled hypertension.

Question 15Medications and Medical Concepts

Which electrolyte abnormality most commonly precipitates digoxin toxicity?

  1. Hyperkalemia
  2. Hypernatremia
  3. Hypokalemia Correct answer.
  4. Hyperchloremia

Explanation

Low potassium increases digoxin binding at the sodium-potassium ATPase and enhances its toxic effects, so hypokalemia is a classic precipitant. Potassium should be monitored, particularly when loop or thiazide diuretics are used concurrently.

Question 16Medications and Medical Concepts

Which medication reverses opioid-induced respiratory depression?

  1. Naloxone Correct answer.
  2. Atropine
  3. Glucagon
  4. Flumazenil

Explanation

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression and sedation. Repeat dosing or infusion may be needed because naloxone's half-life can be shorter than that of the opioid.

Question 17Medications and Medical Concepts

Which analgesic should generally be avoided in a patient with heart failure and chronic kidney disease?

  1. Topical lidocaine
  2. Low-dose aspirin
  3. Acetaminophen
  4. Ibuprofen Correct answer.

Explanation

NSAIDs cause sodium and fluid retention, blunt renal perfusion, and can precipitate heart failure decompensation and acute kidney injury. Acetaminophen is generally preferred for pain in these patients.

Question 18Medications and Medical Concepts

A patient stable on sertraline is started on linezolid and develops agitation, hyperthermia, and clonus. Which condition best fits this presentation?

  1. Agitation, hyperthermia, and clonus Correct answer.
  2. Hyporeflexia and deep sedation
  3. Dry skin and bradycardia
  4. Isolated QT prolongation

Explanation

Linezolid is a weak MAO inhibitor, and combined with an SSRI it can cause serotonin syndrome, marked by mental status change, autonomic instability, hyperthermia, and clonus. The combination should be avoided or closely monitored.

Question 19Medications and Medical Concepts

What is the usual therapeutic serum concentration range for phenytoin?

  1. 25 to 40 mcg/mL
  2. 0.5 to 2 mcg/mL
  3. 10 to 20 mcg/mL Correct answer.
  4. 4 to 12 mcg/mL

Explanation

Phenytoin has a narrow therapeutic index with a usual total serum range of 10 to 20 mcg/mL. Levels above this increase the risk of nystagmus, ataxia, and other neurotoxicity.

Question 20Medications and Medical Concepts

According to the Beers criteria, which medication is generally avoided in older adults because of strong anticholinergic effects?

  1. Atorvastatin
  2. Metformin
  3. Diphenhydramine Correct answer.
  4. Lisinopril

Explanation

First-generation antihistamines such as diphenhydramine are strongly anticholinergic and are associated with confusion, falls, constipation, and urinary retention in older adults. Safer alternatives are preferred for allergy or sleep complaints.

Question 21Medications and Medical Concepts

Which monitoring is most important during long-term amiodarone therapy?

  1. Serum creatinine and urinalysis every month
  2. Complete blood count with differential each visit
  3. Thyroid, lung, and liver function tests Correct answer.
  4. Bone mineral density scanning every year

Explanation

Amiodarone accumulates in tissue and can cause thyroid dysfunction, pulmonary fibrosis, and hepatotoxicity, so periodic thyroid, pulmonary, and hepatic monitoring is recommended. Corneal deposits and photosensitivity are also common.

Question 22Medications and Medical Concepts

Which vaccine is contraindicated in a patient with severe immunocompromise?

  1. Tdap vaccine
  2. Live attenuated zoster vaccine Correct answer.
  3. Inactivated influenza vaccine
  4. Recombinant zoster vaccine

Explanation

Live attenuated vaccines carry a risk of disseminated infection in severely immunocompromised patients and are generally contraindicated. Inactivated and recombinant vaccines are preferred in this population.

Question 23Medications and Medical Concepts

A drug has a half-life of 12 hours. Approximately how long will it take to reach steady state with continuous dosing?

  1. 2 to 3 days Correct answer.
  2. 24 hours
  3. 12 hours
  4. 2 weeks

Explanation

Steady state is generally reached after about 4 to 5 half-lives, which for a 12-hour half-life is roughly 48 to 60 hours, or 2 to 3 days. This principle guides when to check drug levels and expect full effect.

Question 24Medications and Medical Concepts

A patient stable on warfarin is started on trimethoprim-sulfamethoxazole. What change in anticoagulant effect is expected?

  1. Decrease from enzyme induction
  2. Increase from CYP2C9 inhibition Correct answer.
  3. Decrease from protein-binding displacement
  4. No significant change

Explanation

Trimethoprim-sulfamethoxazole inhibits CYP2C9, the enzyme that metabolizes S-warfarin, so warfarin levels and INR rise and bleeding risk increases. Close INR monitoring and dose adjustment are needed.

Question 25Medications and Medical Concepts

Which activity is a core element of a medication therapy management service?

  1. Performing a physical examination
  2. Dispensing the medications
  3. Comprehensive medication review Correct answer.
  4. Ordering laboratory tests

Explanation

The core elements of MTM include a comprehensive medication review, a personal medication list, a medication action plan, intervention or referral, and documentation with follow-up. Physical diagnosis, dispensing, and ordering labs fall outside the MTM core elements.

Question 26Medications and Medical Concepts

Which beta-blocker is considered cardioselective at usual doses?

  1. Labetalol
  2. Carvedilol
  3. Metoprolol Correct answer.
  4. Propranolol

Explanation

Cardioselective beta-blockers preferentially block beta-1 receptors at usual doses, which makes them less likely to cause bronchospasm. Metoprolol is cardioselective, while propranolol is nonselective and carvedilol and labetalol block both alpha and beta receptors.

Question 27Medications and Medical Concepts

Which medication is recommended as first-line pharmacologic therapy for most patients with type 2 diabetes?

  1. Sitagliptin
  2. Metformin Correct answer.
  3. Glipizide
  4. Insulin glargine

Explanation

Metformin is generally recommended as initial pharmacologic therapy for type 2 diabetes because it is effective, has a favorable safety profile, and is inexpensive. Glipizide, insulin glargine, and sitagliptin are used in selected patients or as add-on therapy.

Question 28Medications and Medical Concepts

Which adverse effect is most characteristic of statin therapy?

  1. Symptomatic bradycardia
  2. Persistent dry cough
  3. Hyperkalemia with arrhythmia
  4. Muscle toxicity Correct answer.

Explanation

Statins can cause myalgia and, less commonly, myopathy with elevated creatine kinase. Patients should be counseled to report unexplained muscle pain, tenderness, or weakness.

Question 29Medications and Medical Concepts

Which adverse effect is most characteristic of ACE inhibitors such as lisinopril?

  1. Severe constipation
  2. Dry cough Correct answer.
  3. Peripheral edema
  4. Reflex tachycardia

Explanation

ACE inhibitors increase bradykinin levels, which commonly causes a dry, persistent cough. This cough often resolves after the drug is discontinued.

Question 30Medications and Medical Concepts

Which route of administration is used for nitroglycerin to relieve an acute anginal attack?

  1. Oral tablet
  2. Intramuscular injection
  3. Sublingual tablet Correct answer.
  4. Topical patch

Explanation

Sublingual nitroglycerin is absorbed rapidly and is used for immediate relief of acute angina. Oral nitroglycerin undergoes extensive first-pass metabolism, and patches are used for prophylaxis rather than acute relief.

Question 31Medications and Medical Concepts

Which medication is a short-acting beta-2 agonist used for acute asthma symptoms?

  1. Salmeterol
  2. Fluticasone
  3. Albuterol Correct answer.
  4. Montelukast

Explanation

Albuterol is a short-acting beta-2 agonist that provides rapid bronchodilation for acute asthma symptoms. Salmeterol is long-acting, montelukast is a leukotriene modifier, and fluticasone is an inhaled corticosteroid.

Question 32Medications and Medical Concepts

Which over-the-counter antihistamine is most likely to cause sedation?

  1. Diphenhydramine Correct answer.
  2. Loratadine
  3. Cetirizine
  4. Fexofenadine

Explanation

Diphenhydramine is a first-generation antihistamine that readily crosses the blood-brain barrier and commonly causes sedation. Loratadine and fexofenadine are second-generation agents with little sedating effect.

Question 33Medications and Medical Concepts

Which instruction should be given to a patient taking tetracycline?

  1. Take on an empty stomach Correct answer.
  2. Take with milk
  3. Take with a large meal
  4. Take with an antacid

Explanation

Tetracycline should be taken on an empty stomach because food and dairy products reduce its absorption. Calcium, magnesium, aluminum, and iron can chelate tetracycline and should be separated from the dose.

Question 34Medications and Medical Concepts

Which medication is used to reverse benzodiazepine-induced sedation and respiratory depression?

  1. Naloxone
  2. Flumazenil Correct answer.
  3. Atropine
  4. Physostigmine

Explanation

Flumazenil is a benzodiazepine receptor antagonist that can reverse benzodiazepine-induced sedation and respiratory depression. It must be used cautiously because it can precipitate seizures in dependent patients.

Question 35Medications and Medical Concepts

Which agent is used to reverse the anticoagulant effect of unfractionated heparin?

  1. Andexanet alfa
  2. Vitamin K
  3. Protamine sulfate Correct answer.
  4. Idarucizumab

Explanation

Protamine sulfate binds heparin and neutralizes its anticoagulant effect. Vitamin K reverses warfarin, idarucizumab reverses dabigatran, and andexanet alfa reverses factor Xa inhibitors.

Question 36Medications and Medical Concepts

Which insulin preparation has the most rapid onset of action?

  1. Insulin glargine
  2. Regular insulin
  3. NPH insulin
  4. Insulin lispro Correct answer.

Explanation

Insulin lispro is a rapid-acting analog that begins working within about 15 minutes. Regular insulin is short-acting, NPH is intermediate-acting, and glargine is long-acting.

Question 37Medications and Medical Concepts

Which administration instruction is correct for levothyroxine?

  1. Take with breakfast and calcium
  2. Take only every other day
  3. Take on an empty stomach before breakfast Correct answer.
  4. Take at bedtime with food

Explanation

Levothyroxine should be taken on an empty stomach, typically 30 to 60 minutes before breakfast, for consistent absorption. Calcium, iron, and certain foods can reduce its absorption and should be separated from the dose.

Question 38Medications and Medical Concepts

Which laboratory parameter should be monitored during long-term prednisone therapy?

  1. Serum calcium
  2. Blood glucose Correct answer.
  3. Platelet count
  4. Serum potassium

Explanation

Systemic corticosteroids such as prednisone commonly cause hyperglycemia, so blood glucose should be monitored during long-term therapy. They can also lower potassium and calcium, but glucose monitoring is a key safety parameter.

Question 39Medications and Medical Concepts

Which infusion-related reaction is associated with rapid administration of vancomycin?

  1. Neuroleptic malignant syndrome
  2. Red man syndrome Correct answer.
  3. Malignant hyperthermia
  4. Serotonin syndrome

Explanation

Rapid vancomycin infusion can cause histamine release, leading to flushing, erythema, and hypotension known as red man syndrome. Slowing the infusion rate helps prevent this reaction.

Question 40Medications and Medical Concepts

Which supplement is commonly given with low-dose methotrexate to reduce adverse effects?

  1. Vitamin B12
  2. Vitamin D
  3. Ferrous sulfate
  4. Folic acid Correct answer.

Explanation

Folic acid supplementation reduces methotrexate-related toxicity such as mouth ulcers and gastrointestinal effects without substantially reducing efficacy. It is routinely used with low-dose methotrexate therapy.

Question 41Medications and Medical Concepts

Which medication requires a dose reduction when started with allopurinol because of a serious interaction?

  1. Amoxicillin
  2. Azathioprine Correct answer.
  3. Atorvastatin
  4. Amlodipine

Explanation

Allopurinol inhibits xanthine oxidase, the enzyme that metabolizes azathioprine. Combining them can cause dangerous accumulation of azathioprine metabolites and severe myelosuppression, so the azathioprine dose must be reduced.

Question 42Medications and Medical Concepts

Which mechanism of action describes penicillins such as amoxicillin?

  1. DNA gyrase inhibition
  2. Folate synthesis inhibition
  3. Cell wall synthesis inhibition Correct answer.
  4. Protein synthesis inhibition

Explanation

Penicillins inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins. This weakens the cell wall and leads to bacterial lysis, especially in actively dividing organisms.

Question 43Medications and Medical Concepts

Which cardiac adverse effect is associated with macrolide antibiotics such as erythromycin?

  1. PR interval shortening
  2. QT interval prolongation Correct answer.
  3. Prominent U waves
  4. QRS widening

Explanation

Macrolides can prolong the QT interval and increase the risk of torsades de pointes, especially in patients with other QT-prolonging drugs or electrolyte abnormalities. Caution is warranted in high-risk patients.

Question 44Medications and Medical Concepts

Which monitoring is essential for a patient taking lithium?

  1. Serum lithium and creatinine Correct answer.
  2. Platelet count
  3. Thyroid hormone levels
  4. Liver enzymes

Explanation

Lithium has a narrow therapeutic index and is eliminated by the kidneys, so serum lithium concentrations and renal function must be monitored. Thyroid function is also checked periodically because lithium can cause hypothyroidism.

Question 45Medications and Medical Concepts

Which serious adverse effect is associated with long-term metoclopramide use?

  1. Aplastic anemia
  2. Pulmonary fibrosis
  3. Nephrogenic diabetes insipidus
  4. Tardive dyskinesia Correct answer.

Explanation

Metoclopramide blocks dopamine receptors in the central nervous system, and prolonged use can cause tardive dyskinesia. Therapy is generally limited to avoid this irreversible movement disorder.

Question 46Medications and Medical Concepts

Which antiepileptic drug exhibits zero-order, saturable kinetics at therapeutic doses?

  1. Gabapentin
  2. Phenytoin Correct answer.
  3. Lamotrigine
  4. Levetiracetam

Explanation

Phenytoin metabolism becomes saturated within the therapeutic range, so small dose increases can produce disproportionate rises in serum concentration. This zero-order kinetics makes careful monitoring necessary.

Question 47Medications and Medical Concepts

A patient taking carbamazepine asks about starting a combined oral contraceptive. Which interaction is most important?

  1. It blocks contraceptive absorption
  2. It reduces contraceptive efficacy Correct answer.
  3. It raises contraceptive hormone levels
  4. It causes dangerous hyperkalemia

Explanation

Carbamazepine induces CYP3A4 and increases the metabolism of estrogen and progestin, which can reduce contraceptive efficacy. Patients should be counseled about this interaction and may need an alternative or additional contraceptive method.

Question 48Medications and Medical Concepts

Which antitubercular drug is associated with peripheral neuropathy that is prevented by pyridoxine?

  1. Isoniazid Correct answer.
  2. Pyrazinamide
  3. Ethambutol
  4. Rifampin

Explanation

Isoniazid can cause peripheral neuropathy by interfering with pyridoxine metabolism, so pyridoxine supplementation is used to prevent it. Rifampin, pyrazinamide, and ethambutol have different characteristic toxicities.

Question 49Medications and Medical Concepts

Which electrolyte abnormality is commonly caused by amphotericin B?

  1. Hyperkalemia
  2. Hypokalemia Correct answer.
  3. Hypernatremia
  4. Hypercalcemia

Explanation

Amphotericin B can cause renal tubular injury leading to potassium and magnesium wasting, so hypokalemia is common. Electrolytes and renal function should be monitored during therapy.

Question 50Medications and Medical Concepts

Which laboratory parameter is most important to monitor during cyclosporine therapy?

  1. Hemoglobin level
  2. Serum amylase
  3. Serum creatinine Correct answer.
  4. Serum lipase

Explanation

Cyclosporine is nephrotoxic and has a narrow therapeutic index, so serum creatinine and drug trough concentrations are monitored closely. This helps detect renal impairment and prevent toxicity.