Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on insulin and diabetes drugs and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient is prescribed insulin lispro (Humalog) with meals. Which insulin category is it, and when is it injected relative to a meal?
These questions cover insulins: rapid-acting, insulins: appearance, insulins: mixing technique, insulins: long-acting and insulins: concentrations. 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: A. Insulin lispro is a rapid-acting mealtime insulin. Its label directs injection within 15 minutes before a meal or right after a meal. Insulin aspart (NovoLog) is in the same category.
Why not B: Once-daily basal dosing describes long-acting insulins such as insulin glargine, not lispro.
Why not C: Intermediate-acting insulin is NPH (Humulin N, Novolin N), not lispro.
Why not D: Regular human insulin is the short-acting type given about 30 minutes before meals.
Exam tactic: Rapid-acting (lispro, aspart, glulisine) = right at the meal. Regular = 30 minutes before.
Answer: B. NPH insulin is a suspension, so it looks uniformly cloudy and must be gently rolled or turned to mix before use, not shaken hard. Rapid-acting, regular and long-acting insulins are clear solutions.
Why not A: Insulin glargine is a clear solution. A cloudy vial would be abnormal.
Why not C: Regular insulin is clear. Cloudiness suggests a problem with the product.
Why not D: Insulin lispro is clear and colorless. It should never look cloudy.
Exam tactic: Only NPH (and premixes containing it) is cloudy. Roll it, do not shake it.
Answer: D. The rule is clear before cloudy. Drawing regular insulin first keeps the regular vial from being contaminated with NPH, which would change how fast it acts.
Why not A: Drawing NPH first risks contaminating the regular vial with NPH suspension.
Why not B: The order matters to keep the regular insulin vial free of NPH.
Why not C: Regular and NPH are a classic compatible mix. Glargine is the one that is never mixed.
Exam tactic: Mixing insulins: clear before cloudy.
Answer: C. Insulin glargine works because it forms a depot under the skin at its acidic pH. Mixing or diluting it alters its action, so the label states it must not be mixed with any other insulin or solution.
Why not A: Glargine must not be mixed with any insulin, including rapid-acting products.
Why not B: No time window allows mixing. The answer is never mix glargine.
Why not D: Glargine must not be diluted. Dilution changes its absorption profile.
Exam tactic: Glargine (Lantus, Basaglar, Toujeo) = never mixed. Separate injections.
Answer: A. Toujeo is insulin glargine U-300, meaning 300 units per mL. It comes in pens that dial in units, so the patient never converts units to volume. Toujeo and Lantus are not bioequivalent: a switch from once-daily Lantus can start at the same number of units, but most patients end up needing a higher Toujeo dose, so glucose is watched closely after the change.
Why not B: 100 units/mL is the concentration of Lantus and most standard insulins (U-100).
Why not C: 200 units/mL applies to some other concentrated pens, not Toujeo.
Why not D: 500 units/mL is the concentration of Humulin R U-500, a regular insulin.
Exam tactic: Toujeo = glargine U-300. Lantus = U-100. Humulin R U-500 = 500 units/mL.
Answer: D. Sulfonylureas such as glipizide, glimepiride and glyburide stimulate insulin release regardless of glucose level, so hypoglycemia (shakiness, sweating, confusion) is their main risk, especially if meals are skipped.
Why not A: A dry cough is linked to ACE inhibitors, not sulfonylureas.
Why not B: Genital yeast infections are typical of SGLT2 inhibitors such as empagliflozin.
Why not C: Orange urine is a classic effect of rifampin, not glipizide.
Exam tactic: Sulfonylurea (gli- + -ide) = hypoglycemia risk. Do not skip meals.
Answer: B. SGLT2 inhibitors (-gliflozin) make the kidneys excrete glucose in the urine. The sugar-rich environment raises the risk of genital mycotic infections and urinary tract infections.
Why not A: SGLT2 inhibitors usually cause mild weight loss. Fluid retention is linked to pioglitazone.
Why not C: A dry cough points to ACE inhibitors, not SGLT2 inhibitors.
Why not D: Black stool is linked to iron or bismuth products, not empagliflozin.
Exam tactic: -gliflozin = sugar in the urine = genital yeast infections and UTIs.
Answer: D. Long-acting GLP-1 receptor agonists carry a boxed warning for thyroid C-cell tumors seen in rodents. They are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or with MEN 2.
Why not A: Lactic acidosis is the boxed warning for metformin, not GLP-1 receptor agonists.
Why not B: Tendon rupture is a boxed warning for fluoroquinolone antibiotics.
Why not C: Worsening heart failure is the boxed warning for pioglitazone and other TZDs.
Exam tactic: -glutide (and tirzepatide) boxed warning = thyroid C-cell tumors.
Answer: A. Mounjaro (type 2 diabetes) and Zepbound (chronic weight management) both contain tirzepatide, a dual GIP and GLP-1 receptor agonist given by weekly injection. Holding both at once would be a duplication the pharmacist must review.
Why not B: Semaglutide is the ingredient in Ozempic, Wegovy and Rybelsus, not Mounjaro or Zepbound.
Why not C: Liraglutide is the ingredient in Victoza and Saxenda.
Why not D: Dulaglutide is the ingredient in Trulicity.
Exam tactic: Same molecule, different brands: tirzepatide = Mounjaro and Zepbound. Semaglutide = Ozempic, Wegovy, Rybelsus.
Answer: D. Thiazolidinediones such as pioglitazone cause fluid retention, which can cause or worsen heart failure. They are not recommended in symptomatic heart failure and are contraindicated in severe heart failure.
Why not A: Pancreatitis is a warning for incretin drugs, but it is not the pioglitazone boxed warning.
Why not B: Thyroid C-cell tumors are the boxed warning for GLP-1 receptor agonists.
Why not C: Pioglitazone alone rarely causes hypoglycemia, and it is not its boxed warning.
Exam tactic: -glitazone = fluid retention = heart failure warning.
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