PEBC Evaluating exam practice questions that are most important for exams. Questions worded as actual questions for pharmacy evaluating exam preparation with solved answers, notes, mnemonics, and additional notes.
Question 1: What is the mechanism of action of Abatacept?
A. TNF alpha inhibitor.
B. Binds with CD20 proteins present on B cells.
C. Binds with CD80/86 present on antigen-presenting cells.
D. Tyrosine kinase inhibitor.
E. Multikinase inhibitor
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Answer: C
Abatacept binds to the costimulatory molecules CD80 and CD86 on antigen-presenting cells (APC), thereby blocking interaction with CD28 on T cells.
Question 2: KT is a 30-year-old Chinese woman who is pregnant for the first time. She developed preeclampsia and she is taking methyldopa and prenatal vitamins. Answer the following questions based on the information provided.
Question 2.1: Why did she get preeclampsia?
A. Age
B. Ethnicity
C. First time pregnant
D. Prenatal Vitamins
E. Folic acid deficiency
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Answer: B
Explanation:
Risk factors for preeclampsia: Pre existing hypertesnion, kidney disease before pregnancy, history of preeclampsia in an earlier pregnancy, obesity, women over 40, multiple gestation, African American women > non white women > white women, family history of preeclampsia.
Question 2.2: What to counsel her about methyldopa?
A. Methyldopa is associated with severe rebound hypertension if stopped abruptly.
B. It will cause photosensitivity.
C. It causes erectile dysfunction as sexual dysfunction.
D. It might cause hypotension and dizziness.
E. Methyldopa cause tachycardia.
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Answer: D
Clonidine is associated with severe rebound hypertension if stopped abruptly.
Side effects of methyldopa: orthostatic hypotension, bradycardia, thrombocytopenia, hemolytic anemia, and bone marrow depression. Methyldopa is a prodrug. It is contraindicated in patients taking MAO inhibitors as it causes hypertensive crisis.
Symptoms of hypotension: Dizziness, lightheadedness, blurred vision.
Question 2.3: Which drugs other than methydopa can be recommended to KT?
A. Labetalol
B. Captopril
C. Losartan
D. Hydrochlorthiazide
E. Verapamil
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Answer: A
Labetalol, Methyldopa, and Nifedipine XL are the drugs of choice in pregnancy. Short-acting Nifdedipine is not used in the treatment of hypertension.
Question 3: What is the mechanism of action of Empagliflozin?
A. Sodium Glucose Cotransporter 2 inhibitor
B. SGLT2 promoter
C. GLP-1 analogue
D. DPP4 inhibitor
E. Incretin analopgue
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Answer: A
All ‘-Gliflozins’ (Canagliflozin, Empagliflozin, Dapagliflozin, Ertugliflozin) are SGLT2 inhibitors.
All ‘-glutide’ and ‘-enatide’ are Incretin (GLP1) analogs. Example: Liraglutide, Exenatide, Dulaglutide, Semaglutide, Lixisenatide.
All ‘-gliptins’ are DPP4 inhibitors. Examples: Sitagliptin, Saxagliptin, Linagliptin, Alogliptin.
Question 4: What is the mechanism of action of Atomoxetine? – Most Important
A. Inhibits uptake of Nor epinephrine and dopamine.
B. Selective Nor Epinephrine reuptake inhibitor.
C. Inhibits the uptake of serotonin
D. Stimulates the serotonin receptors to produce euphoric effect.
E. 5 alpha reductase 2 inhibitor
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Answer: B
Atomoxetine is approved for ADHD (Attention deficit hyperactivity disorder). It is preferred in patients with a history of drug abuse.
Atomoxetine is a selective norepinephrine reuptake inhibitor. It does not inhibit dopamine receptors. So it does not produce habit.
Side effects: Nausea, vomiting, Constipation, dry mouth, insomnia, and sexual dysfunction. Contraindications: Do not take Atomoxetine within 2 weeks of MAO inhibitors.
NOTE
Mechanism of action of drugs is important. Expect 5 to 6 questions based on mechanism of action. Also note if the mechanism is reversible or irreversible, competitive or non-competitive. While studying for drugs acting on nervous system, pay close attention to receptors on which the drug is acting. You can expect 1 - 2 questions on receptors.
I will try to cover all the important drug mechanism of action through these questions.
Question 5: What is the mechanism of action of Galantamine?
A. Quaternary alcohol which reversibly inhibits choline esterase enzyme.
B. A carbamate which reversibly inhibits choline esterase enzyme.
C. Pseudo irrversible inhibition of choline esterase enzyme.
D. Direct acting cholinergic agonist.
E. Indirect acting cholinergic agonist
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Answer: B
Physostigmine, Neostigmine, Rivastigmine, Pyridostigmine, Galantamine, and Edrophonium are carbamtes that cause reversible inhibition of the choline esterase enzyme.
Side effects of cholinergic drugs: (mnemonic DUMBELS or WET).
| D | Diarrhea |
| U | Urination |
| M | Myopia |
| B | Bradycardia |
| E | Excessive Sweat |
| L | Lacrimation |
| S | Salivation |
Question 6: Naltrexone is used for alcohol craving. Which neurotransmitter it reduces in the brain?
A. Serotonin
B. Epinephrine
C. Endorphin
D. Dopamine
E. Enkephalin
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Answer: D
Tip: Dopamine is the neurotransmitter that is responsible for addiction. Dopamine also makes us repeatedly do pleasurable things.
Question 7: Based on Tallman letters which of the following combinations is correct?
A. doxoRUBICIN / idaRUBICIN
B. DOBUTamine / DOPamine
C. dobutAMINE / dopAMINE
D. DOPAmine / DOBUTamine
E. Tallman letter involves readback technique
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Answer: B
Additional notes:
- Tallman lettering is used for sound-alike look-alike drug names (LASA or SALAD).
- It is one of the risk mitigation strategies.
- Visual similarity includes a similar length of the names and the number of groups of characters in the names. This similarity is called orthographic similarity.
Rules of capitalisation:
- Capitalization should not be applied to
- Common suffixes and prefixes
- The letter ‘i’ should not be capitalized
- Letters or sections of drug names that are phonetically similar, with the number of syllables, pronunciation stresses, and placement of vowel and consonant sounds being attributes that should be considered when determining the degree of drug name similarity
Question 8: Which of the following infections is not a chronic infection?
A. Hepatitis B
B. Human immunodeficiency virus infection
C. Hepatitis C
D. Infectious mononucleosis
E. Hepatitis A
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Answer: E
Hepatitis A is not a chronic infection. It has oro-fecal transmission. It is caused by ‘Picorna virus’.
Hepatitis B is caused by ‘Hepadna virus’. Hepatitis C is caused by ‘Flavivirus’. Infectious mononucleosis is caused by EBV. These are all chronic infectious diseases.
Question 9: What is not true about Duchenne muscular dystrophy? – Most important
A. Caused by a genetic problem in producing dystrophin.
B. Mostly affect boys.
C. Affects both boys and girls equally.
D. Becker muscular dystrophy progresses slowly than Duchenne muscular dystrophy.
E. Most severe of all muscular dystrophies.
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Answer: C
Duchenne muscular dystrophy is a genetic disorder. Patients with this disease have problem in producing dystrophin. It is a protein that protects muscle fibres from breaking down when exposed to enzymes. Duchenne is caused by a mutation on the mother’s X chromosome. Duchenne is a fatal disease.
Becker muscular dystrophy is similar to Duchenne muscular dystrophy but it progresses slowly than duchenne.
Dystrophin is located between the sarcolemma and the outer layer of myofilaments in muscle fibers.
Question 10: JM was experiencing slowing of the ability to perform mental tasks and mood or personality changes. JM is getting treated for hepatic encephalopathy. JM came to pharmacy complaining about constipation. Which product should a pharmacist recommend?
A. Lactulose
B. Sennoside
C. Glycerine
D. PEG
E. Psyllium
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Answer: A
Hepatic encephalopathy is a range of neuropsychiatric and neuromuscular abnormalities resulting from the buildup of toxic substances. This is due to reduced hepatic function, ultimately impacting brain function. Hepatic encephalopathy is characterized by the accumulation of ammonia.
Lactulose is the preferred agent in this case as it absorbs ammonia.
Question 11: Which drug causes the least hypoglycemia as a side effect?
A. Glyburide
B. Saxagliptin
C. Glimiperide
D. Repaglinide
E. Gliclazide
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Answer: B
SGLT2 inhibitors, GLP-1 analogs, and DPP4 inhibitors cause least hypoglycemia as side effect.
Question 12: How is hydrocodone regulated?
A. Narcotic preparations
B. Straight Narcotics
C. Control drug Part 1
D. CDSA schedule III
E. F&DA part B
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Answer: B
Hydrocodone is regulated under ‘straight Narcotics’.
- Points to remember for straight narcotics
- Repeats/Refills NOT allowed
- Prescription transfer NOT allowed
- Given only by written prescription
- Part fills are allowed
- Hard copies of prescription need to be saved for 2 years and digital copies need to be saved for 7 years.
- Lost of stolen goods have to be reported to the Office of Control Substance within 10 days
Question 13: Fentanyl causes euphoria through which receptor-mediated action?
A. Delta receptor
B. Kappa receptor
C. Mu receptor
D. Serotonin
E. ORL 1
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Answer: C
The mnemonic for all actions mediated by Mu receptors is “MUDPILES“:
Miosis (constriction of the pupils)
Urinary retention
Dependence (physical and psychological dependence)
Pruritus (itching)
Increased pain threshold (analgesia)
Low respiratory rate (respiratory depression)
Euphoria
Sedation
Question 14: JT is a 39-year-old male experiencing constipation for 4 days and comes to the pharmacy complaining that JT did not had any bowel movements for 4 days. JT is otherwise a healthy individual but is taking Naproxen BID for Rheumatoid arthritis pain. What would make the pharmacist refer JT to a doctor?
A. Constipation with no bowel movements for more than 3 days
B. Blood in stool
C. Feeling of satiety after meals
D. Not able to sleep well since last 2 days
E. Worsening of Rheumatoid arthritis pain
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Answer: B
Blood in stool is a risk factor for constipation as well as long-time use of NSAIDs.
Refer to a doctor for constipation for: children less than 2 years old, no bowel movement for more than 7 days, constipation for more than 2 weeks despite using laxatives, blood in stool, bulimia nervosa, pain or bleeding in the rectum, fever, pain in the belly, and feeling of vomiting.
Question 15: A busy pharmacy has to dispose of some narcotics. Who can be a witness for this disposal process?
A. Chiropractor
B. Dietician
C. Registered nurse
D. Intern pharmacist
E. Occupational therapist
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Answer: D
The following individuals can be witnesses in narcotics disposal: Pharmacists, registered technicians, prescribers, and registered intern pharmacists. A pharmacy assistant cannot be a witness.
Question 16: JT is a 25-year-old female who has switched to a vegan diet for over a year now. She comes to the pharmacy asking for recommendations for vitamins. What is the best recommendation for JT?
A. Vit B12 supplement as vegan diet usually lacks vit B12
B. Prenantal vitamins considering her young age
C. Folic acid as she is of child bearing age
D. Vit D as she comes from a country with tropical climate
E. Vit C as many youngsters who smoke lack Vit C
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Answer: A
Source of vit B12: fish, meat, poultry, eggs, and dairy products. Plant foods do not naturally contain vitamin B12.
Question 17: Syphullis is caused by which organism?
A. Treponema denticola
B. Treponema carateum
C. Treponema pertenue
D. Treponema vincentii
E. Treponema palladium
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Answer: E
Notes for quick revision
Symptoms
chancroid ulcer or chancre. Chancre is a hard, round, painless genital ulcer.
Non-itchy rash on palms and feet occurs with the progression of the disease. White or grey lesions appear in warm and moist areas, such as the labia or anus.
Treatment:
- Benzahine Penicillin G – preferred treatment
- 2.4 million units IM – single dose. If the patient is pregnant, then a second dose is given after 1 week
- Benzyl Penicillin (Penicillin G) – preferred treatment for neurosyphillis
- 3 – 4 million units IV Q4H for 10-14 days
- Alternative treatment – Ceftriaxone, Doxycycline
Transmission:
Sexual transmission (oral, anal or vaginal sex through contact with infectious lesions), during pregnancy through the placenta.
Question 17: What is the mechanism of action of Benzodiazepine?
A. Binds to GABAA receptors and cause opening of chloride channels
B. Binds to BZ1 abd BZ2 receptors and cause potentiation of GABAA receptors
C. Benzodiazepined do not have receptor mediated action
D. Benzodiaepines act on 5HT1 receptors as agonist
E. Affects multiple receptors to cause closing of chloride channels for sedative effect
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Answer: B
Benzodiazepine receptors (BZ1 and BZ2) are adjacent to but separate from ABAA receptors. These receptors are only in the CNS. Benzodiazepines increase the affinity of GABAA receptors and cause the opening of chloride channels.
PEBC evaluating exam – Question set #1
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Question 7 option c Boca same words are in tall man lettering
Hi Anum Azam,
C is not the right answer. Common suffixes and prefixes are not capitalized. I have mentioned some basic rules just below the answer which should be helpful in determining the letters which has to be capitalized.
Thanks.