PEBC Pharmacist Evaluating Exam – Sample Questions

1. A once‑daily osmotic tablet is designed to deliver a drug at an approximately constant rate over 24 hours, largely independent of gastrointestinal pH and motility. Which statement best describes the primary mechanism controlling drug release from this system?

2. A patient asks why one capsule is labelled “enteric‑coated delayed‑release” and another “extended‑release.” For an acid‑labile drug that irritates the stomach and is best absorbed in the small intestine, which formulation goal most accurately describes the primary purpose of an enteric‑coated delayed‑release dosage form?

3. An immediate‑release oral formulation of a drug shows a terminal half‑life of 12 hours after oral dosing, but only 3 hours after an intravenous dose in the same patient. Which interpretation best explains this difference?

4. A full agonist produces maximal response at a receptor. When a partial agonist is added and its concentration gradually increased (while the full agonist concentration is kept constant), the overall response decreases below the previous maximum. Which statement best explains this effect?

5. A farmer presents with organophosphate pesticide poisoning: bronchorrhea, miosis, bradycardia, fasciculations, and respiratory distress. He has received adequate atropine but still has significant muscle weakness requiring ventilatory support. Which statement best describes the most appropriate role of pralidoxime in this setting?

6. A patient with long‑standing ischemic cardiomyopathy and reduced ejection fraction develops progressive left ventricular dilation, fluid retention, and worsening symptoms over several months. Which mechanism best explains how chronic neurohormonal activation contributes to this progression?

7. A 68‑year‑old woman presents with pleuritic chest pain and mild dyspnea. Her Wells score for pulmonary embolism is low. A highly sensitive laboratory D‑dimer assay returns negative, using an age‑adjusted cutoff. Which interpretation of this result is most appropriate?

8. A 72‑year‑old man with hypertension on lisinopril/hydrochlorothiazide and stage 3 chronic kidney disease (eGFR 45 mL/min/1.73 m²) asks to use OTC ibuprofen daily for chronic knee pain. Which recommendation best reflects safe, evidence‑based pharmacotherapeutic management?

9. A 55‑year‑old woman stabilized on extended‑release tacrolimus after a kidney transplant wants to start an OTC herbal product, St. John’s wort, for low mood. Which statement best describes the most important pharmacotherapeutic concern?

10. An older adult with hypertension, type 2 diabetes, and osteoarthritis presents for a medication review. You identify: (1) suboptimal BP control; (2) mild ACE‑inhibitor–related cough; (3) patient confusion about insulin timing; and (4) chronic NSAID use despite stage 3 CKD. According to a systematic patient care process, which problem should the pharmacist prioritize addressing first?

11. A 6‑year‑old (20 kg) with cystic fibrosis and a documented multidrug‑resistant Pseudomonas aeruginosa pulmonary exacerbation has failed optimized inhaled tobramycin and two appropriate IV antibiotics. The infectious diseases specialist prescribes oral ciprofloxacin. What is the most appropriate pharmacist response regarding this fluoroquinolone use in a child?

12. A busy community pharmacy receives a handwritten prescription for “hydromorphone 2 mg PO q4h PRN,” but the technician accidentally selects hydromorphone 10 mg/mL oral solution from the shelf because it is stored near hydromorphone 2 mg tablets and both labels look similar. According to best practices for prescription processing and LASA error prevention, at which step should the pharmacist’s verification focus most strongly prevent this error before dispensing?

13. A patient newly started on a basal insulin pen reports that their fasting glucose remains unexpectedly high despite apparently correct dosing. On demonstration, you notice they dial the dose and inject without performing a priming (air-shot) step. Which teaching point best addresses the most likely administration error?

14. A prescription orders dopamine at 10 micrograms/kg/hour for a 72‑kg patient. The pharmacy supplies dopamine 400 mg in 250 mL D5W. What infusion rate (mL/hour) should be set on the IV pump?

15. A family physician writes “no refills” on a new antihypertensive for an older patient, but the patient later tells you they will run out before their next scheduled appointment and cannot get in sooner. Which action best reflects effective interprofessional communication and collaborative care?

16. A patient is prescribed oral bisphosphonate therapy for osteoporosis and plans to take it each morning with their other medications and breakfast. Which administration instruction is most critical to reduce the risk of esophageal irritation and ensure adequate absorption?

17. A randomized controlled trial (RCT) of a new antihypertensive reports a relative risk of stroke of 0.70 (95% CI 0.48–1.02, p = 0.07) compared with standard therapy. Which interpretation best reflects appropriate evidence‑based decision making?

18. A long‑time patient asks you to backdate a refill on a controlled medication so their insurer will cover it, stating they “took extra during a family crisis” and promising not to do it again. Which response best upholds professional ethics and legal obligations?

19. A community pharmacy’s financial statements show rising prescription volume but declining net profit over the past year. Drug acquisition costs are stable, and staffing hours have not changed. Which management action is the most appropriate first step to understand and address the decline?

20. A First Nations client describes previous experiences of being ignored and stereotyped in hospital and says they worry your pharmacy will be the same. According to Indigenous cultural safety and humility standards for pharmacists, what is the most appropriate immediate response?