BULE HORA UNIVERSITY

COLLEGE OF HEALTH AND MEDICAL SCIENCE

DEPARTMENT OF PHARAMACY

Comprehensive Written Exam sample For Pharmacy Students

Time allowed: 4 hrs.

NAME__________________________________________ID NO__________

Set by: Pharmacy Department

INSTRUCTIONS

1. Make sure that your booklet contains 30 pages including cover page and answer sheet
2. Read the instructions carefully and try to attempt all questions
3. Any attempt for cheating results to disqualification.
4. Don’t forget to write your name and ID number

GOOD LUCK!!
December, 2023

1|Page
FOR THE FOLLOWING QUESTIONS CHOOSE THE BEST ANSWER FROM THE GIVEN
ALTERNATIVES AND WRITE DOWN YOUR ANSWER IN THE ANSWER SHEET
PROVIDED (1POINT EACH)

1. A 68-year-old African American woman is admitted to the hospital for new onset acute
decompensated heart failure. Her current medications include felodipine 2.5 mg Qday and
atorvastatin 20 mg Qday. Hemodynamic readings include a PCWP of 16 (2.1 kPa) and a CI
of 1.8 L/min/m2. Which of the following is the MOST appropriate treatment plan?

A. Fluids, inotropes B. Diuretics, vasodilators

C. Fluids, inotropes, vasodilators D. Diuretics, fluids, inotropes

2. A 66-year-old man presents to the ED complaining of palpitations, dizziness,

lightheadedness, and near-syncope. Past medical history is significant for hypertension for 10
years. ECG reveals an irregularly irregular rhythm with no visible P waves and an undulating
baseline. His blood pressure in the ED is 99/63 mm Hg, and his heart rate is 125 beats/min.
Which one of the following is the most appropriate treatment?

A. Immediate direct current cardioversion

B. Amiodarone 300 mg IV administered over 1 hour
C. Digoxin 0.25 mg IV, repeated every 2 hours up to a total dose of 1.5 mg
D. Metoprolol 5 mg IV administered over 2 minutes
3. Mr. BCs is 60 year-old man presents to the clinic today with complaints of shortness of
breath while walking and he have positive sign in JVD, abnormal S3 and S4,and
cardiomegaly, he is diagnosed for heart failure. Which of the following combinations
represents optimal pharmacotherapy of BCs?
A. Furosemide, clonidine, hydrochlorothiazide, and propranolol
B. Furosemide, lisinopril. and carvedilol
C. metoprolol, hydrochlorothiazide, digoxin and furosemide
D. Digoxine, HCT, furosemide, and metoprolol

HPI: 42 year old male with sharp epigastric pain for 6 weeks. Pain is worse with eating and is
present approximately 5 days per week. Some relieve with antacids
MEDS: antacids as needed

2|Page
Allergies: PNC (rash)
Diagnostics: Test for H. pylori is positive.
What is the most appropriate treatment at this time?

A. Amoxicillin 1 g BID plus clarithromycin 500 mg BID plus omeprazole 20 mg BID for 10
days

B. Cephalexin 1 g BID plus clarithromycin 500 mg BID plus omeprazole 20 mg BID for 10
days
C. Bismuth 525 mg QID plus TTC 500 mg QID plus metronidazole 500 mg TID plus
omeprazole 20 mg BID for 14 days
D. Clarithromycin 500 mg BID plus metronidazole 500 mg BID plus omeprazole 20 mg BID
for 10 days.

4. For patients with asthma or COPD exacerbations not responding adequately 10 inhaled
bronchodilators. What is the agent of choice to add to manage the acute exacerbation?

A. Fluticasone B. Budesonide C. methylprednisolone D. Theophylline

5. Which of the following represents the current recommendation for empiric antibiotic therapy
in patients suspected to have ongoing spontaneous bacterial peritonitis?
A. Aztreonam B. Cefotaxime C. Metronidazole D. ciprofloxacin
6. A 47-year-old woman with a history of alcoholic cirrhosis is admitted to the hospital with
nausea, abdominal pain, and fever, PE reveals a distended abdomen with shifting dullness, a
positive fluid wave, and the presence of diffuse rebound tenderness. She also has 1+ lower
extremity edema
Meds: Furosemide 80 mg BID, spironolactone 200 mg QD.
Diagnostics: Paracentesis reveals turbid ascitic flud, sent for culture
LAB: Alb 0.9 g/dL; WBC 1000 (45% PMNs). SCr 0.5; AST 60; ALT 20; Alb 2.5 g/dL,
Total Bili 3.2.

Which one of the following would be the best course of action at this time?

A. Initiate IV albumin and await culture results

B. Initiate IV vancomycin plus tobramycin

3|Page
 C. Initiate IV cefotaxime plus albumin therapy
D. Initiate oral trimethoprim-sulfamethoxazole double strength daily
7. A 65yearold woman with type 2 diabetes, hypertension, osteoporosis, and atrial fibrillation
has a BP of 150/96 mm Hg (150/90 mm Hg when repeated), heart rate of 68 beats/min,
potassium of 3.3 mEq/L (mmol/L), and a serum creatinine of 2.3 mg/dL (203 µmol/L). She
reports an “allergy” to hydrochlorothiazide (severe gout). Presently, she is on verapamil CD
480 mg daily. Which of the following drug regimens would be the most appropriate to add to
her regimen?

A. Chlorthalidone 12.5 mg daily

B. Amlodipine 5 mg daily
C. Atenolol 25 mg daily
D. Valsartan 160 mg daily
8. A 70yearold male patient with DVT and a baseline international normalized ratio (INR) of
1.1 is started on warfarin 5 mg daily on day 1 and day 2 as well as enoxaparin 80 mg SC
BID. The patient has no history of malignancy, malnutrition, heart failure, alcohol abuse, or
liver dysfunction. INR today (day 3) is 1.5. Which of the following reflects the best warfarin
dose for day 3?
A. 10 mg B. 5 mg C. 1 mg D. Hold warfarin today
9. Which one of the following statements best describes how a patient should interpret their
INR results?
A. When the INR is below 2.0 she is at increased risk for bleeding.
B. When the INR is between 2 and 3 she needs to eat less vitamin K containing food in her
diet.
C. When the INR is below 2.0 her dose of warfarin may need to be adjusted.
D. When the INR is higher than 3.0 she is at increased risk for having another VTE
10. In patients with AIDS who have successfully completed primary therapy, lifelong
maintenance therapy to prevent relapse of cryptococcal disease:
A. Is recommended for all patients after successful completion of primary induction therapy,
with fluconazole 800 mg orally daily.
B. Is necessary and recommended for most patients, utilizing a low dosage of fluconazole
(200 mg orally daily)
4|Page
 C. Is recommended for patients who are NOT on HAART therapy with a sustained CD4 cell
count greater than 100 cells/mL (0.1 × 106/L) and undetectable viral load.
D. Amphotericin B 1 mg/kg IV weekly is more effective and better tolerated than oral
fluconazole 200 mg/day.
11. A 35-year-old IV drug abuser has been diagnosed with tricuspid valve endocarditis due to
methicillin-sensitive Staphylococcus aureus. Other than IV drug abuse, his past medical
history is noncontributory. He has no known drug allergies, has normal renal function, and
appears in no apparent distress. Which of the following IV regimens would be most
appropriate?
A. Nafcillin 2 g every 4 hours for 2 weeks plus gentamicin 1 mg/kg every 8 hours for 2
weeks
B. Vancomycin 15 mg/kg every 12 hours for 4 weeks plus gentamicin 1 mg/kg every 8
hours for 2 weeks
C. Nafcillin 2 g every 4 hours for 4 weeks
D. Nafcillin 2 g every 4 hours for 4 weeks plus gentamicin 1 mg/kg every 8 hours for 4
weeks

12. Chala is a 56-year-old man with T2DM. He is a nonsmoker and is concerned about his risk of
coronary heart disease (CHD). His vital signs include BP 152/98 mm Hg (average home
blood pressure 150/92 mm Hg), heart rate 70 beats/minute, and BMI 26.5 kg/m2. His fasting
laboratory test results today include SCr 0.8 mg/dL, TC 188 mg/dL, LDL 130 mg/dL, HDL
30 mg/dL, and TG 90 mg/dL, and his urine albumin/creatinine ratio is 86.5 mg/g (previously
68 mg/g). The patient’s 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 21%.
Which is best for primary prevention of CHD for this patient?
A. Aspirin 325 mg/day.
B. Atorvastatin 10 mg/day.
C. Aspirin 81 mg/day plus atorvastatin 40 mg/day.
D. Atorvastatin 40 mg/day plus clopidogrel 75 mg/ day
13. Alemitu is a 50-year-old woman with peripheral arterial disease (PAD). She has been unable
to tolerate ACEIs and ARBs because of hyperkalemia. Her current medication regimen is
amlodipine 10mg/day, chlorthalidone 12.5 mg/day, metoprolol succinate 25 mg/day,
rosuvastatin 20 mg/day, and aspirin 81 mg/day. Her vital signs today include BP 146/82 mm

5|Page
 Hg, repeated BP 148/85 mm Hg; heart rate 78 beats/minute; weight 69 kg (154 lb); and
height 64 inches. Her laboratory tests show K 4.9 mEq/L, Na 133 mEq/L, and CrCl 65
mL/minute. Which is the best therapeutic plan for this patient?
A. No medication changes are warranted.
B. Initiate hydralazine 25 mg three times daily.
C. Increase metoprolol succinate to 50 mg/day
D. Increase chlorthalidone to 25 mg/day.
14. A.M. is a 32-year-old woman with type 1 diabetes and HTN. Her current medication regimen
is as follows: Enalapril 10 mg/day, chlorthalidone 25 mg/day, amlodipine 10 mg/ day, ethinyl
estradiol 20 mcg/norethindrone 1 mg (for the past 2 years), and insulin as directed. Her vital
signs today include BP 145/83 mm Hg, repeated BP 145/81 mm Hg, heart rate 82
beats/minute, height 66 inches, weight 70kg (155 pounds), and BMI 24.5 kg/m2. A.M. would
prefer not to take any more drugs, if possible. Which is the best clinical plan for A.M.?
A. No change in therapy is currently warranted.
B. Advise weight loss and recheck her blood pressure in 3 months.
C. Change chlorthalidone to hydrochlorothiazide.
D. Discuss changing her contraceptive method.
15. P.T. is a 73-year-old woman with a history of coronary artery disease (CAD; with stent
placement 5 years ago). She has adhered to her medication regimen since her stent placement
without problems. Her primary care physician checked her CK concentration because of
muscle pain that she described as moderate in severity. Her medication regimen has been
stable for the past 3 years and includes atorvastatin 40 mg/ day, aspirin 81 mg/day, carvedilol
6.25 mg twice daily, and omeprazole 20 mg as needed. Fasting laboratory test results show
TC 135 mg/dL, TG 85 mg/ dL, HDL 50 mg/dL, LDL 68 mg/dL, non-HDL 85 mg/dL, SCr
1.2 mg/dL (CrCl [ideal body weight {IBW}] 32 mL/ minute), Na 141 mEq/L, K 4.0 mEq/L,
and CK 503 U/L (normal limits 20–200 U/L). Which is the next best step for P.T.?
A. Continue atorvastatin 40 mg/day and continue monitoring patient symptoms.
B. Discontinue atorvastatin permanently because the patient is statin intolerant.
C. Hold atorvastatin and reassess the patient’s symptoms in 2–4 weeks.
D. Lower the atorvastatin dose to 20 mg every evening and continue monitoring patient
symptoms

6|Page
16. A 65-year-old woman who had a minor ischemic stroke (National Institutes of Health Stroke
Scale [NIHSS] score of -2) 3 weeks ago presents for a follow-up. Her current medications
include aspirin 81 mg/day (taking before the stroke), clopidogrel 75mg/day, chlorthalidone
25 mg/day, lisinopril 40 mg/day, and atorvastatin 80 mg/day. The medical resident has
requested an evaluation of the patient’s antiplatelet therapy. Which recommendation would
best reduce the patient’s risk of recurrent stroke while minimizing the risks of bleeding?
A. Continue clopidogrel and aspirin for a total of 90 days and then continue clopidogrel
indefinitely.
B. Continue both aspirin and clopidogrel indefinitely.
C. Discontinue both clopidogrel and aspirin and initiate ticagrelor 90 mg twice daily
indefinitely.
D. Discontinue clopidogrel and increase aspirin dose to 325 mg/day indefinitely.
17. Alemu is a 62-year-old man with an MI 3 years ago, HTN, depression, PAD, osteoarthritis,
hypothyroidism, type 2 DM (diet controlled), and HFrEF (LVEF of 25%). His medications
include aspirin 81 mg/day, simvastatin 40 mg every night, lisinopril 20 daily, metoprolol
succinate 150 mg/day, furosemide 80 mg twice daily, cilostazol 100 mg twice daily,
acetaminophen 650 mg four times daily, and levothyroxine 0.1 mg/day. He has no known
drug allergies. His vital signs include blood pressure 155/90 mm Hg and heart rate 65
beats/minute. He weighs 100 kg (220 lb). Pertinent laboratory results include K 4.1 mEq/L,
SCr 1.6 mg/dL, and thyroid-stimulating hormone 2.6 mIU/L. His HF is stable and considered
NYHA class III. Which would best maximize the management of J.M.’s HF?
A. Add digoxin 0.125 mg daily.
B. Add losartan 25 mg daily.
C. Add spironolactone 25 mg daily.
D. Add amlodipine 5 mg daily.
18. Shewaferaw is a 38-year-old patient with no history of HTN but a 2-year history of T2DM.
Results of the previous two urine analyses have shown results with urine albumin/creatinine
ratio values greater than 30 mg/dL. Which intervention is best to slow the progression of this
patient’s diabetic nephropathy?
A. Low-sodium diet
B. Angiotensin-converting enzyme inhibitor (ACEI)

7|Page
 C. Dihydropyridine calcium channel blocker (DHP-CCB)
D. Aspirin
19. Which statement is the most accurate regarding the use of antiplatelet therapy in patients with
DM?
A. Aspirin 325 mg once daily should be used as a secondary-prevention strategy in
patients with DM and atherosclerotic cardiovascular (CV) disease.
B. Dual antiplatelet therapy is recommended for patients with DM with a 10-year CV
risk of greater than 10%.
C. Aspirin 75–162 mg once daily should be used for primary prevention in patients older
than 65 years with a history of renal disease.
D. Aspirin 75–162 mg once daily may be considered as a primary prevention strategy in
patients with DM who are at increased CV risk, after a discussion with the patient on
the benefits versus increased risk of bleeding
20. M.K 55 year old newly diagnosed HIV positive patient comes to DUGH ART clinic. While
you asses his past medical history he had history of T2DM, HTN and Myocardial infarction
(MI). Which first line regimen is not preferred for this patient?
A. Abacavir (ABC) based
B. Tenofovir (TDF) based
C. Zidovudin (AZT) based
D. None of the above
21. A 35 years old female patient was diagnosed with tonic-clonic epilepsy and started on
monotherapy with an anti-epileptic drug. After months of therapy the patient starts to
experience nausea, headache, lethargy restlessness, and disorientation. Measurement of
serum electrolytes showed a sodium concentration of 123mEq/L. which of the following
anti-epileptic drug is the most probable cause of moderate hyponatremia?
A. Valproic acid
B. Carbamazepine
C. Phenobarbital
D. Phenytoin
22. T.M, 45 year’s old newly diagnosed stage-II HTN with T2DM patient. As a clinical
pharmacy intern you are working at chronic follow up clinic and asked to give suggestion on

8|Page
 the basic principle of managing hypertension comorbid with DM. of the following one
should not be part of your suggestion
A. ACEI should be included due to their nephroprotective effect
B. Following JNC approach is not necessary
C. Counseling on appropriate life style modification
D. Thiazide diuretics are preferred because they decrease risk of stroke
23. One is not true about JNC strategies in managing HTN
A. Start one drug titrate to maximum dose, and then add a second drug
B. Initial combination therapy is recommended if BP is greater than 30/20 above goal.
C. Begin 2 drugs at the same time, as separate pills or combination pill.
D. Start one drug, and then add a second drug before achieving maximum dose of first
24. Zebiba is a 42-year-old woman with a diagnosis of disseminated Mycobacterium avium
complex (MAC) infection. She has been out of care with the clinic for 2 years and admits
being off ART for about 18 months. She has complaints of night sweats and fever for the past
2 months, and she has lost 11.3 kg (25 lb) during this time. Her current laboratory results
show low hemoglobin, hematocrit, and white blood cell count (WBC); normal SCr; and
increased ALT and alkaline phosphatase. Her viral load is 268,210 copies/mL and CD4 count
is 16 cells/mm3 (2%). Which best characterizes the clinical presentation of MAC infection in
HIV-infected patients?
A. CD4 count less than 200 cells/mm3, fever, and anemia.
B. CD4 count less than 200 cells/mm3, night sweats, weight loss.
C. CD4 count less than 50 cells/mm3, fever, night sweats.
D. CD4 count less than 50 cells/mm3, fever, increased LFTs
25. S.S. is a laboratory technician who reports to her supervisor that she accidentally stuck
herself with a needle used for obtaining a patient’s blood. The source patient was admitted to
the hospital for pneumonia and anemia. Symptoms include fever, cough for 2–3 weeks,
weight loss, and lymphadenopathy. Her medical history includes HTN, ESRD, and syphilis.
Which is best for S.S. regarding post exposure prophylaxis?
A. Start postexposure prophylaxis (PEP) prophylaxis for 28 days.
B. Source patient does not have HIV, so PEP is not indicated.
C. Perform a rapid HIV test on the source patient; then start PEP, if positive.

9|Page
 D. Test source patient for HIV RNA; then start PEP, if positive.
26. T.J. is a 46-year-old man who has been treated for HIV infection for 24 years. He has been
virologically controlled for the past 8 years on ABC/3TC/ATV/r. His TG has gradually
worsened over time, despite diet and exercise, and secondary causes have been ruled out.
Which would be the best ART substitution strategy to address his hypertriglyceridemia?
A. Change ABC to TAF
B. Change ATV/r to EFV
C. Change ATV/r to DTG
D. Change ATV/r to ATV/cobicistat
27. J.C. is a 44-year-old man seen today at the HIV clinic for a routine medical follow-up. His
history includes HIV, diagnosed when he was hospitalized for cryptococcal meningitis 10
months ago. Since then, he has responded to antifungal treatment with symptom resolution
except for residual visual deficits. He is virologically suppressed with CD4 improvements
from baseline of 23 cells/mm3 to 108 cells/mm3 3 months ago and now 132 cells/mm3.
Which is the best plan for this patient’s antifungal treatment?
A. Continue for lifelong prophylaxis.
B. Continue for at least 2 more months
C. Continue until he has visual improvement.
D. Discontinue because of symptom resolution and because CD4 has been greater than
100 cells/mm3 for 3 months or more.
28. Diana is a 42-year-old woman (weight 52 kg) who is HIV positive. She was recently given a
diagnosis of pulmonary TB. Her HIV is controlled on efavirenz 600 mg, tenofovir 300 mg,
emtricitabine 200 mg with a CD4 of 400 cells/mm3 and an undetectable viral load. Which
regimen would be best for treating D.Z.’s TB?
A. Rifampin 600 mg, isoniazid 300 mg, pyrazinamide 1500 mg, ethambutol 800 mg.
B. Rifabutin 150 mg, isoniazid 300 mg, pyrazinamide 1500 mg, ethambutol 800 mg.
C. Rifampin 450 mg, isoniazid 300 mg, pyrazinamide 1500 mg, ethambutol 800 mg.
D. Rifabutin 300 mg, isoniazid 300 mg, pyrazinamide 1500 mg, ethambutol 800 mg.
29. Kemal a 28-year-old man (weight 98 kg), is given a diagnosis of active tuberculosis (TB). He
has no relevant medical history and takes no prescribed medications, over-the-counter drugs,
or herbal products. He has a drug allergy to codeine, and his calculated creatinine clearance

10 | P a g e
 (CrCl) is 94 mL/minute/1.73 m2. His liver function tests are within normal limits. Which is
the most appropriate treatment regimen for this patient?
A. Isoniazid and rifampin, pyrazinamide, and ethambutol daily for 2 months, followed
by isoniazid and rifampin daily for a 4-month continuation phase.
B. Isoniazid, rifampin, pyrazinamide, and ethambutol daily for 4 months, followed by
isoniazid and rifampin daily for a 2-month continuation phase
C. Isoniazid, rifampin, pyrazinamide, and ethambutol daily for 6 months.
D. Isoniazid, rifampin, pyrazinamide, and ethambutol twice weekly for 9 months.
30. L.M, a 28-year-old man with HIV with a diagnosis of active TB. He currently takes a daily
TB regimen of rifabutin 150 mg, isoniazid 300 mg, pyrazinamide 1500 mg, and ethambutol
800 mg, and an HIV regimen of raltegravir 400 mg twice daily plus emtricitabine
200/tenofovir 300 mg. He returns for a follow-up 1 month after beginning his TB treatment
with complaints of blurred vision. Further testing shows he has lost the ability to detect the
color green. Which medication is most likely responsible?
A. Isoniazid.
B. Rifabutin.
C. Pyrazinamide.
D. Ethambutol.
31. A 2-year-old child is brought to the pediatrician's office with symptoms of ear pain, fever,
and irritability. Upon examination, the pediatrician notes erythema and bulging of the
tympanic membrane consistent with otitis media. Which of the following medications is
commonly used for pain relief in children with otitis media?
A. Acetaminophen C. Aspirin
B. Ibuprofen D. Naproxen
32. A 3-year-old child presents to the emergency department with a fever of 39.2°C, irritability,
and lethargy. On physical examination, the child has poor perfusion, tachycardia, and
tachypnea. Laboratory tests show an elevated lactate level of 4.5 mmol/L and a white blood
cell count of 25,000/mm3 with a left shift. The child has a past medical history of eczema
and has a known allergy to penicillin. Which of the following is the most appropriate initial
pharmacotherapy for this child with sepsis?
A. Ceftriaxone C. Clindamycin

11 | P a g e
 B. Azithromycin D. Vancomycin
33. A 3-year-old child is brought to the hospital with severe acute malnutrition. The child is
lethargic, has a distended abdomen, and has pitting edema of both lower extremities.
Laboratory tests show severe anemia (Hb 6.5 g/dL), hypoalbuminemia (serum albumin 1.8
g/dL), hypokalemia (serum potassium 2.8 mEq/L), and elevated liver enzymes (ALT 250
U/L). Which of the following is the most appropriate initial treatment for the hypokalemia in
this patient with severe acute malnutrition?
A. Oral potassium chloride supplementation C. Correction of hypoalbuminemia

B. Intravenous potassium chloride supplementation D. No specific treatment is needed

34. 8-year-old child with a known history of steroid-sensitive nephrotic syndrome presents to the
clinic with symptoms of edema, fatigue, and decreased urine output. The child has been on
maintenance therapy with alternate-day prednisone for the past year. Urine analysis reveals
proteinuria with a protein/creatinine ratio of 4.6.What is the appropriate dosage and duration
of therapy for the first-line medication in this patient?
A. 1 mg/kg/day orally for 3- 6 weeks C. 4 mg/kg/day orally for 4-8weeks
B. 2 mg/kg/day orally for 4-6 weeks D. 5 mg/kg/day orally for 6-8 weeks
35. A 5-year-old male with no previous medical history presents with fever, headache, vomiting,
and photophobia. Lumbar puncture reveals an elevated white blood cell count, decreased
glucose, and elevated protein consistent with pyogenic meningitis. Blood cultures grow
Streptococcus pneumoniae. Which of the following is the most appropriate empiric antibiotic
regimen for this patient?
A. Ceftriaxone 100 mg/kg/day IV once daily
B. Ceftriaxone 100 mg/kg/day IV divided every 12 hours
C. Vancomycin 40 mg/kg/day IV divided every 6 hours and cefotaxime 200 mg/kg/day
IV divided every 6 hours
D. Vancomycin 60 mg/kg/day IV divided every 6 hours and meropenem 120 mg/kg/day
IV divided every 6 hours
36. A physician that worked at primary hospital Asks you about A 75-year-old man had been
receiving gentamicin to treat an urinary tract infection. After three months of therapy patient's
serum creatinine levels were 10 mg/dL ( normal 0.5-1.2) and serum gentamicin

12 | P a g e
 concentrations obtained just before the last dose were 9 mg/dL (normal < 2). Which of the
following is the most likely adverse drug reaction the patient was suffering from?

A. Type II allergic reaction

B. Type III allergic reaction
C. Pseudo allergic reaction
D. Overdose toxicity
37. A 20 years old male patient presented to hospital with sign and symptoms of Sudden high
fever, Stiff neck, Severe headache, Nausea, vomiting and Confusion. The physician diagnosis
was meningitis and they start ceftriaxone plus vancomycin. After taking the medications, the
patient develops sign and symptoms of itchy, hot, red rash that affects the upper body, face,
and neck. It’s characterized by swelling under the skin, weakness, dizziness, a rapid
heartbeat, fever, chills, chest pain, or back pain.
A. its because of rapid infusion of ceftraxone, an allergic reaction known as “gray baby
syndrome”
B. its because of rapid infusion of vancomaycin, an allergic reaction known as “red man
syndrome
C. its because of rapid infusion of vancomaycin, an allergic reaction known as “gray baby
syndrome”
D. its because of rapid infusion of ceftraxone, an allergic reaction known as “red man
syndrome”
38. what are the primary source of drug information
A. indexing and abstracting systems C. Drug formularies
B. treatment guidelines D articles
39. ______________ of clinical trial involves first time human trial in a small number of
patients.
A. Phase I b Phase II c Phase III d Phase IV
40. which one of the following is included in dispensing Model of Practice
A. Responsible for right patient to get the right quantity of the right medication of the right
strength at the right time
B. Provision of drug related information to the public.

13 | P a g e
 C. Ensuring appropriate use of medication, device, and service to achieve optimal
therapeutic outcome.
D. None

41. Mrs. Johnson, a 45-year-old female, visits the pharmacy with a prescription for prednisolone.
She has been prescribed prednisolone 5mg tablets for her allergic reaction. The prescription
reads: "Take 4 tablets daily for 5 days, then reduce by 1 tablet every 3 days." What is the
total number of prednisolone tablets required for Mrs. Johnson's initial prescription?

A. 15 tablets C. 25 tablets
B. 20 tablets D. 30 tablets
42. Mr. Anderson, a 60-year-old male with a history of hypertension and diabetes, visits the
pharmacy with a prescription for multiple medications. His prescription includes the
following: Metformin 500mg BID with meals, Amlodipine 5mg daily, Lisinopril 10mg daily,
and Atorvastatin 20mg daily. Mr. Anderson purchases a 90-day supply of his medications.
How many blister packs of metformin will he need to cover the entire supply if each pack
contains 60 tablets?
A. 1 pack C. 3 packs
B. 2 packs D. 4 packs
43. A 30-year-old female patient comes to the pharmacy with complaints of a persistent dry
cough that has lasted for over a week. She has no significant medical history and is not taking
any medications. The patient asks for a recommendation to alleviate her symptoms. As the
pharmacist, which of the following options would you recommend based on evidence-based
resources?
A. Codeine-containing cough syrup C. Dextromethorphan (DM) cough syrup
B. Honey and warm water gargles D. Over-the-counter antihistamines
44. Which of the following is an important step in medication reconciliation?
A. Discontinuing all medications that are not essential
B. Prescribing new medications to replace those that have been discontinued
C. Verifying the patient's medication list with the patient and other healthcare providers
D. Administering medications without reviewing the patient's medication history

14 | P a g e
45. You have a bottle of drug in solution. The label does not state the concentration of the drug
in the solution, but the amount of drug and the volume of liquid in the container both appear
on the label. To dispense 30 mg of this drug, you can?
A. Obtain further information from the United States Pharmacopoeia
B. Estimate the amount of drug to be dispensed by the volume needed for injection
C. Calculate the concentration from the information given on the label
D. The order cannot be filled

46. Which of the following adverse drug reactions would you report to Ethiopia Food and drug
administration (EFDA) via the yellow card system for reporting?
A. A patient reports a skin rash after starting a course on Amoxicillin capsules.
B. A patient reports experiencing dyspepsia when they take their Indomethacin capsules.
C. A patient complains of a dry irritating cough since they have started taking Ramipril.
D. A patient complains they have experienced diarrhoea since taking azilsartan.
47. A profession can be distinguished from other occupations in terms of their use of knowledge.
A. Professions have access to a body of specialized knowledge that is not available to by
those outside the profession.
B. Professions rely on a body of specialized knowledge which is not accessible to by those
outside the profession.
C. Professions rely on a body of specialized knowledge which is not easily understood by
those outside the profession.
D. Professions apply specialized knowledge which is not available to those outside the
profession.
48. All statements are true about community pharmacy except?
A. They maintain links with other health professionals in primary healthcare
B. It is a unique hybrid of professionalism and business
C. Has more opportunity to interact closely with the prescriber and to promote the rational
prescribing and use of drugs compared with hospital pharmacy
D. Is the place where the dichotomy of the profession exists
49. The following prescriptions are presented at the community pharmacy where you are
employed. Which of the following scenarios would cause the greatest concern?

15 | P a g e
 A. Mrs GH has type II diabetes which is controlled by diet and she is prescribed furosemide
40mg tablets (take one tablet each morning for oedema).
B. Mr LR has Parkinson's disease and is prescribed bumetanide for oedema (one tablet each
morning).
C. Mr SD's blood test results indicate that he has reduced sodium and raised potassium and is
prescribed furosemide 40mg tablets (take one tablet each morning for oedema).
D. Mr VM has an enlarged prostate gland and his urinary output is adequate. He is prescribed
furosemide 20mg tablets (take one tablet each morning for oedema).

50. Under the Federal Controlled Substances Law, all of the following items must appear on a
controlled substance prescription label except;

A. Name, address, and drug enforcement administration number of the pharmacy.

B. Name of the patient.
C. Name of the prescribing practitioner.
D. Serial number assigned to the prescription.
E. Date of the initial filling of the prescription
51. Under the Federal Controlled Substances Law, the crime transfer warning, “Caution: Federal
law prohibits the transfer of this drug to any person other than the patient for whom it was
prescribed,” must appear on the prescription container label of all controlled substances
except;
A. Schedule II controlled substances.
B. Schedule III controlled substances.
C. Schedule IV controlled substances.
D. Schedule V controlled substances.
52. You have been dispensing narcotics to a patient for several months for “back” pain. You are
reasonably convinced that the drug is supporting an addiction. You call the physician and she
tells you that she is using the narcotic for “back” pain. Select the best answer:
A. Refuse to refill the narcotic since it is not a “legitimate” medical purpose.
B. Fill the refill because pain is a “legitimate” medical purpose.
C. Call the medical board and report the physician.
D. Suggest OTC ibuprofen.

16 | P a g e
 E. Give the patient part of the prescription
53. Under the Federal Controlled Substances Law, all of the following entities must register with
the drug enforcement administration except;
A. Prescribers of controlled substances.
B. Pharmacists who dispense controlled substances.
C. Distributors of controlled substances.
D. Importers of controlled substances.
E. Universities conducting instructional activities with controlled substances listed in
Schedules II to V.
54. Which of the following approach to stock management requires that the products will expire
first is issued first?
A. LIFO B. FIFO C. FEFO D. NONE
55. When is consumption method of drug quantification appropriate?
A. If there is accurate consumption data.
B. If drug supply is consistent.
C. If there is appropriate stock management system.
D. If the wastage rate is higher.
E. All except D
56. Which statement is true in ABC and VEN analysis?
A. High percentage of funds spent on large-volume or high-cost item.
B. ABC analysis is a pharmaceutical categories based on clinical importance.
C. During procurement, always give priority to essential pharmaceuticals and then go for
vital pharmaceuticals.
D. None.
57. According to the Ethiopian national Integrated Pharmaceutical Logistics System guideline
health facilities can be labeled as overstocked for specific product;
A. If the calculated months of stock are more than 4 months in hospitals and health
centers.
B. If the calculated months of stock are more than 2 months in health posts.
C. If the calculated months of stock are below 4 months in hospitals and health centers
D. A and B

17 | P a g e
58. Which of the following statement is not true in APTS?
A. The price code is coded in a specific health facility per the cost of the product
whereas the base codes are prepared nationally by MOH.
B. Alpha numeric code is constructed from 8 characters.
C. The copies of price control sheet should be available at all counters of dispensing
units, accountant office, audit office and store.
D. In alphanumeric coding numbering starts from the smallest strength and continues to
the highest.
59. What challenges were exist in the global health care setting that brought an idea of working
with a limited range of basic and reliable drugs.
A. The inaccessibility and unaffordability of the discovered “miracle” medicine for the
developing country.
B. Problems with efficacy and safety due to unregulated pharmaceuticals markets.
C. A serious disasters from inadequately tested or misused drugs.
D. All of the above.
60. A 2-year-old boy was admitted to the emergency department after a generalized tonic-colonic
seizure. His m other reported that the boy apparently ingested several tablets of propranolol,
a β-blocker, which he had found in his father’s dresser drawer. Vital signs on admission were
blood pressure 85/50 mm Hg, heart rate 40 beats per minute (bpm), respiratory rate 20/m in.
The boy received an intramuscular injection of glucagon, a hormone that activates glucagon
receptors in the heart, causing a significant increase in heart contractility. Which of the
following term is best defines the antagonism between glucagon and β-blockers?

A.

B. Chemical D. Competitive
C. Functional E. Pharmacological

61. A new born baby whose mother had epilepsy presented with microcephaly, a broad nasal
bridge, short nose, cleft palate, and hypoplasia of the distal phalanges. Drugs used by the
mother during pregnancy included phenytoin for seizures, methyldopa for pregnancy-induced
hypertension, and erythromycin for an upper respiratory infection during the first trimester.
During the delivery, the woman was treated with diazepam and had epidural anesthesia with

18 | P a g e
 lidocaine. Which of the drugs taken by the mother most likely caused the baby’s presenting
syndrome?

A. Methyldopa C. Erythromycin
B. Phenytoin D. Diazepam

62. A 24-year-old woman admitted to the hospital after a car accident was diagnosed with
neurogenic shock due to a spinal cord injury. An emergency treatment was started that
included the administration of norepinephrine. Which of the following expected effects of the
drug was most likely mediated by the activation of peripheral postsynaptic β1 receptors?

A. Bronchodilation C. Increased liver gluconeogenesis

B. Uterine relaxation D. Increased renin secretion

63. A 32 years old woman with hypertension wishes to become pregnant. Her physician informs
her that she will have to switch to another antihypertensive drug. Which of the following
drugs is absolutely contraindicated in pregnancy?

A. Atenolol C. Prazosin
B. Captopril D. Propranolol

64. Mr. Alemu, A 72-year-old man with hyperlipidemia and renal failure was given high-
intensity atorvastatin for 6 months. His LDL-C is 131 mg/dl, his triglycerides are 710 mg/dl,
and his HDL-C is 32 mg/dl. His doctor wants him to take another agent for hyperlipidemia.
Which one of the following is the best treatment of choice for this patient's hyperlipidemia?

A. Fenofibratae C. Niacin
B. Colestipol D. Gemfibrozil

65. A 60-year-old patient started a new antihypertensive medication. His blood pressure is well
controlled, but he complains of fatigue, drowsiness, and fainting when he gets up from the
bed (orthostatic hypotension).Which of the following drugs is he most likely taking?

A. Metoprolol C. Prazosin
B. Propranolol D. Alfuzosin

19 | P a g e
66. A 57-year-old man with congestive heart failure presents to the emergency department with
shortness of breath. He has +2 pitting edema in his extremities as well. A chest X-ray
confirms the presence of pulmonary edema. The patient is given intravenous furosemide to
remove the excess fluid. Where in the nephron does furosemide act?
A. Descending loop of Henle
B. Distal convoluted tubule
C. Proximal convoluted tubule
D. Thick ascending loop of Henle
67. A 54-year-old woman presents to the primary care clinic with hot flashes and irregular
menstrual cycles. These symptoms started about 3 months ago and have worsened recently.
She has always had regular menstrual cycles until 3 months ago. She would like to start
hormone replacement therapy but estrogen only. What is a common side effect of unopposed
estrogen replacement therapy?
A. Depression
B. Increased risk of endometrial cancer
C. Osteoporosis
D. Rash
68. A 65-year-old man was prescribed with drugs for the treatment of Parkinson’s disease. After
few days, the man came back to the doctor complaining of change in its urine color. What
drug of the following have this side effect profile?

A. Amantadine C. Pramipexole
B. Bromocriptine D. Entacapone

69. A 78-year-old woman with Alzheimer’s disease presents to her primary care physician for a
routine visit. She is brought in by her daughter, who reports her mother has become more
forgetful. The patient is alert to person and place but is unsure of the year. The physician
would like to add memantine to her regimen of donepezil and vitamin E. What is the
mechanism of action of memantine?
A. Acetylcholine receptor antagonist
B. NMDA receptor antagonist
C. Increase dopamine release

20 | P a g e
 D. NMDA receptor agonist
70. A 39-year-old male patient who was prescribed citalopram for depression has decided he
wants to stop taking the drug. When questioned, he said that it was affecting his sexual
performance. You ascertain that he is also trying to overcome his dependency on tobacco
products. If you decide to reinstitute drug therapy in this patient, the best choice would be

A. Amitriptyline C. Fluoxetine
B. Bupropion D. Imipramine

71. A 61-year-old patient with an acute myocardial infarction has severely reduced cardiac
output. He has to undergo emergent coronary artery bypass surgery. Which of the following
would you expect in this patient?
A. Faster induction time with IV anesthetics
B. Need for increased dosage of IV anesthetics
C. Faster induction time with inhaled anesthetics
D. Enhanced removal of inhaled anesthetics to peripheral tissues
72. A 25-year-old man with multiple sexual partners begins to have flulike symptoms. He visits
his primary care physician who recommends an HIV screening test based on his history. He
is found to have an HIV infection and begins a drug regimen. Which of the following works
by blocking the cleavage of the HIV polyproteins?

A. Darunavir C. Enfuvirtide
B. Delavirdine D. Maraviroc

73. A 30-year-old man with human immunodeficiency virus infection is being treated with an
antiretroviral regimen. Four weeks after initiating therapy, he presents to the emergency
department complaining of fever, rash, and gastrointestinal upset. His HLA-B*5701 test is
positive. Which drug is most likely the cause of his symptoms?

A. Zidovudine C. Efavirenz
B. Abacavir D. Darunavir

74. A 50-year-old woman recently diagnosed with ovarian cancer started her first cycle of
combination chemotherapy with paclitaxel, cisplatin, and cyclophosphamide. Which one of

21 | P a g e
 the following drugs should also be administered to counteract a specific adverse effect of
cyclophosphamide?

A. Erythropoietin
B. Leucovorin
C. Mesna
D. Acetylcysteine

22 | P a g e
75. In Ethiopian Food and Drug Authority (EFDA), Mr. Yibeltal is working on HPLC so as to
check whether the equipment is working correctly and actually leads to the expected results.
The process Mr. Yibeltal was performing is:

A. Method validation
B. Qualification
C. Robustness
D. All
76. Mr. Solomon is a pharmaceutical analyst in physicochemical laboratory of EFDA. He wants
to separate A, B and C components of a mixture. The basis for separating these three
components of mixture using of chromatography technique is?
A. The differing movement of particles of different mass in an electrical field
B. The interaction of the components with a stationary and a mobile phase
C. The absorption of infrared radiation by the components.
D. The deflection of charged particles in a magnetic field.
77. A light sensitive active pharmaceutical ingredient (API) is formed into a tablet. The
pharmacist wants to protect the API from photo-degradation by film coating the tablet.
Which ingredient do you think should be added to the coating material to make the film
coating opaque?
A. Polyethylene glycol
B. Bees wax
C. Titanium dioxide
D. Tartrazine
78. Mr. Abebe, a student who is working on structural elucidation of a product form natural
source wants to know the arrangement of molecules and determine the exact structural
formula of his product. Which one of the following instrumental method can provide such
kind of information?
A. Mass spectroscopy

B. Nuclear magnetic resonance

C. Liquid chromatograph

23 | P a g e
 D. UV-Visible spectrophotometry

79. The solubility of a drug depends on the physicochemical properties and chemical nature of
the drug. The drug solubility in aqueous and in non-aqueous solutions, in turn, is affected in
different ways by its characteristics. Which characteristics will increase drug solubility in an
aqueous solution?
A. Presence of an ionized group
B. Presence of a non-polar group
C. High melting point
D. High boiling point
80. The effect of temperature on rate of chemical reaction and hence on the stability of drugs is
very important. The drug stability at the required storage conditions can be estimated by
accelerating drug breakdown using elevated temperatures. The rates of reaction at high
temperatures (where the reaction occurs relatively rapidly) can be measured and the rate
constant at room temperature (where reaction occurs at a very slow rate) is estimated by
extrapolation of data at high temperatures. This method therefore provides a means of
speeding up the measurements of drug stability during preformulation. Which equation is
used to predict the stability of a drug at room temperature from experiments at increased
temperatures?
A. Stokes equation
B. Arrhenius equation
C. Henderson–Hasselbalch
D. Noyes–Whitney equation
81. Which one of the following results to cancellation of import licenses?
A. Complying with specific conditions of licensing
B. Wrongful dealing in medicines, herbal medicines and allied substances
C. Authorized change of premises
D. Complying with other legislation
82. Mr. Dereje is a QC laboratorist at “X” Pharmaceutical Company. He did the QC tests for
samples of furosemide 40 mg tablet dosage form. But during post market surveillance this
drug found and reported to EFDA as quality defect product. The expected reason for QC
test alone is not adequate is:

24 | P a g e
 A. Only what is expected to be found is tested
B. Only small portion of the bulk of the product is tested.
C. There could be a small proportion of defective product in a batch
D. All
83. Which of the following spectroscopic techniques gives a characteristic “finger print” region
for identification of molecules?
A. Ultraviolet- visible absorption
B. Fluorescence spectroscopy
C. Nuclear magnetic resonance spectroscopy
D. Infrared spectroscopy
84. Suppose you are going to determine organophosphate pesticide residues in major staple food
items, which one of the following GC detectors is more preferable?
A. Thermal conductivity detector (TCD)
B. Flame ionization detector (FID)
C. Electron capture detectors (ECD)
D. Mass spectroscopy (MS)
85. Most medicines are made up of the active pharmaceutical ingredients (API) and various
excipients. Which one of the following is not a possible justification for formulating
medicines in this way?

A. The excipients stabilize the API so that it does not degrade appreciably before
administration
B. The excipients reduce the possibility of the API irritating the body
C. The API and the excipients each exert a pharmacological effect
D. all

86. Why ampicillin is usually prepared as granules and reconstituted by a pharmacist with
purified water just prior to dispensing

A. Because of ampicillin is degradation by elevated temperature for drying

B. Because of ampicillin is unstable in aqueous solution
C. Because of ampicillin is heat stable.
D. Because of ampicillin is insoluble in water

25 | P a g e
87. As a pharmacist while you are preparing liquid formulation like solution you may need to
incorporate buffer to avoid PH change. Which buffer is that you should not use for internal
use, to be applied on mucous membranes or to abrade skin?

A. Carbohydrates B. Phosphates C. Citrates D. Borates

88. After a pharmacist prepared a suspension he has got it difficult to disperse solid particles in a
liquid vehicle this might be due to the layer of adsorbed air on the surface. Thus, the
particles, even high density, float on the surface of the liquid until the layer of air is displaced
completely. To solve this problem what measure does the pharmacist should take?
A. Adding suspending agent C. Adding wetting agent
B. Adding preservative D. Adding viscosity of the vehicle
89. A prescription calls for a pharmaceutical formulation of oil and water-soluble drugs together
for a pediatric patient. If you are the pharmacist in charge to prepare the formulation which
the prescription calls for, in which form would you have to prepare?
A. Suspension B. Emulsion C. Solution D. Ointment
90. A compounding pharmacist received a prescription to prepare a certain dermatological
ointment to be applied twice daily for 2 weeks. The pharmacist in charging has prepared the
formulation and dispensed to the patient with adequate counselling What is the most
appropriate cautionary label for the preparation?
A. Take twice daily
B. For topical use only
C. Use for few days only
D. Store at room temperature
91. A hospital pharmacist received a treatment order of Triamcinolone 0.05%, ointment
Base ad 120 gm. sig . Apply daily to the affected area. The pharmacist prepared the medication
accordingly and wrote a label, which includes patient’s name, Triamcinolone ointment, apply
topically daily for one month What is the most likely missed labeling information for this
Extemporaneous prescription?
A. Brand name
B. Generic name
C. Batch number
D. Direction for use

26 | P a g e
92. The sedimentation velocity of particles forming the internal phase of four suspension were
tested and presented in the following table
Types of suspension Sedimentation velocity
(cm/min
1.45
Suspension- 1
Suspension_ 2 3.75
Suspension_3 2.05
Suspension_4 2.56

Which suspension allows adequate time to measure an accurate dose?

A. Suspension _2
B. Suspension_3
C. Suspension_4
D. Suspension_1
93. A compounding pharmacist received a prescription to prepare Alkaline phenol solution
Based on the following ingredient lists.
Alkaline phenol solution
Ingredient formula
- Liquefied phenol 30ml
- Potassium hydroxide 5% 30ml
- Amaranth solution 1ml
- Water to 1000ml
- Send 50ml
94. What is the role of amaranth solution in the preparation described in the above:
A. Active ingredient
B. Cleansing agent
C. Colouring agent
D. Solvent

27 | P a g e
95. Assume that a manufacturing company aiming at producing a conventional oral tablet
containing very potent (low mg) drug. Which one of the following excipients most likely
used in formulation of this tablet?
A. Preservatives C. Antioxidants
B. Diluents D. wetting agents
96. A given drug 'Y' is prescribed for the patient to be prepared in the form of a highly emollient
and viscous ointment for long duration of contact with site of application. Which ointment
base does the pharmacist need to compound it?
A. Hydrocarbon base
B. Absorption base
C. Water removable base
D. Water soluble base

97. One of the following is not in line with ideal characteristics of emulsifying agents
A. Emulsifying agent should produce stable emulsion at low concentration
B. Emulsifying agent should be odorless and tasteless
C. Emulsifying agent should have hydrophilic component/part more predominant
D. Emulsifying agent should be non-toxic and chemically inert
98. Extract true statement
A. The type of macro-emulsion can be identified by observing with our naked eye
B. The internal phase in W/O emulsion is oil
C. O/W emulsion can diluted with oil without phase separation
D. O/W emulsion is preferred to W/O emulsion for oral administration
99. One of the following is in line with ideal qualities of well formulated suspension
A. The discontinuous particles should have moderate viscosity
B. The settled particles should form cake
C. Continuous phase should have moderate viscosity
D. The dispersed particles should settle quickly
100. Select false statement
A. Unlike natural emulsifying agent, inorganic emulsifying agents prevent microbial
growth

28 | P a g e
 B. Emulsifying agent having HLB value of 5 should be used for preparation of W/O
emulsion
C. If inorganic emulsifying agent watted easily with water then it should be used for
preparation of W/O emulsion
D. Unlike cationic and anionic surfactant, non-ionic surfactant can used for
preparation of both W/O and O/W emulsion

29 | P a g e
Answer key

Name: ____________________________________ ID: ____________ Sign: _________

1._______ 18.______ 36._______ 53.________

19.______
2._______ 37._________ 54._________
20.______
3._______ 38._________ 55._________
21.______
4._______ 39._________ 56._________
22.______
5._______ 40._________ 57.________
23.______
6._______ 41._________ 58.________
24.______
7._______ 42._________ 59.________
25.______
8._______ 43._________ 60________
26.______
9._______ 44._________ 61_______
27.______
10.______ 45._________ 62_________
28.______
11.______ 46._________ 63_________
29.______
12.______ 47._________ 64__________
30._______
13._____ 48._________ 65_________
31._______
14._____ 49._________ 66_________
32._______
15._____ 50._________ 67_________
33._______
16._____ 51._________ 68_________
34._______
17.___ 52.________ 69________
35._______

30 | P a g e
70_________ 92_________

71_________ 93_________

72________ 94_________

73________ 95_________

74________ 96__________

75_________ 97__________

76__________ 98____________

77_________ 99___________

78__________ 100___________

79__________

80__________

81__________

82__________

83__________

84__________

85__________

86__________

87__________

88__________

90__________

91__________

31 | P a g e