Pebc CVS Questionnaire

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com
Cardiovascular and CNS MOCK Test
MJ is 82 year women has been customer at your pharmacy for many
years. When her son PK comes to pick her blister pack. She is currently
using hydrochlorothiazide/candesartan 12.5 mg/35 mg, metoprolol 50 mg
bid, amlodipine 10 mg daily, metformin 500 mg tid, glyburide 2.5 mg bid,
glicalizide MR 60 mg daily, clonazepam 0.25 mg tid, metoclopramide PRN
for nausea. Recently her metformin dose is increased to 1000 mg bid to
manage her high HbA1c > 9%. Caregiver of patient wants to know what
medications should be taken with meals
Which of the following medications should be taken with meals?
A) metformin, glyburide, gliclazide, metoclopramide, metoprolol
B) metformin, glyburide, gliclazide and metoprolol
C) metformin, glyburide, gliclazide and hydrochlorothiazide/candesartan
D) metformin, glyburide, gliclazide and metoprolol, hydrochlorothiazide
/candesartan
E) metformin, glyburide, gliclazide
Ans. E
2) Metformin should be taken with meals, because?

A) increase bioavailability
B) decrease hypoglycemia
C) mask taste disturbances
D) decrease gastrointestinal side effects
E) decrease lactic acidosis side effects
Ans. D
Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 1

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3) As part of inter professional collaboration in diabetes care, a pharmacy
may consider referring to diabetic patient to all of the following
professionals?
A) Physicians, nurse practitioners, dieticians, chiropodists, and
optometrists.
B) Physicians, nurse practitioners, physiotherapist, chiropodists, and
podiatrist
C) Physicians, nurse practitioners, psychiatrist, physiotherapist and
podiatrist
D) Physicians, nurse practitioners, dieticians, social worker, and personal
support worker
E) Physicians, nurse practitioners, dieticians, social workers, and
optometrists.
Ans. A
Ref: Pharmacy Practice 2013 and CDA guidelines.
4) KP is a 47-year-old patient has just started raw diet only few days,
taken citrus juice daily. Maintain healthy life style such diet and exercise.
Patient using atorvastatin 20 mg to treat high cholesterol and recent visit
doctor, he increases atorvastatin dose to 40 mg. Patient complains severe
dyspepsia and diarrhea. It’ may be due to:
a. Because he is on raw food diet
b. Changed atorvastatin 20 mg to 40 mg
c. Takes citrus juice
d. Exercise
e. Multivitamins
Ans. B
Tips: What does statins have GI SEs. However statins common GI SEs.
Raw food is high fibre content (insoluble fibre).

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5) KP is diagnosed high LDL and TG, what is the best therapy to initiate?
A) Rosuvastatin
B) Cholestyramine
C) Niacin
D) Fenofibrate
E)Ezetamibe
Ans: A
TC page 438, 6th ed. Rosuvastatin and atorvastatin have high lowering
effect on LDL and TG.
6) KP is 53 year old patient who had hypertension came to pharmacy and

had prescription of rosuvastatin 10 mg daily as doctor diagnosed him to
use hyperlipidemia. Hel told to pharmacist do not want to start
medication. Wants to try lifestyle changes. Pharmacist start talking to him
about his condition and explained to him benefit of using of medication
but also after patient wanted to go lifestyle modification first. What
should a good pharmacist do in this situation?
A) Respect patient autonomy and give him right to decide
B) Ask patient to see different doctor for second opinion
C) Ask patient to start after trying lifestyle modifications
D) Provide patient more evidence base document to show benefit of
medication and dangers of hyperlipidemia.
E) Ask patient what did your doctor tell you.
Ans: D
7) KM a 60 yo MI patient had bypass surgery past 4 months ago using

ASA 325 mg daily, clopidogrel 75 mg daily, rosuvastatin 10 mg daily,
nodolol 80 mg daily and salbutamol PRN, budesonide daily. Now
hospitalized with severe asthma. What is the pharmacist concern in KM?
I) drug and drug interactions
II) drug and disease interactions
III) drug and food interactions
a) I only b) III only c) I and II d) II and III e) I, II and III
Ans: C

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8) A 60 yo patient came to emergency and doctor diagnosed STEMI and

ordered Alteplase injection. Currently patient blood pressure is 190/110.
What is the drug related problem?
A) Patient is receiving medication which is NOT indicated for this therapy
B) Patient is receiving medication have adverse drug reaction
C) Patient is receiving medication that is under dose
D) Patient is receiving medication that is overdose
E) Patient is Not receiving indicated therapy for indication
Ans: A
9) A 66 yo male in warfarin treatment for deep vein thrombosis. A doctor

calls and tells you that one of your mutual patients has taken too many
warfarin tablets in error and has an INR value of 5.2 without any
symptoms of problems. She would like to treat with vitamin K to lower
the INR promptly (within 24 hrs). Do you have any recommendations?
A) Low dose oral vitamin K therapy promptly reduces elevated INR
B) Skip dose of warfarin for a day and monitor INR
C) Continue warfarin therapy increase frequency of monitoring INR
D) Low dose of vitamin K injections promptly reduces elevated INR
E) It is not a concern, so continue therapy without interruption
Ans: A
Tips; as per CMAJ Feb 2003. It is recommended to low dose of oral
vitamin K, 1 mg or 4 to 5 mg for patient with INR more than 5 in bleeding
or no bleeding symptoms.

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10) A 64 yo man weighing 115 kg, and tall 60 inches, presents to his
physician after long international flight complaining of pain, swelling of
his right lower leg. The patient had knee surgery a month before he
travelled. His medication profile includes, CHF (ejection fraction < 15%),
remission from lymphoma, MI. His father, mother, and sister are all
diseased from stroke, pulmonary embolism. Given his profile. Patient
most likely suffering from?
Which of the following is NOT risk factors of DVT?
A) Knee surgery B) over weight C) long flight D) family history
E) Gender
Ans: E
Tips: RF for above patient, except gender. other RFs include age > 40 yr,
cancer, CHF, MI, and obesity and smoking, previous use of HRT and
immobility.
11) What is the most important recommendation should provided to

decrease risk of deep vein thrombosis?
A) Avoid taking flights
B) Increase mobility of legs
C) Avoid physical activity
D) Avoid vitamin K intake
E) Avoid dark green vegetables
Ans: B
12) Patient is hospitalized. Drs initiated heparin infusion. What is

incorrect about heparin?
A) Heparin dose is based on body weight
B) Loading dose is 80 units/kg and maintenance dose is 15 to 25
units/kg/hr.
C) Heparin is slower onset than LMWH
D) LMWH has longer half-life
E) LMWH have predictable response thus not monitored
Ans: C

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13) Which of the following low molecular weight heparin has higher
selectivity to factor Xa.
A) Enoxaparin B) Dalteparin C) Nadroparin D) Tinzaparin E)
Heparin
Ans. A
Tips: LMWH act selectively binding with factor Xa, and factor IIa which is
affects on aPTT. However this has NO effect on prothrombin time,
therefore INR is not beneficial. Ref. Monograph LMWH in CPS.
Dabigatran can be monitored for aPTT. Ref: eCPS
14) MP is a 72 years old patient diagnosed for systolic congestive heart

failure after his LVEF is ≤ 40%. MPs blood pressure reading are 130/85
Doctor categorized MP symptoms according to NYHA class 2. Doctor
considering to prescribed Ramipril 5 mg as initial therapy to CHF? What is
therapeutic benefits of ACEi treatment for patient of CHF?
A) Reduce mortality
B) Reduce readmission in hospital for heart failure
C) Improve symptoms and improve ejection fraction
D Decrease the rate of reinfarction in patients with coronary artery
disease
E) all of the above
Ans. E
Tips: After initiating ACEi blood pressure changes occur in two weeks. Side
effects can occur in 3 days. If cough is bothersome contact doctor.

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15) MP returns to pharmacy with a new prescription of metoprolol 50 mg

bid, because he says his heart failure symptoms were not improved his
doctor said his LVEF <30%. What is therapeutic benefit of beta blockers
therapy in CHF?
A) Reduce mortality
B) Reduce readmission in hospital for heart failure
C) Improve symptoms and improve ejection fraction
D Decrease the rate of reinfarction in patients with coronary artery
disease
E) all of the above
Ans. E
16) Patients using beta blockers (metoprolol, carvedilol and bisoprolol) in

congestive heart failure, have the risk of treatment such as fluid
retention, worsening of heart failure, fatigue, bradycardia, heart
blockade, and hypotension. Thus which of the following are monitored in
congestive heart failure patient using beta blockers?
A) changes in fatigue and dyspnea symptoms
B) Fluid accumulation by taking weight
C) heart rate
D) blood pressure
E) All of the above
Ans. E
Tips: Beta blockers can worsen heart failure thus monitor fluid retention.
If beta blockers are NOT tolerated than add ACEi and ARB or Amlodipine.

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17) After initiating metoprolol therapy, MP visits his physician with
increased pedal edema and shortness of breath. Doctor considering
treating fluid retention and dyspnea. What the best treatment options?
A) Furosemide
B) Spironolactone
C) Hydrochlorothiazide
D) Verapamil
E) Hydralazine and isosorbide dinintrate
ans.
Ans. A
18) What is the therapeutic benefit of adding diuretics to congestive heart

failure patient?
A) Improve CHF symptoms such as pedal edema and dyspnea
B) Decrease mortality
C) Decrease rehospitalization
D) Decrease CHF progression
E) All of the above
Ans. A
19) MPs congestive heart failure continued to deteriorate on optimal

doses of ramipril and metoprolol. Doctor prescribed candesartan 32 mg
daily. What is pharmacist concern?
A) Side effect of hypotension, ↑ SrCr and hyperkalemia (K >5)
B) Combination of ACEi plus ARBs
C) Increased risk of fluid retention
D) Increased aldosterone concentration
E) Risk of renal failure
Ans. A

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20) MPs doctor prescribed digoxin 0.125 mg daily to improve quality of

life and symptoms and exercise tolerance. What is the reason low dose of
digoxin was prescribed?
A) age
B) low ejection fraction
C) hyperkalemia
D) to avoid drug interactions
E) to avoid digitalis toxicity
Ans. A
21) MPs doctor prescribed spironolactone 12.5 mg daily to treat severe

symptoms of congestive heart failure and reduced ejection fraction. What
are the greatest risk of hyperkalemia?
A) patients with renal dysfunction CrCl < 30 ml/min and elevated serum
potassium K+ > 5
B) patients with renal dysfunction CrCl < 30 ml/min and age
C) patients with renal dysfunction CrCl < 30 ml/min and using NSAIDs
D) patients with renal dysfunction CrCl < 30 ml/min and using ACEi
E) patients with renal dysfunction CrCl < 30 ml/min and using ARBs
ans: A
Tips: Spironolactone is added in sever CHF or NYHA class 4 patient.
22) MK is a 62-year-old man. He is on warfarin 2.5 mg daily for the for the
prevention of atrial fibrillation. Past 3 days ago MK developed sore throat
and his doctor considering prescribing ampicillin 500 mg QID
A-Effects of warfarin may be increased resulting in increased risk of
bleeding.
B-Effects of warfarin may be decrease resulting in increased risk of
bleeding.
C- Effects of warfarin may be increased resulting in decreased risk of
bleeding.
D) Effects of warfarin may be decrease resulting in decreased risk of
bleeding.
E) Effects of warfarin may be decrease resulting do not effects on bleeding
Ans: A

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Tips: INR should be monitored upon addition of ampicillin and withdrawal
of ampicillin. INR should be periodically reassessed for at least 3 weeks
after ampicillin discontinue, since adjustment in the warfarin dose may be
necessary to maintain an effective level of anticoagulation.
Cotrimoxazole increase INR. Macrolide (erythromycin, clarithromycin)
increase INR. Fluroquinolones increase INR.
23) MK is currently stabilized on warfarin 2.5 mg QD treatment. Which of

the following drugs may decrease warfarin levels.
A) Carbamazepine
B) Clarithromycin
C-Cotrimoxazole
D-Ciprofloxacin
E-Digoxin
Ans: A
Tips: Carbamazepine is enzyme CYP 2D6 inducers. It will decrease
warfarin blood levels. Clarithromycin (and, to a lesser extent,
azithromycin) and cotrimoxazole may increase warfarin blood levels.
Clarithromycin may also increase levels of carbamazepine, digoxin, statins
and theophylline. Other antibiotics that may increase warfarin and
digoxin levels include fluroquinolones.
24) A 65 years old patient was admitted to ICU experiencing acute

ischemic stroke. His stroke symptoms started 8 hours ago. His was
recently discharged from hospital after treatment of mild hemorrhagic
stroke symptoms. Why did the doctor decided not to give Alteplase?
I) Age
II) more than 3 hours
III) Hemorrhagic symptoms
A) I only
B-III only
C) I and II only
D) II and III only
E)I, II, III
Ans: D
Tips: Age 75 and above, more than 3 hr and bp 185/110 and hemorrhage
are the absolute CIs of alteplase.

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ST, is a 57-year-old male nurse who works for the local pulmonologist,
arrives at work one day complaining of weakness and fatigue. He
explains that these symptoms have worsened over several days. He
reports feeling out of breath when walking around the office but denies
having had these difficulties in the past.
ST's medical history is significant for hypertension and benign prostatic
hypertrophy. Three months ago he was hospitalized with a ventricular
arrhythmia. His current medication regimen includes:
 Felodipine 5 mg daily
 Tamsulosin 0.4 mg daily
 Amiodarone 400 mg daily
ST denies the use of herbal products or OTC medications. He denies
tobacco use but admits to social drinking. His family history is
significant for hypertension.
The pulmonologist for whom ST works is concerned about ST's
symptoms and performs a physical examination, along with laboratory
work. ST's vital signs are reported as follows: blood pressure, 150/95
mm Hg; heart rate, 90 beats/min, temp 98.6°F, and respiratory rate, 20
breaths/min. The exam is unremarkable, with no signs of pulmonary
congestion, lower extremity edema, or signs of infection. The basic
metabolic panel and complete blood count are within normal limits. The
only lab result found to be outside of normal limits is an elevated
erythrocyte sedimentation rate (ESR).
The pulmonologist is concerned that ST's medications may be causing
pulmonary problems. He performs a bronchoscope to obtain a lung
biopsy, which demonstrates diffuse alveolar damage and fibrosis.
25) What could be pulmonologist concern?

A) Felodipine 5 mg daily
B)Tamsulosin 0.4 mg daily
C) Amiodarone 400 mg daily
D)Blood pressure
E) Heart rate
Ans-C
Tips: Amiodarone can cause pulmonary fibrosis (cough and SOB).

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26) All of the following are side effects of amiodarone EXCEPT:
A) Conjunctivitis (optic neuritis, vision changes)
B) Pulmonary fibrosis
C) Aplastic anemia
D) Liver dysfunction
E) Photophobia
Ans: C
Tips: The pulmonologist concerns that ST's medications are causing his
symptoms are valid. ST is exhibiting signs and symptoms of Amiodarone-
induced pulmonary fibrosis. These patients typically present with an
elevated ESR and dyspnea during the first year of therapy. Treatment
involves dosage reduction or discontinuation of amiodarone or initiation
of corticosteroid therapy. Symptoms resolve quickly once therapy is
altered.
27) Which of the following is NOT required to monitor for amiodarone?

A) eye exam
B) occult blood in stools
C) Persistent coughs
D) Chest x-ray
E) Peripheral skin pigmentation
Ans: B
Tips: Occult blood in stool is a traces blood which is NOT detectable.
A 55 year-old male, new patient to your pharmacy, overweight suffered a

non-ST elevation myocardial infarction 6 days ago had PCI in hospital,
bare metal stent to
proximal LAD. Currently his medical conditions hypertension, LDL
2.5mmol/L, Tchol/HDL 5. Social history: has smoked 1 ppd x 30 years,
family history: brother died of MI 6 years ago. Currently have new
prescriptions: EC ASA 325 mg once daily, clopidogrel 75 mg once daily,
metoprolol 50 mg bid and ramipril 2.5 mg once daily. Patient using
currently vitamin E 800 IU uses for the last one year, hoping that prevent
any cardiovascular problems.

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28) What is the recommended blood pressure goals for secondary
prevention of Acute coronary syndrome patients.
A-135/85
B-140/90
C) 145/95
D-160/85
E-150/90
Ans: B
Tips: TC page 460, 6th ed. shows 140/90
29) After percutaneous intervention (PCI), and stent doctor has prescribed
EC ASA 325 mg once daily, clopidogrel 75 mg once daily Which of the
following is NOT the common side effect of clopidogrel?
A)Joint pain (arthralgia) B)headache C) constipation D)Rash
E)Diarrhea
Ans: C
Tips: Comparison of ASA, clopidogrel and ticlopidine.
30) A patient was scheduled for an endovascular coiling procedure to

treat a brain aneurysm. Several days before the procedure, the
neurosurgeon wrote a prescription for Plavix 150 mg po daily with
acetylsalicylic acid (ASA) 325 mg po daily. The patient was to take these
medications to prevent platelet aggregation and clot formation during,
and as a result of, insertion of a foreign substance (the coils) into the
vascular system. The day before the scheduled procedure, the patient
was admitted to the hospital as planned. Fortunately, the patient had
remembered to bring all current medications to the hospital. During
medication reconciliation, the pharmacist noticed that the patient was
taking Pradax 150 mg daily instead of the intended Plavix 150 mg daily.
The hospital pharmacist called the community pharmacy to discuss the
situation. It was determined that the order for Plavix had been
misinterpreted and that Pradax had been dispensed in error.
The hospital pharmacist should inform this incident to?
I) The neurosurgeon should be notified before surgical procedure
II) Institute of Safe Medication Practices Canada

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III) Pharmacy and Therapeutic Committee
A) I only
B) III only
C) I and II only
D) II and III only
E) I,II, III
ANS: C
31) Which of the following measures can prevent these type mix ups
errors!
A) Include the generic name throughout the prescription process like
clopidogrel for Plavix and dabigatran etexilate for Pradaxa
B) Read label with patient at counselling point
C) Read label at the time taking drug from shelf and read label at the time
of counting and placing bottle back into shelf
D) Consider automated alert system in computers.
E) Academic detailing to enhance prescription practices
ANS: A
32) A physician asked for heparin 2,000 units during a procedure. The
nurse retrieved two vials of heparin from an automated dispensing
cabinet that was supposed to be stocked with 1,000 units/1 mL vials. But
a pharmacy technician had accidentally stocked the cabinet with look-
alike vials of 10,000 units/1 mL heparin vials. Both concentrations... are in
the same size vials with similar orange-brown labels and vial caps...
causing the nurse to overlook the stocking error. The patient received
heparin 20,000 units, but the nurse quickly noticed the mistake!
Which of the following is the management of heparin overdose?
I) Stop using heparin and test aPTT and INR
II) Protamine sulphate antidote administration
III) Treatment included administration of intravenous fluids, plasma
volume expander, fresh frozen plasma, packed red blood cells, and
platelets.
A) I only B) III only C-I and II only D)II and III E)I,II, III
ANS:E

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33) Multiple issues often underlie the inadvertent administration of high-

concentration heparin. What are the examples of contributing factors to
such incidents include:
A) The storage of high-concentration heparin vials close to low-
concentration heparin flush products.
B) Confirmation bias that can cause a health care professional to read a
label or select a drug product and “see” what they expect to see, rather
than what is actually selected.
C) Often, more concentrations than necessary are present in both the
pharmacy and patient care area stock.
D) Incomplete communication between physicians and nurses at the time
of gathering drugs and supplies for central vascular line (CVL) insertion
and during procedure
E) All of the above
ANS:E
34) GS is a 49 year women. Her physician had prescribed morphine ‘.5

mg’ IV for the management of post-operative pain. However, a unit
secretary did not see the decimal point and transcribed the order by hand
onto a medication administration record (MAR) as ‘5 mg.’ An experienced
nurse followed the directions on the MAR without question and gave the
5 mg of IV. Morphine initially and another 5 mg dose two hours later.
Which of the following serious symptoms could be associated with fatal
error?
A) Mydriasis
B) Severe constipation
C) Respiratory depression
D) Bleeding
E)All of the above
Ans: C

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35) BN is a 91kg, 52-year old female who was recently diagnosed with
type 2 diabetes. On physical exam her BP was 190/94, serum creatinine
was 150umol/L, K is 4.5mmol/L.
11) The recommended BP target for BN is?
A) <130/80
B)>130/80
C) 140/90
D)<140/90
E)>140/90
Ans: A
36) What is the target waist line circumference?

A)<99 cm B)<102 C)<88 cm d)>88 cm e)>102 cm
Ans:C
37) What is the initial therapy?

A) Ramipril 5 mg
B) Verapamil/Losartan
C) Atenolol
D) metoprolol
E) Hydrochlorothiazide 50 mg
Ans: B
Tips: if it SBP is 20 units higher than 160 and DBP > 10, may require
combo. TC page 456.
38) After 6 months, she has still high blood pressure 155/90, what to do?
A) Increase dose to Ramipril 10 mg
B) Check the compliance of medication
C) Change Ramipril 2.5 mg to Losartan
D) Change Ramipril 2.5 mg to Hydrochlorothiazide 25 mg
E) Change Ramipril 2.5 mg to Metoprolol 50 mg
ANS: B

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39) BB is a 55year old obese man who has been a patient at your
pharmacy for many years. He is receiving atenolol 50 mg OD for
hypertension, atorvastatin 20 mg OD and glyburide 5 mg BID for blood
glucose control. He smoked a pack of cigarettes a day for the last 38
years. His lipid profile is under controlled. By some reason he started to
take herbal product containing niacin and find problem of muscular pain.
This pain was not continuous. What should patient do?
A. Take Tylenol on prn base
B. Refer to his physician
C. Ask for creatinin kinase test
D. Patient need not to worry as this pain subsides after discontinuation of
herbal products.
E. Use antidote of niacin
Ans-D
40) A 65-year-old man with a history of hypertension, atrial fibrillation,

hypercholesterolemia, and a right middle cerebral artery stroke 6 months
previous reports 3 separate episodes of head deviation to the left with
rhythmic jerking of the left arm and left side of his face lasting
approximately 1 minute. He is taking warfarin, atenolol, and atorvastatin.
What is drug of choice for epilepsy.
A) Lamotrigine (monotherapy)
B-Gabapentin,
C-Valproic acid
D-Phenytoin
E-Carbamazepine
Ans: A

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41) A pharmacist is working as a relief in another pharmacy. A patient
came with a prescription of Ativan 1 mg. The pharmacist remembered
that the same patient came with another prescription of same drug two
days ago in the other pharmacy where he worked. What should the
pharmacy do?
A. Call the police
B. Refuse to fill the new prescription
C. Discuss the matter with the patient
D. Call the doctor and tell him that the patient is addictive
Ans: C
Tips: tell patient that, want to discuss with your new doctor.
42) A 58-year-old female Janna is patient with weight of 52 kg. Her

creatinine clearance 40mL/min has MI., Angina, atrial fibrillation, CHF and
hypercholesterolemia.
KCl = 4 meq/L (normal value 3.5 to 5 meq/L).
Current medication: Digoxin 0.125 mg po QD, Furosemide 40 mg po QD,
Warfarin 5 mg po QD, Lovastatin 20mg po initiated 1 month ago,
Captopril 12.5 mg po tid, Kcl, 20 meq po BID, Nitroglycerin 0.4mg SL prn,
Nitroglycerin patch 0.4mg/hr q 24h
Which of the following is appropriate recommendation with Janna’s
physician:
I. Fill the prescription the way it is
II. Decrease digoxin dose
III. Increase furosemide dose
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans: B (III only)
Tips: Digoxin dose is suitable for this creatinin clearance because it is a
low level. Furosemide should be increased due to renal creatinin
clearance is low. TC 4th ed. page 1202. Avoid furosemide if CrCl is < 30
ml/min. Hydrochlorothiazide is <50 ml/min.

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43) A patient was on lovastatin since last six months. His lipid profile is
under controlled. By some reason he started to take herbal product
containing niacin and find problem of muscular pain. This pain was not
continuous. What should patient do?
A) Take Tylenol on PRN base
B) Contact to doctor
C) Contact to doctor and ask for CK-MM tests
D) Patient need not to worry
ANS: C
Tips: TC 6th ed. page 440. Statin induced myopathy management.
44) What laboratory test monitored regularly, patient using statins?

A) LFT (AST +ALT) B) CK-MB C) BP D) RFT E) CK-MM
ANS: A
45)What statin should take with food?

A) Atorvastatin
B) Lovastatin
C-Fluvastatin
D-Simvastatin
E-Rosuvastatin
ANS: B
Tips: FL are taken with food. Lovastatin have very high effect on
bioavailable.
RSAL avoid with antacids because decrease 30% efficacy.
For fluvastatin do not crush or chew

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46) What is the target of total cholesterol in the patient have coronary
artery disease (MI, post MI, STEMI, NSTEMI, Unstable angina)
A) < 2.2 mmol/L
B) <4.0 mmol/L
C) <1.8 mmol/L
D) 4.5 mmol/L
ANS: B
TC page 436, 6th ed.
47) What is the target of LDL in the patient have diabetes mellitus
A) < 2.2 mmol/L
B) <2.0 mmol/L
C) <1.8 mmol/L
D) 2.5 mmol/L
ANS: B
48) Which of the following patient have high risk of Acute Coronary
syndrome.
A) + ve cardiac enzyme like Troponin I
B) ST segment changes (ECG)
C) TIMI risk score > 3
D) Heart failure
E) All of the above
ANS: E
A 80 yo male with NYHA II CHF (EF 33%), purchasing Gravol for nausea,
dizziness, ↓appetite x 2wks. He thinks it is related to recent ramipril dose
increased. Patient medical history include MI (past 3 yr ago), HTN(past 20
yrs), ↑lipids(x 2yrs), CHF(x 1yr), atrial fibrillation ( for 10 wks). His current
meds include: Pravastatin 40mg QD (x2yrs), amiodarone 200mg QD
(x6wks), digoxin 0.25mg QD (x1yr), warfarin 5mg QD
(for a 6wks), carvedilol 25mg BID (x 1yr), HCTZ 25mg QD (x 25yrs),
Ramipril 10mg QD (↑from 5mg 2wks ago).

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49) A patient has symptoms of heart failure at less than ordinary activity,
which is defined as?
A) symptoms may appear at climbing one flight upstairs. Or walking 200
yards
b) symptoms may appear 30 minutes jogging
C-symptoms may appear after 3 to 5 times of exercise for 30 min in a
week
D-None of the above
Ans-A
50) What is initial therapy for patient has heart failure symptoms from
NYHA classification 1 to IV.
A) ACE I and beta blockers
B-ARBs and beta blockers
C-Digoxin and beta blockers
D-Diuretics and beta blockers
E-Spironolactone and beta blockers
Ans: A
51) If hypothetically doctor choose to use metoprolol and enalapril to

assess the tolerability. Which of the following need to be watched?
A) Shortness of breath
B) Ankle edema
C) Weakness
D) Dry or productive cough
E) Fatigue
Ans: D

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52) Ted is a 55 year-old male, and a new patient to your pharmacy. 163
cm, 86 kg
He suffered a non-ST elevation myocardial infarction 1 week ago. He tells
you that he had PCI in hospital, with a bare metal stent to his proximal
LAD. What are the clinical features used to calculate TIMI risk score?
A)Age >65 y
B)hypertension
C)high cholesterol
D)any ASA use within 7 d
E) all of the above
Ans: E
53) AB is 72 kg. 50 y/o woman who was recently diagnosed with type 2
diabetes. On physical exam her BP is 120/80. Her family doctor told her
the results of her 24hour urine collection showed a normal amount of
protein in the urine. Which of the following interventions should be
implemented to decrease Ms AB’s chance of developing renal disease?
A)Initiation of an ACE inhibitor
B)Initiation of an ARB
C)Optimal blood glucose control
D)Reduction of protein intake to 0.6 g/kg/day
ANS: C
54) A patient was taking Dimicron 180 mg (glicalizide) dose recently

decreased to 80 mg BID. also the patient. The patient suppose to be given
1 box of Diovan (valsartan) 80 mg and boxes of Dimicron the label of
Diovan was wrongly placed on Dimicron and the vice versa. The patient is
advised to take 1 pill of Diovan and 2 pill of Dimicron. Because of wrong
labeling, which symptoms patient experience initially?
A) Increased pulse rate
B) decrease pulse rate
C) Decrease systolic pressure
D) decrease diastolic pressure
E) Hypoglycemia
ANS: C

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55) MP is a 50 year old man. His medical history started
hydrochlorothiazide (HCTZ) 25 mg po qd 2 months ago. After 4 months
HCTZ increased 25 mg po because his BP was uncontrolled. He is diabetic,
has hypercholesterolemia. MP had anaphylactic reaction with amoxicillin
in childhood. He smokes half pack a day. Which section of SOAP we have
to write this allergy?
A) Subjective
B) Objective
C) Assessment
D) Plan
E) Follow up
Ans: A
56) Which of the following is the next most appropriate step in treating
MP?
a. Discontinue HCTZ and re-evaluate blood pressure.
b. Adding lisinopril 10 mg po qd to HCTZ 25 mg po qd
c. Adding Atenolol 100 mg po qd to HCTZ 25 mg po qd
d. Increase HCTZ to 50 mg po qd
e. Lifestyle changes require and discontinue HCTZ
Ans: B
Tips: Atenolol masks hypoglycemia and hydrochlorothiazide is
diabetogenic.
57) Counseling on hydrochlorothiazide 25 mg po qd includes:

A. Do not wear contact lenses
B. Take it in the morning
C. Take with a glass of orange juice or banana (K+ supplement)
D. All of the above
E. B and C
Ans: B

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58) A 75 year old female patient on lansoprazole tablet, and ASA 81mg,
admitted to the ICU experiencing DVT. She was given streptokinase, and
her condition was stable and discharged then from the hospital. Best
prophylactic therapy for her is:
(A) Continuous infusion of heparin + warfarin
(B) Warfarin
(C) Subcutaneous dalteparin + warfarin
(D) Subcutaneous dalteparin
(E) Continuous heparin infusion
Ans: (C)
Reference: Therapeutic Choices 5th edition Page 596
59) In the above question, if the patient developed GIT hemorrhage, What
laboratory test is monitored in patient taking heparin and warfarin?
I) aPTT
II) INR
III) no test is required
A-I only B-III only C-I and II only D-II and III only E-I, II, III
Ans: C
60) Which medication show decreased mortality in cardiovascular

disease (CVD):
(A) Nifedipine
(B) Verapamil
(C) Ramipril
(D) Propranolol
(E) Carvedilol
Ans: (C)
Tips: ACEi lower mortality in CAD and Cardio selective beta blockers also
reduce mortality.

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61) A 58 year-old woman presents you with a prescription for simvastatin
(10 mg daily ). She is also taking atenolol (50 mg daily) having suffered a
heart attack last year. Are you happy to dispense the simvastatin? Justify
your decision.
A. There is no interaction with atenolol.
B. There is drug interactions with atenolol
C. Atenolol decrease effect of simvastatin
D. None of the above
Ans: a
62) Which of the following factors cause statin induce myopathy?

A) men
B) using cholestyramine
C) use of fluroquinolone
D) Chronic renal insufficiencies
E) using long duration
Ans. D
Tips: Tell your doctor immediately if any of muscle pain symptoms like
Muscle pain/tenderness/weakness.
Factors increase myopathy with statins: Patient factors: Advanced age

(>80 y), Alcohol abuse, Chronic renal insufficiency, Excessive grapefruit
juice intake, Frailty, small body frame, Hepatic dysfunction,
Hypothyroidism (untreated), Inherited myopathies, and Intercurrent
infections.
Perioperative periods, Polypharmacy, Vigorous exercise, Women are
more affected than men.
Concomitant medications: Amiodarone, Azole antifungals (itraconazole,
ketoconazole),Calcium channel blockers (nondihydropyridine type),
Cyclosporine, Fibrates (particularly gemfibrozil),HIV protease inhibitors,
Macrolide antibiotics (clarithromycin, erythromycin), Nicotinic acid
(rarely)
Statin properties: High statin dose, High bioavailability, Limited protein
binding, Lipophilicity, Membrane transporter affinity

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Potential for drug–drug interactions metabolized by cytochrome P450
pathways, especially 3A4 and 2C9
MP is a 62 year-old male, presents with the following prescriptions after

being discharged from hospital: nitroglycerin patch (Nitro-Dur®) 0.4mg
daily, ASA (Aspirin) 81 mg daily and metoprolol (Lopressor®) 25mg twice
daily.
Past Medical History indicates Stable angina x 2 years, no known allergies,
current medication Nitroglycerin (Nitrostat) sublingual tablets 0.6 mg prn.
63) What is the recommended length of time that AA should go without
wearing the nitroglycerin patch daily to avoid tolerance?
A) 2-4 hours B) 10-12 hours C) 6-8 hours D) 14-16 hours
Ans-B
Tips: Drug free period (nitrate free) is 10 to 12 hours require minimizing
nitrate tolerance.
64) What is an important point to discuss with MP regarding nitroglycerin

patch use?
I) Rotate application site regularly and remove patch for 10-12 hr daily.
II) Redness at application site requires drug discontinuation
III-Remove patch while bathing or showering and occlusive dressings may
increase absorption.
A) I only B-III only C-I and II only D-II and III only E-I, II, III
Ans-A
Tips: Keep patch on while bathing or showering.
65) Which side effects MP has the most at risk of experiencing?

A) Hyperkalemia B-Hypotension C-Cough D-Dry mouth E-
Irritation
Ans-B

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66) Which of the following counselling tips regarding nitroglycerin
sublingual tablet use is NOT appropriate to provide MP
A-Tablets should be stored tightly capped glass bottle
B-Discard cotton plug from bottle.
C- Persistent chest pain after using 3 doses in a 15-minute interval should
prompt to seek immediate medical attention
D) A tingling or burning sensation when dissolved under the tongue is a
reliable test for potency.
E)Tablets should not be chewed or crushed.
Ans-D
67) MJ is 62 year women has been customer at your pharmacy for many
years. MJ comes to pick her new prescription glargine (lantus). She is
currently using regular insulin at bedtime. Her doctor advised her to
continue regular insulin and new prescription of glargine. When she asked
about mixing glargine and regular insulin the same syringe. The
pharmacist should that the product.
A) Stable if administered immediately and may be premixed and stored in
refrigerator for upto 7 days
B)Have not been studied when administered together
C)Should never be mixed in the same syringe
D) Mixing regular and glargine insulin increase risk of cancer side effect
E) If you are using regular and glargine always choose insulin pen devices.
Ans. C

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68) MK is 80 year old patient recently diagnosed with recurrent
paroxysmal atrial fibrillation (two or more episodes are termed as
recurrent). His doctor informed him that even recurrences of atrial
fibrillation can lead to thromboembolism and have enormous amount of
stroke risk. MKs current medical conditions include hypertension, high
LDL, hypothyroidism and asthma. Currently he is on
Canadesartan/hydrochlorothiazide 16 mg/12.5 mg, atorvastatin 40 mg,
levothyroxine 0.25 mcg, salbutamol 1 puff prn, fluticasone inhaler bid.
What is appropriate for the all patient to prevent stroke associated with
atrial fibrillations?
A) anticoagulants therapy
B) antiplatelet therapy
C) ratre control drug such as digoxin, beta-blockers, verapamil, and/or
diltiazem.
D) rythm control drugs such as amiodarone or dronedarone
E) dual antiplatelet therapy
ans: a
Tips: Whether rate or rhythm control is employed, all patients must take
an anticoagulant indefinitely because even asymptomatic recurrences of
AF can lead to thromboembolism.
69) MKs doctor considering to initiate dronedarone therapy to maintain

sinus rythm. Like amiodarone, dronedarone blocks sodium, calcium, and
potassium myocardial currents, providing both rhythm and rate control.
Which of the following is NOT the side effect of dronedarone?
A) pulmonary fibrosis
B) hypothyroidism
C) vision changes
D) skin discolouration
E) all of the above
Ans; E
Tips: dronedarone does not contain iodine, it does not appear to cause
hypothyroidism, pulmonary fibrosis, vision changes, and skin
discolouration, which are significant problems with amiodarone.

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70)Which of the following drugs would cause drug induced atrial
fibrillation?
A) amiodarone
B) dronedarone
C) salbutamol
D) hydrochlorothiazide/candesartan
E) Metoprolol
Ans:C
Tips: salbutamol is beta agonist can induce atrial fibrillation.
71) A52-year-old female patient on omeprazole, iron supplements, ASA

81 mg, she got deep vein thrombosis, is admitted to the hospital and was
given thrombolytic agent. Doctor considering adding antiplatelets dose.
What antiplatelet is suitable?
A) clopidogrel
B) increase ASA dose to 325 mg
C) ASA+Dipyradamole
D) GP IIb/IIIa inhibitors
Ans: B
Tips: clopidogrel inhibits CYP2C19 and this is substrate of omeprazole and
not preferable to combine with PPIs.
72) Which of the following proton pump inhibitor is suitable in patient

receiving clopidogrel?
A) omeprazole B) lansoprazole C) Pantoprazole D) esomeprazole
Ans: C
Tips: From all PPIs, pantoprazole has least drug interaction with
clopidogrel.

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73) A 16-year-old high school student currently on insulin treatment for
his type I diabetes. Current reading for insulin for a patient is:
At 7 am 12 units NPH (70/30), 6 units regular insulin
At 5 pm 12 units NPH (70/30), 6 units regular insulin
Reading at 7 am (2-3 mmol/L)
Reading at 5 pm (2-3 mmol/L)
Target blood sugar levels (5.8 mmol/L) should be between 5 am to 7 pm.
What would you do?
I-Decrease both time NPH (basal) and maintain regular (prandial) insulin
II) Decrease regular insulin, increase NPH
III) Increase NPH morning and evening, decrease regular
a. I only
b. III only
c. I and II
d. II and III
e. I, II and III
Ans. A
74) Concomitant use of diuretics and ACEI, especially in whom diuretic

therapy was recently instituted, may experience hypotension effects after
the first dose of ACEI. This can be minimized by:
a) Discontinue ACEI
b) loop diuretics
c) Discontinue diuretics
d) Discontinue diuretic for few days
e) All of the above
Ans: d (CPS 2007 Pg 10)

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75) You are a new pharmacist practicing in a community pharmacy
setting. A patient John Mikhel, comes into the pharmacy to get a new
prescription filled for Dimicron MR 30 mg (glicalizide), In checking her
patient profile, you learn that she is long-time patron of the pharmacy., is
60 yo, is 6'.1 tall and weighs 200 lbs. His father was passed away at young
age by juvenile diabetes (type I DM) He has a refill history for
Rosuvastatin that indicates a pattern of late refills, in fact, the last refill
should have run out of two weeks ago. She got new prescription for
ramipril filled three weeks ago and one for clarithromycin two weeks ago.
The rosuvastatin, ramipril and Dimicron MR (gliclizide) are prescribed by
Dr AM and the clarithromycin by Dr. PM.
What additional information should be obtained from John in future
interactions? except?
A) Obtain information of current prescription and non prescription
medication to ensure profile is complete.
B) Obtain information of chronic use of medications
C) Assess understanding about acute care medications
D) Possible presence of other medical problems that are not being treated
or his physician is unaware of
E) None of the above
Ans: E
76) What barrier do you think might keep you from getting a complete
picture of her medication therapy?
A) Lack of self confidence and anxiety of her father death with type I DM
B) Environmental barrier because he is tall
C) Administrative barrier at pharmacy
D) Poor communication skills of patient
E) Pharmacist barrier
Ans: A

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77) PK is a 80 year-old woman with osteoporosis, osteoarthritis, chronic
UTIs, essential tremor, and mild cognitive impairment, who has recently
been diagnosed with depression with anxious features. PKs appetite has
significantly diminished and skipping several meals of the day. He is
currently sleeping only for 1 hour.
Current medications include calcium with D 500 mg/400 IU tid,
alendronate 70 mg weekly, and prn acetaminophen extra strength. Which
of the following is a most likely antidepressant to give PK?
a. Citalopram or sertraline
b. Sertraline or Paroxetine
c. Paroxetine or Fluoxetine
d. Venlafaxine or Duloxetine
e. Amitriptyline or bupropion
Ans; A
Tips: Fluoxetine and paroxetine are not good choices in senior due to a propensity to
cause excessive stimulation, sleep disturbance, and agitation; a long half-life
(fluoxetine); and clinically relevant anticholinergic properties (paroxetine).
78) When assessing response of antidepressants, which of the following

symptoms response onset is approximately in 2 weeks?
A) neurovegetative symptoms such as appetite and sleep.
B) mood symptoms
C) cognitive symptoms
D) anxiety symptoms
E) psychosis symptoms
Ans.A
Tips: appetite and sleep may improve in 2 weeks. However mood
improved in 3 weeks. The optimal effect is seen 4 to 6 weeks.

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79) Which of the following SSRIs side effects require dose reduction or
switching of antidepressant?
A) Nausea, diarrhea
B) Sleep disturbances
C) Headache
D) Increased sweating
E) Insomnia
Ans. D
Tips:
Nausea, diarrhea – one week
Sleep disturbances – first week or two
Headache – first week or two
Side effects that require dosage reduction, treatment or
switching of antidepressant:
• Tremor or akathisia
• Sexual dysfunction
• Increased sweating
• Nausea (through CNS stimulation)
80) SD is a 59-year-old retired person. Frequently visit to his

family doctor for difficulty in sleep. Which of the following
patient assessment is LEAST important for insomnia? Patient
denies taking alcohol, smoking and watching TV.
A- Total sleep time
B) Sleep latency
C) Early and/or frequent awakening
D) Alcohol consumption
E) Daytime impact of sleeping problem
Ans. D
TC page 136, 6th ed. Sleep diary. Is it ok to have 15 min brisk
walk before bedtime.

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81) SDs doctor considering to prescribe medication for insomnia.

Which of the following medication have fast onset of action and
least hangover?
A)Zopiclone B) Lorazepam C) Oxazepam
D) Diazepam E) Clonazepam
Ans: A
Tips: Zopiclone is short acting and have least hangover effect.
Triazolam 0.125 mg to 0.250 mg has faster onset of action. Have
No hangover effect. However it has retrograde amnesia.
rebound insomnia, and have day time anxiety. This SEs makes
limited use in initiating sleep.
Oxazepam have NO hangover effect TC page 137.
82) MJ is a 41 years old a chronic alcoholic male, no known

allergies, past medical history: Anxiety, difficulty sleeping.
Current medications: triazolam 0.5 mg qhs x 3 years and
acetaminophen/caffeine/codeine (Tylenol #1) – ii prn headache.
You notice that this patient has been coming in early for refills
for triazolam and has received extra prescriptions for this
medication from many walk-in clinics. Patient approaches you
and states that he is concerned about his triazolam usage, so he
stopped using it 24 hours ago. He asks you what the most
common withdrawal symptoms will be:
A) Diarrhea, shakes and chills
B) Insomnia, muscle spasms and irritability
C) Increased headache, fatigue and nausea
D) Seizures, delirium, and hallucinations
Ans: B

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83) KD is a 65 yr female patient of osteoarthritis on
acetaminophen 650 mg qid ask for 120 tab of Tylenol # 1
recommended by the doctor she already on increase dose so
what is the main concern of the pharmacist. Her lifestyle include
daily drinks 2 to 3 wine.
I) Overdose of acetaminophen
II) Constipation
III) Narcotic regulations
A)I only B-III only C-I and II only D-II and III only E-I,II, III
Ans-C
84)Factors contributing to acetaminophen overdose and liver

toxicity include?
I) ingesting more than the maximum recommended total daily
dose (4 g in 24 hours),
II) taking multiple acetaminophen formulations for different
conditions or symptoms.
III) consuming three or more alcoholic drinks per day while
taking acetaminophen.
A-I only B-III only C-I and II only D-II and III only E-I,II, III
Ans: E
85) If IBs doctor considering to prescribe diclofenax gel (Voltaren
gel) what risk factors you consider? except
A) Age > 65 yo
B) GI bleeding
C) Renal disease < CrCl 30 ml/min
D)if already using oral NSAIDs
Ans: A
TC page 1028, 6th ed. Table 1: Risk factors for developing upper
GI adverse effects with NSAIDs

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86) A patient has been taking an opioid analgesic for the past
three months for back pain resulting from a workplace injury. All
of the following behaviors could be indicators of a developing
addiction disorder, EXCEPT:
a) incidents of lost prescriptions.
b) frequent requests for early refills.
c) prescriptions from multiple family physicians.
d) patient concerns regarding side effects.
e) patient concerns regarding lack of efficacy.
Answer: D
FG is a 65-year-old war veteran with a 40-year history of

paranoid schizophrenia. His symptoms include poor personal
hygiene, blunted affect, and delusions, accompanied by
auditory and visual hallucinations. His delusional symptoms
relate to his wartime experiences. His visual hallucinations
involve enemy soldiers from the war who he believes are
stalking him. FG's auditory hallucinations include the sounds
of war, accompanied by enemy soldiers threatening to end his
life if he does not keep his guard up. FG has been unable to
maintain a job or adequate housing for many years. He
currently lives under a bridge "in case he needs to make a
getaway down the river."

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When workers from the free clinic are able to locate him, they
attempt to provide medical care and evaluate his
schizophrenia. If sample medications are available, they
provide him with them. According to their records, FG was
given haloperidol 15 mg 3 times daily and benztropine 1 mg 3
times daily when they last evaluated him. He was given enough
medication for a few weeks so that they could evaluate the
effectiveness and any adverse effects. During previous trials
with other neuroleptic agents, extrapyramidal side effects have
limited the dose FG could tolerate.
The physician on the team would like to discontinue the
haloperidol and initiate an agent with fewer extrapyramidal
side effects. He searches the medication supply and finds that
he has samples of olanzapine, quetiapine, aripiprazole, and
risperidone, ziprasidone
87) Which agent is least likely to cause extra pyramidal side

effects?
A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone
E) Ziprasidone
Ans.B
Tips:
EPS Symptoms from least to high Clozapine>quetiapine>
Risperidone> Olanzapine.
Risperidone is the agent least likely to cause extrapyramidal

side effects. At doses ≤6 mg per day, the side effect rate with
risperidone is similar to that with placebo. With increased doses,
the risk of extrapyramidal side effects increases. The most

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common side effects with low-dose risperidone are asthenia and
sedation.
88) Which agent is most likely to cause QT prolongation side

effects?
A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone
E) Ziprasidone
Ans: E
Tips: Ziprasidone is contraindicated in QT prolongation.
Risperidone, quetiapine, olanzapine have QT prolongation SEs.
Clozapine has myocardititis SEs.
89) Which agent cause highest weight gain side effects?

A) Olanzapine
B) Quetiapine
C) Aripaprazole
D) Risperidone
E) Ziprasidone
Ans: A
Tips: Olanzapine and clozapine have the highest weight of all
antipsychotics.

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90) MP was recently diagnosed with schizophrenia and was just
discharged from hospital. He is currently taking risperidone 3 mg
twice daily. He tells you that he no longer has delusions or
hallucinations and is feeling more motivated, but he’s been
having trouble with symptoms that he describes as “wanting to
crawl out of his skin” and a hand tremor. What is appropriate
reasoning to tell MP?
I) the symptoms he is describing are normal side effects of
risperidone; because his symptoms of schizophrenia are well
controlled, there is nothing that can be done
II) sometimes the risperidone can cause the symptoms he is
describing; with his permission, you will call his psychiatrist to
discuss reducing his dosage.
III) sometimes the risperidone can cause the symptoms he is
describing; with his permission, you will call his psychiatrist to
discuss switching risperidone with clozapine because it is
associated with fewer extra pyramidal symptoms.
A) I only B) III only C) I and II D) II and III E) I,II,II
Ans: D
91) What receptor likely has the largest impact on risk of

sedation?
a) histamine H1 receptors
b) dopamine D2 receptors
c) histamine H2 receptors
d) alpha1 receptors
e) alpha 2 receptors
Ans: A
Tips: sedation is antihistaminic effects caused by blockade of H1
receptors. Alpha1 receptor inhibition causes orthostatic
hypotension.

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92) Which agent must be taken with meals?
A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone
E) ziprasidone
Ans: E
93) What is not monitored for risperidone?

A) blood pressure and pulse on dose titration
B) Body mass index (BMI)
C) Liver function test at base line and Q6m
D) Lipids and triglyceride levels
E) Cardiomyopathy like chest pain
Tips:E
Bp/pulse BG LFT BMI WBC TG/TC others
Clozapine + + + + + + Cardiotoxicity
Sedation
Risperidone + + + + + EPS: Akithisia
(restlessness)
Olanzapine + + + + EPS: Akithisia
Sedation
Quetiapine + + + +
Ziprasidone
Paliperidone
Aripiprazole

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94) After starting antipsychotics therapy. When symptoms of
schizophrenia will start to resolve?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
E) one month
Ans. A
Tips: start resolving symptoms in 2 weeks and maximum takes 8
weeks.
95) The doctor prescribes a combination treatment of SSRI +

benzodiazepines for which there is a risk for a pharmacokinetic
interaction. Which of the following is the best course of action?
A) Recommend avoiding the combination due to the narrow
safety margin of SSRI
B) Recommend avoiding the combination due to narrow safety
of margin of benzodiazepines
C) Dispense the combination and monitor for increased side
effects of SSRI
D) Dispense the combination and monitor for increased side
effects of benzodiazepines
Ans: D

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96) A 30 yo maniac patient on lithium 600 mg q8h admitted to
hospital with hallucination and disorientation. What is the
better explanation or drug related problem?
A) non adherence
B) taking too much medication
C) Taking too little dose
D) toxicity of lithium
E) Need additional drug therapy
Ans: E
Tips: Lithium min dose 900 mg to 2100 mg daily. Over dose
symptoms can occur if lithium serum levels are over 2 mEq/L.
Hallucination, and disorientation need additional therapies like
mood stabilizers.
97) A 25 year old student is taking paroxetine daily for the

treatment of depression for the past 3 months. Currently doctor
diagnosed patient as maniac. What is appropriate to do?
A) Continue paroxetine and start lithium
B) Discontinue paroxetine and start lithium
C) Continue paroxetine and add haloperidol and lithium
D) Discontinue paroxetine and add haloperidol
E) Increase dose of lithium
Ans: B
98) A patient with neuropathic pain was prescribed

carbamazepine by his doctor, with some relief of his signs and
symptoms but with more side effects that are bothering the
patient. Which of the following symptoms are not dose
dependent?
A-Rash
B-Dizziness
C-visual disturbances
D-GI upset

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Ans-A
Tips: Carbamazepine idiosyncratic ADR is rash, require to
discontinue and talk to doctor. A patient with allergic
amitriptyline should not take carbamazepine because these two
drugs are structurally same class.
99) A 10 years child with ADHD. His doctor diagnosed his

condition and prescribed methylphenidate CR capsule 10 mg
twice daily. Best thing the pharmacist should do is
A-Call the doctor to switch the patient to methylphenidate CR
tab 20 mg/dose since the later is given in divided doses.
B-Call the doctor to ensure him that methylphenidate CR is given
once daily and not twice daily
C-Dispense the prescription as it is
D-Call the doctor to prescribe him methylphenidate since the
capsule can be opened and sprinkled on soft foods
E-None of the above
Ans:B: methylphenidate CR is given as 20 mg/dose 8 hours apart
and controlled release as a single dose
100) What is monitored in 10-year-old using methylphenidate,

except?
A-Weight loss
B-Insomnia
C-Constipation
D-Reduce hyperactivity
E-Attention in his studies
F-Suicidal plans
Ans-C

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77) KM is A 41 year old male using antihypertensive captopril bid and

indomethacin for treatment of acute gout attacks and ASA 81 mg for
primary prevention of cerebrovascular risk. What is the interactions
between captopril and indomethacin?
A) Increase in prostaglandin and Na/water retention
B) Decrease in prostaglandin and Na/Water retention
C) Increase risk of anti inflammatory effect of indomethacin
D) Increase risk of gastrointestinal bleeding
E) Decrease risk of gastrointestinal bleeding
Ans: B
78)JP is a 47 year old male diabetes patient taking metformin 850 mg BID.
Blood sugar is not controlled. Patient complaining he is not taking
medicine regularly due to GI side effect. What to do?
A) Reduce dose of metformin and add gliclazide
B) Reduce dose of metformin and add pioglitazone
C) Reduce dose of metformin and add acarbose
D) Reduce dose of metformin and sitagliptine
E) Reduce dose of metformin and saxigliptine
Ans: A
Tips: choose from difference class and preferably sulfonylureas and more
evidence.
79) If consider adding pioglitazone. Which of the following is true about

using pioglitazone for type 2 diabetes?
a) It lowers risk of fractures
B) It is associated small risk of bladder cancer
C) It has high risk of hypoglycemia
D) It is likely to cause weight loss
E) It lowers risk of heart failure
Ans: B
Tips: Pioglitazone associated with high risk fractures in seniors, small
bladder cancer (monitor blood urine), cause weight gain and high risk of
heart failure.

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80) Complications of diabetes typically include all of the following except:

a) retinopathy
b) nephropathy
c) pulmonary disease
d) cardiovascular disease
e) high triglycerides
ans: C
TIPS: Diabetic complications such as macrovascular or microvascular
changes, neuropathy, kidney disease, erectile dysfunction. REF (TC,4th
edition, 804).
81) A.H. is a 81 year-old female. A.H. presents with a prescription for

warfarin 1 mg tablets to be adjusted based on INR results. AH. explains
the drug is for atrial fibrillation. Current medications: Hydrochlorothiazide
25 mg daily Metoprolol 50 mg BID
Past medical history: Hypertension x 12 years
Which counseling point would NOT be necessary to discuss with A.H.

regarding warfarin use?
I-Avoid taking ibuprofen for pain or fever.
II-Inform all health care providers that you are taking warfarin.
III-Avoid drinking grapefruit juice while taking warfarin.
A) I only B) III only C) I and II D) II and III E) I,II,III
Ans-B
Comments: CYP 2C9 and CYP1A 2 is the most common metabolizing for
enzyme for warfarin.
82) MN a patient with prosthetic valve replacement in his heart was

discharged after having a cerebral ischemic attack. The patient is

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intolerant to ASA. Best prophylactic treatment to be prescribed for the
patient is/are:
(A) Ticlopidine
(B) Clopidogrel 75 mg
(C) Dipyridamole 400 mg/day
(D) Dipyridamole plus Warfarin
(E) ASA 81 mg
Answer: (D)
Tips: Dipyridamole and warfarin are appropriately used cerebral ischemia
specially in artificial valve replacement or prosthetic valve replacement.
83) Several months late, MN is put on ticlopidine. What must she be

aware of to optimize her therapy with this agent?
a. she must ensure that she has her blood tested every week for the first
three months of therapy
b. she must take it on an empty stomach to maximize absorption and
minimize adverse effects
c. she should report fever and sore throat to her physician.
d. she should continue to take ASA with ticlopidine with added benefits
e. she should be aware that constipation is common but it is a transient
effect
Ans: C
TIPS: Ticlopidine causes severe neutropenia during the first 3 to 12 weeks
its symptoms are (fever, chills, sore throat, and ulceration in oral cavity).
The patients should be advised to stop the medication and consult their
physician immidiatly.REF. (CPS, 2003, Ticlid).
84) Which of the following statements is true regarding clopidogrel?

a. it is an antiplatelet agent with a different mechanism of action from
ticlopidine
b) it appears to be more effective than ASA in preventing ischemic stroke
c) it is more effective than warfarin in preventing stroke in atrial
fibrillation
d) the incidence of neutropenia is two percent with clopidogrel

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C) clopidogrel have cross sensitivity with ASA
Ans:B
TIPS: Clopidogril indicated for (MI, ischemic stroke, cardiovascular death,
and/or refractory ischemia). These benefits are occurred when these
patients are treated with ASA. REF (CPS, 2003, Plavix).
85) Which of the following is TRUE about using Aspirin to reduce

cardiovascular risk?
a) 81 mg/day works as well as higher doses for most indications.
b) 325 mg/day is preferred after a stent.
c) Giving Aspirin at bedtime instead of in the morning is proven to
improve outcomes
D) Giving aspirin twice a day instead of once a day is proven to improve
outcomes.
Ans: A
86) Which of the following statements best describes the mechanism of

action of warfarin in preventing stroke?
A) it prevents clot formation by reducing certain clotting factors in the
liver
b) it prevents platelet aggregation by reducing the production of
thromboxane A2
c) it prevents hemorrhagic stroke by reducing bleeding time
d) it prevents prostaglandin synthesis and ultimately platelet aggregation
Ans: A
TIPS: Warfarin act by inhibiting the synthesis of Vit. K depending clotting
factors(ii, vii, ix, and x) and the anticoagulant proteins C and S. REF(CPS,
2003, Coumadin).
87) SD is a 91kg, 52-year old female who was recently diagnosed mild
hypertension On physical exam her BP was 150/94, serum creatinine was
150 umol/L, K is 4.5 mmol/L. She is taking metformin and glicalizide for
the past 4 yrs for type 2 DM.
Recommended hypertension therapy for SD if her blood pressure is?
A. >130/80 B) <140/90 C) <125/75 d) <100/80
Ans: A

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Tips: TC chapter Hypertension page 216. Mild hypertension without
commodities target BP 160/90.
For hemorrhagic stroke more severe headache. However ischemic is less
severe. Pharmacotherapy 8th ed.
88) Complications of hypertension include damage to all of the end

organs except:
a) heart b) eyes c) liver d) large vessels
Ans. C
89) KJ is 57 year old patient on glyburide 2.5 mg bid, metformin 500 mg

tid, and still blood sugar is not controlled because her new lab test HbA1C
7.5%. What to do?
A) switch to insulin
B) add another medication
C) Increase glyburide dose
D) increase metformin
E) Use insulin NPH morning
Ans: C
90) MM a 45 yo male patient with prosthetic valve replacement. His

doctor wants to maintain the Patient on INR 2.5 to 3.5 to avoid any clot
formation. Patient was prescribed Heparin 10,000Iu and Warfarin 4mg PO
qd. Currently patient is stabilized on warfarin 2.5 mg daily for the past 5
yrs. However, patient is not satisfied due to difficulty to keeping up with
warfarin side effects, of nausea and maintaining dietary controls and
frequent monitoring.
MM have heard about new anticoagulant Dabigatran and have some
questions, what is incorrect about Dabigatran?
A) Dabigatran 150 mg twice daily is more effective than warfarin
B)Dabigatran 110 mg twice daily has a better safety profile (less bleeding)
than warfarin
C)Currently Dabigatran have studied only for atrial fibrillation prophylaxis
D)Dabigatran does not require regular monitoring like warfarin
E)It is safe to use in liver failure patient

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Ans: E
Tips: Pradaxa is in the same class as Exanta (ximelagatran) are
factor Xa inhibitor. But Exanta had too much liver toxicity. So
far, liver toxicity doesn't seem to be a serious problem with
Pradax. For now, don't recommend it for patients who already
have liver disease.
91) MM is developed sore throat and his doctor wants to prescribe

ampicillin 500 mg QID
A-Effects of warfarin may be increased resulting in increased risk of
bleeding
B) Effects of warfarin may be decrease resulting in increased risk of
bleeding
C) Effects of warfarin may be increased resulting in decreased risk of
bleeding
D) Effects of warfarin may be decrease resulting in decreased risk of
bleeding
E) Effects of warfarin may be decrease resulting do not effects on bleeding
Ans-A
Tips: INR should be monitored upon addition of ampicillin and
withdrawal of ampicillin. INR should be periodically reassessed for at
least 3 weeks after ampicillin D/C, since adjustment in the warfarin dose
may be necessary to maintain an effective level of anticoagulation.
92) MM is currently stabilized on Warfarin 2.5 mg QD treatment. Which of

the following drugs may decrease warfarin levels
A) Carbamazepine B) Clarithromycin C) Cotrimoxazole D) Ciprofloxacin
E) Digoxin
Ans-A
Tips: Carbamazepine is enzyme CYP 2D6 inducers. It will decrease
warfarin blood levels. Clarithromycin (and, to a lesser extent,
azithromycin) and cotrimoxazole may increase warfarin blood levels.
Clarithromycin may also increase levels of carbamazepine, digoxin,
statins and theophyllines. Other antibiotics that may increase warfarin
and digoxin levels include fluoroquinolones.

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92) A 50 years old man, presented to the emergency ward with swollen
right leg and may have been diagnosed with deep vein thrombosis. The
best initial treatment for this patient is:
A. Give ASA 325 mg po, to act as antiplatelets
B. Give enoxaparin 4000 IU sc q24 hour
C. Give warfarin 3 mg to maintain INR 2 to 3
D. Give enoxaparin + warfarin
E. Give streptokinase 1.5 million IU i.v. is over 1hour
Ans: D
Tips: Since warfarin take 36 hrs for exerting its effect. Hence we use
enoxaprin and to initiate the action promptly and start together with
warfarin.
BM, a 60 year old –old male, diagnosed hypertension for the past 30 years
and 10 year history of Ischemic heart disease (IHD), poorly controlled due
to poor compliance. He has no family history of heart disease and social
history includes smoked for past 40 years; currently smoke 1-2 packs per
week and on average drinks a six pack of beer per week. Current
medications include: Hydrochlorothiazide 25 mg PO daily, nitroglycerin
0.4 mg PRN for chest pain, Ketoprofen, 75 mg PO TID
No known medical allergies, physical examination includes anxious male,
BP 125/90, HR 105, wt 68 kg, 1+ ankle edema, bluish-gray skin
discoloration on sun – exposed areas. Lab values Na 134, K 3.9, Cl 102,
HCO3 28, BUN 6.1, Cr 106, Hct 0.38, Hgb 140, MCV 88, AST 0.70, ALT 0.64,
LDH 3.18, Alk Phos 0.8, Alb 38 & ESR 43 mm/hr.
93) Which of the following monitoring parameters is NOT important in

the early assessment of ACE inhibitor therapy in BM?
A) Serum K+
B) Serum creatinine
C) Renal function test
D)Liver function test
E) Serum Na+
Ans-E
94) Which of the following ACE inhibitor works best if you take it on an
empty stomach?

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A. Lisinopril
B)Captopril
C)Enalapril
D)Ramipril
E)All of the above
Ans: B
Tips: Captopril and parindaropil is taken empty stomach.
95) which of the following antihypertensive should NOT be used in a

patient with systolic dysfunction?
A. Ramipril
B)Felodipine
C)Amlodipine
D)Verapamil
E)Atenolol
Ans-D
Tips: drug of choice for systolic dysfunction. ACEI alternate ARBs. Drug of
choice for isolated systolic hypertension ACE I alternate ARBs. Congestive
heart failure avoid using verapamil and diltiazem because it cause -ve
inotropic effect. Among ACEi fosinopril do NOT require dose adjustment
in renal patient because eliminates renal and hepatic (50:50).
96) Which of the following in BM profile is objective according to SOAP

note?
A) ACE i Side effects
B) Cardiovascular laboratory values
C) Patient symptoms
D) all of the above
Ans: B
97) BMs wants to initiate antiplatelets therapy as cardioprotection? Which of the

following drugs act by irreversible inhibiting platelet function?
I) Acetyle Salicylate
II) Ibuprofen
III) Acetaminophen

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97) Overwhelming data in patients with established CAD supporting the

benefits of anticholenesterase drugs in mortality, cardiovascular mortality
and stroke. What is the drug of choice recommended above patient to
achieve target LDL ?
A) Rosuvastatin
B) Ramipril
C) Niacin
D) Fenofibrate
E) Beta blockers
Ans: A
98) According to institute of safe medication practices increases significant

harm when used in error?
I) warfarin
II) subcutaneous insulin
III) Amiodarone IV
67) Patient with prosthetic valve replacement in his heart was discharged
after having a cerebral ischemic attack. The patient is intolerant to ASA.
Best prophylactic treatment to be prescribed for the patient is/are:
(A) Ticlid (Ticlopidine)
(B) Clopidogrel (Plavix 75mg)
(C) Dipyridamole 400mg/day
(D) Dipyridamole plus Warfarin
(E) None of the above
Ans: (D)

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What medications should be taken with meals according to the passage?

What medications should be taken with meals according to the passage?

What professional(s) would be appropriate for a pharmacy to refer a diabetic patient to according to the passage?

What professional(s) would be appropriate for a pharmacy to refer a diabetic patient to according to the passage?

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2) Metformin should be taken with meals, because?

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 1

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 2

6) KP is 53 year old patient who had hypertension came to pharmacy and

7) KM a 60 yo MI patient had bypass surgery past 4 months ago using

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 3

8) A 60 yo patient came to emergency and doctor diagnosed STEMI and

9) A 66 yo male in warfarin treatment for deep vein thrombosis. A doctor

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 4

11) What is the most important recommendation should provided to

12) Patient is hospitalized. Drs initiated heparin infusion. What is

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14) MP is a 72 years old patient diagnosed for systolic congestive heart

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 6

15) MP returns to pharmacy with a new prescription of metoprolol 50 mg

16) Patients using beta blockers (metoprolol, carvedilol and bisoprolol) in

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 7

18) What is the therapeutic benefit of adding diuretics to congestive heart

19) MPs congestive heart failure continued to deteriorate on optimal

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 8

20) MPs doctor prescribed digoxin 0.125 mg daily to improve quality of

21) MPs doctor prescribed spironolactone 12.5 mg daily to treat severe

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23) MK is currently stabilized on warfarin 2.5 mg QD treatment. Which of

24) A 65 years old patient was admitted to ICU experiencing acute

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25) What could be pulmonologist concern?

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27) Which of the following is NOT required to monitor for amiodarone?

A 55 year-old male, new patient to your pharmacy, overweight suffered a

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30) A patient was scheduled for an endovascular coiling procedure to

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 13

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 14

33) Multiple issues often underlie the inadvertent administration of high-

34) GS is a 49 year women. Her physician had prescribed morphine ‘.5

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 15

36) What is the target waist line circumference?

37) What is the initial therapy?

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 16

40) A 65-year-old man with a history of hypertension, atrial fibrillation,

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 17

42) A 58-year-old female Janna is patient with weight of 52 kg. Her

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 18

44) What laboratory test monitored regularly, patient using statins?

45)What statin should take with food?

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 19

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 20

51) If hypothetically doctor choose to use metoprolol and enalapril to

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 21

54) A patient was taking Dimicron 180 mg (glicalizide) dose recently

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 22

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 23

57) Counseling on hydrochlorothiazide 25 mg po qd includes: