SPEX Study Guide 2026
Everything you need to pass the SPEX exam in one place: the exam format, every topic to study, real practice questions with explanations, flashcards, and full-length practice tests. Free, no sign-up needed.
📋 SPEX Exam Format at a Glance
📚 SPEX Topics to Study (125)
✍️ Sample SPEX Questions & Answers
1. Which medication used for acne treatment is absolutely contraindicated in pregnancy due to teratogenicity?
Oral isotretinoin is a Category X teratogen causing severe birth defects and requires enrollment in the iPLEDGE program for all patients.
2. A pharmacy technician accepts a faxed prescription for a Schedule II controlled substance. What is the pharmacist's appropriate response?
Federal law requires Schedule II controlled substances to be dispensed only with an original written or valid electronic prescription; faxes serve only as a record with limited emergency exceptions.
3. A 65-year-old man has a pearly, telangiectatic papule on his nose that has slowly enlarged over 2 years. Biopsy shows palisading nuclei at the periphery of tumor islands. What is the diagnosis?
Basal cell carcinoma characteristically shows palisading of nuclei at the periphery of tumor nests on histology, with a pearly, telangiectatic clinical appearance.
4. A patient asks their physician to provide a fraudulent sick note to avoid work. What is the appropriate physician response?
Providing fraudulent documentation is a breach of medical ethics and professional integrity, and constitutes fraud.
5. A patient taking phenelzine for depression presents to the ER after self-administering dextromethorphan (DXM) from an OTC cough syrup. Which syndrome is the primary concern and what is its mechanism?
DXM is a sigma-1 receptor agonist and a weak serotonin reuptake inhibitor (SERT inhibitor). When combined with an irreversible MAO inhibitor like phenelzine, which prevents serotonin degradation, the two mechanisms converge to cause serotonin syndrome: hyperthermia, clonus, hyperreflexia, diaphoresis, and agitation. This combination is absolutely contraindicated. DXM does have weak mu-opioid activity, but this is not the dominant clinical concern with MAOI co-administration.
6. In communicable disease control, 'herd immunity threshold' is calculated as 1 − (1/R₀). For measles with an R₀ of 15, what percentage of the population must be immune?
1 − (1/15) = 1 − 0.067 ≈ 0.933, meaning approximately 93% of the population must be immune.