The sample questions that follow are NOT intended or designed to be a sample examination and do NOT represent an exact model of the Pharmacist Qualifying Examination-Part I, in terms of difficulty and proportion of topics. However, individually, these examples are intended to be representative in format and phrasing style of the types of questions found in the Qualifying Examination-Part I. They also illustrate a variety of the competency areas contained in the examination blueprint. Please note that these questions are reviewed and updated periodically.
See the bottom of the page for the answers to the sample questions.
COMPETENCY 1: Patient Care
1. RY is an 85 year old male who lives alone, currently takes 12 different medications. For the past 2 weeks he has telephoned to ask the pharmacist what dose of diuretic he should be taking (this medication looks similar to another tablet that he takes). He calls again today with the same question. After answering his question, the most appropriate pharmacist action should be to:
a. call RY’s family doctor to suggest changing the diuretic to something that looks different.
b. suggest that RY have the labels on his prescription bottles changed to a bigger font for easier reading.
c. recommend that the pharmacy use a blister packaging dosette to dispense RY’s medications.
d. suggest that RY write down the answer to his question so that he does not need to phone again.
e. recommend that RY have his hearing and vision tested at his next physician visit.
2. AD is a 58 year old male with diabetes, angina and erectile dysfunction. His physician consults the pharmacist in order to decide if AD would be a good candidate for sildenafil. The use of sildenafil is CONTRAINDICATED for AD if he takes:
a. isosorbide 5-mononitrate.
b. metoprolol.
c. glyburide.
d. ASA.
e. enalapril.
3. RP has a prescription for famciclovir for shingles (prescribed 2 days ago), and is uncertain about filling it, due to the high cost. Based on the known effectiveness of famciclovir for herpes zoster, benefits that the pharmacist should discuss with RP include:
I prevention of acute zoster-associated pain.
II faster healing time for rash.
III less and shorter duration of post-herpetic neuropathic pain.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
4. Common etiologic agents of community-acquired pneumonia include:
I Escherichia coli.
II Haemophilus influenzae.
III Mycoplasma pneumoniae.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
5. Iron may decrease the absorption of which of the following medications?
a. Ramipril
b. Atenolol
c. Moxifloxacin
d. Ibuprofen
e. Glyburide
6. Which of the following medications is the most appropriate choice for treatment of neuropathic rather than nociceptive pain?
a. Nabilone
b. Tramadol
c. Ibuprofen
d. Meperidine
e. Nortriptyline
7. Appropriate auxiliary labelling for clarithromycin suspension includes which of the following?
a. Shake well before using.
b. Take with plenty of fluids.
c. Avoid prolonged exposure to sunlight.
d. Keep refrigerated.
e. May cause discolouration of urine.
8. The pharmacist fills a prescription for sumatriptan 100 mg tablets for a patient with migraine. Appropriate information to provide to the patient includes which of the following?
a. If the sumatriptan does not relieve the headache within four hours, ergotamine may be used.
b. If no relief is achieved in two hours, sumatriptan may be repeated.
c. If the headache is partially relieved with a single tablet, the dose may be repeated after two hours.
d. The maximum dosage of sumatriptan 100 mg in any 24 hour period is six tablets.
e. If relief is not achieved, no other medication can be used for at least 24 hours.
9. JG has been taking metoclopramide 20 mg, po q6h for the past 3 days as part of her chemotherapy regimen. She normally takes 4 doses daily, with each meal and at bedtime. This morning, she forgot to take her morning dose before leaving home for a hospital check-up. When she arrives at the clinic, she asks the pharmacist what she should do about her missed dose, as she expects to be home again around 11:00 am. The pharmacist should advise JG to:
a. take the missed dose immediately when she gets home and continue as scheduled.
b. take two doses at lunchtime to make up for the missed dose.
c. skip the missed dose and take the next scheduled dose at lunchtime.
d. skip today’s medication and resume her normal schedule tomorrow.
e. space 4 doses into the remaining hours between when JG gets home and her bedtime.
10. EK is a 25 year old female who presents to the pharmacy requesting Plan B® (levonorgestrel) for emergency contraception following an episode of unprotected sex 12 hours ago. After speaking with EK, the pharmacist decides she is a good candidate to receive Plan B®. The pharmacist should include all of the following information in counselling EK, EXCEPT:
a. the effectiveness of Plan B® in EK’s situation is likely to be better than 90%.
b. Plan B® works mainly by dislodging an implanted fertilized egg from the endometrium.
c. EK should take two tablets of Plan B® as a single dose.
d. side effects may include nausea, vomiting, breast tenderness, cramps and spotting.
e. if vomiting occurs within one hour of dosing, a repeat dose may be warranted.
11. All of the following are reasons that elderly patients are more susceptible to drug-induced cognitive changes, EXCEPT:
a. they are more likely to take multiple drugs.
b. they may have hepatic dysfunction.
c. they may have renal dysfunction.
d. they are more sensitive to CNS effects of drugs.
e. they have increased metabolic rates for producing psychoactive metabolites.
12. For a child with asthma, all of the following factors are indicators of poor control, EXCEPT:
a. number of visits to the Emergency Room.
b. limitations on daily activities.
c. awakening at night with asthma symptoms.
d. keeping one canister of salbutamol at home and one at school.
e. number of parent work days missed due to the child illness.
13. Assessment of a patient’s asthma control should include all of the following factors EXCEPT:
a. immunization status.
b. inhalation technique.
c. use of inhaled β2 agonist.
d. use of inhaled corticosteroid.
e. changes in environmental triggers.
14. Which of the following liver enzymes is the first to be elevated in a case of an acetaminophen overdose?
a. Lactic dehydrogenase (LDH)
b. Alanine transaminase (ALT)
c. Aspartate transaminase (AST)
d. Alkaline phosphatase (ALP)
e. Gamma glutamyl transpeptidase (GGT)
15. AJ is a 24 year old, married female, who is planning to become pregnant in the near future. AJ has no medical conditions, no allergies, and is not currently taking any medications. What vitamin supplement should the pharmacist recommend to AJ to prevent neural tube defects in her baby?
a. Niacin
b. Vitamin D
c. Folic acid
d. Pyridoxine
e. Ferrous sulphate
16. Side effects which the pharmacist should monitor in DS, when looking for the effects of excessive topical corticosteroid use, include:
I pruritus.
II telangiectasias.
III striae.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
COMPETENCY 2: Professional Collaboration and Teamwork
17. FR is a 70 year old female client who presents to the pharmacist, complaining of nausea, diarrhea and dizziness for the past three days. Her medication profile includes: ASA, digoxin, enalapril, and amiodarone. She denies any recent diet changes and the only change to her medications was the addition of amiodarone last week. She believes she must have picked up a “stomach bug” and would like something for symptom relief. The most appropriate pharmacist recommendation for FR is to:
a. take loperamide and dimenhydrinate for symptom relief.
b. take increased fluids and bed rest until the symptoms resolve.
c. contact FR’s physician to discontinue the ASA until these symptoms resolve.
d. contact FR’s physician to discontinue amiodarone until these symptoms resolve.
e. contact FR’s physician to suggest that a digoxin level be taken.
18. DS is a 27 year old male who comes to the pharmacy seeking advice because, for the past 24 hours, he has experienced abdominal cramping, mild fever and frequent, loose stools with some blood loss. DS thinks it may be related to the antibiotic he has been taking for a dental abscess. Current medications include: clindamycin 150 mg QID x10 days, started 8 days ago, and losartan 25 mg daily for hypertension, started 3 months ago. The most appropriate pharmacist response is that these symptoms:
a. are expected, transient side-effects of clindamycin; treat symptoms and continue medications.
b. may indicate an interaction between clindamycin and losartan; pharmacist call to dentist is warranted.
c. may indicate clindamycin-related pseudomembranous colitis; seek immediate medical attention.
d. may indicate losartan-related pseudomembranous colitis; seek immediate medical attention.
e. are probably unrelated to DS’s medications; treat for flu symptoms and follow-up if no improvement.
19. FD, a 58 year old male with hypertension, asks the pharmacist if cranberry juice would be useful for his current symptoms, which include frequency and a large volume of urine, but no urgency, or painful urination. Further questioning reveals that for the past 2 months he has also experienced polydipsia and polyphagia. The pharmacist should refer FD to his physician because these symptoms are consistent with:
a. cholelithiasis.
b. a urinary tract infection.
c. prostate hyperplasia.
d. diabetes mellitus.
e. renal complications of hypertension.
20. A local physician approaches the community pharmacist to collaborate on a health promotion pamphlet addressing medication adherence. Which of the following is NOT an appropriate topic for the pamphlet?
a. The team relationship of the patient with both his physician and pharmacist
b. The service of the pharmacy providing reminder calls for medication refills
c. Advice to bring upcoming refill requests to scheduled physician appointments
d. The various kinds of reminder packaging available to assist patients
e. Referral to industry-sponsored consumer websites for information regarding medications
21. Academic detailing by pharmacists provides a service to physicians by:
a. educating on improved prescribing legibility.
b. advising on optimal patient interviewing techniques.
c. recommending strategies to avoid medication wastage.
d. providing current information on best prescribing practices.
e. promoting the use of physician samples given to patients.
COMPETENCY 3: Ethical, Legal and Professional Responsibilities
22. According to the Narcotic Control Regulations of the Controlled Drugs and Substances Act, which of the following practitioners may prescribe narcotic drugs?
a. Veterinarians
b. Nurse practitioners
c. Podiatrists
d. Midwives
e. Physiotherapists
23. The ethical principle of veracity requires that pharmacists:
a. respect the rights of others to make choices.
b. do good to patients, placing the benefit of the patient over other factors such as cost.
c. avoid, remove or prevent harm.
d. act with fairness, to allow people to receive that to which they are entitled.
e. act with honesty, without deception.
24. JN, a 17 year old male with a highly resistant form of testicular cancer, is in hospital for treatment. He is an intelligent, articulate young man. His parents are insisting that the physician treat him with the latest experimental therapy, but JN does not want to undergo the treatment. If the physician goes ahead and gives the experimental therapy what ethical principle will have been violated the most?
a. Confidentiality
b. Non-maleficence
c. Justice
d. Veracity
e. Autonomy
25. Which of the following medications does NOT require witnessed destruction?
a. Ketamine
b. Nabilone
c. Diazepam
d. Testosterone
e. Gabapentin
26. The Canada Health Act (1984) embodies all of the following principles, EXCEPT:
a. affordability.
b. accessibility.
c. comprehensiveness.
d. portability.
e. universality.
27. ST is no longer satisfied with the service she has been getting at Pharmacy X across town, so she comes to your pharmacy requesting a refill of 3 months’ supply on a prescription for an oral contraceptive that she originally had filled at Pharmacy X. What is the correct procedure for obtaining the remaining refills?
a. The pharmacist must contact Pharmacy X to get the prescription refills transferred, and document the transfer appropriately.
b. The pharmacist cannot refill this prescription without phoning the prescribing physician.
c. The pharmacist may refill the prescription as long as the patient provides you with the label from the original prescription.
d. The pharmacist may refill the prescription and notify Pharmacy X within 24 hours that this has been done.
e. Inform ST that the prescription resides at Pharmacy X and she must return there for refills.
28. According to federal legislation, which of the following examples shows a legally correct refill designation on a written prescription for dexamphetamine?
a. Repeat twice.
b. Repeat monthly.
c. Repeat as needed.
d. Repeat twice as required.
e. Repeat twice at 14 day intervals.
29. According to the Benzodiazepine and Other Targeted Substances Regulations, what is the expiry date for refilling a prescription for lorazepam?
a. Six months from the date written
b. Six months from the date originally filled
c. One year from the date written
d. One year from the date originally filled
e. No specific expiry date; at the pharmacist’s discretion
30. The standard of publicly funded health care in Canada is mandated by:
a. the Canada Health Act.
b. individual provinces and territories.
c. Health Canada’s Health Environment and Consumer Safety directorate.
d. Canadian Agency for Drugs and Technologies in Health.
e. National Association of Pharmacy Regulatory Authorities.
31. The pharmacist receives a phone call from a physician who wishes to leave a verbal prescription for 30 alprazolam 0.25 mg tid, with 2 repeats. It is a new prescription for the patient. Which of the following statements is true?
a. Prescriptions for benzodiazepines should be filed with the narcotic and controlled prescriptions.
b. The prescription should not be dispensed because verbal prescriptions are not allowed for benzodiazepines.
c. The prescription may be dispensed for the original quantity only, because refills are not permitted.
d. Transfer of this prescription is permitted as long as the prescription is only transferred once.
e. Keeping reports of sales in a manner that permits an audit is required for all benzodiazepines.
32. For a drug going through research and development processes in Canada, which of the following statements is true?
a. Application for patent protection is granted for a maximum period of three years.
b. A New Drug Submission must be filed in order to start clinical trials.
c. Clinical trials involve three phases assessing animal safety and efficacy.
d. Each package size of a drug product must have a unique Drug Identification Number (DIN).
e. Health Canada under the Food & Drugs Act & Regulations provides Notice of
Compliance.
33. Which of the following is the national voluntary organization for advocacy of pharmacists and patient care?
a. Canadian Foundation for Pharmacy
b. Canadian Pharmacists Association
c. Canadian Patient Safety Institute
d. Institute for Safe Medication Practices
e. National Association of Pharmacy Regulatory Authorities
COMPETENCY 4: Drug, Therapeutic and Practice Information
34. Which of the following would be the most useful reference to learn what combination of antiretroviral agents is currently recommended as a first line therapy to treat HIV infection?
a. Meta-analyses
b. Randomized, controlled trial
c. Pharmacology textbook
d. Clinical practice guidelines
e. Compendium of Pharmaceuticals and Specialties
35. Which information source would be most appropriate to consult first, to determine if labetalol is a cardioselective beta-blocker?
a. Compendium of Pharmaceuticals and Specialties
b. Randomized, controlled trial data
c. Meta analysis of beta blocker therapy
d. Cochrane Library database
e. Case reports
36. Type II statistical error in a study comparing 2 drug treatment regimens occurs when:
a. the control drug is not a “gold standard” treatment.
b. a statistically significant difference exists but the difference is not clinically important.
c. the population under investigation does not represent the population with the disease.
d. the data shows no difference between 2 treatment regimens and a difference actually does exist.
e. the data shows a difference between 2 treatment regimens but a difference does not actually exist.
37. An adequately powered, randomized controlled trial conducted over 2 years demonstrated that the primary outcome (a serious cardiovascular event) occurred in 15% of the patients who received the new drug, whereas the primary outcome occurred in 25% of the patients who received a placebo. The relative risk reduction achieved with the new drug is:
a. 10%.
b. 15%.
c. 25%.
d. 40%.
e. 50%.
38. In an adequately powered, randomized controlled trial conducted over 3 years, a specific serious side effect (i.e. reduction in leukocytes) with conventional therapy is seen in 0.5% of the study sample. In patients who receive a newly discovered drug, only 0.45% experience the same side effect. Based on these results, the minimum number of patients that would need to receive the new drug for 3 years to statistically demonstrate the prevention of one episode of this side effect in at least one patient (i.e., NNT) is:
a. 15.
b. 20.
c. 150.
d. 200.
e. 2000.
COMPETENCY 5: Communication and Education
39. For elderly patients with chronic respiratory conditions, which of the following vaccinations are usually recommended on a yearly basis?
I Influenza virus
II Pneumococcus
III Meningococcus
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
40. All of the following are appropriate suggestions for a pharmacist to give to a patient with allergic rhinitis from multiple environmental triggers, to minimize exposure to possible allergens, EXCEPT:
a. open windows to get fresh air into the home.
b. clean and vacuum on a regular basis.
c. wash bed linens regularly in hot water.
d. use mattress and pillow covers.
e. remove any carpets, if possible.
41. DS wishes to protect her children from West Nile infection and requests information from the pharmacist regarding insect repellents. All of the following are correct responses from the pharmacist, EXCEPT:
a. DEET is the most effective insect repellent available.
b. when needed, sunscreen should be applied to the skin prior to DEET application.
c. DEET effectively binds to the skin and should not be reapplied after swimming.
d. DEET should be washed off young children once they return indoors.
e. products containing citronella oil have a very short duration of effect.
42. A pharmacist is conducting public education sessions on the role of inhaled medications in patients with asthma. Which of the following is the most appropriate indicator of improved asthma control?
a. A decrease in the number of bronchodilator doses used prior to exercise.
b. A decrease in the number of bronchodilator doses used per month.
c. A decrease in the number of corticosteroid doses used per month.
d. An increase in the number of bronchodilator prescriptions filled per month.
e. An increase in the number of corticosteroid prescriptions filled per month.
43. Which of the following medications is LEAST likely to cause embarrassment and worry about social stigma in a school-age child?
a. Insulin
b. Phenytoin
c. Venlafaxine
d. Amoxicillin
e. Methylphenidate
44. When counselling a patient who is upset over a new diagnosis and need for medications, which of the following strategies is NOT appropriate for the pharmacist to use?
a. Providing a private environment for the interaction
b. Advising the patient that things will be okay
c. Probing to clarify the patient’s concerns
d. Letting the patient vent his/her feelings
e. Ending with an encouraging statement
45. Which of the following factors that vary with cultural diversity does NOT directly impact on pharmacist-patient dialogue and communication?
a. Eye contact
b. Hand gestures
c. Facial expressions
d. Interpersonal space
e. Personal learning style
COMPETENCY 6: Drug Distribution
46. A biological safety cabinet would be the best choice when preparing a parenteral formulation of:
a. aminophylline.
b. doxorubicin.
c. magnesium sulfate.
d. nitroglycerin.
e. penicillin.
47. A physician wants to switch a terminally-ill patient from slow release morphine sulphate tablets, 15 mg twice daily, to a liquid morphine sulphate dosage form because the patient has difficulty in swallowing tablets. If a morphine sulphate solution containing 5 mg per mL is prescribed q4h, what volume should be dispensed for a 20 day supply to provide the same pain relief as the tablet regimen?
a. 20 mL
b. 60 mL
c. 80 mL
d. 100 mL
e. 120 mL
48. A patient is currently taking 220 mg of anhydrous zinc sulphate. To receive the equivalent amount of elemental zinc, how many milligrams of zinc sulphate heptahydrate (•7 H20) would the patient have to take? (Molecular weights: zinc 65, ZnSO4 161, H20 18)
a. 123 mg
b. 220 mg
c. 300 mg
d. 392 mg
e. 545 mg
49. Given that 30 g of a mild corticosteroid ointment covers the entire surface of any adult for one application, how much ointment (in grams) should be dispensed for an 18 year old patient who requires treatment on approximately 20% of her body with twice daily application for 14 days?
a. 6 g
b. 12 g
c. 84 g
d. 124 g
e. 168 g
50. BV is a 62 year old, obese female who visits a walk-in-clinic while her physician is away on vacation. She presents to the pharmacist with the following prescription:
Losec® (omeprazole) 30 mg
M: 30
Sig. i daily
The pharmacist knows that this product is only available in 10 mg or 20 mg strengths and that BV’s profile shows that she was previously on the 20 mg strength of this medication. The most appropriate pharmacist response is to:
a. tell BV that the physician has made a prescribing error.
b. ask BV why she visited the clinic today and what the physician told her about the prescription.
c. dispense using omeprazole 10 mg and adjust the quantity and dose accordingly.
d. assume the prescriber was thinking of Prevacid® (lansoprazole) 30 mg and change the prescription accordingly.
e. recommend to BV that she wait to see her regular physician when he returns.
51. Which of the following isLEAST appropriate to consider when a hospital pharmacy manager is organizing assigned responsibilities for clinical pharmacists in the department?
a. Disease/medical area of interest of the individual
b. Communication and interpersonal skills of the individual
c. Advanced training or credentials of the individual
d. Individual’s length of employment at the hospital
e. Willingness of the individual to upgrade learning and skills
52. Which of the following pharmaceuticals is regulated federally under the Precursor Control Regulations of the Controlled Drugs and Substances Act, as a precursor chemical for illicit drug use?
a. Dextromethorphan
b. Dimenhydrinate
c. Diazepam
d. Pseudoephedrine
e. Testosterone
53. 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 behaviours could be indicators of a developing addiction disorder, EXCEPT:
a. incidents of lost prescriptions.
b. frequent requests for early refills.
c. prescriptions from multiple physicians.
d. patient concerns regarding side effects.
e. patient concerns regarding lack of efficacy.
54. In a hospital pharmacy, which of the following is the most effective strategy to enhance safety and minimize the incidence of interpretation errors associated with verbal medication orders?
a. Use of bar code technology on medication orders
b. Use of tall man lettering on medication orders
c. Use of automated dispensing technology
d. Requirement for a read-back to the prescriber of all verbal orders
e. Restricting the acceptance of verbal orders to oral medications only
55. Which of the following classes of medications is most likely to be administered by the intravenous piggyback method?
a. Antibiotics
b. Opioids
c. Insulins
d. Erythropoiesis regulating hormones
e. Neuromuscular blocking agents
56. Which of the following actions would NOT contribute to promoting a safe medication use system in a pharmacy?
a. Providing patients with information on medications
b. Attention to environmental conditions in the pharmacy
c. Offering developmental programs for staff education
d. Rotating staff regularly to assume different responsibilities and tasks
e. Maintaining processes for documentation of medication incidents
COMPETENCY 7: Understanding Management Principles
57. MT, a pharmacy technician, has worked in a community pharmacy for 5 years. He is well-trained and welcomes new learning opportunities. His manager, now wanting to delegate a new technical project to him, should:
I discuss suggested steps to accomplish the project.
II negotiate a time schedule for completion of the project.
III provide support and follow-up as required.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
58. Which of the following is NOT a benefit of performing medication reconciliation activities in a hospital setting?
a. Reduction of medication errors
b. Reduction of inventory pilferage
c. Reduction of preventable adverse effects
d. Assessment of patient adherence to therapy
e. Enhanced accuracy of patient allergy information
59. Factors that determine bioequivalence of two brands of a drug include:
I the taste of the preparations.
II the physical appearance of the preparations.
III pharmacokinetic parameters of the preparations.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
60. Which of the following criteria should be considered when reviewing a medication for addition to the hospital formulary?
a. The amount of samples provided to hospital physicians
b. Research funds donated to the hospital by the pharmaceutical company
c. National adverse drug reaction reports
d. Whether it is a gluten-free oral formulation
e. The length of patent period remaining
61. In deciding what medications are appropriate for its formulary, the hospital must consider a drug’s efficacy, associated workload, and acquisition cost. Several new intravenous antifungal agents (drug A, drug B, drug C, and drug D), all with equal efficacy to drug E, have recently become available. Currently the hospital stocks drug E, which has been available for several years. Data for the medications is as follows:
|
Drug Cost/day
|
Dosing Frequency
|
Treatment Duration (days)
|
|
A $2.50
|
QID
|
14
|
|
B $2.25
|
once daily
|
14
|
|
C $5.00
|
BID
|
7
|
|
D $2.25
|
BID
|
7
|
|
E $2.25
|
QID
|
7
|
The most appropriate choice for the hospital is:
a. Drug A.
b. Drug B.
c. Drug C.
d. Drug D.
e. Drug E.
The next section includes EXAMPLES OF THE CASE SCENARIO FORMAT, in which there are two or more questions in sequence, which are related to the patient information provided in the (bolded) stem information shown at the top of the case.
QUESTIONS 62 TO 64 INCLUSIVE REFER TO THE FOLLOWING:
SM is a 34 year old female who, while vacationing in Mexico, began prophylactic treatment for travellers’ diarrhea. Shortly thereafter she complained of a feeling of fullness in her ears, black stools and a black tongue.
62. Which of the following drugs could be the cause of SM’s complaints?
a. Bismuth subsalicylate
b. Cotrimoxazole
c. Diphenoxylate
d. Loperamide
e. Attapulgite
63. Organisms commonly implicated in the cause of travellers’ diarrhea include:
I Bacteroides fragilis.
II Escherichia coli.
III Shigella sp.
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II and III
64. Which of the following is the most appropriate option for future prevention of traveller’s diarrhea if SM is travelling to Mexico?
a. Ciprofloxacin
b. Tetracycline
c. Erythromycin
d. Trimethoprim
e. Clindamycin
QUESTIONS 65 TO 67 INCLUSIVE REFER TO THE FOLLOWING:
PQ is a 75 year old patient who has just been diagnosed with hypothyroidism. Her past medical history is significant for congestive heart failure, type 2 diabetes mellitus, osteoporosis and chronic stable angina, all of which are well-controlled. Her medications include:
Metoprolol 25 mg bid
Calcium carbonate 1250 mg bid
Vitamin D 1000 IU daily
Glyburide 2.5 mg bid
Enalapril 10 mg bid
Furosemide 40 mg daily
Nitroglycerin SL spray prn
65. PQ should be started on a low dose of levothyroxine because of her:
a. age.
b. gender.
c. diabetes.
d. metoprolol use.
e. nitroglycerin use.
66. Appropriate counselling and follow-up for PQ with initiation of levothyroxine includes all of the following, EXCEPT:
a. separate the levothyroxine dose from calcium tablets by several hours.
b. take levothyroxine on a full stomach for greater absorption.
c. improved control of thyroid levels may also improve her glycemic control.
d. physician follow-up is needed in 6-8 weeks to have her thyroid function tests repeated.
e. closer monitoring of her angina should be done during dosage titration of levothyroxine.
67. Which of the following parameters is the most appropriate for PQ’s self-evaluation of the effectiveness of levothyroxine therapy?
a. Increased energy
b. Weight loss
c. Improved vision
d. Less frequent angina
e. Less frequent urination
QUESTIONS 68 TO 71 INCLUSIVE REFER TO THE FOLLOWING:
A family health team is reviewing recent guidelines for dyslipidemia and cardiovascular risks. Physician colleagues ask the pharmacist for information on the recommendations for monitoring patients in various categories.
68. The current recommendation for performing a baseline plasma lipid profile in men is to screen all males over the age of:
a. 35 years.
b. 40 years.
c. 50 years.
d. 55 years.
e. 60 years.
69. Lipid profile screening is important in all patients who have a history of:
a. COPD.
b. GERD.
c. diabetes.
d. osteoarthritis.
e. liver disease.
70. Which of the following is the primary assessment tool recommended to quantify a patient’s= 10-year risk for total cardiovascular disease?
a. Reynolds risk score
b. Framingham risk score
c. SCORE risk estimator
d. TIMI risk score
e. CHADS II score
71. Which of the following is the most appropriate bio-marker to assess patients who are at intermediate risk for cardiovascular diseases and who do not otherwise qualify for lipid-lowering therapy?
a. Homocysteine
b. Creatinine clearance
c. Lipoprotein-associated phospholipase A2
d. Soluble vascular cell adhesion molecule-1
e. High-sensitivity C-reactive protein
QUESTIONS 72 and 73 REFER TO THE FOLLOWING:
HM is a regular client at the pharmacy. He has been taking quetiapine 300 mg bid for 8 months to help control his schizophrenia symptoms but he has recently noticed that some of his symptoms have been worsening. Prior to starting quetiapine, HM took risperidone therapy for 2 years. HM tells the pharmacist that now his psychiatrist would like to change his regimen to clozapine.
72. In assessing the possible change to clozapine for HM, which of the following statements is the most appropriate for the pharmacist to consider?
a. This change is appropriate, as clozapine may help for patients who fail on other antipsychotics.
b. This change is appropriate, as most patients with schizophrenia will eventually require clozapine.
c. This change is not appropriate, as clozapine will likely produce the same effect as quetiapine.
d. This change is not appropriate, as the cost of monitoring and risk of adverse effects with clozapine is too high.
e. This change is not appropriate, because the preferred recommendation is to add clozapine to the current quetiapine.
73. HM is concerned about the possible adverse effects from clozapine. When discussing monitoring with HM, which of the following statements is the most appropriate to include?
a. Severe problems affecting the blood occur in about 5% of patients taking clozapine.
b. Problems affecting the blood do occur rarely and regular blood labwork would be recommended.
c. The risk of this problem occurring is the highest after one year or more of treatment.
d. Blood labwork done monthly will help to avoid any adverse effects from clozapine.
e. The prescriber has already assessed this risk and has determined that the risk for HM is low.
QUESTIONS 74 TO 76 INCLUSIVE REFER TO THE FOLLOWING:
WW is a 55 year old, obese male (BMI 35) with newly diagnosed type 2 diabetes. His most recent fasting blood glucose is 9.6 mmol/L and A1C is 8%. He also suffers from hypertension and osteoarthritis in his knees. His current medications are: ramipril 20 mg daily and acetaminophen 500 mg qid.
74. Which of the following agents is the most appropriate choice for WW at this time?
a. Gliclazide
b. Sitagliptin
c. Insulin
d. Metformin
e. Acarbose
75. If the anti-hyperglycemic agent chosen for WW is having its intended benefit, the most appropriate therapeutic outcome would be:
a. achieving target A1C at 3 months.
b. fasting blood sugars < 6.1 mmol/L within 1-2 weeks.
c. decreased BMI within 3 months.
d. improved blood pressure control.
e. decreased 10 year coronary event risk.
76. WW would like advice regarding self-monitoring of his blood glucose. Which of the following statements is most appropriate for WW at this time?
a. Blood glucose should be tested upon arising and before each meal
b. Regular self-monitoring of blood glucose may help in achieving optimal control.
c. WW should avoid testing at alternate sites (e.g., forearm) since accuracy is reduced in obese patients.
d. Self-monitoring will help WW to adjust the dosing of oral therapy in relation to meal size.
e. WW should test for nocturnal hypoglycemia at least 3 times weekly.
Part I – Answers to Sample Questions
| 1. (c) | 39. (a) |
| 2. (a) | 40. (a) |
| 3. (d) | 41. (c) |
| 4. (d) | 42. (b) |
| 5. (c) | 43. (d) |
| 6. (e) | 44. (b) |
| 7. (a) | 45. (e) |
| 8. (c) | 46. (b) |
| 9. (c) | 47. (e) |
| 10. (b) | 48. (d) |
| 11. (e) | 49. (e) |
| 12. (d) | 50. (b) |
| 13. (a) | 51. (d) |
| 14. (c) | 52. (d) |
| 15. (c) | 53. (d) |
| 16. (d) | 54. (d) |
| 17. (e) | 55. (a) |
| 18. (c) | 56. (d) |
| 19. (d) | 57. (e) |
| 20. (e) | 58. (b) |
| 21. (d) | 59. (b) |
| 22. (a) | 60. (c) |
| 23. (e) | 61. (d) |
| 24. (e) | 62. (a) |
| 25. (e) | 63. (d) |
| 26. (a) | 64. (a) |
| 27. (a) | 65. (a) |
| 28. (e) | 66. (b) |
| 29. (c) | 67. (a) |
| 30. (a) | 68. (b) |
| 31. (d) | 69. (c) |
| 32. (e) | 70. (b) |
| 33. (b) | 71. (e) |
| 34. (d) | 72. (a) |
| 35. (a) | 73. (b) |
| 36. (d) | 74. (d) |
| 37. (d) | 75. (a) |
| 38. (e) | 76. (b) |