PEBC Pharmacist Qualifying Examination Part II (OSCE)

At an interactive OSCE station, a 58-year-old man newly started on warfarin for non-valvular atrial fibrillation asks what his blood test target should be. According to standard Canadian practice, what INR target and range should you counsel?

• ATarget INR 2.5 (range 2.0-3.0)
• BTarget INR 3.5 (range 3.0-4.0)
• CTarget INR 1.5 (range 1.0-2.0)
• DTarget INR 4.0 (range 3.5-4.5)

A patient at a counselling station is starting metformin 500 mg twice daily for type 2 diabetes. Which counselling point is MOST important to improve tolerability and adherence?

• ATake it on an empty stomach to maximize absorption
• BTake it with meals to reduce gastrointestinal upset
• CStop the drug permanently if any loose stools occur
• DAvoid all carbohydrate-containing foods while on metformin

At an interactive station, a simulated patient hands you a new prescription for sumatriptan and mentions she also takes a daily SSRI for depression. What drug therapy problem should you prioritize when assessing this combination?

• ARisk of hypoglycemia
• BRisk of QT shortening
• CRisk of serotonin syndrome
• DRisk of hyperkalemia

A 70-year-old presents with a prescription for ramipril and reports a dry, persistent cough that started two weeks after beginning the drug. The MOST appropriate clinical action is to:

• AReassure her the cough is unrelated and continue ramipril
• BRecommend an over-the-counter cough suppressant indefinitely
• CDouble the ramipril dose to control blood pressure faster
• DIdentify the ACE-inhibitor cough and recommend the prescriber consider switching to an ARB

At a non-interactive station you receive a prescription: "Amoxicillin 500 mg PO TID x 10 days" for a patient whose chart documents a history of anaphylaxis to penicillin. What is the BEST course of action?

• ADispense as written since the dose is appropriate
• BDispense but add an auxiliary allergy label
• CWithhold dispensing and contact the prescriber to address the documented penicillin anaph…
• DSubstitute cephalexin without contacting the prescriber

A patient picking up a new salbutamol metered-dose inhaler asks how to use it. Which step sequence reflects correct technique you should demonstrate?

• AInhale first, then actuate after holding breath
• BActuate twice rapidly while exhaling, then inhale
• CPlace inhaler in mouth, breathe normally, and actuate at the end of exhalation
• DShake, exhale fully, actuate while inhaling slowly and deeply, hold breath ~10 seconds

During a Best Possible Medication History (BPMH) interview at an OSCE station, which source combination provides the MOST reliable medication history?

• AAt least two sources, e.g., patient interview plus a pharmacy/provincial medication profi…
• BThe patient's memory alone
• CA single pharmacy fill record only
• DThe hospital admission note only

A simulated patient with newly diagnosed type 2 diabetes (A1C 7.2%, eGFR 80, no cardiovascular disease) asks about first-line drug therapy. Reflecting current Canadian guidance, which agent is the usual first-line pharmacologic choice?

• AGlyburide
• BMetformin
• CInsulin glargine
• DPioglitazone

At a station, a patient on simvastatin reports new, diffuse muscle aches and dark urine. What is the MOST appropriate immediate pharmacist action?

• ATell the patient this is a normal statin effect and continue
• BRecommend doubling the statin dose to override the symptom
• CAdd a second statin to improve cholesterol control
• DSuspect myopathy/rhabdomyolysis, advise stopping the statin, and arrange urgent medical a…

A pregnant patient (first trimester) at a counselling station asks for a recommendation for occasional mild headache. Which analgesic is generally considered the preferred non-prescription option in pregnancy?

• AIbuprofen
• BAcetylsalicylic acid (ASA)
• CAcetaminophen
• DNaproxen

At an interactive station a patient with COPD is prescribed prednisone 40 mg daily for 5 days for an exacerbation. The patient asks if she needs to taper. What is the BEST response?

• AA short 5-day course at this dose generally does not require tapering and can be stopped…
• BShe must taper over 4 weeks regardless of course length
• CShe should stop after one dose if she feels better
• DShe should continue indefinitely to prevent another flare

A patient on lisinopril and spironolactone for heart failure presents for a refill. Which laboratory parameter is MOST important to monitor because of this combination?

• ASerum sodium only
• BHemoglobin A1C
• CSerum calcium
• DSerum potassium

A simulated patient asks how to use a new nitroglycerin sublingual spray for angina. Which instruction is correct?

• ASwallow the spray with water for fastest effect
• BSpray onto or under the tongue, do not inhale; if pain persists, repeat per directions an…
• CUse only once per week to avoid tolerance
• DApply the spray to the chest skin over the heart

At a counselling station, a patient newly prescribed levothyroxine for hypothyroidism asks how to take it. What is the standard administration counselling?

• ATake with breakfast and a calcium supplement
• BTake at bedtime with a high-fat snack
• CTake on an empty stomach, typically 30-60 minutes before breakfast, and separate from cal…
• DTake every other day to avoid overdose

A patient on warfarin reports she just started a course of trimethoprim-sulfamethoxazole for a urinary tract infection. What is the priority drug therapy problem?

• AThe antibiotic can potentiate warfarin and increase INR/bleeding risk, requiring closer I…
• BThe antibiotic will make warfarin ineffective
• CNo interaction exists between these drugs
• DWarfarin reduces the antibiotic's efficacy and the dose must be doubled

A 6-year-old child (weight 20 kg) is prescribed amoxicillin 45 mg/kg/day divided every 12 hours. What is the correct dose per administration?

• A225 mg twice daily
• B900 mg twice daily
• C112.5 mg twice daily
• D450 mg twice daily

A patient with osteoporosis is starting alendronate (an oral bisphosphonate). Which administration counselling is essential to ensure efficacy and prevent esophageal injury?

• ATake at bedtime lying down with a small sip of water
• BTake with milk to improve calcium absorption
• CTake with a full glass of water on an empty stomach, remain upright for at least 30 minut…
• DCrush the tablet and mix it into food

At an interactive station, a patient using a combination inhaled corticosteroid/long-acting beta-agonist asks why she keeps getting oral thrush. What is the BEST advice to reduce this adverse effect?

• AStop the inhaler permanently
• BRinse and spit with water after each use and use a spacer if appropriate
• CUse the inhaler twice as often
• DSwallow water immediately before each puff

A patient is prescribed apixaban for atrial fibrillation and asks how it differs from warfarin in terms of monitoring. What is the correct counselling?

• AApixaban requires more frequent INR testing than warfarin
• BApixaban has no bleeding risk
• CApixaban requires weekly vitamin K dosing
• DApixaban does not require routine INR monitoring, but adherence and renal function remain…

A patient presents a prescription for clarithromycin while already taking atorvastatin. Why does this combination warrant pharmacist intervention?

• AClarithromycin inhibits CYP3A4 and can raise atorvastatin levels, increasing myopathy risk
• BClarithromycin makes atorvastatin ineffective
• CThe two drugs cannot be taken in the same week ever
• DThere is no clinically relevant interaction

A patient with chronic kidney disease (eGFR 25 mL/min/1.73m2) is prescribed a new medication. As part of clinical assessment, which is the MOST appropriate pharmacist action?

• AAssess whether the drug is renally cleared and verify the dose is appropriate for the red…
• BAssume all doses are unaffected by kidney function
• CAutomatically refuse to dispense any drug for CKD patients
• DIncrease every dose to compensate for poor kidney function

At a station, a patient on long-term omeprazole asks about a risk you should proactively counsel on with prolonged proton pump inhibitor use. Which is a recognized long-term concern?

• AHyperkalemia
• BReduced absorption of vitamin B12 and magnesium with possible deficiency
• CPermanent loss of taste
• DIncreased INR

A patient with asthma is using their salbutamol reliever more than 4 times per week. What does this MOST likely indicate, and what is the appropriate pharmacist action?

• AExcellent control; no action needed
• BAn allergy to salbutamol; discontinue it
• CPoor asthma control; recommend assessment and likely addition or optimization of inhaled…
• DOveruse that requires switching to oral salbutamol

A patient with major depressive disorder started sertraline 5 days ago and reports feeling no better. What is the BEST counselling response?

• AThe drug has failed; stop it immediately
• BDouble the dose today to speed up the effect
• CAdd a second antidepressant now
• DAntidepressant benefit typically takes several weeks; continue as prescribed, monitor for…

A patient taking metformin is scheduled for a contrast-enhanced CT scan with iodinated contrast. What clinical guidance is MOST appropriate?

• ANo precaution is needed with metformin and contrast
• BPermanently stop metformin after any contrast study
• CAssess renal function and follow local protocol, which may involve temporarily holding me…
• DDouble the metformin dose before the scan

A patient presents with a prescription for prednisone and a separate prescription for an NSAID. What gastrointestinal concern should the pharmacist address?

• AThe combination prevents all ulcers
• BThere is no additive GI risk
• CThe combination causes hypoglycemia
• DThe combination increases risk of GI ulceration and bleeding

At a counselling station, a patient starting an SSRI asks about common early adverse effects. Which is the MOST accurate counselling?

• ANausea, headache, and gastrointestinal upset are common early and usually improve over th…
• BExpect immediate sedation and weight loss within hours
• CSSRIs have no side effects
• DSexual dysfunction never occurs with SSRIs

A patient with gout is prescribed allopurinol during an acute flare. What clinical issue should the pharmacist recognize?

• AAllopurinol should be the sole treatment of the acute flare
• BStarting allopurinol during an acute flare can worsen or prolong the flare; flare prophyl…
• CAllopurinol must be doubled during the flare
• DAllopurinol cures the flare within hours

A patient using a transdermal fentanyl patch for chronic pain asks about heat exposure. What is the correct safety counselling?

• AApply a heating pad over the patch to improve absorption
• BHeat has no effect on patch absorption
• CCut the patch in half to reduce the dose if it feels too strong
• DAvoid external heat sources (heating pads, hot baths, saunas) over the patch because heat…

A breastfeeding mother asks whether she can take an antihistamine for seasonal allergies. Which option is generally preferred while breastfeeding due to lower sedation transfer to the infant?

• AA first-generation sedating antihistamine such as diphenhydramine as first choice
• BNo antihistamine is ever compatible with breastfeeding
• CA second-generation non-sedating antihistamine such as loratadine or cetirizine
• DA topical nasal decongestant taken orally instead

At a station you must counsel a patient starting insulin glargine. Which statement about this insulin is correct?

• AIt is a long-acting basal insulin usually given once daily, providing relatively peakless…
• BIt is a rapid-acting insulin taken with each meal
• CIt should be mixed in the same syringe with regular insulin
• DIt is only used intravenously in hospital

A patient with hypertension and a history of gout is prescribed a thiazide diuretic. What clinical concern should the pharmacist raise?

• AThiazides cure gout
• BThiazides have no metabolic effects
• CThiazides lower potassium so much they always cause gout
• DThiazides can raise serum uric acid and may precipitate gout flares

A patient picks up nitrofurantoin for a urinary tract infection. Their chart shows an eGFR of 25 mL/min/1.73m2. What is the appropriate pharmacist action?

• ADispense without comment
• BRecognize that nitrofurantoin is generally avoided at low eGFR due to reduced efficacy an…
• CDouble the nitrofurantoin dose to overcome poor renal clearance
• DTell the patient to stop drinking fluids to concentrate the urine

A patient on digoxin presents with nausea, visual disturbances (yellow-green halos), and confusion. What should the pharmacist suspect and do?

• AReassure the patient these are normal digoxin effects
• BRecommend doubling the digoxin dose
• CSuspect digoxin toxicity and arrange urgent assessment including digoxin level and electr…
• DAdvise the symptoms are unrelated to any medication

A patient on lithium for bipolar disorder is starting a thiazide diuretic prescribed by another clinician. What is the priority drug therapy problem?

• AThiazides can reduce lithium clearance and raise lithium levels toward toxicity
• BThiazides have no effect on lithium
• CLithium increases the diuretic effect dangerously
• DThe combination causes hyperglycemia only

A patient with seasonal allergic rhinitis asks for the most effective single non-prescription therapy for nasal congestion and sneezing. Which is generally the most effective option for moderate persistent symptoms?

• AAn oral first-generation antihistamine at bedtime
• BAn oral decongestant for two weeks continuously
• CA topical nasal decongestant spray used daily for a month
• DAn intranasal corticosteroid used regularly

A patient on phenytoin for epilepsy reports gum overgrowth and asks if it is related to the medication. What is the BEST response?

• AStop phenytoin immediately without medical advice
• BIt is unrelated to any medication
• CGingival hyperplasia is a recognized phenytoin effect; advise good oral hygiene and discu…
• DDouble the phenytoin dose to fix the gums

A patient taking an MAO inhibitor asks about dietary precautions. Which counselling point is essential?

• AEat as much aged cheese as desired
• BAvoid tyramine-rich foods (e.g., aged cheeses, cured meats) to prevent a hypertensive cri…
• CAvoid all fruits and vegetables
• DThere are no dietary restrictions with MAO inhibitors

A patient with type 2 diabetes on an SGLT2 inhibitor should be counselled to watch for which characteristic adverse effect?

• ASevere weight gain
• BHyperkalemia as the most common effect
• CPermanent vision loss
• DGenital and urinary tract infections and risk of volume depletion

An elderly patient is taking multiple anticholinergic medications. Why is reducing the cumulative anticholinergic burden an important clinical-care goal in older adults?

• AHigh anticholinergic burden increases risk of confusion, falls, urinary retention, and co…
• BIt improves the taste of medications
• CIt has no clinical relevance
• DIt increases the QT interval which is desirable

At a non-interactive station you must verify a dispensed prescription before release. The label reads "Take 1 tablet daily" but the original order states "Take 1 tablet twice daily." What is the correct action?

• ACorrect the labeling error before release so it matches the original prescription
• BRelease the medication since the drug is correct
• CTell the patient to figure out the right frequency themselves
• DDiscard the entire prescription and start over without checking

Under Canada's Narcotic Control Regulations, which type of prescription is NOT permitted for a straight narcotic such as oral hydromorphone?

• AA written prescription signed by the prescriber
• BA verbal (telephoned) prescription
• CA prescription with the patient's name and address
• DA prescription specifying quantity and directions

When processing a new prescription, which is an essential element the pharmacist must confirm is present and valid before dispensing?

• AThe patient's favourite pharmacy brand
• BThe colour of the prescription pad
• CThe prescriber's identity/authority, the drug, strength, dose, quantity, and directions
• DThe patient's social media handle

A non-interactive station presents a compounded oral suspension that has separated and will not resuspend on shaking. What is the appropriate distribution decision?

• ARelease it; appearance does not matter
• BAdd water until it looks uniform and release it
• CTell the patient to drink only the clear top layer
• DDo not release the preparation; assess the quality issue and prepare a fresh, properly co…

A patient requests an early refill of a controlled substance, well before the expected run-out date based on the directions. What is the appropriate distribution response?

• ARefill it without question to keep the customer happy
• BReport the patient to police immediately without assessment
• CAssess the reason, check the dispensing history and directions, and address potential mis…
• DIncrease the quantity dispensed to reduce future early requests

While preparing a product for dispensing, you notice the manufacturer lot has been subject to a Health Canada recall. What is the correct distribution action?

• ADispense remaining stock quickly before anyone notices
• BRelabel it with a new lot number
• CIgnore the recall if the product looks fine
• DQuarantine the affected stock, do not dispense it, and follow the recall procedure