Dispensing (101-200 questions)

Proverbs 16:3

a. for the treatment of cough and asthma symptoms

Lagundi has been studied by the Philippine Department of Health and has suggested a number of therapeutic values. One of these is;

a. for the treatment of cough and asthma symptoms

b. as prophylaxis for migraine

c. for painful or difficult menstruation

d. as supportive treatment for anxiety and depression

b. easier to correct than prevent

The following statements are TRUE regarding incompatibilities in prescription EXCEPT:

a. problems arising during compounding, dispensing and drug administration

b. easier to correct than prevent

c. may be intentional or unintentional

d. must be recognized by the pharmacist

b. Liberation of SO₂ , NO₂ , and H₂ S

Which of the following is considered as an incompatibility in prescription?

a. Release of CO₂ in effervescent formulation

b. Liberation of SO₂ , NO₂ , and H₂ S

c. Precipitates formed in washes and lotions

d. All of these

a. Salting-out

Rationale: Salting-out = Salt makes water busy, so other substances can’t stay dissolved → they come out.

KBr + Camphor water may lead to precipitation. What mechanism is involved?

a. Salting-out

b. change in solvent system

c. change in temperature

d. change in pH

d. polymorphism.

Liquefaction in prescription could be due to the following EXCEPT;

a. eutexia

b. deliquescence

c. hygroscopy

d. polymorphism

d. Deliquescent

---

• Deliquescent → absorbs water and dissolves.

• Hygroscopic → absorbs water but stays solid.

• Eutectic → melts easily.

• Endothermic → absorbs heat.

These substances have strong affinity for moisture and tend to absorb relatively large amounts of water from the atmosphere if exposed to it, forming a liquid solution.

a. Endothermic

b. Eutectic

c. Hygroscopic

d. Deliquescent

a. Precipitation due to chemical reaction

Rx Silver Nitrate, Water. Make isotonic with Sodium Chloride. What incompatibility could be predicted from this combination?

a. Precipitation due to chemical reaction

b. Inactivation of Silver chloride via hydrolysis

c. Evolution of gas

d. Solidification

c. II and III

Liberation of carbon dioxide occurs when acid preparations are combined with carbonates or bicarbonates. Which of the following syrups is incompatible with carbonates and bicarbonates?

I. Syrup, USP

II. Syrup of Ipecac

III. Syrup of Orange

a. I, II and III

b. I and II

c. II and III

d. III only

c. II and III

NOTE: Discoloration of Tablet= Oxidation

Hydrolysis of aspirin tablets can be manifested as;

I. Discoloration of the tablet

II. Vinegar-like odor of the tablet

III. Needle like crystals noted around the tablet

a. I, II and III

b. I and II

c. II and III

d. I and III

d. I and II

In the prescription, Sodium bicarbonate, Sodium salicylate, and Water qs., a brown quinoid derivative of sodium salicylate may be formed. This incompatibility can be remedied by:

I. Adding a color diluent

II. Adding an antioxidant

III. Removal of water

a. I, II and III

b. II and III

c. I and III

d. I and II

b. I and II

Possible remedies for liquefaction of solid substances include;

I. Dispense separately

II. Add adsorbents

III. Add cotton in packaging

a. I and III

b. I and II

c. II and III

d. I,II and III

a. I only

Alkaline salts like phenytoin sodium when placed in an acidic medium will result to:

I. precipitation of phenytoin into free acid

II. Inactivation of phenytoin sodium

III. Evolution of carbon dioxide gas

a. I only

b. II only

c. I and II

d. I, II, and III

c. I and III

Remedy when a solid substance fails to dissolve in a liquid:

I. addition of co-solvent

II. prepare an emulsion

III. prepare a suspension

a. I and II

b. II and III

c. I and III

d. I, II, and III

d. I, II, and III

Which of the following substances or compounds would tend to form a liquid or soft mass when brought in contact with camphor?

I. chloral hydrate

II. phenol

III. salicylic acid

a. I and II

b. II and III

c. I and III

d. I, II, and III

b. chloramphenicol

Dispensing of this antibiotic should be watched carefully as it depresses the bone marrow and block protein synthesis.

a. bacitracin

b. chloramphenicol

c. penicillin

d. cefaclor

c. tinctures instead of fluidextracts

• underdose, less concentrated

Overdosage could be due to the following EXCEPT;

a. Excessive amounts taken at one time

b. Doses repeated at too frequent intervalsm

c. tinctures instead of fluidextracts

d. Dose dumping from modified-release formulation

d. epinephrine

Contact lenses will turn brown when prescribe to a patient who is also using this medication due to the formation of adrenochrome.

a. ibuprofen

b. propranolol

c. lidocaine

d. epinephrine

d. I, II and III

Tetracycline should not be taken with;

I. Dairy products

II. Antacid preparations

III. Hematinics

a. I and II

b. I and III

c. II and III

d. I, II and III

c. I and II

When taking corticosteroids, patient should avoid;

I. NSAIDs

II. Thiazide diuretics

III. Insulin products

a. I, II and III

b. II and III

c. I and II

d. I only

a. understanding

In medication counseling, the basic goal is;

a. understanding

b. disagreement

c. to let the patient do as they are told

d. conflict

b. Repeat prescription counseling

Checking compliance and side effects are information gathered in;

a. New prescription counseling

b. Repeat prescription counseling

c. OTC counseling

d. all

a. I only

A medication history interview is conducted to;

I. new patient

II. returning patient

III. refill prescription

a. I only

b. II only

c. III only

d. I and II

a. I, II and III

Information to be provided in dispensing new prescription include;

I. refill information

II. side effects and adverse effects

III. purpose of the medication

a. I, II and III

b. II and III

c. I and III

d. I and II

b. effectiveness of medication

"Does your medication lower your high blood pressure?" This is a specific question about:

a. compliance

b. effectiveness of medication

c. previous use of medication

d. purpose of medication

d. I, II and III

Practical strategies to reduce errors resulting from sound-alike medications and verbal orders include:

I. read back verbal orders

II. prohibit the use of all verbal orders

III. establish policies on who can receive verbal orders

a. I and II

b. II and III

c. I and III

d. I, II and III

d. Flag shelves where the look-alike products are stored

One strategy to decrease dispensing errors associated with look-alike medications is to:

a. store problem medications alphabetically

b. use only generic names on labels

c. avoid incorporating alerts in computer systems

d. Flag shelves where the look-alike products are stored

b. can result in significant patient harm

Certain medications are deemed high-alert because they:

a. are more error prone

b. can result in significant patient harm

c. are labeled as such by FDA

d. a and c

c. concentrated electrolytes

JCAHO patient safety goals encourage hospitals to remove _______ from floor stock.

a. lidocaine

b. esmolol

c. concentrated electrolytes

d. all of these

Joint Commission on Accrediting Health Organization

JCAHO meaning is ___ ?

Joint Commission on Accrediting Health Organization (JCAHO)

_____ - is the accrediting body of hospital pharmacy

c. Refrigerator

NOTE:

• Refrigerator → 1.5–3.3°C

• Room temp → 20–25°C

• Freezer → Below 0°C

• Incubator → 37°C

A new product has arrived to your pharmacy. The storage requirements on the label read: Store at 1.5°C - 3.3°C. Where would you store it?

a. Room temperature

b. Freezer

c. Refrigerator

d. Incubator

a. Look-alike and Sound-alike drugs

The use of "tall-man" letters in label avoids errors due to;

a. Look-alike and Sound-alike drugs

b. Dangerous abbreviations

c. Illegible handwriting

d. Leading and Trailing zeroes

a. Indomethacin

High-alert medication include all of the following EXCEPT;

a. Indomethacin

b. Lidocaine

c. Colchicine

d. Heparin

d. I, II and III

Drug interactions may be classed as;

I. pharmacokinetic interaction

II. Pharmacodynamic interaction

III. pharmaceutical interactions

a. I and III

b. I and II

c. II and III

d. I, II and III

b. I and II

Which of the following situations can lead to drug interactions?

I. Multiple drug therapy

II. Multiple prescribers

III. Patient compliance

a. I, II and III

b. I and II

c. I and III

d. II and III

c. pharmaceutical interaction

When drugs are mixed inappropriately in syringes or infusion prior to administration, it will give rise to a;

a. pharmacokinetic interaction

b. pharmacodynamic interaction

c. pharmaceutical interaction

d. beneficial interaction

c. IV piggyback

NOTE:

• IV piggyback → small bag, given intermittently through main IV.

• IV push/bolus → quick injection into vein.

• IV infusion → continuous drip.

The intermittent administration of a second solution, like antibiotics, through a Y-tube in the existing IV line is referred to as;

a. IV push

b. IV bolus

c. IV piggyback

d. IV infusion

c. NSS

Amphotericin should not be admixed to;

a. D5W

b. Lactated Ringer's

c. NSS

d. Ringer's Injection

b. I and II

Admixture of any drug is NOT allowed in;

I. Blood derivatives

II. D5W

III. Amino acid

a. I only

b. I and II

c. I and III

d. I, II and

c. Controlled room temperature

Storage condition required for products that must be placed in an area with an air conditioning facility.

a. Cold temperature

b. Room temperature

c. Controlled room temperature

d. Cool temperature

c. Lactose

In compounding phenytoin capsule, the use of this capsule filler should be avoided since it can increase the toxicity of the drug.

a. Starch

b. Microcrystalline cellulose

c. Lactose

d. Bentonite

d. I, II and III

Which of the following can lead to overdosage?

I. Excessive amounts taken at one time

II. Doses repeated at too frequent intervals

III. Dose dumping from modified-release formulation

a. I and III

b. II and III

c. I and II

d. I, II and III

c. I and II

Antagonistic combinations are acceptable if;

I. it is used to modify the action of other ingredients

II. It is given as placebos

III. It will result to no therapeutic action or underdosage

a. I, II and III

b. II and III

c. I and II

d. I and III

c. asthmatics

NOTE:

Asthmatics caution (c):

• Penicillin → may cause allergic reaction.

• Aspirin (ASA) → may trigger asthma attack.

• Both involve hypersensitivity/idiosyncratic reactions.

Penicillin and ASA are contraindicated to;

a. hypertensives

b. patients with ulcer

c. asthmatics

d. anemics

c. chloramphenicol

NOTE: Chloramphenicol → can cause aplastic anemia

Anemics should refrain from the use of;

a. nasal decongestants

b. NSAIDs

c. chloramphenicol

d. ASA

c. high blood pressure

Cough and cold remedies with decongestants are NOT recommended to patients experiencing;

a. low RBC count

b. GI ulcer

c. high blood pressure

d. airway obstruction

d. Isordil

NOTE:
Viagra (Sildenafil) + Isordil (a nitrate) = dangerous drop in blood pressure(hypotension)

Mr. Lu would like to take Viagra, but is also taking Centrum, Vit. E, Lipitor and Isordil. You would like to tell Mr. Lee that it can cause interaction with other agents he was taking. Which of the following agents can cause interaction with Viagra?

a. Centrum

b. Vitamin E

c. Lipitor

d. Isordil

b. Take the other drug at least one hour before or two hours after the intake of the first drug.

A patient with a prescription for Dulcolax EC came to a drugstore. The patient revealed that he is also on antacid therapy. Which of the following information should the pharmacist tell to the patient?

a. Take both drugs right after meal.

b. Take the other drug at least one hour before or two hours after the intake of the first drug.

c. Follow the intake of the laxative with milk for enhanced effect.

d. Crush the tablet and mixed it with antacid for better bioavailability.

c. diphenhydramine

The patient is taking Midazolam as a sleeping pill. Which of the following medications should not be taken concomitantly with midazolam?

a. allopurinol

b. amoxicillin

c. diphenhydramine

d. salbutamol

b. excessive drowsiness and sedation

What is the consequence of taking Diphenhydramine and midazolam?

a. excessive sweating

b. excessive drowsiness and sedation

c. chest pain

d. palpitation

b. Amoxicillin can decrease the effectiveness of the oral contraceptive

Ms. Cruz orders an Oral Contraceptive Pills (OCP) and Amoxicillin trihydrate 500 mg for two weeks. What is the potential problem recognized if the two drugs are taken concomitantly?

a. OCP can weaken the antibacterial property of amoxicillin

b. Amoxicillin can decrease the effectiveness of the oral contraceptive

c. Amoxicillin increases the risk of OCP's adverse drug reaction

d. There is no problem with the two drugs

c. take the two drugs as prescribed, but use mechanical method of contraception or practice abstinence

Refer to the previous number. What should be your recommendation if the two drugs are taken?

a. take the OCP qod

b. take amoxicillin 2 hours after taking OCP

c. take the two drugs as prescribed, but use mechanical method of contraception or practice abstinence

d. Stop Amoxicillin and continue the OCP

c. Do not refrigerate

If amoxicillin suspension was dispensed, which of the following information does NOT apply to the dispensed product?

a. Allergy to penicillin

b. Shake the bottle well

c. Do not refrigerate

d. Take for 7 days or complete the course

d. Ketoconazole - antacids

The mechanism of interaction of the following is complexation EXCEPT;

a. Tetracycline-milk (Calcium)

b. Penicillamine-Aluminum or Iron salts

c. Flouroquinolones - Al and Mg containing antacids

d. Ketoconazole - antacids

b. rifampicin

NOTE:

• Rifampicin → red-orange

• Vitamin B2 (Riboflavin) → bright yellow

• Chloroquine → blue-green

• Vitamin C → clear or slightly yellow

A red orange urine is to be expected while taking this drug

a. vitamin B2

b. rifampicin

c. chloroquine

d. vitamin C

d. antacids

The following agents alter GI absorption of drugs taken concomitantly by altering GI motility and gastric emptying EXCEPT;

a. anticholinergics

b. metoclopramide

c. cathartics

d. antacids

a. I, II and III

The bioavailability of bisphosphonates may be markedly reduced if taken with;

I. Coffee

II. Orange juice

III. Mineral water

a. I, II and III

b. II and III

c. I and II

d. I and III

d. Miglitol

In some situation, medication should be administered with food to obtain optimum benefit. This is TRUE with;

a. Captopril

b. Alendronate

c. theophylline in controlled release form

d. Miglitol

a. at the start (at first bite) of each meal

For optimum benefit associated with alpha-glucosidase inhibitors used in diabetes, these should be taken;

a. at the start (at first bite) of each meal

b. at least ½ hour before the first food

c. with plain water only

d. after each meal

c. interruption of the enterohepatic circulation

By reducing microbial flora, antibiotics decrease the effectiveness of oral contraceptives. This is due to:

a. increased extent of GI metabolism

b. alteration of Vitamin K production by microorganism

c. interruption of the enterohepatic circulation

d. reduced absorption of oral contraceptives

b. an immediate-release formulation

Food does NOT alter the activity of theophylline significantly when the drug is administered in;

a. a controlled-release form

b. an immediate-release formulation

c. a transdermal patch

d. injection form

c. Planogram

A diagram that shows how and where specific retail merchandise should be placed on shelves or display cabinets.

a. Pharmacy Lay-out

b. Pharmagram

c. Planogram

d. Pharmacy design

a. Warfarin + Phenylbutazone

The following drug interaction may manifest alteration of pH, EXCEPT:

a. Warfarin + Phenylbutazone

b. Antacid + Salicylates

c. Antacid + Bisacodyl

d. Antacid + Ketoconazole

c. hypertensive crisis

Consumption of cheese or Chianti wine with Isocarboxazid can lead to;

a. increased bleeding

b. diminished antihypertensive activity

c. hypertensive crisis

d. decreased antidepressant property

a. displacement of warfarin from protein-binding sites

Warfarin and sulfonamide given concurrently leads to increased anticoagulant effect. This may be due to;

a. displacement of warfarin from protein-binding sites

b. stimulation of warfarin's metabolism

c. increased absorption of warfarin

d. decrease vit. K synthesis

a. decreased effectiveness of the antifungal agent

Administration of Ketoconazole to a patient who is currently taking Omeprazole would likely result to:

a. decreased effectiveness of the antifungal agent

b. decreased activity of the PPI

c. enhanced activity of antifungal agent

d. increased activity of the antiulcer drug

b. adsorbption

Antidiarrheal agents decreases absorption of other agents concurrently by

a. increasing Gi motility

b. adsorbption

c. absorption

d. decreasing GI motility

c. bile acid sequestrants

Use of hypolipidemic drugs result to malabsorption of fat-soluble vitamins and certain drugs

a. statins

b. fibrates

c. bile acid sequestrants

d. niacin

a. Resin - Digitalis glycosides

Cholestyramine and colestipol binds with a variety of lipophilic materials taken concomitantly with it. Which of these interactions with resin could be of clinical value?

a. Resin - Digitalis glycosides

b. Resin - fat soluble vitamins

c. Resin - Warfarin

d. Resin - ASA

d. pravastatin

Absorption of HMG-CoA reductase inhibitors can be enhanced with food with the exception of:

a. rosuvastatin

b. atorvastatin

c. simvastatin

d. pravastatin

d. lovastatin

Which of the following anti -cholesterol drugs are best taken at night?

a. niacin

b. gemfibrozil

c. colestipol

d. lovastatin

a. alteration of pH

Bisacodyl interacts with milk through what mechanism?

a. alteration of pH

b. complexation

c. adsorption

d. alteration of motility rate

a. I, II, and III

Moxifloxacin product labeling recommends that this antibacterial agent should be taken at least 4 hours before or 8 hours after taking;

I. Antacid preparations

II. Multivitamins with Zinc

III. Yogurt

a. I, II, and III

b. I and II

c. I and III

d. II and III

b. I and II

Which of the following statements is TRUE regarding the interactions of Penicillamine?

I. Absorption of penicillamine is reduced by aluminum and iron salts through chelation mechanism

II. Antacid and penicillamine should be administered at least 2 hours apart

III. Penicillamine should be administered with metals preparation

a. I, II and III

b. I and II

c. I and III

d. II and III

d. I, II, and III

The consumption of grapefruit juice has been reported to increase the serum concentration of some drugs. Which of the following drugs can be affected by grapefruit juice?

I. Amlodipine

II. Lovastatin

III. Cyclosporine

a. I and II

b. I and III

c. II and III

d. I, II, and III

b. 2 hrs

If an antacid is to be taken with ketoconazole, the two drugs be administered at least _____ apart to avoid interaction.

a. 1 hr

b. 2 hrs

c. 3 hrs

d. 4 hrs

d. I and III

Antibiotics enhance the pharmacologic action and increase the toxicity of the following drugs due to alteration of GI flora.

I. anticoagulant

II. oral contraceptives

III. digoxin

a. I, II and III

b. II and III

c. I and II

d. I and III

c. displacement from plasma protein binding site

What is the mechanism of interaction between methotrexate and salicylates?

a. induction of metabolism

b. inhibition of metabolism

c. displacement from plasma protein binding site

d. additive effect

a. CLINISTIX ®

Ampicillin will produce a false-positive reactions when testing for the presence of glucose in urine using the following, EXCEPT:

a. CLINISTIX ®

b. CLINITEST ®

c. Benedict's Solution

d. Fehling's Solution

d. III only

Concurrent use of alcohol with benzodiazepines result to;

I. Hyperexcitability

II. Hallucinations

III. Coma

a. I, II and III

b. I and II

c. II and III

d. III only

b. I and III

The activity of drug metabolizing enzymes can be increased by;

I. Phenobarbital

II. Grapefruit juice

III. Smoking

a. I and II

b. I and III

c. III only

d. I, II and III

d. Omeprazole beads in apple sauce

Which of the following interactions is not a harmful food-drug interaction?

a. Raw green salads with warfarin on DVT prophylaxis

b. Milk with doxycycline

c. Grapefruit juice and cyclosporine

d. Omeprazole beads in apple sauce

d. Penicillin with probenecid to prolong the antibacterial effect to treat STD

Which of the following is a valid therapeutic use of a drug interaction?

a. Citalopram and MAOI to treat depression

b. ASA and warfarin to enhance anticoagulation

c. Levofloxacin taken with antacid to decrease GI intolerance

d. Penicillin with probenecid to prolong the antibacterial effect to treat STD

d. competition for tubular secretion

The mechanism behind Probenecid and Penicillin interaction is;

a. enzyme induction

b. enzyme inhibition

c. alteration in gastric emptying

d. competition for tubular secretion

c. Enzyme induction

Indinavir Antiretroviral Therapy (ART) taken concomitantly with St. John's Wort for depression leads to decrease ART efficacy. This is most likely due to;

a. Additive toxicity

b. Antagonistic effect

c. Enzyme induction

d. Enzyme Inhibition

c. I and II

Drugs having similar pharmacological effects include;

I. antipsychotics - antihistamines - alcohol

II. antipsychotic - TCA's - trihexyphenidyl

III. thiazide diuretics - oral hypoglycemics

a. I, II and III

b. II and III

c. I and II

d. III only

d. blocking the transport of drug

Grapefruit juice decreases the efficacy of Allegra (fexofenadine) by;

a. increasing the activity of drug metabolizing enzymes

b. inhibiting the cytochrome P450 enzymes

c. increasing the absorption of drugs

d. blocking the transport of drug

Enzyme inhibitor

Grapefruit juice is an ____ [enzyme inducer/ enzyme inhibitor]

a. increases the enzyme activity

Chronic use of alcohol may;

a. increases the enzyme activity

b. inhibits hepatic enzymes

c. decrease gastric emptying

d. enhance elimination of other agents taken concurrently

Enzyme inducer

Chronic Alcoholism is an ____ [enzyme inducer/ enzyme inhibitor]

Enzyme inhibitor

Acute Alcoholism is an ____ [enzyme inducer/ enzyme inhibitor]

b. Cimetidine

Inducers of CYP3A4 include all of the following EXCEPT;

a. Phenobarbital

b. Cimetidine

c. St. John's wort

d. Carbamazepine

b. Intake of Rifampin

Enzyme inhibition may be precipitated by all of the following EXCEPT;

a. Use of macrolide antibiotics

b. Intake of Rifampin

c. Acute use of alcohol by non alcoholic individuals

d. Consumption of grapefruit juice

Enzyme inducer

Rifampin is an____ [enzyme inducer/ enzyme inhibitor]

c. I and III

TRUE statements include;

I. HIV protease inhibitors are extensively metabolized via CYP3A4 pathways

II. Rifampin is a strong enzyme inhibitor that is contraindicated with HIV protease inhibitors

III. Concurrent use of HIV protease inhibitor and enzyme inducers could compromise the effectiveness of the antiretroviral regimen for HIV infection

a. I, II and III

b. II and III

c. I and III

d. I and II

b. Insomnia

A smoker was prescribed with lorazepam. What would likely happen if he continuously smokes while on the drug therapy?

a. Prolonged sleep

b. Insomnia

c. no effect

d. coma and death

c. increased risk of thrombus formation

Phenobarbital can increase the rate of metabolism of warfarin. The result of this interaction is;

a. increased anticonvulsant property of Phenobarbital

b. decreased anticonvulsant property of Phenobarbital

c. increased risk of thrombus formation

d. decreased risk of thrombus formation

b. I and III

The efficacy of estrogens and progestins as an oral contraceptive may be reduced by drugs that can increase their metabolism. Which of the following agents can cause that interaction?

I. Phenobarbital

II. Ampicillin

III. Rifampin

a. I, II and III

b. I and III

c. I and II

d. II and III

Enzyme inducer

Phenobarbital is an ____ [enzyme inducer/ enzyme inhibitor]

b. pyridoxine

This agent reduces the action of levodopa by accelerating its decarboxylation to dopamine in the peripheral tissues.

a. carbidopa

b. pyridoxine

c. entacapone

d. dopamine