Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on opioids, NSAIDs and pain medications and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient picking up Percocet asks if she can also take Tylenol Extra Strength for headaches. Why must the pharmacist review this?
These questions cover acetaminophen: hidden duplication, drug classes: NSAIDs, migraine: triptans, opioids: opioid use disorder and opioids: fentanyl transdermal. 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. Percocet is oxycodone plus acetaminophen. Adding Tylenol stacks a second acetaminophen source and raises the risk of exceeding the daily limit and causing liver damage.
Why not B: Acetaminophen does not block oxycodone; the problem is a duplicate ingredient.
Why not C: Percocet contains oxycodone and acetaminophen, not ibuprofen.
Why not D: Tylenol Extra Strength is an OTC product and does not require a prescription.
Exam tactic: Always check combination products (Percocet, hydrocodone/APAP, cold and flu, PM products) for hidden acetaminophen.
Answer: C. Celecoxib is a COX-2 selective NSAID. Like other prescription NSAIDs, it carries boxed warnings for cardiovascular events and GI bleeding.
Why not A: Skeletal muscle relaxants include cyclobenzaprine and methocarbamol.
Why not B: Opioid agonists include oxycodone and morphine; celecoxib is not an opioid.
Why not D: Xanthine oxidase inhibitors, such as allopurinol, lower uric acid in gout.
Exam tactic: -coxib = COX-2 selective NSAID.
Answer: A. Sumatriptan is a triptan used for acute treatment of migraine attacks. It is taken at the onset of a migraine, not as a daily preventive.
Why not B: Triptans are not migraine preventives; daily prevention uses drugs such as topiramate or propranolol.
Why not C: Sumatriptan is not an anticonvulsant and is not used for seizures.
Why not D: Muscle spasm is treated with skeletal muscle relaxants such as cyclobenzaprine.
Exam tactic: -triptan = stops a migraine attack in progress.
Answer: B. Buprenorphine/naloxone (Suboxone) is used to treat opioid use disorder. It is a Schedule III controlled substance. The naloxone component discourages misuse by injection.
Why not A: Acute overdose is reversed with naloxone alone, such as Narcan nasal spray.
Why not C: Alcohol withdrawal is usually managed with benzodiazepines, not buprenorphine.
Why not D: Migraine is treated with triptans or analgesics, not buprenorphine/naloxone.
Exam tactic: Suboxone = OUD treatment, C-III. Narcan = overdose rescue.
Answer: A. External heat (heating pads, electric blankets, hot tubs, saunas, heat lamps) increases fentanyl release and absorption through the skin. Fentanyl patch labeling warns this can cause overdose and fatal respiratory depression.
Why not B: Heat increases, rather than destroys, fentanyl delivery.
Why not C: Skin irritation can occur with patches, but the heat warning is about overdose.
Why not D: Heat increases drug release from the patch; it does not stop it.
Exam tactic: Fentanyl patch + heat = more drug in, overdose risk.
Answer: C. OxyContin is extended-release oxycodone. Crushing, chewing or dissolving it defeats the extended-release design and can deliver a potentially fatal dose rapidly. A 'do not crush or chew' auxiliary label applies.
Why not A: The danger of crushing is rapid opioid release, not stomach ulcers.
Why not B: Crushing does not inactivate oxycodone; it releases it too fast.
Why not D: Crushing does not change oxycodone into another opioid.
Exam tactic: ER, XR, XL, SR, CR, LA: do not crush or chew.
Answer: A. Carisoprodol has been federally controlled in Schedule IV since 2012 because of abuse potential; it is metabolized to meprobamate.
Why not B: Cyclobenzaprine is not a federally controlled substance.
Why not C: Methocarbamol is not a federally controlled substance.
Why not D: Tizanidine is not a federally controlled substance.
Exam tactic: Carisoprodol is the muscle relaxant that is C-IV.
Answer: B. Allopurinol is a xanthine oxidase inhibitor that lowers uric acid production. It is taken daily long term to prevent gout attacks, not to treat an acute flare.
Why not A: Acute flares are treated with NSAIDs, colchicine or corticosteroids; allopurinol does not give fast relief.
Why not C: Allopurinol is not an NSAID and is taken every day, not as needed.
Why not D: Allopurinol is not an opioid.
Exam tactic: Allopurinol = prevention (daily). Colchicine, NSAIDs, steroids = flare treatment.
Answer: D. Lyrica is pregabalin, used for neuropathic pain, fibromyalgia and partial-onset seizures. Pregabalin is a federal Schedule V controlled substance.
Why not A: Carbamazepine is the generic for Tegretol, an anticonvulsant.
Why not B: Gabapentin is the generic for Neurontin.
Why not C: Duloxetine is the generic for Cymbalta, an SNRI also used for nerve pain.
Exam tactic: Lyrica = pregabalin (C-V). Neurontin = gabapentin.
Answer: B. Naltrexone is an opioid antagonist. In a patient with opioids in the body it can precipitate acute opioid withdrawal and blocks opioid pain relief. The label requires patients to be opioid-free (typically 7 to 10 days) before starting, so the pharmacist contacts the prescriber.
Why not A: Naltrexone blocks opioid receptors. It reduces, rather than increases, the effect of oxycodone.
Why not C: Naltrexone is not a controlled substance. The problem is its antagonist effect, not a schedule.
Why not D: A disulfiram-like reaction comes from alcohol with drugs such as metronidazole, not from naltrexone with an opioid.
Exam tactic: Naltrexone = opioid blocker. Any current opioid on the profile = withdrawal risk. Flag it.
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