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Part I - Sample Questions

The sample questions that follow are NOT intended or designed to be a sample exam and do
NOT represent an exact model of the Pharmacist Qualifying Examination-Part I, in terms of
difficulty and proportion of topics. However, individually, these examples are intended to be
representative in format and phrasing style of the types of questions found in the Qualifying
Examination-Part I. They also illustrate a variety of the competency areas contained in the exam
blueprint. Please note that, although these questions are reviewed and updated annually to
ensure currency of content, if guidelines or legislation change in the interim, the answers may not
be accurate.
Click here for the answers to the sample questions.

COMPETENCY 1: Ethical, Legal and Professional Responsibilities

1. According to the Narcotic Control Regulations of the Controlled Drugs and Substances Act,
which of the following practitioners may prescribe narcotic drugs?
a. Midwives
b. Chiropractors
c. Osteopaths
d. Pharmacists

2. The ethical principle of veracity requires that pharmacists:

a. respect the rights of others to make choices.
b. do good to patients, placing the benefit of the patient over other factors such as cost.
c. act with fairness, to allow people to receive that to which they are entitled.
d. act with honesty and without deception.

3. After speaking with a patient regarding her questions about weight loss and healthy methods of
long term weight maintenance, the customer still wishes to use a herbal remedy recommended by
her best friend. Which of the following ethical principles must the pharmacist respect regarding
this patient’s plan?
a. Justice
b. Beneficence
c. Autonomy
d. Confidentiality

4. According to federal legislation, which of the following medications requires witnessed

destruction in a pharmacy?
a. Ketamine
b. Duloxetine

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c. Galantamine
d. Topiramate

5. KP presents to the pharmacy with a new prescription for Drug X. The pharmacist identifies that
Drug X has the potential to interact with another medication that KP is taking and contacts the
prescriber. The prescriber provides rationale for using the two agents at the same time. The
pharmacist and physician agree upon appropriate follow-up measures over the next several
days. Which of the following statements is correct regarding documentation of the pharmacist’s
encounter with the physician? The encounter:
a. does not need to be documented, as no changes were made to the prescription and the
pharmacist has determined it is appropriate to dispense the medication.
b. should not be documented, as documentation poses the risk of increasing the prescriber’s
liability if an adverse event occurs.
c. should be documented in the patient’s pharmacy profile and the patient should be provided with
a copy of the note to reduce the pharmacist’s liability.
d. should be documented in the patient’s pharmacy profile, with a description of the monitoring
plan.

6. According to federal legislation, which of the following examples shows a legally correct refill
designation on a written prescription for dexamphetamine?
a. Repeat twice.
b. Repeat monthly.
c. Repeat twice as required.
d. Repeat twice at 14 day intervals.

7. According to the Benzodiazepine and Other Targeted Substances Regulations, what is the
expiry date for refilling a prescription for lorazepam?
a. Six months from the date written
b. Six months from the date originally filled
c. One year from the date written
d. One year from the date originally filled

8. Which of the following pharmaceuticals is regulated federally under the Precursor Control
Regulations of the Controlled Drugs and Substances Act, as a precursor chemical for illicit drug
use?
a. Dextromethorphan
b. Dimenhydrinate
c. Diazepam
d. Pseudoephedrine

9. For a drug undergoing research and development processes in Canada, which of the following
statements is correct?
a. Application for patent protection is granted for a maximum period of three years.
b. A New Drug Submission must be filed in order to start clinical trials.
c. Clinical trials involve three phases that assess animal safety and efficacy.
d. Health Canada, under the Food & Drugs Act & Regulations, provides Notice of Compliance.

10. Which of the following is the national voluntary organization for advocacy of pharmacists and
patient care?
a. Canadian Pharmacists Association
b. Canadian Patient Safety Institute
c. Institute for Safe Medication Practices

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d. National Association of Pharmacy Regulatory Authorities

11. According to Health Canada, a pharmacist administering a vaccine must document which of
the following information in the patient's record of vaccination?
a. Date of birth
b. List of other medications
c. Post-immunization adverse effects
d. Drug allergies

COMPETENCY 2: Patient Care

12. RY is an 85 year old male who lives alone and currently takes 12 different medications. For
the past 2 weeks he has telephoned to ask the pharmacist what dose of diuretic he should be
taking (this medication looks similar to another tablet that he takes). He calls again today with the
same question. After answering his question, the most appropriate pharmacist action should be
to:
a. call RY’s family doctor to suggest changing the diuretic to something that looks different.
b. suggest that RY have the labels on his prescription bottles changed to a bigger font for easier
reading.
c. recommend that the pharmacy use a blister packaging dosette to dispense RY’s medications.
d. suggest that RY write down the answer to his question so that he does not need to phone
again.

13. JQ is a 67 year old male with type 2 diabetes that is controlled with insulin. Today, JQ’s wife
calls the pharmacist to inquire what to do regarding JQ’s very low blood glucose reading (2.8
mmol/L). She also notes that he seems to be confused. JQ’s wife should be instructed to:
a. take JQ immediately to the nearest emergency department.
b. have JQ eat a carbohydrate-rich meal and retest in 1 hour.
c. give JQ a 15-20 gram glucose supplement and retest in 15 minutes.
d. retest JQ’s blood glucose level in 1 hour and phone back if it remains low.

14. RF is an 80 year old female who developed CDAD (Clostridium difficile-associated diarrhea)
after recent treatment of a urinary tract infection with ciprofloxacin. She is admitted to hospital with
severe symptoms including profound diarrhea (8 watery bowel movements per day), severe
abdominal pain, fever (39°C) and confusion. Based on her symptoms, which of the following is
the most appropriate therapy choice for her?
a. Oral fidaxomicin
b. Oral metronidazole plus intravenous vancomycin
c. Oral cholestyramine
d. Oral vancomycin plus intravenous metronidazole

15. CC, a 72 year old female, complains to the pharmacist that her stomach has been bothering
her recently. Current medications include: levothyroxine 100 mcg po daily (x 30 years),
acetaminophen 500 mg po qid (x 5 months), atorvastatin 40 mg po at bedtime (x 4 years),
ibuprofen 400 mg po tid prn for joint pain (x 2 months) and zopiclone 3.75 mg po at bedtime prn (x
3 months). Which of the following drug therapy problems is most likely contributing to CC’s recent
symptoms?
a. Too high a dosage of atorvastatin
b. Too high a dosage of zopiclone
c. Use of ibuprofen without gastroprotection
d. Drug interaction between atorvastatin and zopiclone

16. AM has been taking bupropion XL 300 mg po daily for four months for the treatment of

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depression and reports to the pharmacist that he is not experiencing any improvement in his
symptoms. After the pharmacist consults with the prescriber, it is decided to change his
medication to citalopram 20 mg po daily. Which of the following is the recommended method for
making this switch in antidepressant therapy?
a. Stop bupropion and start citalopram 20 mg daily the next day.
b. Stop bupropion and wait 7 days before starting citalopram 20 mg daily.
c. Taper bupropion over 7 days and then start citalopram 20 mg daily.
d. Start citalopram 20 mg daily and then taper bupropion dose over 7 days.

17. The pharmacist fills a prescription for sumatriptan 100 mg tablets for a patient with migraine.
Appropriate information to provide to the patient includes which of the following?
a. If the sumatriptan does not relieve the headache within four hours, ergotamine may be used.
b. If no relief is achieved in two hours, a dose of 200 mg should be taken.
c. If the headache returns, a dose of 100 mg can be repeated two hours after the first dose.
d. The maximum dosage of sumatriptan 100 mg in any 24 hour period is six tablets.

18. JG has been taking metoclopramide 10 mg po q6h for the past 3 days as part of her
chemotherapy regimen. She normally takes 4 doses daily, 30 minutes prior to meals and at
bedtime. This morning, she forgot to take her morning dose before leaving home for a hospital
check-up. When she arrives at the clinic, she asks the pharmacist what she should do about her
missed dose, as she expects to be home again around 11:00 am. The pharmacist should advise
JG to:
a. take the missed dose immediately when she gets home and continue as scheduled.
b. take two doses at lunchtime to make up for the missed dose.
c. skip the missed dose and take the next scheduled dose at lunchtime.
d. space 4 doses into the remaining hours between when JG gets home and her bedtime.

19. EK is a 25 year old female who presents to the pharmacy requesting Plan B® (levonorgestrel)
for emergency contraception following an episode of unprotected sex 12 hours ago. After
speaking with EK, the pharmacist decides she is a good candidate to receive Plan B®. The
pharmacist should include which of the following counselling information for EK?
a. Take one tablet daily for 3 consecutive days.
b. A pregnancy test should be done 5 days after completing Plan B®.
c. Plan B® will protect EK from pregnancy due to unprotected intercourse until her next menses.
d. EK may experience spotting a few days after taking Plan B®.

20. Following a pharmacist’s interview of a patient seen in an asthma clinic, which of the following
findings should be documented in the “plan” section of the SOAP format notes?
a. Nocturnal symptoms
b. Pulmonary test results
c. Dyspnea on exertion
d. Review of inhaler technique at next visit

21. For a child with asthma, which of the following factors is an indicator of poor control?
a. Number of colds experienced each year
b. Need for use of a spacer device with inhalers
c. Awakening at night with asthma symptoms
d. Keeping one canister of salbutamol at home and one at school

22. Which of the following pathogens is most commonly implicated in acute bacterial

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rhinosinusitis?
a. E. coli
b. S. aureus
c. S. pneumoniae
d. N. meningitidis

23. DC, a 57 year old female, receives a prescription for celecoxib 100 mg po bid for osteoarthritis
in her knees and hands. DC's only current medication is acetaminophen 650 mg po tid prn for
joint pain. She enjoys a glass of wine with dinner and is a non-smoker. DC is otherwise healthy.
Which of the following best represents the pharmacist's assessment of DC's new therapy?
a. DC should discontinue acetaminophen with celecoxib use.
b. DC should discontinue her wine consumption with celecoxib use.
c. DC requires concurrent cytoprotection with celecoxib use.
d. DC has no current drug therapy problems.

24. BG, a 45 year old male with type 1 diabetes mellitus, is currently using a premixed 30/70
combination of regular and intermediate-acting insulin subcut bid (before breakfast and supper).
The following blood glucose values are observed:
5.8 mmol/L at 2200 h
3.6 mmol/L at 0300 h
10.2 mmol/L at 0800 h (2 hours after breakfast)
Which of the following is the most appropriate initial adjustment for BG’s insulin regimen?
a. Decrease the suppertime insulin dose.
b. Increase the suppertime insulin dose.
c. Decrease the breakfast time insulin dose.
d. Increase the breakfast time insulin dose.

25. For a patient who receives a chemotherapy regimen containing cisplatin, which of the
following is a significant adverse effect of cisplatin?
a. Ototoxicity
b. Hepatotoxicity
c. Photosensitivity
d. Pulmonary fibrosis

26. Cyclosporine is known to inhibit cytochrome P450 isoenzyme 3A4. Which of the following
medications could have elevated serum concentrations due to inhibition of metabolism by
concurrent cyclosporine?
a. Amoxicillin
b. Atorvastatin
c. Metoprolol
d. Levothyroxine

27. FR is a 70 year old female client who presents to the pharmacist, complaining of nausea,
diarrhea and dizziness for the past three days. Her medication profile includes: ASA, digoxin,
enalapril, and amiodarone. She denies any recent diet changes and the only change to her
medications was the addition of amiodarone last week. She believes she must have picked up a
“stomach bug” and would like something for symptom relief. The most appropriate pharmacist
recommendation for FR is to:
a. take loperamide and dimenhydrinate for symptom relief.
b. take increased fluids and bed rest until the symptoms resolve.
c. contact FR’s physician to discontinue amiodarone until these symptoms resolve.

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d. contact FR’s physician to suggest that a digoxin level be taken.

28. FD, a 58 year old male with hypertension, asks the pharmacist if cranberry juice would be
useful for his current symptoms, which include frequency and a large volume of urine, but no
urgency, or painful urination. Further questioning reveals that for the past 2 months he has also
experienced polydipsia and polyphagia. The pharmacist should refer FD to his physician because
these symptoms are consistent with:
a. a urinary tract infection.
b. prostate hyperplasia.
c. diabetes mellitus.
d. renal complications of hypertension.

29. DS is a 27 year old male who comes to the pharmacy seeking advice because, for the past 24
hours, he has experienced abdominal cramping, mild fever and frequent, loose stools with some
blood loss. DS thinks it may be related to the antibiotic he has been taking for a dental abscess.
Current medications include: clindamycin 150 mg po qid x10 days, started 8 days ago, and
losartan 25 mg po daily for hypertension, started 3 months ago. The most appropriate pharmacist
response is that these symptoms:
a. are expected, transient side-effects of clindamycin; treat symptoms and continue medications.
b. may indicate an interaction between clindamycin and losartan; pharmacist call to dentist is
warranted.
c. may indicate clindamycin-related pseudomembranous colitis; seek immediate medical
attention.
d. are probably unrelated to DS’s medications; treat for flu symptoms and follow-up if no
improvement.

30. Following the measurement of high amounts of free cortisol in the urine of a patient, a
confirmatory test for the diagnosis of Cushing’s syndrome is a test for normal cortisol
suppression, through the administration of:
a. budesonide.
b. triamcinolone acetonide.
c. prednisolone.
d. dexamethasone.

31. For patients with a previous history of gastric ulcers who require ASA daily for stroke
prophylaxis, which of the following is the most effective management strategy?
a. Concurrent use of an H2 antagonist
b. Use of an enteric-coated product
c. Reduce the dose of ASA to every other day
d. Screening and eradication of H. pylori

32. CY is a 58 year old female who has heart failure (NYHA III). Her physician wants CY to start
therapy with spironolactone or eplerenone. Which of the following adverse effects is found
significantly more often with spironolactone than with eplerenone?
a. Bradycardia
b. Gynecomastia
c. Hyperkalemia
d. Prolonged QT interval

COMPETENCY 3: Product Distribution

33. Appropriate auxiliary labelling for clarithromycin suspension includes which of the following?

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a. Shake well before using

b. Take with plenty of fluids
c. Avoid prolonged exposure to sunlight
d. Keep refrigerated

34. A biological safety cabinet would be the best choice for preparing a parenteral formulation of:
a. alteplase.
b. doxorubicin.
c. nitroglycerin.
d. penicillin.

35. A physician wants to switch a terminally-ill patient from slow release morphine sulphate
tablets, 15 mg po twice daily, to a liquid morphine sulphate dosage form because the patient has
difficulty in swallowing tablets. If a morphine sulphate solution containing 5 mg per mL is
prescribed q4h, what volume should be dispensed for a 20 day supply to provide the same pain
relief as the tablet regimen?
a. 20 mL
b. 60 mL
c. 100 mL
d. 120 mL

36. A patient is currently taking 220 mg of anhydrous zinc sulphate. To receive the equivalent
amount of elemental zinc, how many milligrams of zinc sulphate heptahydrate (•7 H20) would the
patient require? (Molecular weights: zinc 65, ZnSO4 161, H20 18)
a. 123 mg
b. 220 mg
c. 300 mg
d. 392 mg

37. Given that 30 g of a mild corticosteroid ointment covers the entire surface of any adult for one
application, how much ointment (in grams) should be dispensed for an 18 year old patient who
requires treatment on approximately 20% of her body with twice daily application for 14 days?
a. 12 g
b. 84 g
c. 124 g
d. 168 g

38. A patient in an intensive care unit is ordered a dopamine intravenous infusion to start at a rate
of 5 mcg/kg/min. If the patient weighs 158 pounds and dopamine is available as a premixed
intravenous solution containing 200 mg/250 mL, what is the hourly infusion rate?
a. 3 mL/h
b. 9 mL/h
c. 27 mL/h
d. 39 mL/h

39. BV is a 62 year old, obese female who visits a walk-in-clinic while her physician is away on
vacation. She presents to the pharmacist with the following prescription:
Losec® (omeprazole) 30 mg
M: 30
Sig. i po daily
The pharmacist knows that this product is only available in 10 mg or 20 mg strengths and that
BV’s profile shows that she was previously on the 20 mg strength of this medication. The most

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appropriate initial pharmacist response is to:

a. tell BV that the physician has made a prescribing error.
b. ask BV why she visited the clinic today and what the physician told her about the prescription.
c. dispense using omeprazole 10 mg and adjust the quantity and dose accordingly.
d. assume the prescriber was thinking of Prevacid® (lansoprazole) 30 mg and change the
prescription accordingly.

40. A community pharmacy provides prescriptions for elderly patients in a nearby long-term care
facility where the nursing staff administer medications. When processing the monthly refills for
NR, an 83 year old female resident, the pharmacist notices that NR’s lorazepam refills have been
ordered several days early on the last 2 occasions. Which of the following is the most appropriate
action for the pharmacist to take?
a. Ask NR if there has been a dosage change with her lorazepam.
b. Ask the nurse at the residence to check NR’s medication administration records.
c. Alert the prescribing physician that NR is taking more lorazepam than prescribed.
d. Report the nursing staff at the residence for a fraudulent diversion of medication.

41. A physician asks the pharmacist about obtaining a Special Access Programme (SAP)
medication. Which of the following statements is true regarding accessing medications through
SAP?
a. SAP authorization certifies that the drug is safe and effective.
b. All SAP medications are provided free of charge to patients.
c. Medications may be authorized for a maximum duration of three months.
d. The manufacturer has the final authority on whether to supply the requested drug.

42. Which of the following classes of medications is most likely to be administered by the
intravenous piggyback method?
a. Antibiotics
b. Opioids
c. Insulins
d. Erythropoiesis regulating hormones

43. Which of the following statements is correct regarding compounded sterile preparations
(CSPs) in a hospital pharmacy?
a. Immediate-use CSPs that are intended for urgent use situations have less stringent preparation
criteria than other CSPs.
b. A multi-dose batch of an immediate-use CSP may be prepared for a patient.
c. A pharmacist must be directly responsible for the labelling of all finished CSPs, even when
prepared by trained personnel.
d. Beyond-use dates are ideally determined by test sampling of the individual CSP batch.

44. Which of the following drug orders is incomplete and requires follow-up with the prescriber?

a. Zithromax Z-Pak® (azithromycin 250 mg), 2 tabs po day 1 and 1 tab po days 2-5
b. Flonase® (fluticasone) 100 mcg spray, 1 or 2 sprays in each nostril bid x 1 bottle
c. Actonel® (risedronate), 35 mg po once weekly x 12 tabs
d. Zocor® (simvastatin), 1 tab po hs for 3 months

45. Which of the following factors is most likely to contribute to a widespread shortage of a
pharmaceutical product?
a. Lot recall

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b. Patent expiration
c. De-listing by provincial drug plans
d. Lack of raw material

46. Which of the following characteristics is the most important for assessing the bioequivalence
of two brands of a pharmaceutical dosage form?
a. Excipients
b. Physical appearance
c. Manufacturing cost
d. Pharmacokinetic properties

47. Which of the following injectable products requires refrigerated storage?

a. Gravol® (dimenhydrinate)
b. Enbrel® (etanercept)
c. Imitrex® (sumatriptan succinate)
d. EpiPen® (epinephrine)

48. A male patient weighing 165 pounds is brought to the Emergency Room approximately 6
hours after ingestion of an overdose of acetaminophen. Acetylcysteine IV will be administered
according to the following dosing regimen:
Total IV dose = 300 mg/kg given over 20 hours, as follows:
Loading Dose:150 mg/kg in 250 mL D5W IV given over 15 minutes, followed by:
First infusion: 50 mg/kg in 500 mL D5W IV given over 4 hours, followed by:
Second infusion: 100 mg/kg in 1 L D5W given over 16 hours.
Which of the following represents the correct preparation of the three acetylcysteine IV bags
needed for this patient?
a. Acetylcysteine 2.25 g in 250 mL D5W; 0.2 g in 500 mL D5W; 1.6 g in 1 L D5W
b. Acetylcysteine 11.25 g in 250 mL D5W; 3.75 g in 500 mL D5W; 7.5 g in 1 L D5W
c. Acetylcysteine 22.5 g in 1 L of D5W
d. Acetylcysteine 24.75 g in 250 mL D5W; 8.25 g in 500 mL D5W; 16.5 g in 1 L D5W

49. A patient is receiving warfarin (using 2 mg tablets in compliance packaging) according to the
following regimen:
Sunday (Su), Tuesday (Tu), Thursday (Th) and Friday (F) - 6 mg
Monday (M), Wednesday (W) and Saturday (Sa) - 2 mg
The patient’s recent INR results have been consistently high and it is decided that the weekly
dose should be reduced by 20%. Which of the following regimens would be most appropriate if
the patient is to continue using 2 mg tablets in compliance packaging?
a. Su, Tu, F - 5 mg; M, Th - 3 mg; W, Sa - 1 mg
b. Su, M, Tu, W, Th, F - 4 mg; Sa - no warfarin
c. 4 mg daily
d. 3.5 mg daily

COMPETENCY 4: Practice Setting

50. MT, a registered pharmacy technician, has worked in a community pharmacy for 5 years. He
is well-trained and welcomes new learning opportunities. His manager now wants to assign a new
project related to the preparation of sterile products in the pharmacy. Which of the following steps
should be taken first with the technician?

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a. Explore educational opportunities to prepare the technician for the project.

b. Provide an overview of the project goals and the intended role of the technician.
c. Discuss suggested strategies to effectively accomplish the project.
d. Negotiate a timeframe for the completion of the project.

51. Which of the following criteria should be considered when reviewing a medication for addition
to the hospital formulary?
a. The amount of samples provided to hospital physicians
b. Research funds donated to the hospital by the pharmaceutical company
c. National adverse drug reaction reports
d. Willingness of the pharmaceutical company to sponsor educational events

52. In deciding what medications are appropriate for its formulary, the hospital must consider a
drug’s efficacy, safety, associated workload, and acquisition cost. Several new intravenous
antifungal agents (drug A, drug B, and drug C), all with equal efficacy and safety to drug D, have
recently become available. Currently the hospital stocks drug D, which has been available for
several years. Data for the medications is as follows:

Drug Cost/day Dosing Frequency Treatment Duration (days)

A $2.25 once daily 14

B $5.00 bid 7

C $2.25 bid 7

D $2.25 qid 7

The most appropriate choice for the hospital is:

a. Drug A.
b. Drug B.
c. Drug C.
d. Drug D.

53. A pharmacy manager is conducting yearly performance reviews for her pharmacy assistants.
Which of the following statements is true regarding this process?
a. A group review is an effective means to motivate underperforming staff.
b. Only performance issues of which the employee has been made aware should be included in
the review.
c. Staff who work in the same role should be ranked in comparison to one another.
d. The results of the performance review should not be considered for employee wage increases.

COMPETENCY 5: Health Promotion

54. Which of the following is an appropriate recommendation for a pharmacist to provide to a
patient regarding chronic allergic rhinitis from multiple environmental triggers?
a. Use oxymetazoline 2 sprays in each nostril bid
b. Use zippered, allergen-proof casings for mattresses and pillows
c. Open windows to get fresh air into the home
d. Take ibuprofen 200 mg/pseudoephedrine 30 mg po q8h

55. DS wishes to protect her children from West Nile infection and requests information from the

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pharmacist regarding insect repellents. Which of the following is correct information from the
pharmacist?
a. DEET should be applied to the skin before sunscreen.
b. DEET is an effective repellant against mosquitoes, ticks and stinging insects.
c. Products containing oil of citronella are not recommended for children under 6 years of age.
d. Products containing oil of citronella have a very short duration of effect.

56. A pharmacist is planning a public information session regarding the prevention and
management of osteoporosis. Which of the following is an appropriate lifestyle recommendation
to include?
a. Drink 1-2 glasses of red wine with dinner.
b. Increase weight-bearing exercise such as walking.
c. Daily calcium needs are best met through supplements rather than diet.
d. Rely on assistive devices such as canes or walkers to reduce the risk of falls.

57. Which of the following scenarios best describes an effective strategy for a pharmacist to use
to assist a patient who is a smoker in the preparation stage of change?
a. Providing factual information about the consequences of smoking to raise
the patient’s awareness
b. Identifying barriers and temptations associated with smoking cessation
c. Helping the patient to set a quit date and announce the decision to family and friends
d. Supporting and problem solving to address short-term, unanticipated issues

COMPETENCY 6: Knowledge and Research Application

58. Which of the following would be the most useful reference to learn what combination of
antiretroviral agents is currently recommended as a first line therapy to treat HIV infection?
a. Meta-analyses
b. A randomized, controlled trial
c. Clinical practice guidelines
d. Compendium of Pharmaceuticals and Specialties

59. Which information source would be most appropriate to consult first, to determine if
buprenorphine/naloxone (Suboxone®) is available in a country outside of North America?
a. Compendium of Pharmaceuticals and Specialties
b. Medline
c. Martindale: The Complete Drug Reference
d. Cochrane Library database

60. Type II statistical error in a study comparing 2 drug treatment regimens occurs when:
a. the control drug is not a "gold standard" treatment.
b. a statistically significant difference exists but the difference is not clinically important.
c. the population under investigation does not represent the population with the disease.
d. the data shows no difference between 2 treatment regimens and a difference actually does
exist.

61. An adequately powered, randomized controlled trial conducted over 2 years demonstrated
that the primary outcome (a serious cardiovascular event) occurred in 15% of the patients who
received the new drug, whereas the primary outcome occurred in 25% of the patients who
received a placebo. The relative risk reduction achieved with the new drug is:
a. 10%.

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b. 15%.
c. 25%.
d. 40%.

62. In an adequately powered, randomized controlled trial conducted over 3 years, a specific
serious side effect (i.e., reduction in leukocytes) with conventional therapy is seen in 0.5% of the
study sample. In patients who receive a newly discovered drug, only 0.45% experience the same
side effect. Based on these results, the minimum number of patients that would need to receive
the new drug for 3 years to statistically demonstrate the prevention of one episode of this side
effect in at least one patient (i.e., NNT) is:
a. 20.
b. 150.
c. 200.
d. 2000.

63. A pharmacist has received information regarding a new drug to treat hypertension. The
information is based on a 2 month, placebo controlled, randomized study of 1000 adults that
showed a significant average decrease in systolic pressure from 160 mm Hg to 141 mm Hg and
diastolic pressure from 98 mm Hg to 86 mm Hg. The most common adverse reactions were
stomach upset and dizziness. Which of the following is the most significant limitation of this
study?
a. The study size was too small to assess benefits adequately.
b. The patients did not achieve guideline targets for hypertension.
c. Lowered blood pressure is a surrogate outcome.
d. Long term safety and efficacy were not assessed.

64. A drug is being evaluated for the risk of hyperkalemia. A large retrospective, case control
study has provided the following information:

Cases Controls

5250 5000

Number with hyperkalemia 22 7

What is the odds ratio for hyperkalemia with this drug?

a. 1
b. 2
c. 3
d. 4

65. A physician from the emergency department contacts the hospital pharmacist about a patient
visiting from the United States who has taken an apparent overdose of an unidentified tablet. The
physician has one of the tablets and is able to provide a description as well as information about
the markings on the tablet. The most appropriate reference for the pharmacist to consult in order
to identify the tablet is:
a. Medline.
b. RxFiles.
c. Micromedex.
d. Drug Product Database.

COMPETENCY 7: Communication and Education

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66. When counselling a patient who is upset about a new diagnosis and need for medications,
which of the following strategies is NOT appropriate for the pharmacist to use?
a. Providing a private environment for the interaction
b. Advising the patient that things will be okay
c. Probing to clarify the patient’s concerns
d. Letting the patient vent his/her feelings

67. In a hospital pharmacy, which of the following is the most effective strategy to enhance safety
and minimize the incidence of interpretation errors associated with verbal medication orders?
a. Use of bar code technology on medication orders
b. Use of TALLman lettering on medication orders
c. Use of automated dispensing technology
d. Requirement for a read-back to the prescriber of all verbal orders

COMPETENCY 8: Intra and Inter-Professional Collaboration

68. A 27 year old patient presents to a community pharmacy for the first time and tells the
pharmacist that he experienced an allergy to a penicillin product as a child. His symptoms
included hives, wheezing and facial swelling, which resulted in hospitalized care. Which of the
following is the most important reason for a community pharmacist to document this type of
information in a patient’s medication profile record?
a. To provide drug allergy information to the patient’s insurance provider
b. To encourage the patient to fill future prescriptions at this pharmacy
c. To enhance continuity of patient care regardless of the prescriber
d. To provide a record of cognitive services for insurance reimbursement

69. YZ is a patient who presents to the pharmacy for a refill of atenolol 50 mg tablets. The profile
shows one refill remaining. A 90-day supply of 90 tablets was dispensed and billed to his
insurance plan 60 days ago. YZ tells the pharmacist that he is currently taking atenolol 50 mg
twice daily, as directed by his physician. Checking the original prescription determines that YZ
was prescribed atenolol 50 mg daily. What is the most appropriate initial pharmacist response?
a. Fill the prescription early and charge YZ the full amount.
b. Contact YZ’s prescriber to request authorization for an early refill.
c. Contact YZ’s prescriber to clarify the dose and the early refill.
d. Offer to advance YZ with a supply of tablets and bill his insurance in 30 days.

70. Academic detailing by pharmacists provides a service to physicians by:

a. educating on improved prescribing legibility.
b. advising on optimal patient interviewing techniques.
c. providing current information on best prescribing practices.
d. promoting the use of physician samples given to patients.

71. A community pharmacist decides to collaborate with the local health department to offer
expanded services for geriatric patients. Which of the following is the most appropriate first step to
take?
a. Hire an additional registered pharmacy technician to assist with the increased workload.
b. Arrange for a meeting with the local public health nurses.
c. Seek financial sponsorship from pharmaceutical manufacturers.
d. Gather information about geriatric issues in the community.

72. RL is a 53 year old female with type 2 diabetes mellitus who is managed with oral metformin.
Her current A1C is 8.0%. RL does take her metformin regularly, but admits that she seldom cooks

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and only has time after work to pick up convenience foods or take-out meals. Which of the
following health care professionals is the most appropriate to address RL’s needs?
a. Pharmacist
b. Dietitian
c. Family physician
d. Nurse practitioner

COMPETENCY 9: Quality and Safety

73. Which of the following is the most appropriate quality assurance measure to assess the
competency of a staff pharmacist?

a. Rapid turnaround time on dispensing of medications

b. Documented “catches” of near miss medication errors
c. No patient complaints received by the pharmacy manager
d. Number of continuing education sessions attended

74. Which of the following is NOT a benefit of performing medication reconciliation activities in a
hospital setting?
a. Reduction of medication errors
b. Reduction of inventory pilferage
c. Reduction of preventable adverse effects
d. Assessment of patient adherence to therapy

75. An attending physician used the computerized practitioner order entry (CPOE) system in the
hospital to order a single bolus infusion of 1 L Ringer’s lactate solution to be administered over 1
hour to a patient. The evening pharmacist validated the electronic order without a stop date, and
the nurse verified the pharmacist’s entry. The medication administration record displayed an
ongoing order of 1 L Ringer’s lactate to be given every hour, which the nurses administered. The
patient received an excess 9 L of Ringer’s lactate in error. The unit pharmacist detected the error
in the morning and notified the physician. The patient had pleural effusions requiring transfer to
the ICU. The pharmacist submits an incident report in the hospital’s confidential internal safety
incident reporting system. Whose identity is the most appropriate to be documented in this report?
a. The attending physician
b. The pharmacist who validated the order
c. The nurse who verified the order
d. The nurses who administered the Ringer’s lactate

The next section includes EXAMPLES OF THE CASE SCENARIO FORMAT, in which there
are two or more questions in sequence, which are related to the patient information
provided in the (bolded) stem information shown at the top of the case.

QUESTIONS 76 TO 78 INCLUSIVE REFER TO THE FOLLOWING:

PB is a 70 year old female who is on the final day of a 10-day course of cotrimoxazole
(sulfamethoxazole/trimethoprim) DS, i po bid for mild pyelonephritis. PB’s medical
conditions include hypertension and osteoarthritis, for which she takes enalapril 5 mg po
bid and acetaminophen 650 mg po qid. PB has been feeling unwell for the past two days,
complaining of abdominal pain, diarrhea, and muscle weakness. She presents to the
emergency department, where it is discovered that her serum potassium level is 5.9
mmol/L (normal: 3.5-5.0 mmol/L) and her estimated creatinine clearance is 70 mL/min.

76. What drug therapy problem is PB currently experiencing?

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a. Her dosage of cotrimoxazole is too low.

b. Her dosage of cotrimoxazole is too high.
c. She is experiencing a drug interaction between enalapril and cotrimoxazole
d. She is experiencing a drug interaction between acetaminophen and cotrimoxazole.

77. PB’s hyperkalemia puts her at risk for developing which of the following?
a. Arrhythmias
b. Renal failure
c. Rhabdomyolysis
d. Metabolic alkalosis

One month later, PB returns to her family physician with symptoms of another urinary tract
infection (UTI). When hospitalized last month, her urinalysis showed resolution of the
original UTI. This is now PB’s third UTI in the past six months. She is still taking enalapril
and acetaminophen as before, and she has no known allergies.

78. After resolution of the current infection, which of the following is the most appropriate regimen
for UTI prophylaxis for PB?
a. Cotrimoxazole
b. Trimethoprim
c. Nitrofurantoin
d. Prophylaxis is not indicated for PB.

QUESTIONS 79 TO 81 INCLUSIVE REFER TO THE FOLLOWING:

PQ is a 75 year old patient who has just been diagnosed with hypothyroidism. Her past
medical history is significant for heart failure, type 2 diabetes mellitus, anemia and chronic
stable angina, all of which are well-controlled. Her medications include:
Carvedilol 6.25 mg po bid
Ferrous fumarate 300 mg po daily
Vitamin D 1000 units po daily
Glyburide 2.5 mg po bid
Enalapril 10 mg po bid
Furosemide 40 mg po daily
Nitroglycerin sublingual spray prn
79. PQ should be started on a low dose of levothyroxine because of her:
a. age.
b. gender.
c. diabetes.
d. metoprolol use.

80. Appropriate counselling and follow-up for PQ with initiation of levothyroxine includes all of the
following, EXCEPT:
a. separate the levothyroxine dose from ferrous fumarate by several hours.
b. take levothyroxine on a full stomach for greater absorption.
c. physician follow-up is needed in 6-8 weeks to have her thyroid function tests repeated.
d. closer monitoring of her angina should be done during dosage titration of levothyroxine.

81. Which of the following parameters is the most appropriate for PQ's self-evaluation of the
effectiveness of levothyroxine therapy?
a. Increased energy

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b. Weight loss
c. Improved vision
d. Less frequent angina

QUESTIONS 82 TO 84 INCLUSIVE REFER TO THE FOLLOWING:

A family health team is reviewing recent guidelines for dyslipidemia and cardiovascular
risks. Physician colleagues ask the pharmacist for information on the recommendations
for monitoring patients in various categories.

82. The current recommendation for performing a baseline plasma lipid profile in men is to screen
all males over the age of:
a. 35 years.
b. 40 years.
c. 50 years.
d. 55 years.

83. Lipid profile screening is important in all patients who have a history of:
a. COPD.
b. GERD.
c. diabetes.
d. liver disease.

84. Which of the following is the primary assessment tool recommended to quantify a patient’s 10-
year risk for total cardiovascular disease?
a. Framingham risk score
b. SCORE risk estimator
c. TIMI risk score
d. CHADS2 score

QUESTIONS 85 and 86 REFER TO THE FOLLOWING:

HM is a regular client at the pharmacy. He has been taking quetiapine 300 mg po bid for 8
months to help control his schizophrenia symptoms but he has recently noticed that some
of his symptoms have been worsening. Prior to starting quetiapine, HM took risperidone
therapy for 2 years. HM is a regular smoker and smokes between 10-20 cigarettes per day.
HM tells the pharmacist that now his psychiatrist would like to change his regimen to
clozapine.

85. In assessing the possible change to clozapine for HM, which of the following statements is the
most appropriate for the pharmacist to consider?
a. This change is appropriate, as clozapine may help patients who fail on other antipsychotics.
b. This change is not appropriate, as clozapine will likely produce the same effect as quetiapine.
c. This change is not appropriate, as the cost of monitoring and risk of adverse effects with
clozapine is too high.
d. This change is not appropriate, because the preferred recommendation is to add clozapine to
the current quetiapine.

86. HM is concerned about the possible adverse effects from clozapine. When discussing
monitoring with HM, which of the following statements is the most appropriate to include?
a. Dry eyes and dry mouth occur frequently and may be managed with nonprescription

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supplements.
b. Problems affecting the blood do occur rarely and regular blood labwork is required.
c. Cigarette smoking may increase the likelihood of experiencing side effects from clozapine.
d. Parkinsonian and other movement disorders may occur even with low doses of clozapine.

QUESTIONS 87 TO 89 INCLUSIVE REFER TO THE FOLLOWING:

WW is a 55 year old, obese male (BMI 35) with newly diagnosed type 2 diabetes. His most
recent fasting blood glucose is 9.6 mmol/L and A1C is 8%. He also suffers from
hypertension and osteoarthritis in his knees. His current medications are: ramipril 20 mg
po daily and acetaminophen 500 mg po qid.

87. Which of the following agents is the most appropriate choice for WW at this time?
a. Gliclazide
b. Sitagliptin
c. Canagliflozin
d. Metformin

88. If the anti-hyperglycemic agent chosen for WW is having its intended benefit, the most
appropriate therapeutic outcome would be:
a. achieving target A1C at 3 months.
b. fasting blood glucose < 6.1 mmol/L within 2 weeks.
c. decreased BMI within 3 months.
d. no episodes of hyperglycemia.

89. After starting on the anti-hyperglycemic agent, WW would like advice regarding self-
monitoring of his blood glucose. Which of the following statements is most appropriate for WW?
a. Blood glucose should be tested upon waking and before each meal.
b. Self-monitoring of blood glucose is not warranted at this time.
c. WW should avoid testing at alternate sites (e.g., forearm) since accuracy is reduced in obese
patients.
d. Self-monitoring will help WW to adjust the dosing of oral therapy in relation to meal size.

QUESTIONS 90 TO 91 INCLUSIVE REFER TO THE FOLLOWING:

TK is a 63 year old male with chronic kidney disease (Cr Cl = 29 mL/min/1.73m2) and gout.
He experienced his last gout attack about 2 months ago. Today his toe is extremely
painful, hot, red and swollen. At a walk-in clinic, he receives a prescription for naproxen
500 mg po bid for 5 days. TK’s other current medication is pravastatin 20 mg po at
bedtime.

90. What drug therapy problem should the pharmacist identify for TK?
a. Naproxen is inferior to indomethacin for the treatment of acute gout.
b. The duration of naproxen treatment is too short.
c. Naproxen should be avoided in patients taking pravastatin.
d. Naproxen should be avoided in patients with renal dysfunction.

91. Following successful resolution of the acute episode, TK’s physician decides that he should
initiate allopurinol. TK should be advised to:
a. limit fluid intake.
b. take medication on an empty stomach.

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c. use precautions to avoid photosensitivity.

d. report any skin rash or itching to the physician.

QUESTIONS 92 TO 94 INCLUSIVE REFER TO THE FOLLOWING:

TK is a 54 year old male who is a new patient at the pharmacy. He presents today with a
new prescription for 20 diazepam 10 mg, i po qid and taper as directed over 5-7 days. In
discussion with the pharmacist, TK admits that he has abused alcohol for the last 3 years,
but that he stopped drinking yesterday when he went to an alcohol treatment centre. He
discloses that he has not been looking after himself or eating well in recent months. His
current symptoms include agitation, insomnia and tremulousness. His medical history is
otherwise insignificant.

92. Which of the following drug therapy problems is the most important current issue for the
pharmacist to identify for TK?
a. TK is receiving too high a dose of diazepam.
b. Diazepam is not indicated for TK.
c. TK requires treatment with thiamine.
d. TK is not currently experiencing any drug therapy problems.

During the consultation, TK notices that his neighbour’s daughter, Cheryl, is employed as
a front-shop cashier in the pharmacy. He feels uncomfortable about providing further
information about his medical condition.

93. What is the most appropriate initial action to be taken by the pharmacist?
a. Advise TK that disclosure of information is necessary to address his medical needs.
b. Suggest that TK can go to another pharmacy if he wishes to avoid this concern.
c. Offer a private counselling area and advise TK that no information will be disclosed to Cheryl.
d. Advise TK that alcohol abuse is a medical problem and he should not feel uncomfortable about
it.

Later that same day, TK returns to the pharmacy with his vial of diazepam. He tells the
pharmacist that he did not receive the labeled quantity of the medication. The pharmacist
determines that a counting error did occur.

94. What is the best way for the pharmacist to prevent this type of error in the pharmacy in the
future?
a. Require that all narcotics and benzodiazepine prescriptions be counted only by pharmacist
staff.
b. Obtain signatures from patients picking up orders to confirm receipt of the correct labelled
quantity.
c. Double count all narcotics and benzodiazepines and document on the prescription hard-copy.
d. Use an electronic pill counter to ensure accurate prescription quantities for these medications.

QUESTIONS 95 TO 97 INCLUSIVE REFER TO THE FOLLOWING:

AE is a morbidly obese (BMI 42), 54 year old female with osteoporosis, who takes the
following medications:
Alendronate/vitamin D (Fosavance®)
Metformin extended-release (Glumetza®)
Gliclazide modified-release (Diamicron MR®)

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Calcium citrate
Ranitidine
AE is scheduled to undergo bariatric surgery that will result in a bypass of the duodenum,
proximal jejenum and all of her stomach except for the cardia. Her surgeon has asked AE
to discuss any necessary modifications to her medication regimen with her pharmacist.

95. Which of the following physiologic factors would be expected to increase following AE's
gastric bypass surgery?
a. Gastric pH
b. Surface area of the gastric mucosa
c. Gastric emptying time
d. Enterohepatic recirculation

96. Which of the following online resources is the most useful for determining appropriate
postsurgical modifications to AE's medication regimen?
a. RxFiles
b. CredibleMeds
c. PubMed
d. RxTx

97. Which of the following alternatives is the most appropriate recommendation for the pharmacist
to suggest for switching AE's osteoporosis therapy?
a. Teriparatide
b. Etidronate
c. Denosumab
d. Raloxifene

QUESTIONS 98 TO 99 INCLUSIVE REFER TO THE FOLLOWING:

TG, a 43 year old male, is admitted to the Emergency Room following a car accident. TG is
diagnosed with an open femur fracture. In the trauma treatment area, the extensive leg
wound requires thorough cleaning prior to fracture reduction. TG did not take any
medications prior to the accident and is not known to have any medical conditions.

98. The emergency physician asks the pharmacist what IV antibiotic prophylaxis should be given
to TG for the open fracture. Which of the following would provide the most appropriate empiric
antibiotic coverage for TG?
a. Cefazolin + metronidazole
b. Clindamycin + vancomycin
c. Metronidazole + gentamicin
d. Cefazolin + gentamicin

Following the fracture reduction surgery, TG is transferred from the emergency

department to the orthopedics ward for monitoring before he can be discharged to a
rehabilitation center.

99. Which of the following therapies for deep vein thrombosis prophylaxis is the most appropriate
while TG remains bedridden?
a. Clopidogrel
b. Enoxaparin
c. Warfarin

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d. Rivaroxaban

QUESTIONS 100 TO 101 INCLUSIVE REFER TO THE FOLLOWING:

FN, an 83 year old female, has early onset Alzheimer's disease, Parkinson's disease, mild
heart failure and urinary incontinence. She often becomes agitated in the evening. Her
current medications include the following:
Levodopa-carbidopa CR 200/50 mg po bid
Risperidone 0.25 mg po bid
Bumetanide 1 mg po daily
Donepezil 10 mg po daily
Ramipril 2.5 mg po qam
Calcium citrate 500 mg (elemental) po tid

100. Which of FN's medications is most likely contributing to her urinary incontinence?
a. Levodopa-carbidopa
b. Risperidone
c. Bumetanide
d. Ramipril

101. Which of FN's medications may worsen her Parkinson's diseases?

a. Risperidone
b. Donepezil
c. Ramipril
d. Calcium citrate

QUESTIONS 102 TO 103 INCLUSIVE REFER TO THE FOLLOWING:

Amoxicillin suspension is available in two strengths as shown below

Amoxicillin 125 mg/5 mL (100 mL bottle size) costs $3.20
Amoxicillin 250 mg/5 mL (100 mL bottle size) costs $5.40
Using the information provided above, the pharmacist is required to fill the following
prescription: Amoxicillin 187.5 mg po tid x 10 days

102. Which of the following provides the most cost-effective dosing regimen, rounding to full
bottles?
a. 2 bottles of amoxicillin 125 mg/5 mL
b. 3 bottles of amoxicillin 125 mg/5 mL
c. 1 bottles of amoxicillin 250 mg/5 mL
d. 2 bottles of amoxicillin 250 mg/5 mL

103. Which of the following provides the smallest, correct volume of amoxicillin suspension
needed for each dose of this prescription?
a. 3.75 mL of amoxicillin 125 mg/5 mL
b. 7.5 mL of amoxicillin 125 mg/5 mL
c. 3.75 mL of amoxicillin 250 mg/5 mL
d. 7.5 mL of amoxicillin 250 mg/5 mL

Answers to Sample Questions

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