Changed PTCE Exam Questions

Cyanocobalamin (Vitamin B12)is used to treatpernicious anemia, a condition caused byVitamin B12 deficiencydue to the body’s inability to absorb it properly.

Pernicious anemiais an autoimmune disorder where the stomach does not produceintrinsic factor, a protein needed for Vitamin B12 absorption.

Symptoms includefatigue, weakness, neurological issues (numbness, tingling), and megaloblastic anemia.

Cyanocobalamin is given viaIM injection or high-dose oral supplementation.

(A) Pernicious anemia✅Correct – Cyanocobalamin is the primary treatment.

(B) Alcohol withdrawal❌Incorrect – Thiamine (Vitamin B1) is used for alcohol withdrawal, not cyanocobalamin.

(C) Hypothyroidism❌Incorrect – Treated withlevothyroxine (Synthroid), not Vitamin B12.

(D) Narrow-angle glaucoma❌Incorrect – Treated withtimolol, acetazolamide, or surgery, not cyanocobalamin.

Cyanocobalamin Prescribing Information (NIH):

PTCB Exam Content Outline – Disease States & Medications

Key Facts About Cyanocobalamin & Pernicious Anemia:Analysis of Answer Choices:References for Pharmacy Technicians:

TheInstitute for Safe Medication Practices (ISMP)maintains a list oferror-prone abbreviationsthat shouldnot be usedin medication orders to prevent misinterpretation and medication errors.

Analysis of the Answer Choices:Abbreviation

Meaning

ISMP Recommendation

U

Units

❌Do NOT use→ Can be mistaken for "0" or "4" (e.g., 10U could be misread as 100).Use"unit"instead.

AD

Right ear

❌Do NOT use→ Can be confused with "OD" (right eye).Use"right ear"instead.

AU

Both ears

❌Do NOT use→ Can be confused with "OU" (both eyes).Use"both ears"instead.

gtt

Drop

✅Accepted→ Common and not considered error-prone.

Since"gtt" for drop is not on ISMP's "Do Not Use" list, it is the correct answer.

ISMP List of Error-Prone Abbreviations– Confirms that "U," "AD," and "AU" should not be used in prescriptions.

Joint Commission "Do Not Use" List– Prohibits "U" and similar abbreviations to prevent dosing errors.

PTCB PTCE Exam Content Outline– Covers error prevention strategies, including abbreviation safety.

Key References:

ARisk Evaluation and Mitigation Strategy (REMS)program is required by theFDAfor certain medications that have serious safety concerns, ensuring their risks do not outweigh their benefits.Mycophenolateis subject to a REMS program due to its severe teratogenic effects.

(A) Sertraline❌Not Subject to REMS

Sertraline (Zoloft) is aSelective Serotonin Reuptake Inhibitor (SSRI)used to treat depression and anxiety.

While SSRIs can carry arisk of birth defects (such as persistent pulmonary hypertension in newborns - PPHN),sertraline is not included in the REMS program.

(B) Ondansetron❌Not Subject to REMS

Ondansetron (Zofran) is anantiemeticused to prevent nausea and vomiting.

While some studies suggest a possible increased risk of congenital defects, it isnot part of a REMS program.

(C) Montelukast❌Not Subject to REMS

Montelukast (Singulair) is aleukotriene receptor antagonist (LTRA)used forasthma and allergies.

It has aBoxed Warningfor mental health side effects butis not subject to a REMS program for pregnancy risks.

(D) Mycophenolate✅Correct – Subject to REMS

Mycophenolate (CellCept, Myfortic)is animmunosuppressantused to prevent organ rejection in transplant patients.

It carries ahigh risk of birth defects and miscarriage, making pregnancy preventionmandatorywhile taking the medication.

TheMycophenolate REMS Programrequires:

Mandatory counselingon pregnancy risks

Negative pregnancy testsbefore starting therapy

Use of effective contraceptionbefore, during, and after treatment

FDA REMS Program for

FDA REMS Program Overview:

PTCB Exam Content Outline – Medication Safety & Risk Management

Analysis of Answer Choices:References for Pharmacy Technicians:

Amlodipine(10 mg) anddiltiazem(30 mg) are bothcalcium channel blockers (CCBs)used to treat hypertension and angina.

When a patient is prescribed two medications from the same therapeutic class, the pharmacy's prescription processing system may flag this as"therapeutic duplication."

This alert is meant toprevent potential adverse effectssuch as excessive lowering of blood pressure or heart rate.

A. Prior authorization required→ Not applicable unless the insurance requires special approval before covering the drug.

C. NDC not covered→ Would appear if the specific drug product (based on its National Drug Code) is not covered by insurance, but this scenario relates to duplication, not coverage.

D. Refill too soon→ This applies to refilling a medication before the allowed time frame, but the scenario describes a new prescription.

PTCB PTCE Exam Content Outline – Drug Interactions and Therapeutic Duplication

Lexicomp and Micromedex Drug Databases– Reference sources for drug classifications.

ISMP Guidelines on Preventing Therapeutic Duplication Errors

Why Other Answers Are Incorrect?Pharmacy Technician References: