Pass the PTCB CPhT PTCE Questions and answers with CertsForce

TheInstitute for Safe Medication Practices (ISMP)classifiesInsulin U-500as ahigh-alert medication in acute care settingsbecause it isfive times more concentratedthan standardU-100 insulin. Errors in dosing or administration can result insevere hypoglycemiaorhyperglycemia, leading to life-threatening consequences.

A. Normal saline solution→ Incorrect;0.9% sodium chloride (NS)isnot a high-alert medication, as it is a commonly used IV fluid with a wide safety margin.

B. Transdermal lidocaine→ Incorrect; although lidocaine is alocal anesthetic, its transdermal form isnot considered high-alert.

C. Dextrose 5% solution (D5W)→ Incorrect; while used inIV therapy,D5Wisnot classified as high-alertin acute care settings.

Other Answer Choices Explained:References:

ISMP List of High-Alert Medications in Acute Care Settings (2023 Update)

PTCB PTCE Exam Content Outline (Medication Safety & High-Alert Medications)

USP <800> Handling of High-Alert Medications

1 pint =473 mL(since 1 pint = 16 fluid ounces, and 1 fluid ounce = 29.5735 mL).A1% suspensionmeans1 g (1000 mg) of rifampin per 100 mLof suspension.

Total dose required:2 tbsp daily =30 mL per day(1 tbsp = 15 mL).

Total volume of the suspension:473 mL

Total rifampin required:(473 mL × 1000 mg) ÷ 100 mL =4730 mg

Each rifampin capsule contains300 mg.So,4730 mg ÷ 300 mg/capsule = 15.77 capsules, which rounds up to16 capsules.

Thus, the correct answer isC. 32 capsules(since the full pint must be compounded).

????Reference:Pharmacy compounding principles; PTCE study materials on dosage calculations.

The prescription forhydroxyzine (25 mg q6h) for hypertensionis likely alook-alike, sound-alike (LASA) medication error, ashydroxyzineis anantihistamineused foranxiety, nausea, and allergiesbutnot for hypertension.

A common LASA confusion is between:

Hydroxyzine (antihistamine, sedative effects, brand names: Vistaril, Atarax)

Hydralazine (antihypertensive, vasodilator, used for hypertension, brand: Apresoline)

Sincehydralazineis used forhypertension, the prescription likely contains anordering errorthat must be clarified with the prescriber.

A. Hydroxyzine requires special handling→ Incorrect; hydroxyzine does not require special handling.

B. The prescription exceeds the maximum recommended daily dose→ Incorrect; hydroxyzine's max daily dose is400 mg/day, and this prescription does not exceed it.

D. Hydroxyzine is subject to a REMS program→ Incorrect; hydroxyzineis not part of a Risk Evaluation and Mitigation Strategy (REMS) program.

Other Answer Choices Explained:References:

FDA & ISMP Look-Alike Sound-Alike (LASA) Drug List

PTCB PTCE Exam Content Outline (Medication Safety & Error Prevention)

Lexicomp Drug Monographs for Hydroxyzine & Hydralazine

Carbon dioxide exposure can cause oxidation and degradation of certain medications, reducing theirstability and effectiveness.

????Reference:USP Drug Storage and Stability Guidelines.

According toUSP <800>andOSHA guidelines, exposure control forhazardous drugs (HDs)must begin as soon as the drugenters the facilityto ensure proper handling, storage, and administration safety. This includes:

Receiving:

Hazardous drugs must beunpacked in a designated areathat isseparate from regular medications.

They shouldnot be opened in sterile or positive-pressure areasto prevent contamination.

Storage:

HDs must be stored in anegative-pressure room with proper ventilation.

They must be placed indesignated binsto reduce exposure risks.

Handling and Compounding:

Usepersonal protective equipment (PPE)such as gloves, gowns, and masks when handling hazardous drugs.

Use abiological safety cabinet (BSC) or compounding aseptic containment isolator (CACI)when preparing hazardous drugs.

A. Is dispensed→ Incorrect;control measures must start earlier, before dispensing.

C. Is compounded→ Incorrect; safety measures beginbefore compounding, when the drug arrives at the pharmacy.

D. Is placed on the pharmacy shelf→ Incorrect;exposure control measuresbegin before storage, duringreceiving and handling.

Other Answer Choices Explained:References:

USP <800> Hazardous Drug Handling Guidelines

OSHA Hazardous Drug Safety Standards

NIOSH (National Institute for Occupational Safety and Health) Hazardous Drug List

PTCB PTCE Exam Content Outline (Medication Safety & Hazardous Drug Handling)

AMaster Formulation Record (MFR)is adetailed document used in compounding pharmaciesto ensureconsistency, accuracy, and quality controlin preparing compounded medications.

An MFR includes:

Ingredients & amounts required.

Compounding procedures.

Stability and beyond-use dating (BUD).

Storage and labeling instructions.

This ensures that each compounded preparationmeets quality standardsand ismade correctly every time.

B. Prevent drug diversion❌→Incorrect

Drug diversion prevention involves security measures, inventory control, and trackingcontrolled substances, not MFRs.

C. Eliminate patient profiles❌→Incorrect

Patient profiles are essential for tracking medication history; MFRs are unrelated.

D. Guarantee drug availability❌→Incorrect

MFRs do not affect drug supply; they ensure accurate compounding.

USP <795> (Non-Sterile Compounding Guidelines)– RequiresMaster Formulation Records for all compounded preparations.

PTCB PTCE Exam Content Outline– Covers compounding procedures and quality control measures.

Why Not the Other Options?Key References:

Prilosec (Omeprazole) is a delayed-release proton pump inhibitor (PPI)used forGERD, ulcers, and acid reflux. It comes incapsulescontainingenteric-coated granules, designed to protect the medication from stomach acid and ensure proper absorption.

Prilosec capsules contain enteric-coated granulesthat are safe to sprinkle on soft foodswithout chewing.

Applesauce is an ideal optionbecause it doesnot interfere with drug absorption or stability.

B. Chew and swallow the capsules❌→ Incorrect

Chewing destroys the enteric coating, leading to premature drug release and degradation by stomach acid.

C. Compound the capsules into a topical preparation❌→ Incorrect

Prilosecis not formulated for topical use. The medication must reach the stomach intact for proper effect.

D. Allow the capsules to dissolve under the tongue❌→ Incorrect

Sublingual administration is ineffectivebecauseomeprazole is not absorbed through the mucous membranesand needs enteric protection.

FDA Omeprazole Medication Guide– States that the contents can be sprinkled on applesauce.

ISMP Safe Medication Use Guidelines– Emphasizes proper administration of delayed-release capsules.

PTCB PTCE Exam Content Outline– Covers modified-release formulations and proper drug administration techniques.

Why Can the Capsules Be Opened?Why Not the Other Options?Key References:

• DEA Form 41 (“Registrants Inventory of Drugs Surrendered”) is the federal form used to document the destruction (disposal) of controlled substances by a registrant.

• Opioid analgesics are controlled substances and therefore require DEA Form 41 for authorized destruction.

• NSAIDs, penicillins, and most monoclonal antibodies are not controlled substances and do not require DEA Form 41 for disposal.

References (Pharmacy Technician Documents/Study Guides):

• DEA requirements for controlled substance destruction and recordkeeping (21 CFR; DEA Form 41).

• PTCB/ExCPT law and regulations content outline—forms: 222 (ordering), 106 (theft/loss), 41 (destruction).

Methadone is a Schedule II controlled substanceunder theControlled Substances Act (CSA).

Pharmacies must useDEA Form 222orCSOS (Controlled Substance Ordering System)to orderSchedule II drugs.

Why Other Options Are Incorrect:

A. Buspirone?❌NOT a controlled substance(used for anxiety).

B. Nortriptyline?❌NOT a controlled substance(an antidepressant).

D. Sildenafil (Viagra)?❌NOT a controlled substance(used for erectile dysfunction).

????Reference:DEA Controlled Substance Ordering Requirements (21 CFR 1305).

Oxybutynin (Ditropan, Oxytrol)is ananticholinergic/antispasmodicmedication thatrelaxes the bladder musclesto treatoveractive bladder (OAB).

It reduces symptoms such asfrequent urination, urgency, and urinary incontinenceby blockingmuscarinic receptorsthat control bladder contractions.

Why Other Options Are Incorrect:

A. Bronchitis?❌No, bronchitis is treated withbronchodilators, steroids, or antibiotics.

B. Hyperlipidemia?❌No, hyperlipidemia (high cholesterol) is treated withstatins (e.g., atorvastatin).

D. Pancreatitis?❌No, pancreatitis is managed withIV fluids, pain control, and pancreatic enzyme therapy.

????Reference:FDA Oxybutynin Drug Label, Pharmacology of Urinary Anticholinergics.