PTCE Pharmacy Technician Certification (CPhT) Exam Questions and Answers

DEA requires a full inventory of all controlled substances every 2 years (biennial inventory).

Schedule II drugs requirea separate recordfrom Schedules III–V.

????Reference:DEA Controlled Substance Inventory Regulations (21 CFR 1304.11).

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

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

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

ISMP’s “Do Not Use” / error-prone abbreviations and dose designations emphasize avoiding trailing zeros (e.g., “120.0 mcg”), because the decimal point can be overlooked, potentially causing a tenfold error (e.g., read as 1200 mcg). ISMP also recommends using a leading zero before a decimal (e.g., 0.2 mg) to prevent misreads; thus 0.2 mg (A) and 1.4 mg (D) adhere to that guidance. 300 mcg (B) uses an acceptable unit (“mcg” rather than “µg”). Therefore, “120.0 mcg” (C) is the most error-prone due to the trailing zero.

References (Pharmacy Technician documents / Study Guides):

• ISMP Error-Prone Abbreviations, Symbols, and Dose Designations list: avoid trailing zeros; always use a leading zero before a decimal.

• PTCB/ExCPT medication safety sections covering safe dose expressions and ISMP recommendations.

• NCC MERP/ISMP educational materials on decimal point misinterpretation and tenfold dosing errors.

The Master Formulation Record (MFR) is a standardized document that provides step-by-step instructions on how to compound a specificnonsterile preparation.

It includes:

Active and inactive ingredients

Mixing instructions

Equipment needed

Beyond-use dating (BUD)

Storage requirements

Why Other Options Are Incorrect:

A. Medication Guide?❌Intended for patient information, not compounding.

C. Patient Package Insert?❌Explains medication use but doesn’t contain compounding instructions.

D. Safety Data Sheet (SDS)?❌Contains safety and hazard information, not formulation instructions.

????Reference:USP <795> Nonsterile Compounding Standards, PTCB Compounding Study Guide.

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

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

REMS Requirements for Suboxone:

Prescriber Certification:Only specially certified providers can prescribe Suboxone.

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

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

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

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

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

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

Suboxone REMS Guidelines (www.suboxonerems.com).

PTCB PTCE Exam Content Outline – REMS and Medication Safety.

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

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

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

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

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

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

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

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

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

Pharmacy Technician References:

Levigating agentsreduce theparticle sizeof powders to make themeasier to mix into an ointment base.

Common levigating agents includemineral oil, glycerin, and propylene glycol.

Why Other Options Are Incorrect:

A. Emulsifying agents?❌Help mix oil and water but do NOT help incorporate solids into ointments.

B. Diluents?❌Used toincrease bulk volume(e.g., lactose in tablets).

D. Preservatives?❌Prevent microbial growth, but do NOT help mix solids into ointments.

????Reference:USP <795> Nonsterile Compounding Guidelines.

Formula: Dose ÷ Concentration = Volume (mL)

30 mg ÷ 20 mg/mL = 1.5 mL

????Reference:PTCB Calculation Guide, Pharmacy Dosage Conversions.

Comprehensive and Detailed Step-by-Step Explanation:

Step 1: Use the formula

A math equations with black text Description automatically generated with medium confidence

Explanation of Answer Choices:✅C. 2.5→Correct.2.5 mL provides the required25 mg dose.❌A. 0.5→ Incorrect. Too low.❌B. 2→ Incorrect. Under-dose.❌D. 5→ Incorrect. Over-dose.

????Reference:

USP <795>: Pharmaceutical Calculations

PTCB Exam: Dosage Conversions

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

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

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

To determine how muchdrug (active ingredient)is in2 oz (ounces) of cream, we use the given ratio and perform unit conversions.

120 gof cream contains3 gof drug.

2 ozof cream =2 × 28.35 g(since1 oz = 28.35 g)

2 oz = 56.7 g

Step 1: Identify Given DataStep 2: Set Up a Proportion3 g drug120 g cream=x g drug56.7 g cream\frac{3 \text{ g drug}}{120 \text{ g cream}} = \frac{x \text{ g drug}}{56.7 \text{ g cream}}120 g cream3 g drug​=56.7 g creamx g drug​

Step 3: Solve forxxxx=3×56.7120=170.1120=1.42≈1.5 gx = \frac{3 \times 56.7}{120} = \frac{170.1}{120} = 1.42 \approx 1.5 \text{ g}x=1203×56.7​=120170.1​=1.42≈1.5 g

Thus,1.5 g of drugis present in2 oz of cream.

B. 6 g→ Incorrect; this would assume a higher drug concentration.

C. 15 g→ Incorrect; this is a miscalculation of the ratio.

D. 60 g→ Incorrect; far exceeds the total weight of the cream.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations – Ratios and Proportions)

United States Pharmacopeia (USP) General Chapters on Compounding

The Pharmacy Technician’s Pocket Drug Reference

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

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

Proof of ID

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

A log of purchases maintained by the pharmacy

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

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

Federal regulations require a Patient Package Insert (PPI) to be dispensed with oral contraceptives and with estrogen-containing products. The regulation specifies that a PPI must be provided with each prescription and refill in the outpatient setting and with the first dose and at least every 30 days in institutional settings. This requirement applies specifically to oral contraceptives, not broadly to androgens, corticosteroids, or oral chemotherapy (which more commonly require a Medication Guide, not a PPI).

References (Pharmacy Technician documents/Study Guides):

• 21 CFR 310.501 (Patient package inserts for oral contraceptives).

• 21 CFR 310.515 (Patient package inserts for estrogens).

• PTCB/ExCPT Exam Guides: Patient information requirements (PPI vs. Medication Guide).

Comprehensive and Detailed Step-by-Step Explanation:

Cyclophosphamideis ahazardous drugclassified byNIOSH (National Institute for Occupational Safety and Health).USP Chapter 800mandates thatall surfaces exposed to hazardous drugs (HDs), including counting trays, must be decontaminated after each useto prevent cross-contamination.

????Explanation of Answer Choices:✅C. Decontaminated after each use→Correct.Hazardous drug residues must be removed after each use to prevent contamination.❌A. Activated before each use→ Incorrect. There is no"activation"process for hazardous drug counting trays.❌B. Disposed of after each use→ Incorrect.Counting trays are reusable but must be properly cleaned.❌D. Sterilized before each use→ Incorrect.Sterilization applies to sterile compounding, not hazardous drug handling.

????Reference:

USP <800>: Handling Hazardous Drugs in Healthcare Settings

NIOSH List of Hazardous Drugs (Cyclophosphamide)

Comprehensive and Detailed Step-by-Step Explanation:

Underfederal law (21 CFR §1306.25),Schedule III-V controlled substances (e.g., Alprazolam)can be transferred ONCEfor refill purposes between licensed pharmacieswith a shared database.Schedule II drugs (e.g., Methylphenidate, Fentanyl, Hydromorphone) CANNOT be transferred.

????Explanation of Answer Choices:✅A. Alprazolam (C-IV)→Correct.Schedule III-V drugs can be transferred ONCEfor refill purposes.❌B. Methylphenidate (C-II)→ Incorrect.Schedule II drugs cannot be transferred.❌C. Fentanyl (C-II)→ Incorrect.C-II drugs are non-transferablebetween pharmacies.❌D. Hydromorphone (C-II)→ Incorrect.C-II drugs cannot be transferred.

????Reference:

DEA Controlled Substance Act (CSA)

21 CFR §1306.25 – Prescription Transfers

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

Receiving:

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

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

Storage:

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

They must be placed indesignated binsto reduce exposure risks.

Handling and Compounding:

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

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

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

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

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

Other Answer Choices Explained:References:

USP <800> Hazardous Drug Handling Guidelines

OSHA Hazardous Drug Safety Standards

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

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

Lot numbers are required for drug recalls and tracking purposes.

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

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

The prescribed directions are ½ tablet twice daily of 10 mg tablets, which equals 5 mg twice daily and uses 1 tablet per day. A quantity of #30 should last 30 days. If the patient ran out in 16 days, they used about 2 tablets/day, consistent with taking 10 mg twice daily (i.e., a full tablet BID), which is Option D.

References (Pharmacy Technician documents / Study Guides):

• PTCB/ExCPT Math & Dosing sections: Interpreting SIGs, calculating day’s supply from directions and quantity.

• Community Pharmacy Workflow texts: Refill-too-soon troubleshooting and adherence/error assessment.

To calculate how muchamoxicillin suspensionwill be used in the first5 days, we follow these steps:

Amoxicillin concentration:250 mg per5 mL

Dosage:1 tsp (5 mL) three times daily (tid)

Duration:First5 days

Step 1: Identify Given InformationStep 2: Calculate Total Daily Volume5 mL×3=15 mL per day5 \text{ mL} \times 3 = 15 \text{ mL per day}5 mL×3=15 mL per day

Step 3: Multiply by 5 Days15 mL/day×5 days=75 mL15 \text{ mL/day} \times 5 \text{ days} = 75 \text{ mL}15 mL/day×5 days=75 mL

Thus, the patient will use75 mLof medication in the first5 days.

A. 25 mL→ Incorrect; this would be correct if taken onlyonce dailyinstead ofthree times daily.

B. 50 mL→ Incorrect; this is the correct amount for3.3 days, not 5 days.

D. 150 mL→ Incorrect; this is thefull 10-day course, not just the first 5 days.

Other Answer Choices Explained:References:

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

USP <795> Nonsterile Compounding Guidelines

Lexicomp Drug Monograph for Amoxicillin Suspension

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

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

Proof of ID

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

A log of purchases maintained by the pharmacy

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

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

Needlegauge (G)refers to thediameter of the needle’s lumen(opening).The higher the gauge number, the smaller the needle diameter.

Lower gauge (e.g., 13G, 18G)→Larger needle(wider opening)

Higher gauge (e.g., 27G)→Smaller needle(narrower opening)

Common Needle Gauges and Their Uses:Gauge (G)

Needle Diameter (mm)

Common Use

13G

2.4 mm

IV drug administration (large-bore)

18G

1.2 mm

Drawing thick medications (e.g., oil-based injections)

20G

0.9 mm

General intramuscular (IM) injections

27G

0.4 mm

Subcutaneous (SC) or intradermal (ID) injections (e.g., insulin, vaccines)

Since27Gis the highest gauge listed, it corresponds to thesmallestneedle diameter, making it the correct answer.

A. 13G❌→ One of the largest gauges, used for IV fluids or blood transfusions.

B. 18G❌→ Large needle used for thick medications likedepot injections or contrast agents.

C. 20G❌→ Common forintramuscular injectionsbut larger than 27G.

PTCB PTCE Exam Content Outline– Covers needle gauges, injection routes, and proper medication administration.

USP <797> & USP <800>– Provide sterile compounding guidelines, including appropriate needle gauge selection.

CDC Vaccine Administration Guidelines– Recommend25-30Gfor subcutaneous and intradermal injections.

Why Not the Other Options?Key References:

A potential error is a mistake that is identified and corrected before it reaches the patient.

Example:A technician fillshydralazineinstead ofhydroxyzine, but the pharmacist catches the mistake before dispensing.

????Reference:ISMP Medication Error Categories, PTCE Pharmacy Error Prevention Guide.

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

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

Why Other Options Are Incorrect:

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

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

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

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

Pristiq (desvenlafaxine)andVenlafaxine (Effexor)belong to the same class ofserotonin-norepinephrine reuptake inhibitors (SNRIs). They both work by inhibiting the reuptake ofserotonin (5-HT) and norepinephrine (NE), increasing their levels in the synaptic cleft to enhance neurotransmission, which is effective in treatingmajor depressive disorder (MDD).

A. Valacyclovir→ Incorrect; valacyclovir is anantiviralused to treatherpes simplex and varicella-zoster infections.It inhibits viral DNA replication, not neurotransmitter reuptake.

B. Varenicline→ Incorrect; varenicline (Chantix) is apartial nicotinic receptor agonistused forsmoking cessation, not an SNRI.

D. Verapamil→ Incorrect; verapamil is acalcium channel blocker (CCB)used forhypertension and arrhythmias, which has no relation to antidepressant mechanisms.

Other Answer Choices Explained:References:

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

Lexicomp Drug Monographs for Desvenlafaxine and Venlafaxine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

Cefdinir is a third-generation cephalosporin antibiotic commonly used to treat bacterial infections, including otitis media (middle ear infection) in children. It is available in both capsule and suspension forms. However, cefdinir suspension is supplied in different concentrations, typically125 mg/5 mLand250 mg/5 mL.

The prescription provided specifies"Cefdinir suspension 5 mL PO q12h x 10 days", but it does not mention the concentration (strength) of the suspension. Without this crucial information, the pharmacy cannot accurately determine the total dosage the patient will receive. Different strengths would result in significantly different amounts of cefdinir per dose.

For example:

If the prescriber intended125 mg/5 mL, then the patient would receive125 mg per dose (250 mg daily).

If the prescriber intended250 mg/5 mL, then the patient would receive250 mg per dose (500 mg daily).

This discrepancy could lead tounderdosing or overdosing, making it essential for the pharmacy to contact the prescriber to confirm the correct concentration before dispensing.

A. Cefdinir is not available as a suspension.→ Incorrect. Cefdinir is available inoral suspensionform, typically in 125 mg/5 mL and 250 mg/5 mL concentrations.

C. Cefdinir suspension is not indicated for otitis media.→ Incorrect. Cefdinir is FDA-approved for the treatment of otitis media in pediatric patients.

D. Cefdinir suspension was prescribed for a child old enough to swallow capsules.→ Incorrect. While some 8-year-old children may be able to swallow capsules, many pediatric patients prefer liquid formulations, and prescribers often choose suspensions for better compliance.

PTCB PTCE Exam Content Outline – Medication Order Entry and Fill Process(Ensuring accuracy of prescriptions, including strength and formulation).

FDA Drug Label for Cefdinir– Indicates available strengths and dosing requirements.

Lexicomp Drug Information for Cefdinir– Lists the recommended pediatric dosages and available suspension concentrations.

Pharmacology Textbooks (e.g., "Mosby’s Pharmacy Technician: Principles and Practice")– Reinforce the importance of verifying missing prescription details before dispensing.

Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

Comprehensive and Detailed Step-by-Step Explanation:

Mycophenolateis animmunosuppressantused inorgan transplantsand isteratogenic (causes birth defects).It requiresRisk Evaluation and Mitigation Strategies (REMS).

????Explanation of Answer Choices:✅B. Mycophenolate→Correct.High risk ofbirth defects, requiring REMS.❌A. Miconazole→ Incorrect.An antifungal with no REMS requirement.❌C. Phentermine→ Incorrect.Used for weight loss, not teratogenic.❌D. Phenytoin→ Incorrect.Has risks but no REMS requirement.

????Reference:

FDA REMS Program for Mycophenolate

PTCB Exam: Medication Safety & REMS

Comprehensive and Detailed Step-by-Step Explanation:

Levothyroxine (Synthroid)is athyroid hormone replacementused to treathypothyroidism. It must be takenon an empty stomachbecause food, calcium, and ironinterfere with its absorption.

Administration Guidelines for Levothyroxine:

Take30-60 minutes before breakfastwith afull glass of water.

Avoidcalcium, iron, and antacidsfor4 hoursafter taking it.

????Explanation of Answer Choices:✅A. Levothyroxine→Correct.Absorption is reduced by food, calcium, and iron.❌B. Amlodipine→ Incorrect.A calcium channel blocker that can be taken with or without food.❌C. Cyclobenzaprine→ Incorrect.A muscle relaxant with no food restrictions.❌D. Loratadine→ Incorrect.An antihistamine that does not require fasting.

????Reference:

American Thyroid Association (ATA) Levothyroxine Guidelines

FDA Drug Labeling for Synthroid

Diflucan (fluconazole) is an antifungal, whileDiprivan (propofol) is a sedative/anesthetic used for surgery.

Look-Alike, Sound-Alike (LASA) errorsoccur when medications havesimilar names but different indications.

Why Other Options Are Incorrect:

B. Clonidine (BP medication) & Klonopin (anxiolytic)→ LASA error but not antifungal vs. anesthetic.

C. Metronidazole (antibiotic) & Metformin (diabetes drug)→ LASA error but different categories.

D. Amiloride (diuretic) & Amlodipine (BP medication)→ LASA error but different categories.

????Reference:ISMP List of High-Risk LASA Medications.

Comprehensive and Detailed Step-by-Step Explanation:

Methotrexate is a hazardous antineoplastic drug listed by NIOSH (National Institute for Occupational Safety and Health). It requires PPE when handled or cleaned up.

????Explanation of Answer Choices:

✅C. Methotrexate → Correct. Listed as a hazardous drug requiring PPE.

❌A. Amiodarone → Incorrect. Not classified as hazardous.

❌B. Atorvastatin → Incorrect. A statin, not hazardous.

❌D. Midazolam → Incorrect. A benzodiazepine, not hazardous.

????Reference:

NIOSH List of Hazardous Drugs (2020)

USP <800>: PPE Requirements for Hazardous Drugs

TheInstitute for Safe Medication Practices (ISMP)classifiesInsulin U-500as ahigh-alert medication in acute care settingsbecause it isfive times more concentratedthan standardU-100 insulin. Errors in dosing or administration can result insevere hypoglycemiaorhyperglycemia, leading to life-threatening consequences.

A. Normal saline solution→ Incorrect;0.9% sodium chloride (NS)isnot a high-alert medication, as it is a commonly used IV fluid with a wide safety margin.

B. Transdermal lidocaine→ Incorrect; although lidocaine is alocal anesthetic, its transdermal form isnot considered high-alert.

C. Dextrose 5% solution (D5W)→ Incorrect; while used inIV therapy,D5Wisnot classified as high-alertin acute care settings.

Other Answer Choices Explained:References:

ISMP List of High-Alert Medications in Acute Care Settings (2023 Update)

PTCB PTCE Exam Content Outline (Medication Safety & High-Alert Medications)

USP <800> Handling of High-Alert Medications

Amlodipine(10 mg) anddiltiazem(30 mg) are bothcalcium channel blockers (CCBs)used to treat hypertension and angina.

When a patient is prescribed two medications from the same therapeutic class, the pharmacy's prescription processing system may flag this as"therapeutic duplication."

This alert is meant toprevent potential adverse effectssuch as excessive lowering of blood pressure or heart rate.

A. Prior authorization required→ Not applicable unless the insurance requires special approval before covering the drug.

C. NDC not covered→ Would appear if the specific drug product (based on its National Drug Code) is not covered by insurance, but this scenario relates to duplication, not coverage.

D. Refill too soon→ This applies to refilling a medication before the allowed time frame, but the scenario describes a new prescription.

PTCB PTCE Exam Content Outline – Drug Interactions and Therapeutic Duplication

Lexicomp and Micromedex Drug Databases– Reference sources for drug classifications.

ISMP Guidelines on Preventing Therapeutic Duplication Errors

Why Other Answers Are Incorrect?Pharmacy Technician References:

NSAIDs (e.g., ibuprofen, naproxen, aspirin) can irritate the gastric mucosa, increase gastric acidity, and worsen GERD symptoms or cause GI adverse effects such as dyspepsia and ulceration. Acetaminophen does not have NSAID gastric effects and is the preferred OTC analgesic/antipyretic for patients with GERD or those at risk for GI complications, when appropriate and within dosing limits.

Emulsionsaremixtures of two immiscible liquids (e.g., oil and water) stabilized by an emulsifying agent.

When an emulsion breaks (phase separation occurs), the oil and water separate permanently, rendering the medication unusable.

Why Other Options Are Incorrect:

A. Tinctures?❌Alcohol-based solutions with dissolved drug, no phase separation occurs.

B. Solutions?❌Homogeneous mixtures that do NOT separate.

C. Suspensions?❌May settle over time but can be re-mixed by shaking.

????Reference:USP <795> Compounded Dosage Forms, PTCE Compounding Guidelines.

]

A medication'sstabilityrefers tohow well it maintains potency, effectiveness, and safety over time. Several factors candegrade medications, includingoxygen, moisture, temperature, and light.

Oxygen exposurecan causeoxidation, leading to drug degradation and loss of potency.

Many medications, especiallyvitamins (e.g., vitamin C), biologics, and certain antibiotics, are susceptible to oxidative damage.

Medications requiring protection from oxygen are often packaged inair-tight containersorblister packs.

A. Allergies→ Incorrect; allergies affect thepatient, not the drug’sstability.

B. Equivalence→ Incorrect; equivalence refers tobioavailabilitybetween generic and brand-name drugs, not drug stability.

D. Indications→ Incorrect; indications refer toapproved uses of a drug, not factors affecting its stability.

Other Answer Choices Explained:References:

USP <797> and <795> Guidelines on Medication Stability

FDA Drug Stability and Shelf Life Guidelines

PTCB PTCE Exam Content Outline (Medication Storage & Stability)

Diflucan (Fluconazole) is an antifungal medicationused to treatsystemic and local fungal infections, including:

Candidiasis (oral thrush, vaginal yeast infections)

Cryptococcal meningitis

Fungal infections in immunocompromised patients (HIV/AIDS, chemotherapy patients, etc.)

Fluconazole works byinhibiting fungal ergosterol synthesis, which is essential for fungal cell membrane integrity.

A. Bacterial infections❌→Incorrect

Fluconazole does NOT treat bacterial infections; antibiotics are required instead.

B. Gastroesophageal reflux disease (GERD)❌→Incorrect

Proton pump inhibitors (PPIs) or H2 blockers(e.g., omeprazole, ranitidine) are used for GERD.

C. Altitude sickness❌→Incorrect

Acetazolamide (Diamox) is used for altitude sickness, not fluconazole.

FDA Fluconazole Drug Label– Confirms antifungal indications.

Centers for Disease Control and Prevention (CDC) Guidelines– Lists fluconazole asa treatment for candidiasis and cryptococcal meningitis.

PTCB PTCE Exam Content Outline– Covers antifungal medications and their indications.

Why Not the Other Options?Key References:

Comprehensive and Detailed Step-by-Step Explanation:

Adispensing erroroccurs when a pharmacy provides amedication that differs from the prescribed order.This may involvewrong drug, dose, form, or incorrect labeling.

????Explanation of Answer Choices:✅D. Received by the patient→Correct.Adispensing error is an error in what the patient actually receives, not what they request.❌A. Requested by the patient→ Incorrect.A patient request does not determine dispensing errors.❌B. On the plan formulary→ Incorrect.Formulary status affects insurance, not dispensing accuracy.❌C. Supplied by the wholesaler→ Incorrect.Errors in supply do not qualify as dispensing errors.

????Reference:

ISMP Guidelines on Medication Errors

PTCB Medication Safety Guidelines

TheInstitute for Safe Medication Practices (ISMP)classifiesInsulin U-500as ahigh-alert medication in acute care settingsbecause it isfive times more concentratedthan standardU-100 insulin. Errors in dosing or administration can result insevere hypoglycemiaorhyperglycemia, leading to life-threatening consequences.

A. Normal saline solution→ Incorrect;0.9% sodium chloride (NS)isnot a high-alert medication, as it is a commonly used IV fluid with a wide safety margin.

B. Transdermal lidocaine→ Incorrect; although lidocaine is alocal anesthetic, its transdermal form isnot considered high-alert.

C. Dextrose 5% solution (D5W)→ Incorrect; while used inIV therapy,D5Wisnot classified as high-alertin acute care settings.

Other Answer Choices Explained:References:

ISMP List of High-Alert Medications in Acute Care Settings (2023 Update)

PTCB PTCE Exam Content Outline (Medication Safety & High-Alert Medications)

USP <800> Handling of High-Alert Medications

Comprehensive and Detailed Step-by-Step Explanation:

Underfederal law (21 CFR §1306.25),Schedule III-V controlled substances (e.g., Alprazolam)can be transferred ONCEfor refill purposes between licensed pharmacieswith a shared database.Schedule II drugs (e.g., Methylphenidate, Fentanyl, Hydromorphone) CANNOT be transferred.

????Explanation of Answer Choices:✅A. Alprazolam (C-IV)→Correct.Schedule III-V drugs can be transferred ONCEfor refill purposes.❌B. Methylphenidate (C-II)→ Incorrect.Schedule II drugs cannot be transferred.❌C. Fentanyl (C-II)→ Incorrect.C-II drugs are non-transferablebetween pharmacies.❌D. Hydromorphone (C-II)→ Incorrect.C-II drugs cannot be transferred.

????Reference:

DEA Controlled Substance Act (CSA)

21 CFR §1306.25 – Prescription Transfers

Folic acid (Vitamin B9) is crucial for fetal development, reducing the risk of neural tube defects like spina bifida.

Recommended dose: At least 400 mcg daily before pregnancy and during the first trimester.

????Reference:CDC Folic Acid Pregnancy Guidelines, PTCE Vitamin & Supplement Guide.

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

FDA Acetaminophen Warnings

PTCB Medication Safety Guidelines

CellCept (mycophenolate mofetil) carries a REMS due to embryo-fetal toxicity; it includes strict pregnancy prevention and counseling requirements for patients of reproductive potential. Pharmacy technicians are trained to recognize REMS medications and associated dispensing requirements (e.g., medication guides, documentation). Creon (pancrelipase), Celexa (citalopram), and Cialis (tadalafil) do not have REMS focused on pregnancy avoidance.

References (Pharmacy Technician documents/Study Guides): REMS overview and examples in medication safety modules; immunosuppressants and teratogenicity counseling requirements; FDA REMS concepts taught in PTCB/ExCPT-aligned materials.

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

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

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

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

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

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

Brand Name

Atorvastatin

Lipitor✅

Simvastatin

Zocor

Pravastatin

Pravachol

Fluvastatin

Lescol

Rosuvastatin

Crestor

Lovastatin

Mevacor

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

PTCB Exam Content Outline – Generic & Brand Name Drug Recognition

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

References for Pharmacy Technicians:

Clopidogrel (Plavix) is an antiplatelet drug used to prevent blood clots, reducing the risk of heart attack (myocardial infarction) and stroke.

It is commonly prescribed afterstent placement, heart attack, or stroke.

Why Other Options Are Incorrect:

B. GERD?❌Treated withPPIs or H2 blockers(e.g., omeprazole, ranitidine).

C. Chronic migraines?❌Treated withbeta-blockers, triptans, or topiramate.

D. Type 2 diabetes?❌Treated withmetformin, insulin, or GLP-1 agonists.

????Reference:AHA Guidelines on Antiplatelet Therapy.

Oxaprozinis anonsteroidal anti-inflammatory drug (NSAID)used to treat arthritis. It is listed on theISMP (Institute for Safe Medication Practices) List of Confused Drug Namesdue to its similarity toTopamax (topiramate), an anticonvulsant used for epilepsy and migraine prevention. The confusion arises because both drug nameslook and sound similar, which can lead to dispensing errors.

A. Tobradex→ Incorrect. Tobradex is anantibiotic/steroid ophthalmic medicationand is not confused with oxaprozin.

C. Tradjenta→ Incorrect. Tradjenta (linagliptin) is aDPP-4 inhibitor for diabetesand is not commonly confused with oxaprozin.

D. Trileptal→ Incorrect. Trileptal (oxcarbazepine) is ananticonvulsantbut is not on the ISMP Confused Drug List with oxaprozin.

Incorrect Answer Choices:Pharmacy Technician References:

PTCB PTCE Exam Content Outline (Error Prevention and Look-Alike/Sound-Alike (LASA) Drugs)

Institute for Safe Medication Practices (ISMP) List of Confused Drug Names

FDA Drug Safety Communications

Mosby’s Pharmacy Technician Exam Review

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

FDA Orange Book

PTCB Exam: Therapeutic Equivalence

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

Oral tablets

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

The others:

Dobutamine – IV only (used in cardiac settings)

Benzonatate – Oral capsules only (cough suppressant)

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

From Mosby’s Pharmacy Technician:

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

Comprehensive and Detailed Step-by-Step Explanation:

TheInstitute for Safe Medication Practices (ISMP)is anon-profit organizationdedicated tomedication safetyanderror preventionthrougheducation, research, and advocacy.

????Explanation of Answer Choices:✅B. ISMP (Institute for Safe Medication Practices)→Correct.The ISMP providesmedication safety guidelines, high-alert drug lists, and error-prevention strategies.❌A. FDA (Food and Drug Administration)→ Incorrect. TheFDA regulates drug safetybut isnot a non-profit organization.❌C. DEA (Drug Enforcement Administration)→ Incorrect. TheDEA enforces controlled substance laws, not medication safety education.❌D. CDC (Centers for Disease Control and Prevention)→ Incorrect. TheCDC focuses on public health, not medication error prevention.

????Reference:

ISMP Official Website

PTCB Exam: Medication Safety & Risk Management

Risedronate (Actonel) is a bisphosphonate used for osteoporosis.

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

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

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

Amoxicillin/clavulanate is a penicillin-class (β-lactam) antibiotic. Its labeling includes a contraindication in patients with a history of hypersensitivity to β-lactams (e.g., penicillins; often caution with cephalosporins due to cross-reactivity). Allergy to quinolones (B) is unrelated pharmacologically. Pregnancy or breastfeeding (C) is not an absolute contraindication (risk/benefit assessment is used). Hypertension (D) is not relevant. Therefore, beta-lactam hypersensitivity is the clear contraindication.

References (Pharmacy Technician documents/Study Guides):

• Anti-infectives section of technician study guides: β-lactam structure, class allergies, and contraindications.

• Drug labeling standards: contraindication for penicillin hypersensitivity in amoxicillin-containing products.

• ISMP safety guidance: allergy screening for β-lactam antibiotics.

Comprehensive and Detailed Step-by-Step Explanation:

Cephalexin suspension (Keflex)is anantibioticthat must berefrigerated after reconstitutionanddiscarded after 14 daysto maintain stability and potency.

????Explanation of Answer Choices:✅D. Keep refrigerated; Discard after 14 days→Correct.Proper storage is2-8°C (36-46°F), with a 14-day shelf life.❌A. Protect from light; Discard after 7 days→ Incorrect.Refrigeration is required, not just light protection.❌B. Protect from light; Discard after 14 days→ Incorrect.Light protection is not a major concern for cephalexin.❌C. Keep refrigerated; Discard after 7 days→ Incorrect.Cephalexin is stable for 14 days, not just 7.

????Reference:

USP <795>: Beyond-Use Dating for Reconstituted Suspensions

FDA Drug Stability Guidelines

When adrug recalloccurs due totemperature excursions(exposure to temperatures outside the manufacturer’s recommended range during transport or storage), the pharmacy mustimmediately remove all affected productfrom its inventory to prevent dispensing compromised medication.

Remove the Affected Product:Quarantine the recalled drug to ensure it is not dispensed.

Verify the Recall Details:Confirm the lot number, expiration date, and reason for the recall using FDA or manufacturer recall notices.

Document the Recall Action:Log details in the pharmacy's recall records for compliance.

Follow Manufacturer or FDA Instructions:Some recalls require returning the product, while others require disposal according to hazardous waste guidelines.

Notify Patients and Providers (If Necessary):If the medication has already been dispensed, further action may be needed depending on recall severity.

B. Contact patients who received a therapeutically equivalent product.→ Incorrect. The recall applies to thespecificaffected lot, not all similar medications. Pharmacists would first verify which patients received the recalled drugbefore contacting them.

C. Switch patients from the oral solution to oral capsules.→ Incorrect. The recall does not automatically require a formulation change. The pharmacy must verify availability of unaffected stock or alternative treatments before making substitutions.

D. Contact all prescribers who recently prescribed the product.→ Incorrect. While prescribersmayneed notification if the recall affects patient treatment, thefirst stepis ensuring the recalled product is removed from stock to prevent further dispensing.

PTCB PTCE Exam Content Outline – Medication Safety and Recall Procedures.

FDA Drug Recall Guidelines (www.fda.gov).

USP <1079> Good Storage and Distribution Practices for Pharmaceuticals.

National Association of Boards of Pharmacy (NABP) Recall Compliance Standards.

Manufacturer Recall Notices (Example: Pfizer, Eli Lilly, etc.).

Mosby’s Pharmacy Technician: Principles and Practice – Recall Classifications and Actions.

Steps to Follow in a Drug Recall:Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

????Reference:PTCE Pharmacy Dilution Calculations.

Phenytoin (Dilantin)is ananticonvulsantthatstabilizes neuronal membranesbyblocking sodium channels, reducing seizure activity.

Used forepilepsy, tonic-clonic seizures, and status epilepticus.

Why Other Options Are Incorrect:

A. Clonidine?❌Used forhypertension and ADHD, NOT seizures.

B. Atomoxetine?❌Used forADHD, NOT seizures.

C. Guanfacine?❌Used forhypertension and ADHD, NOT seizures.

????Reference:FDA Drug Label for Phenytoin, Epilepsy Foundation Guidelines.

Oxybutynin (Ditropan, Oxytrol)is ananticholinergic/antispasmodicmedication thatrelaxes the bladder musclesto treatoveractive bladder (OAB).

It reduces symptoms such asfrequent urination, urgency, and urinary incontinenceby blockingmuscarinic receptorsthat control bladder contractions.

Why Other Options Are Incorrect:

A. Bronchitis?❌No, bronchitis is treated withbronchodilators, steroids, or antibiotics.

B. Hyperlipidemia?❌No, hyperlipidemia (high cholesterol) is treated withstatins (e.g., atorvastatin).

D. Pancreatitis?❌No, pancreatitis is managed withIV fluids, pain control, and pancreatic enzyme therapy.

????Reference:FDA Oxybutynin Drug Label, Pharmacology of Urinary Anticholinergics.

USP <800> mandates that hazardous drug exposure requires immediate decontamination.

Flushing the affected area with large amounts of water for at least 15minutes is the first step.

For eye exposure, an eye wash station must be used immediately.

Why Other Options Are Incorrect:

A. Writing a report first?❌Incident reports should be done AFTER flushing the area.

B. Ice bag?❌Ice can worsen chemical burns.

C. Soapy water?❌Soap may react with chemicals, causing further irritation.

????Reference:USP <800> Hazardous Drug Handling, OSHA Chemical Safety Guidelines.

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

Increased mortality in elderly patients with dementia-related psychosis

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

Neuroleptic malignant syndrome (NMS)

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

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

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

Other Answer Choices Explained:References:

FDA Medication Guide Requirements for Olanzapine (Zyprexa)

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

Comprehensive and Detailed Step-by-Step Explanation:

Desvenlafaxine (Pristiq)is anSNRI (Serotonin-Norepinephrine Reuptake Inhibitor)used to treatmajor depressive disorder (MDD).

????Explanation of Answer Choices:✅B. Major depressive disorder→Correct.Desvenlafaxine is FDA-approved fordepression.❌A. Hypertension→ Incorrect.Not an antihypertensive.❌C. Benign prostatic hypertrophy→ Incorrect.Alpha-blockers like Tamsulosin treat BPH.❌D. Atrial fibrillation→ Incorrect.Beta-blockers, not SNRIs, manage atrial fibrillation.

????Reference:

FDA Drug Database: Desvenlafaxine

PTCB Exam: Pharmacology for Technicians

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

Receiving:

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

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

Storage:

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

They must be placed indesignated binsto reduce exposure risks.

Handling and Compounding:

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

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

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

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

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

Other Answer Choices Explained:References:

USP <800> Hazardous Drug Handling Guidelines

OSHA Hazardous Drug Safety Standards

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

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

Comprehensive and Detailed Step-by-Step Explanation:

Clozapine (Clozaril)is anatypical antipsychoticused to treatschizophrenia. However, it has a severe side effect calledagranulocytosis, which causesa dangerous drop in white blood cells (WBCs) and neutrophils (ANCs), increasing the risk of infections.

????Explanation of Answer Choices:✅D. Clozapine→Correct.Patients must be enrolled in theClozapine REMS program, and pharmacies must verifyANC and WBC resultsbefore dispensing.❌A. Aripiprazole→ Incorrect.Aripiprazole (Abilify) does not require ANC monitoring.❌B. Fluoxetine→ Incorrect.Fluoxetine (Prozac) is an SSRI and does not require blood monitoring.❌C. Amitriptyline→ Incorrect.Amitriptyline is a tricyclic antidepressant and does not require ANC monitoring.

????Reference:

FDA Clozapine REMS Program

PTCB Exam: Medication Safety & Risk Evaluation

Comprehensive and Detailed Step-by-Step Explanation:

To preventheparin dosing errors, theFDA requires labeling to display:

Strength per total volume (e.g., 10,000 units/10 mL)

Strength per mL in parentheses (e.g., 1,000 units/mL)

????Explanation of Answer Choices:✅C. Strength per mL enclosed in parentheses→Correct.❌A. Percentage weight per volume→ Incorrect.Heparin is not measured this way.❌B. Volume per total strength→ Incorrect.Reverse order of required labeling.❌D. mL per dose enclosed in parentheses→ Incorrect.Dosing varies by prescription.

????Reference:

FDA Heparin Labeling Guidelines

Comprehensive and Detailed Step-by-Step Explanation:

Lorazepam oral concentrate (Ativan)should be storedat controlled room temperature (20-25°C or 68-77°F)and protected fromlight. It should not be refrigerated or frozen.

????Explanation of Answer Choices:✅B. Lanoxin oral solution→Correct.LikeLorazepam, Lanoxin (Digoxin)requires room temperature storage.❌A. Lamictal chewable tablets→ Incorrect.Stored at room temperature, but not a liquid formulation.❌C. Lyumjev KwikPen→ Incorrect.Insulin pens require refrigeration.❌D. Lunesta tablets→ Incorrect.A solid dosage form, not comparable to a liquid oral concentrate.

????Reference:

USP <1079>: Storage and Handling of Pharmaceuticals

FDA Storage Recommendations for Lorazepam

TheM-M-R II (Measles, Mumps, and Rubella) vaccinemust bereconstituted only with the manufacturer-supplied diluentto maintain its efficacy and stability.

The manufacturer-provided diluent contains stabilizing agents that preserve the live attenuated virus.

Using normal saline can alter the pH and degrade the vaccine, making it ineffective.

The vaccine must be discarded if reconstituted incorrectlyand not administered.

A. Administer the vaccine as the diluents are equivalent.❌→Incorrect

Normal saline is NOT equivalent to the manufacturer’s diluentand can compromise the vaccine’s potency.

B. Report the incident to the Drug Enforcement Administration (DEA).❌→Incorrect

Vaccine errors should be reported to the CDC’s Vaccine Adverse Event Reporting System (VAERS), not the DEA(which handles controlled substances, not vaccines).

C. Contact the Environmental Protection Agency (EPA) for guidance.❌→Incorrect

The EPA regulates hazardous waste, not vaccine errors.The CDC or vaccine manufacturer should be contacted for guidance.

CDC Vaccine Storage and Handling Guidelines– States thatvaccines must be reconstituted only with manufacturer-supplied diluents.

FDA Guidelines for M-M-R II Vaccine– Confirms that improper reconstitutionrenders the vaccine ineffective.

PTCB PTCE Exam Content Outline– Covers proper vaccine handling and error prevention.

Why Is Normal Saline Not an Acceptable Diluent?Why Not the Other Options?Key References:

FDA recall classifications are defined by the likelihood and severity of health consequences:

• Class I: Reasonable probability that use/exposure will cause serious adverse health consequences or death (e.g., microbial contamination of a sterile product or a life-threatening wrong drug situation).

• Class II: May cause temporary or medically reversible adverse health consequences, or where the probability of serious adverse consequences is remote.

• Class III: Not likely to cause adverse health consequences; often labeling or packaging issues that do not impact safety/efficacy.

For nystatin suspension:

• Bacterial contamination (A) or fungal contamination (C) represents a clinically significant contamination with potential for harm—this aligns with Class I (or Class II in some limited contexts depending on product/route), but certainly not Class III.

• Wrong active ingredient present (B) (e.g., presence of carbamazepine) is a serious error that can cause significant harm and is typically Class I.

• Incorrect lot number on the label (D) is a labeling defect not likely to cause adverse health consequences, aligning with a Class III recall.

Beyond-use dates (BUDs) apply specifically to compounded medicationsand indicate thetime frame in which the medication remains stable and safe to use.

BUDs are different from expiration dates, which are determined by manufacturers through long-term stability testing.

USP <795> BUD Guidelines for Nonsterile Compounds:

Non-aqueous formulations(e.g., capsules, powders) →6 months

Water-containing oral formulations(e.g., suspensions) →14 days (refrigerated)

Water-containing topical formulations(e.g., creams, lotions) →30 days

Why Other Options Are Incorrect:

B. Manufactured preparation expiration dates?❌Expiration dates apply tocommercially manufactured drugs, NOT compounded ones.

C. Shelf-life of manufactured drugs?❌This is determined by themanufacturer’s expiration date.

D. Time to prepare a compound?❌BUDsdo not refer to preparation time.

????Reference:USP <795> & USP <797> Guidelines, PTCE Compounding Study Materials.

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

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

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

Storage Considerations for Other Medications:

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

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

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

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

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

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

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

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

Thus, the patient should take3 mL per dose.

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

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

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

Other Answer Choices Explained:References:

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

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

Vistaril = Hydroxyzine, anantihistamine used for anxiety, nausea, and allergies.

Meclizine (Antivert) is also an antihistaminebut is used primarily formotion sickness and vertigo.

????Reference:FDA Approved Drug List, PTCE Medication Guide.

During pregnancy, medication safety is classified by theFDA Pregnancy Categories(prior to 2015) or thePregnancy and Lactation Labeling Rule (PLLR)(current system).

Acetaminophen (Tylenol) is considered the safest analgesic for pregnant women, especially for treating mild to moderate pain or fever.

It hasno known teratogenic effectswhen used at recommended doses.

A. Isotretinoin❌→Severe risk in pregnancy (Category X / Contraindicated)

Causes severe birth defects(craniofacial, cardiac, and central nervous system malformations).

Requires enrollment in theiPLEDGE programto prevent pregnancy exposure.

C. Lovastatin❌→Not safe in pregnancy (Category X / Contraindicated)

Cholesterol-lowering statins are teratogenic, as fetal development requires cholesterol.

D. Triazolam❌→Not safe in pregnancy (Category X / Contraindicated)

A benzodiazepine that can cause birth defects, neonatal withdrawal syndrome, and CNS depression in the fetus.

FDA Pregnancy and Lactation Labeling Rule (PLLR)– Discusses medication risks in pregnancy.

American College of Obstetricians and Gynecologists (ACOG) Guidelines– Listsacetaminophen as the preferred pain reliever during pregnancy.

PTCB PTCE Exam Content Outline– Covers drug safety in special populations, including pregnancy.

Why Not the Other Options?Key References:

Cyclosporine is a cornerstone immunosuppressant for transplant recipients and is a narrow therapeutic index medication requiring close monitoring of drug levels and renal function due to risks such as nephrotoxicity, hypertension, and extensive drug–drug interactions (CYP3A4 substrate). While prednisone is commonly used post-transplant, it does not require serum level monitoring like cyclosporine. Acetaminophen and doxycycline do not have the same transplant-specific monitoring needs.

Carvedilol (Coreg) and labetalol are both non-selective beta-blockersused to treathypertension and heart failure.

Therapeutic substitutionis allowed whentwo drugs have similar effects but different chemical structures.

Carvedilol is often used in place of labetalol, especially in heart failure patients.

Why Other Options Are Incorrect:

A. Albuterol?❌Abronchodilator for asthma/COPD, not a beta-blocker.

C. Tramadol?❌Apain reliever (opioid-like), not a beta-blocker.

D. Estradiol?❌Ahormone replacement therapy, not a beta-blocker.

????Reference:PTCE Medication Classification Guide, FDA Beta-Blocker Comparisons.

Methadone is a Schedule II controlled substanceunder theControlled Substances Act (CSA).

Pharmacies must useDEA Form 222orCSOS (Controlled Substance Ordering System)to orderSchedule II drugs.

Why Other Options Are Incorrect:

A. Buspirone?❌NOT a controlled substance(used for anxiety).

B. Nortriptyline?❌NOT a controlled substance(an antidepressant).

D. Sildenafil (Viagra)?❌NOT a controlled substance(used for erectile dysfunction).

????Reference:DEA Controlled Substance Ordering Requirements (21 CFR 1305).

Enteric-coated (EC) tabletsare designed todelay drug release until they reach the intestine, preventing stomach irritation and degradation by gastric acid. The coatingresists stomach acidbut dissolves in thehigher pH environment of the intestines.

Aspirin EC(prevents stomach irritation)

Pantoprazole EC(proton pump inhibitor)

Diclofenac EC(NSAID)

A. Buffered→ Incorrect; buffered formulationsneutralize stomach acidbut do not delay release until the intestines.

C. Controlled release→ Incorrect; controlled-release formulationsgradually release medicationover time but are not specifically designed tobypass the stomach.

D. Buccal→ Incorrect; buccal tablets dissolve in thecheek mucosa, bypassing the digestive system entirely.

Examples of Enteric-Coated Medications:Other Answer Choices Explained:References:

FDA Drug Formulation Guidelines

USP <795> Drug Release & Absorption Standards

PTCB PTCE Exam Content Outline (Pharmaceutical Dosage Forms & Drug Release Mechanisms)

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

American College of Rheumatology (ACR) Gout Treatment Guidelines

PTCB Exam: Pharmacology for Technicians

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

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

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

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

Other Answer Choices Explained:References:

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

Lexicomp Drug Monograph for Ciprofloxacin

FDA Fluoroquinolone Safety Warnings

Diflucan (fluconazole) is an antifungal, whileDiprivan (propofol) is a sedative/anesthetic used for surgery.

Look-Alike, Sound-Alike (LASA) errorsoccur when medications havesimilar names but different indications.

Why Other Options Are Incorrect:

B. Clonidine (BP medication) & Klonopin (anxiolytic)→ LASA error but not antifungal vs. anesthetic.

C. Metronidazole (antibiotic) & Metformin (diabetes drug)→ LASA error but different categories.

D. Amiloride (diuretic) & Amlodipine (BP medication)→ LASA error but different categories.

????Reference:ISMP List of High-Risk LASA Medications.

• Enbrel (etanercept) is a biologic that requires refrigeration at 2–8°C (36–46°F) prior to dispensing and during storage per manufacturer labeling.

• Testosterone injections (e.g., cypionate/enanthate) are typically stored at controlled room temperature.

• Lovenox (enoxaparin) prefilled syringes and heparin injections are also stored at controlled room temperature; refrigeration is not required.

Therefore, the injection that must be refrigerated is Enbrel.

References (Pharmacy Technician Documents/Study Guides):

• Storage and stability in manufacturer labeling for biologics and injectables; pharmacy technician references on refrigerated biologics (e.g., etanercept) vs. room-temperature injectables (testosterone, enoxaparin, heparin).

Comprehensive and Detailed Step-by-Step Explanation:

Glipizide (Glucotrol)is asulfonylurea, a class oforal hypoglycemic agentsused intype 2 diabetes. It works by stimulatinginsulin releasefrom the pancreas, which can causelow blood sugar (hypoglycemia)if insulin levels become too high.

Symptoms of Hypoglycemia:

Shakiness, sweating, dizziness

Confusion, irritability, rapid heartbeat

Severe cases: Seizures, unconsciousness

????Explanation of Answer Choices:✅C. Glipizide→Correct.Causeshypoglycemiaas it increases insulin secretion.❌A. Haloperidol→ Incorrect.Antipsychotic (Haldol), not related to blood sugar regulation.❌B. Gemfibrozil→ Incorrect.Lipid-lowering agent (fibrate), does not causehypoglycemia.❌D. Hydrochlorothiazide→ Incorrect.A diuretic that may cause hyperglycemia (increased blood sugar), not hypoglycemia.

????Reference:

American Diabetes Association (ADA) Guidelines on Hypoglycemia

USP Drug Classification Database

PTCB Exam: Diabetes Medications & Side Effects

Prilosec (Omeprazole) is a delayed-release proton pump inhibitor (PPI)used forGERD, ulcers, and acid reflux. It comes incapsulescontainingenteric-coated granules, designed to protect the medication from stomach acid and ensure proper absorption.

Prilosec capsules contain enteric-coated granulesthat are safe to sprinkle on soft foodswithout chewing.

Applesauce is an ideal optionbecause it doesnot interfere with drug absorption or stability.

B. Chew and swallow the capsules❌→ Incorrect

Chewing destroys the enteric coating, leading to premature drug release and degradation by stomach acid.

C. Compound the capsules into a topical preparation❌→ Incorrect

Prilosecis not formulated for topical use. The medication must reach the stomach intact for proper effect.

D. Allow the capsules to dissolve under the tongue❌→ Incorrect

Sublingual administration is ineffectivebecauseomeprazole is not absorbed through the mucous membranesand needs enteric protection.

FDA Omeprazole Medication Guide– States that the contents can be sprinkled on applesauce.

ISMP Safe Medication Use Guidelines– Emphasizes proper administration of delayed-release capsules.

PTCB PTCE Exam Content Outline– Covers modified-release formulations and proper drug administration techniques.

Why Can the Capsules Be Opened?Why Not the Other Options?Key References:

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

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

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

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

Peripheraledema

Flushing

Fatigue

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

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

Lexicomp Drug Monograph for Amlodipine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

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

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

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

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

Thus, the patient should take3 mL per dose.

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

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

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

Other Answer Choices Explained:References:

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

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

When entering prescription information into a pharmacy computer system,using leading zeros helps prevent medication dosing errorsby clearly specifying the correct dose.

What Are Leading Zeros?Aleading zerois azero placed before a decimal pointto prevent misinterpretation.

✅Correct:0.5 mg(clearly means half a milligram)

❌Incorrect:.5 mg(could be mistaken for 5 mg, leading to a10× overdose).

A. Allergies❌→Important, butnot directly related to dosing errors.

C. Insurance Information❌→Unrelated to medication dosing safety.

D. Contraindications❌→Relevant to medication selection, but not specific to preventing dosing errors.

ISMP Best Practices for Medication Safety– Recommends usingleading zerosto prevent dosing mistakes.

Joint Commission "Do Not Use" List– Warns against missing leading zeros in prescriptions.

PTCB PTCE Exam Content Outline– Covers prescription entry and error prevention strategies.

Why Not the Other Options?Key References:

To determine how muchdrug (active ingredient)is in2 oz (ounces) of cream, we use the given ratio and perform unit conversions.

120 gof cream contains3 gof drug.

2 ozof cream =2 × 28.35 g(since1 oz = 28.35 g)

2 oz = 56.7 g

Step 1: Identify Given DataStep 2: Set Up a Proportion3 g drug120 g cream=x g drug56.7 g cream\frac{3 \text{ g drug}}{120 \text{ g cream}} = \frac{x \text{ g drug}}{56.7 \text{ g cream}}120 g cream3 g drug​=56.7 g creamx g drug​

Step 3: Solve forxxxx=3×56.7120=170.1120=1.42≈1.5 gx = \frac{3 \times 56.7}{120} = \frac{170.1}{120} = 1.42 \approx 1.5 \text{ g}x=1203×56.7​=120170.1​=1.42≈1.5 g

Thus,1.5 g of drugis present in2 oz of cream.

B. 6 g→ Incorrect; this would assume a higher drug concentration.

C. 15 g→ Incorrect; this is a miscalculation of the ratio.

D. 60 g→ Incorrect; far exceeds the total weight of the cream.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations – Ratios and Proportions)

United States Pharmacopeia (USP) General Chapters on Compounding

The Pharmacy Technician’s Pocket Drug Reference

In prescription terminology,"troche" refers to a dosage form, specifically alozengethat dissolves slowly in the mouth to release medication.

Atroche (or lozenge)is asolid, flavoredmedication thatdissolves in the mouthover time, allowing for gradual drug absorption.

Used for:

Local effects(e.g., sore throat relief with benzocaine troches)

Systemic effects(e.g., hormone replacement therapy troches)

A. Time❌→ Incorrect

"Troche" doesnotindicate when to take the medication.

C. Rate❌→ Incorrect

"Troche" doesnotindicate how fast the drug is absorbed.

D. Route❌→ Incorrect

"Troche"describes the dosage form, whilerouterefers to how a drug is administered (e.g., oral, IV).

USP-NF (United States Pharmacopeia–National Formulary)– Defines dosage forms, including lozenges/troches.

PTCB PTCE Exam Content Outline– Covers pharmaceutical dosage forms and prescription terminology.

ISMP Medication Safety Guidelines– Includes troches in standard medication formulations.

Definition of Troche:Why Not the Other Options?Key References:

AZ-Pakrefers to theAzithromycin 5-day therapy pack, which is commonly prescribed forbacterial infectionssuch as respiratory infections. The standard dosing regimen follows a"loading dose" strategyto quickly reach effective drug levels in the body:

Day 1:Taketwo tablets (500 mg total).

Days 2-5:Takeone tablet (250 mg) daily.

This regimen helps achieverapid therapeutic concentrationswhile maintaining effectiveness over five days.

A. 1 tablet PO on the current day, then 1 PO daily for 4 days→ Incorrect; aloading dose (2 tablets on Day 1)is required for proper drug efficacy.

B. 1 tablet PO on the current day, then 1 PO daily for 5 days→ Incorrect; the Z-Pak is a5-day regimen, not 6 days.

D. 3 tablets PO on the current day, then 1 PO every other day for 6 days→ Incorrect; this isnot a standard dosing regimenfor azithromycin.

Other Answer Choices Explained:References:

FDA Drug Monograph for Azithromycin (Z-Pak)

Lexicomp Drug Guide – Azithromycin Dosing

PTCB PTCE Exam Content Outline (Pharmacology – Infectious Disease Medications)

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

Controlled substance transfers MUST be done by pharmacists.

????Reference:State Board of Pharmacy Regulations.

Comprehensive and Detailed Step-by-Step Explanation:

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

Injectable insulins(risk of hypoglycemia, coma).

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

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

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

????Reference:

ISMP List of High-Alert Medications

FDA Guidelines on Medication Errors

PTCB Exam: Medication Safety & Risk Management

Upon receiving a recall notice, thefirststep a pharmacy technician should take is toverify whether the recalled product is present in the pharmacy’s inventory. This is critical because:

Product Identification– The pharmacy must determine if it has the affected lot numbers, expiration dates, or specific product variations mentioned in the recall notice.

Patient Safety– If the product is in stock, it must be removed from inventory immediately to prevent accidental dispensing.

Regulatory Compliance– TheFDA, manufacturer, or wholesaleroften provides specific instructions for handling recalled medications, and the pharmacy must comply with those guidelines.

FDA Drug Recall Guidelines– Recalls are classified intoClass I, II, and III, and the process requires inventory verification before further actions.

PTCB PTCE Exam Content Outline– The PTCB exam emphasizes medication safety and regulatory compliance, which includes proper handling of recalls.

The Drug Supply Chain Security Act (DSCSA)– This federal law mandates tracking and traceability of pharmaceutical products, reinforcing the importance of inventory checks during recalls.

Pharmacy Policy & Procedures– Most pharmacies followStandard Operating Procedures (SOPs)where verification of stock is the first step before contacting patients or returning products.

Key References:????Why Not the Other Options?

A. Call any affected patients❌→ This step is necessaryafterthe recall is confirmed and documented. If the pharmacy does not have the recalled product, patient notification is unnecessary.

B. Put the recall notice in the inventory technician’s box for processing❌→ Delaying action by simply passing the notice alongwithout verifying stockcan lead to patient harm.

D. Send the product back❌→ While returning recalled products is part of the process, itshould only occur after verification and proper documentation.

Comprehensive and Detailed Step-by-Step Explanation:

TheNational Drug Code (NDC)is a10- or 11-digit numberidentifying a drug'smanufacturer, product, and package size.

????NDC Format:

XXXXX−YYYY−ZZ\text{XXXXX} - \text{YYYY} - \text{ZZ}XXXXX−YYYY−ZZ

First 5 digits= Manufacturer

Middle 4 digits= Drug, strength, and formulation

Last 2 digits=Package size

✅A. Package size→Correct.Since the first two segments(00781-1506)are identical, the difference is in thelast segment, which representspackage size.❌B. Dosage→ Incorrect. Thedosage (mg strength) remains the same.❌C. Manufacturer→ Incorrect. Themanufacturer is the same (first 5 digits are identical).❌D. Strength→ Incorrect. Thestrength is unchanged.

????Reference:

FDA NDC Directory

PTCB Inventory Management Guidelines

Duloxetine (Cymbalta)is anSNRI antidepressantoften confused withparoxetine (Paxil), another SSRI antidepressantdue tosimilar names andoverlapping indications.

????Reference:ISMP List of Look-Alike, Sound-Alike (LASA) Medications.

Look-alike/sound-alike (LASA) drug name pairs (e.g., hydralazine vs hydroxyzine) are a well-recognized cause of wrong-drug errors. ISMP and technician training resources emphasize verifying the National Drug Code (NDC) and/or barcode scanning against the prescription to ensure the correct drug, strength, and manufacturer are selected before counting. The NDC uniquely identifies the labeler, product, and package; thus, verifying the NDC is a stronger safety check than relying on tablet color (which can vary) or lot number (used for traceability/recalls, not drug selection). Strength verification is important, but first you must ensure the correct drug; NDC verification accomplishes both drug and strength confirmation.

References (Pharmacy Technician documents / Study Guides):

• ISMP community pharmacy medication safety guidance on LASA verification and barcode/NDC checks.

• PTCB/ExCPT Medication Safety sections: LASA risk-reduction strategies; NDC use in product selection.

• FDA/Drug listing education: NDC identifies labeler–product–package; used to ensure correct product selection.