COC EXAM QUESTION

1. A patient came to a pharmacy with a prescription for

the extemporaneous preparation of 3% hydrogen
peroxide. The pharmacist told the patient that the
Medicine can be prepared at the pharmacy, but there
is no bottle for packaging. The patient wanted to buy
the bottle from a nearby supplier and asked the
pharmacist the type of bottle required.

What is the most appropriate type of bottle?

A.Opaque plastic dropper bottle

B. Glass bottle with tight-fitting cap
C. Metal bottle with tight-fitting cap
D.Amber glass bottle with screw cap
2. A junior pharmacist working in an outpatient clinic
repackages medicines using polyvinyl chloride (PVC)
plastic material. In the process, the pharmacist is
concerned that some of the drugs interact with plastic
packaging materials.

What are the most common drugs that interact with

chloride (PVC)?

A.Diazepam, vitamin A acetate, hydralazine

B. Pyridoxine, Paracetamol, Nifedipine, Ionized
C. Vitamin D3, Heparin, Prednisolone, Codeine
D.Phenobarbital, Hydrocortisone, Methyl Paraben

3. A pharmacist working in a hospital received three

different batches of Acetylsalicylic acid 325mg tablets
with different expiry dates. The pharmacist then
started to keep record of the received drugs on bin
cards.
 What is the most appropriate way to fill the bin cards?

A.Record each batch on the same bin card

B. Record each batch on a separate bin card
C. Record consecutive batches on the same bin card
D.Record products with comparable expiry dates on the
same bin card

4. In a hospital intensive care unit (ICU), medication

error occurs in 30% of the head of inpatient pharmacy
to design a dispensing technique with least patients
taking a drug with narrow therapeutic window. An
internist approach possible errors in poor
infrastructure settings.

What type of dispensing technique should be designed

by the pharmacist?
 A. Bulk ward stock
B. Unit-dose system
C. Individual medication
D.Automated medication

5. The pharmacy store in a referral hospital uses a cyclic

stock counting approach the store manager wanted to
select some medicines that can be counted more than
once in a year. To select the priority medicines, the
store manager conducted an analysis of the total cost
and total volume of the medicines in the previous year.

What kind of analysis is most likely conducted by the

store manager?

A.ABC
B. CBA
C. CEA
D.VEN
6. A health center pharmacy employs a system of
periodic inventory control in which stocks are
replenished up to a pre-established level. No running
stock records are kept and the only stock control
document is a pre-printed sheet showing each item, its
description, the unit of issue, and the recommended
maximum stock level for that item.

What relevant inventory control system has been used

in the health center?

A. Double-shelf system
B. Imprest system
C. Indent System
D.Pull system
7. In a certain district, more than 200 people were
injured due to a land slide. Most of the casualties are
coming to your hospital. A pharmacist working in the
dispensary received a verbal order of certain vital
medications.

What appropriate measure should the pharmacist

take?

A. Enforcing the prescriber to bring a prescription paper

B. Recommending the prescriber to have the medicine
from the store
C. Dispensing the drug and register it as OTC medication
D.Dispensing the drug and get a written confirmation
later

8. A physician working at the inpatient department

prescribes 1gm of Ceftriaxone injection IV BID for one
 day for an admitted patient. Ceftriaxone is only
available as 0.25 gm per vial in the dispensary.

What actual amount of Ceftriaxone should be

dispensed?

A.8 vials of 0.25gm Ceftriaxone

B. 6 vials of 0.25gm Ceftriaxone
C. 4 vials of 0.25gm Ceftriaxone
D.2 vials of 0.25gm Ceftriaxone

9. An experimental pharmacologist investigating an ant-

diabetic activity of selected medicinal plant conducted
safety evaluation of extract Y. Up on experimentation
he observes that the extract killed half of the tested
mice at a dose of 60 mg/ml and also lower blood
glucose level in half of experimental mice at a dose of
20 mg/ml.
 What is the therapeutic index of extract Y

A. 1/3
B. 1/2
C. 2
D.3

10. A pharmacist working in a community pharmacy

contacted by a patient having a prescription dictating
iron solution with 55 mg of elemental iron. The
formulation available in the dispensary was 5 mg
elemental iron in 1 teaspoonful.

How many milliliters of solution should be dispensed?

A. 45 milliliters
B. 55 milliliters
C. 65 milliliters
D.75 milliliters
11. A 35-year-old female is diagnosed for febrile seizure.
She comes with a prescription containing
Phenobarbital with the appropriate dosage. She is
taking oral contraceptive pill for a long period of time.
She is not voluntary for other family planning methods
including condom. The pharmacist communicates the
issue of drug interaction to the prescriber and the
prescriber asks the pharmacist for alternatives.

What should be the response of the pharmacist?

A. Increasing the dose of Phenobarbital

B. Increasing the dose of oral contraceptive pill
C. Decreasing the dose of oral contraceptive pill
D. Decreasing the dose of Phenobarbital
12. A physician ordered a patient to be on a sustained
release preparation of drug X to maintain average
plasma concentration of 10 mg/ml. The volume
distribution and the half-life for drug X are estimated
to be 15 Liter and 0.5 respectively. The fraction of
drug X absorption is assumed as 2 and to be given
every 6 hours.

What doses of drug X should be administered?

A. 425 mg
B. 325 mg
C. 225 mg
D.125 mg

13. A patient weighing 50 kg was diagnosed with

systemic fungal infection. Physician prescribed
Amphotericin B 1.5 mg/kg/day for the patient.
 What total dosage of Amphotericin B should be
dispensed for the patient daily basis?

A.105mg
B. 95 mg
C. 85 mg
D.75mg

14. A pharmacist working in dispensary outlet

encountered an extemporaned prescription that
dictates for preparation of 5% tetracycline ointment
for topical use. The pharmacist prepared the
medication as per the prescription and dispensed the
medication correctly with appropriate counseling. One
we later, the patient came again and complained for
lack of improvement even though he took the
medication as per the instruction. Upon the
examination the formulation, the preparation was
found to form caking.
 What is the relevant cause for this formulation
problem?

A.Lack of stability
B. Microbial contamination
C. Inappropriate proportion
D.Incorrect API

15. A pharmacist working at outpatient pharmacy

dispensary was give prescription that dictates the
preparation of 3% Sodium Bicarbonate BP in 1 sterile
water.

How much Sodium Bicarbonate will be needed to

prepare the product?

A. 0.03 gm
B. 0.003 gm
 C. 0.3 gm
D.0.33 gm

16. A Pharmacist working in a certain pharmaceutical

industry was asked to prepare 10 capsules of
Verapamil each containing 20 mg active
pharmaceutical ingredient with a total weight of
Verapamil 200 mg BP.

How can the quantitative particular be expressed on

the label?

A. Verapamil BP 20 mg Lactose BP 100 mg

B. Verapamil BP 100 mg Lactose BP 200 mg
C. Verapamil BP 200 mg Lactose BP 20 mg
D.Verapamil BP 20 mg Lactose 13P 180 mg.
17. A patient has a fungal infection on his foot. The
physician prescribes potassium permanganate BP 0.2
%w/v. The prescription dictates for the preparation of
150 ml of this solution.

What amount of potassium permanganate will be

enclosed in every 100 ml of the solution?

A. 100 mg
B. 150 mg
C. 200 mg
D.250 mg

18. A patient was diagnosed with acute coronary

syndrome and the following drugs were prescribed.
 Nitroglycerin, sublingual, 0.4mg every 05 minutes
 Morphine PO 4mg
 Aspirin 300mg stat PO then 75mg PO daily
 Clopidogrel 300mg followed by 75mg/d PO
 Which medication should be packaged with a tightly
fit glass?

A. Aspirin
B. Clopidogrel
C. Nitroglycerin
D.Morphine

19. A mother of five-year-old child came to a dispensary

with two prescriptions: Mupirocin 2% ointment for
the child impetigo and Magnesium Trisilicate for
mother's dyspepsia treatment. The pharmacist
labeled the drugs and dispensed to the patient. Three
days later, she came with her child having diarrhea.

What important part of labeling has been missed?

A.For external use only

 B. Avoid exposure to sunlight
C. Apply thin film on the lesion
D.Keep out of the reach of children

20. A 42-year-old male diagnosed with psoriasis and

was prescribed Betamethasone Dipropionate cream
0.05%. The pharmacist labeled and provided the drug
to patient.

What message should be included on the labeling to

minimize side effect?

A. For external use only

B. To be applied thinly
C. Keep out of the reach of children
D. Discard if lasted more than 4-months.
21. A newly hired pharmacist started working in
dispensary outlets. He is be guided by his seniors on
how to dispense medications including labeling and
packaging.

What important issues should be advised during

packaging of medicines?

A. Suppositories should be packaged in paper made

containers
B. Tablets should be packaged with collapsible tubes
C. Ointments should be packaged with paper made
containers
D. Liquids should be packaged in light resistant glasses

22. A 35-year-old woman, who is a type-1 diabetes

mellitus patient, comes to dispensary with a
 prescription stating insulin injections for 2 months
period.

What is the most relevant counseling about storage of

insulin?

A. Store the medicine in the hot place

B. Store the medicine in dry place
C. Store the medicine in a refrigerator
D. Store the medicine in any place at home

23. A 30-year-old male patient has come to a

dispensary with a prescription Metronidazole 500 mg
PO TID for 7 days. In the dispensary, Metronidazole
available in 250 mg strength.

How do you label the medicine before dispensing?

A. Take three capsule at a time with eight hour
difference
B. Take two capsules at a time with eight hour
difference
C. Take six capsule a day every twelve hour difference
D. Take three capsule a day every twelve hour difference

24. A 29-years-old lady came to the dispensary to

consult why she be cam pregnant unintentionally
while she was highly adherent to her contraceptive
pills. When you assess, you found that she was on anti-
TB therapy for weeks on drug regimen containing
Isoniazid, Rifampicin, Pyrazinamide Ethambutol

What was the responsible drug for failure of the

contraceptive?

A. Isoniazid
B. Rifampicin
 C. Pyrazinamide
D.Ethambutol

25. A client comes with prescription containing

Mebendazole for helmin infection. The pharmacist
dispensed without telling any message to the client.

What important counseling has been missed on the

direction to use the drug?

A. Swallow the intact tablet with a glass of water

B. Chew well and then swallow with a glass of water
C. Keep under the tongue and swallow the residue with a
glass of water
D.Keep buccally and swallow the residue with a glass of
water
26. A patient comes with prescription containing
Ephedrine and Theophylline as regular maintenance
therapy for her recurrent asthma. The client wants you
tell her about dietary restrictions.

What is the most appropriate advice to this patient for

the course of therapy?

A. Avoid milk products

B. Avoid coffee and tea
C. Minimize sugar and salt
D.Avoid banana

27. A three-week-old child with abdominal cramp,

fever, bloody diarrhea has been diagnosed with
bacillary dysentery. His mother came to a dispensary
with prescription ordering sulfamethoxazole plus
Trimethoprim 100/20mg BID seven days.
 What is the most likely expected risk of dispensing the
drug?

A. Bilirubin induced brain damage

B. A gray discoloration and hypertension
C. Liver and kidney damage
D. Flushing, nausea and tinnitus

28. 28-year-old pharmacist a hospital had a habit of

abusing Methadone was diagnosed with pulmonary
tuberculosis and treated with Rifampicin, Isoniazid.
Pyramthambutol Three weeks later the pharmacist
came back with withdrawal symptoms

What is the most likely do interact that led to the

withdrawal symptom?

A. Methadone – Ethambutol
 B. Methadone - Isoniazid
C. Methadone - Rifampicin
D.Methadone-Pyrazinamide

29. A prescriber wants you to recommend on an

antipsychotic drug of choice for his 59-year-old
schizophrenic patient being concerned of drug-drug
interactions the patient is on effective
Hydrochlorothiazide therapy for his stage I
hypertension but occasionally shows manifestation of
mild hypotension.

What is the most appropriate antipsychotic drug to

this patient?

A.Haloperidol
B. Clozapine
C. Chlorpromazine
D.Thioridazine
30. A 25-year-old male diagnosed with stable angina
came with prescription containing Propranolol. You
asked him about his medication history, and the
patient mentioned that he is on daily therapy of
Salmeterol for his recurrent asthma.

Which undesirable outcome might happen with this

prescription?

A. Increased toxicity of Salmeterol

B. Failure of Salmeterol therapy
C. Failure of Propranolol therapy
D.Increased toxicity of Propranolol

31. A 45-year-old woman diagnosed with heart failure

was taking optimum dose of Digoxin and Furosemide
for the last two months. She comes to a hospital
 complaining of shortness of breath and rapid
palpitation. The physician suspects the patient has
atrial fibrillation and prescribes quinidine.

What is the most likely appropriate advice for this

patient?

A. Increasing the dose of Quinidine

B. Decreasing the dose of Quinidine
C. Reducing the dose of Digoxin
D.Increasing the dose of Digoxin

32. A 35-year-old female epileptic patient have been

taking Phenobarbitone 100mg PO BID for last 2 years
combined oral contraceptives as clinical pharmacy you
have to evaluate for possible drug-drug interaction
between her current medications.
 What is the most likely appropriate source of
information you will use?

A. Abstracting services
B. Text books
C. clinical Studies
D.Review articles

33. A research team within drug and therapeutic

committee were assigned on searching additional
published studies about the effect of selenium on the
prevention and treatment of cancer.

What is the most appropriate secondary database used

for this purpose?

A.PubMed
B. Up To Date
C. Google scholar
 D.FDA website

34. The pharmacist in drug information center planned

to write a newsletter on adverse drug reactions of IV
fluids.

What is the first step the pharmacist should describe?

A. Define the information sources

B. Define the audience
C. Identify constraints
D. Design a newsletter

35. A clinical director of the hospital selected you to

lead the formation of a panel to be involved in the
development of pediatrics clinical practice guidelines
 (CPG) in your hospital. The hospital gives services for
more than 10,000 inpatients. The most prevalent
cases are of infectious in origin and also with other
non-communicable diseases.

What is the first appropriate initial step, the team

should perform to prepare the CPG?

A.Conduct a systematic search for evidence

B. Determine the study screening selection criteria
C. Define the clinical questions to be addressed
D.Critically appraise individual studies

36. A nurse working in clinical care about the storage

condition of the vaccines containers, what is the most
appropriate advice you give for the nurse?

A.Store the vaccines in around -20°C

 B. Store the cines in around 25°C
C. Store the vaccines in above SC
D.Store the vaccines in around -2°C

37. As beginner pharmacist in a given health institution,

you may get order from the sensor pharmacist to
arrange drugs in the dispensary so as dispensing
process.

What is the most appropriate arrangement of the

medicine on the shelf?

A.Drugs with the short expiry date in front of the shelf

B. Drugs with long expiry date on top of the shelf
C. Drugs with the short expiry date in the back of the
shelf
D.Drugs with the long expiry date in front of the shelf
38. A pharmacist working in a hospital OPD dispensary
was assigned to carry out documentation activities of
the room.

What information is most important to ensure

accountable and transparent transaction?

A. Record all information on the normal prescription in a

registration book and dispose the field prescriptions
B. Record all information on the special prescription in a
registration book and store the field prescriptions for
01 year
C. Record all information on the special prescription in a
registration book and store the field prescriptions for
02 year
D.Record all information on the normal prescription in a
registration book store the field prescriptions for 02
year
39. A 25-year-old man was diagnosed with Visceral
Leishmaniasis and prescribed with Sodium
Stibogluconate. Unfortunately, the drug was out of
stock as the disease was not common in the area
before. Hence, the patient was sent to other
dispensaries with copy of the prescription.

What would be the most appropriate management

Method to support the supply management?

A.Documentation of prescription
B. Prescription registration
C. Evaluation of prescription
D.Billing of prescription

40. The pharmacy department head was conducting a

monthly supportive supervision at drug information
 center and noticed that a pharmacist in charge failed
to document some of his daily activities.

What is the most likely missed documentation?

A. The ultimate question

B. The materials searched
C. The response
D.The follow-up

41. A pharmacist working in a drug information center

(DIC) of a hospital utilized a Modified systematic
approach that includes data evaluation, analysis and
Synthesis to provide drug information to clients.
While undertaking the activities, the pharmacist
presented the competing view points and
considerations.
 What would be the most appropriate next step in
response formulation?

A. Refute the major strengths and present weaknesses

B. Defend the major weaknesses and promote the
strengths
C. State the assessment of the literature or information
reviewed
D.Reiterate the final assessment in support of the
superior viewpoints

42. A 24-year-old female student was admitted to a

hospital for the past three days after she developed
falciparum malaria and currently ready for discharge
following excellent clinical improvement. She has a
history of peptic ulcer disease and was on Cimetidine
for the last seven days. While the nurse was checking
vital signs for discharge, she found high grade fever of
38.7°C. The Nurse told her to stay for one more day
 and follow her current condition. The fever is not
persistent in nature and fluctuating between 37.7°C to
39.2°C for the last 24hrs. Her WBC count remains
elevated and notably, her eosinophils count is
increased with nearly normal neutrophils count.
Despite her high-grade fever, she has a relative
bradycardia. Other laboratory investigations are within
normal range.

What will be the suspected cause of high grade fever

in this patient?

A.Malaria is relapsing
B. Drug induced fever
C. Other nosocomial infection
D.Brady arrhythmia

43. A known HIV/AIDS patient who is on HAART for the

past few months' presents to ART clinic with fever,
 dyspnea, tachypnea and non-productive cough. Chest
radiography revealed subtle bilateral and interstitial
infiltrates. A pulse ox meter shows minimal hypoxia
(oxygen saturation of 88%).

What is the most likely diagnosis of this patient?

A. Pulmonary tuberculosis
B. Pneumocystis carinii pneumonia
C. Toxoplasmosis
D.Histoplasmosis

44. A pharmacist was evaluating randomized clinical trial

articles. During the process he found a topic
conducted to compare cure rate of Omeprazole
capsule and tablet. In both of the dosage forms, 200
study participants were included For those taking
Omeprazole capsule placebo tablet was given while for
 those taking Omeprazole tablet placebo capsule was
given.

What is the intention of including placebo formulation

in the above study?

A. To reduce selection bias

B. To reduce interpretation bias
C. To reduce performance bias
D.To reduce adverse drug reaction

45. A Pharmacist conducted critical appraisal of four

different scientific literatures done on hepatocyte
protective effect of a new drug. The type of those
articles were case-control, prospective cohort,
randomized controlled clinical trial, systematic review
with meta-analysis containing only randomized
controlled clinical trial.
What is the preferred literature type that can be applied
in practical context?

A.Randomized controlled trial

B. Prospective cohort
C. Systematic review
D.Case-control

46. There is an epidemic of measles on certain area and

the drug information center pharmacist is asked to
give information about medications and prevention
strategies to the community on FM radio.

What is most likely recommended mechanism during

transmitting the message?

A.Talking professionally
B. Making conversation hidden
 C. Providing excessive information
D.Using the international language

47. A patient taking Enalapril for hypertension was

admitted to a hospital with drug adverse event which
his physician classified as "category A" and told the
nurse to manage accordingly. The Nurse was not sure
about "category A" adverse drug event and asked you
for clarification.

What is your most likely response?

A. Extended pharmacological effect

B. Idiosyncratic reactions
C. Chronic exposure
D.Low dosage
48. A 46-year-old patient was admitted with the
diagnosis of spinal tuberculosis. He started on daily
Isoniazid 300 mg, Rifampin 600 mg, Pyrazinamide
1.500 mg. and Ethambutol 1,200 mg. The patient
cannot move due to his lower motor paralysis. After
one week of his admission, he developed deep vein
thrombosis (DVT). He started management of DVT
with Heparin 80 units/kg and then 18 units/kg/hr via
infusion and Warfarin 2.5 mg daily. The international
normalization ratio (INR) values were less than 1.5 up
to day five.

What drug therapy problem is most likely identified in

this patient?

A. Rifampin and Warfarin should not be given together

B. The dose of Rifampin is too high since there is enzyme
inhibition
C. The maintenance dose of Heparin is too low
D.The dose of Warfarin is too low since there is enzyme
induction
49. A 63-year-old female patient diagnosed with Stage C
heart failure and an ejection fraction of 25%, is
currently taking Lisinopril 20 mg daily, Furosemide 40
mg twice daily, Digoxin 0.125 mg daily, and Carvedilol
3.125 mg twice daily. Today, she presents with
increased shortness of breath, fatigue, and ankle
swelling. She also reports a 10 kg weight gain over the
past week. Her laboratoratory values are significant
for serum potassium of 5.2 mEq/L (5.2 mmol/l.) and
serum creatinine of 2.2 mg/dL. (194 µmol/L).

What is the most appropriate initial intervention for

this patient?

A. Increase dose of Lisinopril to 20 mg twice daily

B. Add Spironolactone 25 mg daily
C. Increase dose of furosemide to 80 mg twice daily
D.Increase dose of digoxin to 0.25 mg daily
50. A 69-year-old woman was admitted with the
diagnosis of acute deep vein thrombosis. She was
started management with Warfarin 2.5 mg daily and
Heparin 17,500 IU Sc twice daily. After two days of her
treatment, her PTT became greater than 140 seconds.
She noted also a blood mixed feces. On complete
blood count hemoglobin and Hematocrit is normal.
Her current international normalization ratio is within
the normal range. You suspected adverse drug
reaction from her current regimen.

What is the next appropriate intervention for this

patient?

A. Discontinue Heparin and administer a Vitamin k

antagonist
B. Discontinue Heparin and administer a recombinant
factor VII
C. Discontinue Heparin and administer packed red
blood cells
 D.Discontinue Heparin and administer a Protamine
sulfate

51. A 44-year-old patient with history of deep vein

thrombosis has been taking Warfarin 2.5 mg for 6
months with good laboratory control presented to
your hospital for routine follow up. Laboratory
investigation, shows that the international
normalization (INR) value of 4.5.

What is the most appropriate next step for this

patient?

A.Withhold administration of Warfarin

B. Administer Vitamin K via slow intravenous injection
C. Continue with the same therapy
D.Administer Prothrombin complex concentrates
52. A 68-year-old man with stable angina, who is
currently receiving Simvastatin 40mg daily with well
controlled lipid levels (TC 3.8mmol/L; LDL-C
1.8mmol/L;HDL-C,, 0.9mmol/L, triglycerides
1.3mmol/L). He has been on Simvastatin for the past 7
years, and has complained previously about muscle
aches, but on this visit he states that his muscle pain
has become more troublesome. He asks, if there is
something else he can take to control his cholesterol.

What is the best management option you recommend

for this patient?

A. Replace Simvastatin 40 mg daily with Atorvastatin 40

mg daily
B. Discontinue Simvastatin
C. Decrease dose of Simvastatin to 20 mg daily
D.Continue with Simvastatin 40 mg daily
53. A Nine-year-old male child with severe asthma came
to hospital. He was treated with Albuterol via
Nibulaizer in emergency and discharged with inhaled
Beclomethasone. The family is informed to give high
dose of Beclomethasone for better control of the
symptom.

What risk does this child may develop if he takes high

dose of Beclomethasone?

A. Hypoglycemia
B. Growth suppression
C. Cushing syndrome
D.Cataract formation

54. A 42-year-old man who came to the hospital was

diagnosed for moderate persistent asthma. He had
 intermittent asthma symptoms when he was 30 years
of age, and he had never smoked. A physician planned
for better control of patient's asthma symptoms with
drug.

What is the most appropriate medication?

A. Tiotropium metered-dose aerosol inhalation

B. Salmeterol dry powder aerosol inhalation
C. Mometasone dry powder aerosol inhalation
D.Albuterol metered-dose aerosol inhalation

55. A 45-year-old man with type 2 diabetes mellitus

came to diabetic clinic for regular follow-up. He has
been taking Metformin 1 gm daily. On laboratory
investigation his Glycosylated hemoglobin test shows
10%.

What is the most appropriate next management?

 A. His diabetes is well controlled, continue current
medication
B. His diabetes is poorly controlled, needs addition of
Insulin
C. His diabetes is well controlled, reduce dose of
current medication
D.His diabetes is poorly controlled, needs addition of
Glyburide

56. A 19-year-old woman develops secondary

amenorrhea followed by symptoms of palpitations,
nervousness, and heat intolerance and sweating.
There is a strong family history of autoimmune
disease. The physical examination shows that she
appears anxious and sweaty, her pulse is 120 beats
per minute and regular, and there is a smooth goiter
with a soft bruit. There is tremor of the outstretched
fingers. A pregnancy test is positive. Blood was sent to
the laboratory for standard investigations, including T3
and T4.
 What is the most appropriate drug therapy for this
patient?

A. Start low dose of Methimazole with Proponalol

B. Start low dose of Carbimazole with Proponalol
C. Start low dose of radioactive iodine with Proponalol
D. Start low dose of Propylthiouracil with Proponalol

57. A 40-year-old female patient, presented with chief

complaint of nausea, vomiting and Epigastric pain of
three weeks duration. She reported brown colored
loose stool she has documented Penicillin allergy. Her
physical examination shows Epigastric tenderness and
vital signs (1-37.2°C BP-128/80mmHg, pulse-76
beats/min) Laboratory values are Hemoglobin of
14mg/dl., Hematocrit of 41% and fecal antigen test is
positive for Helicobacter pylori and others are within
normal ranges. The attending physician decided to put
her on Helicobacter pylori eradication therapy,
 What triple therapy regimen is the most appropriate
for this patient?

A.Omeprazole 20mg BID Clarithromycin 500mg BID+

Metronidazole 500mgBID for 14 days
B. Omeprazole 20mg BID+ Clarithromycin 500mgBID+
Amoxicillin 1gm BID for 14 days
C. Omeprazole 20mg BID+ Amoxicillin Ig BID +
Tetracycline 500mg BID for 14 days
D.Omeprazole 20mg BID + Amoxicillin Ig BID
Metronidazole 500mg BID for 14 days

58. A 50-year-old man is brought to the surgical ICU

after emergency surgery. He has no past medical
history. Currently, he is on Ibuprofen 800 mg
alternating with Oxycodone 5 mg/ acetaminophen 325
mg two tablets every 8 hours for surgical site pain,
Dexamethasone 4mg oral IV daily and Lorazepam I mg
IV as an adjunct to antiemetic. An attending clinical
 pharmacist has identified the patient is experiencing
sedation and amnesia.

What medication is most likely to cause for the

identified ADR in this patient?

A.Lorazepam
B. Oxycodone
C. Acetaminophen
D.Dexamethasone

59. A 38-year-old known chronic liver disease (CLD)

patient becomes somnolent and irritable. On physical
examination his abdomen is very tender to mild
palpation. Vital signs (BP-68/50mmHg, PR-102
beats/min, Temperature-38.8°C,RR-18 breaths/min),
oxygen saturation 98% on room air. The medical
resident suspects spontaneous bacterial peritonitis
(SBP) and orders a diagnostic paracentesis. Polymorph
 nuclear neutrophil (PMN) of ascitic fluid is 370 cells/uL,
and Serum ascitic albumin gradient (SAAG) is 1.2
gm/dL. Upon return of laboratory investigation,
physician consulted you to select appropriate
antibiotics for spontaneous bacterial peritonitis

What appropriate empiric antibiotic do you

recommend for this patient?

A. Ampicillin Igm IV four times daily

B. Cefotaxime Igm IV daily
C. Metronidazole 1gm IV three times daily
D.Cloxacillin 500mg four times daily

60. A 62-year-old obese man with PUD and TH DM came

for his monthly refill. He reports nausea and vomiting
of two episodes since last visit. He has no other
comorbiditics. His current medications are Metformin
BID, Pantoprazole 20 mg BID and Atorvastatin 20 mg
 daily at night. The senior physician requests your
recommendation to add drugs for cardiovascular risk
prevention.

What is the most appropriate drug you recommend for

this patient?

A.Aspirin
B. Warfarin
C. Clopidogrel
D.Heparin

61. A two-year-old child was admitted to hematologic

clinic with clinical signs of ecchymoses, hemarthroses,
joint pain & swelling and erythema. On laboratory
investigation the factor VIII level (0.01-0.05 units/mL).
From family history, his grandfather, who died 6
months was found to be between ago had hemophilia
A. Currently, she is worried about her son.
 A hematologist diagnosed the child with hemophilia A
and he approached you to select appropriate first line
treatment for this child.

What will be the most appropriate first line

intervention for this child?

A. Surgical intervention
B. Recombinant factor VIII
C. Desmopressin therapy
D.Plasma-derived products of factor VIII

62. A 36-year-old man has been taking phenytoin

100mg PO TID for his epilepsy for the last 12 months.
But, recently he has been developing symptoms of
fatigue, pallor, weakness and dyspnea on exertion. On
further evaluation, neurologist requested you to
evaluate for adverse drug reaction (ADR) from
phenytoin. On your evaluation by using Naranjo ADR
 assessment tool, the Current signs and symptoms of
anemia is possibly from phenytoin.

What is the most appropriate intervention in

management of ADR in this patient?

A. Initiate Vitamin B₁2

B. Initiate Folic acid
C. Initiate Iron-dextran
D.Initiate Epoctin alpha

63. A 68-year-old woman presents to hospital for follow

up at orthopedic clinic Acetaminophen trial therapy
has failed to relief her Osteoarthritis. She is also taking
Amlodipine 5mg BID for the treatment of
hypertension.

What is the appropriate next drug therapy initiated in

this patient?
 A. Meloxicam
B. Tramadol
C. Nabumetone
D.Indomethacin

64. A 49-year-old professional singer was admitted to

internal medicine ward with a diagnosis of Graves’s
disease. She was initially treated with Carbimazole,
but developed a severe generalized rash, which
necessitated withdrawal of the drag A similar rash
occurred within 2 weeks of starting propylthiouracil
(PTU). She is overtly thyrotoxicosis with a blood
pressure of 160/50 mmHg, a pulse of 110 beats/min
and a large thyroid gland with a vascular bruit.
Laboratory results show an elevated free Thyroxine
and an undetectable thyroid-stimulating hormone.

What is the most appropriate treatment option for this

patient on admission?
 A.Propranolol
B. Propranolol and lithium
C. Propranolol, lithium and surgical removal
D.Propranolol, lithium and radioactive iodine

65. A 27-year-old woman comes with a 3-month history

of intermittent heat intolerance, sweats, tremor, and
severe muscle weakness, which has limited her ability
to climb stairs. She is also bothered by the pounding of
her heart and inability to keep food and liquids down.
She previously received iodide drops with symptomatic
improvement, but her disease recurred despite its
continued administration. Thyroid function test shows
total Thyroxine of 6 mcg/dL (normal, 5-12); free
Thyroxine of 2 ng/dl (normal, 0.7-1.9); thyroid-
stimulating hormone <0.01 punits/mL (normal, 0.5-
4.7), and a random blood glucose of 350 mg/dL
(normal, 70-110). Her current BP is 180/90 mmHg with
a pulse of 125 beats/minute, and a diffusely enlarged
 thyroid gland that is about four times normal (about
100 gm).

What is the next most appropriate intervention in this

patient?

A. Initially with thioamides followed by iodides

B. Initially with thioamides followed by surgery
C. Initially with thioamides followed by radioactive
iodides
D.Initially with thioamides followed by beta-blockers

66. A hospital pharmacy procurement team was

requested to purchase digoxin a month ago however,
the team failed to avail the drug on time. As a result,
an increased hospitalization of heart failure patients
was observed.
 Which ethical principle is most likely violated by the
team?

A. Autonomy
B. Honesty
C. Justice
D.Non-maleficence

67. A pharmacist who works in a regional PPSA hub,

received procurement requests from three referral
hospitals. However, the stock was insufficient to fulfill
all the three requests. Finally, the pharmacist used
population size and disease morbidity to calculate the
quantities of medicines to be received by each
hospital.

What is the most relevant ethical principle in the

pharmacist's decision?
 A. Autonomy
B. Beneficence
C. Non-maleficence
D.Justice

A pharmacist seeks justice in the distribution of health resources.

When health resources are allocated, a pharmacist is fair and
equitable, balancing the needs of patients and society.

68. A diabetic patient visited a pharmacy to refill a

prescription containing Glibenclamide 2.5 mg/day. The
patient was also taking Ciprofloxacin (500 mg bid) for
the past two days and decided to discontinue the
antibiotic. Despite the pharmacist's attempt to explain
the possible consequences of such a decision, the
patient refused to take ciprofloxacin or an alternative
antibiotic. Finally, the pharmacist accepted the
patient's decision and dispensed the glibenclamide.

What is the most relevant ethical principle in the

pharmacist's reaction?
 A.Autonomy
B. Transparency
C. Confidentiality
D.Accountability

In general, competent adult patients should be treated as

autonomous decision-makers who have the legal and
ethical right to make informed decisions about the
direction of their own medical care, unencumbered by
paternalistic interference.

69. A patient visited a community pharmacy with an

authorized prescription for morphine 10 mg. The
pharmacist checked the pharmacy records and found
that the patient has bought 50 tablets of the same
drug 3 days earlier.

What would be the most likely ethical course of action

for the pharmacist?

A. Dispensing the drug as prescribed

B. Refusing to dispense the drug
 C. Contacting the prescriber for confirmation
D. Reporting the case to the relevant authority

70. A 55-year-old woman with complaints of palpable

lump, nipple discharge and edema, redness and
warmth on her breast came to a hospital. Her history
shows that she gave no bath until now and she saw her
menses at age of 10. She also smokes cigarette and
drinks alcohol. The biopsy was taken and test was
done which revealed a breast cancer.

What are the conditions that show this patient has

breast cancer?

A.Nulli- parity, smoking cigarette and being age 55

years
B. Seeing menses at age of 10 years and nulli-parity
C. Smoking cigarette, drinking alcohol and null-parity
D.Smoking cigarette and seeing menses at age of 10
years

71. A 50-year-old woman with a diagnosis of colorectal

cancer was admitted to a hospital. The medications
ordered for her colorectal cancer includes FOLFOX
(Fluorouracil, Leucovorin, and Oxaliplatin).

What is the predicted importance of Leucovorin in this

patient?

A. Because of its chemotherapeutic effect

B. To counter act the adverse effect of Fluorouracil
C. To increase the absorption time of fluorouracil
D. To decrease the adverse effect of Oxaliplatin
72. A hospital drug and therapeutics committee wants
to prepare an essential medicines list.

What is the most relevant factor in the selection of

medicines to be included in the list?

A. Availability in the international market

B. Unit prices of the medicines
C. The local disease pattern
D. The national disease pattern

73. A pharmacist working in a hospital's inventory

management team wants to select pharmaceuticals
for procurement in the next budget year. The
pharmacist wants to purchase all pharmaceuticals in
the essential medicine list. In the process, the
pharmacist has listed all vital pharmaceuticals to be
purchased. However, the allocated budget is
inadequate.
 What is the most appropriate next step?

A. Select low cost essential medicines

B. Select low cost desirable medicines
C. Select slow moving medicines
D. Select fast moving medicines

74. A pharmacist member of a hospital drug and

therapeutics committee (UTC) recommended the
preparation of an essential medicines list and the use
of the list in the procurement process ofer members of
the DTC wanted to get justifications on the advantages
of using the essential medicines list during
procurement.

What is the reason of using essential medicines list in

the procurement process?
A. Limiting the quantity of each medicine to be procured
B. Ensuring availability of medicines at the hospital
C. Helping the DTC to efficiently hire health professionals
D.Limiting procurement to products from local suppliers

75. A hospital drug and therapeutics committee (DTC)

assigns a pharmacist to help with the selection of
medicines for inclusion in the procurement list. For
each medicine, the pharmacist wanted to get
information on indications for use, dosage schedule,
contraindications, side effects and information that
should be given to the patient.

What is the most appropriate source of information

that should be used?

A.Hospital formulary manual

B. Hospital essential medicine list
C. Standard treatment guideline
 D.National essential medicine list

76. A primary hospital utilized 300, 250, 200 and 450

Packs of Ceftriaxone injection in September, October,
November and December, respectively. The lead time
for the product is two months with safety stock of 600
packs. The procurement period is also six months.

What would be the maximum stock level of

Ceftriaxone injection?

A. 1800 pack
B. 3000 pack
C. 2400 pack
D.4200 pack
77. Assume, you are a hospital pharmacist engaged in
managing the hospital inventory. The lead time for a
product is less than three hours.

How is the safety stock and average monthly

consumption related with the lead time?

A. Safety stock is not required since the lead time of the

products is zero
B. The safety stock is equal to the average monthly
consumption
C. The safety stock is twice the average monthly
consumption
D. The lead time doesn't affect the maximum stock level

78. A 34-year old male who was diagnosed with knee

Psoriasis and put on cream BID six weeks back, visited
the outpatient department with complaints of clinical
 remission despite he applied as per the direction given
before.

For which drug therapy should the pharmacist give a

priority for this patient?

A. Adherence
B. Effectiveness
C. Safety
D.Indication

79. A Five-year-old child was diagnosed with drug-

induced skin reaction secondary to Cephalexin
250mg/5ml BID use for community acquired
pneumonia since two days back. The patient was
febrile and the eruption was very painful and itchy.
The dermatologist on duty request a pharmacist for
possible recommendations on the drug being taken by
the child.
 What would be the most appropriate recommendation
for this patient?

A. Initiate analgesic agent

B. Avoid sunlight exposure
C. Discontinue with the medication
D.Use antihistaminergic agent

80. A 43-year-old female patient was diagnosed with

stage-II breast cancer. The general surgeon in charge
conducted a breast-conserving surgery as her breast
was big in size. Then, he sent her back home with an
appointment after three months. The oncology
pharmacist assessed for the possibility of adjuvant
therapy initiation for the residual cancerous tissue.

What drug therapy should the pharmacist give a

priority for this patient?
 A. Adherence
B. Effectiveness
C. Safety
D.Indication

81. A 28-year-old female patient presented with a single

painless, palpable lump in her right breast. The fine-
needle aspiration cytology showed malignant changes
of the cells. Therefore she was diagnosed with early
stages breast cancer and put on Doxorubicin 60 mg/m²
IV and Cyclophosphamide 600 mg/m² IV to be
repeated every 21 days for four cycles after surgical
resection of the lump.

What would be the main purpose of initiating these

chemotherapeutic drugs?

A. Cure the disease state

B. Conserve the breast tissue
 C. Control the sign and symptoms
D.Decrease the disease progression

82. 43-year-old known diabetes mellitus man visited an

OPD for his regular follow up. He was taking
Metformin 1000 mg BID for the last three months in
addition to life style modifications. His respiration is
18/min, blood pressure 115/80 mmHg, pulse rate
68/min. Laboratory result shows that K 4.8 meq/L
(normal range: 3.5-4.5 meq/L), Na 143 meq/L (normal
range: 136-146 meq/L), estimated GFR 48
ml/min/1.73m², BUN 28 mg/dL (normal range: 7-20
mg/dL) and fasting blood glucose 150 mg/dL. Based on
the findings, the physician planned to increase
Metformin to 1500 mg BID and give appointment for
three months a waiting of the clinical pharmacist's
recommendation.

What is the most appropriate recommendation the

pharmacist should deliver?
A. support the physician's decision
B. Add insulin to the current regimen
C. Add Glibenclamide to the current regimen
D.Discontinue with Metformin and initiate Glibenclamide

83. A 30-year-old woman was presented to an

emergency department with signs and symptoms
suggestive of diabetic ketoacidosis. Then, the clinical
team started to manage the patient with regular
insulin and intravenous fluids.

What is the most likely monitoring parameter during

acute patient management?

A. Serum insulin level

B. Serum potassium level
C. Serum alkaline phosphatase
D. Serum low density lipoprotein
84. A 26-year-old woman visited an outpatient
department with a complaint of Epigastric pain of
three days duration. She further reports that the pain
is accompanied by heart burn, belching and bloating
and it usually awakens her from sleep between 12:00-
3:00 AM. Based on the findings, the physician
suspected bacterial infection.

What is the most appropriate diagnostic test for this

patient?

A. Urea breath test

B. Stool guaiac test
C. Fecal antigen test
D.Antibody detection test
85. An 18-year-old boy presented to a clinic with a
complaint of dyspnea and coughing limited his ability
to cope up with his basketball teammates. He states
that "it is worse playing outdoors and worsens in
recent days than a month ago". He has a history of
experiencing several attack of bronchitis as a young
child and the teammate's match usually lasts 90-95
minutes.

What is the most appropriate preventive therapy for

this patient?

A. Albuterol 10 minutes before exercise

B. Salmeterol 10 minutes before exercise
C. Formoterol 10 minutes before exercise
D.Terbutaline 10 minutes before exercise

86. A 67-year-old man was presented to an emergency

department with a complaint of excessive bleeding
from minor bruising and cuts while shaving his face.
The patient medication history shows that he has been
 taking Warfarin for atrial fibrillation for three years,
Beclomethasone and Salbutamol for his asthma for six
months. In addition, he started an oral Theophylline
three weeks back because of increasing in frequency
and severity of asthma symptoms. The laboratory
result indicates that international normalized ratio
(INR) of 3.5 (normal range: 2.5-3.5).

What is the most appropriate management for this

patient?

A. Monitor INR
B. Discontinue with Warfarin
C. Administer vitamin K
D.Discontinue with Theophylline

87. A 28-year-old known Type-l diabetes woman visited

an outpatient department complaining bilateral foot
pain, which she described as a burning and tingling
sensation. She is on Insulin therapy for the last six
 years and currently has poor glycemic control. An
examination of her feet reveals that cool extremities
with absent pulses, reduced vibration perception and
loss of 10-g monofilament pressure sensation.

What is the most likely assessment in favor of her

presentation?

A. Peripheral neuropathy
B. Deep vein thrombosis
C. Autonomic neuropathy
D.Peripheral arterial disease

88. A 45-year-old male patient presented to a health

center with fever, muscle pain. The patient mentioned
of having unprotected sexual intercourse investigation,
his antibody feet revealed an HIV infection.

What is the most likely status of this disease?

 A. Latency period
B. Asymptomatic stage
C. Symptomatic disease
D.The acute viral syndrome

89. A 35-year-old pregnant woman who is taking anti-

tuberculosis drugs comes with a compliant of
numbness in her feet. The physician suspected
Isoniazid indicated peripheral neuropathy and
prescribed pyridoxine 25mg PO daily as a treatment.

What is the mechanism behind her peripheral

neuropathy?

A. Increasing production of GABA

B. Decreasing the concentration of glutamate
C. Inhibiting the enzyme N-acetyltransferase-2
D.Depleting neuronal pyridoxal 3-phosphate
90. A 43-year-old woman with schizophrenia has gained
5.5 kg weight with an in abdominal girth since she
started taking Risperidone over the past 3 months.

For what clinical condition will the woman most likely

be exposed?

A. Hypertension
B. Diabetes mellitus
C. Congestive heart failure
D.Ascites from liver failure

91. A 57-year-old man with long term schizophrenia has

been maintained on a new anti psychiatric drug. Now
he reports that there are frequent incidences of
seizure since he started taking medication. All other
findings are normal.

What is the most likely drug that is responsible for his

complaint?
 A. Clozapine
B. Olanzapine
C. Risperidone
D. Ziprasidone

92. A 35-year-old high school teacher began to

experience mood changes in recent days. He losing
interest in his work and lost the desire to play his daily
tennis match. He preoccupied with feelings of guilt,
worthlessness, and hopelessness. In addition to
psychiatric symptoms, the patient complained of
muscle aches throughout his body. Physic and
laboratory tests were unremarkable. After six weeks of
therapy with Fluoxetine, symptoms resolved.
However, the patient again complains of sexual
dysfunction.

What will be the most useful initial approach to

manage his compliant?
 A. Wait and see
B. Reduce the dose
C. Initiate Sildenafil
D.Change to other antidepressant

93. A 28-year-old man with manic-depressive disorder

has been maintained on Lithium carbonate for two
years and his mood was stable in those years. Now, he
reports a gradual Onset of fatigue, weight gain and
cold intolerance.

What is the most likely laboratory test to diagnosis his

problem?

A. Thyroid-stimulating hormone
B. Hepatic function panel
C. Glucose tolerance test
D.Hematocrit
94. A 10-year-old boy, who is on an antiepileptic drug
for one year for generalized tonic seizure visits a
dentistry clinic complaining an overgrowth of gum
tissue. On assessment, other findings are
unremarkable. The dentist in charge consults a clinical
pharmacist for possible association with the patient's
antiepileptic drug that he could not remember by its
name.

What is the most likely drug the pharmacist would

suspect?

A. Sodium valproate
B. Phenobarbitone
C. Carbamazepine
D.Phenytoin

95. A 45-day-old child is presented to an emergency

department with irritability and fever. Culture showed
streptococcus pneumonia which was diagnosed as
 bacterial meningitis. The physician in charge
prescribed Ceftriaxone 100 mg/kg BID for 14 days and
Dexamethasone 0.6 mg/kg/day to be given 20 minutes
before the first antibiotic dose and QID for 02 days.

What is the most likely drug therapy problem that

needed additional Dexamethasone needed?

A. Increase in neurologic sequel

B. Decrease in bactericidal activity
C. Increase in antibiotic penetration
D.Decrease in antibiotic penetration

96. A 45-year-old man presents to a hospital with

compliant of cough of two days duration. The patient
has no previous medication and medical history. On
physical examination, his pulse rate is 70/min,
respiration is 16/min, blood pressure is 110/70 mmHg,
and the patient is oriented to time, person and place.
On laboratory investigation, blood urea nitrogen is 12
 mg/dl (Normal range: 8-23 mg/dL). The presumptive
diagnosis is community acquired pneumonia.

What is the most appropriate initial therapy for this

patient?

A. Benzyl penicillin 3 million IU LV. QID for 7 days

B. Amoxicillin 500 mg P.O. TID for 7 days
C. Ceftazidime 1gm IV. TID for 10 days
D.Ceftriaxone 1gm IV BID for 7 days

97. A 25-year-old woman presents to a hospital with a

complaints of worsening pain, redness, and swelling
on her left leg of three days due to an abrasion that
occurred after a falling accident. During the past one
and half days, the leg becomes increasingly painful and
tight the patient has no past medical and medication
history. On examination, the area is red, painful, warm
to touch, and there is no discharge, fever or chills. The
presumptive diagnosis is mild cellulites’.
 What is the most appropriate empirical therapy for
this patient?

A. Ceftriaxone 1g IV BID for 5 days

B. Amoxicillin 500 mg orally TID for 7 days
C. Cloxacillin 500 mg orally QID for 7 days
D.Penicillin VK 250 mg orally TID for 7 days

98. A 20-year-old sexually active male patient is

diagnosed for gonococcal urethritis and came with a
prescription containing a certain drug with the
appropriate dosage. The pharmacist working in the
dispensary tells the patient to take the drug with or
without food.

What is the most likely drug dispensed for this patient?

A. Azithromycin
B. Clarithromycin
C. Erythromycin
 D.Vancomycin

99. A 25-year-old female patient diagnosed with

lymphogranuloma venereum and anemia comes to a
pharmacist with a prescription that requests for
Doxycycline 100 mg PO BID for three weeks and a
certain another drug. The pharmacist advises the
patient to take the other drug an hour before or two
hours after taking the Doxycycline.

What is the most likely drug that is dispensed with

Doxycycline?

A. Cyanocobalamin
B. Ferrous sulfate
C. Folic acid
D. Iron dextran
100. A patient with stable angina comes with a
prescription containing sublingual Nitroglycerine with
appropriate dosage. The pharmacist on duty is
concerned about the tolerance issue associated with
nitroglycerine and wants to tell his patient important
information that can enhance the efficacy of the
prescribed drug.

What is the most pertinent advise the pharmacist

could give in this case?

A. Increase drug's daily dose

B. Take the drug regularly
C. Have a drug free period
D.Stop this drug abruptly