Medications is 35% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on therapeutic duplication and drug stability and see exactly which concepts would cost you points on test day.
Start the 10 questions →A patient picking up Percocet asks the technician to also ring up a bottle of Extra Strength Tylenol for headaches. Why should the technician involve the pharmacist?
These questions cover therapeutic duplication: acetaminophen, therapeutic duplication: ACE inhibitors, therapeutic duplication: SSRIs, therapeutic duplication: NSAIDs and therapeutic duplication: statins after a switch. 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 with acetaminophen, and Tylenol is acetaminophen. Using both duplicates acetaminophen and raises the risk of exceeding the daily limit and causing liver damage. OTC acetaminophen labels warn against using other products that contain acetaminophen.
Why not B: The concern is a duplicated ingredient, not a change in how fast oxycodone works.
Why not C: There is no rule against selling an OTC product with a prescription.
Why not D: Tylenol is an OTC product sold on open shelves.
Exam tactic: Combination opioid + OTC pain reliever: check for hidden acetaminophen.
Answer: B. Lisinopril (Zestril, Prinivil) and enalapril (Vasotec) are both ACE inhibitors (generic names ending in -pril). Two drugs from the same class for the same purpose are a therapeutic duplication, so the pharmacist must review it before filling.
Why not A: Enalapril is an ACE inhibitor, not a diuretic.
Why not C: Enalapril and lisinopril are two different generic drugs; Vasotec is the brand of enalapril.
Why not D: Different names do not rule out duplication; the drug class is what matters.
Exam tactic: Same suffix on two active drugs (-pril + -pril) = flag for duplication.
Answer: C. Sertraline (Zoloft) and escitalopram (Lexapro) are both selective serotonin reuptake inhibitors. Taking two SSRIs together duplicates therapy and raises the risk of serotonin-related side effects. The pharmacist should confirm whether one is meant to replace the other.
Why not A: Escitalopram is an antidepressant, not an antibiotic.
Why not B: Dosage form does not prevent duplication; the drug class does.
Why not D: The generic name of Zoloft is sertraline. Escitalopram is the generic of Lexapro.
Exam tactic: Two SSRIs at once = possible duplication, ask the pharmacist.
Answer: A. Naproxen and ibuprofen are both nonsteroidal anti-inflammatory drugs. Using two NSAIDs together adds no benefit and increases the risk of side effects such as GI bleeding and kidney injury. The pharmacist should counsel the patient.
Why not B: The problem is added NSAID side effects, not blocked absorption.
Why not C: Naproxen is an NSAID, not an opioid.
Why not D: OTC status does not remove the risk of duplicating a drug class.
Exam tactic: Rx NSAID + OTC NSAID = duplication. Send the question to the pharmacist.
Answer: C. Simvastatin (Zocor) and atorvastatin (Lipitor) are both HMG-CoA reductase inhibitors (statins). Taking both is a therapeutic duplication that raises the risk of side effects such as muscle damage. The pharmacist confirms with the prescriber and the old prescription is inactivated.
Why not A: Remaining refills do not make taking two statins appropriate.
Why not B: The most recent order replaced simvastatin; filling the old drug ignores the switch.
Why not D: A technician cannot create a new dosing schedule, and alternating still exposes the patient to two statins.
Exam tactic: Old and new drug from the same class both active = duplication alert.
Answer: B. Lantus labeling states that an opened vial, whether kept in a refrigerator or at room temperature, should be discarded 28 days after first use.
Why not A: The printed expiration date applies to unopened vials stored as directed, not to an opened vial.
Why not C: 7 days is too short for Lantus vials.
Why not D: 90 days is far longer than the labeled in-use period.
Exam tactic: Opened Lantus vial: 28 days, fridge or not.
Answer: B. Nitroglycerin sublingual tablet labeling states they should be kept in the original glass container and tightly capped after each use to prevent loss of potency.
Why not A: The reason is stability, not cost.
Why not C: The concern is potency loss over time, not how fast the tablet dissolves.
Why not D: There is no ban on plastic containers for heart medications; the requirement comes from this product's storage labeling.
Exam tactic: Nitroglycerin SL: original glass bottle, cap tight.
Answer: C. Latanoprost labeling directs storing unopened bottles refrigerated at 2°C to 8°C. Once a bottle is opened, it may be stored at room temperature up to 25°C (77°F) for 6 weeks.
Why not A: This reverses the labeled storage: unopened bottles go in the refrigerator.
Why not B: Latanoprost is not stored frozen.
Why not D: An opened bottle may be kept at room temperature, and the in-use period is 6 weeks, not 7 days.
Exam tactic: Xalatan: fridge until opened, then room temp for 6 weeks.
Answer: B. Zithromax labeling says to store the constituted oral suspension at 5°C to 30°C (41°F to 86°F) and use it within 10 days. Refrigeration is not required.
Why not A: Refrigeration is not required, and the labeled use period is 10 days.
Why not C: The suspension is not frozen.
Why not D: The labeled use period is 10 days, and the suspension is not stored in the freezer.
Exam tactic: Azithromycin suspension: no fridge needed, 10 days.
Answer: D. Omeprazole (Prilosec) and pantoprazole (Protonix) are both proton pump inhibitors (generic names ending in -prazole). Taking two drugs from the same class for the same purpose is a therapeutic duplication.
Why not A: Metformin (a biguanide) and glipizide (a sulfonylurea) are different classes often used together for diabetes.
Why not B: An ACE inhibitor plus a thiazide diuretic is a common combination of different classes.
Why not C: Albuterol is a short-acting bronchodilator and fluticasone is an inhaled corticosteroid, two different classes.
Exam tactic: Duplication = same class, same purpose. Look for the shared suffix.
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