Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on pregnancy, pediatric and older adult cautions and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient picks up Synthroid (levothyroxine). Which administration instruction is correct?
These questions cover administration: levothyroxine, brand and generic names: anticonvulsants, pregnancy cautions: isotretinoin, pregnancy cautions: ACE inhibitors and pregnancy cautions: handling hazardous tablets. 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. Levothyroxine is taken once daily on an empty stomach, 30 minutes to 1 hour before breakfast, with water. It is an NTI drug, so consistent timing and product matter.
Why not A: Calcium binds levothyroxine and reduces absorption; they should be separated.
Why not B: Food, especially a large meal, reduces and varies levothyroxine absorption.
Why not D: Levothyroxine is daily maintenance therapy, not an as-needed drug.
Exam tactic: Levothyroxine: same time daily, empty stomach, away from calcium and iron.
Answer: D. Tegretol is carbamazepine, an anticonvulsant also used for trigeminal neuralgia. It is a narrow therapeutic index drug monitored with blood levels and a strong liver enzyme inducer.
Why not A: Topiramate is Topamax.
Why not B: Lamotrigine is Lamictal.
Why not C: Levetiracetam is Keppra.
Exam tactic: Tegretol = carbamazepine. Watch the Tegretol / Toprol-XL look-alike pair.
Answer: C. Isotretinoin is a potent teratogen that can cause severe birth defects. Its REMS program (iPLEDGE) requires registration and, for patients who can become pregnant, pregnancy testing and contraception.
Why not A: Isotretinoin is taken orally at home, not given in a hospital.
Why not B: Isotretinoin is not addictive; the restriction is about birth defects.
Why not D: Isotretinoin is not a controlled substance.
Exam tactic: Isotretinoin = iPLEDGE = teratogen.
Answer: D. ACE inhibitors and ARBs carry a boxed warning for fetal toxicity: drugs acting on the renin-angiotensin system can injure and kill the developing fetus, so they are discontinued as soon as pregnancy is detected.
Why not A: ACE inhibitors are avoided in pregnancy. Labetalol and nifedipine are among the usual choices.
Why not B: Fetal harm is greatest in the second and third trimesters, so the third trimester is the worst time to continue it.
Why not C: A higher dose would increase fetal exposure and risk. The warning is to stop the drug.
Exam tactic: -pril and -sartan in pregnancy = fetal toxicity boxed warning.
Answer: A. Finasteride can be absorbed through the skin and may cause abnormal development of the genitals of a male fetus. Women who are or may be pregnant should not handle crushed or broken tablets; intact coated tablets limit contact.
Why not B: Light exposure of the tablets is not a risk to the person handling them.
Why not C: The precaution is about skin contact with tablet dust, not pharmacist presence.
Why not D: Storage location does not create a pregnancy risk.
Exam tactic: Finasteride and dutasteride: pregnant women avoid contact with broken tablets or leaking capsules.
Answer: B. Valproate products carry a boxed warning for fetal risk (major congenital malformations, especially neural tube defects, and decreased IQ), hepatotoxicity and pancreatitis.
Why not A: Complex sleep behaviors are the boxed warning for zolpidem.
Why not C: Tendon rupture is a fluoroquinolone boxed warning.
Why not D: The suicidality boxed warning applies to antidepressants.
Exam tactic: Valproate: fetal harm, liver, pancreas.
Answer: C. Aspirin and other salicylates given to children or teenagers during viral illnesses such as chickenpox or flu are linked to Reye's syndrome, a rare but serious condition affecting the brain and liver.
Why not A: Aspirin is available OTC; the concern is safety, not prescription status.
Why not B: Aspirin does reduce fever; the problem is Reye's syndrome risk.
Why not D: Aspirin does not spread chickenpox lesions; the risk is Reye's syndrome.
Exam tactic: Child or teen + viral illness + salicylate = Reye's syndrome.
Answer: D. Diphenhydramine is strongly anticholinergic and sedating. In older adults it can cause confusion, falls, constipation and urinary retention, and it is on the Beers Criteria list of medications to avoid.
Why not A: Diphenhydramine is an OTC product and is not a controlled substance.
Why not B: Diphenhydramine does cause drowsiness in older adults; the problem is safety, not lack of effect.
Why not C: Raising blood sugar is not the main concern with diphenhydramine.
Exam tactic: First-generation antihistamines in the elderly = confusion and falls (Beers).
Answer: A. Codeine and tramadol are contraindicated in children younger than 12 years, and in children younger than 18 after tonsillectomy or adenoidectomy, because of life-threatening respiratory depression in ultra-rapid metabolizers.
Why not B: The issue is safety, not that codeine is too weak.
Why not C: Codeine is given orally; the restriction is the patient's age.
Why not D: Changing the dosage form does not remove the contraindication.
Exam tactic: Codeine or tramadol + child under 12 (or tonsillectomy under 18) = contraindicated.
Answer: C. Testosterone gels carry a boxed warning for secondary exposure: children who touch application sites can show virilization. Patients wash hands, cover the site with clothing once dry and avoid skin-to-skin contact.
Why not A: Low blood sugar is not the secondary exposure risk.
Why not B: Sunburn of the application site is not the boxed warning.
Why not D: Scent allergy is not the boxed warning.
Exam tactic: Testosterone gel: wash hands, cover the site, keep children away.
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