Free PEBC Exam Practice Questions

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Question 1

Fentanyl is a very potent opioid pain reliever that is 20 to 40 times more potent than heroin and 100 times more potent than morphine. This high potency makes the risk of accidental overdose very high. Which of the following fentanyl formulations is not approved in Canada?

A. IV Solution

B. Transdermal Patch

C. Sublingual Tablet

D. Lozenge

E. Nasal Spray

Answer: D

Lozenge (Actiq) is not yet available in Canada.

 

Question 2

Fentanyl can lead to both short-term and long-term mental and physical effects. Which of the following is a long-term physical effect of fentanyl?

A. Constipation

B. Dizziness

C. Nausea

D. Slow breathing

E. Confusion

F. Depression

G. Constricted pupils

H. Impulsiveness

Answer: A

B and E are short-term mental effects

C, D, and G are short-term physical effects

F and H are long-term mental effects

 

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Cannabis math. What is the estimated THC dose if 1 joint containing 0.5 grams of 12% THC dried cannabis is smoked? Assume 50% loss by combustion. 

A. 5 mg

B. 15 mg

C. 30 mg

D. 60 mg

Answer: C

A.  Calculation: 500 mg cannabis x 12% THC = 60 mg

If 50% loss to combustion, then the amount of THC smoke is: 60 mg THC x 50% = 30 mg

Question 2

Mrs. Peter had two episodes of deep vein thrombosis. She has been using warfarin for the past 9 months as a preventive strategy. DVT is the most common type of venous thrombosis. Mrs. Peter is visiting the pharmacy to discuss her interest in recreational cannabis. Which of the following cannabinoids may induce CYP1A2 resulting in decreased levels of warfarin?

A. Vaped cannabis

B. Oral THC/CBD

C. Oral CBD

D. Smoked cannabis

Answer: D

Evidence show that smoking cannabis may potentially cause significant interaction with warfarin mediated by CYP1A2 resulting in increased warfarin clearance, which leads to reduced warfarin effects. There are no reports of interactions between edible cannabis and warfarin.

Additional learning: All cannabinoids have additive CNS effects with alcohol, benzodiazepines, opioids etc.

 

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Overview of Remdesivir

Remdesivir is an antiviral nucleotide with broad antiviral activity. The active form of remdesivir acts as a nucleoside (adenosine triphosphate) analog and inhibits the RNA polymerase of coronaviruses including SARS-CoV-2. Remdesivir is incorporated by RNA polymerase into the growing RNA molecule and allows the addition of three more nucleotides before RNA synthesis is inhibited.

Remdesivir is a phosphoramidate prodrug that must be metabolized within host cells to its triphosphate active metabolite to effectively compete with ATP for incorporation into newly synthesized viral RNA. Due to much higher selectivity of mammalian DNA and RNA polymerases, including human mitochondrial RNA polymerase, for ATP over remdesivir triphosphate, remdesivir is not a significant inhibitor of these enzymes, which accounts for its overall tolerability and safety profile.

The results of clinical trials suggest that IV administration of remdesivir may shorten the time to recovery from COVID-19 and may reduce mortality. The duration of action is moderate, as it is given once daily.

Side effects include:

• Severe headache
• Irregular heartbeats
• Light-headedness
• Fever or chills
• Wheezing
• Nausea
• Itching, sweating

Remdesivir was authorized with conditions in Canada on July 27, 2020. It was authorized for the treatment of severe COVID-19 in adults and youth aged 12 years and over and weighing at least 40 kg with pneumonia requiring supplemental oxygen. It was the first medication authorized specifically for the treatment of COVID-19 and remains one of the few approved therapies in Canada.

Manufacturer:

Gilead Sciences Canada Inc.

Availability in Canada:

100 mg / 20 mL remdesivir solution, single-dose vial, intravenous administration
100 mg / vial remdesivir powder for injection, single-dose vial, intravenous administration

Prescription status:

Remdesivir (Veklury) is available by prescription only.

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PEBC Exam: The Management of Multiple Sclerosis

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Overview of Multiple Sclerosis

Multiple Sclerosis (MS) is a progressive and potentially disabling disease of the central nervous system (brain and spinal cord). The hallmark of MS is the destruction of the protective myelin sheath around nerve fibers by the immune system resulting in the impairment of communication between the brain and the rest of the body.

Symptoms of MS depend on the degree of nerve damage. Some patients with severe Multiple Sclerosis may lose the ability to walk independently while others may experience long periods of remission without any new symptoms. Unfortunately, there is no cure for MS. All available treatments help lessen the frequency of relapses and potentially delay the progression of physical disability. Canada has the fifth highest worldwide prevalence of MS, affecting 240 out of every 100,000 people. Relapsing-remitting MS (RRMS) is the most common type of MS, affecting 85 to 90 percent of patients.

Common symptoms may include:

• Numbness/weakness of limbs and/or trunk affecting typically on one side of the body at a time
• Unsteady gait, tremors, or lack of coordination
• Electric-shock sensations occurring with certain neck movements, mostly bending the neck forward known as Lhermitte sign
• Memory impairment

Vision symptoms may include:

• Partial or complete loss of vision often with pain affecting typically one eye at a time
• Blurred vision
• Double vision

Treatments

For many years, there were limited treatments available in Canada and they were all given by intramuscular or subcutaneous injection. Recently, three new oral drugs have been approved by Health Canada; these more patient-friendly oral drugs have changed the landscape of Multiple Sclerosis treatment in Canada.

 

Summary of MS Drugs in Canada
Name	Drug Administration
Interferon   beta-1a (Avonex or Rebif)	Injection
Interferon   beta-1b (Betaseron or Extavia)	Injection
Glatiramer   acetate (Copaxone)	Injection
Natalizumab (Tysabri)	Infusion
Alemtuzumab (Lemtrada)	Infusion
Fingolimod (Gilenya)	Oral
Dimethyl fumarate (Tecfidera)	Oral
Teriflunomide (Aubagio)	Oral

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PEBC Exam Review Made Easy!

PEBC Exam Preparation Tips

As a practicing pharmacist or pharmacy technician in Canada, you are expected to be actively engaged in the community you serve to inform and educate. Here is an overview of the key elements of an effective education session in a community.

Step 1: Identify the learning needs of participants. Examples: weight management, smoking cessation, drug therapy compliance, diabetes management, blood pressure control…

Step 2: Identify an educational method that is appropriate for the participants. Examples: scenarios, show and tell, Q&As…

Step 3: Use appropriate communication techniques to deliver the educational session. Examples: live, videos, web-based, prints such as flyers, articles, booklet…

Step 4: Assess the outcomes of the education session against the previously identified learning needs. Examples: ask questions, encourage verbal feedback, written quiz, surveys…

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Cytisine is a new smoking cessation drug approved by Health Canada in August 2017 as a natural health product (NHP) which acts as a partial agonist of the α4β2 nicotinic acetylcholine receptor responsible for the central effects of nicotine. Cytisine is available without a prescription. Here is the detailed dosing regimen of Cytisine in smoking cessation.

Free PEBC Exam Practice Questions

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Cytisine is a natural health product approved in August 2017 by Heath Canada as a smoking cessation aid. It works by blocking the effects of nicotine to reduce cravings and withdrawal symptoms. How would you counsel a patient to take cytisine during the first 3 days of treatment?

A. Take 1 capsule once daily with a corresponding reduction of the number of cigarettes smoked
B. Take 1 capsule 2 times daily every 6 hrs with a corresponding reduction of the number of cigarettes smoked
C. Take 1 capsule 3 times daily every 4 hrs with a corresponding reduction of the number of cigarettes smoked
D. Take 1 capsule 6 times daily every 2 hrs with a corresponding reduction of the number of cigarettes smoked
E. Take 1 capsule as needed with a corresponding reduction of the number of cigarettes smoked

Answer: D

Cytisine is a new smoking cessation drug approved by Health Canada in August 2017 as a natural health product (NHP) which acts as a partial agonist of the α4β2 nicotinic acetylcholine receptor responsible for the central effects of nicotine. Cytisine is available without a prescription. Contraindications include arterial hypertension, advanced atherosclerosis, and pregnancy or breastfeeding. The adverse effects reported with Cytisine are largely gastrointestinal (dyspepsia and nausea) and sleep disturbance, which are self-limiting.

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Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple types seizures, slowness of intellectual growth, and a specific electroencephalogram disturbance. Which of the following cannabinoids is indicated for the treatment of seizures associated with Lennox-Gastaut syndrome?

A. Nabiximols

B. Nabilone

C. CBD

D. Cannabis

E. THC

Answer: C

THC and CBD are the two primary substances found in cannabis. Nabiximols (Sativex) is extracted THC/CBD used to treat advanced cancer pain, Multiple Sclerosis neuropathic pain or spasticity; Nabilone (Cesamet) is THC analog used to treat severe nausea and vomiting due to cancer chemotherapy, AIDS-related anorexia, palliative pain, and neuropathic pain.

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A 55-year-old patient with Type 2 diabetes mellitus is non-compliant with medication and diet recommendations. The simplest and informative way to assess for past non-compliance and long-term glycemic control would be to perform which of the following tests?

A. Fasting blood glucose test
B. Glucose tolerance test
C. Glycated hemoglobin test
D. Urine ketone test

Answer: C

Glycated hemoglobin or A1C test identifies the three-month average plasma glucose concentration. The test is limited to a three-month average because the maximum lifespan of a red blood cell is 120 days.

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Parathyroid hormone (PTH) is a peptide hormone produced by the parathyroid gland. Which of the following statements is NOT correct regarding the biological functions of PTH?

1. Stimulates the activation of vitamin D in kidneys
2. Increases the level of calcium in blood by stimulating the activity of osteoblasts
3. Enhances the reabsorption of calcium in kidneys
4. Increases the level of phosphate in blood by stimulating the activity of osteoclasts
5. Inhibits the reabsorption of phosphate in kidneys

Answer: B

The level of calcium in blood is increased due to the stimulation of osteoclasts; osteoclasts are bone-resorbing cells.

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Questions of the Week:

Which of the following recently approved drugs is used in the treatment of Parkinson’s disease?

A. Mirabegron

B. Rotigotine

C. Trametinib

D. Pasireotide

E. Olodaterol

Answer: B

Rotigotine is a transdermal dopamine agonist for Parkinson's disease and restless legs syndrome.

Mirabegron- A beta-3 agonist for overactive bladder; Trametinib- A kinase inhibitor for advanced melanoma; Pasireotide - A somatostatin analog for Cushing's disease; Olodaterol- Inhaled long-acting beta-agonist bronchodilator for COPD.

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Evolocumab is a monoclonal antibody used along with diet and maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia who need additional lowering of LDL cholesterol.  Which of the following statements best describes the mechanism of evolocumab?

     A. Inhibits subtilisin/kexin a protein that targets LDL receptors for degradation and thereby reduces the liver's ability to remove LDL-cholesterol from the blood

     B. Inhibits HMG-CoA reductase, an enzyme found in liver tissue that plays a key role in the production of cholesterol in the body

     C. Inhibits lipolysis and decrease subsequent hepatic fatty acid uptake as well as inhibit hepatic secretion of VLDL

     D. Inhibits the absorption of cholesterol binding to a critical mediator the Niemann-Pick C1-Like 1 (NPC1L1) protein on the gastrointestinal tract epithelial cells

     E. Acts by trapping bile acids leading to decreased enterohepatic recirculation of bile acids, increased synthesis of new bile acids by the liver from cholesterol and subsequent reduction of blood cholesterol levels

Answer: A

B is the mechanism of statins such as atorvastatin; C is the mechanism of fibrates such as gemfibrozil; D is the mechanism of cholesterol absorption inhibitors such as ezetimibe; E is the mechanism of bile acids sequestrants such as colestipol

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Review of Temperatures for Different Types of Storage Conditions

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Freezing: –25°C to –10°C

Refrigeration (cold): 2°C to 8°C

Refrigeration (cool): 8°C to 15°C

Controlled room temperature: 15°C to 20°C

Drug conservation temperature: 15°C to 30°C

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