PTCE Pharmacy Technician Certification (CPhT) Exam Questions and Answers

Comprehensive and Detailed Step-by-Step Explanation:

Levetiracetam (Keppra)is classified as ananticonvulsantused to treatseizures (epilepsy).It works by stabilizing electrical activity in the brain.

????Explanation of Answer Choices:✅C. Anticonvulsant→Correct. Levetiracetam is indicated forpartial-onset, myoclonic, and tonic-clonic seizures.❌A. Antibiotic→ Incorrect. Levetiracetam does not treat bacterial infections.❌B. Antihyperglycemic→ Incorrect. Antihyperglycemics lowerblood sugar(e.g., metformin, glipizide).❌D. Antihypertensive→ Incorrect. Antihypertensives lowerblood pressure(e.g., amlodipine, lisinopril).

????Reference:

PTCB Exam: Pharmacology for Technicians

FDA Approved Drug Database (Levetiracetam)

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.

Outdated (expired) medicationsmust not be dispensedand should bequarantinedin a separate area to prevent accidental use.

Remove outdated products from active stock immediately.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:

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.

1 pint =473 mL(since 1 pint = 16 fluid ounces, and 1 fluid ounce = 29.5735 mL).A1% suspensionmeans1 g (1000 mg) of rifampin per 100 mLof suspension.

Total dose required:2 tbsp daily =30 mL per day(1 tbsp = 15 mL).

Total volume of the suspension:473 mL

Total rifampin required:(473 mL × 1000 mg) ÷ 100 mL =4730 mg

Each rifampin capsule contains300 mg.So,4730 mg ÷ 300 mg/capsule = 15.77 capsules, which rounds up to16 capsules.

Thus, the correct answer isC. 32 capsules(since the full pint must be compounded).

????Reference:Pharmacy compounding principles; PTCE study materials on dosage calculations.

Thevaricella (chickenpox) vaccine(brand nameVarivax) is alive attenuated virus vaccinethat requiresfreezingto maintain stability.

TheCDC and manufacturers (Merck) require that Varicella vaccine be stored in a freezer at:

Temperature range: -50°C to -15°C (-58°F to +5°F)

Acceptable range:-20°C to -10°C (-4°F to 14°F)

Do NOT store in the refrigerator–Refrigeration deactivates the live virus, making the vaccine ineffective.

Store in a stand-alone freezer(not in a refrigerator/freezer combo) to ensure temperature stability.

B. In the refrigerator (2°C to 8°C/36°F to 46°F)❌→Incorrect.

Refrigerationcompromises the vaccine’s potency, leading to inactivation of the live virus.

C. At room temperature (15°C to 30°C/59°F to 86°F)❌→Incorrect.

Room temperature storage causes rapid degradation of the live virus, rendering the vaccine ineffective.

D. In a warmer (30°C to 40°C/86°F to 104°F)❌→Incorrect & Unsafe.

Thisdestroysthe vaccine and makes it completely ineffective.

Centers for Disease Control and Prevention (CDC) Vaccine Storage and Handling Guidelines– States that varicella vaccinesmust be stored in the freezer at -50°C to -15°C (-58°F to +5°F).

Manufacturer (Merck) Guidelines for Varivax– Specifies strict freezer storage requirements.

USP <797> & USP <800> Guidelines– Discuss vaccine stability and proper storage conditions.

PTCB PTCE Exam Content Outline– Covers vaccine storage and handling protocols.

Proper Long-Term Storage Conditions for Varicella VaccineWhy Not the Other Options?Key References:

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.

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

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

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

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

Other Answer Choices Explained:References:

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

Lexicomp Drug Monographs for Desvenlafaxine and Venlafaxine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

ARisk Evaluation and Mitigation Strategy (REMS)program is required by theFDAfor certain medications that have serious safety concerns, ensuring their risks do not outweigh their benefits.Mycophenolateis subject to a REMS program due to its severe teratogenic effects.

(A) Sertraline❌Not Subject to REMS

Sertraline (Zoloft) is aSelective Serotonin Reuptake Inhibitor (SSRI)used to treat depression and anxiety.

While SSRIs can carry arisk of birth defects (such as persistent pulmonary hypertension in newborns - PPHN),sertraline is not included in the REMS program.

(B) Ondansetron❌Not Subject to REMS

Ondansetron (Zofran) is anantiemeticused to prevent nausea and vomiting.

While some studies suggest a possible increased risk of congenital defects, it isnot part of a REMS program.

(C) Montelukast❌Not Subject to REMS

Montelukast (Singulair) is aleukotriene receptor antagonist (LTRA)used forasthma and allergies.

It has aBoxed Warningfor mental health side effects butis not subject to a REMS program for pregnancy risks.

(D) Mycophenolate✅Correct – Subject to REMS

Mycophenolate (CellCept, Myfortic)is animmunosuppressantused to prevent organ rejection in transplant patients.

It carries ahigh risk of birth defects and miscarriage, making pregnancy preventionmandatorywhile taking the medication.

TheMycophenolate REMS Programrequires:

Mandatory counselingon pregnancy risks

Negative pregnancy testsbefore starting therapy

Use of effective contraceptionbefore, during, and after treatment

FDA REMS Program for Mycophenolate:https://www.mycophenolaterems.com/

FDA REMS Program Overview: https://www.fda.gov/drugs/risk-evaluation-and-mitigation-strategies-rems

PTCB Exam Content Outline – Medication Safety & Risk Management

Analysis of Answer Choices:References for Pharmacy Technicians:

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.

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

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

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

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

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

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

Brand Name

Atorvastatin

Lipitor✅

Simvastatin

Zocor

Pravastatin

Pravachol

Fluvastatin

Lescol

Rosuvastatin

Crestor

Lovastatin

Mevacor

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

PTCB Exam Content Outline – Generic & Brand Name Drug Recognition

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

References for Pharmacy Technicians:

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

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

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

Therefore, the injection that must be refrigerated is Enbrel.

References (Pharmacy Technician Documents/Study Guides):

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

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.

DEA requires allcontrolled substance prescriptionsto include thedate of issueas per21 CFR 1306.05(a).

Other required elements:

Patient’s full name and address

Drug name, strength, dosage form, quantity

Directions for use

Prescriber’s name, address,DEA number, and signature

????Reference:DEA Controlled Substance Act;21 CFR 1306.05.

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

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:

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:

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

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

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

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

Other Answer Choices Explained:References:

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

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

USP <800> Handling of High-Alert Medications

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.

Schedule III & IV drugs can be refilled up to 5 times within 6 months from the date written.

After 6 months or 5 refills, a new prescription is required.

????Reference:DEA Controlled Substance Act (21 CFR 1306).

Comprehensive and Detailed Step-by-Step Explanation:

Nasonexis anasal corticosteroidused to treatallergic rhinitis. Thegeneric name is mometasone furoate.

????Explanation of Answer Choices:✅A. Mometasone furoate→Correct.Theactive ingredient in Nasonex.❌B. Loteprednol etabonate→ Incorrect.A corticosteroid, but used for eye inflammation.❌C. Desloratadine→ Incorrect.An antihistamine, not a steroid.❌D. Fluticasone→ Incorrect.Similar corticosteroid, but the generic for Flonase, not Nasonex.

????Reference:

FDA Orange Book (Nasonex and Generics)

PTCB Exam: Generic & Brand Name Medications

Handling and internal transport of hazardous waste in the workplace require compliance with OSHA standards, including Hazard Communication and HAZWOPER (29 CFR 1910.120) training for personnel involved in hazardous waste operations. While external shipment of hazardous materials involves DOT/EPA rules, within pharmacy and healthcare settings, technicians moving hazardous waste containers to storage must have OSHA-mandated training. DEA pertains to controlled substances, FDA regulates drug approval/labeling, and ISMP is a safety organization but does not mandate training.

References (Pharmacy Technician documents / Study Guides):

• USP <800> Hazardous Drugs—Handling in Healthcare Settings: personnel training expectations and references to OSHA standards for safe handling.

• OSHA Hazard Communication Standard and HAZWOPER training requirements as cited in pharm tech safety modules.

• PTCB/ExCPT study materials on hazardous drugs/waste handling and applicable regulatory bodies

Comprehensive and Detailed Step-by-Step Explanation:

To preventheparin dosing errors, theFDA requires labeling to display:

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

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

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

????Reference:

FDA Heparin Labeling Guidelines

Addyi (flibanserin)is used to treat hypoactive sexual desire disorder (HSDD) in premenopausal women. It is subject to aRisk Evaluation and Mitigation Strategy (REMS) programbecause of its potential to causesevere hypotension (low blood pressure) and syncope (fainting), especially when taken with alcoholor moderate-to-strong CYP3A4 inhibitors.

The REMS program requires healthcare providers and pharmacists to be certified before prescribing or dispensing Addyi. Patients must be counseled on the risks, and alcohol use is strictly contraindicated while taking this medication.

B. is an emergency oral contraceptive→ Incorrect. Addyi is not a contraceptive; it treats HSDD.

C. contains an opioid analgesic→ Incorrect. Addyi is not an opioid; it affects serotonin and dopamine receptors.

D. is a monoclonal antibody→ Incorrect. Addyi is a non-hormonal serotonin receptor agonist/antagonist, not a monoclonal antibody.

Incorrect Answer Choices:Pharmacy Technician References:

PTCB PTCE Exam Content Outline (Medication Safety and REMS Programs)

FDA REMS Database for Addyi (Flibanserin)

Lexicomp Drug Monograph on Addyi

Mosby’s Pharmacy Technician Exam Review

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

Candidiasis (oral thrush, vaginal yeast infections)

Cryptococcal meningitis

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

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

A. Bacterial infections❌→Incorrect

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

B. Gastroesophageal reflux disease (GERD)❌→Incorrect

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

C. Altitude sickness❌→Incorrect

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

FDA Fluconazole Drug Label– Confirms antifungal indications.

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

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

Why Not the Other Options?Key References:

Comprehensive and Detailed Step-by-Step Explanation:

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

Naproxen (Aleve, Naprosyn) is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.

????Reference:FDA NSAID Safety Guidelines.

PerUSP standards, a drug with an expiration date ofMarch 2025is consideredvalid until the last day of the month, which isMarch 31, 2025. This applies unless otherwise specified by the manufacturer.

If a drug is labeledMM/YYYY, itremains valid until the last day of that month.

If a drug is labeled with aspecific day (MM/DD/YYYY), itexpires at the end of that day.

A. February 28, 2025→ Incorrect; the expiration is at the end ofMarch, not February.

B. March 1, 2025→ Incorrect; the drug is stillusable until March 31.

D. March 1, 2026→ Incorrect; the drugexpires in March 2025, not 2026.

Expiration Date Rules:Other Answer Choices Explained:References:

USP <797> Pharmaceutical Compounding – Expiration and Beyond-Use Dating (BUD) Guidelines

FDA Drug Expiration Date Regulations

PTCB PTCE Exam Content Outline (Pharmaceutical Storage & Stability)

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)

Formula: Dose ÷ Concentration = Volume (mL)

30 mg ÷ 20 mg/mL = 1.5 mL

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

Comprehensive and Detailed Step-by-Step Explanation:

Nasonexis anasal corticosteroidused to treatallergic rhinitis. Thegeneric name is mometasone furoate.

????Explanation of Answer Choices:✅A. Mometasone furoate→Correct.Theactive ingredient in Nasonex.❌B. Loteprednol etabonate→ Incorrect.A corticosteroid, but used for eye inflammation.❌C. Desloratadine→ Incorrect.An antihistamine, not a steroid.❌D. Fluticasone→ Incorrect.Similar corticosteroid, but the generic for Flonase, not Nasonex.

????Reference:

FDA Orange Book (Nasonex and Generics)

PTCB Exam: Generic & Brand Name Medications

Naproxen (Aleve, Naprosyn) is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.

????Reference:FDA NSAID Safety Guidelines.

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

FDA REMS Program for Mycophenolate

PTCB Exam: Medication Safety & REMS

Comprehensive and Detailed Step-by-Step Explanation:

High-alert medicationsaredrugs that carry a higher risk of significant patient harmif used incorrectly.IV propranololis abeta-blocker (adrenergic antagonist)that can causesevere bradycardia, hypotension, and cardiac arrestif administered improperly.

????Explanation of Answer Choices:✅A. Adrenergic antagonist→Correct.Propranololblocks beta receptors, reducing heart rate and blood pressure.❌B. Chemotherapeutic agent→ Incorrect.Propranolol is not a chemotherapy drug.❌C. Opioid→ Incorrect.Propranolol is not an opioid.❌D. Anticoagulant→ Incorrect.Propranolol does not affect blood clotting.

????Reference:

ISMP List of High-Alert Medications

PTCB Exam: Medication Safety & Risk Management

Sertraline (Zoloft)is anSSRI antidepressantused formajor depressive disorder (MDD), anxiety, and other mood disorders.Suicidal ideation(thoughts of self-harm) is aserious and potentially life-threatening side effect, especially inyoung adults. A pharmacy technicianmust notify the pharmacist immediatelyif a patient reportssuicidal thoughts, as this may require immediate medical intervention.

A. Presents new insurance coverage→ Incorrect; this is an administrative issue, not a clinical concern.

B. Requests the refill two days early→ Incorrect; a slight early refill request does not indicate a safety concern.

D. Reports improved interest and motivation→ Incorrect; this is apositive treatment response, not an urgent issue.

Other Answer Choices Explained:References:

FDA Black Box Warning for SSRIs – Suicide Risk in Young Adults

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

Lexicomp Drug Monograph for Sertraline (Zoloft)

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

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

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

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

Thus, the patient should take3 mL per dose.

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

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

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

Other Answer Choices Explained:References:

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

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

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.

Apidra (insulin glulisine)is arapid-acting insulinthat must bestored between 36°F and 46°F (2°C to 8°C)in the refrigerator. If frozen,it is no longer usableand shouldnever be thawed or dispensed. The best course of action is toreturn it to the distributorto ensure medication integrity and patient safety.

A. Thawed and stored in a refrigerator→ Incorrect;frozen insulin loses its potencyand shouldnot be used.

B. Sent to the prescriber→ Incorrect; the prescriber does not handle medication storage or replacements.

C. Dispensed to a patient→ Incorrect;frozen insulin is ineffectiveand could harm the patient.

Other Answer Choices Explained:References:

FDA Insulin Storage and Handling Guidelines

USP <797> Sterile Preparations – Storage Conditions

Manufacturer Storage Requirements for Apidra (Sanofi-Aventis)

Chemotherapy drugs (e.g., methotrexate, cisplatin)arehigh-alertdue to theirtoxicity, risk of overdose, and narrow therapeutic index.

????Reference:ISMP High-Alert Medication List, PTCE Study Materials.

In the providedcompounded prescription, the antifungal agent isnystatin.

Nystatin is a polyene antifungalthat works by binding toergosterolin fungal cell membranes, causing leakage of cellular contents and fungal cell death.

It iscommonly used for fungal infections, particularlycutaneous or mucosal Candida infections(e.g., diaper rash, oral thrush).

A. Cholestyramine.→ Incorrect. Cholestyramine is abile acid sequestrantused to lowercholesteroland treatdiarrhea(often in combination with other ingredients for skin irritation or wounds).

B. Hydrocortisone.→ Incorrect. Hydrocortisone is acorticosteroidused to reduceinflammation and itching, but it does not kill fungi.

C. Zinc oxide.→ Incorrect. Zinc oxide is askin protectantused fordiaper rash and minor burns, but it is not an antifungal.

Lexicomp Drug Database – Nystatin Mechanism of Action.

FDA Drug Label for Nystatin – Antifungal Properties.

PTCB PTCE Exam Content Outline – Compounded Preparations and Active Ingredients.

Mosby’s Pharmacy Technician: Principles and Practice – Dermatologic Compounding.

Why Is Nystatin an Antifungal?Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:Conclusion:Pharmacy technicians must befamiliar with drug classificationsto correctly identify active ingredients incompounded prescriptions.Nystatin is the only antifungal agentin the provided formulation.

1 pint =473 mL(since 1 pint = 16 fluid ounces, and 1 fluid ounce = 29.5735 mL).A1% suspensionmeans1 g (1000 mg) of rifampin per 100 mLof suspension.

Total dose required:2 tbsp daily =30 mL per day(1 tbsp = 15 mL).

Total volume of the suspension:473 mL

Total rifampin required:(473 mL × 1000 mg) ÷ 100 mL =4730 mg

Each rifampin capsule contains300 mg.So,4730 mg ÷ 300 mg/capsule = 15.77 capsules, which rounds up to16 capsules.

Thus, the correct answer isC. 32 capsules(since the full pint must be compounded).

????Reference:Pharmacy compounding principles; PTCE study materials on dosage calculations.

• DEA Form 41 (“Registrants Inventory of Drugs Surrendered”) is the federal form used to document the destruction (disposal) of controlled substances by a registrant.

• Opioid analgesics are controlled substances and therefore require DEA Form 41 for authorized destruction.

• NSAIDs, penicillins, and most monoclonal antibodies are not controlled substances and do not require DEA Form 41 for disposal.

References (Pharmacy Technician Documents/Study Guides):

• DEA requirements for controlled substance destruction and recordkeeping (21 CFR; DEA Form 41).

• PTCB/ExCPT law and regulations content outline—forms: 222 (ordering), 106 (theft/loss), 41 (destruction).

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

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

Pharmacy technician scope of practice is defined by state regulation and generally includes technical functions under a pharmacist’s supervision. In many states, technicians may initiate transfers of non-controlled prescriptions (often technician-to-technician) as part of the dispensing workflow. Activities such as patient counseling (A), clinical review (B), and approving the validity of controlled prescriptions (D) are considered professional/judgmental tasks and are reserved for the pharmacist.

References (Pharmacy Technician documents / Study Guides):

• NABP Model State Pharmacy Act—differentiation of pharmacist vs. technician duties.

• PTCB/ExCPT role delineation: technician tasks include processing, data entry, and certain communications (e.g., non-controlled transfers) under pharmacist supervision; clinical judgment and counseling are pharmacist-only.

• State practice act summaries frequently used in technician training modules regarding transfers and controlled vs. non-controlled prescriptions.

Grapefruit juice inhibits CYP3A4 enzymes, increasingbudesonide levels inthe blood, leading tohigher risk of side effects (immune suppression, adrenal insufficiency).

Budesonide is a corticosteroid used for Crohn’s disease and asthma.

Why Other Options Are Incorrect:

B. Dairy products?❌No significant interaction.

C. Leafy greens?❌Affectswarfarin (not budesonide).

D. Aged cheese?❌Interacts withMAO inhibitors, not budesonide.

????Reference:FDA Drug-Food Interaction Guide, PTCB Medication Safety Guidelines.

Before dispensing a prescription, pharmacy technicians and pharmacists must ensure that it iscomplete, clear, and unambiguousto avoid medication errors.

Medication:Lisinopril

Strength:20 mg (Clear)

Route:PO (by mouth) (Clear)

Directions:Take 1 tab PO q8h (every 8 hours)❌(Needs Clarification)

Quantity:30 tablets (Clear)

Refills:12 (Needs verification but is not the main issue)

Lisinopril is an ACE inhibitorused for hypertension and heart failure.

Standard dosing is once daily (q24h), not every 8 hours (q8h).

A frequency of q8h (three times daily) is unusual and could be a prescribing error.

Pharmacists must verify with the prescriber before dispensing.

(A) Directions for use✅Correct – "q8h" is incorrect for lisinopril and needs clarification.

(B) Medication strength❌Incorrect – "20 mg" is a standard strength for lisinopril.

(C) Route of administration❌Incorrect – "PO" (by mouth) is correct.

(D) Number of refills❌Incorrect – While 12 refills is uncommon for chronic medications, it is not the primary issue.

Lisinopril Prescribing Information (FDA): https://www.accessdata.fda.gov

Institute for Safe Medication Practices (ISMP) – High-Alert Medications:https://www.ismp.org

PTCB Exam Content Outline – Prescription Processing & Clarification

Analysis of the Prescription:Why the Directions Need Clarification:Analysis of Answer Choices:References for Pharmacy Technicians:

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

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:

Citalopram (Celexa) is an SSRI (Selective Serotonin Reuptake Inhibitor) used for depression and anxiety.

Other drugs listed are for schizophrenia (clozapine, haloperidol) or anxiety (lorazepam).

????Reference:FDA Approved Antidepressants, PTCE Medication Classification Guide.

In pharmacy practice and per USP/FDA conventions, when a manufacturer’s expiration date is expressed only as a month and year (e.g., “EXP 03/2026”), the product remains usable through the last day of that month. This standard is applied for product beyond-use and stock management, ensuring consistent interpretation across labeling and inventory control.

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:

Comprehensive and Detailed Step-by-Step Explanation:

ACE inhibitors (Angiotensin-Converting Enzyme inhibitors)are medications thatrelax blood vesselsandlower blood pressure. Drugs in this class typically end in "-pril" (e.g.,Lisinopril, Enalapril, Ramipril).

????Explanation of Answer Choices:✅C. ACE inhibitors→Correct.These lowerblood pressure and reduce strain on the heart.❌A. Beta blockers→ Incorrect.End in "-olol" (e.g., Metoprolol, Propranolol), reduce heart rate.❌B. Calcium channel blockers→ Incorrect.End in "-dipine" (e.g., Amlodipine, Nifedipine), lower blood pressure differently.❌D. Statins→ Incorrect.End in "-statin" (e.g., Atorvastatin, Simvastatin), used for cholesterol, not blood pressure.

????Reference:

American Heart Association (AHA) Guidelines

FDA Drug Classification Database

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

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

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

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

Aspirin EC(prevents stomach irritation)

Pantoprazole EC(proton pump inhibitor)

Diclofenac EC(NSAID)

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

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

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

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

FDA Drug Formulation Guidelines

USP <795> Drug Release & Absorption Standards

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

Comprehensive and Detailed Step-by-Step Explanation:

A math formula on a white background Description automatically generated

Explanation of Answer Choices:✅C. 20→Correct.2 tablets per day × 10 days = 20 tablets.❌A. 5→ Incorrect. Under-dose.❌B. 10→ Incorrect. Under-dose.❌D. 40→ Incorrect. Over-dose.

????Reference:

USP <795> Pharmaceutical Calculations

PTCB Exam: Dosing Conversions

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

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

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

Storage Considerations for Other Medications:

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

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

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

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

Comprehensive and Detailed Step-by-Step Explanation:

Root-Cause Analysis (RCA)is asystematic approachused toidentify the underlying causes of medication errors. RCA focuses onsystems and processes, not individual blame.

????Explanation of Answer Choices:✅B. Focusing primarily on systems and processes rather than individual performance→Correct.RCA aims toprevent future errors by improving systems.❌A. Termination of employment→ Incorrect.Blaming individuals does not address system failures.❌C. Immediate reporting to the state board→ Incorrect.RCA is an internal investigation process.❌D. Criminal charges→ Incorrect.RCA focuses on improvement, not legal punishment.

????Reference:

ISMP Guidelines on Root-Cause Analysis

PTCB Medication Safety Principles

Comprehensive and Detailed Step-by-Step Explanation:

A white background with black text Description automatically generated

Explanation of Answer Choices:✅B. 10→Correct.❌A. 1→ Incorrect.1 tablet contains 100 mg, not 1000 mg.❌C. 100→ Incorrect.Overdose.❌D. 1000→ Incorrect.Severe overdose.

????Reference:

USP <795> Pharmaceutical Calculations

PTCB Dosage Conversions

Comprehensive and Detailed Step-by-Step Explanation:

OnceBasaglar insulin pensare opened, they must bediscarded after 28 dayseven if insulin remains, as potency decreases.

????Explanation of Answer Choices:✅D. 28 days→Correct.FDA-approved discard time for Basaglar.❌A. 1 day→ Incorrect.Too short.kabtak chaoiyue❌B. 7 days→ Incorrect.Too short.❌C. 14 days→ Incorrect.Incorrect expiration timeframe.

????Reference:

FDA Basaglar Storage Guidelines

PTCB Exam: Medication Storage and Expiration

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.

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

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

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

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

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

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

The vaccine must be discarded if reconstituted incorrectlyand not administered.

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

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

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

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

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

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

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

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

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

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

????Reference:USP <797> Sterile Compounding Guidelines.

Aricept (Donepezil) is a cholinesterase inhibitorused for treatingmild, moderate, or severe Alzheimer's disease dementia.

Itworks by increasing acetylcholine levels in the brain, improving memory and cognitive function.

FDA-approved for all stages of Alzheimer’s disease.

B. Azilect❌→Used for Parkinson’s disease, not Alzheimer's.

Azilect (Rasagiline) is a monoamine oxidase-B (MAO-B) inhibitorthat helps manage Parkinson’s symptoms but is not indicated for dementia.

C. Ambien❌→Used for insomnia, not Alzheimer's dementia.

Ambien (Zolpidem) is a sedative-hypnotic for sleep disordersand does not treat cognitive decline.

D. Atacand❌→Used for hypertension, not dementia.

Atacand (Candesartan) is an angiotensin receptor blocker (ARB) used to treat high blood pressure and heart failure.

FDA Approved Uses for Donepezil (Aricept)– Confirms its indication for all stages of Alzheimer’s disease.

Alzheimer’s Association Treatment Guidelines– Listscholinesterase inhibitors as first-line therapy for dementia.

PTCB PTCE Exam Content Outline– Covers pharmacologic treatments for cognitive disorders.

Why Not the Other Options?Key References:

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

Day 1:Taketwo tablets (500 mg total).

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

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

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

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

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

Other Answer Choices Explained:References:

FDA Drug Monograph for Azithromycin (Z-Pak)

Lexicomp Drug Guide – Azithromycin Dosing

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

Prochlorperazine (Compazine suppository)requiresrefrigeration(store at2°C to 8°C / 36°F to 46°F) to maintain stability.

Other suppositories are stored atroom temperatureunless specified.

????Reference:Manufacturer Storage Guidelines, USP Storage Standards.

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

Amoxicillin concentration:250 mg per5 mL

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

Duration:First5 days

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

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

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

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

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

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

Other Answer Choices Explained:References:

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

USP <795> Nonsterile Compounding Guidelines

Lexicomp Drug Monograph for Amoxicillin Suspension

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.

Comprehensive and Detailed Step-by-Step Explanation:

Alot number (or batch number)is aunique identifierassigned to a specific batch of medication by themanufacturer. It helps trackrecalls, expiration dates, and quality control.

????Explanation of Answer Choices:✅D. Manufacturer→Correct.Manufacturers assignlot numbersfor tracking and recall purposes.❌A. FDA→ Incorrect. TheFDA does not assign lot numbersbut regulatesdrug safety and labeling.❌B. DEA→ Incorrect. TheDEA controls controlled substancesbut does not issuelot numbers.❌C. Wholesaler→ Incorrect.Wholesalers distribute drugs but do not assign lot numbers.

????Reference:

FDA Drug Product Recall Guidelines

PTCB Inventory Management Section

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:

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

References (Pharmacy Technician documents / Study Guides):

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

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

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

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:

To calculate the percentage ofpsylliumin the final preparation:

Formula:

A math equations with numbers and symbols Description automatically generated with medium confidence

Sincepsylliummakes up500 gout of1000 g (1 kg)of the bulk laxative, it accounts for50%of the total formulation.

????Reference:

USP <795>Compounding Standards

PTCE ExamPharmaceutical Calculations

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

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

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

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).

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:

Tetracyclines, includingdoxycycline and minocycline, are broad-spectrum antibiotics used to treat bacterial infections. They have amajor drug-drug interaction with calcium-containing antacidsand other minerals.

Chelation Effect:Calcium binds to tetracycline, forminginsoluble complexesthat prevent the antibiotic from being absorbed in thegastrointestinal (GI) tract.

Reduced Efficacy:Because the drug cannot be absorbed, the antibiotic’s effectiveness is significantly reduced.

Similar Interactions:Magnesium, iron, and aluminum (found in many antacids, dairy products, and multivitamins) also reduce tetracycline absorption.

Take on an Empty Stomach(1 hour before or 2 hours after meals).

Avoid Dairy, Antacids, and Multivitaminsfor at least2 hours before and aftertaking tetracycline.

Drink with a Full Glass of Waterto prevent esophageal irritation.

B. Decongestants that contain pseudoephedrine.→ Incorrect. Pseudoephedrine does not interact with tetracycline.

C. Antitussives that contain dextromethorphan.→ Incorrect. Dextromethorphan does not affect tetracycline absorption.

D. Analgesics that contain acetaminophen.→ Incorrect. Acetaminophen does not bind to tetracycline or impact its absorption.

Lexicomp Drug Interaction Database – Tetracycline and Calcium Interactions.

FDA Drug Label for Tetracycline – Absorption and Drug Interaction Warnings.

Mosby’s Pharmacy Technician: Principles and Practice – Tetracycline Pharmacology.

PTCB PTCE Exam Content Outline – Drug Interactions and Contraindications.

Why Should Tetracycline Not Be Taken with Calcium-Containing Antacids?Patient Counseling for Tetracycline Use:Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

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:

Root-Cause Analysis (RCA)is asystematic processused inhealthcare and pharmacy settingstoidentify the underlying factors that contributed to an error or safety event. RCA helps pharmacy staff determinewhy a problem occurredand implement corrective actions toprevent future occurrences.

Identify the problem or event.

Gather and analyze data.

Determine the root cause(s).

Develop and implement corrective actions.

Monitor for improvement and prevention of recurrence.

A. Determine which medication should be dispensed→ Incorrect; RCA is focused onerror investigation, not routine dispensing decisions.

B. Decipher prescriber handwriting during order entry→ Incorrect; this is not the purpose of RCA, though poor handwriting may be identified as a contributing factor in an error.

C. Increase pharmacy revenue and inventory turnover→ Incorrect; RCA is aboutpatient safety and error prevention, not financial performance.

Steps in Root-Cause Analysis (RCA):Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) RCA Guidelines

FDA Medication Error Prevention Strategies

PTCB PTCE Exam Content Outline (Quality Assurance & Medication Safety)

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

ISMP Guidelines on Medication Errors

PTCB Medication Safety Guidelines

Incompatibility in a nonsterile compound can be identified through various physical, chemical, and therapeutic changes.An unexpected change in odoris a key indicator of chemical instability, contamination, or degradation of a compounded preparation. Some ingredients may break down into volatile compounds, leading to noticeable odor changes.

A. A clear solution→ Incorrect; clarity alone does not indicate incompatibility.Some solutions may be clear but still chemically unstable.

B. The use of a pH buffer system→ Incorrect; buffer systems are used to maintain pH stability and prevent incompatibility rather than indicate it.

D. Suspension particles settling to the bottom of a container→ Incorrect; suspensions naturally settle and require shaking before use.This is not necessarily a sign of incompatibility.

Other Answer Choices Explained:References:

USP <795> Pharmaceutical Compounding—Nonsterile Preparations

PTCB PTCE Exam Content Outline (Medication Safety & Quality Assurance)

Remington: The Science and Practice of Pharmacy

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

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

Why Other Options Are Incorrect:

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

B. Atomoxetine?❌Used forADHD, NOT seizures.

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

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

Comprehensive and Detailed Step-by-Step Explanation:

Step 1: Use the formula

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

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

????Reference:

USP <795>: Pharmaceutical Calculations

PTCB Exam: Dosage Conversions

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

References (Pharmacy Technician documents / Study Guides):

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

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

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

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

Comprehensive and Detailed Step-by-Step Explanation:

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

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

????Reference:

FDA Orange Book

PTCB Exam: Therapeutic Equivalence

Under federal DEA requirements for transferring controlled substance prescriptions in Schedules III–V, the receiving pharmacist must document key original prescription details, including the date of original dispensing, the original date of issuance, the original number of refills authorized, the number of refills remaining, and pertinent information about the transferring pharmacy (name, address, DEA, and Rx number), as well as the name of the transferring pharmacist. Information such as the medication’s expiration date or the receiving pharmacy’s DEA number is not required to be newly noted by the receiving pharmacy for the transfer record. The prescriber’s DEA number is part of the original prescription, but federal transfer documentation specifically requires noting the original dispensing date rather than re-recording the prescriber’s DEA.

References (Pharmacy Technician documents / Study Guides):

• DEA regulations for transfers of Schedule III–V prescriptions (21 CFR 1306.25) — required information for transferring and receiving pharmacists.

• PTCB/ExCPT prep materials: controlled substance prescription transfer documentation requirements.

Comprehensive and Detailed Step-by-Step Explanation:

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

Administration Guidelines for Levothyroxine:

Take30-60 minutes before breakfastwith afull glass of water.

Avoidcalcium, iron, and antacidsfor4 hoursafter taking it.

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

????Reference:

American Thyroid Association (ATA) Levothyroxine Guidelines

FDA Drug Labeling for Synthroid

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