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

Experiencingphotosensitivity(increased sensitivity to sunlight) as a result of takingciprofloxacinis an example of anadverse drug reaction (ADR). Thisunexpectedandundesirableeffect occurs in some individuals due tofluoroquinolones causing cellular damage from UV exposure.

A. Intended effect→ Incorrect; the intended effect of ciprofloxacin isbacterial infection treatment, not photosensitivity.

C. Synergistic effect→ Incorrect; asynergistic effectoccurs whentwo drugs work togetherto produce a greater effect, which is not the case here.

D. Anaphylactic reaction→ Incorrect;anaphylaxisis asevere allergic reactionwithrespiratory distress, hypotension, and swelling, not photosensitivity.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Medication Safety & Side Effects)

Lexicomp Drug Monograph for Ciprofloxacin

FDA Fluoroquinolone Safety Warnings

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

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

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

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

Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) Medication Safety Guidelines

FDA Medication Error Reporting and Prevention Guidelines

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

Cefdinir is a third-generation cephalosporin antibiotic commonly used to treat bacterial infections, including otitis media (middle ear infection) in children. It is available in both capsule and suspension forms. However, cefdinir suspension is supplied in different concentrations, typically125 mg/5 mLand250 mg/5 mL.

The prescription provided specifies"Cefdinir suspension 5 mL PO q12h x 10 days", but it does not mention the concentration (strength) of the suspension. Without this crucial information, the pharmacy cannot accurately determine the total dosage the patient will receive. Different strengths would result in significantly different amounts of cefdinir per dose.

For example:

If the prescriber intended125 mg/5 mL, then the patient would receive125 mg per dose (250 mg daily).

If the prescriber intended250 mg/5 mL, then the patient would receive250 mg per dose (500 mg daily).

This discrepancy could lead tounderdosing or overdosing, making it essential for the pharmacy to contact the prescriber to confirm the correct concentration before dispensing.

A. Cefdinir is not available as a suspension.→ Incorrect. Cefdinir is available inoral suspensionform, typically in 125 mg/5 mL and 250 mg/5 mL concentrations.

C. Cefdinir suspension is not indicated for otitis media.→ Incorrect. Cefdinir is FDA-approved for the treatment of otitis media in pediatric patients.

D. Cefdinir suspension was prescribed for a child old enough to swallow capsules.→ Incorrect. While some 8-year-old children may be able to swallow capsules, many pediatric patients prefer liquid formulations, and prescribers often choose suspensions for better compliance.

PTCB PTCE Exam Content Outline – Medication Order Entry and Fill Process(Ensuring accuracy of prescriptions, including strength and formulation).

FDA Drug Label for Cefdinir– Indicates available strengths and dosing requirements.

Lexicomp Drug Information for Cefdinir– Lists the recommended pediatric dosages and available suspension concentrations.

Pharmacology Textbooks (e.g., "Mosby’s Pharmacy Technician: Principles and Practice")– Reinforce the importance of verifying missing prescription details before dispensing.

Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

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

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

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

The vaccine must be discarded if reconstituted incorrectlyand not administered.

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

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

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

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

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

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

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

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

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

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

During pregnancy, medication safety is classified by theFDA Pregnancy Categories(prior to 2015) or thePregnancy and Lactation Labeling Rule (PLLR)(current system).

Acetaminophen (Tylenol) is considered the safest analgesic for pregnant women, especially for treating mild to moderate pain or fever.

It hasno known teratogenic effectswhen used at recommended doses.

A. Isotretinoin❌→Severe risk in pregnancy (Category X / Contraindicated)

Causes severe birth defects(craniofacial, cardiac, and central nervous system malformations).

Requires enrollment in theiPLEDGE programto prevent pregnancy exposure.

C. Lovastatin❌→Not safe in pregnancy (Category X / Contraindicated)

Cholesterol-lowering statins are teratogenic, as fetal development requires cholesterol.

D. Triazolam❌→Not safe in pregnancy (Category X / Contraindicated)

A benzodiazepine that can cause birth defects, neonatal withdrawal syndrome, and CNS depression in the fetus.

FDA Pregnancy and Lactation Labeling Rule (PLLR)– Discusses medication risks in pregnancy.

American College of Obstetricians and Gynecologists (ACOG) Guidelines– Listsacetaminophen as the preferred pain reliever during pregnancy.

PTCB PTCE Exam Content Outline– Covers drug safety in special populations, including pregnancy.

Why Not the Other Options?Key References:

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

Increased mortality in elderly patients with dementia-related psychosis

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

Neuroleptic malignant syndrome (NMS)

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

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

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

Other Answer Choices Explained:References:

FDA Medication Guide Requirements for Olanzapine (Zyprexa)

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

In prescription terminology,"troche" refers to a dosage form, specifically alozengethat dissolves slowly in the mouth to release medication.

Atroche (or lozenge)is asolid, flavoredmedication thatdissolves in the mouthover time, allowing for gradual drug absorption.

Used for:

Local effects(e.g., sore throat relief with benzocaine troches)

Systemic effects(e.g., hormone replacement therapy troches)

A. Time❌→ Incorrect

"Troche" doesnotindicate when to take the medication.

C. Rate❌→ Incorrect

"Troche" doesnotindicate how fast the drug is absorbed.

D. Route❌→ Incorrect

"Troche"describes the dosage form, whilerouterefers to how a drug is administered (e.g., oral, IV).

USP-NF (United States Pharmacopeia–National Formulary)– Defines dosage forms, including lozenges/troches.

PTCB PTCE Exam Content Outline– Covers pharmaceutical dosage forms and prescription terminology.

ISMP Medication Safety Guidelines– Includes troches in standard medication formulations.

Definition of Troche:Why Not the Other Options?Key References:

When entering prescription information into a pharmacy computer system,using leading zeros helps prevent medication dosing errorsby clearly specifying the correct dose.

What Are Leading Zeros?Aleading zerois azero placed before a decimal pointto prevent misinterpretation.

✅Correct:0.5 mg(clearly means half a milligram)

❌Incorrect:.5 mg(could be mistaken for 5 mg, leading to a10× overdose).

A. Allergies❌→Important, butnot directly related to dosing errors.

C. Insurance Information❌→Unrelated to medication dosing safety.

D. Contraindications❌→Relevant to medication selection, but not specific to preventing dosing errors.

ISMP Best Practices for Medication Safety– Recommends usingleading zerosto prevent dosing mistakes.

Joint Commission "Do Not Use" List– Warns against missing leading zeros in prescriptions.

PTCB PTCE Exam Content Outline– Covers prescription entry and error prevention strategies.

Why Not the Other Options?Key References:

Cytoxan (cyclophosphamide)belongs to thechemotherapy agentdrug classification. It is analkylating agentused to treat various types ofcancer, including:

Leukemia

Lymphoma

Breast cancer

Ovarian cancer

It works byinterfering with DNA replication in rapidly dividing cells, preventing cancer growth.

A. ACE inhibitor❌→Incorrect

ACE inhibitors (angiotensin-converting enzyme inhibitors)are used forhypertension and heart failure(e.g., lisinopril, enalapril).

C. Antibiotic❌→Incorrect

Antibioticstreatbacterial infections(e.g., amoxicillin, azithromycin).

D. Narcotic❌→Incorrect

Narcotics (opioids) are pain relievers(e.g., morphine, oxycodone).Cytoxan is not an opioid.

National Cancer Institute (NCI) Drug Dictionary– ClassifiesCytoxan as an alkylating chemotherapy agent.

PTCB PTCE Exam Content Outline– Covers chemotherapy drugs and their classifications.

FDA Drug Classification Guidelines– Lists Cytoxan as acytotoxic antineoplastic (chemotherapy) drug.

Why Not the Other Options?Key References:

TheInstitute for Safe Medication Practices (ISMP)maintains a list oferror-prone abbreviationsthat shouldnot be usedin medication orders to prevent misinterpretation and medication errors.

Analysis of the Answer Choices:Abbreviation

Meaning

ISMP Recommendation

U

Units

❌Do NOT use→ Can be mistaken for "0" or "4" (e.g., 10U could be misread as 100).Use"unit"instead.

AD

Right ear

❌Do NOT use→ Can be confused with "OD" (right eye).Use"right ear"instead.

AU

Both ears

❌Do NOT use→ Can be confused with "OU" (both eyes).Use"both ears"instead.

gtt

Drop

✅Accepted→ Common and not considered error-prone.

Since"gtt" for drop is not on ISMP's "Do Not Use" list, it is the correct answer.

ISMP List of Error-Prone Abbreviations– Confirms that "U," "AD," and "AU" should not be used in prescriptions.

Joint Commission "Do Not Use" List– Prohibits "U" and similar abbreviations to prevent dosing errors.

PTCB PTCE Exam Content Outline– Covers error prevention strategies, including abbreviation safety.

Key References:

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

An MFR includes:

Ingredients & amounts required.

Compounding procedures.

Stability and beyond-use dating (BUD).

Storage and labeling instructions.

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

B. Prevent drug diversion❌→Incorrect

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

C. Eliminate patient profiles❌→Incorrect

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

D. Guarantee drug availability❌→Incorrect

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

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

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

Why Not the Other Options?Key References:

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

Prescription dose:150 mg per dose

Suspension concentration:250 mg per 5 mL

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

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

Thus, the patient should take3 mL per dose.

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

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

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

Other Answer Choices Explained:References:

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

USP <795> Guidelines for Nonsterile Compounding & Drug Dilution

Lexicomp Drug Monograph for Amoxicillin Suspension

Per the FDA-approved labeling for NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), the product should be stored refrigerated at 2°C to 8°C (36°F to 46°F) prior to dispensing. After dispensing, NuvaRing may be stored at room temperature for a limited period per labeling (commonly referenced in technician materials as up to 4 months), but pharmacy stock should be kept refrigerated before it is dispensed. Freezing is not recommended.

References (Pharmacy Technician documents/Study Guides):

• NuvaRing Prescribing Information: Storage conditions (refrigeration prior to dispensing; room temperature allowance after dispensing).

• PTCB Top 200/Storage Requirements: Hormonal contraceptive ring storage.

• ASHP/Institutional storage guidelines for temperature-sensitive medications.

Multiple-dose vials (MDVs)containpreservativesto inhibit microbial growth. These vials are designed formultiple withdrawalsover time, increasing the risk of contamination. Preservatives, such asbenzyl alcohol or phenol, help prevent bacterial or fungal contamination after repeated needle insertions.

A. stability and compatibility→ Incorrect. Preservatives do not inhibit drug stability; they prevent microbial contamination.

B. sorption and leaching→ Incorrect. Sorption (adsorption/absorption of drugs onto container surfaces) and leaching (release of chemicals from containers) are unrelated to preservatives.

D. synergistic reactions→ Incorrect. Synergistic reactions refer to drug interactions, not contamination prevention.

Incorrect Answer Choices:Pharmacy Technician References:

PTCB PTCE Exam Content Outline (Sterile and Non-Sterile Compounding)

USP <797> Guidelines for Sterile Compounding

American Society of Health-System Pharmacists (ASHP) Guidelines on Multiple-Dose Vials

Mosby’s Pharmacy Technician Exam Review

ISMP maintains a “List of Confused Drug Names” highlighting look-alike/sound-alike name pairs with a history of mix-ups. Chlordiazepoxide (a benzodiazepine) and chlorpromazine (a typical antipsychotic) are a classic LASA pair on ISMP lists and in technician study materials, given their similar prefixes (“chlor…”) and length/appearance, leading to documented wrong-drug errors. While other pairs may also resemble one another, ISMP’s established examples include chlordiazepoxide/chlorpromazine specifically.

References (Pharmacy Technician documents / Study Guides):

• ISMP List of Confused Drug Names (community/inpatient).

• PTCB/ExCPT Medication Safety: LASA examples and tall-man lettering strategies.

• ASHP/ISMP LASA risk-reduction recommendations for selection, storage, and labeling.

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

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

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

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

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

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

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

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

National Center for Complementary and Integrative Health (NCCIH) – St. John’s Wort:https://www.nccih.nih.gov/

MedlinePlus – St. John's Wort Drug Interactions:https://medlineplus.gov

PTCB Exam Content Outline – Herbal Supplements & Drug Interactions

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

Lipitor is the brand name forAtorvastatin, aHMG-CoA reductase inhibitor (statin)used to lower cholesterol and reduce the risk of cardiovascular disease.

(A) Provastatin❌Incorrect –Misspelled, should bePravastatin(Pravachol).

(B) Fluvastatin❌Incorrect – Fluvastatin (Lescol) is another statin, but not the generic for Lipitor.

(C) Simvastatin❌Incorrect – Simvastatin (Zocor) is a statin but not the generic for Lipitor.

(D) Atorvastatin✅Correct – The generic name for Lipitor.

Analysis of Answer Choices:Statins & Their Brand Names:Generic Name

Brand Name

Atorvastatin

Lipitor✅

Simvastatin

Zocor

Pravastatin

Pravachol

Fluvastatin

Lescol

Rosuvastatin

Crestor

Lovastatin

Mevacor

Lipitor Prescribing Information: https://www.pfizer.com/products/product-detail/lipitor

PTCB Exam Content Outline – Generic & Brand Name Drug Recognition

Pharmacology for Pharmacy Technicians, 3rd Edition – Perspective on Statin Medications

References for Pharmacy Technicians:

In pharmacy practice and per USP/FDA conventions, when a manufacturer’s expiration date is expressed only as a month and year (e.g., “EXP 03/2026”), the product remains usable through the last day of that month. This standard is applied for product beyond-use and stock management, ensuring consistent interpretation across labeling and inventory control.

To determine the required volume in milliliters (mL) to administer 120 mg of furosemide using a stock concentration of 40 mg/2 mL, follow these steps:

Ordered dose =120 mg

Stock concentration =40 mg per 2 mL

Step 1: Identify Given ValuesStep 2: Set Up a ProportionUse the formula:

Volume required (mL)=(Ordered dose (mg)Stock concentration (mg/mL))\text{Volume required (mL)} = \left( \frac{\text{Ordered dose (mg)}}{\text{Stock concentration (mg/mL)}} \right)Volume required (mL)=(Stock concentration (mg/mL)Ordered dose (mg)​)

First, determine the concentration inmg per mL:

40 mg2 mL=20 mg/mL\frac{40 \text{ mg}}{2 \text{ mL}} = 20 \text{ mg/mL}2 mL40 mg​=20 mg/mL

Now, calculate the required volume:

120 mg20 mg/mL=6 mL\frac{120 \text{ mg}}{20 \text{ mg/mL}} = 6 \text{ mL}20 mg/mL120 mg​=6 mL

Thus, the correct answer is6 mL.

Final Answer: C. 6 mLPharmacy Technician References:

PTCB PTCE Exam Content Outline (Medication Order Interpretation & Dosage Calculations)

USP <797> Guidelines for Sterile Compounding

Mosby’s Pharmacy Technician Exam Review

American Pharmacists Association (APhA) Pharmacy Technician Guide

NSAIDs (e.g., ibuprofen, naproxen, aspirin) can irritate the gastric mucosa, increase gastric acidity, and worsen GERD symptoms or cause GI adverse effects such as dyspepsia and ulceration. Acetaminophen does not have NSAID gastric effects and is the preferred OTC analgesic/antipyretic for patients with GERD or those at risk for GI complications, when appropriate and within dosing limits.

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

Oral tablets

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

The others:

Dobutamine – IV only (used in cardiac settings)

Benzonatate – Oral capsules only (cough suppressant)

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

From Mosby’s Pharmacy Technician:

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

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

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

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

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

Other Answer Choices Explained:References:

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

Lexicomp Drug Monographs for Desvenlafaxine and Venlafaxine

Goodman & Gilman’s The Pharmacological Basis of Therapeutics

Needlegauge (G)refers to thediameter of the needle’s lumen(opening).The higher the gauge number, the smaller the needle diameter.

Lower gauge (e.g., 13G, 18G)→Larger needle(wider opening)

Higher gauge (e.g., 27G)→Smaller needle(narrower opening)

Common Needle Gauges and Their Uses:Gauge (G)

Needle Diameter (mm)

Common Use

13G

2.4 mm

IV drug administration (large-bore)

18G

1.2 mm

Drawing thick medications (e.g., oil-based injections)

20G

0.9 mm

General intramuscular (IM) injections

27G

0.4 mm

Subcutaneous (SC) or intradermal (ID) injections (e.g., insulin, vaccines)

Since27Gis the highest gauge listed, it corresponds to thesmallestneedle diameter, making it the correct answer.

A. 13G❌→ One of the largest gauges, used for IV fluids or blood transfusions.

B. 18G❌→ Large needle used for thick medications likedepot injections or contrast agents.

C. 20G❌→ Common forintramuscular injectionsbut larger than 27G.

PTCB PTCE Exam Content Outline– Covers needle gauges, injection routes, and proper medication administration.

USP <797> & USP <800>– Provide sterile compounding guidelines, including appropriate needle gauge selection.

CDC Vaccine Administration Guidelines– Recommend25-30Gfor subcutaneous and intradermal injections.

Why Not the Other Options?Key References:

Under federal DEA requirements for transferring controlled substance prescriptions in Schedules III–V, the receiving pharmacist must document key original prescription details, including the date of original dispensing, the original date of issuance, the original number of refills authorized, the number of refills remaining, and pertinent information about the transferring pharmacy (name, address, DEA, and Rx number), as well as the name of the transferring pharmacist. Information such as the medication’s expiration date or the receiving pharmacy’s DEA number is not required to be newly noted by the receiving pharmacy for the transfer record. The prescriber’s DEA number is part of the original prescription, but federal transfer documentation specifically requires noting the original dispensing date rather than re-recording the prescriber’s DEA.

References (Pharmacy Technician documents / Study Guides):

• DEA regulations for transfers of Schedule III–V prescriptions (21 CFR 1306.25) — required information for transferring and receiving pharmacists.

• PTCB/ExCPT prep materials: controlled substance prescription transfer documentation requirements.

Federal regulations require a Patient Package Insert (PPI) to be dispensed with oral contraceptives and with estrogen-containing products. The regulation specifies that a PPI must be provided with each prescription and refill in the outpatient setting and with the first dose and at least every 30 days in institutional settings. This requirement applies specifically to oral contraceptives, not broadly to androgens, corticosteroids, or oral chemotherapy (which more commonly require a Medication Guide, not a PPI).

References (Pharmacy Technician documents/Study Guides):

• 21 CFR 310.501 (Patient package inserts for oral contraceptives).

• 21 CFR 310.515 (Patient package inserts for estrogens).

• PTCB/ExCPT Exam Guides: Patient information requirements (PPI vs. Medication Guide).

Arashis acommon allergic reactionto medications.Drug allergiesoccur when the immune system overreacts to a medication, leading to symptoms such as:

Skin rash (most common)

Hives (urticaria)

Swelling (angioedema)

Anaphylaxis (severe reaction)

A. Dizziness❌→Side effect, not an allergic reaction.

Some medications (e.g., antihypertensives) cause dizziness, but it isnot an immune system response.

B. Constipation❌→Side effect, not an allergic reaction.

Opioids (e.g., morphine, oxycodone) commonly cause constipation, but it isnot due to an allergy.

C. Nausea❌→Side effect, not an allergic reaction.

Many medications (e.g., antibiotics, chemotherapy) cause nausea, but this isnot an immune-mediated reaction.

American Academy of Allergy, Asthma & Immunology (AAAAI)– Defines allergic reactions to medications.

FDA Drug Allergy Guidelines– Lists common symptoms of drug allergies.

PTCB PTCE Exam Content Outline– Covers adverse drug reactions and medication safety.

Why Not the Other Options?Key References:

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

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

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

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

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

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

76439= Manufacturer/Labeler Code

103= Product Code (Specific Drug & Strength)

10= Package Size

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

A. 76439-208-10❌→Incorrect

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

B. 76439-103-50✅→Correct

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

C. 74693-103-10❌→Incorrect

Different manufacturer (74693 instead of 76439).

D. 74693-206-50❌→Incorrect

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

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

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

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

Analyzing the Answer Choices:Key References:

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

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

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

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

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

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

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

It iscorrectly administered intramuscularly (IM)in thedeltoid muscle.

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

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

Varivax is alive-attenuated varicella (chickenpox) vaccine.

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

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

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

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

It should be administeredintramuscularly (IM).

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

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

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

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

CDC General Best Practices for Immunization:https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html

Vaccine Adverse Event Reporting System (VAERS): https://vaers.hhs.gov/

Immunization Action Coalition (IAC) - Vaccine Administration Guidelines: https://www.immunize.org/technical-support/administering-vaccines/

Institute for Safe Medication Practices (ISMP) - Vaccine Safety Recommendations: https://www.ismp.org/recommendations/immunization-safety

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

ISMP’s “Do Not Use” / error-prone abbreviations and dose designations emphasize avoiding trailing zeros (e.g., “120.0 mcg”), because the decimal point can be overlooked, potentially causing a tenfold error (e.g., read as 1200 mcg). ISMP also recommends using a leading zero before a decimal (e.g., 0.2 mg) to prevent misreads; thus 0.2 mg (A) and 1.4 mg (D) adhere to that guidance. 300 mcg (B) uses an acceptable unit (“mcg” rather than “µg”). Therefore, “120.0 mcg” (C) is the most error-prone due to the trailing zero.

References (Pharmacy Technician documents / Study Guides):

• ISMP Error-Prone Abbreviations, Symbols, and Dose Designations list: avoid trailing zeros; always use a leading zero before a decimal.

• PTCB/ExCPT medication safety sections covering safe dose expressions and ISMP recommendations.

• NCC MERP/ISMP educational materials on decimal point misinterpretation and tenfold dosing errors.

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

Remove outdated products from active stock immediately.

Label and store them separatelyuntil proper disposal.

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

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

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

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

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

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

FDA Drug Disposal Guidelines: https://www.fda.gov/drugs/disposal-unused-medicines

DEA Controlled Substance Disposal Regulations: https://www.deadiversion.usdoj.gov

PTCB Exam Content Outline – Inventory Management & Drug Disposal

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

• Needed dose: 400 mg per dose.

• Available concentration: 300 mg/5 mL.

• Use proportion/dimensional analysis:

- mL=400 mg×5 mL300 mg=2000300 mL=6.6‾ mL≈6.7 mL\text{mL} = 400\ \text{mg} \times \frac{5\ \text{mL}}{300\ \text{mg}} = \frac{2000}{300}\ \text{mL} = 6.\overline{6}\ \text{mL} \approx 6.7\ \text{mL}mL=400 mg×300 mg5 mL​=3002000​ mL=6.6 mL≈6.7 mL.

• Thus, 6.7 mL per dose is required.

References (Pharmacy Technician documents / Study Guides):

• PTCB/ExCPT pharmacy calculations—dose-concentration conversions using ratio-proportion or dimensional analysis.

• Nonsterile compounding and dispensing references—accurate liquid dose calculations from mg/mL strengths.

Under the federal Controlled Substances Act, schedules are codified in Title 21 of the Code of Federal Regulations (CFR), Part 1308. Schedule II substances are those with a high potential for abuse, with use potentially leading to severe psychological or physical dependence, and which have accepted medical uses in the United States. Methadone is explicitly listed as a Schedule II opioid analgesic. By contrast, metoprolol (a beta-blocker), metformin (a biguanide antidiabetic), and methotrexate (an antimetabolite) are not controlled substances under federal scheduling.

To determine the required volume of U-100 insulin to administer a20-unitdose ofNPH insulin, we use the concentration definition:

U-100 insulinmeans100 units per 1 ml

We need20 units

Using the formula:

Volume (ml)=Dose (units)Concentration (units/ml)\text{Volume (ml)} = \frac{\text{Dose (units)}}{\text{Concentration (units/ml)}}Volume (ml)=Concentration (units/ml)Dose (units)​Volume=20 units100 units/ml=0.2 ml\text{Volume} = \frac{20 \text{ units}}{100 \text{ units/ml}} = 0.2 \text{ ml}Volume=100 units/ml20 units​=0.2 ml

Thus, the correct answer is0.2 ml.

A. 0.02 ml→ Incorrect; this would correspond to only 2 units.

B. 1 ml→ Incorrect; this would correspond to 100 units, far exceeding the prescribed dose.

D. 2 ml→ Incorrect; this would correspond to 200 units, which is incorrect.

Other Answer Choices Explained:References:

PTCB PTCE Exam Content Outline (Pharmaceutical Calculations)

USP <797> Pharmaceutical Compounding—Sterile Preparations

American Pharmacists Association (APhA) Pharmacy Technician Certification Review

According tofederal law,a reverse distributor must issue a DEA Form 222 (or electronic equivalent) when a pharmacy requests the destruction of a Schedule II controlled substance.

Reverse distributorshandle the return and disposal ofexpired, damaged, or unusable controlled substances.

DEA Form 222 (or CSOS, the electronic equivalent) is required for Schedule II drugs.

Hydrocodone with acetaminophen (e.g., Norco, Vicodin)is aSchedule II controlled substance, requiringDEA Form 222for reverse distribution.

A. Acetaminophen with codeine❌→Schedule III

Does not require DEA Form 222; instead, DEA Form 41 is used for disposal.

C. Promethazine with codeine❌→Schedule V

Lower abuse potential; does not require DEA Form 222.

D. Pseudoephedrine with ibuprofen❌→Not a controlled substance

Pseudoephedrine is regulated under the Combat Methamphetamine Epidemic Act (CMEA), not the DEA controlled substance schedules.

DEA Controlled Substances Act (CSA)– Confirms thatSchedule II drugs require DEA Form 222 for reverse distribution.

PTCB PTCE Exam Content Outline– Covers controlled substances and reverse distribution requirements.

DEA Diversion Control Division Guidelines– Listshydrocodone as a Schedule II drug requiring Form 222 for disposal.

Understanding DEA Form 222 and Reverse Distribution:Why is Hydrocodone with Acetaminophen the Correct Answer?Why Not the Other Options?Key References:

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

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

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

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

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

D. Hyperlipidemia→ Incorrect;unrelated to vaccines.

Other Answer Choices Explained:References:

CDC VAERS Reporting Criteria for Adverse Vaccine Reactions

FDA Vaccine Safety Monitoring Guidelines

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

Risk Evaluation and Mitigation Strategies (REMS)areFDA-required programsto ensure that thebenefits of certain medications outweigh their risks. REMS programsrestrict prescribing, dispensing, and monitoringdue to the potential for serious side effects or misuse.

Suboxoneis used foropioid dependenceand containsbuprenorphine, apartial opioid agonist, which can causeaddiction, misuse, and respiratory depressionif used improperly.

REMS Requirements for Suboxone:

Prescriber Certification:Only specially certified providers can prescribe Suboxone.

Patient Education:Patients must be informed about the risks of misuse, overdose, and dependence.

Limited Dispensing:Pharmacists must ensure prescriptions meet REMS criteria before dispensing.

A. Xarelto (Rivaroxaban).→ Incorrect. While Xarelto is an anticoagulant, it isnot under REMS.

C. Warfarin.→ Incorrect. Warfarin requires monitoring butdoes not have a REMS program.

D. Haloperidol.→ Incorrect. Haloperidol is an antipsychotic, but itdoes not have a REMS program.

FDA REMS Program List (www.accessdata.fda.gov).

Suboxone REMS Guidelines (www.suboxonerems.com).

PTCB PTCE Exam Content Outline – REMS and Medication Safety.

Mosby’s Pharmacy Technician: Principles and Practice – REMS Regulations.

Why Is Suboxone (Buprenorphine/Naloxone) Under REMS?Why the Other Answer Choices Are Incorrect:Pharmacy Technician References:

Needlegauge (G)refers to thediameter of the needle’s lumen(opening).The higher the gauge number, the smaller the needle diameter.

Lower gauge (e.g., 13G, 18G)→Larger needle(wider opening)

Higher gauge (e.g., 27G)→Smaller needle(narrower opening)

Common Needle Gauges and Their Uses:Gauge (G)

Needle Diameter (mm)

Common Use

13G

2.4 mm

IV drug administration (large-bore)

18G

1.2 mm

Drawing thick medications (e.g., oil-based injections)

20G

0.9 mm

General intramuscular (IM) injections

27G

0.4 mm

Subcutaneous (SC) or intradermal (ID) injections (e.g., insulin, vaccines)

Since27Gis the highest gauge listed, it corresponds to thesmallestneedle diameter, making it the correct answer.

A. 13G❌→ One of the largest gauges, used for IV fluids or blood transfusions.

B. 18G❌→ Large needle used for thick medications likedepot injections or contrast agents.

C. 20G❌→ Common forintramuscular injectionsbut larger than 27G.

PTCB PTCE Exam Content Outline– Covers needle gauges, injection routes, and proper medication administration.

USP <797> & USP <800>– Provide sterile compounding guidelines, including appropriate needle gauge selection.

CDC Vaccine Administration Guidelines– Recommend25-30Gfor subcutaneous and intradermal injections.

Why Not the Other Options?Key References:

Root-Cause Analysis (RCA)is asystematic processused inhealthcare and pharmacy settingstoidentify the underlying factors that contributed to an error or safety event. RCA helps pharmacy staff determinewhy a problem occurredand implement corrective actions toprevent future occurrences.

Identify the problem or event.

Gather and analyze data.

Determine the root cause(s).

Develop and implement corrective actions.

Monitor for improvement and prevention of recurrence.

A. Determine which medication should be dispensed→ Incorrect; RCA is focused onerror investigation, not routine dispensing decisions.

B. Decipher prescriber handwriting during order entry→ Incorrect; this is not the purpose of RCA, though poor handwriting may be identified as a contributing factor in an error.

C. Increase pharmacy revenue and inventory turnover→ Incorrect; RCA is aboutpatient safety and error prevention, not financial performance.

Steps in Root-Cause Analysis (RCA):Other Answer Choices Explained:References:

ISMP (Institute for Safe Medication Practices) RCA Guidelines

FDA Medication Error Prevention Strategies

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

Enteric-coated (EC) tabletsare designed todelay drug release until they reach the intestine, preventing stomach irritation and degradation by gastric acid. The coatingresists stomach acidbut dissolves in thehigher pH environment of the intestines.

Aspirin EC(prevents stomach irritation)

Pantoprazole EC(proton pump inhibitor)

Diclofenac EC(NSAID)

A. Buffered→ Incorrect; buffered formulationsneutralize stomach acidbut do not delay release until the intestines.

C. Controlled release→ Incorrect; controlled-release formulationsgradually release medicationover time but are not specifically designed tobypass the stomach.

D. Buccal→ Incorrect; buccal tablets dissolve in thecheek mucosa, bypassing the digestive system entirely.

Examples of Enteric-Coated Medications:Other Answer Choices Explained:References:

FDA Drug Formulation Guidelines

USP <795> Drug Release & Absorption Standards

PTCB PTCE Exam Content Outline (Pharmaceutical Dosage Forms & Drug Release Mechanisms)

Look-alike/sound-alike (LASA) drug name pairs (e.g., hydralazine vs hydroxyzine) are a well-recognized cause of wrong-drug errors. ISMP and technician training resources emphasize verifying the National Drug Code (NDC) and/or barcode scanning against the prescription to ensure the correct drug, strength, and manufacturer are selected before counting. The NDC uniquely identifies the labeler, product, and package; thus, verifying the NDC is a stronger safety check than relying on tablet color (which can vary) or lot number (used for traceability/recalls, not drug selection). Strength verification is important, but first you must ensure the correct drug; NDC verification accomplishes both drug and strength confirmation.

References (Pharmacy Technician documents / Study Guides):

• ISMP community pharmacy medication safety guidance on LASA verification and barcode/NDC checks.

• PTCB/ExCPT Medication Safety sections: LASA risk-reduction strategies; NDC use in product selection.

• FDA/Drug listing education: NDC identifies labeler–product–package; used to ensure correct product selection.

Look-alike/sound-alike (LASA) medications pose asignificant risk of medication errors. To reduce this risk, pharmacies should:

Use both brand and generic nameson labels to clarify drug identity.

Example:"Celexa (Citalopram)" vs. "Celebrex (Celecoxib)."

B. Place the drug next to another look-alike/sound-alike drug on the shelf if they are alphabetical.❌→Incorrect

LASA drugs shouldnotbe stored next to each other.

Example:Hydroxyzine and Hydralazine should be stored separatelyto avoid mix-ups.

C. Review the first five digits of the NDC to confirm the correct product.❌→Incorrect

The first five digits (manufacturer code) only identify the manufacturer, not the specific drug.

Instead, checking theentire NDC (all 10-11 digits) is necessary.

D. Take hazardous drug precautions.❌→Incorrect

LASA errors are a labeling issue, not a hazardous drug issue.

Institute for Safe Medication Practices (ISMP) LASA Guidelines– Recommends usingboth brand and generic names on labels.

FDA & Joint Commission LASA Drug Safety Recommendations– Emphasizes labeling improvements for LASA drugs.

PTCB PTCE Exam Content Outline– Covers medication safety and error prevention strategies.

Why Not the Other Options?Key References:

• In medication safety terminology used across pharmacy technician study materials and safety taxonomies, an adverse event (specifically, a preventable adverse drug event) occurs when a medication error reaches the patient and results in harm or has the clear potential for harm (e.g., incorrect patient’s medication taken for several doses).

• By contrast, near misses (or “close calls”) are errors that are intercepted before they reach the patient, such as when a pharmacist catches incorrect directions during counseling (Option A), when a technician detects that a prescription was bagged but not yet verified (Option C), or when a technician finds a prescription placed in the wrong will-call bin before pickup (Option D). These represent process breakdowns with potential for harm but no patient exposure once intercepted.

• Therefore, the scenario most likely to lead to an adverse event is Option B, where the patient has already ingested medication intended for another patient. That constitutes an error that reached the patient, with a meaningful risk of harm, aligning with definitions for preventable adverse drug events.

References (Pharmacy Technician documents/Study Guides):

• NCC MERP (National Coordinating Council for Medication Error Reporting and Prevention) Taxonomy and definitions on medication errors, near misses, and events reaching the patient.

• ISMP (Institute for Safe Medication Practices) medication safety terminology and event classification used in community and institutional pharmacy practice.

• PTCB/ExCPT-aligned Pharmacy Technician Certification study guides: sections on medication safety, event reporting, and error prevention (definitions of “adverse event,” “medication error,” and “near miss/close call”).

• ASHP guidelines on preventing medication errors in community pharmacy workflows (verification steps, counseling interception points, and will-call bin best practices).

Ciprofloxacin is afluoroquinolone antibioticthat chelates (binds) withdivalent and trivalent cationssuch ascalciumfound in milk. This interaction forms aninsoluble complex, significantly reducing ciprofloxacin’s absorption in the gastrointestinal (GI) tract, leading to decreased bioavailability and reduced therapeutic effect.

B. Distribution→ Incorrect; milk does not directly impact the distribution of ciprofloxacin in the bloodstream.

C. Metabolism→ Incorrect; ciprofloxacin is primarily metabolized in the liver, and milk does not inhibit its enzymatic breakdown.

D. Excretion→ Incorrect; ciprofloxacin is mainly excreted by the kidneys, and milk does not significantly impact this process.

Other Answer Choices Explained:Pharmacist’s Recommendation:Patients should take ciprofloxacinat least 2 hours before or 6 hours afterconsuming dairy products to avoid reduced drug absorption.

Linaclotide (brand name: Linzess)must be dispensed in its original containerbecause:

It is highly moisture-sensitive, and removing it from its original container may lead to degradation.

The manufacturer provides a desiccantin the original packaging toprotect against humidity.

A. Furosemide❌→Does not require original container.

While furosemide tablets should be stored properly,they do not require dispensing in the original container.

C. Valsartan❌→Does not require original container.

Valsartan tablets arestable outside the original container.

D. Sertraline❌→Does not require original container.

Sertraline (Zoloft)can be repackagedwithout stability issues.

FDA Linzess Storage Guidelines– States that Linzessmust be stored in its original container with desiccant.

USP <797> & <800> Guidelines– Cover proper storage and handling of moisture-sensitive drugs.

PTCB PTCE Exam Content Outline– Includes special drug storage requirements.

Why Not the Other Options?Key References:

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

References (Pharmacy Technician documents / Study Guides):

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

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

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

Amlodipine(10 mg) anddiltiazem(30 mg) are bothcalcium channel blockers (CCBs)used to treat hypertension and angina.

When a patient is prescribed two medications from the same therapeutic class, the pharmacy's prescription processing system may flag this as"therapeutic duplication."

This alert is meant toprevent potential adverse effectssuch as excessive lowering of blood pressure or heart rate.

A. Prior authorization required→ Not applicable unless the insurance requires special approval before covering the drug.

C. NDC not covered→ Would appear if the specific drug product (based on its National Drug Code) is not covered by insurance, but this scenario relates to duplication, not coverage.

D. Refill too soon→ This applies to refilling a medication before the allowed time frame, but the scenario describes a new prescription.

PTCB PTCE Exam Content Outline – Drug Interactions and Therapeutic Duplication

Lexicomp and Micromedex Drug Databases– Reference sources for drug classifications.

ISMP Guidelines on Preventing Therapeutic Duplication Errors

Why Other Answers Are Incorrect?Pharmacy Technician References: