ExCPT Exam (Exam for the Certification of Pharmacy Technicians) — Questions and Answers

Question 1: Under HIPAA, which of the following is considered Protected Health Information (PHI)?

General health tips in a pharmacy newsletter
Anonymized aggregate patient data used for research
A patient's diagnosis combined with their name and date of birth (Correct answer)
A patient's first name alone

Correct answer: A patient's diagnosis combined with their name and date of birth

PHI is individually identifiable health information that includes any data element (name, date, condition, etc.) that could be used to identify a specific person's health status.

Question 2: Under the Combat Methamphetamine Epidemic Act (CMEA), what is the maximum amount of pseudoephedrine-containing products a customer may purchase per day?

1.8 grams
3.6 grams (Correct answer)
9 grams
7.5 grams

Correct answer: 3.6 grams

CMEA limits pseudoephedrine sales to 3.6 grams per day and 9 grams per 30-day period per customer. Sales must be logged and purchasers must show valid photo ID.

Question 3: If DAW was not specified on the prescription, which dispensing code should be used to a Cymbalta 20 mg prescription?

4
48
30
0 (Correct answer)

Correct answer: 0

DAW (Dispense As Written) codes are used in pharmacy billing to indicate specific dispensing instructions from the prescriber. DAW code 0 signifies that no DAW code was specified on the prescription, meaning the pharmacist can substitute a generic equivalent if available and permissible by law. This is the default code when the prescriber does not indicate a preference for a brand-name drug.

Question 4: Which of the following is classified as a parenteral route of administration?

Rectal
Oral
Intramuscular (Correct answer)
Sublingual

Correct answer: Intramuscular

Parenteral routes bypass the gastrointestinal tract; intramuscular (IM) injection is a parenteral route, while oral, rectal, and sublingual routes all involve mucosal absorption.

Question 5: A compounding technician is preparing an IV admixture. Which of the following actions is considered a critical step in maintaining aseptic technique?

Wearing a surgical mask only, without gloves
Compounding near an open window for ventilation
Wiping the vial stopper with a 70% isopropyl alcohol swab before needle entry (Correct answer)
Using tap water to rinse equipment before compounding

Correct answer: Wiping the vial stopper with a 70% isopropyl alcohol swab before needle entry

Swabbing the vial stopper with 70% isopropyl alcohol before needle entry disinfects the surface and prevents introducing contaminants into the sterile preparation.

Question 6: A patient's daughter calls the pharmacy asking for a list of her mother's current medications. The mother is a long-time patient at the pharmacy. To comply with the Health Insurance Portability and Accountability Act (HIPAA), what is the most appropriate action for the pharmacy technician?

Tell the daughter to have her mother call the pharmacy directly.
Ask the daughter to verify her mother's date of birth before providing the list.
Provide the list, as she is an immediate family member.
Deny the request unless the patient has provided prior written authorization to release information to the daughter. (Correct answer)

Correct answer: Deny the request unless the patient has provided prior written authorization to release information to the daughter.

HIPAA's Privacy Rule protects a patient's Protected Health Information (PHI), which includes their medication list. PHI cannot be disclosed to family members without the patient's explicit authorization, typically through a signed consent form on file at the pharmacy. Simply verifying a date of birth is not sufficient, and while having the patient call is an option, the core HIPAA principle is the requirement of documented authorization.

Question 7: Which of the following routes of administration would provide the fastest onset of action for a medication?

Subcutaneous (SubQ)
Intravenous (IV) (Correct answer)
Transdermal (TD)
Oral (PO)

Correct answer: Intravenous (IV)

The intravenous (IV) route administers the medication directly into the bloodstream, bypassing absorption barriers. This results in the most rapid onset of action compared to oral, transdermal, or subcutaneous routes, which all require the drug to be absorbed into the systemic circulation over time.

Question 8: Keflin dosage for adults is 1 g. What dosage would be appropriate for a 50-pound child?

500 mg
170 mg
750 mg
333 mg (Correct answer)

Correct answer: 333 mg

To determine an appropriate pediatric dosage based on an adult dose, Clark's Rule is often used. This rule calculates the child's dose by dividing the child's weight in pounds by 150 pounds (average adult weight) and multiplying by the adult dose. For a 50-pound child and a 1000 mg (1 g) adult dose, the calculation is (50 lbs / 150 lbs) * 1000 mg, which equals approximately 333 mg.

Question 9: When verifying a new prescription, which of the following elements must the technician confirm is present on the written prescription?

Patient's diagnosis code
Patient's insurance ID number
Prescriber's DEA expiration date
Date the prescription was written (Correct answer)

Correct answer: Date the prescription was written

A valid prescription must include the date written (along with prescriber info, patient info, drug, dose, quantity, sig, and signature). The date is essential for validating the prescription and determining if it is still valid.

Question 10: Which of the following is a strategy recommended by the Institute for Safe Medication Practices (ISMP) to reduce errors between look-alike drug names like hydrALAZINE and hydrOXYzine?

Using a black marker to cross out the brand name.
Storing the medications in different refrigerators.
Implementing the use of 'Tall Man' lettering. (Correct answer)
Only allowing the pharmacist to dispense these medications.

Correct answer: Implementing the use of 'Tall Man' lettering.

The use of 'Tall Man' lettering (e.g., hydrOXYzine vs. hydrALAZINE) is a specific strategy endorsed by the ISMP and FDA to help distinguish between look-alike drug names. By capitalizing dissimilar parts of the names, it draws attention to the differences and helps reduce the risk of selecting the wrong medication.

Question 11: Which of the following is a key counseling point for a patient starting warfarin therapy?

Increase vitamin K foods dramatically every week.
Maintain a consistent intake of vitamin K–containing foods. (Correct answer)
Stop the medication if minor bruising occurs once.
Avoid all blood tests while taking warfarin.

Correct answer: Maintain a consistent intake of vitamin K–containing foods.

Warfarin is an anticoagulant that works by interfering with vitamin K-dependent clotting factors. Therefore, maintaining a consistent intake of vitamin K-containing foods is crucial to ensure stable therapeutic effects and prevent fluctuations in its effectiveness. Significant changes in vitamin K intake can either increase the risk of bleeding or reduce the drug's efficacy.

Question 12: A pharmacy technician counts 98 tablets of oxycodone when the perpetual inventory shows 100. What should the technician do?

Assume counting error and move on
Adjust the record to match the count without documentation
Report the discrepancy to the pharmacist immediately (Correct answer)
Reorder 2 tablets to correct the inventory

Correct answer: Report the discrepancy to the pharmacist immediately

Any discrepancy in Schedule II inventory must be immediately reported to the pharmacist, who will investigate and document it.

Question 13: If a medication is to be taken p.c., and. Should it be taken?

Birth date
After meals (Correct answer)
Room temperature
In the morning

Correct answer: After meals

In medical abbreviations, 'p.c.' stands for 'post cibum,' which is Latin for 'after meals.' This instruction is crucial for medications that need to be taken with food to reduce stomach upset, improve absorption, or for other specific therapeutic reasons related to digestion. Adhering to this timing helps ensure the medication's effectiveness and minimizes adverse effects.

Question 14: A compounded preparation contains a controlled substance. Which additional regulatory requirement applies?

DEA regulations for controlled substance handling, storage, and record-keeping apply (Correct answer)
USP <797> sterility testing is waived
The BUD is automatically extended to 180 days
The preparation can only be compounded in a 503B outsourcing facility

Correct answer: DEA regulations for controlled substance handling, storage, and record-keeping apply

When compounding involves controlled substances, DEA regulations overlay all other compounding requirements — including proper DEA registration, storage in appropriate vaults/safes, and mandatory record-keeping.

Question 15: Which of the following best describes a black box warning on a medication label?

A minor side effect with low risk.
An advertisement for brand-name drugs.
A suggestion for over-the-counter dosing.
A strong FDA warning about serious risks. (Correct answer)

Correct answer: A strong FDA warning about serious risks.

A black box warning is the strongest warning the U.S. Food and Drug Administration (FDA) requires for prescription drugs. It highlights serious or life-threatening risks, such as severe adverse effects or potential drug interactions, that are associated with the medication. This warning is crucial for prescribers and patients to understand the significant dangers and ensure safe medication use.

Question 16: A patient taking simvastatin should be warned about which potential serious adverse effect?

Sudden hearing improvement
Permanent tooth discoloration
Increased hair growth
Severe muscle pain or weakness (Correct answer)

Correct answer: Severe muscle pain or weakness

Patients taking statin medications like simvastatin should be warned about the potential for severe muscle pain or weakness, a condition known as myopathy. In rare but serious cases, this can progress to rhabdomyolysis, which involves severe muscle breakdown and can lead to kidney damage. Patients are advised to report any unexplained muscle symptoms promptly.

Question 17: What is the primary reason for wearing sterile gloves during aseptic technique in sterile compounding?

To comply with OSHA temperature regulations
To prevent static electricity from damaging the LAFW
To protect the compounder from chemical exposure
To prevent introduction of microorganisms from skin flora into the preparation (Correct answer)

Correct answer: To prevent introduction of microorganisms from skin flora into the preparation

The primary purpose is to protect the sterile preparation from microbial contamination — human skin harbors microorganisms that could contaminate sterile products and cause serious patient harm.

Question 18: Which dosage form delivers medication directly into the lungs via a machine that creates a fine mist?

Nasal spray
Dry powder inhaler (DPI)
Metered-dose inhaler (MDI)
Nebulizer solution (Correct answer)

Correct answer: Nebulizer solution

A nebulizer converts liquid medication into a fine aerosol mist that can be inhaled continuously through a mask or mouthpiece, ideal for patients unable to coordinate an MDI.

Question 19: Which government agency is primarily responsible for licensing pharmacists, registering pharmacy technicians, and disciplining licensees for misconduct within a specific state?

Drug Enforcement Administration (DEA)
State Board of Pharmacy (Correct answer)
Food and Drug Administration (FDA)
The Joint Commission

Correct answer: State Board of Pharmacy

The State Board of Pharmacy is the regulatory body responsible for establishing and enforcing pharmacy laws and regulations at the state level. This includes licensing pharmacists and pharmacies, registering technicians, and taking disciplinary action against those who violate the state's Pharmacy Practice Act. The FDA regulates drug manufacturing and approval, while the DEA enforces controlled substance laws.

Question 20: What does the term 'clean room' refer to in a sterile compounding pharmacy?

A designated storage area for compounded preparations
Any pharmacy area that has been mopped and sanitized daily
An environmentally controlled space with defined ISO air quality classifications for sterile preparation (Correct answer)
A room with controlled temperature used for refrigerated products

Correct answer: An environmentally controlled space with defined ISO air quality classifications for sterile preparation

A clean room is an ISO-classified, environmentally controlled space designed to minimize airborne particulates and microbial contamination during sterile compounding.

Question 21: Which ISO classification is required for the Primary Engineering Control (PEC — laminar airflow workbench or BSC) used in sterile compounding?

ISO Class 5 (Correct answer)
ISO Class 4
ISO Class 8
ISO Class 7

Correct answer: ISO Class 5

USP <797> requires the PEC (the critical work zone inside the LAFW or BSC) to maintain ISO Class 5 air quality — no more than 3,520 particles ≥0.5 µm per cubic meter of air.

Question 22: Which of the following best describes the difference between a manufacturer's expiration date and a compound's beyond-use date (BUD)?

The expiration date applies to sterile products, while the BUD applies to non-sterile products.
The BUD is always longer than the manufacturer's expiration date.
They are interchangeable terms for the same concept.
The expiration date is determined by the drug manufacturer based on stability testing, while the BUD is assigned by the pharmacy for a specific compounded preparation. (Correct answer)

Correct answer: The expiration date is determined by the drug manufacturer based on stability testing, while the BUD is assigned by the pharmacy for a specific compounded preparation.

A manufacturer's expiration date is based on extensive stability testing of a specific, sealed commercial product. A beyond-use date (BUD) is assigned to a compounded preparation by the pharmacy and is determined by factors like the date of compounding, ingredients used, and USP guidelines to ensure safety and potency for a custom-made product.

Question 23: How many teaspoons are equivalent to 15 mL?

5 teaspoons
1 teaspoon
2 teaspoons
3 teaspoons (Correct answer)

Correct answer: 3 teaspoons

1 teaspoon = 5 mL; 15 mL ÷ 5 mL/tsp = 3 teaspoons.

Question 24: Which system is widely used to classify medication errors by severity?

ISMP classification
ASHP error index
NCC MERP index (Correct answer)
FDA MedWatch scale

Correct answer: NCC MERP index

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index categorizes errors from Category A (no error, circumstances) to Category I (error contributing to patient death).

Question 25: What is a 'par level' in pharmacy inventory management?

The DEA quota for controlled substances
The minimum stock quantity that triggers a reorder (Correct answer)
The expiration date tracking threshold
The maximum amount of a drug that can be ordered at once

Correct answer: The minimum stock quantity that triggers a reorder

A par level is the minimum inventory quantity below which a reorder is placed to prevent stockouts.

Question 26: A prescription calls for 250 mg of amoxicillin. The available suspension is 125 mg/5 mL. How many mL should be dispensed per dose?

2.5 mL
5 mL
20 mL
10 mL (Correct answer)

Correct answer: 10 mL

250 mg ÷ 125 mg/5 mL = 10 mL per dose.

Question 27: A pharmacy discovers a significant loss of a Schedule II controlled substance. According to federal law, which DEA form must be completed and submitted to report this loss?

DEA Form 224
DEA Form 222
DEA Form 41
DEA Form 106 (Correct answer)

Correct answer: DEA Form 106

DEA Form 106 is the official form required by the Drug Enforcement Administration (DEA) for registrants to report the theft or significant loss of any controlled substances. DEA Form 222 is for ordering Schedule I and II substances, DEA Form 41 is for the destruction of controlled substances, and DEA Form 224 is the application for new registration.

Question 28: If a drug costs $0.85 per tablet and the patient needs a 30-day supply of 2 tablets per day, what is the total drug cost?

$34.00
$25.50
$17.00
$51.00 (Correct answer)

Correct answer: $51.00

2 tablets/day × 30 days = 60 tablets; 60 × $0.85 = $51.00.

Question 29: When preparing an IV admixture, what should the technician do BEFORE adding a drug to an IV bag?

Visually inspect the IV bag for particulate matter, leaks, and clarity (Correct answer)
Spike the bag with the primary IV tubing
Warm the IV bag to 37°C in a water bath
Shake the IV bag vigorously to mix contents

Correct answer: Visually inspect the IV bag for particulate matter, leaks, and clarity

Before adding any drug to an IV bag, the bag must be visually inspected for particulate matter, discoloration, cloudiness, leaks, cracks, or any abnormality that would render it unsuitable for use.

Question 30: Which of the following abbreviations is on the 'Do Not Use' list due to risk of medication errors?

BID
PRN
QD (Correct answer)
PO

Correct answer: QD

QD (intended to mean 'once daily') is on the Do Not Use list because it can be misread as QID (four times daily), leading to dangerous overdosing.

Question 31: If a cream is labeled 2.5% w/w, how many mg of active ingredient are in a 30 g tube?

250 mg
750 mg (Correct answer)
25 mg
75 mg

Correct answer: 750 mg

2.5% of 30 g = 0.75 g = 750 mg.

Question 32: Which storage requirement applies to nitroglycerin tablets?

Store in original glass container, away from heat and light (Correct answer)
No special storage requirements
Store in the refrigerator at 2–8°C
Store frozen at -20°C

Correct answer: Store in original glass container, away from heat and light

Nitroglycerin tablets must be stored in the original glass container, protected from heat, light, and moisture, as they are highly volatile.

Question 33: Which of the following medications is considered a 'high-alert' drug that requires special safeguards due to its high risk of causing significant patient harm?

Insulin glargine 100 units/mL (Correct answer)
Amoxicillin 500 mg
Omeprazole 20 mg
Cetirizine 10 mg

Correct answer: Insulin glargine 100 units/mL

Insulin is classified as a high-alert medication by ISMP because dosing errors can cause severe hypoglycemia or hyperosmolar states. High-alert drugs require extra verification steps, independent double-checks, and special storage protocols.

Question 34: Which federal law first required the child-resistant packaging for most OTC and prescription medications?

Poison Prevention Packaging Act of 1970 (Correct answer)
Durham-Humphrey Amendment of 1951
Drug Listing Act of 1972
Pure Food and Drug Act of 1906

Correct answer: Poison Prevention Packaging Act of 1970

The Poison Prevention Packaging Act (PPPA) of 1970 required child-resistant packaging for most prescription and OTC drugs to reduce accidental pediatric poisonings.

Question 35: Which of the following is a common pharmacologic effect of beta-blockers such as metoprolol?

Cause bronchodilation in the lungs.
Increase heart rate and cardiac output.
Decrease heart rate and blood pressure. (Correct answer)
Stimulate insulin secretion in the pancreas.

Correct answer: Decrease heart rate and blood pressure.

Beta-blockers like metoprolol work by blocking beta-adrenergic receptors, primarily in the heart. This action reduces the heart's workload by decreasing heart rate and myocardial contractility. Consequently, this leads to a reduction in blood pressure and cardiac output.

Question 36: When a pharmacy technician counsels a patient picking up a new prescription, which verification step MOST directly helps catch a potential dispensing error before the patient leaves?

Asking the patient to confirm their date of birth again at pickup
Reminding the patient to store the medication at room temperature
Confirming the patient's insurance information is current
Having the patient open the bag and describe what condition the medication is for (Correct answer)

Correct answer: Having the patient open the bag and describe what condition the medication is for

Asking the patient to describe the condition being treated creates a 'closed-loop' verification — if the drug dispensed doesn't match the patient's stated condition, a dispensing error is caught before harm occurs. This technique is an important final safety check.

Question 37: A compounding formula requires 30% of ingredient A and 70% of ingredient B. If making 120 g total, how many grams of ingredient A are needed?

30 g
36 g (Correct answer)
40 g
84 g

Correct answer: 36 g

30% × 120 g = 0.30 × 120 = 36 g of ingredient A.

Question 38: What is the term for a medication error that reaches the patient but does not cause harm?

Adverse drug event
Near miss
No-harm error (Correct answer)
Potential error

Correct answer: No-harm error

A 'no-harm error' (NCC MERP Category C or D) is one that reaches the patient but does not cause harm, as opposed to a near miss which is intercepted before reaching the patient.

Question 39: After filling a prescription for an antibiotic suspension, the pharmacy technician should affix which auxiliary label to alert the patient about storage?

'May cause drowsiness — Use caution when driving'
'Avoid prolonged exposure to sunlight'
'Refrigerate — Do not freeze' (Correct answer)
'Take with food or milk'

Correct answer: 'Refrigerate — Do not freeze'

Most reconstituted antibiotic suspensions (e.g., amoxicillin, azithromycin) require refrigeration after mixing to maintain potency. The correct auxiliary label reminds patients of this requirement.

Question 40: A technician receives a prescription with an unclear dose. What is the safest action to take?

Call the patient and ask what they think it should be.
Guess the most common dose and fill it.
Alert the pharmacist so the prescriber can be consulted. (Correct answer)
Skip the dose and dispense the medication anyway.

Correct answer: Alert the pharmacist so the prescriber can be consulted.

An unclear dose on a prescription is a significant red flag for a potential medication error and must never be guessed or assumed. The safest and most appropriate action for a pharmacy technician is to immediately alert the pharmacist. The pharmacist is legally responsible for clarifying the prescription with the prescriber to ensure patient safety before dispensing any medication.

Question 41: When a prescription is labeled 'DAW 1,' what does this mean?

Daily administration warning
Dispense as written — prescriber mandates brand name, no generic substitution (Correct answer)
Drug approved for waiver — generic allowed
Dispense as written — patient requests brand name

Correct answer: Dispense as written — prescriber mandates brand name, no generic substitution

DAW (Dispense As Written) code 1 indicates that the prescriber has specified brand name only — the pharmacist cannot substitute a generic equivalent.

Question 42: A technician is compounding a hazardous drug (HD) intravenously. Which type of Primary Engineering Control (PEC) is required to ensure both product sterility and personnel safety?

Laminar Airflow Workbench (LAFW)
A HEPA filter in the general pharmacy
Class II Biological Safety Cabinet (BSC) (Correct answer)
Compounding Aseptic Isolator (CAI)

Correct answer: Class II Biological Safety Cabinet (BSC)

A Class II Biological Safety Cabinet (BSC) is required for compounding sterile hazardous drugs. It provides a sterile environment for the product while using negative pressure and HEPA-filtered exhaust to protect the compounder and the environment from exposure to the hazardous drug.

Question 43: What does the prescription sig code 'QID' instruct?

Four times daily (Correct answer)
Every four hours around the clock
At bedtime only
Every other day

Correct answer: Four times daily

QID derives from the Latin 'quater in die,' meaning four times daily. Pharmacy technicians must accurately interpret sig codes — confusing QID (four times daily) with Q4H (every four hours) could result in a dangerous dosing error.

Question 44: A prescriber writes for amoxicillin 500 mg capsules, but the pharmacy has amoxicillin 500 mg tablets in stock. What should the pharmacy technician do?

Check with the pharmacist before making any substitution (Correct answer)
Dispense the tablets — oral solid forms are interchangeable
Call the prescriber to get a new prescription for tablets
Dispense capsules from another pharmacy as a courtesy

Correct answer: Check with the pharmacist before making any substitution

Even minor substitutions require pharmacist authorization. The pharmacist must review therapeutic equivalence and any clinical implications before approving a formulation change.

Question 45: 15 mg/kg of an antibiotic is recommended twice daily by IV. How much in milligrams should a youngster who weighs 66 pounds take every day?

1000 mg
900 mg (Correct answer)
225 mg
4500 mg

Correct answer: 900 mg

First, convert the youngster's weight from pounds to kilograms: 66 pounds / 2.2 lbs/kg = 30 kg. The dose is 15 mg/kg, so the dose per administration is 15 mg/kg * 30 kg = 450 mg. Since the medication is recommended twice daily, the total daily dose is 450 mg * 2 = 900 mg.

Question 46: Which term refers to the maximum effect a drug can produce regardless of dose?

Half-life
Potency
Bioavailability
Efficacy (Correct answer)

Correct answer: Efficacy

Efficacy refers to the maximum therapeutic effect a drug can produce, regardless of the dose administered. It represents the drug's ability to achieve the desired clinical response or benefit. Potency, in contrast, describes the amount of drug needed to produce an effect, while bioavailability relates to the proportion of a drug that reaches systemic circulation.

Question 47: Convert 98.6°F to Celsius.

36°C
40°C
32°C
37°C (Correct answer)

Correct answer: 37°C

(98.6°F − 32) × 5/9 = 66.6 × 0.555 = 37°C.

Question 48: A patient reports they accidentally took their spouse's blood pressure medication. This is an example of which type of medication error?

Prescribing error
Monitoring error
Omission error
Wrong patient error (Correct answer)

Correct answer: Wrong patient error

A wrong patient error occurs when a medication intended for one patient is taken or administered to another patient.

Question 49: A pharmacy receives an oral (telephone) prescription for a Schedule II controlled substance. Under federal law, how may this be handled?

Accepted if the prescriber faxes the Rx within 24 hours
Accepted for up to a 30-day supply without emergency designation
Accepted only in emergencies; pharmacist must get a written Rx within 7 days (Correct answer)
Never accepted under any circumstances

Correct answer: Accepted only in emergencies; pharmacist must get a written Rx within 7 days

Under the CSA, oral prescriptions for Schedule II drugs are only permitted in genuine emergencies (limited to the amount needed for the emergency period), and the prescriber must provide a signed written prescription within 7 days.

Question 50: Under the Poison Prevention Packaging Act of 1970 (PPPA), which of the following oral prescription medications is generally exempt from child-resistant packaging requirements?

Sublingual nitroglycerin tablets (Correct answer)
Ibuprofen 800mg tablets
Amoxicillin oral suspension
Ferrous sulfate tablets

Correct answer: Sublingual nitroglycerin tablets

The Poison Prevention Packaging Act (PPPA) allows for several exemptions to child-resistant packaging. Sublingual nitroglycerin is exempt because it is used in emergency situations for conditions like angina, where quick access is critical. Most other oral prescription drugs, including common antibiotics, high-strength NSAIDs, and iron supplements, require child-resistant packaging unless the patient or prescriber requests otherwise.

Question 51: When compounding a sterile preparation, which of the following actions is performed first in the garbing process before entering the cleanroom's buffer area?

Donning a non-shedding gown
Donning sterile gloves
Washing hands and forearms
Putting on a hair cover and face mask (Correct answer)

Correct answer: Putting on a hair cover and face mask

The correct garbing sequence, from dirtiest to cleanest, requires applying shoe covers, then a hair cover, beard cover (if applicable), and a face mask before proceeding to hand hygiene and donning a gown. This minimizes contamination of cleaner items.

Question 52: What is one key reason pharmacies use automated dispensing technologies such as counting machines?

To replace the need for pharmacists entirely
To improve efficiency and reduce counting errors. (Correct answer)
To eliminate all legal responsibilities
To avoid keeping any paper records

Correct answer: To improve efficiency and reduce counting errors.

Automated dispensing technologies, such as counting machines, significantly enhance pharmacy operations by speeding up the filling process and minimizing human error in counting medications. These systems improve efficiency by freeing up technician time for other tasks and contribute to greater accuracy in dispensing. Ultimately, this leads to improved patient safety and a more streamlined workflow.

Question 53: Which of the following is a key difference between a 503A compounding pharmacy and a 503B outsourcing facility?

503A pharmacies must comply with cGMP regulations
503B outsourcing facilities can compound large batches without patient-specific prescriptions under FDA oversight (Correct answer)
503B facilities are not required to register with the FDA
503A pharmacies can compound large batch sizes for office stock without patient-specific prescriptions

Correct answer: 503B outsourcing facilities can compound large batches without patient-specific prescriptions under FDA oversight

503B outsourcing facilities are FDA-registered entities that can compound large batches for office stock/hospital use without individual patient prescriptions but must comply with cGMP standards and FDA oversight.

Question 54: Sulfisoxazole susp. 300 mg po is what you've ordered. You currently store a 250 mg/5 mL solution. Amount disbursed =

1.2 mL
3 mL
5 mL
6 mL (Correct answer)

Correct answer: 6 mL

To calculate the volume of suspension needed, divide the desired dose by the concentration of the stock solution and then multiply by the volume associated with that concentration. You need 300 mg, and the stock is 250 mg in 5 mL. So, (300 mg / 250 mg) * 5 mL equals 1.2 * 5 mL, resulting in 6 mL to be dispensed.

Question 55: Which component of aseptic technique involves maintaining a direct, unobstructed pathway of ISO 5 air from the HEPA filter to the critical site?

Garbing sequence
Gowning procedure
Critical site protection / first air principle (Correct answer)
Hand hygiene protocol

Correct answer: Critical site protection / first air principle

The 'first air principle' means the first air to contact a critical site (needle tip, vial septum, syringe tip) must be uncontaminated ISO 5 air directly from the HEPA filter — no objects should block this airflow.

Question 56: A pharmacy technician is preparing a non-aqueous topical cream by mixing two commercially available ointments. According to USP Chapter <795>, what is the maximum beyond-use date (BUD) that can be assigned to this compounded preparation when stored at room temperature?

6 months (Correct answer)
14 days
90 days
30 days

Correct answer: 6 months

According to USP Chapter <795> guidelines for non-sterile compounding, the default BUD for non-aqueous formulations (like ointments and creams made from commercial products) is the earliest expiration date of any active pharmaceutical ingredient (API) or 6 months, whichever is earlier.

Question 57: Which type of drug return requires completion of DEA Form 41?

Expired Schedule III–V medications for destruction (Correct answer)
Refrigerated biologics past expiration
OTC medications returned by patients
Recalled brand-name drugs

Correct answer: Expired Schedule III–V medications for destruction

DEA Form 41 is used when a pharmacy destroys expired, damaged, or unwanted Schedule II–V controlled substances.

Question 58: When compounding a non-sterile topical cream, which of the following equipment is most commonly used to achieve a uniform mixture?

Autoclave
Laminar airflow workbench
Electronic mortar and pestle (or ointment mill) (Correct answer)
Biological safety cabinet

Correct answer: Electronic mortar and pestle (or ointment mill)

An electronic mortar and pestle or ointment mill is used in non-sterile compounding to triturate and blend ingredients into a smooth, uniform topical preparation.

Question 59: USP Chapter <797> primarily governs which type of compounding?

Oral solid dosage form compounding
Non-sterile topical preparations
Sterile preparations (injections, ophthalmic, IV admixtures) (Correct answer)
Hazardous drug handling only

Correct answer: Sterile preparations (injections, ophthalmic, IV admixtures)

USP <797> establishes standards for compounding sterile preparations (CSPs) to prevent microbial contamination, pyrogens, and other harmful substances in parenteral and other sterile products.

Question 60: You get a prescription for 250 mg of amoxicillin for a 12-year-old child who weighs 88 pounds. Adults should take 500 mg daily. You draw the pharmacist's attention to the prescription because:

the dosage is too high, according to Young’s Rule
the dosage is under therapeutic dosage
It is not necessary to alert the pharmacist, the prescription is fine (Correct answer)
the dosage is too high, according to the child’s weight

Correct answer: It is not necessary to alert the pharmacist, the prescription is fine

The prescribed dosage of 250 mg of amoxicillin for a 12-year-old weighing 88 pounds is generally considered safe and appropriate. Pediatric dosages for amoxicillin typically range from 20-50 mg/kg/day, and for an 88-pound child (approx. 40 kg), this would be 800-2000 mg/day. A 250 mg dose falls well within this therapeutic range, especially if administered multiple times a day, and is lower than the typical adult dose of 500 mg.

Question 61: Which dosage form is specifically designed to release medication slowly over an extended period?

Enteric-coated tablet
Extended-release tablet or capsule (Correct answer)
Immediate-release tablet
Oral solution

Correct answer: Extended-release tablet or capsule

Extended-release (ER) or sustained-release (SR) tablets and capsules are specifically formulated to release medication slowly over an extended period. This design allows for less frequent dosing, maintains more consistent drug levels in the body, and can improve patient adherence. Other dosage forms like immediate-release or enteric-coated tablets have different release profiles.

Question 62: In pharmacy, what is a 'formulary'?

A list of all FDA-approved drugs
A list of drugs covered and preferred by a specific insurance plan (Correct answer)
A pharmacy's master inventory list
A reference guide for compounding formulas

Correct answer: A list of drugs covered and preferred by a specific insurance plan

A formulary is a list of prescription drugs covered by a health insurance plan, often tiered by co-pay amount to encourage use of preferred (lower-cost) options.

Question 63: Which DEA form is required when a pharmacy orders Schedule II controlled substances from a DEA-registered distributor?

DEA Form 41
DEA Form 222 (Correct answer)
DEA Form 363
DEA Form 106

Correct answer: DEA Form 222

DEA Form 222 (or its electronic equivalent, CSOS) is the official order form mandated by the DEA for purchasing or transferring Schedule II controlled substances. It must be kept on file for at least 2 years.

Question 64: Why is it important to maintain accurate perpetual inventory for controlled substances?

To ensure accurate records and detect diversion. (Correct answer)
To reduce the need for pharmacist oversight
To avoid ordering medications from wholesalers
To set higher cash prices for medications

Correct answer: To ensure accurate records and detect diversion.

Controlled substances are highly regulated due to their potential for abuse and diversion, making accurate record-keeping essential. Maintaining a perpetual inventory, which involves continuously tracking every dose received and dispensed, is legally required and crucial for accountability. This meticulous record-keeping helps pharmacies detect any discrepancies, identify potential theft or diversion, and comply with DEA regulations.

Question 65: A pharmacy technician is preparing a magic mouthwash that contains several liquid ingredients. Which piece of equipment is most appropriate for accurately measuring 25 mL of a low-viscosity liquid for this non-sterile compound?

A beaker
A conical graduate
An oral syringe
A graduated cylinder (Correct answer)

Correct answer: A graduated cylinder

For measuring liquids in non-sterile compounding, a graduated cylinder provides greater accuracy than a conical graduate or a beaker. An oral syringe is also accurate but is typically used for smaller volumes or for direct administration. A graduated cylinder is the standard tool for this volume.

Question 66: Which of the following is an example of a Class I drug recall?

A product with minor cosmetic defects
A product that may cause serious adverse health consequences or death (Correct answer)
A product recalled due to marketing violations
A product with incorrect labeling that is unlikely to cause harm

Correct answer: A product that may cause serious adverse health consequences or death

A Class I recall involves a product where there is a reasonable probability of serious adverse health consequences or death.

Question 67: What is the purpose of auxiliary labels on a prescription bottle?

To provide supplemental warnings or administration instructions (Correct answer)
To show the pharmacy's NPI number
To replace the main prescription label when space is limited
To indicate the drug's controlled substance schedule

Correct answer: To provide supplemental warnings or administration instructions

Auxiliary labels are supplemental stickers added to the prescription bottle to communicate important safety information such as 'Take with food,' 'May cause drowsiness,' or 'Avoid prolonged sun exposure.' They reinforce safe medication use beyond what the main label states.

Question 68: USP <800> standards apply primarily to which category of compounded preparations?

Veterinary compounded medications only
Hazardous drugs, including many chemotherapy agents (Correct answer)
Nutritional supplements and vitamins
OTC topical creams and ointments

Correct answer: Hazardous drugs, including many chemotherapy agents

USP <800> establishes safety standards for handling hazardous drugs — including many antineoplastic (chemotherapy) agents — to protect healthcare workers, patients, and the environment from exposure.

Question 69: A patient presents a new prescription for hydroxyzine. The pharmacy technician notices the patient's profile shows an active prescription for hydralazine. Which of the following is the MOST appropriate action for the technician to take?

Ask the patient what conditions they are being treated for.
Alert the pharmacist to a potential look-alike/sound-alike (LASA) drug confusion. (Correct answer)
Contact the prescriber directly to verify the prescription.
Dispense the hydroxyzine as written without question.

Correct answer: Alert the pharmacist to a potential look-alike/sound-alike (LASA) drug confusion.

Hydroxyzine and hydralazine are a well-known look-alike/sound-alike (LASA) drug pair that can be easily confused, leading to medication errors. The technician's primary responsibility in this scenario is to recognize the potential for error and bring it to the attention of the pharmacist for clinical resolution. The pharmacist can then take further steps, such as speaking with the patient and/or contacting the prescriber.

Question 70: How many milliliters are in 2.5 liters?

25 mL
250 mL
0.25 mL
2,500 mL (Correct answer)

Correct answer: 2,500 mL

1 liter = 1,000 mL, so 2.5 liters = 2,500 mL.

Question 71: Which law established the framework for the FDA's authority over prescription vs. over-the-counter drug classification?

Harrison Narcotic Tax Act of 1914
Federal Food, Drug, and Cosmetic Act of 1938
Kefauver-Harris Amendment of 1962
Durham-Humphrey Amendment of 1951 (Correct answer)

Correct answer: Durham-Humphrey Amendment of 1951

The Durham-Humphrey Amendment of 1951 defined which medications require a prescription (legend drugs) vs. those that can be sold OTC, and established the legal framework for pharmacist dispensing.

Question 72: Which of the following is the correct way to dispose of non-controlled, non-hazardous expired medications in a retail pharmacy?

Place them in an authorized pharmaceutical take-back program or mail-back envelope (Correct answer)
Flush them down the sink
Throw them in the regular trash
Return them to the distributor without documentation

Correct answer: Place them in an authorized pharmaceutical take-back program or mail-back envelope

Authorized pharmaceutical take-back programs or DEA-approved mail-back envelopes are the recommended method for safe disposal of non-controlled medications.

Question 73: What is the purpose of a perpetual inventory system for Schedule II controlled substances?

To maintain a running count of each Schedule II drug on hand (Correct answer)
To manage generic substitutions
To automate insurance billing
To track all OTC sales

Correct answer: To maintain a running count of each Schedule II drug on hand

A perpetual inventory provides a continuous, real-time count of Schedule II drugs to ensure accountability and detect diversion.

Question 74: A pharmacy technician notices that a high-alert medication is stored on an open shelf with other routine drugs. What should they do?

Hide it behind other medications.
Notify the pharmacist and segregate the medication. (Correct answer)
Move it to the front of the shelf for easy access.
Leave it where it is and ignore the issue.

Correct answer: Notify the pharmacist and segregate the medication.

High-alert medications carry a heightened risk of causing significant patient harm if used in error. Storing them on an open shelf with routine drugs increases the chance of a dispensing mistake. A technician should immediately notify the pharmacist so these medications can be properly segregated, labeled, and stored according to safety protocols, such as in a designated high-alert area, to prevent errors.

Question 75: Under HIPAA, which of the following is a right that patients have regarding their Protected Health Information (PHI)?

The right to have all pharmacy records destroyed after each transaction
The right to prohibit all pharmacy staff members from ever viewing their records
The right to request an amendment to their health record if they believe it is inaccurate (Correct answer)
The right to receive a printed copy of every prescription within 24 hours of dispensing

Correct answer: The right to request an amendment to their health record if they believe it is inaccurate

HIPAA grants patients the right to request amendments or corrections to their health records. Pharmacies must act on such requests within 60 days and may only deny them under specific circumstances.

Question 76: The Durham-Humphrey Amendment of 1951 primarily established which of the following in U.S. pharmacy law?

Child-resistant packaging requirements for dispensed medications
Mandatory proof of drug efficacy before FDA approval
Pharmacist counseling requirements for all new prescriptions
The legal distinction between prescription-only and over-the-counter drugs (Correct answer)

Correct answer: The legal distinction between prescription-only and over-the-counter drugs

The Durham-Humphrey Amendment defined which drugs require a practitioner's prescription (bearing the Rx legend) versus those that can be sold OTC, creating the legal framework still used today.

Question 77: What does it mean when a drug is labeled 'NTE' on a prescription?

New therapeutic entity — first-in-class drug
Not to exceed — a quantity or dose maximum instruction (Correct answer)
No transfer enabled — non-transferable controlled substance
Not therapeutically equivalent — cannot be substituted

Correct answer: Not to exceed — a quantity or dose maximum instruction

NTE stands for 'Not to Exceed' and is used to indicate a maximum quantity or dose — for example, 'NTE 4 tablets per day' or 'NTE QTY 30.'

Question 78: What are the three segments of a National Drug Code (NDC) number?

Insurance bin, group number, and member ID
DEA schedule, lot number, and manufacturer
Prescriber ID, drug name, and expiration date
Labeler, product, and package size (Correct answer)

Correct answer: Labeler, product, and package size

The NDC is an 11-digit identifier split into three segments: the labeler code (manufacturer/distributor), the product code (drug name, strength, and dosage form), and the package size code. It uniquely identifies every drug product sold in the US.

Question 79: A non-sterile compounded cream contains a base of petrolatum and an active drug. Which type of record is the compounding pharmacy required to maintain for this preparation?

A DEA Form 222 for each batch
A stability certificate from an independent laboratory for each batch
A compounding record (batch record) for each preparation made (Correct answer)
An FDA pre-market approval application

Correct answer: A compounding record (batch record) for each preparation made

USP <795> and state regulations require pharmacies to maintain a compounding record (master formulation record + compounding record) for each non-sterile preparation, documenting ingredients, quantities, equipment, BUD, and compounder identity.

Question 80: Which adverse effect is most commonly associated with ACE inhibitors such as lisinopril?

Dry, persistent cough (Correct answer)
Blurred vision
Uncontrolled nosebleeds
Severe constipation

Correct answer: Dry, persistent cough

A dry, persistent cough is a very common and well-known adverse effect associated with ACE inhibitors like lisinopril. This cough is thought to be caused by the accumulation of bradykinin, a substance that is normally broken down by the ACE enzyme. If the cough is bothersome, patients may be switched to an ARB.

Question 81: What does the DEA Form 222 allow a pharmacy to do?

Transfer Schedule II drugs between pharmacies for patient pickup
Report suspicious prescribing patterns to the DEA
Order Schedule I and II controlled substances from a DEA-registered supplier (Correct answer)
Dispose of expired Schedule III-V substances

Correct answer: Order Schedule I and II controlled substances from a DEA-registered supplier

DEA Form 222 (or the electronic equivalent CSOS) is the official ordering document used by DEA-registered practitioners and pharmacies to purchase Schedule I and II controlled substances.

Question 82: A pharmacy technician is filling a prescription and notices the patient has a known drug allergy to penicillin. The prescription is for amoxicillin. What should the technician do?

Dispense and add an allergy warning label
Substitute cephalexin without consulting the pharmacist
Alert the pharmacist immediately about the allergy before dispensing (Correct answer)
Dispense since amoxicillin is usually safe in penicillin allergy

Correct answer: Alert the pharmacist immediately about the allergy before dispensing

Amoxicillin is a penicillin-class antibiotic. A documented penicillin allergy is a potential contraindication that the pharmacist must evaluate before dispensing.

Question 83: A prescription reads: 'Take ii tabs tid × 10 days.' How many tablets should be dispensed?

60 tablets (Correct answer)
30 tablets
20 tablets
40 tablets

Correct answer: 60 tablets

2 tablets × 3 times/day × 10 days = 60 tablets.

Question 84: Which antibiotic class does amoxicillin belong to?

Macrolide
Tetracycline
Penicillin (Correct answer)
Cephalosporin

Correct answer: Penicillin

Amoxicillin is a broad-spectrum antibiotic that belongs to the penicillin class of antibiotics. It is a beta-lactam antibiotic, meaning it works by inhibiting bacterial cell wall synthesis. Amoxicillin is commonly prescribed to treat various bacterial infections, including respiratory tract infections, ear infections, and urinary tract infections.

Question 85: USP Chapter <795> governs which type of pharmaceutical compounding?

Sterile preparations for injection
Non-sterile preparations (creams, ointments, oral liquids, capsules) (Correct answer)
Veterinary sterile injections only
Radiopharmaceutical compounding

Correct answer: Non-sterile preparations (creams, ointments, oral liquids, capsules)

USP <795> provides standards for non-sterile compounded preparations including topicals (creams, ointments, gels), oral preparations (solutions, suspensions, capsules), and other non-sterile dosage forms.

Question 86: An enteric-coated tablet is specifically designed to:

Be absorbed through the skin
Resist dissolution in stomach acid (Correct answer)
Dissolve quickly under the tongue
Release medication over 24 hours

Correct answer: Resist dissolution in stomach acid

Enteric coatings protect the tablet from dissolution in the acidic stomach environment, allowing it to dissolve in the small intestine instead.

Question 87: What is the required DEA form for reporting the theft or significant loss of controlled substances?

DEA Form 41
DEA Form 224
DEA Form 106 (Correct answer)
DEA Form 222

Correct answer: DEA Form 106

DEA Form 106 must be filed to report theft or significant loss of controlled substances.

Question 88: Under federal law, how long must a pharmacy retain records for Schedule II controlled substances?

1 year
2 years (Correct answer)
3 years
5 years

Correct answer: 2 years

Federal DEA regulations require pharmacies to maintain Schedule II records for a minimum of 2 years; however, many states require longer retention periods.

Question 89: When compounding hazardous drugs (HDs), which type of primary engineering control is required?

Positive pressure cleanroom
Standard pharmacy compounding hood
Horizontal laminar airflow workbench (LAFW)
Biological safety cabinet (BSC) Class II Type A2 or C-PEC (Correct answer)

Correct answer: Biological safety cabinet (BSC) Class II Type A2 or C-PEC

Hazardous drugs must be compounded in a containment primary engineering control (C-PEC) such as a Class II BSC or Compounding Aseptic Containment Isolator (CACI) to protect personnel from toxic drug exposure.

Question 90: Which of the following best describes 'garbing' as it applies to sterile compounding?

The process of donning personal protective equipment in the correct order before entering the clean room (Correct answer)
Sterilizing equipment using an autoclave
Calibrating the laminar airflow workbench filters
Labeling compounded preparations with BUD and lot number

Correct answer: The process of donning personal protective equipment in the correct order before entering the clean room

Garbing refers to the sequential process of putting on required PPE — such as shoe covers, hair covers, gown, mask, and sterile gloves — in the correct order to maintain the cleanliness of the sterile compounding environment.

Question 91: Why is proper documentation of medication errors and near misses important in pharmacy operations?

To avoid complying with state regulations
To justify increasing medication prices.
To assign blame to staff members.
To help improve processes and prevent future errors. (Correct answer)

Correct answer: To help improve processes and prevent future errors.

Proper documentation of medication errors and near misses is crucial for continuous quality improvement and patient safety in pharmacy operations. These reports provide valuable data that can be analyzed to identify root causes, systemic weaknesses, and areas for process improvement. By learning from these events, pharmacies can implement corrective actions and develop strategies to prevent similar errors from occurring in the future.

Question 92: Which route of administration is used for tuberculin skin tests (TST)?

Intravenous
Subcutaneous
Intramuscular
Intradermal (Correct answer)

Correct answer: Intradermal

Tuberculin skin tests are given intradermally (into the dermis layer of skin) to create a wheal that is read 48-72 hours later for immune response.

Question 93: Which abbreviation on a prescription indicates the drug should be injected into a vein?

ID
IV (Correct answer)
IM
SQ

Correct answer: IV

IV stands for intravenous, indicating the medication is to be administered directly into a vein.

Question 94: What is the purpose of media-fill testing in sterile compounding?

To test the potency of active pharmaceutical ingredients
To test the pH of compounded IV solutions before dispensing
To verify that a compounder's aseptic technique does not introduce microbial contamination (Correct answer)
To simulate a hazardous drug spill response

Correct answer: To verify that a compounder's aseptic technique does not introduce microbial contamination

Media-fill tests use a sterile microbiological growth medium in place of actual drug solution. If technique is proper, the medium should remain sterile (no growth); turbidity indicates a breach in aseptic technique.

Question 95: If a dose of 5,000 micrograms is required and the medication's strength is 1 mg/mL, how much should be taken out of the vial?

1.25 ml
225 ml
1.0 ml
0.5 mL (Correct answer)

Correct answer: 0.5 mL

To determine the correct volume, first convert the required dose to milligrams. If the intended dose was 500 micrograms (0.5 mg), then given the medication's strength of 1 mg/mL, you would need to withdraw 0.5 mL from the vial. This calculation (0.5 mg / 1 mg/mL) yields 0.5 mL, which delivers 500 micrograms of the medication.

Question 96: What is the purpose of 'prospective drug utilization review' (Pro-DUR) in pharmacy?

Assess a patient's adherence record after 6 months of therapy
Evaluate a prescription before it is dispensed to identify potential drug problems (Correct answer)
Review all prescriptions filled last month for billing errors
Review drugs for formulary placement at the insurance level

Correct answer: Evaluate a prescription before it is dispensed to identify potential drug problems

Prospective DUR occurs before dispensing — the pharmacist reviews for drug interactions, therapeutic duplications, incorrect dosing, and contraindications before the medication is given to the patient.

Question 97: Ethambutol 10 mg/kg is the dosage you requested for a toddler who weighs 88 lb. 1 dosage =

880 mg
800 mg
400 mg (Correct answer)
200 mg

Correct answer: 400 mg

To calculate the correct dosage, first convert the child's weight from pounds to kilograms. Since 1 kilogram is approximately 2.2 pounds, an 88-pound toddler weighs 40 kg (88 lb / 2.2 lb/kg). Then, multiply the dosage per kilogram by the child's weight in kilograms: 10 mg/kg * 40 kg equals a 400 mg dosage.

Question 98: Which of the following is the FIRST step in the standard pharmacy dispensing workflow?

Conduct the final pharmacist verification
Count and pour the medication
Receive and review the prescription for completeness and validity (Correct answer)
Prepare the medication label

Correct answer: Receive and review the prescription for completeness and validity

The first step is to receive the prescription and review it for all required elements, potential forgery, patient allergies, and any obvious clinical concerns before entering data.

Question 99: Which of the following medications must be stored in the refrigerator (2–8°C)?

Metformin tablets
Atorvastatin tablets
Lisinopril tablets
Insulin glargine (unopened) (Correct answer)

Correct answer: Insulin glargine (unopened)

Unopened insulin glargine must be refrigerated at 2–8°C to maintain potency.

Question 100: A pharmaceutical company issues a recall for a batch of blood pressure medication because it may cause temporary or medically reversible adverse health consequences. According to the FDA, what is the classification for this type of recall?

Class II (Correct answer)
Class I
Class III
Class A

Correct answer: Class II

The FDA classifies recalls into three categories. A Class II recall is issued when the use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences, or where the probability of serious adverse health consequences is remote. A Class I recall is for situations where there is a reasonable probability of serious adverse health consequences or death. A Class III recall is for products that are unlikely to cause any adverse health consequences.

ExCPT Exam (Exam for the Certification of Pharmacy Technicians)

The ExCPT exam certifies the knowledge and skills of pharmacy technicians, enabling them to assist pharmacists in various healthcare settings.

100

Questions

120 min

Time Limit

70%

To Pass

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