PTCE Practice Questions 2026: 8 Exam-Style Items Explained

Answer: D — Zolpidem tablets

Zolpidem is Schedule IV. Federal rules let Schedule III-V prescriptions be given orally by the prescriber and refilled up to 5 times within 6 months of the date written. The other three are Schedule II: they can never be refilled, and an oral order is allowed only in a genuine emergency, limited to the emergency supply, with a written or electronic prescription delivered within 7 days.

• A. Fentanyl is Schedule II: no refills, and an oral order is only allowed in an emergency with a follow-up prescription within 7 days.
• B. Morphine is Schedule II; every fill needs its own prescription, and routine phone-in orders are not allowed.
• C. Oxycodone stays Schedule II when combined with acetaminophen, so the same no-refill, no-routine-oral-order rules apply.

Answer: B — The reverse distributor issues a DEA Form 222 (or CSOS order) to the pharmacy

A DEA Form 222 (or its electronic CSOS equivalent) is issued by the registrant receiving Schedule I-II substances. Here the reverse distributor is the receiver, so it sends the order to the pharmacy. After destroying the drugs, the reverse distributor records the destruction on its own DEA Form 41.

• A. The pharmacy is the supplier in this transfer; a 222 is issued by the receiving registrant, so this reverses the roles.
• C. Form 41 records destruction after the fact; it does not replace the order form needed to move C-II drugs between registrants.
• D. Form 106 reports theft or significant loss; a planned return for destruction is neither.

Answer: B — Clozapine

The 2023 AGS Beers Criteria list drugs to avoid in older adults with a history of seizures or epilepsy because they lower the seizure threshold, including bupropion, tramadol and several antipsychotics such as clozapine, chlorpromazine and olanzapine. A drug-disease interaction like this is a DUR issue the technician escalates to the pharmacist.

• A. Beers flags NSAIDs such as celecoxib for GI bleeding, kidney injury and heart failure, not for lowering the seizure threshold.
• C. Oxybutynin is strongly anticholinergic, so Beers flags it for dementia, delirium and urinary retention rather than epilepsy.
• D. Beers advises against starting aspirin for primary prevention in older adults because of bleeding risk; seizures are not the concern.

Answer: D — Methotrexate

Methotrexate is an antineoplastic that is also used in low weekly doses for rheumatoid arthritis and psoriasis, and it is on the NIOSH hazardous drug list, so handling calls for gloves, separate storage and USP <800> procedures. Oral methotrexate is also an ISMP high-alert drug because daily dosing in place of weekly dosing has caused fatal errors.

• A. Oxycodone is tightly controlled as Schedule II because of diversion risk; that is a DEA security rule, not a hazardous-drug handling rule.
• B. Amoxicillin is not a hazardous drug; the handling concern is penicillin allergy, which is why counting trays are cleaned after use.
• C. Statins such as atorvastatin are routine drugs with no special hazardous-handling requirements.

Answer: A — Look-alike/sound-alike (LASA) drugs

Tramadol and trazodone share most of their letters and sound alike, and ISMP lists them as a confused drug-name pair. Prevention strategies for LASA pairs include separating them on the shelf, Tall Man lettering, barcode scanning at fill and checking the indication.

• B. Therapeutic duplication means two drugs from the same class for the same purpose; tramadol is an opioid analgesic and trazodone an antidepressant often used for sleep.
• C. Tramadol is Schedule IV, but trazodone is not a controlled substance at all.
• D. Pharmaceutical alternatives contain the same active ingredient in a different dosage form, strength or salt; these are two different drugs.

Answer: C — Category C

NCC MERP Category C is an error that reached the patient but caused no harm. It cannot be A or B because the drug reached the patient, and it is not D because no extra monitoring or intervention was needed to confirm or prevent harm.

• A. Category A means circumstances or events with the capacity to cause error - no error actually occurred.
• B. Category B is an error that occurred but did not reach the patient, such as one caught at verification.
• D. Category D is an error that reached the patient and required monitoring to confirm no harm and/or intervention to prevent harm.

Answer: D — 17 mg

A ratio strength of 1:10,000 w/v means 1 g of drug in 10,000 mL. 170 mL x (1 g / 10,000 mL) = 0.017 g, and 0.017 g x 1,000 mg/g = 17 mg.

• A. 0.017 is the answer in grams; keeping the number but switching the unit to mg is the trap.
• B. This is off by a factor of 100, the result of dividing by 1,000,000 mL instead of 10,000 mL.
• C. This is off by a factor of 10, as if the solution were 1:100,000.

Answer: D — 840 mL

qid means four times a day - here before the three meals and at bedtime. 30 mL x 4 doses/day x 7 days = 840 mL. The ac and hs notes tell the patient when to take it; they do not change the dose count.

• A. 210 mL (30 x 7) counts only one dose a day.
• B. 420 mL (30 x 2 x 7) reads the frequency as twice daily.
• C. 630 mL (30 x 3 x 7) counts only the three before-meal doses and drops the bedtime dose.