PTCE Sample Questions Answers

TheNational Drug Code (NDC)is a unique 10- or 11-digit number assigned to each drug product in the U.S.Understanding how NDC numbers are structuredis key to answering this question correctly.

The NDC format is as follows:XXXXX-YYYY-ZZ

First segment (XXXXX)→Labeler (Manufacturer or Distributor)

Second segment (YYYY)→Product Code (Specific Drug, Strength, and Formulation)

Third segment (ZZ)→Package Size (Quantity in the Package)

How to Find the Correct Answer?The given NDC:76439-103-10

76439= Manufacturer/Labeler Code

103= Product Code (Specific Drug & Strength)

10= Package Size

To matchthe same medication, theManufacturer (76439) and Product Code (103) must remain the same. Only thepackage size (last segment) can change.

A. 76439-208-10❌→Incorrect

Product Code (208) does not match (103).

B. 76439-103-50✅→Correct

Same manufacturer (76439) and same drug (103), but different package size (50 instead of 10).

C. 74693-103-10❌→Incorrect

Different manufacturer (74693 instead of 76439).

D. 74693-206-50❌→Incorrect

Different manufacturer (74693) and different product code (206).

FDA NDC Directory– Provides details on NDC structure and product identification.

PTCB PTCE Exam Content Outline– Covers NDC interpretation and drug identification.

Drug Supply Chain Security Act (DSCSA)– Reinforces correct medication identification using NDC.

Analyzing the Answer Choices:Key References:

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

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.

Stock rotation ensures medications with earlier expiration dates are used first by placing them in the front of the shelf, and medications with later expiration dates behind. This practice is part of the FEFO (First Expired, First Out) system.

From Mosby’s Pharmacy Technician: Principles and Practice:

“Stock rotation using the FEFO method ensures medication integrity and minimizes waste due to expiration.”

This differs from:

A – relates to ordering, not shelf arrangement

B – refers to product recall or removal

C – defines inventory turnover, not physical placement

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)

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.

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.

Nitroglycerin sublingual tablets are light- and moisture-sensitive, requiring storage in tight, light-resistant containers. Removing them from their original glass container can compromise potency. Therefore, they must always be dispensed in the original container provided by the manufacturer.

According to USP Packaging and Storage Requirements and Mosby’s Pharmacy Technician:

“Nitroglycerin SL tablets lose potency quickly when exposed to air or light. Do not repackage; dispense only in manufacturer-supplied container.”

Other options do not require original container for stability:

Methotrexate – may be repackaged

Metoprolol XL – stable in unit-dose or amber vials

Allopurinol – routine packaging allowed

AClass I recallis themost seriousrecall issued when amedication labeling erroror contaminationcould result in serious harm or death.

Enoxaparin (Lovenox)is ananticoagulant, whilephytonadione (Vitamin K1)is anantidote for warfarin toxicity—confusing these could lead to life-threatening bleeding or clotting issues.

TheFDA mandates an immediate Class I recallfor errors that could causefatal outcomes.

Why Other Options Are Incorrect:

B. Class II?❌Used formoderate health risks(e.g., subpotent drugs).

C. Class III?❌Used forminor errors(e.g., misprinted labels, minor defects).

D. Misbranding?❌Misbranding is a regulatory issue butnot a recall classification.

????Reference:FDA Drug Recall Guidelines, ISMP Medication Safety Alerts.

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).

Isotretinoin (Absorica, Claravis, etc.) is subject to a REMS program called iPLEDGE, required by the FDA to prevent fetal exposure due to high risk of teratogenicity. Female patients of reproductive age must:

Use two forms of contraception

Take monthly pregnancy tests

Receive special counseling and consent

From FDA REMS Guidelines:

“Isotretinoin is subject to a REMS program (iPLEDGE) due to its known, serious risk of severe birth defects if taken during pregnancy.”

Other options:

Clotrimazole – Antifungal, OTC and Rx; no REMS

Amitriptyline – Tricyclic antidepressant; no REMS

Tamsulosin – Used for BPH; no REMS

Filgrastim (Neupogen) injection is a refrigerated biologicthat must be storedbetween 2°C and 8°C (36°F–46°F).

Other optionscan be stored at room temperature.

????Reference:USP Refrigeration Guidelines, Manufacturer Storage Instructions.

ANarrow Therapeutic Index (NTI) drugis a medication in whichsmall differences in dose or blood concentrationcan lead to serioustoxicityorsubtherapeutic effects. These drugs requirecareful dosing and monitoringto avoid adverse effects or treatment failure.

Small Margin of Safety:The difference between theminimum effective concentration (MEC)and theminimum toxic concentration (MTC)is very narrow.

Requires Therapeutic Drug Monitoring (TDM):Blood levels of the drug must be regularly monitored to maintain efficacy while avoiding toxicity.

High Risk of Adverse Effects:Even minor dosage adjustments or variations in patient metabolism can cause toxicity.

Strict Pharmacokinetic and Pharmacodynamic Considerations:Factors likerenal and hepatic function, drug interactions, and patient weightsignificantly impact the drug’s effect.

Warfarin (Coumadin) → Risk of bleeding.

Digoxin → Risk of toxicity affecting the heart.

Phenytoin → Risk of severe neurological effects.

Levothyroxine → Risk of under- or over-treatment of thyroid disorders.

Theophylline → Risk of respiratory or cardiac toxicity.

Carbamazepine → Risk of serious neurological side effects.

A. Shorter window of guaranteed stability.→ Incorrect. NTI drugs do not necessarily have a shorter shelf-life or stability concerns compared to other drugs. Stability depends on formulation and storage conditions.

B. Incompatibility with therapeutic monitoring.→ Incorrect. NTI drugsrequiretherapeutic monitoring, not the opposite.

C. Synergistic effect on other medications.→ Incorrect. While NTI drugs can interact with other drugs, not all exhibit a synergistic effect (where combined drugs produce a greater effect than expected).

PTCB PTCE Exam Content Outline – Medication Safety and Quality Assurance(Monitoring NTI drugs).

FDA Narrow Therapeutic Index Drug List(Guidelines on NTI medications).

Lexicomp and Micromedex Drug Databases(Provide monitoring recommendations for NTI drugs).

USP <800> Hazardous Drugs and USP <797> Sterile Compounding Guidelines(Ensure safe handling and dispensing of NTI drugs).

Mosby’s Pharmacy Technician: Principles and Practice(NTI drug classification and monitoring).

Key Characteristics of NTI Drugs:Examples of NTI Drugs:Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

To determine theweight/weight (w/w) percentage strength, use the formula:

\text{w/w % strength} = \left( \frac{\text{Mass of Active Ingredient (g)}}{\text{Total Mass of Final Product (g)}} \right) \times 100

Given:

Mass of zinc oxide (active ingredient) = 4.5 g

Total mass of final ointment = 30 g

\text{w/w % strength} = \left( \frac{4.5}{30} \right) \times 100 =0.15×100= 0.15 \times 100=0.15×100 =15%= 15\%=15%

(A) 0.25%❌Incorrect – This is too low.

(B) 10%❌Incorrect – This would be true if 3 g of zinc oxide were used in 30 g total.

(C) 15%✅Correct – The calculation confirms this answer.

(D) 17.5%❌Incorrect – This would be true if 5.25 g of zinc oxide were used in 30 g total.

Pharmaceutical Calculations, 15th Edition– Howard C. Ansel

The United States Pharmacopeia (USP) Chapter <795>– Compounding Non-Sterile Preparations

PTCB Exam Content Outline – Pharmaceutical Calculations

Analysis of Answer Choices:References for Pharmacy Technicians:

Risperdal Consta (risperidone long-acting injection) is an antipsychotic medication used to treat schizophrenia and bipolar disorder. It is supplied as a powder that must be reconstituted with a diluent before administration as an intramuscular (IM) injection.

According to the manufacturer’s storage guidelines:

Refrigeration Requirement:Risperdal Consta should be stored in a refrigerator (36°F to 46°F or 2°C to 8°C) to maintain stability.

Room Temperature Stability:If removed from refrigeration, Risperdal Consta can remain stable at room temperature (≤77°F or 25°C)for up to 14 days. After this period, the product should not be used if it has not been administered.

This stability information is critical for pharmacy technicians handling the medication, as it ensures proper storage and prevents medication degradation, which can affect efficacy and safety.

Risperdal Consta (Janssen Pharmaceuticals) Prescribing Information– Official manufacturer guidelines.

PTCB PTCE Exam Content Outline – Medication Storage and Stability– Covers best practices for proper drug storage and handling.

United States Pharmacopeia (USP) Standards– Guidelines on temperature control for pharmaceutical products.

Pharmacy Technician References:This information is essential for pharmacy technicians preparing Risperdal Consta for dispensing or administration, ensuring compliance with manufacturer and regulatory guidelines.

Comprehensive and Detailed Step-by-Step Explanation:

The abbreviation "PR" stands for "per rectum", which is a route of administration where the medication is inserted into the rectum for absorption.

????Explanation of Answer Choices:

✅A. Route of administration → Correct. "PR" means rectal administration (e.g., suppositories).

❌B. Frequency of dosing → Incorrect. Frequency abbreviations include BID (twice daily), QD (once daily), etc.

❌C. Medication strength → Incorrect. Strength is indicated by mg, mcg, etc.

❌D. Dosage form → Incorrect. Dosage forms include tablets, capsules, solutions, etc.

????Reference:

ISMP List of Common Prescription Abbreviations

PTCB Exam: Medication Order Interpretation

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

Comprehensive and Detailed Step-by-Step Explanation:

Shingrix (Zoster Vaccine Recombinant)must be stored in therefrigerator (2°C to 8°C / 36°F to 46°F)and shouldnever be frozen.

????Explanation of Answer Choices:✅C. Shingrix that was stored in a freezer→Correct.Shingrixloses potencywhen frozen.❌A. Boostrix (Tdap) stored in a refrigerator→ Incorrect.Proper storage condition.❌B. Havrix (Hepatitis A vaccine) stored in a refrigerator→ Incorrect.Proper storage condition.❌D. Varivax (Varicella vaccine) stored in a freezer→ Incorrect.Varivax must be stored frozen (-50°C to -15°C).

????Reference:

CDC Vaccine Storage & Handling Guidelines

USP <1079>: Vaccine Storage

Withdrawal occurs when a drug-dependent individual stops taking the drug abruptly, leading to physiological symptoms.

Example:Opioid withdrawal can cause nausea, sweating, and tremors.

Withdrawal differs from addiction, which involvescompulsive drug-seeking behavior.

????Reference:DEA Controlled Substance Abuse Guide, PTCE MedicationSafety Guidelines.

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

Bupropion (Wellbutrin, Zyban) requires a Medication Guide due to risks of suicidal thoughts and neuropsychiatric effects.

Medication Guides are FDA-required leaflets given with specific medications that have serious risks.

Examples of Medications Requiring a Medication Guide:

Antidepressants (e.g., SSRIs, SNRIs, bupropion) → Suicide risk

NSAIDs → GI bleeding risk

Opioids → Addiction risk

Fluoroquinolones → Tendon rupture risk

????Reference:FDA Medication Guide Requirements, ISMP Patient Safety Guidelines.

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.

TheInstitute for Safe Medication Practices (ISMP)maintains a list oferror-prone abbreviationsthat shouldnot be usedin medication orders to prevent misinterpretation and medication errors.

Analysis of the Answer Choices:Abbreviation

Meaning

ISMP Recommendation

U

Units

❌Do NOT use→ Can be mistaken for "0" or "4" (e.g., 10U could be misread as 100).Use"unit"instead.

AD

Right ear

❌Do NOT use→ Can be confused with "OD" (right eye).Use"right ear"instead.

AU

Both ears

❌Do NOT use→ Can be confused with "OU" (both eyes).Use"both ears"instead.

gtt

Drop

✅Accepted→ Common and not considered error-prone.

Since"gtt" for drop is not on ISMP's "Do Not Use" list, it is the correct answer.

ISMP List of Error-Prone Abbreviations– Confirms that "U," "AD," and "AU" should not be used in prescriptions.

Joint Commission "Do Not Use" List– Prohibits "U" and similar abbreviations to prevent dosing errors.

PTCB PTCE Exam Content Outline– Covers error prevention strategies, including abbreviation safety.

Key References:

NTI drugs have small differences between effective and toxic doses.

Examples:Warfarin, Digoxin, Lithium, Theophylline.

Requires close monitoring (lab tests, dose adjustments).

????Reference:FDA NTI Drug List, PTCB Medication Safety Guidelines.

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

Linaclotide (brand name: Linzess)must be dispensed in its original containerbecause:

It is highly moisture-sensitive, and removing it from its original container may lead to degradation.

The manufacturer provides a desiccantin the original packaging toprotect against humidity.

A. Furosemide❌→Does not require original container.

While furosemide tablets should be stored properly,they do not require dispensing in the original container.

C. Valsartan❌→Does not require original container.

Valsartan tablets arestable outside the original container.

D. Sertraline❌→Does not require original container.

Sertraline (Zoloft)can be repackagedwithout stability issues.

FDA Linzess Storage Guidelines– States that Linzessmust be stored in its original container with desiccant.

USP <797> & <800> Guidelines– Cover proper storage and handling of moisture-sensitive drugs.

PTCB PTCE Exam Content Outline– Includes special drug storage requirements.

Why Not the Other Options?Key References:

Comprehensive and Detailed Step-by-Step Explanation:

Hospitals mayredispenseunopened, sealed, unit-dose medicationsreturned frominpatients, as long as they areproperly storedand not tampered with.

????Explanation of Answer Choices:✅C. Unopened units-of-use returned from inpatients may be redispensed→Correct.Hospital pharmacies canredispense sealed unit-dose medications from inpatients.❌A. Unlabeled medications may be dispensed by the nurse at discharge→ Incorrect.Unlabeled meds cannot be dispensed due to safety concerns.❌B. Unopened units-of-use returned from outpatients may be redispensed→ Incorrect.Medications dispensed to outpatients cannot be returned to stock.❌D. Crediting of unused doses is not feasible→ Incorrect.Many hospitals have systems for crediting unused doses.

????Reference:

USP <795> and <797>: Hospital Medication Storage

PTCB Medication Safety Regulations

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

Total daily dose = 23 units (AM) + 17 units (PM) = 40 units/day

60 days × 40 units = 2,400 units needed

Each NPH insulin vial contains 1,000 units (10 mL × 100 units/mL)

2,400 units ÷ 1,000 units/vial = 2.4 vials → round up to 3 vials

From Pharmacy Technician Certification Exam Review:

“When calculating insulin quantities, always round up to ensure the patient has sufficient supply. Insulin is typically dispensed in 10 mL vials containing 100 units/mL.”

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:

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:

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

When abody area is exposed to a hazardous substance, thefirst actionshould be tothoroughly flush the area with watertoimmediately remove the contaminantand reduce absorption into the skin.

Flush the affected area with water for at least 15 minutes.

Remove contaminated clothing.

Seek medical attention if needed.

Report the incident to the pharmacy manager.

A. Notify the pharmacy manager→ Incorrect;the immediate priorityis to flush the area.Reporting comes after decontamination.

C. Call environmental services for cleanup→ Incorrect; personal exposure should be addressed before worrying about cleanup.

D. Go to the emergency department→ Incorrect; first aid (flushing with water) should beperformed immediatelybefore seeking additional care if necessary.

Proper Emergency Response:Other Answer Choices Explained:References:

USP <800> Guidelines for Handling Hazardous Drugs

OSHA (Occupational Safety and Health Administration) Hazardous Substance Exposure Protocols

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

Multiple-dose vials (MDVs)containpreservativesto inhibit microbial growth. These vials are designed formultiple withdrawalsover time, increasing the risk of contamination. Preservatives, such asbenzyl alcohol or phenol, help prevent bacterial or fungal contamination after repeated needle insertions.

A. stability and compatibility→ Incorrect. Preservatives do not inhibit drug stability; they prevent microbial contamination.

B. sorption and leaching→ Incorrect. Sorption (adsorption/absorption of drugs onto container surfaces) and leaching (release of chemicals from containers) are unrelated to preservatives.

D. synergistic reactions→ Incorrect. Synergistic reactions refer to drug interactions, not contamination prevention.

Incorrect Answer Choices:Pharmacy Technician References:

PTCB PTCE Exam Content Outline (Sterile and Non-Sterile Compounding)

USP <797> Guidelines for Sterile Compounding

American Society of Health-System Pharmacists (ASHP) Guidelines on Multiple-Dose Vials

Mosby’s Pharmacy Technician Exam Review

Comprehensive and Detailed Step-by-Step Explanation:

Procardiais thebrand name for Nifedipine, acalcium channel blocker (CCB)used totreat hypertension and angina.

????Explanation of Answer Choices:✅A. Nifedipine→Correct.Procardia = Nifedipine.❌B. Felodipine→ Incorrect.Another CCB, but not the generic for Procardia.❌C. Diltiazem→ Incorrect.A different CCB (Cardizem).❌D. Amlodipine→ Incorrect.A CCB (Norvasc), but not the generic for Procardia.

????Reference:

FDA Orange Book

PTCB Exam: Generic & Brand Name Medications

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.

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:

Maximum dose: 2 tabs twice daily (4 tabs/day).

20 tabs ÷ 4 per day = 5 days.

????Reference:PTCB Pharmacy Dosage Calculations.

Dilution formula:C₁V₁ = C₂V₂

C₁ = 20%, V₁ = 100 mL, C₂ = 2%

(20)(100) = (2)(V₂) → V₂ = 1000 mL(final volume after dilution).

Convert to oz:1000 mL ÷ 59 mL (2 oz) = 16 bottles.

????Reference:PTCE Pharmacy Dilution Calculations, USP <795> Guidelines.

USP <800> mandates that personal protective equipment (PPE) be worn when handling hazardous drug spillsto protect againstinhalation, skin absorption, or accidental ingestion.

Full PPE includes gloves, gowns, eye protection, and respiratory protection when necessary.

????Reference:USP <800> Hazardous Drug Handling Guidelines.

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.”

Look-alike/sound-alike (LASA) medications are drugs that areeasily confused due to similar spelling or pronunciation, which increases the risk of medication errors.

Citalopram(Celexa) →Selective serotonin reuptake inhibitor (SSRI) used for depression

Celecoxib(Celebrex) →Nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation

Why Are Citalopram and Celecoxib Considered LASA?Both drugs sharesimilar spelling and pronunciation, increasing the chance of errors inprescribing, dispensing, and administration.

Example of potential errors: A patient withdepressionmay mistakenly receiveCelecoxib (NSAID)instead ofCitalopram (antidepressant), leading to untreated depression and unnecessary NSAID use.

A. Lisinopril and Metoprolol❌→Different drug classes, butnot commonly confused.

Lisinopril(ACE inhibitor for blood pressure)

Metoprolol(Beta-blocker for blood pressure and heart conditions)

C. Acebutolol and Acetazolamide❌→Although their names look similar, they haveless common confusion in clinical practice.

Acebutolol(Beta-blocker)

Acetazolamide(Diuretic for glaucoma, altitude sickness)

D. Naproxen and Misoprostol❌→These are oftenprescribed togetherbut arenot confused with each other.

Naproxen(NSAID for pain)

Misoprostol(Used to protect the stomach from NSAID-induced ulcers)

Institute for Safe Medication Practices (ISMP) LASA List– ConfirmsCitalopram and Celecoxibas common look-alike/sound-alike drugs.

PTCB PTCE Exam Content Outline– Covers error prevention strategies, including LASA medications.

FDA Medication Error Prevention Guidelines– Recommends usingTall Man Lettering(e.g.,CeleXib vs. CitaloPram) to differentiate LASA drugs.

Why Not the Other Options?Key References:

Linagliptin is thegeneric name for Tradjenta, a medication used to treattype 2 diabetes mellitus.

Linagliptin is a DPP-4 inhibitor (Dipeptidyl Peptidase-4 Inhibitor).

Works byincreasing incretin levels, which boost insulin secretion and reduce glucagon levels.

Used tolower blood glucose levelsin patients with type 2 diabetes.

(A) Forteo❌Incorrect – Forteo (teriparatide) is for osteoporosis.

(B) Januvia❌Incorrect – Januvia (sitagliptin) is another DPP-4 inhibitor but not the same as Tradjenta.

(C) Tradjenta✅Correct – The brand name for linagliptin.

(D) Xarelto❌Incorrect – Xarelto (rivaroxaban) is an anticoagulant.

Tradjenta Prescribing Information (FDA):https://www.tradjenta.com

American Diabetes Association (ADA) – Pharmacologic Approaches to Diabetes Management:https://diabetesjournals.org

PTCB Exam Content Outline – Brand & Generic Name Drug Recognition

Drug Classification & Mechanism:Analysis of Answer Choices:References for Pharmacy Technicians:

Comprehensive and Detailed Step-by-Step Explanation:

To find how muchmentholis needed:

(0.25100)×600g=1.5g=1500mg\left( \frac{0.25}{100} \right) \times 600 g = 1.5 g = 1500 mg(1000.25​)×600g=1.5g=1500mg

????Explanation of Answer Choices:✅C. 1500 mg→Correct.0.25% of 600 g = 1500 mg.❌A. 15 mg→ Incorrect.Calculation error.❌B. 150 mg→ Incorrect.Incorrect decimal placement.❌D. 15 g→ Incorrect.Overestimated.

????Reference:

USP <795>: Pharmaceutical Compounding – Nonsterile Preparations

PTCB Exam: Pharmaceutical Calculations

Pantoprazole (Protonix)is aproton pump inhibitor (PPI)that isonly available by prescriptionfor treatingGERD, Zollinger-Ellison syndrome, and peptic ulcers.

Omeprazole (Prilosec), Lansoprazole (Prevacid), and Esomeprazole (Nexium)are availableOTC and by prescriptionin different strengths.

Prescription PPIsare typically higher strength than OTC versions.

????Reference:FDA Drug Approvals for OTC and Prescription PPIs.

1 oz = 30 mL

4 oz × 30 mL = 120 mL

????Reference:PTCE Pharmacy Conversions Guide.

According toCDC Hand Hygiene Guidelines, pharmacy technicians should wash their hands withsoap and waterinstead of alcohol-based hand sanitizer when:

Hands are visibly dirty→ Alcohol-based sanitizers are ineffective against certain contaminants like dirt, grease, and some bacteria.

Before eating→ Prevents ingestion of harmful pathogens.

After using the restroom→ Soap and water are required to remove potential fecal contamination.

A. They have time, before eating, and after eating❌→Incorrect

Handwashing ismandatorywhen hands are dirty or after using the restroom, not just when there's time.

B. Their hands are visibly clean, after eating, and before each patient❌→Incorrect

Washing isnot required if hands appear clean—sanitizer is acceptable in most situations except when visibly soiled.

C. They have finished filling prescriptions, before eating, and after each patient❌→Incorrect

Hand hygiene is important, but hand sanitizer is typically used between patients unless hands are visibly dirty.

CDC Hand Hygiene in Healthcare Settings– Recommendssoap and waterfor visibly soiled hands and after restroom use.

USP <797> Guidelines for Aseptic Technique– Emphasizes proper handwashing for sterile compounding.

PTCB PTCE Exam Content Outline– Covers infection control and hand hygiene protocols.

Why Not the Other Options?Key References:

Comprehensive and Detailed Step-by-Step Explanation:

Pseudoephedrine(Sudafed) is asympathomimetic decongestantthat causesvasoconstrictionand canincrease blood pressure.

????Explanation of Answer Choices:✅B. Hypertension→Correct.Pseudoephedrinecan cause arise in blood pressure, so it should be used cautiously in patients withhypertension.❌A. Asthma→ Incorrect.Pseudoephedrine does not directly worsen asthma, but it may cause mild bronchodilation.❌C. Hypokalemia→ Incorrect.Pseudoephedrine does not affect potassium levels.❌D. Eczema→ Incorrect. Eczema is unrelated topseudoephedrine use.

????Reference:

Combat Methamphetamine Epidemic Act (CMEA) Regulations

American Heart Association (AHA) Guidelines on Hypertension

Prilosec (omeprazole) is a PPIused to reduce stomach acid forGERD and ulcers.

????Reference:FDA PPI Drug Classification Guide.

Arexvyis anRSV (respiratory syncytial virus) vaccinefor adults60+ years.

Oncereconstituted, itmust be used within 4 hoursto ensurestability and potency.

After4 hours, bacterial growth andloss of vaccine efficacymake it unsafe for administration.

Why Other Options Are Incorrect:

A. 30 minutes?❌Too short—vaccines are stable for a longer duration.

C. 24 hours?❌Too long—Arexvy degrades faster.

D. 1 week?❌No vaccine remains effective for 7 days after reconstitution.

????Reference:CDC Vaccine Storage & Handling Guidelines,Arexvy Manufacturer Labeling (GSK).

Lisinopril is anangiotensin-converting enzyme (ACE) inhibitor, commonly used forhypertension (high blood pressure)andheart failure. A well-known side effect of ACE inhibitors is apersistent dry, hacking cough.

The cough is caused bybradykinin accumulation, which occurs due to ACE inhibition.

This coughdoes not respond to cough suppressantsand can be bothersome for patients.

If the cough is severe, thepharmacist may recommend switching to an angiotensin II receptor blocker (ARB) such as losartan, which does not cause this side effect.

B. Purchase fexofenadine for seasonal allergies❌→ No significant interaction between lisinopril and fexofenadine.

C. Mention that they have lowered their cholesterol❌→ Cholesterol levels do not affect lisinopril’s mechanism of action.

D. Report that their blood pressure has been normal lately❌→ This is expected with effective treatment and does not require pharmacist intervention unless the patient wants to discontinue the medication.

PTCB PTCE Exam Content Outline– Covers drug interactions, side effects, and patient counseling.

American Heart Association (AHA) Guidelines– Lists ACE inhibitor side effects, including dry cough.

FDA Lisinopril Medication Guide– Mentions dry cough as a common adverse effect requiring pharmacist consultation.

Why is the Cough Significant?Why Not the Other Options?Key References:

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.

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

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.

AUstands for"auris utraque", meaning"both ears".✅

Sig codes (Signa codes)are abbreviations used in prescriptions to indicate how a medication should be taken or applied.

Why Other Options Are Incorrect:

q.s. (quantum satis):Means "a sufficient quantity," NOT"shake well."❌

IN:Refers tointranasal, NOTintramuscular (IM).❌

q.i.d. (quater in die):Means"four times a day,"NOT"three times a day".❌

????Reference:PTCB Official Sig Code List,Institute for Safe Medication Practices (ISMP) Approved Abbreviations.

Pharmacy technicians must notify the pharmacistimmediatelyif a patient has an allergy to a prescribed medication.Dispensing an allergenic drug could cause severe reactions, including anaphylaxis.

Check for allergies and drug interactionsin the patient’s profile.

Alert the pharmacistif an allergy is detected.

Ensure proper labelingfor allergy warnings.

(A) To obtain the patient’s medication history❌Incorrect – Technicians can review medication history, but pharmacists must intervene forallergies or significant concerns.

(B) If the patient is allergic to the prescribed medication✅Correct – An allergy could be life-threatening and requires pharmacist intervention.

(C) To clarify the date and time of the order❌Incorrect – Technicians can check the order date, but this is not a critical pharmacist intervention.

(D) If a patient has never taken the prescribed medication before❌Incorrect – Whilefirst-time medication use requires counseling, it does not always require pharmacist intervention unless there aredrug interactions, high-risk medications, or allergies.

Institute for Safe Medication Practices (ISMP) – Allergy Checking Protocols:https://www.ismp.org

PTCB Exam Content Outline – Medication Order Processing & Pharmacist Consultation

Key Responsibilities of a Pharmacy Technician in Medication Order Entry:Analysis of Answer Choices:References for Pharmacy Technicians:

Zyrtec (cetirizine)is asecond-generation antihistamineused to treatallergies.

Schizophreniais a psychiatric disorder treated withantipsychotics, NOT antihistamines.

This is likely aLook-Alike Sound-Alike (LASA) error, where the intended drug wasZyprexa (olanzapine), anantipsychoticcommonly used for schizophrenia.

The technician must alert the pharmacist before dispensing.

Why Other Options Are Incorrect:

A. Special Handling?❌No, Zyrtec is OTC and does not require special handling.

B. Exceeding Daily Dose?❌No, Zyrtec’s max daily dose is 10 mg for adults.

D. REMS Program?❌No, Zyrtec is not part of aRisk Evaluation and Mitigation Strategy (REMS) program.

????Reference:ISMP’s LASA Drug List,FDA Drug Labeling Guidelines.

Asmanex HFA (Mometasone) is an inhaled corticosteroid used for asthma.

A spacer improves medication delivery by holding the medication in a chamber, allowing better lung absorption.

This is especially important for children and elderly patients.

Why Other Options Are Incorrect:

A. Nebulizer?❌Not needed for an HFA inhaler; used for liquid medications.

C. Ventilator?❌Used for mechanical breathing, not asthma maintenance.

D. Glucometer?❌Used for blood sugar monitoring, unrelated to inhalers.

????Reference:Global Initiative for Asthma (GINA) Guidelines, PTCB Respiratory Medication Guidelines.

Methotrexateis achemotherapy agentand animmunosuppressantused for cancer and autoimmune diseases.

It is classified ashazardous pharmaceutical wasteunderResource Conservation and Recovery Act (RCRA)due to itstoxicity.

It must be disposed of followingEPA guidelines for hazardous waste disposal.

????Reference:RCRA hazardous waste disposal regulations;USP <800> guidelines for hazardous drugs.

Outdated (expired) medicationsmust not be dispensedand should bequarantinedin a separate area to prevent accidental use.

Remove outdated products from active stock immediately.

Label and store them separatelyuntil proper disposal.

Follow DEA, FDA, and state board guidelines for disposal.

Some medications (e.g., controlled substances) require special disposal procedures.

(A) Shipped to the DEA for disposal❌Incorrect – Only controlled substances require DEA disposal (viaReverse Distributor).

(B) Kept on the shelf to be dispensed first❌Incorrect – Expired medications should NEVER be dispensed.

(C) Isolated from active dispensing stock✅Correct – Medications must be separated from usable stock to prevent dispensing errors.

(D) Reported to the ISMP for tracking❌Incorrect – ISMP (Institute for Safe Medication Practices) monitors medication errors, not expiration management.

FDA Drug Disposal Guidelines: https://www.fda.gov/drugs/disposal-unused-medicines

DEA Controlled Substance Disposal Regulations: https://www.deadiversion.usdoj.gov

PTCB Exam Content Outline – Inventory Management & Drug Disposal

Pharmacy Technician Guidelines for Handling Expired Medications:Analysis of Answer Choices:References for Pharmacy Technicians:

St. John's Wort (Hypericum perforatum)is anherbal supplementcommonly used formild to moderate depression.

Containshypericin and hyperforin, which may increaseserotonin, dopamine, and norepinephrinelevels.

Often used as analternative treatment for depression, but not FDA-approved for this indication.

Hasserious drug interactions, including withantidepressants (SSRIs, SNRIs), warfarin, oral contraceptives, and cyclosporine.

(A) Immune enhancer❌Incorrect – Not primarily used to boost the immune system.

(B) Mild antidepressant✅Correct – Used for mild depression.

(C) Antioxidant❌Incorrect – While it has some antioxidant properties, this is not its primary use.

(D) Antihypertensive❌Incorrect – It does not lower blood pressure.

National Center for Complementary and Integrative Health (NCCIH) – St. John’s Wort:https://www.nccih.nih.gov/

MedlinePlus – St. John's Wort Drug Interactions:https://medlineplus.gov

PTCB Exam Content Outline – Herbal Supplements & Drug Interactions

How St. John’s Wort Works:Analysis of Answer Choices:References for Pharmacy Technicians:

Comprehensive and Detailed Step-by-Step Explanation:

Corticosteroidsare a class of medications used toreduce inflammation.Fluocinoloneis atopical corticosteroidused foreczema, psoriasis, and allergic reactions.

????Explanation of Answer Choices:✅B. Fluocinolone→Correct.Fluocinolone is a corticosteroidused in skin conditions.❌A. Progesterone→ Incorrect.Progesterone is a hormone, not a corticosteroid.❌C. Methyltestosterone→ Incorrect.Methyltestosterone is an androgen (male hormone).❌D. Spironolactone→ Incorrect.Spironolactone is a potassium-sparing diuretic, not a steroid.

????Reference:

FDA Drug Classification Database

USP Drug Information Handbook

The axilla refers to the underarm area. Clobetasol is a high-potency corticosteroid, and such steroids are not recommended for use on thin-skinned areas like the face, groin, or underarms (axilla) due to risk of increased absorption and adverse effects like skin atrophy.

Mosby’s Pharmacy Technician: Principles and Practice explains:

“High-potency corticosteroids should not be applied to intertriginous areas such as the axilla, groin, or face due to increased absorption and systemic risk.”

Comprehensive and Detailed Step-by-Step Explanation:

Stock rotation (First In, First Out - FIFO)ensures thatolder medications are used before newer stock, reducing expired medication dispensing.

????Explanation of Answer Choices:✅C. Rotating stock on a regular basis→Correct.FIFO method reduces waste and errors.❌A. Verifying each lot number→ Incorrect.Lot numbers do not indicate expiration dates.❌B. Using the newest medications first→ Incorrect.Older stock should be used first.❌D. Using the last in, first out method→ Incorrect.Opposite of the correct practice.

????Reference:

USP <1079>: Medication Storage and Inventory Control

PTCB Exam: Inventory Management

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.

A vaccine administration error occurs when a vaccine is given in a way that deviates from standard guidelines established by the Centers for Disease Control and Prevention (CDC) and the vaccine manufacturer’s recommendations. Some administration errors must be reported voluntarily to theVaccine Adverse Event Reporting System (VAERS)to help improve vaccine safety and prevent future errors.

(A) Fluzone was administered subcutaneously.✅(Incorrect Route – Error that Should Be Reported)

Fluzone is aninactivated influenza vaccine (IIV)that should be administeredintramuscularly (IM).

Subcutaneous (SQ) administration isnot recommendedand may reduce vaccine efficacy.

According to theCDC and the Immunization Action Coalition (IAC), administering an inactivated influenza vaccine subcutaneously is a vaccine administration error and should be reported.

(B) Boostrix was administered intramuscularly.❌(Correct Route – No Error)

Boostrix is aTdap (Tetanus, Diphtheria, and Acellular Pertussis) vaccineindicated for booster immunization.

It iscorrectly administered intramuscularly (IM)in thedeltoid muscle.

Since the correct administration route was followed, this does not qualify as a vaccine administration error.

(C) Varivax was administered subcutaneously.❌(Correct Route – No Error)

Varivax is alive-attenuated varicella (chickenpox) vaccine.

It iscorrectly administered subcutaneously (SQ), typically in the upper arm or thigh.

Since the correct administration route was followed, this is not a vaccine administration error.

(D) Shingrix was administered intramuscularly.❌(Correct Route – No Error)

Shingrix is arecombinant zoster vaccine (RZV)used for shingles prevention.

It should be administeredintramuscularly (IM).

Since the correct administration route was followed, this is not a vaccine administration error.

TheInstitute for Safe Medication Practices (ISMP)and theCDCrecommend reportingvaccine administration errorsto VAERS, especially if the error could affect the vaccine’s efficacy or patient safety.

Administration of Fluzonevia the incorrect route (subcutaneously instead of intramuscularly)could alter immune response and should be reported.

If a vaccine is given via the incorrect route, the CDC provides guidance on whether the dose needs to be repeated. For inactivated influenza vaccines given subcutaneously, the CDC states that the dose doesnot need to be repeated, but the error should still be documented and reported.

CDC General Best Practices for Immunization:https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

Vaccine Adverse Event Reporting System (VAERS): https://vaers.hhs.gov/

Immunization Action Coalition (IAC) - Vaccine Administration Guidelines: https://www.immunize.org/technical-support/administering-vaccines/

Institute for Safe Medication Practices (ISMP) - Vaccine Safety Recommendations: https://www.ismp.org/recommendations/immunization-safety

Analysis of Each Answer Choice:Reporting Vaccine Administration Errors:References for Pharmacy Technicians:

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