Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on anticoagulants, antiplatelets and statins and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient taking atorvastatin mentions unexplained muscle pain and weakness in both legs. Why should the technician bring this to the pharmacist promptly?
These questions cover counseling points: statins, drug classes: lipid-lowering agents, drug classes: antiplatelets, brand and generic names: antiplatelets and dosage forms: warfarin tablet colors. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the PTCE.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: C. Statins can cause myopathy, and rarely rhabdomyolysis, a serious breakdown of muscle tissue that can damage the kidneys. Unexplained muscle pain, tenderness or weakness should be reported to the prescriber.
Why not A: A dry cough is linked to ACE inhibitors. Statins are known for muscle effects.
Why not B: Statins do not raise potassium. That risk belongs to drugs like spironolactone.
Why not D: Statins are not known to cause hypoglycemia. The concern is myopathy.
Exam tactic: Statin + unexplained muscle pain = report it (myopathy, rhabdomyolysis).
Answer: D. Ezetimibe (Zetia) is a cholesterol absorption inhibitor. It reduces absorption of cholesterol from the small intestine and is often added to a statin.
Why not A: Inhibiting HMG-CoA reductase is how statins work. Ezetimibe is not a statin.
Why not B: Bile acid sequestrants such as cholestyramine work this way, not ezetimibe.
Why not C: Activating PPAR-alpha describes fibrates such as fenofibrate.
Exam tactic: Zetia = blocks gut absorption. Statin = blocks liver production.
Answer: A. Clopidogrel is an antiplatelet agent (P2Y12 inhibitor). It prevents platelet aggregation and lowers the risk of stent thrombosis, heart attack and stroke.
Why not B: Dissolving existing clots is the job of thrombolytics such as alteplase, not clopidogrel.
Why not C: Blocking factor Xa describes apixaban and rivaroxaban, which are anticoagulants.
Why not D: Lowering LDL cholesterol is the role of statins, not clopidogrel.
Exam tactic: Antiplatelet (clopidogrel, ticagrelor, aspirin) = platelets. Anticoagulant (warfarin, -xaban) = clotting factors.
Answer: D. Brilinta is ticagrelor, a P2Y12 antiplatelet used with low-dose aspirin after acute coronary syndrome to reduce cardiovascular events.
Why not A: Clopidogrel is the P2Y12 inhibitor sold as Plavix.
Why not B: Prasugrel is another P2Y12 inhibitor, but it is not Brilinta.
Why not C: Dabigatran is the direct thrombin inhibitor sold as Pradaxa.
Exam tactic: P2Y12 antiplatelets: clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel.
Answer: B. Warfarin strengths are color coded: 1 mg pink, 2 mg lavender, 2.5 mg green, 3 mg tan, 4 mg blue, 5 mg peach, 6 mg teal, 7.5 mg yellow, 10 mg white. A color that does not match the strength is a red flag at product verification.
Why not A: Pink is the color of the 1 mg warfarin tablet.
Why not C: Blue is the color of the 4 mg warfarin tablet.
Why not D: White is the color of the 10 mg warfarin tablet.
Exam tactic: Warfarin color does not match the strength = stop and check.
Answer: B. Isosorbide mononitrate is a long-acting nitrate used to prevent angina. It has a slow onset and is not indicated for acute attacks. Acute chest pain is treated with fast-acting sublingual nitroglycerin, as directed by the prescriber.
Why not A: Isosorbide mononitrate ER is taken daily for prevention, not for attacks.
Why not C: Isosorbide mononitrate is a nitrate vasodilator, not an anticoagulant.
Why not D: Isosorbide mononitrate is a nitrate, not a beta blocker.
Exam tactic: Long-acting nitrate = prevention. Sublingual nitroglycerin = acute attack.
Answer: D. Warfarin blocks vitamin K-dependent clotting factors. Vitamin K (phytonadione) restores their production and is used to reverse warfarin, along with other measures for serious bleeding.
Why not A: Protamine sulfate reverses heparin, not warfarin.
Why not B: Naloxone reverses opioid overdose and has no effect on warfarin.
Why not C: Flumazenil reverses benzodiazepines and has no effect on warfarin.
Exam tactic: Warfarin antidote = vitamin K. Heparin antidote = protamine.
Answer: A. Rivaroxaban 15 mg and 20 mg tablets must be taken with food, because absorption is much lower on an empty stomach. For atrial fibrillation, the dose is taken with the evening meal.
Why not B: The 15 mg and 20 mg tablets need food for full absorption, so an empty stomach is wrong.
Why not C: Antacids are not part of rivaroxaban dosing.
Why not D: Rivaroxaban 20 mg for atrial fibrillation is taken once daily, not every other day.
Exam tactic: Xarelto 15 mg and 20 mg = with food. In atrial fibrillation, with the evening meal.
Answer: B. One tablet is dissolved under the tongue at the first sign of an attack and may be repeated about every 5 minutes, up to 3 tablets in 15 minutes. The label says to seek emergency help if pain persists after 3 tablets in 15 minutes or feels different from usual; many clinicians (per AHA guidance) tell patients to call 911 if pain is not better 5 minutes after the first tablet.
Why not A: The label allows repeat doses every 5 minutes, so the limit is not a single tablet.
Why not C: Two tablets stops short of the labeled maximum of 3 in 15 minutes.
Why not D: 5 tablets exceeds the labeled maximum and risks severe hypotension.
Exam tactic: Nitro SL: 1 every 5 minutes, max 3 in 15 minutes. Still in pain after the limit (or worse) = emergency help.
Answer: C. Nitrates such as isosorbide mononitrate and nitroglycerin relax and widen blood vessels. Dilation of vessels in the head commonly causes headache, which often lessens with continued use.
Why not A: Nitrates lower blood pressure. They do not raise it.
Why not B: Nitrates are not known to cause hypoglycemia.
Why not D: Nitrate headache comes from vasodilation, not fluid buildup.
Exam tactic: Nitrates: headache, dizziness, low blood pressure. Never with PDE-5 inhibitors.
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