The PEBC Evaluating Exam unlocks the door to your dream of becoming a licensed pharmacist in Canada ????????. Feeling a wave of exam anxiety wash over you? Don’t sweat it! This jam-packed Q&A guide is your ultimate weapon to conquer the PEBC.
PEBC evaluating exam practice questions that are most important for exams. More of these questions will be published.
Table of Contents for PEBC Evaluating exam
PEBC EVALUATING EXAM Questions 1 – 10
Question 1: Glutathione consists of which of the following amino acids?
A. Glutamate, cysteine, Lysine
B. Tryptophan, Glycine, Isoleucine
C. Glutamate, Cysteine, Glycine
D. Glutamate, Tryptophan, Arginine
E. Tryptophan, Valine, Arginine
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Answer: C
Glutathione is a naturally occurring tripeptide produced by the liver. Glutathione is an antioxidant that prevents oxidation of hemoglobin to methemoglobin.
G6PD (Glucose-6-phosphate dehydrogenase) enzyme is required to generate NADPH. This NADPH is utilized to keep glutathione in reduced form (GSH). This GSH prevents the oxidation of Hemoglobin. Deficiency of G6PD enzyme causes hemolytic anemia.
Diagnosis of G6PD deficiency is done by Spectrophotometric assay. Coomb’s test is done to distinguish if the lysis of RBCs is due to G6PD deficiency or an autoimmune disorder. Hence Coomb’s test is considered as the differential diagnosis test.
Question 2: JT is a 29-year-old female who is taking Oxcarbazepine BID for epilepsy. She came to the pharmacy to seek some recommendations on Oral Contraceptives. What would be the pharmacist’s concern?
A. Oxcarbazepine does not have a significant effect on the pharmacological action of oral contraceptives and can be given.
B. Oxcarbazepine is a metabolite of carbamazepine which signifcantly reduces the efficacy of combined contraceptive pills.
C. Ask the doctor to change Oxcarbazepine to carbamazepine to avoid any interaction.
D. No need for contraceptives as Oxcarbazepine reduces ovulation.
E. Reduce the dose of contraceptives as Oxcarbazepine increases the efficacy of contraceptives.
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Answer: A
Oxcarbazepine is not autoinducer. So, there is no interaction.
Carbamazepine, Phenytoin, Topiramate, and Rifampin are some examples of inducers. Mnemonic = Car with Fan fell from the Top of a Roof.
Question 3: Where is Testosterone produced in the body?
A. Seminiferous tubules in testes in men.
B. Leydig cells in men and ovaries in women
C. Testosterone is a male sexual hormone and is produced only in epidydimis in the testes of men.
D. Adrenal gland is the primary source in men and ovaries in women.
E. Testosterone is produced by parathyroid gland in both men and women.
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Answer: B
Testosterone is produced by Leyding cells in the testes in men and ovaries in women. Adrenal glands also produce testosterone but in very small quantity in both men and women.
Also remember: Sperms are produced by seminiferous tubules and mature in the epididymis. Seminal fluid is produced from seminal vesicles.
Question 4: Fluoride toxicity and Stannous fluoride toxicity of fluoride is 8 mg/kg. The weight of the patient is 22 lb. If 0.4% stannous fluoride is used how much minimum dose is required to cause toxicity? (4.1 mg of stannous fluoride contains 1 mg of fluoride)
A. 82 ml
B. 8.2 ml
C. 180.4 ml
D. 82000 ml
E. 320 ml
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Answer: A
Explanation
Step 1: Weight 22 lb = 10 kg.
The toxicity of fluoride is 8 mg/kg. So 8 x 10 = 80 mg.
Step 2: Now, 4.1 mg stannous fluoride – 1 mg of fluoride.
? – 80 mg of fluoride. (Cross multiply)
= 4.1 x 80/1 = 328 mg of stannous fluoride will cause toxicity.
Step 3: 0.4 gm = 400 mg.
400mg of stannous fluoride – 100 ml
328 mg of stannous fluoride – ? = (328 x 100)/400 = 82 ml (Cross multiply)
Question 5: A 7-year-old woman with metastatic breast cancer had a mastectomy and started chemo and radiation, even though she took her antiemetics as prescribed she is having nausea and vomiting 6 to 7 times a day and she came to the pharmacist saying she gets tired and she would rather die than go through this again. Answer the following questions based on the information provided.
Question 5.1: What is the appropriate question to ask her?
A. Are you sure you took your anti emetics as prescribed?
B. What adverse effects were you expecting from your chemo treatment?
C. Do you know how your chemotherapy works?
D. When is your next scheduled check up?
E. How do you know it is because of chemotherapy?
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Answer: A
Explanation: Here the patient is complaining about the symptoms. So a pharmacist has to make sure that the person took her medicines.
Question 5.2: What is the next thing to tell her?
A. Explain how her chemotherapy works and why she is experiencing this effect?
B. Tell her its alright to refuse chemotherapy.
C. Tell her this is only the first time and it will stop.
D. Tell her “this is not going to stop any time soon.
E. Explain the her family physician can change her chemotherapy.
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Answer: A
This is a situation where a pharmacist is expected to show empathy. Empathy means the ability to understand another person’s pain and suffering. Note that empathy and sympathy are different. Sympathy means that you feel sorry for another person’s pain.
Question 6: Mechanism of action of Omalizumab
A. TNF Alpha inhibitor
B. Humanized monoclonal antibody
C. B cell depletion
D. HER2 directed analogue of Trustuzumab
E. Inhibits the binding of IgE
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Answer: E
IgE binds to IgE receptors (Fc epsilon RI receptors = FCERI) and release mediators of allergic response. Omalizumab binds to free IgE, which lowers free IgE levels and cause FCERI receptors on mast cells and basophils. This reduces the release of mediators of allergic response.
Tip: Omalizumab, Mepolizumab, Reslizumab = use in Asthma
Mnemonic 1: Omar Mop the floor and Rest
Mnemonic 2: R-O-Me (ROME) = Reslizumab, Omalizumab, Mepolizumab
| Omalizumab | Mepolizumab | Reslizumab | |
| M (Mechanism) | Anti IgE | Anti IL-5 | Anti IL-5 |
| R (Reduces) | Reduces IgE binding | Reduces Eosinophils | Reduces Eosinophils |
| M (Main use) | Asthma (allergic) | Asthma (Eosinophilic) | Asthma (Eosinophilic) |
Question 7: What is the mechanism of action of Rituximab?
A. TNF Alpha inhibitor
B. B cell depletion with CD80 target site
C. B cell depletion with CD20 target site
D. HER2 inhibitory analogue of Niratinib
E. Inhibits the binding of IgE
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Answer: C
Rituximab targets CD20 – protein present on all B cells from the stage of cell development. Rituximab binds to this protein (CD20) present on both normal and malignant B-cells. Then, the body’s natural immune defenses are recruited to attack and kill the marked B-cells. Stem cells (young cells in bone marrow) do not have CD20 antigen. Hence, Rituximab is less likely to cause bone marrow suppression.
Rituximab is used in non-Hodgkin’s lymphoma
Question 8: JT is a hypertensive male taking Lisinopril for more than 5 years. Currently, he is complaining that he is not able to sleep properly as he has to wake up in the night a couple of times to urinate. JT is also taking Finasteride for Benign Prostatic Hyperplasia. The doctor prescribed him Alfuzosin. What is the pharmacist’s concern with the prescription?
A. Do not dispense as this is duplication of therapy.
B. No rpoblem to dispense as Alfuzosin is approved for urinary retention in Benign Prostatic Hyperplasia.
C. Do not dispense as JT's sleep disturbances can be managed by dimenhydrinate.
D. Call the doctor and ask to change Alfuzosin with Nifedipine XL as it has better hypertensive control than Alfuzosin.
E. Prazosin is a better option in JT's case as it causes less syncope.
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Answer: B
Alfuzosin is approved for urinary retention and symptomatic treatment in Benign Prostatic Hyperplasia. Tamsulosin and Sildosin are α-1A selective blockers.
Prazosin is used for nightmares and scorpion bites.
α-1 blockers/antagonists: 1st gen = Prazosin; 2nd gen = Terazosin, Doxazosin; 3rd gen = Alfuzosin, Sildosin, Tamsulosin. Mnemonic: Post Traumatic Disorder in American Special Troops.
Question 9: KT is a young woman who recently gave birth to a child. She came to the pharmacy to find out if she could store breast milk in the fridge and feed the same milk to the baby during the day when the baby is hungry. What is the pharmacist’s recommendation?
A. should be consumed right away as breast milk cannot be stored at room temperature.
B. Breast Milk can be stored for 24 hours in a cooler with ice packs.
C. Breast milk should never be stored under frozen conditions as it destroys some fo the milk's properties.
D. Pharmacist cannot answer this question and KT should ask her doctor.
E. Can be stored at room temperature upto 25 °C or less for more than 4 hours.
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Answer: B
Please remember the below-mentioned information as it is important from PEBC evaluating exam perspective.
| Freshly expressed breast milk | Thawed breast milk (previously frozen) | |
| Room Temperature (25 °C or colder) | Upto 4 Hours | Do not store, Throw away |
| Cooler with Ice packs | Upto 24 Hours | Do not store, Throw away |
| Single door refrigerator (3.8 °C or below) | Upto 3 days | Upto 24 hours |
| In a freezer with a separate door (-17.8 °C or below) | Upto 6 months | Never refreeze thawed milk |
| Single-door refrigerator (3.8 °C or below) | Upto 12 months | Never refreeze thawed milk |
Points to remember:
- Do not use hot water or a microwave to thaw breast milk as it can destroy some of the milk’s properties. Also, it creates hot spots which may cause burn injuries to the baby.
- Never refreeze breast milk.
- When thawing, fat will rise to the top of the milk. Gently stir. Do not shake.
- Use within 1 hour after warming. Discard the remaining if you cannot finish it.
- Always store breast milk at the back of the refrigerator where it is the coldest.
- Store milk in small increments of 2 to 4 oz for easy thawing.
Question 10: What is the preferred anticoagulant for a patient who has stage 5 renal disease?
A. Abciximab
B. Dabigatran
C. Rivaroxaban
D. Enoxaparin
E. Warfarin
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Answer: E
Warfarin has 100% hepatic elimination. Hence, Warfarin is the answer.
Question 11: What is the mechanism of action of Finasteride?
A. Xanthine Oxidase inhibitor
B. Competitive and specific inhibition of 5-α reductase type II.
C. Pseudo irreversible inhibition of 5-α reductase type II.
D. Stimulates the conversion of Testosterone to dehydroxy testosterone by acting as an agonist of 5-α reductase type II.
E. Competitive and specific inhibition of 5-α reductase type I.
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Answer: B
Notes for quick revision:
- 5-α reductase inhibitors:
- Finasteride (inhibition of 5-α reductase type II)
- Used in BPH and male alopecia
- Dutasteride (inhibition of 5-α reductase type I and type II)
- Finasteride (inhibition of 5-α reductase type II)
- Side effects: Decreased libido and sexual dysfunction, hypersensitive reactions like rash and testicular pain.
- Contraindication: Not indicated for use in women and children.
Question 12: Which is the important invivo factor for the disintegration of oral solid dosage forms?
A. Gastric peristalysis helps with the breaking of tablets and capsules.
B. Gastrin secreted by G cells of the stomach.
C. Amylase and Lipase found in the stomach.
D. Gastric acidic pH is the most contributing factor.
E. Use of a superdisintegrant like sodium starch glycollate.
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Answer: D
Explanation:
Peristalsis moves the content of the stomach to the intestine. It has no role in disintegration as such. None of the enzymes found in the stomach do not play a major role in disintegration. Since the question is asking for invivo factor, we can rule out super disintegrants as it is not invivo.
Question 13: A patient was prescribed Drug X, administered orally at a dosage of 250 mg every 8 hours. The bioavailability of the drug is 1 (100%), and its clearance rate is 2.8 ml/hr. What is the steady-state concentration of Drug X in the patient?
A. 11.16 mg/ml
B. 12.52 mg/ml
C. 15.83 mg/ml
D. 18.39 mg/ml
E. 20.17 mg/ml
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Answer: A
Explanation:
Css = F×D / cl×t where F bioavailability D dose Cl clearance T interval
Css = 1 x 250 / 2.8 x 8 = 11.16 mg/ml
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