Free Pharmacist mock test

Pharmacist sample questions with answers

10 more original exam-style Pharmacist questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · Pharmacology, Drug Classes, ADRs & Drug Interactions

   A non-diabetic patient with heart failure with reduced ejection fraction is prescribed dapagliflozin. Which statement about this indication is correct?

   1. AIt is approved only for glycemic control and has no role in heart failure
   2. BIt is contraindicated in any patient without diabetes
   3. CIt is approved to reduce cardiovascular death and heart-failure hospitalization in HFrEF, including non-diabetics
   4. DIt is indicated exclusively for type 1 diabetes
   Show answer and explanation

   Correct answer: C. It is approved to reduce cardiovascular death and heart-failure hospitalization in HFrEF, including non-diabetics

   SGLT2 inhibitors such as dapagliflozin are approved to reduce cardiovascular death and heart-failure hospitalization in patients with HFrEF regardless of diabetes status, based on trials like DAPA-HF. They are not restricted to diabetics, are not contraindicated in non-diabetics, and are not indicated for type 1 diabetes management.

   Reference: 2022 AHA/ACC/HFSA Heart Failure Guideline; DAPA-HF trial (NEJM 2019)

2. Question 2 · Pharmaceutics, Biopharmaceutics & Pharmacokinetics

   Many recombinant protein products, such as filgrastim and monoclonal antibodies, must be stored refrigerated and protected from agitation. What is the main stability concern this handling addresses?

   1. APhotolysis of aromatic side chains
   2. BOxidation of the polymeric coating
   3. CPhysical instability such as denaturation and aggregation of the protein
   4. DRacemization of the sugar backbone
   Show answer and explanation

   Correct answer: C. Physical instability such as denaturation and aggregation of the protein

   Therapeutic proteins are prone to physical instability including unfolding (denaturation) and aggregation, which are accelerated by heat and mechanical stress such as shaking, and aggregates can reduce potency and increase immunogenicity. Refrigeration and gentle handling limit these processes; photolysis, coating oxidation, and sugar racemization are not the primary aggregation-related concerns for these products.

   Reference: Crommelin, Pharmaceutical Biotechnology: Fundamentals and Applications, 5th ed., 2019

3. Question 3 · Basic Biomedical Sciences

   In a purine base found in DNA, which structural feature distinguishes purines from pyrimidines?

   1. AA single six-membered nitrogen-containing ring
   2. BA fused double-ring system (a pyrimidine ring fused to an imidazole ring)
   3. CA ribose sugar instead of deoxyribose
   4. DThe presence of a methyl group at position 5
   Show answer and explanation

   Correct answer: B. A fused double-ring system (a pyrimidine ring fused to an imidazole ring)

   Purines (adenine and guanine) have a bicyclic structure consisting of a six-membered pyrimidine ring fused to a five-membered imidazole ring. Pyrimidines (cytosine, thymine, uracil) have only a single six-membered ring. The sugar type distinguishes DNA from RNA, not purines from pyrimidines, and a 5-methyl group specifically characterizes thymine.

   Reference: Lehninger Principles of Biochemistry, 8th ed., 2021

4. Question 4 · Pharmacy Law, Ethics & Regulatory Affairs

   A pharmacist-investigator plans a trial enrolling adults who lack decision-making capacity. Which safeguard is most consistent with research ethics standards?

   1. AProceed without consent because the participants cannot object
   2. BObtain consent from a legally authorized representative, ensure the research cannot be done in a capable population, and obtain ethics committee approval
   3. CEnroll them only if the sponsor pays a higher fee
   4. DRely on verbal agreement from other patients in the ward
   Show answer and explanation

   Correct answer: B. Obtain consent from a legally authorized representative, ensure the research cannot be done in a capable population, and obtain ethics committee approval

   Research with participants lacking capacity requires consent from a legally authorized representative, justification that the research cannot instead be conducted in a capable population, additional protections, and independent ethics committee approval. Proceeding without consent, basing enrollment on sponsor fees, or relying on unrelated patients' agreement all violate the protections owed to vulnerable participants.

   Reference: World Medical Association Declaration of Helsinki (2013); ICH Good Clinical Practice E6(R2) (2016)

5. Question 5 · Toxicology & Poisoning Management

   A patient receiving high cumulative doses of doxorubicin for chemotherapy is at greatest risk of which dose-dependent organ toxicity, and which agent is used to reduce it?

   1. ANephrotoxicity; prevented by mesna
   2. BDilated cardiomyopathy/heart failure; risk reduced by dexrazoxane
   3. CHepatotoxicity; prevented by N-acetylcysteine
   4. DOtotoxicity; prevented by amifostine
   Show answer and explanation

   Correct answer: B. Dilated cardiomyopathy/heart failure; risk reduced by dexrazoxane

   Anthracyclines such as doxorubicin cause dose-dependent, potentially irreversible cardiotoxicity (dilated cardiomyopathy and heart failure), and dexrazoxane is an iron-chelating cardioprotectant used to reduce this risk. Mesna prevents ifosfamide/cyclophosphamide hemorrhagic cystitis, not anthracycline cardiotoxicity.

   Reference: ESMO/ASCO cardio-oncology guidance; DiPiro Pharmacotherapy, 11th ed.

6. Question 6 · Public Health, Pharmacoeconomics, Pharmacoepidemiology & Biostatistics

   In a trial, the event rate is 20% with placebo and 15% with a new drug. What is the number needed to treat (NNT) to prevent one event?

   1. A5
   2. B20
   3. C10
   4. D25
   Show answer and explanation

   Correct answer: B. 20

   The absolute risk reduction is 20% minus 15%, which equals 5% or 0.05. The NNT is the reciprocal of the absolute risk reduction, so 1 divided by 0.05 equals 20. Values such as 5, 10, or 25 result from incorrect arithmetic or from confusing NNT with relative risk reduction.

   Reference: Guyatt et al., Users' Guides to the Medical Literature (current)

7. Question 7 · Clinical Therapeutics & Disease-State Management

   A 40-year-old man with bipolar disorder maintained on lithium develops vomiting, coarse tremor, confusion, and ataxia. He recently started a new medication for hypertension. Which co-prescribed drug most likely precipitated lithium toxicity by reducing its renal clearance?

   1. AAmlodipine
   2. BHydrochlorothiazide
   3. CDoxazosin
   4. DHydralazine
   Show answer and explanation

   Correct answer: B. Hydrochlorothiazide

   Thiazide diuretics such as hydrochlorothiazide reduce renal lithium clearance by increasing proximal tubular reabsorption of sodium and lithium, leading to elevated lithium levels and toxicity manifest as tremor, ataxia, and confusion. Amlodipine, doxazosin, and hydralazine do not significantly impair lithium clearance.

   Reference: Lithium prescribing information; standard pharmacotherapy and drug-interaction references

8. Question 8 · Pharmaceutical Calculations & Compounding

   A 1 g antibiotic vial must yield a final volume of 4 mL after reconstitution. If the powder displacement volume is 0.7 mL, what volume of diluent should be added?

   1. A0.7 mL
   2. B3.3 mL
   3. C4 mL
   4. D4.7 mL
   Show answer and explanation

   Correct answer: B. 3.3 mL

   Diluent volume = final volume − displacement volume = 4 mL − 0.7 mL = 3.3 mL. Adding the full 4 mL would ignore the powder's own volume and overfill the vial.

   Reference: Ansel's Pharmaceutical Calculations, 15th ed. (2017)

9. Question 9 · Medicinal Chemistry, Pharmacognosy & Dietary Supplements

   A neonate is at higher risk of chloramphenicol-induced gray baby syndrome. The underlying metabolic explanation is an immature capacity for which Phase II reaction?

   1. ASulfation
   2. BAcetylation
   3. CGlucuronidation
   4. DGlutathione conjugation
   Show answer and explanation

   Correct answer: C. Glucuronidation

   Neonates have immature UDP-glucuronosyltransferase activity, so glucuronidation is deficient; chloramphenicol, which is normally inactivated by glucuronide conjugation, accumulates to toxic levels causing gray baby syndrome (cardiovascular collapse). Sulfation is relatively well developed at birth and partly compensates for other drugs, while acetylation and glutathione conjugation are not the rate-limiting deficient pathway responsible for this specific toxicity.

   Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 13th ed. (2018)

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

    An OTC weight-management product contains orlistat 60 mg. Which counseling point is essential for a patient starting it?

    1. AIt suppresses appetite centrally, so take it on an empty stomach
    2. BIt blocks dietary fat absorption and can cause oily/loose stools; take a multivitamin at bedtime
    3. CIt is safe to take with a very high-fat diet without GI effects
    4. DIt should be combined with a stimulant laxative for best results
    Show answer and explanation

    Correct answer: B. It blocks dietary fat absorption and can cause oily/loose stools; take a multivitamin at bedtime

    Orlistat inhibits pancreatic lipase, blocking absorption of about a quarter of dietary fat, which can cause steatorrhea, oily spotting, and fecal urgency, and it reduces absorption of fat-soluble vitamins, so a multivitamin taken at bedtime (separated from doses) is advised. It is not a central appetite suppressant, GI effects worsen with high-fat meals, and adding a stimulant laxative is inappropriate.

    Reference: Orlistat 60 mg OTC labeling; NICE weight management guidance