Free Pharmacy Technician Certification Exam (PTCE) practice questions

The answer

Answer: B. Metformin belongs to the biguanide class of antidiabetic medications. It is first-line therapy for type 2 diabetes mellitus and works primarily by decreasing hepatic glucose production. ACE inhibitors like lisinopril, beta-blockers like metoprolol, and calcium channel blockers like amlodipine are used for hypertension, not as primary antidiabetics.

Source: PTCE Content Outline — Medications: Drug Classifications

The answer

Answer: B. Amiodarone inhibits CYP2C9 and CYP3A4, the enzymes that clear warfarin, so warfarin levels and the INR rise and bleeding risk goes up; the warfarin dose is often reduced and INR checked more often. Warfarin does not induce the enzymes that metabolize amiodarone, so a weaker amiodarone effect is not the concern. Low blood sodium and seizures are not part of this interaction. The INR goes up, not down, so a lower bleeding risk is the opposite of what happens.

Source: PTCE Content Outline — Medications: Drug Interactions

The answer

Answer: C. Sublingual tablets (such as nitroglycerin) are placed under the tongue where they dissolve rapidly for direct absorption through the oral mucosa into the bloodstream, bypassing first-pass metabolism. Enteric-coated tablets resist stomach acid and dissolve in the intestine. Extended-release capsules release drug slowly over time. Chewable tablets are meant to be chewed before swallowing.

Source: PTCE Content Outline — Medications: Dosage Forms and Routes

The answer

Answer: D. Sertraline is an SSRI, a first-line treatment for depression, anxiety disorders, and OCD. SSRIs selectively block the reuptake of serotonin in the brain. Benzodiazepines like alprazolam enhance GABA activity. MAOIs like phenelzine inhibit monoamine oxidase. TCAs like amitriptyline block norepinephrine and serotonin reuptake non-selectively and have more anticholinergic side effects than SSRIs.

Source: PTCE Content Outline — Medications: Drug Classifications

The answer

Answer: B. Omeprazole blocks only proton pumps that are actively secreting, and a meal is what switches them on. Taking the dose 30 to 60 minutes before eating puts the drug in the blood when the pumps activate. Food does not increase omeprazole absorption. The drug has no effect on blood sugar. It is acid-labile, but that is why it comes in a delayed-release form; acid breakdown is not the reason for the empty-stomach timing.

Source: PTCE Content Outline — Medications: Drug Administration

The answer

Answer: B. A persistent dry, nonproductive cough is a well-known side effect of ACE inhibitors like lisinopril, occurring in up to 10–15% of patients. It is caused by accumulation of bradykinin in the lungs. If intolerable, the prescriber may switch to an ARB (like losartan). Hair growth changes, jaundice, and muscle spasms are not characteristic side effects of ACE inhibitors.

Source: PTCE Content Outline — Medications: Side Effects

The answer

Answer: C. Since October 6, 2014, all hydrocodone combination products such as hydrocodone/acetaminophen are Schedule II. They cannot be refilled and need a written or electronic prescription; an oral order is allowed only in an emergency. Schedule III is where these products sat before 2014 and still covers items like testosterone and codeine combinations of 90 mg or less per dosage unit. Schedule IV holds drugs such as benzodiazepines. Schedule V covers low-dose codeine cough preparations.

Source: PTCE Content Outline — Federal Requirements: DEA Schedules

The answer

Answer: B. HIPAA permits disclosure of protected health information (PHI) without authorization in specific circumstances, including to law enforcement officials with a valid court order, subpoena, or court-ordered warrant. The other scenarios described do not meet HIPAA exceptions. Employers, other patients, and pharmaceutical representatives do not have a legal right to access individual patient prescription records without explicit authorization.

Source: PTCE Content Outline — Federal Requirements: HIPAA

The answer

Answer: B. The Controlled Substances Act (CSA), administered by the DEA, requires that records related to controlled substances (receipts, dispensing, and disposal) be maintained for a minimum of two years from the date of the transaction. HIPAA addresses privacy of health information, DSCSA addresses drug supply chain traceability, and the Fair Packaging and Labeling Act regulates product labeling.

Source: PTCE Content Outline — Federal Requirements: Record Keeping

The answer

Answer: D. Pregabalin is a Schedule V controlled substance, the lowest schedule, alongside lacosamide and cough preparations that contain small amounts of codeine. Zolpidem is a Schedule IV sleep aid, grouped with the benzodiazepines. Buprenorphine sits in Schedule III, together with products such as testosterone. Methylphenidate is a Schedule II stimulant with a high potential for abuse, so its prescriptions cannot carry refills.

Source: PTCE Content Outline — Federal Requirements: DEA Schedules

The answer

Answer: C. Refills exist only when the prescriber authorizes them, so a prescription with no refills written can be filled once and never refilled, whatever its schedule. Up to 5 refills within 6 months is the federal ceiling for Schedule III to V drugs, and it applies only when the prescriber writes those refills. Unlimited refills for a year is never allowed for a controlled substance. Three refills within 6 months would still need the prescriber to authorize them, and none were written here.

Source: PTCE Content Outline — Federal Requirements: Controlled Substances

The answer

Answer: D. Of these choices, only verifying product identifiers is a DSCSA duty. The law requires dispensers to have systems to verify the product identifier (NDC, serial number, lot number and expiration date in a 2D barcode) at the package level, especially when a product is suspect. DSCSA does not require pharmacies to lab-test incoming drugs. It sets no 30-day quarantine for normal shipments; quarantine applies to suspect product. Wholesaler licensing must be checked, but the rule is that trading partners be licensed, not licensed in the pharmacy's own state.

Source: PTCE Content Outline — Federal Requirements: DSCSA

The answer

Answer: C. Schedule II drugs are ordered on DEA Form 222 or through the electronic CSOS system, and when the order arrives the pharmacy records the quantity and date received on its copy or electronic record. DEA Form 224 is the application a pharmacy files to register with the DEA, not a receiving record. DEA Form 106 reports theft or significant loss. DEA Form 41 documents the destruction of controlled substances.

Source: PTCE Content Outline — Federal Requirements: Controlled Substances

The answer

Answer: D. Celecoxib is a sulfonamide-containing NSAID (COX-2 selective inhibitor). Patients with a documented sulfa allergy may experience cross-reactivity. Metformin, lisinopril, and atorvastatin do not contain sulfonamide moieties. However, the technician should always defer clinical allergy evaluation to the pharmacist, who can assess the nature and severity of the allergy before any dispensing decision.

Source: PTCE Content Outline — Patient Safety: Allergy Alerts

The answer

Answer: D. Hydralazine, a vasodilator for high blood pressure, and hydrochlorothiazide, a thiazide diuretic, share the 'hydr-' start, similar length and the same heart and blood pressure use, and ISMP lists them among commonly confused names. Haloperidol is an antipsychotic whose name looks nothing like hydralazine. Hydroxychloroquine is an antimalarial and lupus drug that is confused with hydroxyzine, not hydralazine. Hydromorphone is an opioid usually confused with morphine.

Source: PTCE Content Outline — Patient Safety: Look-Alike/Sound-Alike Drugs

The answer

Answer: C. The Institute for Safe Medication Practices (ISMP) classifies high-alert medications as those bearing a heightened risk of causing significant patient harm when used in error. Insulin, particularly when given in incorrect doses or to the wrong patient, can cause fatal hypoglycemia or severe hyperglycemia (DKA). Cost, DEA scheduling, and storage requirements do not determine the high-alert classification.

Source: PTCE Content Outline — Patient Safety: High-Alert Medications

The answer

Answer: D. A product whose labeling requires refrigeration and that has sat at room temperature for two days can no longer be trusted for potency, so the technician sets it aside for disposal and tells the pharmacist, who decides whether a fresh bottle is prepared. Freezing does not reverse heat exposure and can damage a suspension. Shaking only resuspends the drug and does nothing for potency. Putting it back in the refrigerator hides the storage error and still sends out a compromised product.

Source: PTCE Content Outline — Patient Safety: Medication Storage

The answer

Answer: A. Tall-man lettering capitalizes the letters that differ between look-alike names, such as hydrOXYzine and hydrALAZINE, so the eye catches the difference and picks the right drug. It is a safety measure, not a speed aid. It adds capital letters and saves no characters or printing cost. FDA and ISMP recommend tall-man names for specific confusable pairs; there is no FDA rule that every drug name on a label be capitalized.

Source: PTCE Content Outline — Patient Safety: Error Prevention

The answer

Answer: A. Warfarin is not a controlled substance, so federal law sets no refill limit; the number of refills is what the prescriber authorizes, within state rules such as a one-year expiration. The 5 refills in 6 months cap applies only to Schedule III and IV drugs. Saying refills are not allowed confuses warfarin with Schedule II drugs. A 3-refill, 90-day limit does not exist in federal law.

Source: PTCE Content Outline — Order Entry: Prescription Processing

The answer

Answer: C. A prior authorization rejection means the plan wants the prescriber to justify the drug before it pays, so the pharmacy notifies the prescriber's office to start the request. Switching to another drug without the prescriber's consent is outside the pharmacy's authority. Offering the cash price can come up later, but the patient should first get the chance to have the claim covered. Dispensing and then billing the patient without telling them skips the PA and leaves the patient with an unexpected charge.

Source: PTCE Content Outline — Order Entry: Insurance and Billing

The answer

Answer: D. A perpetual inventory records every receipt, dispensing and disposal as it happens, so the running balance should always match what is on the shelf and a gap shows up quickly. It is not limited to Schedule II; pharmacies may keep one for any schedule. Tracking only monthly receipts would miss everything dispensed or destroyed. Expiration dates are checked during stock rotation and are not what defines a perpetual count.

Source: PTCE Content Outline — Order Entry: Inventory Management

The answer

Answer: D. Ibuprofen and other NSAIDs reduce platelet function and can irritate the stomach lining, so with warfarin they raise the chance of a GI bleed. Acetaminophen at recommended doses is the usual pain choice for warfarin users, though regular high doses can raise the INR. Loratadine, a non-sedating antihistamine, has no meaningful bleeding interaction. Omeprazole may slightly affect warfarin metabolism but does not cause the platelet effect that makes NSAIDs risky.

Source: PTCE Content Outline — Medications: Drug Interactions

The answer

Answer: B. Nitroglycerin is volatile and loses potency to heat, light, air and moisture, so the tablets stay in their original tightly capped glass bottle at room temperature; plastic absorbs the drug. A pill organizer on a bathroom shelf exposes them to humidity, air and light. Refrigeration is not recommended because moisture condenses each time the cold bottle is opened. A plastic bag in the freezer combines the wrong container with damaging cold and moisture.

Source: PTCE Content Outline — Patient Safety: Medication Storage

The answer

Answer: C. PPIs like omeprazole lower stomach acid, and levothyroxine absorbs less well in a less acidic stomach, so the technician flags the combination for the pharmacist, who may advise consistent timing or suggest thyroid level checks. Dispensing without comment skips that review. Refusing to fill is a decision outside a technician's role. Swapping in another thyroid product is a substitution only the prescriber or pharmacist can make.

Source: PTCE Content Outline — Patient Safety: Error Prevention

The answer

Answer: B. The order works out to 25 mg a day, and the only tablet on hand is 100 mg, so the pharmacy calls the prescriber to get the dose written in a strength that can be dispensed, such as 25 mg tablets. Switching to 100 mg daily quadruples the dose. Two 25 mg tablets a day would give 50 mg, double the intended dose. Splitting a 100 mg tablet in half yields 50 mg, still twice the order.

Source: PTCE Content Outline — Order Entry: Prescription Processing

The answer

Answer: D. Day 1 uses two 250 mg tablets (500 mg), and days 2 through 5 use one tablet each, so 2 + 4 = 6 tablets, the standard Z-Pak. Five tablets forgets the extra tablet on day 1. Eight tablets would be two a day for four days, which the directions do not say. Ten tablets would mean two tablets every day for five days.

Source: PTCE Content Outline — Medications: Dosage Calculations

The answer

Answer: B. The taper has two phases: 2 tablets a day for 5 days is 10 tablets, then 1 tablet a day for 5 days is 5 more, so 15 tablets are dispensed. Ten tablets covers only the first phase. Twenty tablets assumes 2 tablets a day for all 10 days. Twenty-five tablets does not match any reading of the directions.

Source: PTCE Content Outline — Medications: Dosage Calculations

The answer

Answer: D. Atorvastatin is the generic name for the brand product Lipitor. It is an HMG-CoA reductase inhibitor (statin) used to lower cholesterol and reduce cardiovascular risk. Rosuvastatin is Crestor, simvastatin is Zocor, and pravastatin is Pravachol — all statins but different products.

Source: PTCE Content Outline — Medications: Top 200 Drugs (Brand/Generic)

The answer

Answer: A. Geometric dilution starts with the small amount of drug and an equal amount of diluent, mixes them, then adds diluent equal to the mixture each time, so a potent drug ends up evenly spread. It is not a drying step for removing moisture. It does not stop after one equal-parts mix; the doubling repeats until all diluent is in. Cutting particle size is trituration, a separate step.

Source: PTCE Content Outline — Medications: Compounding Basics

The answer

Answer: A. An ointment slab (pill tile) and spatula let the compounder spread, fold and shear the ointment so the drug spreads evenly through the base. A mortar and pestle mainly reduces powder particle size and is awkward and wasteful for stiff ointments. A graduated cylinder and stirring rod measure and mix liquids. An analytical balance weighs ingredients but does no mixing.

Source: PTCE Content Outline — Medications: Compounding Basics

The answer

Answer: A. A broken seal on a controlled substance case means the contents may have been tampered with or stolen, so the technician refuses the delivery and alerts the pharmacist, who contacts the distributor and documents it. Opening and counting the case first makes the pharmacy the owner of a possible loss. Accepting it and reporting only if short ignores the tampering itself. Putting it in the safe with no record breaks the receiving records the DEA requires.

Source: PTCE Content Outline — Federal Requirements: Controlled Substance Handling

The answer

Answer: B. The DEA registrant, usually the pharmacist-in-charge, is responsible for the biennial inventory and may authorize others to perform it, and the record must be kept for at least two years. A technician can help count only under that authorization, not simply because of their job title. Law enforcement does not take the pharmacy's inventory. An intern may participate only if authorized, so 'the intern' is not the defined role.

Source: PTCE Content Outline — Federal Requirements: Controlled Substance Handling

The answer

Answer: A. A PDMP is a state database of controlled substance dispensing that lets prescribers and pharmacists see a patient's fills across providers and pharmacies, revealing doctor shopping or risky combinations. It tracks prescriptions per patient, not how many pharmacies dispense controlled drugs. It covers controlled substances and does not limit non-controlled medications. It has no role in setting prices.

Source: PTCE Content Outline — Federal Requirements: Prescription Monitoring

The answer

Answer: D. DEA rules require the registration certificate to be kept at the registered location and be available for inspection; it does not have to be posted on the wall. Employee salaries are private payroll records. Social media accounts have no federal display rule. A daily count of prescriptions filled is not something any federal rule requires a pharmacy to post.

Source: PTCE Content Outline — Federal Requirements: Federal Pharmacy Law

The answer

Answer: B. Where states or federal PREP Act authority allow technicians to vaccinate, the supervising pharmacist generally must be on site and readily available to oversee the process and handle reactions. Pharmacy immunizations run under protocols or standing orders, so a written order for each patient is not required. The technician completes the immunization training, not the pharmacist instead. Supervision continues throughout, so the pharmacist does not step away once the shot begins.

Source: PTCE Content Outline — Pharmacy Law: State Law Variations

The answer

Answer: B. HIPAA and professional ethics bind every member of the pharmacy staff, so the technician should tactfully remind coworkers not to discuss patient details where others can hear. Technicians are covered by the same privacy duty as pharmacists. Posting on social media would be a clear privacy breach. A break room conversation is still a disclosure if people without a need to know can hear it.

Source: PTCE Content Outline — Pharmacy Law: Ethics Scenarios

The answer

Answer: D. Receiving starts by checking the shipment against the packing slip and the original purchase order, item by item, for drug, strength, quantity and condition, so errors are caught before stock reaches the shelf. Calling the wholesaler before opening anything gives them nothing to check. Expiration dates matter, but they are reviewed after the order is confirmed. Signing the slip and shelving first accepts errors the pharmacy has not yet found.

Source: PTCE Content Outline — Inventory: Drug Ordering and Receiving

The answer

Answer: B. The DSCSA product identifier is a 2D Data Matrix barcode on each package holding four elements: the NDC, a unique serial number, the lot number and the expiration date. Wholesaler name, price and ship date travel in transaction documents, not the package code. Pharmacist name and prescription number are added at dispensing on the patient label. Patient names never appear on a manufacturer's package.

Source: PTCE Content Outline — Inventory: DSCSA Requirements

The answer

Answer: D. Unexplained muscle pain, tenderness or weakness can signal statin myopathy or, rarely, rhabdomyolysis, so patients are told to report it promptly. Stopping when cholesterol improves is wrong; the drug is what keeps it down. Atorvastatin may be taken with or without food. Only large amounts of grapefruit juice matter for atorvastatin, moderate alcohol is not banned, and its long half-life allows any time of day, not bedtime only.

Source: PTCE Content Outline — Patient Education: Medication Counseling

The answer

Answer: C. Occasional mild heartburn is a good fit for an antacid such as calcium carbonate, which works within minutes, or an OTC H2 blocker such as famotidine. Pseudoephedrine is a nasal decongestant with no effect on stomach acid. Bisacodyl is a stimulant laxative, not a heartburn treatment. A daily PPI is meant for frequent heartburn, and recommending a prescription drug is outside OTC self-care.

Source: PTCE Content Outline — Patient Education: OTC Recommendations