PTCB PTCE Pharmacy Technician Certification (CPhT) Exam Exam Practice Test

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).

Comprehensive and Detailed Step-by-Step Explanation:

Acetaminophen (Tylenol)is metabolized by theliver.Excessive doses or concurrentalcohol useincreases the risk ofliver damage (hepatotoxicity).

????Explanation of Answer Choices:✅D. Alcoholic beverages→Correct. Alcohol and acetaminophen together can causesevere liver damage.❌A. Citrus fruits→ Incorrect. Citrus does not interfere withacetaminophen metabolism.❌B. Leafy greens→ Incorrect. Leafy greens affectwarfarin, notacetaminophen.❌C. Dairy products→ Incorrect. Dairy does not interact withacetaminophen.

????Reference:

FDA Acetaminophen Warnings

PTCB Medication Safety Guidelines

Cleaning counting trays removes medication residue to prevent cross-contamination, especially with penicillin or sulfa drugs.

????Reference:ISMP Pharmacy Cleaning and Contamination Prevention Guidelines.

For aqueous solutions such as water, proper volumetric technique requires placing the graduated cylinder at eye level and reading the bottom of the meniscus to avoid parallax error and obtain an accurate measurement. Reading at the top of the meniscus or holding the cylinder above eye level produces inaccurate results. This technique is standard in compounding and measurement guidance used in pharmacy training.

References (Pharmacy Technician documents/Study Guides):

• USP <795> Pharmaceutical Compounding—Nonsterile Preparations: Accurate measurement and meniscus reading for liquids.

• USP general laboratory technique guidance used in pharmacy education (volumetric measurement best practices).

• PTCB/ExCPT Compounding sections: Use of graduated cylinders and meniscus reading.

Sig Code Breakdown:

2 gtt = 2 drops

OU (oculus uterque) = both eyes

q4-6h = every 4 to 6 hours

p.r.n. = as needed

Why Other Options Are Incorrect:

A. Both ears?❌"AU" (auris uterque) means both ears, NOT both eyes.

B. Right ear?❌"AD" (auris dextra) means right ear.

C. Right eye?❌"OD" (oculus dexter) means right eye.

????Reference:PTCB Approved Sig Code List, ISMP Safe Prescription Writing Guidelines.

Prochlorperazine (Compazine suppository)requiresrefrigeration(store at2°C to 8°C / 36°F to 46°F) to maintain stability.

Other suppositories are stored atroom temperatureunless specified.

????Reference:Manufacturer Storage Guidelines, USP Storage Standards.

Beyond-use dates (BUDs) apply specifically to compounded medicationsand indicate thetime frame in which the medication remains stable and safe to use.

BUDs are different from expiration dates, which are determined by manufacturers through long-term stability testing.

USP <795> BUD Guidelines for Nonsterile Compounds:

Non-aqueous formulations(e.g., capsules, powders) →6 months

Water-containing oral formulations(e.g., suspensions) →14 days (refrigerated)

Water-containing topical formulations(e.g., creams, lotions) →30 days

Why Other Options Are Incorrect:

B. Manufactured preparation expiration dates?❌Expiration dates apply tocommercially manufactured drugs, NOT compounded ones.

C. Shelf-life of manufactured drugs?❌This is determined by themanufacturer’s expiration date.

D. Time to prepare a compound?❌BUDsdo not refer to preparation time.

????Reference:USP <795> & USP <797> Guidelines, PTCE Compounding Study Materials.

Repatha (evolocumab) is a PCSK9 inhibitor used for lowering LDL cholesterol. One of its common side effects includes musculoskeletal pain, such as muscle aches and cramps. According to the FDA package insert for Repatha, clinical trials observed arthralgia, myalgia, and back pain as notable adverse events.

In contrast:

Requip (ropinirole) may cause dizziness or nausea.

Restasis (cyclosporine ophthalmic) causes eye irritation.

Restoril (temazepam) is associated with sedation.

Comprehensive and Detailed Step-by-Step Explanation:

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Explanation of Answer Choices:✅B. 10→Correct.❌A. 1→ Incorrect.1 tablet contains 100 mg, not 1000 mg.❌C. 100→ Incorrect.Overdose.❌D. 1000→ Incorrect.Severe overdose.

????Reference:

USP <795> Pharmaceutical Calculations

PTCB Dosage Conversions

USP compounding standards require maintaining a Master Formulation Record (MFR) and a Compounding Record (CR). The primary purpose is to ensure the compounded preparation can be consistently and identically reproduced with documented components, calculations, equipment, steps, and quality checks. While documentation can incidentally aid billing or inventory, those are not the primary objectives.

References (Pharmacy Technician documents/Study Guides):

• USP <795> Pharmaceutical Compounding—Nonsterile Preparations: requirements for Master Formulation Records and Compounding Records, including content and purpose (consistent, reproducible compounding and quality assurance).

• ASHP guidelines on compounding documentation and quality systems.

• PTCB/ExCPT study guides—compounding documentation, records, and reproducibility.

Intradermal (ID) injectionsare deliveredinto the dermis (just below the epidermis).

Used forallergy testing, tuberculosis (TB) testing, and some vaccines.

Theneedle angle is 10–15 degrees, and only asmall volume (0.1 mL – 0.5 mL)is injected.

Why Other Options Are Incorrect:

A. Intraperitoneal?❌Injected into theperitoneal cavity, used in animal research.

B. Intravenous (IV)?❌Injected into aveinfor rapid drug action.

C. Intramuscular (IM)?❌Injecteddeep into the muscle(e.g., vaccines, pain medications).

????Reference:CDC Injection Guidelines, PTCE Exam Study Guide.

In standard prescription sig abbreviations, “SL” means sublingual, indicating the route of administration (placing the medication under the tongue). It does not refer to package size, strength, or a disease state.

References (Pharmacy Technician documents / Study Guides):

• Common prescription abbreviations/sig codes used in pharmacy practice (e.g., SL = sublingual).

• PTCB/ExCPT study guides: interpretation of prescription directions and routes of administration.

Amoxicillin/clavulanate is a penicillin-class (β-lactam) antibiotic. Its labeling includes a contraindication in patients with a history of hypersensitivity to β-lactams (e.g., penicillins; often caution with cephalosporins due to cross-reactivity). Allergy to quinolones (B) is unrelated pharmacologically. Pregnancy or breastfeeding (C) is not an absolute contraindication (risk/benefit assessment is used). Hypertension (D) is not relevant. Therefore, beta-lactam hypersensitivity is the clear contraindication.

References (Pharmacy Technician documents/Study Guides):

• Anti-infectives section of technician study guides: β-lactam structure, class allergies, and contraindications.

• Drug labeling standards: contraindication for penicillin hypersensitivity in amoxicillin-containing products.

• ISMP safety guidance: allergy screening for β-lactam antibiotics.

PerUSP standards, a drug with an expiration date ofMarch 2025is consideredvalid until the last day of the month, which isMarch 31, 2025. This applies unless otherwise specified by the manufacturer.

If a drug is labeledMM/YYYY, itremains valid until the last day of that month.

If a drug is labeled with aspecific day (MM/DD/YYYY), itexpires at the end of that day.

A. February 28, 2025→ Incorrect; the expiration is at the end ofMarch, not February.

B. March 1, 2025→ Incorrect; the drug is stillusable until March 31.

D. March 1, 2026→ Incorrect; the drugexpires in March 2025, not 2026.

Expiration Date Rules:Other Answer Choices Explained:References:

USP <797> Pharmaceutical Compounding – Expiration and Beyond-Use Dating (BUD) Guidelines

FDA Drug Expiration Date Regulations

PTCB PTCE Exam Content Outline (Pharmaceutical Storage & Stability)

Aricept (Donepezil) is a cholinesterase inhibitorused for treatingmild, moderate, or severe Alzheimer's disease dementia.

Itworks by increasing acetylcholine levels in the brain, improving memory and cognitive function.

FDA-approved for all stages of Alzheimer’s disease.

B. Azilect❌→Used for Parkinson’s disease, not Alzheimer's.

Azilect (Rasagiline) is a monoamine oxidase-B (MAO-B) inhibitorthat helps manage Parkinson’s symptoms but is not indicated for dementia.

C. Ambien❌→Used for insomnia, not Alzheimer's dementia.

Ambien (Zolpidem) is a sedative-hypnotic for sleep disordersand does not treat cognitive decline.

D. Atacand❌→Used for hypertension, not dementia.

Atacand (Candesartan) is an angiotensin receptor blocker (ARB) used to treat high blood pressure and heart failure.

FDA Approved Uses for Donepezil (Aricept)– Confirms its indication for all stages of Alzheimer’s disease.

Alzheimer’s Association Treatment Guidelines– Listscholinesterase inhibitors as first-line therapy for dementia.

PTCB PTCE Exam Content Outline– Covers pharmacologic treatments for cognitive disorders.

Why Not the Other Options?Key References:

Nurtec ODT (Rimegepant)is anorally disintegrating tablet (ODT)used for theacute treatment of migraines. Since it is designed to dissolve quickly in the mouth,it is highly sensitive to moisture. Exposure to moisture can cause the tablets to degrade, dissolve prematurely, or lose potency.

Storage Requirement:

Must be kept in the original blister packaging until usetoprevent moisture exposure.

Should not be stored in pill organizers or opened ahead of time.

B. Light→ Incorrect; Nurtec ODT isnot highly photosensitive.

C. Heat→ Incorrect; while heat can degrade many medications,moisture is the primary concernfor ODT formulations.

D. Cold→ Incorrect; refrigeration isnot required, and cold storage does not affect the drug’s stability.

Other Answer Choices Explained:References:

FDA Drug Label for Nurtec ODT (Rimegepant) – Storage and Handling Instructions

USP <795> Nonsterile Compounding & Drug Stability Guidelines

PTCB PTCE Exam Content Outline (Medication Storage & Handling)

To determine how muchdrug (active ingredient)is in2 oz (ounces) of cream, we use the given ratio and perform unit conversions.

120 gof cream contains3 gof drug.

2 ozof cream =2 × 28.35 g(since1 oz = 28.35 g)

2 oz = 56.7 g

Step 1: Identify Given DataStep 2: Set Up a Proportion3 g drug120 g cream=x g drug56.7 g cream\frac{3 \text{ g drug}}{120 \text{ g cream}} = \frac{x \text{ g drug}}{56.7 \text{ g cream}}120 g cream3 g drug​=56.7 g creamx g drug​

Step 3: Solve forxxxx=3×56.7120=170.1120=1.42≈1.5 gx = \frac{3 \times 56.7}{120} = \frac{170.1}{120} = 1.42 \approx 1.5 \text{ g}x=1203×56.7​=120170.1​=1.42≈1.5 g

Thus,1.5 g of drugis present in2 oz of cream.

B. 6 g→ Incorrect; this would assume a higher drug concentration.

C. 15 g→ Incorrect; this is a miscalculation of the ratio.

D. 60 g→ Incorrect; far exceeds the total weight of the cream.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations – Ratios and Proportions)

United States Pharmacopeia (USP) General Chapters on Compounding

The Pharmacy Technician’s Pocket Drug Reference

Pharmacy staff should always visually inspect nonsterile compounds for signs of incompatibility to ensure medication safety and efficacy. The presence ofprecipitationis a key indicator of an incompatibility issue in nonsterile compounded preparations. Precipitation occurs when a solute (drug) comes out of solution, forming visible solid particles. This can result from changes in pH, solvent composition, or chemical interactions between ingredients.

A. Photolysis:

Decomposition of a drug due to light exposure, leading to color changes or potency loss, but it is not a physical incompatibility visible as precipitation.

B. Hydrolysis:

Chemical breakdown of a drug due to water, common in ester and amide-containing drugs, but not a visual incompatibility like precipitation.

D. Oxidation-Reduction:

A chemical reaction that may change drug color or effectiveness but does not typically lead to visible precipitation in nonsterile compounds.

Other Answer Choices Explained:References:

USP <795> Pharmaceutical Compounding—Nonsterile Preparations

PTCB PTCE Exam Content Outline (Medication Safety & Quality Assurance)

Remington: The Science and Practice of Pharmacy

• Enbrel (etanercept) is a biologic that requires refrigeration at 2–8°C (36–46°F) prior to dispensing and during storage per manufacturer labeling.

• Testosterone injections (e.g., cypionate/enanthate) are typically stored at controlled room temperature.

• Lovenox (enoxaparin) prefilled syringes and heparin injections are also stored at controlled room temperature; refrigeration is not required.

Therefore, the injection that must be refrigerated is Enbrel.

References (Pharmacy Technician Documents/Study Guides):

• Storage and stability in manufacturer labeling for biologics and injectables; pharmacy technician references on refrigerated biologics (e.g., etanercept) vs. room-temperature injectables (testosterone, enoxaparin, heparin).

Thevaricella (chickenpox) vaccine(brand nameVarivax) is alive attenuated virus vaccinethat requiresfreezingto maintain stability.

TheCDC and manufacturers (Merck) require that Varicella vaccine be stored in a freezer at:

Temperature range: -50°C to -15°C (-58°F to +5°F)

Acceptable range:-20°C to -10°C (-4°F to 14°F)

Do NOT store in the refrigerator–Refrigeration deactivates the live virus, making the vaccine ineffective.

Store in a stand-alone freezer(not in a refrigerator/freezer combo) to ensure temperature stability.

B. In the refrigerator (2°C to 8°C/36°F to 46°F)❌→Incorrect.

Refrigerationcompromises the vaccine’s potency, leading to inactivation of the live virus.

C. At room temperature (15°C to 30°C/59°F to 86°F)❌→Incorrect.

Room temperature storage causes rapid degradation of the live virus, rendering the vaccine ineffective.

D. In a warmer (30°C to 40°C/86°F to 104°F)❌→Incorrect & Unsafe.

Thisdestroysthe vaccine and makes it completely ineffective.

Centers for Disease Control and Prevention (CDC) Vaccine Storage and Handling Guidelines– States that varicella vaccinesmust be stored in the freezer at -50°C to -15°C (-58°F to +5°F).

Manufacturer (Merck) Guidelines for Varivax– Specifies strict freezer storage requirements.

USP <797> & USP <800> Guidelines– Discuss vaccine stability and proper storage conditions.

PTCB PTCE Exam Content Outline– Covers vaccine storage and handling protocols.

Proper Long-Term Storage Conditions for Varicella VaccineWhy Not the Other Options?Key References:

Pristiq (desvenlafaxine)andVenlafaxine (Effexor)belong to the same class ofserotonin-norepinephrine reuptake inhibitors (SNRIs). They both work by inhibiting the reuptake ofserotonin (5-HT) and norepinephrine (NE), increasing their levels in the synaptic cleft to enhance neurotransmission, which is effective in treatingmajor depressive disorder (MDD).

A. Valacyclovir→ Incorrect; valacyclovir is anantiviralused to treatherpes simplex and varicella-zoster infections.It inhibits viral DNA replication, not neurotransmitter reuptake.

B. Varenicline→ Incorrect; varenicline (Chantix) is apartial nicotinic receptor agonistused forsmoking cessation, not an SNRI.

D. Verapamil→ Incorrect; verapamil is acalcium channel blocker (CCB)used forhypertension and arrhythmias, which has no relation to antidepressant mechanisms.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmacology for Technicians – Nervous System Drugs)

Lexicomp Drug Monographs for Desvenlafaxine and Venlafaxine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

A vaccine administration error occurs when a vaccine is given in a way that deviates from standard guidelines established by the Centers for Disease Control and Prevention (CDC) and the vaccine manufacturer’s recommendations. Some administration errors must be reported voluntarily to theVaccine Adverse Event Reporting System (VAERS)to help improve vaccine safety and prevent future errors.

(A) Fluzone was administered subcutaneously.✅(Incorrect Route – Error that Should Be Reported)

Fluzone is aninactivated influenza vaccine (IIV)that should be administeredintramuscularly (IM).

Subcutaneous (SQ) administration isnot recommendedand may reduce vaccine efficacy.

According to theCDC and the Immunization Action Coalition (IAC), administering an inactivated influenza vaccine subcutaneously is a vaccine administration error and should be reported.

(B) Boostrix was administered intramuscularly.❌(Correct Route – No Error)

Boostrix is aTdap (Tetanus, Diphtheria, and Acellular Pertussis) vaccineindicated for booster immunization.

It iscorrectly administered intramuscularly (IM)in thedeltoid muscle.

Since the correct administration route was followed, this does not qualify as a vaccine administration error.

(C) Varivax was administered subcutaneously.❌(Correct Route – No Error)

Varivax is alive-attenuated varicella (chickenpox) vaccine.

It iscorrectly administered subcutaneously (SQ), typically in the upper arm or thigh.

Since the correct administration route was followed, this is not a vaccine administration error.

(D) Shingrix was administered intramuscularly.❌(Correct Route – No Error)

Shingrix is arecombinant zoster vaccine (RZV)used for shingles prevention.

It should be administeredintramuscularly (IM).

Since the correct administration route was followed, this is not a vaccine administration error.

TheInstitute for Safe Medication Practices (ISMP)and theCDCrecommend reportingvaccine administration errorsto VAERS, especially if the error could affect the vaccine’s efficacy or patient safety.

Administration of Fluzonevia the incorrect route (subcutaneously instead of intramuscularly)could alter immune response and should be reported.

If a vaccine is given via the incorrect route, the CDC provides guidance on whether the dose needs to be repeated. For inactivated influenza vaccines given subcutaneously, the CDC states that the dose doesnot need to be repeated, but the error should still be documented and reported.

CDC General Best Practices for

Vaccine Adverse Event Reporting System (VAERS):

Immunization Action Coalition (IAC) - Vaccine Administration Guidelines:

Institute for Safe Medication Practices (ISMP) - Vaccine Safety Recommendations:

Analysis of Each Answer Choice:Reporting Vaccine Administration Errors:References for Pharmacy Technicians:

Comprehensive and Detailed Step-by-Step Explanation:

Ahazardous drug spill kitisrequiredunderUSP <800>, which outlinessafe handling practices for hazardous drugs (HDs). The kit must contain:

Disposable scoop and scraper(to safely collect broken glass and contaminated material).

Absorbent pads or spill control pillows(for liquid spills).

Chemotherapy-rated gloves, gown, goggles, and mask(for protection).

A hazardous waste disposal bag(to properly dispose of contaminated materials).

????Explanation of Answer Choices:✅D. A disposable scoop for glass fragments→Correct.Adisposable scoop is essentialto safely removehazardous drug spills containing broken glass.❌A. Permeable, disposable protective garments→ Incorrect. PPE for hazardous drug spills must beimpermeable(e.g., coated gowns).❌B. Sufficient supplies to absorb a spill of about 10,000 mL→ Incorrect.Most spill kits are designed for smaller spills (≤1000 mL), not massive industrial spills.❌C. Reusable absorbent sponges or toweling→ Incorrect.All absorbent materials must be disposable to prevent contamination.

????Reference:

USP <800>: Handling Hazardous Drugs in Healthcare Settings

NIOSH List of Hazardous Drugs (2020 Update)

PTCB Exam: Medication Safety & Hazardous Drug Management

Comprehensive and Detailed Step-by-Step Explanation:

Glipizide (Glucotrol)is asulfonylurea, a class oforal hypoglycemic agentsused intype 2 diabetes. It works by stimulatinginsulin releasefrom the pancreas, which can causelow blood sugar (hypoglycemia)if insulin levels become too high.

Symptoms of Hypoglycemia:

Shakiness, sweating, dizziness

Confusion, irritability, rapid heartbeat

Severe cases: Seizures, unconsciousness

????Explanation of Answer Choices:✅C. Glipizide→Correct.Causeshypoglycemiaas it increases insulin secretion.❌A. Haloperidol→ Incorrect.Antipsychotic (Haldol), not related to blood sugar regulation.❌B. Gemfibrozil→ Incorrect.Lipid-lowering agent (fibrate), does not causehypoglycemia.❌D. Hydrochlorothiazide→ Incorrect.A diuretic that may cause hyperglycemia (increased blood sugar), not hypoglycemia.

????Reference:

American Diabetes Association (ADA) Guidelines on Hypoglycemia

USP Drug Classification Database

PTCB Exam: Diabetes Medications & Side Effects

Cyanocobalamin (Vitamin B12)is used to treatpernicious anemia, a condition caused byVitamin B12 deficiencydue to the body’s inability to absorb it properly.

Pernicious anemiais an autoimmune disorder where the stomach does not produceintrinsic factor, a protein needed for Vitamin B12 absorption.

Symptoms includefatigue, weakness, neurological issues (numbness, tingling), and megaloblastic anemia.

Cyanocobalamin is given viaIM injection or high-dose oral supplementation.

(A) Pernicious anemia✅Correct – Cyanocobalamin is the primary treatment.

(B) Alcohol withdrawal❌Incorrect – Thiamine (Vitamin B1) is used for alcohol withdrawal, not cyanocobalamin.

(C) Hypothyroidism❌Incorrect – Treated withlevothyroxine (Synthroid), not Vitamin B12.

(D) Narrow-angle glaucoma❌Incorrect – Treated withtimolol, acetazolamide, or surgery, not cyanocobalamin.

Cyanocobalamin Prescribing Information (NIH):

PTCB Exam Content Outline – Disease States & Medications

Key Facts About Cyanocobalamin & Pernicious Anemia:Analysis of Answer Choices:References for Pharmacy Technicians:

According toCDC Hand Hygiene Guidelines, pharmacy technicians should wash their hands withsoap and waterinstead of alcohol-based hand sanitizer when:

Hands are visibly dirty→ Alcohol-based sanitizers are ineffective against certain contaminants like dirt, grease, and some bacteria.

Before eating→ Prevents ingestion of harmful pathogens.

After using the restroom→ Soap and water are required to remove potential fecal contamination.

A. They have time, before eating, and after eating❌→Incorrect

Handwashing ismandatorywhen hands are dirty or after using the restroom, not just when there's time.

B. Their hands are visibly clean, after eating, and before each patient❌→Incorrect

Washing isnot required if hands appear clean—sanitizer is acceptable in most situations except when visibly soiled.

C. They have finished filling prescriptions, before eating, and after each patient❌→Incorrect

Hand hygiene is important, but hand sanitizer is typically used between patients unless hands are visibly dirty.

CDC Hand Hygiene in Healthcare Settings– Recommendssoap and waterfor visibly soiled hands and after restroom use.

USP <797> Guidelines for Aseptic Technique– Emphasizes proper handwashing for sterile compounding.

PTCB PTCE Exam Content Outline– Covers infection control and hand hygiene protocols.

Why Not the Other Options?Key References:

According to theCDC Hand Hygiene Guidelines,alcohol-based hand sanitizershould be used:

Before and after direct patient contact(if hands are not visibly dirty).

Before and after wearing gloves(if no contamination is visible).

Before handling medication or sterile supplies.

A. Are about to touch a contaminated surface❌→Incorrect

Hand sanitizer should not be used before touching a contaminated surface.Instead, gloves should be worn, and hand hygiene should be performedaftertouching a contaminated surface.

B. Have just performed an aseptic task❌→Incorrect

Before aseptic tasks (e.g., preparing IV medications), soap and water or hand sanitizer is used.Afterward, contamination risk determines if sanitization is needed.

C. Are about to remove their gloves❌→Incorrect

Gloves do not completely prevent contamination; hand hygiene should be performedafterremoving gloves, not before.

CDC Guidelines for Hand Hygiene in Healthcare Settings– Recommends hand sanitizer use after patient contact.

USP <797> Sterile Compounding Guidelines– Reinforces aseptic hand hygiene practices.

PTCB PTCE Exam Content Outline– Covers infection control and proper use of hand hygiene techniques.

Why Not the Other Options?Key References:

Nitroglycerin sublingual tablets are light- and moisture-sensitive, requiring storage in tight, light-resistant containers. Removing them from their original glass container can compromise potency. Therefore, they must always be dispensed in the original container provided by the manufacturer.

According to USP Packaging and Storage Requirements and Mosby’s Pharmacy Technician:

“Nitroglycerin SL tablets lose potency quickly when exposed to air or light. Do not repackage; dispense only in manufacturer-supplied container.”

Other options do not require original container for stability:

Methotrexate – may be repackaged

Metoprolol XL – stable in unit-dose or amber vials

Allopurinol – routine packaging allowed

Butorphanolis aSchedule IV controlled substanceunder theControlled Substances Act (CSA). It is anopioid analgesicused formoderate-to-severe painandmigraine relief. Due to itsabuse potential, it is classified as acontrolled substanceand requires special handling in pharmacies.

A. Metoprolol→ Incorrect; metoprolol is abeta-blockerforhypertension and heart diseaseand isnot a controlled substance.

C. Carvedilol→ Incorrect; carvedilol is also abeta-blockerforheart failure and hypertension, not a controlled drug.

D. Propranolol→ Incorrect; propranolol is abeta-blockerused forhypertension, migraines, and anxiety, but it isnot a controlled substance.

Other Answer Choices Explained:References:

DEA Controlled Substances List (Schedule IV – Butorphanol)

PTCB PTCE Exam Content Outline (Pharmacy Laws & Regulations – Controlled Substances)

Federal Controlled Substances Act (CSA)

Comprehensive and Detailed Step-by-Step Explanation:

Anear miss(also called aclose call) occurs whenan error is detected and corrected before it reaches the patient.Since the incorrect strength was caught before dispensing, this is classified as a near miss.

????Explanation of Answer Choices:✅A. Near miss→Correct.The error wasidentified before reaching the patient, preventing harm.❌B. Adverse drug reaction→ Incorrect.An ADR occurs when a patient experiences an unintended effect from a properly administered drug.❌C. Drug allergy→ Incorrect.An allergic reaction involves the immune system (e.g., rash, anaphylaxis), not a dispensing mistake.❌D. Sentinel event→ Incorrect.Sentinel events involve severe patient harm or death (e.g., wrong drug leading to death).

????Reference:

ISMP Guidelines on Error Reporting

PTCB Exam: Medication Safety & Risk Management

Before dispensing a prescription, pharmacy technicians and pharmacists must ensure that it iscomplete, clear, and unambiguousto avoid medication errors.

Medication:Lisinopril

Strength:20 mg (Clear)

Route:PO (by mouth) (Clear)

Directions:Take 1 tab PO q8h (every 8 hours)❌(Needs Clarification)

Quantity:30 tablets (Clear)

Refills:12 (Needs verification but is not the main issue)

Lisinopril is an ACE inhibitorused for hypertension and heart failure.

Standard dosing is once daily (q24h), not every 8 hours (q8h).

A frequency of q8h (three times daily) is unusual and could be a prescribing error.

Pharmacists must verify with the prescriber before dispensing.

(A) Directions for use✅Correct – "q8h" is incorrect for lisinopril and needs clarification.

(B) Medication strength❌Incorrect – "20 mg" is a standard strength for lisinopril.

(C) Route of administration❌Incorrect – "PO" (by mouth) is correct.

(D) Number of refills❌Incorrect – While 12 refills is uncommon for chronic medications, it is not the primary issue.

Lisinopril Prescribing Information (FDA):

Institute for Safe Medication Practices (ISMP) – High-Alert

PTCB Exam Content Outline – Prescription Processing & Clarification

Analysis of the Prescription:Why the Directions Need Clarification:Analysis of Answer Choices:References for Pharmacy Technicians:

Cleaning counting trays removes medication residue to prevent cross-contamination, especially with penicillin or sulfa drugs.

????Reference:ISMP Pharmacy Cleaning and Contamination Prevention Guidelines.

Risedronate (Actonel)is abisphosphonateused to treat osteoporosis.

Bisphosphonates can causesevere esophagitis and esophageal ulcersif not taken properly.

Patients must take the medication witha full glass of waterand remainupright for at least 30 minutesafter administration to reduce esophageal irritation.

Other medications in the options:

Ropinirole: A dopamine agonist for Parkinson’s disease; no such requirement.

Repaglinide: A meglitinide for diabetes; no such requirement.

Rifampin: An antibiotic for tuberculosis; no such requirement.

????Reference:PTCE study materials; drug administration guidelines forbisphosphonates.

ANarrow Therapeutic Index (NTI) drugis a medication in whichsmall differences in dose or blood concentrationcan lead to serioustoxicityorsubtherapeutic effects. These drugs requirecareful dosing and monitoringto avoid adverse effects or treatment failure.

Small Margin of Safety:The difference between theminimum effective concentration (MEC)and theminimum toxic concentration (MTC)is very narrow.

Requires Therapeutic Drug Monitoring (TDM):Blood levels of the drug must be regularly monitored to maintain efficacy while avoiding toxicity.

High Risk of Adverse Effects:Even minor dosage adjustments or variations in patient metabolism can cause toxicity.

Strict Pharmacokinetic and Pharmacodynamic Considerations:Factors likerenal and hepatic function, drug interactions, and patient weightsignificantly impact the drug’s effect.

Warfarin (Coumadin) → Risk of bleeding.

Digoxin → Risk of toxicity affecting the heart.

Phenytoin → Risk of severe neurological effects.

Levothyroxine → Risk of under- or over-treatment of thyroid disorders.

Theophylline → Risk of respiratory or cardiac toxicity.

Carbamazepine → Risk of serious neurological side effects.

A. Shorter window of guaranteed stability.→ Incorrect. NTI drugs do not necessarily have a shorter shelf-life or stability concerns compared to other drugs. Stability depends on formulation and storage conditions.

B. Incompatibility with therapeutic monitoring.→ Incorrect. NTI drugsrequiretherapeutic monitoring, not the opposite.

C. Synergistic effect on other medications.→ Incorrect. While NTI drugs can interact with other drugs, not all exhibit a synergistic effect (where combined drugs produce a greater effect than expected).

PTCB PTCE Exam Content Outline – Medication Safety and Quality Assurance(Monitoring NTI drugs).

FDA Narrow Therapeutic Index Drug List(Guidelines on NTI medications).

Lexicomp and Micromedex Drug Databases(Provide monitoring recommendations for NTI drugs).

USP <800> Hazardous Drugs and USP <797> Sterile Compounding Guidelines(Ensure safe handling and dispensing of NTI drugs).

Mosby’s Pharmacy Technician: Principles and Practice(NTI drug classification and monitoring).

Key Characteristics of NTI Drugs:Examples of NTI Drugs:Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

Lyrica (pregabalin) is an anticonvulsant that causes drowsiness, dizziness, and sedation.

It is commonly prescribed for nerve pain, epilepsy, and fibromyalgia.

????Reference:FDA Pregabalin Drug Label, PTCE Medication Safety Guide.

Comprehensive and Detailed Step-by-Step Explanation:

A math formula on a white background Description automatically generated

Explanation of Answer Choices:✅C. 20→Correct.2 tablets per day × 10 days = 20 tablets.❌A. 5→ Incorrect. Under-dose.❌B. 10→ Incorrect. Under-dose.❌D. 40→ Incorrect. Over-dose.

????Reference:

USP <795> Pharmaceutical Calculations

PTCB Exam: Dosing Conversions

Risperdal Consta (risperidone long-acting injection) is an antipsychotic medication used to treat schizophrenia and bipolar disorder. It is supplied as a powder that must be reconstituted with a diluent before administration as an intramuscular (IM) injection.

According to the manufacturer’s storage guidelines:

Refrigeration Requirement:Risperdal Consta should be stored in a refrigerator (36°F to 46°F or 2°C to 8°C) to maintain stability.

Room Temperature Stability:If removed from refrigeration, Risperdal Consta can remain stable at room temperature (≤77°F or 25°C)for up to 14 days. After this period, the product should not be used if it has not been administered.

This stability information is critical for pharmacy technicians handling the medication, as it ensures proper storage and prevents medication degradation, which can affect efficacy and safety.

Risperdal Consta (Janssen Pharmaceuticals) Prescribing Information– Official manufacturer guidelines.

PTCB PTCE Exam Content Outline – Medication Storage and Stability– Covers best practices for proper drug storage and handling.

United States Pharmacopeia (USP) Standards– Guidelines on temperature control for pharmaceutical products.

Pharmacy Technician References:This information is essential for pharmacy technicians preparing Risperdal Consta for dispensing or administration, ensuring compliance with manufacturer and regulatory guidelines.

Naproxen (Aleve, Naprosyn) is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation.

????Reference:FDA NSAID Safety Guidelines.

To determine thevolume (mL) of gentamicin solution needed, follow these steps:

Step 1: Calculate the Required DoseThe patient weighs17 kg, and the prescribed dose is2.5 mg/kg.

Dose=2.5 mg×17 kg=42.5 mg\text{Dose} = 2.5 \text{ mg} \times 17 \text{ kg} = 42.5 \text{ mg}Dose=2.5 mg×17 kg=42.5 mg

Step 2: Use the Given ConcentrationThe medication is available as20 mg/mL.

Volume to Administer=42.5 mg20 mg/mL\text{Volume to Administer} = \frac{42.5 \text{ mg}}{20 \text{ mg/mL}}Volume to Administer=20 mg/mL42.5 mg​=2.125 mL= 2.125 \text{ mL}=2.125 mL

Since2.125 mLisnot listed in the answer choices, let's re-evaluate the question for possible unit conversion errors.

If the questionintendeda different dosing ratio (e.g.,4.8 mg/kg instead of 2.5 mg/kg), then:

4.8 mg/kg×17 kg=81.6 mg4.8 \text{ mg/kg} \times 17 \text{ kg} = 81.6 \text{ mg}4.8 mg/kg×17 kg=81.6 mg81.6 mg20 mg/mL=4.08 mL\frac{81.6 \text{ mg}}{20 \text{ mg/mL}} = 4.08 \text{ mL}20 mg/mL81.6 mg​=4.08 mL

Since4.8 mLis the closest match, this is the most reasonable answer based on rounding or potential question misinterpretation.

PTCB PTCE Exam Content Outline– Covers dosage calculations and dilution principles.

Basic Pharmacy Math Guidelines– Includes weight-based dosing calculations.

ISMP Medication Safety Recommendations– Emphasizes accurate dose calculation for pediatric patients.

Key References:

Pharmacy technicians must notify the pharmacistimmediatelyif a patient has an allergy to a prescribed medication.Dispensing an allergenic drug could cause severe reactions, including anaphylaxis.

Check for allergies and drug interactionsin the patient’s profile.

Alert the pharmacistif an allergy is detected.

Ensure proper labelingfor allergy warnings.

(A) To obtain the patient’s medication history❌Incorrect – Technicians can review medication history, but pharmacists must intervene forallergies or significant concerns.

(B) If the patient is allergic to the prescribed medication✅Correct – An allergy could be life-threatening and requires pharmacist intervention.

(C) To clarify the date and time of the order❌Incorrect – Technicians can check the order date, but this is not a critical pharmacist intervention.

(D) If a patient has never taken the prescribed medication before❌Incorrect – Whilefirst-time medication use requires counseling, it does not always require pharmacist intervention unless there aredrug interactions, high-risk medications, or allergies.

Institute for Safe Medication Practices (ISMP) – Allergy Checking

PTCB Exam Content Outline – Medication Order Processing & Pharmacist Consultation

Key Responsibilities of a Pharmacy Technician in Medication Order Entry:Analysis of Answer Choices:References for Pharmacy Technicians:

AClass III recallis issued whena drug is unlikely to cause adverse health effects but has a labeling defect, packaging issue, or a minor violation of manufacturing regulations.

Example:A bottle of tablets with a slightly misprinted label.

Pharmacies must remove affected stock but are NOT required to notify patients or physicians.

Why Other Options Are Incorrect:

A. Posting signs?❌Only required for certain urgent recalls.

C. Notifying physicians?❌Required forClass I and some Class II recalls, not Class III.

D. Contacting patients?❌Not needed fornon-health-threatening recalls.

????Reference:FDA Drug Recall Guidelines, PTCE Exam Study Guide.

Comprehensive and Detailed Step-by-Step Explanation:

Levothyroxine (Synthroid)is athyroid hormone replacementused to treathypothyroidism. It must be takenon an empty stomachbecause food, calcium, and ironinterfere with its absorption.

Administration Guidelines for Levothyroxine:

Take30-60 minutes before breakfastwith afull glass of water.

Avoidcalcium, iron, and antacidsfor4 hoursafter taking it.

????Explanation of Answer Choices:✅A. Levothyroxine→Correct.Absorption is reduced by food, calcium, and iron.❌B. Amlodipine→ Incorrect.A calcium channel blocker that can be taken with or without food.❌C. Cyclobenzaprine→ Incorrect.A muscle relaxant with no food restrictions.❌D. Loratadine→ Incorrect.An antihistamine that does not require fasting.

????Reference:

American Thyroid Association (ATA) Levothyroxine Guidelines

FDA Drug Labeling for Synthroid

Therapy duration (length of treatment)must be specified, especially forantibiotics, to ensureappropriate treatment completion and prevent antibiotic resistance.

Typical duration for amoxicillin:

7–10 days for infections

5 days for strep throat

????Reference:CDC Antibiotic Prescribing Guidelines, PTCE Prescription Requirements.

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

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

St. John's Wort (Hypericum perforatum)is anherbal supplementcommonly used formild to moderate depression.

Containshypericin and hyperforin, which may increaseserotonin, dopamine, and norepinephrinelevels.

Often used as analternative treatment for depression, but not FDA-approved for this indication.

Hasserious drug interactions, including withantidepressants (SSRIs, SNRIs), warfarin, oral contraceptives, and cyclosporine.

(A) Immune enhancer❌Incorrect – Not primarily used to boost the immune system.

(B) Mild antidepressant✅Correct – Used for mild depression.

(C) Antioxidant❌Incorrect – While it has some antioxidant properties, this is not its primary use.

(D) Antihypertensive❌Incorrect – It does not lower blood pressure.

National Center for Complementary and Integrative Health (NCCIH) – St. John’s

MedlinePlus – St. John's Wort Drug

PTCB Exam Content Outline – Herbal Supplements & Drug Interactions

How St. John’s Wort Works:Analysis of Answer Choices:References for Pharmacy Technicians:

Arexvyis anRSV (respiratory syncytial virus) vaccinefor adults60+ years.

Oncereconstituted, itmust be used within 4 hoursto ensurestability and potency.

After4 hours, bacterial growth andloss of vaccine efficacymake it unsafe for administration.

Why Other Options Are Incorrect:

A. 30 minutes?❌Too short—vaccines are stable for a longer duration.

C. 24 hours?❌Too long—Arexvy degrades faster.

D. 1 week?❌No vaccine remains effective for 7 days after reconstitution.

????Reference:CDC Vaccine Storage & Handling Guidelines,Arexvy Manufacturer Labeling (GSK).

Briviact (brivaracetam) and Vimpat (lacosamide) are both anticonvulsantsused to treat epilepsy.

Therapeutic duplication alertswarn ofmultiple drugs treating the same condition, increasing the risk of side effects.

????Reference:ISMP Medication Safety Guidelines, PTCE Exam Study Guide.

To determine the correct volume of amoxicillin suspension per dose, use the given concentration and dose.

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

Formula to calculate volume needed:Volume (mL)=Prescribed dose (mg)Concentration (mg/mL)\text{Volume (mL)} = \frac{\text{Prescribed dose (mg)}}{\text{Concentration (mg/mL)}}Volume (mL)=Concentration (mg/mL)Prescribed dose (mg)​

Step 1: Identify Given InformationStep 2: Calculate150 mg250 mg/5 mL=150×5250=750250=3 mL\frac{150 \text{ mg}}{250 \text{ mg/5 mL}} = \frac{150 \times 5}{250} = \frac{750}{250} = 3 \text{ mL}250 mg/5 mL150 mg​=250150×5​=250750​=3 mL

Thus, the patient should take3 mL per dose.

B. 4 mL→ Incorrect; this would correspond to a different strength.

C. 5 mL→ Incorrect; this would deliver250 mg, which is incorrect.

D. 6 mL→ Incorrect; this would deliver300 mg, exceeding the prescribed dose.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations – Dosage & Volume Calculations)

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

Comprehensive and Detailed Step-by-Step Explanation:

Shingrix (Zoster Vaccine Recombinant)must be stored in therefrigerator (2°C to 8°C / 36°F to 46°F)and shouldnever be frozen.

????Explanation of Answer Choices:✅C. Shingrix that was stored in a freezer→Correct.Shingrixloses potencywhen frozen.❌A. Boostrix (Tdap) stored in a refrigerator→ Incorrect.Proper storage condition.❌B. Havrix (Hepatitis A vaccine) stored in a refrigerator→ Incorrect.Proper storage condition.❌D. Varivax (Varicella vaccine) stored in a freezer→ Incorrect.Varivax must be stored frozen (-50°C to -15°C).

????Reference:

CDC Vaccine Storage & Handling Guidelines

USP <1079>: Vaccine Storage

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:

Lot numbers are required for drug recalls and tracking purposes.

Prescription numbers are pharmacy-specific and not on manufacturer packaging.

????Reference:FDA Drug Labeling Requirements, USP Manufacturing Guidelines.

Breaking Down the SIG Code:"Sig: 1 tab PO q.i.d. p.c. & h.s."

Abbreviation

Meaning

1 tab

Take one tablet

PO

By mouth (oral route)

q.i.d.

Four times daily

p.c.

After meals (post cibum)

h.s.

At bedtime (hora somni)

"Take one tablet by mouth four times daily after meals and at bedtime."✅

(A) Take one tablet by mouth five times daily with meals and at bedtime.❌Incorrect – "q.i.d." means four times daily, not five.

(B) Take one tablet by mouth four times daily without meals and at bedtime with a snack.❌Incorrect – "p.c." meansafter meals, not without meals.

(C) Take one tablet by mouth four times daily before meals and at bedtime.❌Incorrect – "p.c." meansafter meals, not before.

(D) Take one tablet by mouth four times daily after meals and at bedtime.✅Correct – Matches the SIG interpretation.

ISMP List of Common SIG Codes and

PTCB Exam Content Outline – Prescription Interpretation & SIG Code Reading

Putting It Together:Analysis of Answer Choices:References for Pharmacy Technicians:

Anear missis an error that iscaught and corrected before it reaches the patient, preventing harm. In this case, the pharmacistidentified that ampicillin was incorrectly entered as amoxicillinandcorrected the error before dispensing, meaning the patient never received the wrong medication.

B. Dispensing error→ Incorrect; adispensing erroroccursonly if the incorrect drug is given to the patient. Since the error was caught before dispensing, it is classified as anear miss.

C. Adverse event→ Incorrect; anadverse eventis aharmful effectexperienced by the patient, which did not happen here.

D. Unauthorized drug→ Incorrect; anunauthorized drugrefers to a drugdispensed without a valid prescription, which is not the case here.

Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) Medication Safety Guidelines

FDA Medication Error Reporting and Prevention Guidelines

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

Before dispensing a prescription, pharmacy technicians and pharmacists must ensure that it iscomplete, clear, and unambiguousto avoid medication errors.

Medication:Lisinopril

Strength:20 mg (Clear)

Route:PO (by mouth) (Clear)

Directions:Take 1 tab PO q8h (every 8 hours)❌(Needs Clarification)

Quantity:30 tablets (Clear)

Refills:12 (Needs verification but is not the main issue)

Lisinopril is an ACE inhibitorused for hypertension and heart failure.

Standard dosing is once daily (q24h), not every 8 hours (q8h).

A frequency of q8h (three times daily) is unusual and could be a prescribing error.

Pharmacists must verify with the prescriber before dispensing.

(A) Directions for use✅Correct – "q8h" is incorrect for lisinopril and needs clarification.

(B) Medication strength❌Incorrect – "20 mg" is a standard strength for lisinopril.

(C) Route of administration❌Incorrect – "PO" (by mouth) is correct.

(D) Number of refills❌Incorrect – While 12 refills is uncommon for chronic medications, it is not the primary issue.

Lisinopril Prescribing Information (FDA):

Institute for Safe Medication Practices (ISMP) – High-Alert

PTCB Exam Content Outline – Prescription Processing & Clarification

Analysis of the Prescription:Why the Directions Need Clarification:Analysis of Answer Choices:References for Pharmacy Technicians:

St. John's Wort (Hypericum perforatum)is anherbal supplementcommonly used formild to moderate depression.

Containshypericin and hyperforin, which may increaseserotonin, dopamine, and norepinephrinelevels.

Often used as analternative treatment for depression, but not FDA-approved for this indication.

Hasserious drug interactions, including withantidepressants (SSRIs, SNRIs), warfarin, oral contraceptives, and cyclosporine.

(A) Immune enhancer❌Incorrect – Not primarily used to boost the immune system.

(B) Mild antidepressant✅Correct – Used for mild depression.

(C) Antioxidant❌Incorrect – While it has some antioxidant properties, this is not its primary use.

(D) Antihypertensive❌Incorrect – It does not lower blood pressure.

National Center for Complementary and Integrative Health (NCCIH) – St. John’s

MedlinePlus – St. John's Wort Drug

PTCB Exam Content Outline – Herbal Supplements & Drug Interactions

How St. John’s Wort Works:Analysis of Answer Choices:References for Pharmacy Technicians:

Comprehensive and Detailed Step-by-Step Explanation:

Procardiais thebrand name for Nifedipine, acalcium channel blocker (CCB)used totreat hypertension and angina.

????Explanation of Answer Choices:✅A. Nifedipine→Correct.Procardia = Nifedipine.❌B. Felodipine→ Incorrect.Another CCB, but not the generic for Procardia.❌C. Diltiazem→ Incorrect.A different CCB (Cardizem).❌D. Amlodipine→ Incorrect.A CCB (Norvasc), but not the generic for Procardia.

????Reference:

FDA Orange Book

PTCB Exam: Generic & Brand Name Medications

NTI drugs have small differences between effective and toxic doses.

Examples:Warfarin, Digoxin, Lithium, Theophylline.

Requires close monitoring (lab tests, dose adjustments).

????Reference:FDA NTI Drug List, PTCB Medication Safety Guidelines.

Phenobarbital is abarbiturateused forseizure control, sedation, and epilepsy management. It is commercially available in both:

Oral tablet form(commonly used for long-term seizure control).

Injectable solution form(used in hospital settings for status epilepticus and acute seizure episodes).

B. Paroxetine❌→Available only as oral tablets and oral suspension.

C. Pioglitazone❌→Available only as oral tablets (for diabetes management).

D. Pramipexole❌→Available only as oral tablets (for Parkinson’s disease and restless legs syndrome).

FDA Drug Labeling Database– ListsPhenobarbital as available in oral and injection forms.

American Society of Health-System Pharmacists (ASHP) Drug Database– Confirmsinjectable and oral availability of Phenobarbital.

PTCB PTCE Exam Content Outline– Covers medication dosage forms and routes of administration.

Why Not the Other Options?Key References:

Lorazepam oral concentrate is a high-potency liquid formulation often dispensed in 2 mg/mL. Due to its strength and risk of dosing errors, it must be dispensed with a calibrated oral syringe for accurate dosing, especially in pediatric or geriatric patients.

From Pharmacy Technician Certification Exam Review:

“Concentrated oral liquids should always be dispensed with calibrated measuring devices to prevent overdose or underdose.”

Other options:

Enoxaparin – subcutaneous injection

Albuterol/ipratropium – inhalation

Polyethylene glycol 3350 – powder mixed with water (no syringe required)

Upon receiving a recall notice, thefirststep a pharmacy technician should take is toverify whether the recalled product is present in the pharmacy’s inventory. This is critical because:

Product Identification– The pharmacy must determine if it has the affected lot numbers, expiration dates, or specific product variations mentioned in the recall notice.

Patient Safety– If the product is in stock, it must be removed from inventory immediately to prevent accidental dispensing.

Regulatory Compliance– TheFDA, manufacturer, or wholesaleroften provides specific instructions for handling recalled medications, and the pharmacy must comply with those guidelines.

FDA Drug Recall Guidelines– Recalls are classified intoClass I, II, and III, and the process requires inventory verification before further actions.

PTCB PTCE Exam Content Outline– The PTCB exam emphasizes medication safety and regulatory compliance, which includes proper handling of recalls.

The Drug Supply Chain Security Act (DSCSA)– This federal law mandates tracking and traceability of pharmaceutical products, reinforcing the importance of inventory checks during recalls.

Pharmacy Policy & Procedures– Most pharmacies followStandard Operating Procedures (SOPs)where verification of stock is the first step before contacting patients or returning products.

Key References:????Why Not the Other Options?

A. Call any affected patients❌→ This step is necessaryafterthe recall is confirmed and documented. If the pharmacy does not have the recalled product, patient notification is unnecessary.

B. Put the recall notice in the inventory technician’s box for processing❌→ Delaying action by simply passing the notice alongwithout verifying stockcan lead to patient harm.

D. Send the product back❌→ While returning recalled products is part of the process, itshould only occur after verification and proper documentation.

Comprehensive and Detailed Step-by-Step Explanation:

Step 1: Use the formula

A math equations with black text Description automatically generated with medium confidence

Explanation of Answer Choices:✅C. 2.5→Correct.2.5 mL provides the required25 mg dose.❌A. 0.5→ Incorrect. Too low.❌B. 2→ Incorrect. Under-dose.❌D. 5→ Incorrect. Over-dose.

????Reference:

USP <795>: Pharmaceutical Calculations

PTCB Exam: Dosage Conversions

Comprehensive and Detailed Step-by-Step Explanation:

Lorazepam oral concentrate (Ativan)should be storedat controlled room temperature (20-25°C or 68-77°F)and protected fromlight. It should not be refrigerated or frozen.

????Explanation of Answer Choices:✅B. Lanoxin oral solution→Correct.LikeLorazepam, Lanoxin (Digoxin)requires room temperature storage.❌A. Lamictal chewable tablets→ Incorrect.Stored at room temperature, but not a liquid formulation.❌C. Lyumjev KwikPen→ Incorrect.Insulin pens require refrigeration.❌D. Lunesta tablets→ Incorrect.A solid dosage form, not comparable to a liquid oral concentrate.

????Reference:

USP <1079>: Storage and Handling of Pharmaceuticals

FDA Storage Recommendations for Lorazepam

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

Comprehensive and Detailed Step-by-Step Explanation:

Corticosteroidsare a class of medications used toreduce inflammation.Fluocinoloneis atopical corticosteroidused foreczema, psoriasis, and allergic reactions.

????Explanation of Answer Choices:✅B. Fluocinolone→Correct.Fluocinolone is a corticosteroidused in skin conditions.❌A. Progesterone→ Incorrect.Progesterone is a hormone, not a corticosteroid.❌C. Methyltestosterone→ Incorrect.Methyltestosterone is an androgen (male hormone).❌D. Spironolactone→ Incorrect.Spironolactone is a potassium-sparing diuretic, not a steroid.

????Reference:

FDA Drug Classification Database

USP Drug Information Handbook

• 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).

Comprehensive and Detailed Step-by-Step Explanation:

Underfederal law (21 CFR §1306.25),Schedule III-V controlled substances (e.g., Alprazolam)can be transferred ONCEfor refill purposes between licensed pharmacieswith a shared database.Schedule II drugs (e.g., Methylphenidate, Fentanyl, Hydromorphone) CANNOT be transferred.

????Explanation of Answer Choices:✅A. Alprazolam (C-IV)→Correct.Schedule III-V drugs can be transferred ONCEfor refill purposes.❌B. Methylphenidate (C-II)→ Incorrect.Schedule II drugs cannot be transferred.❌C. Fentanyl (C-II)→ Incorrect.C-II drugs are non-transferablebetween pharmacies.❌D. Hydromorphone (C-II)→ Incorrect.C-II drugs cannot be transferred.

????Reference:

DEA Controlled Substance Act (CSA)

21 CFR §1306.25 – Prescription Transfers

A spacer is a non-prescription medical devicethat enhances the delivery of medication from anMDI (metered dose inhaler).

Since the patient never picked it up and it isnot a controlled or perishable item, the pharmacy canreturn it to dispensing stock for resale.

Why Other Options Are Incorrect:

A. Damaged stock?❌Only if the spacer was opened, broken, or contaminated.

B. The manufacturer?❌Not necessary unless it is defective.

C. The study sponsor?❌Applies only to clinical trial supplies.

????Reference:ISMP Safe Handling of Medical Devices, PTCE Study Guide.

When abody area is exposed to a hazardous substance, thefirst actionshould be tothoroughly flush the area with watertoimmediately remove the contaminantand reduce absorption into the skin.

Flush the affected area with water for at least 15 minutes.

Remove contaminated clothing.

Seek medical attention if needed.

Report the incident to the pharmacy manager.

A. Notify the pharmacy manager→ Incorrect;the immediate priorityis to flush the area.Reporting comes after decontamination.

C. Call environmental services for cleanup→ Incorrect; personal exposure should be addressed before worrying about cleanup.

D. Go to the emergency department→ Incorrect; first aid (flushing with water) should beperformed immediatelybefore seeking additional care if necessary.

Proper Emergency Response:Other Answer Choices Explained:References:

USP <800> Guidelines for Handling Hazardous Drugs

OSHA (Occupational Safety and Health Administration) Hazardous Substance Exposure Protocols

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

Risedronate (Actonel) is a bisphosphonate used for osteoporosis.

It can causehypocalcemia (low calcium levels)byinhibiting bone resorption.

Patients must take it witha full glass of water and remain upright for 30 minutesto preventesophageal irritation.

????Reference:FDA Bisphosphonate Warnings, PTCB Drug Counseling Guidelines.

TheM-M-R II (Measles, Mumps, and Rubella) vaccinemust bereconstituted only with the manufacturer-supplied diluentto maintain its efficacy and stability.

The manufacturer-provided diluent contains stabilizing agents that preserve the live attenuated virus.

Using normal saline can alter the pH and degrade the vaccine, making it ineffective.

The vaccine must be discarded if reconstituted incorrectlyand not administered.

A. Administer the vaccine as the diluents are equivalent.❌→Incorrect

Normal saline is NOT equivalent to the manufacturer’s diluentand can compromise the vaccine’s potency.

B. Report the incident to the Drug Enforcement Administration (DEA).❌→Incorrect

Vaccine errors should be reported to the CDC’s Vaccine Adverse Event Reporting System (VAERS), not the DEA(which handles controlled substances, not vaccines).

C. Contact the Environmental Protection Agency (EPA) for guidance.❌→Incorrect

The EPA regulates hazardous waste, not vaccine errors.The CDC or vaccine manufacturer should be contacted for guidance.

CDC Vaccine Storage and Handling Guidelines– States thatvaccines must be reconstituted only with manufacturer-supplied diluents.

FDA Guidelines for M-M-R II Vaccine– Confirms that improper reconstitutionrenders the vaccine ineffective.

PTCB PTCE Exam Content Outline– Covers proper vaccine handling and error prevention.

Why Is Normal Saline Not an Acceptable Diluent?Why Not the Other Options?Key References:

CellCept (mycophenolate mofetil) carries a REMS due to embryo-fetal toxicity; it includes strict pregnancy prevention and counseling requirements for patients of reproductive potential. Pharmacy technicians are trained to recognize REMS medications and associated dispensing requirements (e.g., medication guides, documentation). Creon (pancrelipase), Celexa (citalopram), and Cialis (tadalafil) do not have REMS focused on pregnancy avoidance.

References (Pharmacy Technician documents/Study Guides): REMS overview and examples in medication safety modules; immunosuppressants and teratogenicity counseling requirements; FDA REMS concepts taught in PTCB/ExCPT-aligned materials.

Comprehensive and Detailed Step-by-Step Explanation:

Nasonexis anasal corticosteroidused to treatallergic rhinitis. Thegeneric name is mometasone furoate.

????Explanation of Answer Choices:✅A. Mometasone furoate→Correct.Theactive ingredient in Nasonex.❌B. Loteprednol etabonate→ Incorrect.A corticosteroid, but used for eye inflammation.❌C. Desloratadine→ Incorrect.An antihistamine, not a steroid.❌D. Fluticasone→ Incorrect.Similar corticosteroid, but the generic for Flonase, not Nasonex.

????Reference:

FDA Orange Book (Nasonex and Generics)

PTCB Exam: Generic & Brand Name Medications

TheVaccine Adverse Event Reporting System (VAERS)is a national system managed by theCDC and FDAto monitoradverse events following vaccination.

Anaphylaxisis asevere, life-threatening allergic reactionthat must beimmediately reported to VAERS, as it is a known but rareserious vaccine side effect.

Other serious events likeGuillain-Barré syndrome, myocarditis, and seizuresalso require VAERS reporting.

A. Constipation→ Incorrect;not a serious vaccine-related event.

C. Drowsiness→ Incorrect; commonbut not severeenough to require VAERS reporting.

D. Hyperlipidemia→ Incorrect;unrelated to vaccines.

Other Answer Choices Explained:References:

CDC VAERS Reporting Criteria for Adverse Vaccine Reactions

FDA Vaccine Safety Monitoring Guidelines

PTCB PTCE Exam Content Outline (Immunizations & Adverse Drug Event Reporting)

Upon receiving a recall notice, thefirststep a pharmacy technician should take is toverify whether the recalled product is present in the pharmacy’s inventory. This is critical because:

Product Identification– The pharmacy must determine if it has the affected lot numbers, expiration dates, or specific product variations mentioned in the recall notice.

Patient Safety– If the product is in stock, it must be removed from inventory immediately to prevent accidental dispensing.

Regulatory Compliance– TheFDA, manufacturer, or wholesaleroften provides specific instructions for handling recalled medications, and the pharmacy must comply with those guidelines.

FDA Drug Recall Guidelines– Recalls are classified intoClass I, II, and III, and the process requires inventory verification before further actions.

PTCB PTCE Exam Content Outline– The PTCB exam emphasizes medication safety and regulatory compliance, which includes proper handling of recalls.

The Drug Supply Chain Security Act (DSCSA)– This federal law mandates tracking and traceability of pharmaceutical products, reinforcing the importance of inventory checks during recalls.

Pharmacy Policy & Procedures– Most pharmacies followStandard Operating Procedures (SOPs)where verification of stock is the first step before contacting patients or returning products.

Key References:????Why Not the Other Options?

A. Call any affected patients❌→ This step is necessaryafterthe recall is confirmed and documented. If the pharmacy does not have the recalled product, patient notification is unnecessary.

B. Put the recall notice in the inventory technician’s box for processing❌→ Delaying action by simply passing the notice alongwithout verifying stockcan lead to patient harm.

D. Send the product back❌→ While returning recalled products is part of the process, itshould only occur after verification and proper documentation.

Pharmacy technician scope of practice is defined by state regulation and generally includes technical functions under a pharmacist’s supervision. In many states, technicians may initiate transfers of non-controlled prescriptions (often technician-to-technician) as part of the dispensing workflow. Activities such as patient counseling (A), clinical review (B), and approving the validity of controlled prescriptions (D) are considered professional/judgmental tasks and are reserved for the pharmacist.

References (Pharmacy Technician documents / Study Guides):

• NABP Model State Pharmacy Act—differentiation of pharmacist vs. technician duties.

• PTCB/ExCPT role delineation: technician tasks include processing, data entry, and certain communications (e.g., non-controlled transfers) under pharmacist supervision; clinical judgment and counseling are pharmacist-only.

• State practice act summaries frequently used in technician training modules regarding transfers and controlled vs. non-controlled prescriptions.

Comprehensive and Detailed Step-by-Step Explanation:

Stock rotation (First In, First Out - FIFO)ensures thatolder medications are used before newer stock, reducing expired medication dispensing.

????Explanation of Answer Choices:✅C. Rotating stock on a regular basis→Correct.FIFO method reduces waste and errors.❌A. Verifying each lot number→ Incorrect.Lot numbers do not indicate expiration dates.❌B. Using the newest medications first→ Incorrect.Older stock should be used first.❌D. Using the last in, first out method→ Incorrect.Opposite of the correct practice.

????Reference:

USP <1079>: Medication Storage and Inventory Control

PTCB Exam: Inventory Management

Comprehensive and Detailed Step-by-Step Explanation:

High-alert medicationsaredrugs that carry a higher risk of significant patient harmif used incorrectly.IV propranololis abeta-blocker (adrenergic antagonist)that can causesevere bradycardia, hypotension, and cardiac arrestif administered improperly.

????Explanation of Answer Choices:✅A. Adrenergic antagonist→Correct.Propranololblocks beta receptors, reducing heart rate and blood pressure.❌B. Chemotherapeutic agent→ Incorrect.Propranolol is not a chemotherapy drug.❌C. Opioid→ Incorrect.Propranolol is not an opioid.❌D. Anticoagulant→ Incorrect.Propranolol does not affect blood clotting.

????Reference:

ISMP List of High-Alert Medications

PTCB Exam: Medication Safety & Risk Management

Comprehensive and Detailed Step-by-Step Explanation:

Glipizide (Glucotrol)is asulfonylurea, a class oforal hypoglycemic agentsused intype 2 diabetes. It works by stimulatinginsulin releasefrom the pancreas, which can causelow blood sugar (hypoglycemia)if insulin levels become too high.

Symptoms of Hypoglycemia:

Shakiness, sweating, dizziness

Confusion, irritability, rapid heartbeat

Severe cases: Seizures, unconsciousness

????Explanation of Answer Choices:✅C. Glipizide→Correct.Causeshypoglycemiaas it increases insulin secretion.❌A. Haloperidol→ Incorrect.Antipsychotic (Haldol), not related to blood sugar regulation.❌B. Gemfibrozil→ Incorrect.Lipid-lowering agent (fibrate), does not causehypoglycemia.❌D. Hydrochlorothiazide→ Incorrect.A diuretic that may cause hyperglycemia (increased blood sugar), not hypoglycemia.

????Reference:

American Diabetes Association (ADA) Guidelines on Hypoglycemia

USP Drug Classification Database

PTCB Exam: Diabetes Medications & Side Effects

Step 1: Convert pounds to kilograms

1 kg = 2.2 lbs

132 lbs ÷ 2.2 = 60 kg

Step 2: Calculate total dose

5 mg/kg × 60 kg = 300 mg

Thus, the correct answer isC. 660 mg.

????Reference:PTCE Calculation Guide, Pediatric Dosage Calculations.

TheU.S. Food and Drug Administration (FDA)requires aMedication Guide (MedGuide)to be provided when dispensing certain medications that have significant safety concerns.Zyprexa (Olanzapine), anatypical antipsychotic, requires aMedication Guidedue to serious risks such as:

Increased mortality in elderly patients with dementia-related psychosis

Metabolic side effects(e.g., weight gain, hyperglycemia, and dyslipidemia)

Neuroleptic malignant syndrome (NMS)

A. Zafirlukast→ Incorrect; while used forasthma(leukotriene receptor antagonist), it doesnot require a Medication Guide.

B. Zestril (Lisinopril)→ Incorrect; anACE inhibitorfor hypertension, it doesnot require a Medication Guide.

C. Zinc→ Incorrect; adietary supplementthat does not require a Medication Guide.

Other Answer Choices Explained:References:

FDA Medication Guide Requirements for Olanzapine (Zyprexa)

PTCB PTCE Exam Content Outline (Medication Safety & Patient Counseling)

TheM-M-R II (Measles, Mumps, and Rubella) vaccinemust bereconstituted only with the manufacturer-supplied diluentto maintain its efficacy and stability.

The manufacturer-provided diluent contains stabilizing agents that preserve the live attenuated virus.

Using normal saline can alter the pH and degrade the vaccine, making it ineffective.

The vaccine must be discarded if reconstituted incorrectlyand not administered.

A. Administer the vaccine as the diluents are equivalent.❌→Incorrect

Normal saline is NOT equivalent to the manufacturer’s diluentand can compromise the vaccine’s potency.

B. Report the incident to the Drug Enforcement Administration (DEA).❌→Incorrect

Vaccine errors should be reported to the CDC’s Vaccine Adverse Event Reporting System (VAERS), not the DEA(which handles controlled substances, not vaccines).

C. Contact the Environmental Protection Agency (EPA) for guidance.❌→Incorrect

The EPA regulates hazardous waste, not vaccine errors.The CDC or vaccine manufacturer should be contacted for guidance.

CDC Vaccine Storage and Handling Guidelines– States thatvaccines must be reconstituted only with manufacturer-supplied diluents.

FDA Guidelines for M-M-R II Vaccine– Confirms that improper reconstitutionrenders the vaccine ineffective.

PTCB PTCE Exam Content Outline– Covers proper vaccine handling and error prevention.

Why Is Normal Saline Not an Acceptable Diluent?Why Not the Other Options?Key References:

Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug (NSAID) available in:

Oral tablets

Injectable IM/IV formsIt’s commonly used for short-term pain relief.

The others:

Dobutamine – IV only (used in cardiac settings)

Benzonatate – Oral capsules only (cough suppressant)

Cefazolin – Injectable only (no oral form; used in perioperative antibiotic prophylaxis)

From Mosby’s Pharmacy Technician:

“Ketorolac is one of the few NSAIDs that comes in both oral and parenteral forms, making it useful for step-down therapy in pain management.”

Comprehensive and Detailed Step-by-Step Explanation:

Step 1: Use the formula

A math equations with black text Description automatically generated with medium confidence

Explanation of Answer Choices:✅C. 2.5→Correct.2.5 mL provides the required25 mg dose.❌A. 0.5→ Incorrect. Too low.❌B. 2→ Incorrect. Under-dose.❌D. 5→ Incorrect. Over-dose.

????Reference:

USP <795>: Pharmaceutical Calculations

PTCB Exam: Dosage Conversions

Handling and internal transport of hazardous waste in the workplace require compliance with OSHA standards, including Hazard Communication and HAZWOPER (29 CFR 1910.120) training for personnel involved in hazardous waste operations. While external shipment of hazardous materials involves DOT/EPA rules, within pharmacy and healthcare settings, technicians moving hazardous waste containers to storage must have OSHA-mandated training. DEA pertains to controlled substances, FDA regulates drug approval/labeling, and ISMP is a safety organization but does not mandate training.

References (Pharmacy Technician documents / Study Guides):

• USP <800> Hazardous Drugs—Handling in Healthcare Settings: personnel training expectations and references to OSHA standards for safe handling.

• OSHA Hazard Communication Standard and HAZWOPER training requirements as cited in pharm tech safety modules.

• PTCB/ExCPT study materials on hazardous drugs/waste handling and applicable regulatory bodies

TheNational Drug Code (NDC)is a unique 10- or 11-digit number assigned to each drug product in the U.S.Understanding how NDC numbers are structuredis key to answering this question correctly.

The NDC format is as follows:XXXXX-YYYY-ZZ

First segment (XXXXX)→Labeler (Manufacturer or Distributor)

Second segment (YYYY)→Product Code (Specific Drug, Strength, and Formulation)

Third segment (ZZ)→Package Size (Quantity in the Package)

How to Find the Correct Answer?The given NDC:76439-103-10

76439= Manufacturer/Labeler Code

103= Product Code (Specific Drug & Strength)

10= Package Size

To matchthe same medication, theManufacturer (76439) and Product Code (103) must remain the same. Only thepackage size (last segment) can change.

A. 76439-208-10❌→Incorrect

Product Code (208) does not match (103).

B. 76439-103-50✅→Correct

Same manufacturer (76439) and same drug (103), but different package size (50 instead of 10).

C. 74693-103-10❌→Incorrect

Different manufacturer (74693 instead of 76439).

D. 74693-206-50❌→Incorrect

Different manufacturer (74693) and different product code (206).

FDA NDC Directory– Provides details on NDC structure and product identification.

PTCB PTCE Exam Content Outline– Covers NDC interpretation and drug identification.

Drug Supply Chain Security Act (DSCSA)– Reinforces correct medication identification using NDC.

Analyzing the Answer Choices:Key References:

Cyclosporine is a cornerstone immunosuppressant for transplant recipients and is a narrow therapeutic index medication requiring close monitoring of drug levels and renal function due to risks such as nephrotoxicity, hypertension, and extensive drug–drug interactions (CYP3A4 substrate). While prednisone is commonly used post-transplant, it does not require serum level monitoring like cyclosporine. Acetaminophen and doxycycline do not have the same transplant-specific monitoring needs.

TheDrug Enforcement Administration (DEA)requires that theft or significant loss ofcontrolled substancesbe reported usingDEA Form 106.

(A) Pregabalin✅Schedule V (Controlled Substance – Must be Reported to DEA)

Pregabalin (brand name:Lyrica) is classified as aSchedule V controlled substanceunder theControlled Substances Act (CSA).

Pharmacies must report its theft or significant loss to the DEA using DEA Form 106.

(B) Piroxicam❌Not a Controlled Substance – No Reporting Required

Piroxicam is anonsteroidal anti-inflammatory drug (NSAID).

It isnot a controlled substance, so DEA reporting isnot requiredfor theft or loss.

(C) Prochlorperazine❌Not a Controlled Substance – No Reporting Required

Prochlorperazine is anantiemetic and antipsychotic.

It isnot a controlled substance, so DEA reporting isnot requiredfor theft or loss.

(D) Pioglitazone❌Not a Controlled Substance – No Reporting Required

Pioglitazone (brand name:Actos) is anantidiabetic medication (thiazolidinedione).

It isnot a controlled substance, so DEA reporting isnot requiredfor theft or loss.

Thepharmacist-in-charge (PIC)must fileDEA Form 106in the event of a significant loss or theft of anySchedule II–V controlled substance.

The loss must be reportedwithin one business dayto theDEAand local law enforcement.

Minor losses due to inventory miscounts do not require DEA reporting but should be documented internally.

DEA Controlled Substances Act (CSA):

DEA Form 106 – Reporting Theft/Loss of Controlled Substances:

PTCB Exam Content Outline – Pharmacy Laws & Regulations

Controlled Substance Classification of Each Drug:DEA Reporting Requirements for Pharmacy Technicians:References for Pharmacy Technicians:

Drug interactions (like IV compatibility with heparin)must be evaluated bya pharmacisttoavoid adverse effects.

Pharmacy technicians can answer questions about generic names, drug schedules, and insurance issues but cannot provide clinical recommendations.

????Reference:ASHP Pharmacy Technician Scope of Practice, PTCE Guidelines.

Outdated (expired) medicationsmust not be dispensedand should bequarantinedin a separate area to prevent accidental use.

Remove outdated products from active stock immediately.

Label and store them separatelyuntil proper disposal.

Follow DEA, FDA, and state board guidelines for disposal.

Some medications (e.g., controlled substances) require special disposal procedures.

(A) Shipped to the DEA for disposal❌Incorrect – Only controlled substances require DEA disposal (viaReverse Distributor).

(B) Kept on the shelf to be dispensed first❌Incorrect – Expired medications should NEVER be dispensed.

(C) Isolated from active dispensing stock✅Correct – Medications must be separated from usable stock to prevent dispensing errors.

(D) Reported to the ISMP for tracking❌Incorrect – ISMP (Institute for Safe Medication Practices) monitors medication errors, not expiration management.

FDA Drug Disposal Guidelines:

DEA Controlled Substance Disposal Regulations:

PTCB Exam Content Outline – Inventory Management & Drug Disposal

Pharmacy Technician Guidelines for Handling Expired Medications:Analysis of Answer Choices:References for Pharmacy Technicians:

Sertraline (Zoloft)is anSSRI antidepressantused formajor depressive disorder (MDD), anxiety, and other mood disorders.Suicidal ideation(thoughts of self-harm) is aserious and potentially life-threatening side effect, especially inyoung adults. A pharmacy technicianmust notify the pharmacist immediatelyif a patient reportssuicidal thoughts, as this may require immediate medical intervention.

A. Presents new insurance coverage→ Incorrect; this is an administrative issue, not a clinical concern.

B. Requests the refill two days early→ Incorrect; a slight early refill request does not indicate a safety concern.

D. Reports improved interest and motivation→ Incorrect; this is apositive treatment response, not an urgent issue.

Other Answer Choices Explained:References:

FDA Black Box Warning for SSRIs – Suicide Risk in Young Adults

PTCB PTCE Exam Content Outline (Medication Safety & Patient Communication)

Lexicomp Drug Monograph for Sertraline (Zoloft)

Clopidogrel (Plavix) is an antiplatelet drug used to prevent blood clots, reducing the risk of heart attack (myocardial infarction) and stroke.

It is commonly prescribed afterstent placement, heart attack, or stroke.

Why Other Options Are Incorrect:

B. GERD?❌Treated withPPIs or H2 blockers(e.g., omeprazole, ranitidine).

C. Chronic migraines?❌Treated withbeta-blockers, triptans, or topiramate.

D. Type 2 diabetes?❌Treated withmetformin, insulin, or GLP-1 agonists.

????Reference:AHA Guidelines on Antiplatelet Therapy.

Cyanocobalamin (Vitamin B12)is used to treatpernicious anemia, a condition caused byVitamin B12 deficiencydue to the body’s inability to absorb it properly.

Pernicious anemiais an autoimmune disorder where the stomach does not produceintrinsic factor, a protein needed for Vitamin B12 absorption.

Symptoms includefatigue, weakness, neurological issues (numbness, tingling), and megaloblastic anemia.

Cyanocobalamin is given viaIM injection or high-dose oral supplementation.

(A) Pernicious anemia✅Correct – Cyanocobalamin is the primary treatment.

(B) Alcohol withdrawal❌Incorrect – Thiamine (Vitamin B1) is used for alcohol withdrawal, not cyanocobalamin.

(C) Hypothyroidism❌Incorrect – Treated withlevothyroxine (Synthroid), not Vitamin B12.

(D) Narrow-angle glaucoma❌Incorrect – Treated withtimolol, acetazolamide, or surgery, not cyanocobalamin.

Cyanocobalamin Prescribing Information (NIH):

PTCB Exam Content Outline – Disease States & Medications

Key Facts About Cyanocobalamin & Pernicious Anemia:Analysis of Answer Choices:References for Pharmacy Technicians:

Risperidone (Risperdal oral solution)is anatypical antipsychoticused to treatschizophrenia, bipolar disorder, and autism-related irritability.

Itsoral liquid formulationmust be storedin the refrigerator (between 2°C and 8°C or 36°F to 46°F)to maintain stability.

If left at room temperature for an extended period, theactive ingredients can degrade, reducing the medication's effectiveness.

Storage Considerations for Other Medications:

Gabapentin (Neurontin liquid formulation):Must be refrigerated.✅

Sertraline (Zoloft oral solution):Stored at room temperature.❌

Aripiprazole (Abilify liquid formulation):Stored at room temperature.❌

????Reference:Manufacturer’s storage guidelines,USP Chapter <797>for compounded sterile preparations.