Module 3 - PB

Proverbs 16:3

A) Eosinophils

A patient presents with wheezing, pruritus, and a recent history of intestinal helminth infection. The complete blood count shows an increased proportion of granulocytes involved in IgE-mediated allergic responses and defence against multicellular parasites. Which cells are most likely elevated?
a. Eosinophils
b. Neutrophils
c. Lymphocytes
d. Basophils

B) 80mL

How many mL will you dispense for a prescription calling for a 100g of a liquid substance with a sp.gr. Of 1.25:
a. 75mL
b. 80mL
c. 85mL
d. 90mL

C) Hypercalcemia and hypophosphatemia

Parathyroid hormone (PTH) primarily affects calcium and phosphate levels in the blood. Which of the following best describes the typical effect of increased PTH secretion on serum calcium and phosphate levels?
a. Hypocalcemia and hypophosphatemia
b. Hypercalcemia and hyperphosphatemia
c. Hypercalcemia and hypophosphatemia
d. Hypocalcemia and hyperphosphatemia

D) 830.40

A 65-year-old patient bought a total of P1,038 of medicines from your pharmacy. After availing the 20% senior citizen discount, how much is the discounted price?
a. P750.50
b. P815.10
c. P820.50
d. 830.40
e. 950.15

B) Aspirin, acetaminophen, and ibuprofen are implicated in Reye's syndrome.

All of the following statements concerning contraindications with chronic use of over-the-counter (OTC) analgesic agents are correct except which one?
a. Aspirin, ibuprofen, and naproxen sodium are contraindicated in patients with bleeding disorders, peptic ulcer, and the third trimester of pregnancy.
b. Aspirin, acetaminophen, and ibuprofen are implicated in Reye's syndrome.
c. Acetaminophen is contraindicated in patients with active alcoholism, hepatic disease or viral hepatitis.
d. For analgesia, the dosage of ibuprofen is 200 to 400mg every 4 to 6 hours prn with maximum daily dose of 1200mg.

D) Drug B has a high association constant for binding the protein and is given in large dose.

A clinically noticeable drug interaction resulting from the displacement of drug A by drug B from common plasma protein-binding sites is most often seen when:
a. Drug B has a low associate constant for binding the protein and is given in large dose.
b. Drug A has high association constant for binding the protein.
c. Drug B is more toxic than Drug A.
d. Drug B has a high association constant for binding the protein and is given in large dose.

B) Hyperosmotic laxatives

Glycerin suppositories are examples of what type of laxatives?
a. Saline laxative
b. Hyperosmotic laxatives
c. Stimulant laxatives
d. Emollient laxatives
e. Lubricant laxatives

C) Alkaline phosphatase (ALP)

Which serum enzyme typically shows a disproportionate elevation in biliary obstruction or cholestasis?
a. Alanine aminotransferase (ALT)
b. Aspartate aminotransferase (AST)
c. Alkaline phosphatase (ALP)
d. Creatine kinase (CK)

B) 9.0% NSS: isotonic solution

Which of the following is incorrect pairing?
a. 0.009% NSS: hypotonic solution
b. 9.0% NSS: isotonic solution
c. 0.9% NSS: isotonic solution
d. 0.09% NSS: hypotonic solution

B) Albuterol

Which of the following primarily works by relaxing airway smooth muscles to quickly relieve bronchospasm?
a. Salmeterol
b. Albuterol
c. Montelukast
d. Budesonide

B) Increase in INR due to pharmacokinetic interaction

What will be observed in a patient undergoing anticoagulant therapy with warfarin who also took cholestyramine?
a. Increase in INR due to pharmacodynamic interaction
b. Increase in INR due to pharmacokinetic interaction
c. Decrease in INR due to pharmacodynamic interaction
d. Decrease in INR due to pharmacokinetic interaction

C) II, IV

Which of the following drugs can increase the clearance of another drug?
I. Grapefruit juice
II. Phenytoin
III. Cimetidine
IV. Griseofulvin
a. II, III, IV
b. I, II
c. II, IV
d. III, IV

B) 0.48

If a gallon of a certain liquid weighs 1,800g, what is the specific gravity of the liquid?
a. 0.25
b. 0.48
c. 0.55
d. 0.75
e. 1.25

D) Bacteria

What type of microorganism is responsible for causing leptospirosis?
a. Virus
b. Parasites
c. Fungus
d. Bacteria

B) They are derived from polysaccharides and resemble fiber in mechanism of action.

Which of the following statements adequately describes bulk-forming laxatives?
a. They can cause diarrhea if not taken with at least 8oz water.
b. They are derived from polysaccharides and resemble fiber in mechanism of action.
c. They have a relatively fast onset of action of 4 to 8 hours and duration of 12 to 24 hours.
d. They produce a more complete evacuation of the bowels than stimulant products.

D) I, II, III, and IV

Which of the following substances are components of the standard oral rehydration salts (ORS) formulation?
I. Sodium
II. Potassium
III. Chloride
IV. Glucose
a. I and II only
b. I and III only
c. I, II, and III only
d. I, II, III, and IV

A) Type A

What type of ADR is bleeding caused by heparin?
a. Type A
b. Type B
c. Type C
d. Type D
e. Type E

A) Erroneous

What type of error is present in the sample prescription?

a. Erroneous
b. Violative
c. Impossible
d. No error

C) I, III, IV

What should be done by the pharmacist when he/she encounters this type of prescription?

I. Fill the prescription.
II. Do not fill the prescription.
III. Keep the prescription.
IV. Inform buyer of generic options.
a. I only
b. II only
c. I, III, IV
d. II, III, IV

B) Take 1 tab q4h or as needed

What is indicated in the transcription part of the prescription?

a. Biogesic 500mg tab
b. Take 1 tab q4h or as needed
c. Rx
d. #12

C) Hepatic necrosis

Toxicity that may be caused by accidental overdose of the drug written in the prescription is likely to be:

a. Loss of hearing
b. Hypoprothrombinemia
c. Hepatic necrosis
d. Optic neuropathy

B) S2

Which of the following licenses is required for a doctor to prescribe dangerous drugs?
a. S1
b. S2
c. S3
d. S4
e. S5

B) Synergism

What interaction exists between Sulfamethoxazole and Trimethoprim?
a. Addition
b. Synergism
c. Potentiation
d. Antagonism
e. NOTA

A) Take ½ tablet

A patient was instructed to take Clonidine 75mcg SL tablet to control their hypertension. The only available preparation is 0.15mg per tablet. How should the patient be instructed to take the drug?
a. Take ½ tablet
b. Take 1 tablet
c. Take 1 ½ tablets
d. Take 2 tablets
e. Take 3 tablets

C) Rheumatoid arthritis

Methotrexate is commonly used as an antineoplastic agent. It is also indicated for the treatment of which of the following conditions?
a. Hypertension
b. Diabetes mellitus
c. Rheumatoid arthritis
d. Hyperlipidemia

B) Drug B

Which of the following drugs is the safest?
a. Drug A
b. Drug B
c. Drug C
d. Two of the above
e. NOTA

B) Take ½ tablet of Alprazolam (Xanor) 500 micrograms at bedtime as needed for insomnia

½ tab Alprazolam (Xanor) 500μg hs prn for insomnia
a. Take ½ tablet of Alprazolam (Xanor) 500 nanograms after dinner for insomnia
b. Take ½ tablet of Alprazolam (Xanor) 500 micrograms at bedtime as needed for insomnia
c. Take ½ capsule of Alprazolam (Xanor) 500 micrograms at bedtime as needed for insomnia
d. Take ½ tablet of Alprazolam (Xanor) 500 micrograms every night at bedtime for insomnia

B) 50mL/hour

If 10mg of a drug are added to a 500-mL large-volume parenteral fluid, what should be the rate of flow, in milliliters per hour, to deliver 1mg of drug per hour?
a. 20mL/hour
b. 50mL/hour
c. 60mL/hour
d. 75mL/hour
e. 100mL/hour

B) Pharmaceutical interaction

It occurs when drugs are mixed in syringes or infusion fluids prior to administration.
a. Pharmacodynamic interaction
b. Pharmaceutical interaction
c. Pharmacokinetic interaction
d. All of the above

C) CK-MB

An increase in which of the following markers denote a myocardial infarction?
a. Creatinine
b. CK-MM
c. CK-MB
d. CK-BB
e. NOTA

B) Category B

Pregnancy risk category characterized with no evidence of harm to animal studies but no adequate and well-controlled studies for pregnant women?
a. Category A
b. Category B
c. Category C
d. Category D

D) Allows prolonged contact with the oral mucosa

Which of the following is an advantage of using lozenges as a dosage form?
a. Provides rapid systemic absorption
b. Suitable for intravenous administration
c. Preventable first-pass metabolism completely
d. Allows prolonged contact with the oral mucosa

C) Liquefaction

When combined, Lidocaine and Prilocaine liquefy to form a cream. Which of the following "incompatibilities" is observed?
a. Insolubility
b. Polymorphism
c. Liquefaction
d. Leaching
e. Water loss

C) Fondaparinux

The following drugs have label warnings against their use in pregnant women, except:
a. Ibuprofen
b. Aspirin
c. Fondaparinux
d. Warfarin

A) Hypokalemia

Which of the following conditions increases the risk of digoxin toxicity?
a. Hypokalemia
b. Hypocalcemia
c. Hypermagnesemia
d. Hyponatremia
e. NOTA

C) Antidiarrheal therapy

Which of the following is NOT a therapeutic use of magnesium sulfate?
a. Treatment of eclampsia seizures
b. Correction of hypomagnesemia
c. Antidiarrheal therapy
d. Management of asthma exacerbation

D) A prospective, randomized, standard-of-care comparison trial

An investigator wishes to study a new drug for the treatment of hypertension in patients with diabetes. What is the best type of trial design the investigator should use for determining causality in this particular study?
a. A case-control study
b. A prospective cohort study
c. A prospective, randomized, placebo-controlled trial
d. A prospective, randomized, standard-of-care comparison trial

A) Oxidation of ascorbic acid

All are characteristics of physical instability in parenteral nutrition except:
a. Oxidation of ascorbic acid
b. Lipid destabilization
c. Increase tendency for creaming and cracking of the lipid emulsion
d. Positively charged ions increase their tendency to join or coalesce in the parenteral nutrition.

B) 2 tsp

A 12-year-old patient was prescribed a dose of 500mg Paracetamol every 4 hours as needed for fever. If the available drug and syrup preparation was 250mg/5mL, how many teaspoons is needed per dose?
a. 1 tsp
b. 2 tsp
c. 3 tsp
d. 4 tsp
e. 5 tsp

B) Diphenhydramine

Which of the following is an OTC drug that can be used for allergies and insomnia?
a. Amlodipine
b. Diphenhydramine
c. Atorvastatin
d. Amoxicillin

B) <120 and <80

Normal BP according to JNC 8 Guidelines
a.

D) Ketoconazole

All of the following are potential treatment options for psoriasis except:
a. Salicylic acid
b. Topical hydrocortisone
c. Coal tar
d. Ketoconazole

B) Filgrastim

Which of the following is a granulocyte colony-stimulating factor (G-CSF) used for the treatment of neutropenia?
a. Cisplatin
b. Filgrastim
c. Bevacizumab
d. Gefitinib

C) Pharmaceutical Care

The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life
a. Good Pharmacy Practice
b. Clinical Pharmacy
c. Pharmaceutical Care
d. Rational Drug Use
e. NOTA

B) Secondary Source

Abstracting services
a. Primary Source
b. Secondary Source
c. Tertiary Source
d. Ternary Source

B) Category B

A patient was prescribed Hydroxyzine. The inpatient pharmacist mistakenly dispensed Hydralazine instead of Hydroxyzine. The nurse caught the error right before administering the drug to the patient. According to the NCC MERP Classification, what medication error was incurred?
a. Category A
b. Category B
c. Category C
d. Category D
e. Category E

B) Upper GI bleeding

During fecaysis, a patient's stool is found to be black, tarry stool. This usually indicates?
a. Normal
b. Upper GI bleeding
c. Lower GI bleeding
d. Fat malabsorption
e. NOTA

A) Dobutamine

The following can be used in a patient experiencing anaphylactic reaction, except:
a. Dobutamine
b. Diphenhydramine
c. Epinephrine
d. Hydrocortisone

B) 35g

How much amino acids (in g) is in the final preparation?

a. 30g
b. 35g
c. 40g
d. 45g
e. 50g

E) 50g

How much dextrose (in g) is in the final preparation?

a. 30g
b. 35g
c. 40g
d. 45g
e. 50g

B) Pharmacokinetic interaction

When two interacting drugs results to the alteration of the absorption of one of the drugs, this interaction is classified as:
a. Pharmacodynamic interaction
b. Pharmacokinetic interaction
c. Therapeutic interaction
d. Idiosyncratic interaction

C) Microcytic, hypochromic

Characteristics of RBC in IDA:
a. Macrocytic, normochromic
b. Microcytic, normochromic
c. Microcytic, hypochromic
d. Macrocytic, hypochromic

B) Minoxidil

Which of the following vasodilators can cause hirsutism as an adverse effect?
a. Hydralazine
b. Minoxidil
c. Diazoxide
d. Sodium nitroprusside
e. NOTA

B) Lymphocytopenia

Which hematological abnormality is most directly associated with progressive HIV infection and AIDS due to the depletion of CD4+ T cells?
a. Lymphocytosis
b. Lymphocytopenia
c. Eosinophilia
d. Neutrophilia

C) No food intake

Which of the following increases the risk of hypoglycemia?
a. Use of oral glucose tablets
b. Excess food intake
c. No food intake
d. A and B
e. B and C

B) Mix each ingredient separately with an inert absorbent

Which technique can help prevent liquefaction when dispensing powders that form a eutectic mixture?
a. Triturate them vigorously together without additives
b. Mix each ingredient separately with an inert absorbent
c. Add water to the powders
d. Heat the ingredients before packaging

B) Cosmetic purposes

Which of the following is an indicated use of Botulinum toxin type A?
a. Treatment of bacterial infections
b. Cosmetic purposes
c. Chronic migraine
d. Antibiotic-resistant skin ulcers

B) S-isomer

Which isomer of Thalidomide is responsible for its teratogenic effects?
a. R-isomer
b. S-isomer
c. Cis-isomer
d. Trans-isomer
e. NOTA

B) Kidneys

A patient was found to have high serum creatinine. This indicates damage in which of the following organ/s?
a. Heart
b. Kidneys
c. Liver
d. Pancreas
e. NOTA

B) Individually packaged and labelled doses ready for administration

A unit-dose drug distribution system provides
a. A one-month supply kept at the bedside
b. Individually packaged and labelled doses ready for administration
c. Unlabelled bulk containers for each ward
d. Medicines that patients divide themselves

B) Explain that controlled blood pressure may reflect effective therapy and discuss the matter with the prescriber before making changes

A patient asks whether they may stop their antihypertensive medicine because their blood pressure is now controlled. What is the pharmacist's best response?
a. Advise the patient to stop because the treatment goal has been achieved.
b. Explain that controlled blood pressure may reflect effective therapy and discuss the matter with the prescriber before making changes
c. Recommend taking the medicine only when symptoms occur
d. Suggest replacing the medicine with a herbal medicine

A) Carcinogenesis

According to Rawlins-Thompson classification Type D ADR includes
a. Carcinogenesis
b. Bradycardia associated with beta blockers
c. Anaphylaxis associated with penicillin
d. Opiate withdrawal symptom

B) Methylphenidate

Which of the following medications is commonly prescribed as a first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD)?
a. Phenobarbital
b. Methylphenidate
c. Diazepam
d. Fluoxetine

B) Assess the interaction and communicate with the prescriber

A patient taking warfarin is prescribed metronidazole. What should the pharmacist do?
a. Ignore the interaction because both medicines are prescribed
b. Assess the interaction and communicate with the prescriber
c. Automatically discontinue warfarin
d. Tell the patient to take both medicines at exactly the same time

B) Addison's Disease

What adverse effect can be observed when immediately stopping the use of corticosteroids?
a. Cushing's Syndrome
b. Addison's Disease
c. Hypertension
d. Arrhythmia
e. NOTA

A) Subtract expenses from gross profit

Which of the following is appropriate when deriving the net profit of pharmacy for a given period?
a. Subtract expenses from gross profit
b. Add liabilities with the owner's equity
c. Subtract inventory cost from the total value of goods to be sold
d. Add purchases to the beginning inventory of a specified period

B) 26 gtt/min

15mL of 10% Calcium Gluconate injection and 10mL of a multivitamin infusion are mixed with 500mL of NSS. The infusion is to be administered over a period of 5 hours. If the infusion set is calibrated at 15 drops per mL, at what rate in drops per minute should the flow rate be adjusted in order to administer the infusion over the desired time interval?
a. 25 gtt/min
b. 26 gtt/min
c. 0.12 gtt/min
d. 7 gtt/min

C) Cost-Effectiveness Analysis

Compares cost of different treatment options with benefits expressed as therapeutic objective/outcomes/units of improvement (e.g., years of life gained)
a. Cost-Minimization Analysis
b. Cost-Benefit Analysis
c. Cost-Effectiveness Analysis
d. Cost-Utility Analysis
e. Cost of Illness

C) Anti-gout

Peperomia pellucida, a DOH-approved medicinal plant, is primarily used as:
a. Antidiabetic
b. Antifungal
c. Anti-gout
d. Anti-diarrheal

C) Chloramphenicol

Which of the following drugs can cause aplastic anemia if its nitro reduction is defective in the body?
a. Naloxone
b. Paracetamol
c. Chloramphenicol
d. Penicillin
e. NOTA

D) Oral hypoglycemic agents

Miglitol and Acarbose are examples of:
a. Antihypertensive agents
b. Antiplatelet agents
c. Antibacterial agents
d. Oral hypoglycemic agents

B) Lidocaine

Which drug should be used as a local/topical anesthetic for a minor skin procedure?
a. Diazepam
b. Lidocaine
c. Nitrous oxide
d. Ibuprofen
e. NOTA

D) Tiotropium

Which drug functions as an antimuscarinic?
a. Salbutamol
b. Montelukast
c. Budesonide
d. Tiotropium

C) Oral vancomycin

Which of the following is the most appropriate treatment for a severe case of Clostridium difficile-associated diarrhea in a hospitalized patient?
a. Oral metronidazole
b. IV metronidazole
c. Oral vancomycin
d. IV vancomycin

D) Class IV

NYHA functional limitation class that indicates the degree of effort necessary to elicit HF symptoms that occur at rest:
a. Class I
b. Class II
c. Class III
d. Class IV

A) Amphotericin B

Which of the following antifungal medications should be used with caution in patients with kidney problems?
a. Amphotericin B
b. Flucytosine
c. Ketoconazole
d. Fluconazole
e. NOTA

B) Physiological antagonism

What kind of antagonism occurs between acetylcholine and epinephrine?
a. Chemical antagonism
b. Physiological antagonism
c. Competitive antagonism
d. Pharmacological antagonism

A) IgG

Which immunoglobulin is the most abundant?
a. IgG
b. IgM
c. IgA
d. IgE
e. IgD

C) III, IV

The following is expected in a patient with diabetes insipidus:
I. High ADH
II. High specific gravity of urine
III. Low ADH
IV. Low specific gravity of urine
a. II, III
b. I, IV
c. III, IV
d. I, II

A) Ultrasonography

Which of the following is not an invasive test or procedure?
a. Ultrasonography
b. Venipuncture
c. Endoscopy
d. Paracentesis

C) 1.7mL

A patient weighs 13.5kg and is prescribed a medication for 0.5mg/kg/dose. The stock strength is 20mg/5mL. What volume will you give the patient?
a. 1.2mL
b. 1.5mL
c. 1.7mL
d. 2.1mL

A) Paracetamol

Which of the following analgesics is safe to use in patients with peptic ulcer?
a. Paracetamol
b. Ibuprofen
c. Naproxen
d. Mefenamic acid
e. NOTA

D) FIFO

Inventory classification system where the oldest inventory items are assumed to be sold or used first
a. ABC Analysis
b. VED Analysis
c. Perpetual Inventory System
d. FIFO
e. FEFO

C) 0.67 mmol

A solution of sulfuric acid (H2SO4) has a normality of 0.5N. How many millimoles of H2SO4 are present in 2.68mL of this solution? MW = 98.09g/mol
a. 0.87 mmol
b. 0.54 mmol
c. 0.67 mmol
d. 0.83 mmol

A) Substance/Drug Abuse Treatment and Rehabilitation Center

According to the New Classification of "Other Health Facilities" under AO 2012-0012, the following are examples of Category D Health Facility, EXCEPT:
a. Substance/Drug Abuse Treatment and Rehabilitation Center
b. Dialysis Clinic
c. Physical Medicine and Rehabilitation Center/Clinic
d. In-Vitro Fertilization Center

E) P675

A tube of ointment from the supplier costs P450. To make a profit of 50% on the cost, how much should you set the selling price be?
a. P575
b. P600
c. P625
d. P650
e. P675

D) I, III, IV

Which of the following statements are true regarding food and drug interaction?
I. As a general rule, interaction is minimized if drug is taken 1hr before or 2hrs after meal
II. Decreases gastric emptying rate
III. Reduce gastric irritation
IV. Itraconazole + fatty meal results in increased drug absorption
a. I, II, III
b. II, IV
c. III, IV
d. I, III, IV

E) AOTA

Which of the following is a restricted antimicrobial?
a. Tobramycin
b. Linezolid
c. Ertapenem
d. Aztreonam
e. AOTA

D) Synergism

A patient is taking lagundi and salbutamol concurrently. What is the possible interaction?
a. No possible interaction
b. Decrease absorption of salbutamol
c. Addition
d. Synergism

B) Potentiation

Principle behind the combination of Imipinem and Cilastatin (Primaxin ®)
a. Antagonism
b. Potentiation
c. Synergism
d. Additive

B) Gelatinization

A suspension with the following ingredients: FeCl3, Fe(OH)3, acacia, FD&C #5 (orange color) and methylparaben will reveal this manifestation:
a. Polymerization
b. Gelatinization
c. Cementation
d. Precipitation

C) Philippine General Hospitals

The following are examples of Specialty Hospitals, EXCEPT:
a. Philippine Orthopedic Center
b. Lung Center of the Philippines
c. Philippine General Hospitals
d. San Lazaro Hospital
e. Dr. Jose Fabella Memorial Hospital

A) Lozenges

Dichlorobenzyl alcohol is a common ingredient found in:
a. Lozenges
b. Troches
c. Pastilles
d. NOTA

C) Primary literature

For medical information sources, what category would journal articles belong?
a. Company-provided literature
b. Tertiary literature
c. Primary literature
d. Secondary literature

A) Overdose

A patient weighing 120lbs was administered 2.1g of a drug that was intended to be dosed at 30mg/kg. What can you say about the dose administered?
a. Overdose
b. Underdose
c. Correct dose
d. Cannot determine

C) IV

True about Meclizine, except:
I. Antihistamine
II. For vertigo
III. Chewable tablet
IV. Muscarinic agonist
a. I and II
b. III
c. IV
d. NOTA

A) Medication administration may be delayed while the pharmacy processes and delivers each patient-specific order.

Which of the following is a recognized disadvantage of the individual inpatient prescription-order system?
a. Medication administration may be delayed while the pharmacy processes and delivers each patient-specific order.
b. Large quantities of medicines must be stored in each patient-care unit.
c. Medication wastage and pilferage are increased because medicines are supplied as unrestricted ward stock.
d. Pharmacist review of individual medication orders is eliminated.

C) Chemical incompatibility

A formulation contains an oxidizing agent and a reducing agent that react with each other, resulting in degradation and loss of potency. What type of incompatibility is demonstrated?
a. Physical incompatibility
b. Therapeutic incompatibility
c. Chemical incompatibility
d. Physical and therapeutic incompatibility

D) Enoxaparin

An example of LMH
a. Dabigatran
b. Warfarin
c. Sertraline
d. Enoxaparin

C) Celecoxib 200mg capsule

Which of the following oral analgesics generally requires a valid prescription before it can be dispensed in the Philippines?
a. Aspirin 325mg tablet
b. Ibuprofen 200mg tablet
c. Celecoxib 200mg capsule
d. Paracetamol 500mg tablet