Clinical Pharmacy Prometric exam questions with answers

1. Question 1Cardiovascular Pharmacotherapymedium

   A 66-year-old man with HFrEF (LVEF 30%) is stable on sacubitril/valsartan, bisoprolol and spironolactone at target doses. Potassium is 4.6 mmol/L and eGFR 55 mL/min/1.73 m2. Which addition is recommended to reduce mortality and hospitalisation?

   1. AIvabradine
   2. BDigoxin
   3. CDapagliflozin
   4. DHydralazine with nitrate
   Show answer and explanation▾

   Answer: C. Dapagliflozin

   SGLT2 inhibitors such as dapagliflozin are one of the four foundational therapies for HFrEF and reduce cardiovascular death and heart failure hospitalisation. Digoxin reduces hospitalisation but not mortality, and ivabradine is reserved for patients in sinus rhythm with a heart rate of 70 bpm or more despite beta-blockade.

2. Question 2Critical Care, Renal and Hepatic Considerationshard

   A 70-year-old man weighs 60 kg and has a serum creatinine of 120 micromol/L. Using the Cockcroft-Gault equation (CrCl = [(140 - age) x weight x 1.23] / creatinine in micromol/L), what is his estimated creatinine clearance?

   1. AAbout 36 mL/min
   2. BAbout 52 mL/min
   3. CAbout 61 mL/min
   4. DAbout 43 mL/min
   Show answer and explanation▾

   Answer: D. About 43 mL/min

   (140 - 70) x 60 x 1.23 = 5,166, and 5,166 / 120 = 43 mL/min. Replacing 1.23 with the female constant of 1.04 would wrongly give about 36 mL/min.

3. Question 3Critical Care, Renal and Hepatic Considerationsmedium

   Which ICU patient has the clearest indication for stress ulcer prophylaxis?

   1. APost-operative patient eating normally
   2. BMechanically ventilated for more than 48 hours
   3. CPatient on low-dose aspirin only
   4. DPatient receiving enteral nutrition with no risk factors
   Show answer and explanation▾

   Answer: B. Mechanically ventilated for more than 48 hours

   Mechanical ventilation for more than 48 hours and coagulopathy are the main risk factors for clinically important stress-related bleeding. Patients eating normally or without risk factors do not benefit and are exposed to PPI-associated adverse effects.

4. Question 4Endocrine, Respiratory and Gastrointestinal Pharmacotherapymedium

   A 30-year-old with mild asthma uses salbutamol several times a week and takes no controller. According to GINA, what is the preferred treatment?

   1. ASalbutamol as needed, with no controller
   2. BAs-needed low-dose budesonide-formoterol
   3. CDaily montelukast 10 mg at night
   4. DA short course of oral prednisolone
   Show answer and explanation▾

   Answer: B. As-needed low-dose budesonide-formoterol

   GINA Track 1 recommends as-needed low-dose ICS-formoterol for mild asthma because it reduces severe exacerbations compared with SABA alone. SABA-only treatment is no longer recommended for adults.

5. Question 5Pharmacokinetics and Therapeutic Drug Monitoringeasy

   A drug with a half-life of 8 hours is started as a regular maintenance dose without a loading dose. Approximately when will steady state be reached?

   1. A8 hours
   2. B16 hours
   3. C32-40 hours
   4. D96 hours
   Show answer and explanation▾

   Answer: C. 32-40 hours

   Steady state is reached after about 4-5 half-lives, which is 32-40 hours for a half-life of 8 hours. One half-life gives only 50% of steady state.

6. Question 6Infectious Diseases and Antimicrobial Stewardshipmedium

   A 40-year-old reports a mild itchy rash with amoxicillin 15 years ago. He now needs surgical prophylaxis. What is the most appropriate choice?

   1. ACefazolin, which has a dissimilar side chain
   2. BAvoid all beta-lactams permanently
   3. CAmoxicillin with antihistamine cover
   4. DVancomycin as the only safe option
   Show answer and explanation▾

   Answer: A. Cefazolin, which has a dissimilar side chain

   For a remote non-severe reaction, cefazolin can be given because its R1 side chain is dissimilar to amoxicillin and cross-reactivity is very low. Avoiding all beta-lactams leads to less effective alternatives such as vancomycin and more surgical site infections.

7. Question 7Oncology, Haematology and Anticoagulationhard

   A patient with high-risk Burkitt lymphoma is starting chemotherapy and has a baseline uric acid of 0.62 mmol/L. Rasburicase is considered. Which test must be checked before giving it?

   1. AGlucose-6-phosphate dehydrogenase status
   2. BThiopurine methyltransferase activity
   3. CHLA-B*5801
   4. DDihydropyrimidine dehydrogenase activity
   Show answer and explanation▾

   Answer: A. Glucose-6-phosphate dehydrogenase status

   Rasburicase generates hydrogen peroxide and can cause severe haemolysis and methaemoglobinaemia in G6PD deficiency, so it is contraindicated in these patients. HLA-B*5801 screening relates to allopurinol hypersensitivity.

8. Question 8Special Populationseasy

   An 80-year-old asks for something to help her sleep. Which medicine is best avoided because of strong anticholinergic effects in older adults?

   1. ADiphenhydramine
   2. BMelatonin
   3. CParacetamol
   4. DRamelteon
   Show answer and explanation▾

   Answer: A. Diphenhydramine

   First-generation antihistamines such as diphenhydramine are highly anticholinergic and are listed in the Beers Criteria to avoid because of confusion, constipation, urinary retention and falls in older adults. Melatonin does not carry these anticholinergic risks.

9. Question 9Infectious Diseases and Antimicrobial Stewardshipmedium

   A 70 kg adult with normal renal function is started on extended-interval gentamicin at 7 mg/kg. What dose should be given?

   1. A210 mg
   2. B350 mg
   3. C490 mg
   4. D700 mg
   Show answer and explanation▾

   Answer: C. 490 mg

   7 mg/kg x 70 kg = 490 mg once daily, with the interval adjusted using a level and nomogram such as the Hartford nomogram. 210 mg corresponds to conventional 3 mg/kg/day dosing, not extended-interval dosing.

10. Question 10Neurology, Psychiatry and Painmedium

    A patient on sertraline 150 mg daily is started on IV linezolid for VRE bacteraemia. Two days later he has agitation, tremor, clonus and fever. What is the most likely cause?

    1. ANeuroleptic malignant syndrome
    2. BSerotonin syndrome
    3. CLinezolid-induced lactic acidosis
    4. DAlcohol withdrawal
    Show answer and explanation▾

    Answer: B. Serotonin syndrome

    Linezolid is a reversible non-selective MAO inhibitor, and combined with an SSRI it can cause serotonin syndrome with clonus, agitation and hyperthermia. Neuroleptic malignant syndrome has slower onset, bradyreflexia and lead-pipe rigidity rather than clonus.

11. Question 11Oncology, Haematology and Anticoagulationmedium

    A patient on warfarin with an INR of 6.2 presents with an intracranial haemorrhage. What is the most appropriate reversal?

    1. AOral vitamin K 2 mg only
    2. BWithhold warfarin, recheck INR tomorrow
    3. CIV protamine sulfate 50 mg
    4. DFour-factor PCC plus IV vitamin K
    Show answer and explanation▾

    Answer: D. Four-factor PCC plus IV vitamin K

    Life-threatening bleeding on warfarin needs rapid reversal with four-factor PCC plus IV vitamin K to sustain the effect. Protamine reverses heparin, not warfarin, and oral vitamin K alone acts too slowly.

12. Question 12Pharmacokinetics and Therapeutic Drug Monitoringmedium

    A drug has a volume of distribution of 0.5 L/kg and oral bioavailability of 100%. What loading dose is needed to achieve a plasma concentration of 10 mg/L in an 80 kg patient?

    1. A400 mg
    2. B200 mg
    3. C800 mg
    4. D40 mg
    Show answer and explanation▾

    Answer: A. 400 mg

    Loading dose = Vd x target concentration / F = (0.5 x 80) L x 10 mg/L / 1 = 400 mg. Forgetting to multiply the Vd by body weight gives an erroneously small dose.

13. Question 13Pharmacokinetics and Therapeutic Drug Monitoringmedium

    When should a blood sample for digoxin level be taken after an oral dose to give an interpretable result?

    1. A30 minutes after the dose
    2. BAt least 6 hours after the dose
    3. C1 hour after the dose
    4. DAny time, timing is irrelevant
    Show answer and explanation▾

    Answer: B. At least 6 hours after the dose

    Digoxin has a long distribution phase, so samples should be taken at least 6 hours after a dose. Earlier sampling gives falsely high concentrations that do not reflect tissue levels.

14. Question 14Pharmacokinetics and Therapeutic Drug Monitoringmedium

    A patient on phenytoin 300 mg daily has a level of 10 mg/L. The dose is increased to 400 mg daily. What is the expected effect on the steady-state level?

    1. AA proportional rise to about 13 mg/L
    2. BNo meaningful change in the level
    3. CA fall in level from auto-induction
    4. DA disproportionately large rise in level
    Show answer and explanation▾

    Answer: D. A disproportionately large rise in level

    Phenytoin follows Michaelis-Menten kinetics, so as metabolism saturates a modest dose increase produces a disproportionately large rise in concentration. A proportional rise would only apply to drugs with linear kinetics.

15. Question 15Special Populationsmedium

    A 15 kg child with acute otitis media is prescribed high-dose amoxicillin at 90 mg/kg/day divided twice daily. What is each dose?

    1. A450 mg
    2. B900 mg
    3. C675 mg
    4. D1,350 mg
    Show answer and explanation▾

    Answer: C. 675 mg

    The daily dose is 90 x 15 = 1,350 mg, divided into two doses of 675 mg. Giving 1,350 mg per dose would double the intended daily exposure.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.