Pharmacist Prometric exam questions with answers

1. Question 1Clinical Therapeutics & Disease-State Managementmedium

   A 60-year-old man with type 2 diabetes has an eGFR of 50 mL/min/1.73 m2 and a urine albumin-to-creatinine ratio of 40 mg/mmol (354 mg/g). He takes metformin and the maximum tolerated dose of ramipril. Which addition is most likely to slow progression of his kidney disease?

   1. AA sulfonylurea such as gliclazide
   2. BAn SGLT2 inhibitor such as empagliflozin
   3. CA DPP-4 inhibitor such as sitagliptin
   4. DAn angiotensin receptor blocker added to ramipril
   Show answer and explanation▾

   Answer: B. An SGLT2 inhibitor such as empagliflozin

   KDIGO and ADA guidance recommend an SGLT2 inhibitor with proven kidney benefit for people with type 2 diabetes and CKD with eGFR of 20 or above, on top of maximally tolerated ACE inhibitor or ARB, because it reduces albuminuria, eGFR decline and kidney failure. Adding an ARB to an ACE inhibitor (dual RAAS blockade) increases hyperkalaemia and acute kidney injury without improving outcomes.

2. Question 2Clinical Therapeutics & Disease-State Managementhard

   A 55-year-old man stabilised on allopurinol 300 mg daily for 2 years presents with an acute gout flare of the first metatarsophalangeal joint. He has normal renal function and no contraindication to NSAIDs. What is the most appropriate advice?

   1. AStop allopurinol until the flare settles, then restart at 100 mg daily
   2. BDouble the allopurinol dose to 600 mg daily to clear urate faster
   3. CStop allopurinol permanently because it has failed to prevent flares
   4. DContinue allopurinol and treat the flare with an NSAID or colchicine
   Show answer and explanation▾

   Answer: D. Continue allopurinol and treat the flare with an NSAID or colchicine

   Urate-lowering therapy should not be interrupted during an acute flare, because fluctuating urate levels prolong and provoke attacks; the flare is treated separately with an NSAID, colchicine or a corticosteroid. Stopping allopurinol is a common but outdated practice. Dose titration should be gradual and guided by serum urate, not doubled during a flare.

3. Question 3Pharmacology, Drug Classes, ADRs & Drug Interactionsmedium

   A patient taking simvastatin 40 mg daily is prescribed a 7-day course of clarithromycin for a chest infection. What is the most appropriate recommendation?

   1. AWithhold simvastatin for the duration of the clarithromycin course
   2. BContinue simvastatin and halve the clarithromycin dose
   3. CContinue both and check creatine kinase at the end of the course
   4. DSwitch the antibiotic to rifampicin to avoid an interaction
   Show answer and explanation▾

   Answer: A. Withhold simvastatin for the duration of the clarithromycin course

   Clarithromycin is a strong CYP3A4 inhibitor and greatly increases simvastatin exposure, raising the risk of myopathy and rhabdomyolysis; the combination is contraindicated, so the statin is paused for the short course. Monitoring CK while continuing both does not prevent the harm. Reducing the antibiotic dose risks treatment failure.

4. Question 4Pharmacology, Drug Classes, ADRs & Drug Interactionseasy

   A patient started on an ACE inhibitor develops a persistent dry cough. Accumulation of which substance is thought to cause this adverse effect?

   1. AAngiotensin II
   2. BHistamine
   3. CBradykinin
   4. DAldosterone
   Show answer and explanation▾

   Answer: C. Bradykinin

   ACE (kininase II) also breaks down bradykinin, so ACE inhibition allows bradykinin and related mediators to accumulate in the airways, causing dry cough; the same mechanism contributes to angioedema. Angiotensin II levels fall, not rise, with ACE inhibitors, which is why switching to an ARB usually resolves the cough.

5. Question 5Pharmaceutical Calculations & Compoundingmedium

   Dopamine 400 mg is added to 250 mL of glucose 5%. An 80 kg patient is prescribed 5 micrograms/kg/min. What infusion rate is needed?

   1. A25 mL/h
   2. B12 mL/h
   3. C15 mL/h
   4. D30 mL/h
   Show answer and explanation▾

   Answer: C. 15 mL/h

   The concentration is 400,000 micrograms / 250 mL = 1,600 micrograms/mL. The dose is 5 x 80 = 400 micrograms/min, or 24,000 micrograms/h, and 24,000 / 1,600 = 15 mL/h. A result of 30 mL/h comes from wrongly using a concentration of 800 micrograms/mL, which would double the dose, so each step of the calculation should be checked.

6. Question 6Pharmaceutical Calculations & Compoundingmedium

   A pharmacist needs 450 mL of 70% v/v ethanol and has 95% v/v and 50% v/v ethanol in stock. Using alligation, what volumes are required?

   1. A200 mL of 95% and 250 mL of 50%
   2. B250 mL of 95% and 200 mL of 50%
   3. C225 mL of 95% and 225 mL of 50%
   4. D300 mL of 95% and 150 mL of 50%
   Show answer and explanation▾

   Answer: A. 200 mL of 95% and 250 mL of 50%

   Alligation gives 70 - 50 = 20 parts of 95% and 95 - 70 = 25 parts of 50%, a total of 45 parts, so 450 mL needs 200 mL of 95% and 250 mL of 50%. Check: 190 mL + 125 mL of ethanol = 315 mL in 450 mL, which is 70%. Reversing the parts is the classic error and produces about 75%.

7. Question 7Pharmaceutics, Biopharmaceutics & Pharmacokineticshard

   A 60 kg patient needs an intravenous loading dose of aminophylline to achieve a plasma theophylline concentration of 10 mg/L. Theophylline volume of distribution is 0.5 L/kg and aminophylline contains 80% theophylline. There is no recent theophylline exposure. What loading dose of aminophylline is required?

   1. A300 mg
   2. B240 mg
   3. C600 mg
   4. D375 mg
   Show answer and explanation▾

   Answer: D. 375 mg

   The theophylline loading dose is Vd x Cp = 0.5 x 60 x 10 = 300 mg. Because aminophylline is only 80% theophylline (salt factor 0.8), the aminophylline dose is 300 / 0.8 = 375 mg. Giving 300 mg ignores the salt factor and under-loads the patient, while 240 mg wrongly multiplies by 0.8 instead of dividing.

8. Question 8Pharmaceutics, Biopharmaceutics & Pharmacokineticseasy

   A patient asks why she must not crush her enteric-coated tablets. What is the main purpose of an enteric coating?

   1. ATo prolong drug release evenly over 24 hours
   2. BTo prevent the tablet dissolving in the acidic stomach
   3. CTo mask the taste and make swallowing easier
   4. DTo increase absorption through the buccal mucosa
   Show answer and explanation▾

   Answer: B. To prevent the tablet dissolving in the acidic stomach

   Enteric coatings are polymers that resist gastric acid and dissolve at the higher pH of the small intestine, protecting acid-labile drugs or protecting the stomach from irritant drugs. Crushing destroys this protection. Prolonged release over 24 hours is the function of modified-release formulations, a different technology.

9. Question 9Medicinal Chemistry, Pharmacognosy & Dietary Supplementsmedium

   A kidney transplant recipient taking ciclosporin asks whether she can take St John's wort for low mood. What is the main concern?

   1. AIt induces CYP3A4 and P-gp, lowering ciclosporin levels
   2. BIt inhibits CYP3A4, raising ciclosporin levels and risking nephrotoxicity
   3. CIt causes additive immunosuppression and increases infection risk
   4. DIt binds ciclosporin in the gut, preventing its absorption
   Show answer and explanation▾

   Answer: A. It induces CYP3A4 and P-gp, lowering ciclosporin levels

   St John's wort (Hypericum perforatum) is a potent inducer of CYP3A4 and P-glycoprotein, and has caused subtherapeutic ciclosporin levels and acute transplant rejection; the combination should be avoided. Describing it as an enzyme inhibitor reverses the actual mechanism, which is the most common misconception.

10. Question 10Nonprescription (OTC) & Self-Care / Counter Medicationeasy

    Which patient asking for loperamide for diarrhoea should be referred to a doctor rather than treated over the counter?

    1. AA 30-year-old with 24 hours of watery stools after travel
    2. BA 25-year-old with mild cramps and loose stools since yesterday
    3. CA 40-year-old with fever and blood in the stool
    4. DA 50-year-old with two loose stools today and no other symptoms
    Show answer and explanation▾

    Answer: C. A 40-year-old with fever and blood in the stool

    Bloody diarrhoea with fever suggests invasive bacterial infection or inflammatory bowel disease; antimotility agents such as loperamide are avoided and medical assessment is needed. Short-lived watery diarrhoea in otherwise well adults, including mild traveller's diarrhoea, can be managed with oral rehydration and, where appropriate, loperamide.

11. Question 11Special Populationsmedium

    A woman at 10 weeks' gestation has asymptomatic bacteriuria with an organism sensitive to all of the following. Which antibiotic is most appropriate?

    1. ATrimethoprim
    2. BNitrofurantoin
    3. CCiprofloxacin
    4. DDoxycycline
    Show answer and explanation▾

    Answer: B. Nitrofurantoin

    Nitrofurantoin is a suitable first-line choice for bacteriuria in pregnancy, avoided only near term because of a risk of neonatal haemolysis. Trimethoprim is a folate antagonist and is avoided in the first trimester because of a possible increase in neural tube defects. Fluoroquinolones and tetracyclines are generally avoided in pregnancy.

12. Question 12Toxicology & Poisoning Managementhard

    A man presents after drinking a homemade spirit. He has blurred vision, a high anion gap metabolic acidosis and an increased osmolar gap. Which antidote is preferred?

    1. AN-acetylcysteine
    2. BPralidoxime
    3. CFlumazenil
    4. DFomepizole
    Show answer and explanation▾

    Answer: D. Fomepizole

    Visual disturbance with high anion gap acidosis and an osmolar gap is typical of methanol poisoning; fomepizole inhibits alcohol dehydrogenase, preventing conversion to toxic formic acid, and ethanol is an alternative if fomepizole is unavailable, with haemodialysis for severe cases. N-acetylcysteine is the antidote for paracetamol poisoning, not toxic alcohols.

13. Question 13Patient Assessment, Counseling, Drug Information & Evidence-Based Practiceeasy

    A woman is starting weekly oral alendronic acid for osteoporosis. Which counselling point is correct?

    1. ATake it with breakfast and a glass of milk to reduce stomach upset
    2. BTake it at bedtime with water so that it is absorbed overnight
    3. CTake it with a calcium supplement to improve its effect on bone
    4. DTake it fasting with plain water and stay upright for 30 minutes
    Show answer and explanation▾

    Answer: D. Take it fasting with plain water and stay upright for 30 minutes

    Alendronic acid is poorly absorbed and irritant to the oesophagus, so it is taken after an overnight fast with plain water, at least 30 minutes before food, drink or other medicines, while remaining upright. Milk, food and calcium supplements bind bisphosphonates and sharply reduce absorption, and lying down at bedtime increases the risk of oesophagitis.

14. Question 14Public Health, Pharmacoeconomics, Pharmacoepidemiology & Biostatisticshard

    A screening test is evaluated in 1,000 people: 90 true positives, 10 false negatives, 30 false positives and 870 true negatives. What is the positive predictive value?

    1. A75%
    2. B90%
    3. C96.7%
    4. D98.9%
    Show answer and explanation▾

    Answer: A. 75%

    PPV is true positives divided by all positive results: 90 / (90 + 30) = 75%. Sensitivity, the tempting distractor, is 90 / (90 + 10) = 90%; specificity is 870 / 900 = 96.7% and NPV is 870 / 880 = 98.9%. PPV depends on prevalence as well as test accuracy.

15. Question 15Pharmacy Practice Management, Medication Safety & Dispensing Systemsmedium

    A hospital medication safety committee reviews a serious incident in which concentrated potassium chloride was given undiluted. Which measure is most effective at preventing recurrence?

    1. ASend a reminder email to all nurses about the dangers of potassium
    2. BRemove concentrated potassium from ward stock and use premixed bags
    3. CStore the concentrated ampoules on a higher shelf in the ward cupboard
    4. DAdd a warning sticker to the ward medication fridge door
    Show answer and explanation▾

    Answer: B. Remove concentrated potassium from ward stock and use premixed bags

    Removing concentrated potassium from routine ward stock and using ready-to-use premixed infusions is a system-level forcing function, which is much stronger than education or warnings in the hierarchy of controls. Reminder emails and labels rely on human memory and attention, which is the weakest type of intervention.

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