ExCPT Drugs and Drug Therapy Practice Test

25 practice questions

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1. Question 1 of 25Hard

   A patient taking digoxin for heart failure is also prescribed furosemide. Which electrolyte abnormality caused by furosemide most increases the risk of digoxin toxicity?

   1. AA. Hypokalemia
   2. BB. Hypercalcemia
   3. CC. Hyponatremia
   4. DD. Hyperkalemia
   Show answer to question 1

   Answer: A. Hypokalemia

   Furosemide increases urinary potassium loss, and low potassium lets more digoxin bind to the sodium-potassium ATPase pump, increasing the risk of digoxin toxicity and arrhythmias. Potassium should be monitored closely in patients taking both drugs.

   Why the other options are wrong

   • BHypercalcemia can also worsen digoxin toxicity, but loop diuretics such as furosemide increase calcium excretion rather than cause hypercalcemia.
   • CHyponatremia can occur with diuretics but does not increase digoxin binding or toxicity the way low potassium does.
   • DFurosemide lowers potassium rather than raising it, and high potassium actually reduces digoxin binding to its pump.

2. Question 2 of 25Easy

   Which dosage form is designed to dissolve slowly in the mouth without water and is absorbed through the oral mucosa?

   1. AA. Effervescent tablet
   2. BB. Sublingual tablet
   3. CC. Extended-release capsule
   4. DD. Enteric-coated tablet
   Show answer to question 2

   Answer: B. Sublingual tablet

   Sublingual tablets are placed under the tongue and dissolve for rapid absorption via the oral mucosa, bypassing first-pass metabolism.

   Why the other options are wrong

   • AEffervescent tablets are dissolved in water before drinking.
   • CExtended-release capsules release drug over hours in the GI tract.
   • DEnteric-coated tablets resist stomach acid and dissolve in the intestines.

3. Question 3 of 25Hard

   A patient taking a first-generation antihistamine such as diphenhydramine is most likely to experience which anticholinergic side effect?

   1. AA. Pupillary constriction
   2. BB. Frequent diarrhea
   3. CC. Urinary retention
   4. DD. Increased salivation
   Show answer to question 3

   Answer: C. Urinary retention

   First-generation antihistamines cross the blood-brain barrier and nonselectively block muscarinic receptors, causing anticholinergic effects such as urinary retention, dry mouth, blurred vision, and constipation. Increased salivation is incorrect because anticholinergic agents decrease exocrine secretions, leading to xerostomia rather than excess saliva.

4. Question 4 of 25Easy

   Which of the following over-the-counter medications is indicated to treat acute diarrhea?

   1. AA. Docusate sodium
   2. BB. Meclizine
   3. CC. Famotidine
   4. DD. Loperamide
   Show answer to question 4

   Answer: D. Loperamide

   Loperamide slows intestinal motility and is used to treat acute and chronic diarrhea. Docusate sodium is a stool softener used to relieve constipation, famotidine is an acid reducer used for heartburn, and meclizine is an antihistamine used to prevent motion sickness and vertigo.

5. Question 5 of 25Hard

   A patient taking an ACE inhibitor such as lisinopril reports a persistent dry cough. What is the most likely cause?

   1. AA. Increased prostaglandin synthesis
   2. BB. Direct irritation of the respiratory tract
   3. CC. Accumulation of bradykinin due to ACE inhibition
   4. DD. Bronchospasm from beta blockade
   Show answer to question 5

   Answer: C. Accumulation of bradykinin due to ACE inhibition

   ACE inhibitors block the conversion of angiotensin I to angiotensin II and also prevent the breakdown of bradykinin. Accumulated bradykinin can stimulate cough receptors, leading to a dry cough.

   Why the other options are wrong

   • AIncreased prostaglandin synthesis is associated with NSAIDs, not ACE inhibitors.
   • BDirect irritation is not a known mechanism; the cough is mediated by bradykinin, not direct irritation.
   • DBronchospasm is associated with beta blockers (e.g., propranolol), not ACE inhibitors.

6. Question 6 of 25Medium

   A patient with hypertension and heart failure is prescribed spironolactone. To which diuretic class does this medication belong?

   1. AA. Thiazide diuretic
   2. BB. Potassium-sparing diuretic
   3. CC. Loop diuretic
   4. DD. Osmotic diuretic
   Show answer to question 6

   Answer: B. Potassium-sparing diuretic

   Spironolactone antagonizes aldosterone receptors to promote sodium and water excretion while conserving potassium, classifying it as a potassium-sparing diuretic. Loop diuretics such as furosemide act on the loop of Henle and commonly cause potassium loss rather than retention.

7. Question 7 of 25Easy

   A patient is prescribed metformin for type 2 diabetes. To which drug class does metformin belong?

   1. AA. Biguanide
   2. BB. DPP-4 inhibitor
   3. CC. Sulfonylurea
   4. DD. SGLT2 inhibitor
   Show answer to question 7

   Answer: A. Biguanide

   Metformin is a biguanide that works by decreasing hepatic glucose production and improving insulin sensitivity. It is first-line therapy for type 2 diabetes.

   Why the other options are wrong

   • BDPP-4 inhibitors (e.g., sitagliptin) increase incretin levels; metformin is not in this class.
   • CSulfonylureas (e.g., glipizide) stimulate insulin release from the pancreas, not metformin's mechanism.
   • DSGLT2 inhibitors (e.g., empagliflozin) increase glucose excretion in urine; metformin is not an SGLT2 inhibitor.

8. Question 8 of 25Medium

   A physician orders a liquid medication to be administered via a nasogastric (NG) tube. Into which broad category of administration does this route fall?

   1. AA. Topical
   2. BB. Transmucosal
   3. CC. Parenteral
   4. DD. Enteral
   Show answer to question 8

   Answer: D. Enteral

   The enteral route includes any delivery of medication directly into the gastrointestinal tract, such as orally, rectally, or through feeding tubes like an NG tube. Parenteral administration bypasses the digestive tract completely, typically utilizing sterile injections such as intravenous or intramuscular routes.

9. Question 9 of 25Medium

   A patient starting immediate-release niacin therapy for hyperlipidemia reports uncomfortable facial flushing and warmth. What intervention can help alleviate this reaction?

   1. AA. Increasing the niacin dose rapidly to promote faster drug tolerance
   2. BB. Consuming a hot beverage immediately after taking the niacin dose
   3. CC. Taking aspirin thirty minutes prior to the niacin dose
   4. DD. Taking the niacin dose on an empty stomach first thing in the morning
   Show answer to question 9

   Answer: C. Taking aspirin thirty minutes prior to the niacin dose

   Niacin-induced cutaneous flushing is prostaglandin-mediated, and taking an aspirin 30 minutes before the niacin dose helps blunt this prostaglandin release and reduces flushing symptoms. Hot beverages and taking niacin on an empty stomach actually worsen the cutaneous vasodilation and flushing. Rapidly escalating the dose increases the severity of adverse effects rather than building tolerance safely.

10. Question 10 of 25Medium

    Why are some tablets formulated with an enteric coating?

    1. AA. To protect the drug from stomach acid or prevent stomach irritation
    2. BB. To allow the tablet to dissolve in the stomach for faster absorption
    3. CC. To provide a sustained release over 24 hours
    4. DD. To make the tablet easier to swallow
    Show answer to question 10

    Answer: A. To protect the drug from stomach acid or prevent stomach irritation

    Enteric coating resists gastric acid, allowing the tablet to dissolve in the intestines. This protects acid-labile drugs (e.g., omeprazole) or reduces stomach irritation (e.g., aspirin).

    Why the other options are wrong

    • BEnteric coating delays dissolution until after the stomach; it does not promote faster absorption in the stomach.
    • CSustained release is achieved by special matrix or osmotic systems, not enteric coating alone.
    • DEase of swallowing is improved by film coating or smaller size, not enteric coating.

11. Question 11 of 25Hard

    A technician is processing a new prescription for a patient with a history of atrial fibrillation. The medication is classified as a Class III antiarrhythmic. Which of the following drugs fits this classification?

    1. AA. Flecainide
    2. BB. Verapamil
    3. CC. Lidocaine
    4. DD. Amiodarone
    Show answer to question 11

    Answer: D. Amiodarone

    Amiodarone is a Class III antiarrhythmic: it blocks potassium channels and prolongs repolarization, and it is used for atrial fibrillation and ventricular arrhythmias.

    Why the other options are wrong

    • AFlecainide is a Class IC antiarrhythmic.
    • BVerapamil is a calcium channel blocker (Class IV antiarrhythmic).
    • CLidocaine is a Class IB antiarrhythmic, not Class III.

12. Question 12 of 25Hard

    A patient is prescribed lisinopril for hypertension. Which adverse effect is most commonly associated with this class of medications?

    1. AA. Bradycardia
    2. BB. Dry cough
    3. CC. Hyperkalemia
    4. DD. Constipation
    Show answer to question 12

    Answer: B. Dry cough

    Lisinopril is an ACE inhibitor. A persistent dry cough is a well-known side effect due to accumulation of bradykinin. It occurs in up to 20% of patients.

    Why the other options are wrong

    • ABradycardia is more commonly associated with beta-blockers, not ACE inhibitors.
    • CHyperkalemia can occur with ACE inhibitors but is less common than cough and usually in patients with renal impairment or those taking potassium supplements.
    • DConstipation is not a typical side effect of ACE inhibitors; it is more common with calcium channel blockers or opioids.

13. Question 13 of 25Medium

    Which therapeutic category does a beta blocker such as metoprolol belong to?

    1. AA. Endocrine agents
    2. BB. Central nervous system agents
    3. CC. Respiratory agents
    4. DD. Cardiovascular agents
    Show answer to question 13

    Answer: D. Cardiovascular agents

    Beta blockers like metoprolol are used for hypertension, angina, and heart failure, placing them in the cardiovascular therapeutic category.

    Why the other options are wrong

    • AEndocrine agents include insulin, thyroid hormones, and oral hypoglycemics.
    • BCentral nervous system agents include antidepressants, antipsychotics, and anxiolytics, not beta blockers.
    • CRespiratory agents include bronchodilators and corticosteroids for asthma/COPD.

14. Question 14 of 25Medium

    Which of the following medications is classified as an angiotensin-converting enzyme (ACE) inhibitor?

    1. AA. Atorvastatin
    2. BB. Omeprazole
    3. CC. Metformin
    4. DD. Lisinopril
    Show answer to question 14

    Answer: D. Lisinopril

    Lisinopril is an ACE inhibitor used to treat hypertension and heart failure. ACE inhibitors end in '-pril'.

    Why the other options are wrong

    • AAtorvastatin is a statin used to lower cholesterol.
    • BOmeprazole is a proton pump inhibitor used for acid reflux.
    • CMetformin is a biguanide used for type 2 diabetes.

15. Question 15 of 25Easy

    A patient newly started on warfarin for atrial fibrillation returns for follow up lab work. Which laboratory value is used to monitor the anticoagulant effect and guide dose adjustments?

    1. AA. International normalized ratio (INR)
    2. BB. Hemoglobin A1c
    3. CC. Platelet count
    4. DD. Partial thromboplastin time (PTT)
    Show answer to question 15

    Answer: A. International normalized ratio (INR)

    Warfarin's effect is monitored with the prothrombin time reported as the INR. The INR guides dose adjustments; for atrial fibrillation the usual target range is 2 to 3.

    Why the other options are wrong

    • BHemoglobin A1c measures long-term blood glucose control, not anticoagulation.
    • CPlatelet count does not reflect warfarin's effect on clotting factors.
    • DPTT is used to monitor unfractionated heparin, not warfarin.

16. Question 16 of 25Easy

    Which of the following is a brand name for the generic drug metformin?

    1. AA. Lipitor
    2. BB. Synthroid
    3. CC. Lasix
    4. DD. Glucophage
    Show answer to question 16

    Answer: D. Glucophage

    Glucophage is the brand name for metformin, a first-line oral antidiabetic agent. Lasix is furosemide (diuretic), Lipitor is atorvastatin (statin), and Synthroid is levothyroxine (thyroid hormone).

    Why the other options are wrong

    • ALipitor is the brand name for atorvastatin, a cholesterol-lowering medication.
    • BSynthroid is the brand name for levothyroxine, used for hypothyroidism.
    • CLasix is the brand name for furosemide, a loop diuretic.

17. Question 17 of 25Medium

    A patient is prescribed a transdermal patch for motion sickness. The patch should be applied 4 hours before travel. Which route of administration does this represent?

    1. AA. Intramuscular - injection into a muscle
    2. BB. Transdermal - systemic absorption through the skin
    3. CC. Subcutaneous - injection into the fatty layer under the skin
    4. DD. Topical - application to a localized area of skin
    Show answer to question 17

    Answer: B. Transdermal - systemic absorption through the skin

    A transdermal patch, such as scopolamine for motion sickness, releases drug steadily through the skin into the bloodstream for a systemic effect.

    Why the other options are wrong

    • AIntramuscular is an injection route, not a patch.
    • CSubcutaneous is an injection route, not a patch.
    • DTopical is for local effect, not systemic.

18. Question 18 of 25Medium

    A pharmacy receives a prescription for montelukast (Singulair) 10 mg tablets. Which therapeutic class does this medication belong to?

    1. AA. Long-acting beta-2 agonist
    2. BB. Mast cell stabilizer
    3. CC. Leukotriene receptor antagonist
    4. DD. Inhaled corticosteroid
    Show answer to question 18

    Answer: C. Leukotriene receptor antagonist

    Montelukast is an oral leukotriene receptor antagonist that blocks the action of leukotriene D4, reducing airway inflammation and bronchoconstriction in asthma and allergic rhinitis. Mast cell stabilizers include cromolyn, whereas medications like salmeterol are long-acting beta-2 agonists.

19. Question 19 of 25Easy

    Which of the following is an over-the-counter (OTC) medication commonly used for pain relief?

    1. AA. Ibuprofen
    2. BB. Warfarin
    3. CC. Metformin
    4. DD. Lisinopril
    Show answer to question 19

    Answer: A. Ibuprofen

    Ibuprofen is available OTC for pain and fever. Metformin (diabetes), warfarin (anticoagulant), and lisinopril (hypertension) are prescription-only medications.

    Why the other options are wrong

    • BWarfarin is a prescription anticoagulant requiring monitoring, not OTC.
    • CMetformin is a prescription medication for type 2 diabetes, not available OTC.
    • DLisinopril is a prescription ACE inhibitor for hypertension, not OTC.

20. Question 20 of 25Hard

    A patient is prescribed metoprolol succinate for heart failure. Which of the following is a common side effect that the patient should be counseled about?

    1. AA. Cough
    2. BB. Insomnia
    3. CC. Bradycardia
    4. DD. Hyperglycemia
    Show answer to question 20

    Answer: C. Bradycardia

    Metoprolol is a beta-blocker; beta-blockers commonly cause bradycardia (slow heart rate) due to blockade of beta-1 receptors in the heart.

    Why the other options are wrong

    • ACough is a common side effect of ACE inhibitors, not beta-blockers.
    • BInsomnia can occur with beta-blockers but is less common than bradycardia; beta-blockers are more likely to cause fatigue or sleep disturbances.
    • DHyperglycemia is more commonly associated with diuretics or corticosteroids.

21. Question 21 of 25Medium

    A pharmacy technician is reviewing a patient's medication profile and sees amoxicillin. Which drug classification does amoxicillin belong to, and what is its primary therapeutic use?

    1. AA. Fluoroquinolone antibiotic; used for urinary tract infections
    2. BB. Penicillin antibiotic; used for bacterial infections
    3. CC. Cephalosporin antibiotic; used for skin infections
    4. DD. Macrolide antibiotic; used for respiratory infections
    Show answer to question 21

    Answer: B. Penicillin antibiotic; used for bacterial infections

    Amoxicillin is a penicillin-class antibiotic used to treat a variety of bacterial infections, such as otitis media, sinusitis, and urinary tract infections.

    Why the other options are wrong

    • AFluoroquinolones include ciprofloxacin, not amoxicillin.
    • CCephalosporins include cephalexin, not amoxicillin.
    • DMacrolides include azithromycin, not amoxicillin.

22. Question 22 of 25Medium

    A patient with asthma uses a maintenance inhaler containing a corticosteroid. Which therapeutic category does this medication belong to?

    1. AA. Bronchodilator
    2. BB. Anti-inflammatory
    3. CC. Mast cell stabilizer
    4. DD. Anticholinergic
    Show answer to question 22

    Answer: B. Anti-inflammatory

    Inhaled corticosteroids (e.g., fluticasone) are anti-inflammatory agents that reduce airway inflammation in asthma, used for long-term control.

    Why the other options are wrong

    • ABronchodilators (e.g., albuterol) relax airway muscles but are not anti-inflammatory.
    • CMast cell stabilizers (e.g., cromolyn) prevent mast cell degranulation but are not corticosteroids.
    • DAnticholinergics (e.g., ipratropium) are bronchodilators, not anti-inflammatory.

23. Question 23 of 25Easy

    A pharmacy technician is reviewing a prescription for a medication that ends in the suffix '-olol'. Which drug class does this suffix typically indicate?

    1. AA. Beta-blocker
    2. BB. Calcium channel blocker
    3. CC. ACE inhibitor
    4. DD. Angiotensin II receptor blocker
    Show answer to question 23

    Answer: A. Beta-blocker

    The suffix '-olol' is characteristic of beta-blockers (e.g., metoprolol, atenolol). These drugs block beta-adrenergic receptors and are used for hypertension, angina, and arrhythmias. ACE inhibitors often end in '-pril', calcium channel blockers in '-dipine', and ARBs in '-sartan'.

    Why the other options are wrong

    • BCalcium channel blockers often end in '-dipine' (e.g., amlodipine), not '-olol'.
    • CACE inhibitors typically end in '-pril' (e.g., lisinopril), not '-olol'.
    • DAngiotensin II receptor blockers (ARBs) typically end in '-sartan' (e.g., losartan), not '-olol'.

24. Question 24 of 25Medium

    Which combination of medications presents a high risk for life-threatening hyperkalemia if taken together without careful laboratory monitoring?

    1. AA. Atenolol and atorvastatin
    2. BB. Spironolactone and lisinopril
    3. CC. Furosemide and metoprolol
    4. DD. Hydrochlorothiazide and amlodipine
    Show answer to question 24

    Answer: B. Spironolactone and lisinopril

    Combining a potassium-sparing aldosterone antagonist such as spironolactone with an ACE inhibitor such as lisinopril creates an additive potassium-retaining effect, significantly raising the risk of severe hyperkalemia. Furosemide promotes renal potassium excretion rather than retention, which tends to decrease serum potassium concentrations instead.

25. Question 25 of 25Hard

    A patient stabilized on warfarin is prescribed a short course of an antibiotic for a dental infection. Which antibiotic poses the greatest risk of significantly increasing the patient's INR and bleeding risk?

    1. AA. Doxycycline
    2. BB. Azithromycin
    3. CC. Metronidazole
    4. DD. Amoxicillin
    Show answer to question 25

    Answer: C. Metronidazole

    Metronidazole inhibits CYP2C9, the enzyme that clears the more potent S-enantiomer of warfarin, so warfarin levels and the INR can rise sharply and increase bleeding risk. Patients who need it while on warfarin require closer INR monitoring or a warfarin dose reduction.

    Why the other options are wrong

    • ADoxycycline may raise the INR modestly, mainly by reducing vitamin K made by gut bacteria, but its effect is far smaller than metronidazole's.
    • BAzithromycin has only a modest, occasional effect on the INR and does not strongly inhibit warfarin metabolism.
    • DAmoxicillin can nudge the INR up by altering gut flora that make vitamin K, but this effect is minor compared with metronidazole.

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