Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on respiratory and GI drugs and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient starting fluticasone furoate/vilanterol (Breo Ellipta) asks why the label tells him to rinse his mouth after each use. What does rinsing help prevent?
These questions cover counseling points: inhaled corticosteroids, dosage forms: dry powder inhalers, boxed warnings: leukotriene modifiers, drug classes: combination inhalers and dosage forms: nebulizer suspensions. 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. Inhaled corticosteroid left in the mouth and throat can cause oropharyngeal candidiasis (thrush) and hoarseness. Rinsing with water and spitting it out without swallowing reduces this risk.
Why not A: Tooth discoloration is linked to tetracyclines in children, not inhaled steroids.
Why not B: Rinsing the mouth has no effect on wheezing. It removes steroid residue.
Why not D: A dry cough is the classic ACE inhibitor effect, not the reason for rinsing.
Exam tactic: Any inhaler with a steroid (ICS): rinse, gargle, spit.
Answer: D. Spiriva HandiHaler is a dry powder inhaler. One tiotropium capsule is placed in the chamber, pierced, and the powder is inhaled once daily. Swallowing capsules is a known error.
Why not A: Swallowing the capsule delivers no useful dose to the lungs. It is for inhalation only.
Why not B: The powder is inhaled from the device. It is never sprinkled on food.
Why not C: HandiHaler capsules are not a nebulizer product.
Exam tactic: Capsule + inhaler device = for inhalation only. Add the auxiliary label: do not swallow.
Answer: C. Montelukast's boxed warning covers serious neuropsychiatric events, including agitation, depression, sleep disturbances, and suicidal thoughts or behavior. A Medication Guide is provided with each dispensing.
Why not A: Montelukast's boxed warning is not about liver failure.
Why not B: Fetal toxicity is the boxed warning for ACE inhibitors and ARBs.
Why not D: Tendon rupture is a boxed warning for fluoroquinolones.
Exam tactic: Montelukast = mood and behavior changes = boxed warning + Medication Guide.
Answer: A. Fluticasone furoate is an inhaled corticosteroid, umeclidinium is a long-acting muscarinic antagonist, and vilanterol is a long-acting beta-2 agonist. Trelegy is a once-daily maintenance triple therapy, not a rescue inhaler.
Why not B: Trelegy contains no short-acting agent. Umeclidinium is a LAMA.
Why not C: Trelegy contains no SABA or leukotriene antagonist.
Why not D: Umeclidinium is long-acting (LAMA), not short-acting like ipratropium.
Exam tactic: -terol = beta agonist. -ium (tiotropium, umeclidinium, ipratropium) = antimuscarinic.
Answer: D. Budesonide inhalation suspension is an inhaled corticosteroid for young children. It is placed in a jet nebulizer and inhaled through a mouthpiece or face mask. It is a daily controller, not a rescue medicine.
Why not A: Budesonide ampules contain a liquid suspension, not a pressurized canister.
Why not B: Nasal sprays are a different product. These ampules are for inhalation.
Why not C: The suspension is inhaled. Swallowing it would not treat the airways.
Exam tactic: Respules and other ampules for inhalation = nebulizer.
Answer: B. Ipratropium is a short-acting muscarinic antagonist (SAMA). It relaxes airway smooth muscle by blocking acetylcholine and is often combined with albuterol for COPD.
Why not A: Albuterol is the short-acting beta-2 agonist in this combination, not ipratropium.
Why not C: Ipratropium is not a steroid. Examples of ICS are budesonide and fluticasone.
Why not D: Tiotropium and umeclidinium are long-acting. Ipratropium is short-acting.
Exam tactic: Ipratropium = short-acting, several times daily. Tiotropium = long-acting, once daily.
Answer: B. Benzonatate capsules must be swallowed whole. Chewing or sucking them can numb the mouth and throat, causing choking. Accidental ingestion by children under 10 can be fatal, so storage out of reach is stressed.
Why not A: Releasing the drug in the mouth can numb the throat and cause choking.
Why not C: Milk is not part of benzonatate directions.
Why not D: Benzonatate is an oral capsule, not an inhaled product.
Exam tactic: Benzonatate: swallow whole, never chew, childproof storage.
Answer: D. Proton pump inhibitors block acid pumps that become active when food arrives. Taking the dose before a meal, usually 30 to 60 minutes before breakfast, gives the best acid control.
Why not A: PPIs work best when taken before a meal, not after dinner with an antacid.
Why not B: A bedtime snack does not activate the acid pumps the way a meal after the dose does.
Why not C: PPIs are taken daily on schedule. They do not give fast relief of an episode.
Exam tactic: -prazole = PPI = before breakfast, daily, not for instant relief.
Answer: C. Famotidine is an H2 receptor antagonist. It blocks histamine-2 receptors on stomach cells, which reduces acid secretion. Cimetidine and nizatidine share the -tidine suffix.
Why not A: Proton pump inhibitors end in -prazole, such as omeprazole.
Why not B: Antacids neutralize existing acid. Famotidine reduces acid production.
Why not D: Misoprostol is the prostaglandin analog. Famotidine is not.
Exam tactic: -tidine = H2 blocker. -prazole = PPI.
Answer: D. Ondansetron blocks serotonin 5-HT3 receptors in the gut and the brain's vomiting center. It prevents nausea and vomiting from chemotherapy, radiation and surgery. Granisetron shares the -setron suffix.
Why not A: Metoclopramide and prochlorperazine act mainly on dopamine. Ondansetron does not.
Why not B: H2 blockers such as famotidine reduce acid. They are not antiemetics.
Why not C: Aprepitant is the NK1 antagonist. Ondansetron blocks 5-HT3 receptors.
Exam tactic: -setron = 5-HT3 antagonist antiemetic.
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