While the actual 2025 PTCB exam contains 90 questions in total (not 100), about 40% of the exam covers math-heavy topics such as Medication Order Entry and Fill Process. 

Below is a curated set of high-yield practice questions across the 14 essential math domains required for the 2025 exam. For a full 90-question simulation, use the Official PTCB Practice Tools or Mometrix PTCB Review. 

I. Conversions & Roman Numerals

1. Roman Numerals: What is the Arabic number for the Roman numeral MCDXVI?

   1. Answer: 1,416.

2. Weight Conversion: How many kilograms is a patient who weighs 154 lbs?

   1. Answer: 70 kg (154 ÷ 2.2 = 70).

3. Liquid Volume: How many milliliters are in 3 ounces?

   1. Answer: 88.7 mL or 90 mL (using 29.57 mL or 30 mL per oz). 

II. Dosage Calculations

4. Day Supply: A prescription reads: Amoxicillin 400mg/5mL; dispense 100mL; Sig: 1 tsp bid. What is the day supply?

   1. Answer: 10 days. (1 tsp = 5 mL; 5 mL × 2 times/day = 10 mL/day. 100 mL ÷ 10 mL/day = 10 days).

5. Quantity to Dispense: 1 tab po q6h x 7 days. How many tablets should be dispensed?

   1. Answer: 28 tablets (q6h = 4 times/day; 4 × 7 = 28).

6. Pediatric Weight-Based: A child weighs 44 lbs. The dose is 5 mg/kg. What is the correct dose?

   1. Answer: 100 mg (44 lbs = 20 kg; 20 kg × 5 mg = 100 mg). 

III. Concentrations & Dilutions

7. Percentage Strength: How many grams of dextrose are in 600 mL of a 20% solution?

   1. Answer: 120 g (20 g / 100 mL = x / 600 mL; x = 120).

8. Ratio Strength: Convert 0.4% to a ratio strength.

   1. Answer: 1:250 (0.4 / 100 = 1 / x; x = 250).

9. Dilution (C1V1): You have 500 mL of a 15% solution. If you dilute it to 5%, what is the final volume?

   1. Answer: 1,500 mL (15% × 500 mL = 5% × V2; V2 = 1,500 mL). 

IV. IV Flow Rates & Alligations

10. IV Flow Rate (gtt/min): Infuse 1,000 mL over 8 hours using tubing with a drop factor of 20 gtt/mL. What is the rate?

    1. Answer: ~42 gtt/min (1,000 mL × 20 gtt / 480 min = 41.66).

11. Infusion Rate (mL/hr): A patient receives 3L of TPN over 24 hours. What is the rate in mL/hr?

    1. Answer: 125 mL/hr (3,000 mL ÷ 24 hr).

12. Alligation: Mix 60% alcohol and 30% alcohol to get 50 mL of 50% alcohol. How much 60% is needed?

    1. Answer: 33.3 mL (Using alligation: 20 parts of 60% and 10 parts of 30% = 30 total parts. [20/30] × 50 = 33.3). 

V. Compounding & Specialized Math

13. BMI Calculation: What is the BMI of a patient weighing 164 lbs (74.4 kg) and 187 cm (1.87 m) tall?

    1. Answer: 21 (Formula: kg/m²).

14. BSA Calculation: A dose is 50 mg/m². How many mg for a patient with a BSA of 1.4 m²?

    1. Answer: 70 mg (50 × 1.4).

15. Powder Volume: If 10g of lidocaine is added to water to make 200mL, what is the final concentration?

    1. Answer: 5% w/v (10g / 200mL = 5g / 100mL). 

2025 Exam Math Requirements:

• Calculators: You cannot bring your own; a handheld or on-screen calculator is provided.

• Time Limit: 110 minutes for 90 questions (approx. 1.2 minutes per question).

• Focus Areas: Alligations, IV flow rates, and pediatric dosing remain the most frequent "difficult" items. 

In pharmacy practice and on the 2025 PTCB exam, math errors are frequent contributors to medication safety incidents. Most mistakes stem from mechanical errors in calculation or misinterpreting standard notations. 

1. Decimal Point Misplacement (The 10-Fold Error) 

One of the most dangerous and common errors involves misplaced decimals, which can result in a patient receiving 10 times the required dose (overdose) or one-tenth of it (underdose). 

• Trailing Zeros: Writing "5.0 mg" instead of "5 mg" is a major risk; if the decimal is missed, it can be misread as 50 mg.

• Leading Zeros: Always use a zero before a decimal (e.g., 0.5 mg, not .5 mg) to ensure the decimal point is noticed. 

2. Conversion and Unit Mismatches

Failing to convert between measurement systems or using mixed units in a single calculation often leads to incorrect results. 

• Weight Conversions: Confusing pounds (lbs) and kilograms (kg) is critical, as many doses are weight-based (mg/kg).

• Concentration Units: Forgetting to convert milligrams to grams when calculating ratio strengths (w/v) often causes errors, as w/v is standardly measured in grams per 100 mL. 

3. Dosing Schedule and Frequency Errors

Misinterpreting how a dose is distributed over time is a frequent clinical and exam error. 

• Total Daily Dose vs. Single Dose: Technicians may accidentally calculate the entire daily amount as a single dose (e.g., giving 1,200 mg at once instead of 400 mg three times daily).

• Duration Mismatches: Incorrectly calculating the day supply for liquid medications, especially when the dose is prescribed in teaspoons or tablespoons rather than milliliters. 

4. Ratio and Proportion Setup

When using the ratio and proportion method, mistakes often occur from setting up the equation incorrectly. 

• Upside-Down Ratios: Placing units in the wrong position (e.g., setting grams/mL equal to mL/grams) will yield a mathematically incorrect answer.

• Dimensional Analysis Failure: Not writing out and physically canceling units during complex calculations (like IV drip rates) increases the likelihood of multiplying when you should have divided. 

5. Factors Contributing to Errors

Beyond math skills, several environmental and psychological factors contribute to mistakes in both practice and exam settings for 2025: 

• Mathematical Anxiety and Pressure: Rushing due to time constraints or exam stress leads to multi-step errors.

• Reliance on Memory: Memorizing formulas instead of understanding the underlying method can lead to "blanking" during a test.

• Distractions: Interruptions in a busy pharmacy environment account for nearly three-quarters of real-world medication errors. 

Over the past month, the college has investigated several complaints involving registrants who have calculated and then dispensed an incorrect, and potentially dangerous, dose of ranitidine solution for infant patients. Pharmacists and pharmacy technicians are reminded to follow these tips for ensuring accurate calculations:

• Ensure calculations, especially unusual calculations, are consistently documented on the prescription or transaction record and checked by two members of the pharmacy team. If a pharmacist is working independently, have a second pharmacy staff member check the calculations at the earliest opportunity (such as the beginning of the next shift)
   

• As part of the prescription processing and assessment process, always circle (or otherwise clearly document) medication strengths on written prescriptions that contain a change in a patient’s previous dose.
   

• Be extra diligent in processing and dispensing “high-alert” drugs, such as prednisone, methotrexate, and warfarin. Not only can high-alert drugs cause significant harm to patients when used in error, but these drugs often require dosing calculations as part of the dispensing process. Pharmacists and pharmacy technicians should regularly review current high-alert drug listings from sources such as the Institute for Safe Medication Practices (see http://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp).
   

• Implement a warning system for stocked high-alert drugs within the pharmacy and audit the implementation of the warning system quarterly.
   

• When performing the final check on a prescription, including any required calculations, always check the original written prescription first, before reviewing the prepared prescription bottle or transaction record. (This checking includes never applying a signature to a       prescription transaction record until the pharmacist or pharmacy technician has verified the prepared prescription is 100 per cent current, complete, accurate, and appropriate.)
   

• Ensure that once a critical task has been started (e.g., making/verifying a calculation as part of a final check on a prescription), it is completed without interruption, or if an interruption cannot be avoided, ensure the critical task is repeated from the beginning.

• Specify the length of therapy ordered by the prescriber within the written instructions on the prescription label.
   

• Specify both the volume and quantity for the calculated dose of all liquid medications within the written instructions on the prescription label, (e.g., Take 5ml (125mg) three times daily for ten days).
   

• Review and implement the ACP’s Chat, Check and Chart (CCC) tools to assist in patient assessment, as an additional means of verifying the appropriateness of prescription calculations. By more consistently asking the three prime questions, pharmacists and pharmacy technicians can better verify the accuracy of any prescription calculations they are required to make.
   

• When dealing with a patient’s agent, confirm that the agent is aware of how the patient has been instructed to take the medication and can relate all information provided by the pharmacist back to the patient, such as confirming number of dosage units (e.g., tablets or capsules) to be taken and duration of therapy. If the patient’s agent cannot confirm or relate the necessary inform, contact the patient directly.

Pharmacy math for the 2025 PTCB exam focuses on accuracy in conversions, dosage calculations, and concentrations

. Below are representative sample questions based on common exam topics: 

1. Unit Conversions (Liquid Measure) 

Question: A patient is prescribed 2 teaspoons of a medication three times daily for 10 days. How many milliliters (mL) should be dispensed? 

• A. 100 mL

• B. 300 mL

• C. 150 mL

• D. 60 mL

• Answer: B. 300 mL.

• Explanation: 1 teaspoon (tsp) = 5 mL. The patient takes 2 tsp (10 mL) three times a day, which is 30 mL/day. Over 10 days:

• 30 mL×10=300 mL30 mL cross 10 equals 300 mL

• 30 mL×10=300 mL. 

2. Dosage Calculation (Weight-Based) 

Question: A pediatric patient weighs 44 lbs. The prescribed dosage is 20 mg/kg/day divided into two doses. How many mg should be given per dose? 

• A. 200 mg

• B. 400 mg

• C. 880 mg

• D. 440 mg

• Answer: A. 200 mg.

• Explanation: First, convert lbs to kg:

• 44 lbs÷2.2=20 kg44 lbs divided by 2.2 equals 20 kg

• 44 lbs÷2.2=20 kg. Total daily dose:

• 20 kg×20 mg/kg=400 mg/day20 kg cross 20 mg/kg equals 400 mg/day

• 20 kg×20 mg/kg=400 mg/day. Since it is divided into two doses:

• 400 mg÷2=200 mg/dose400 mg divided by 2 equals 200 mg/dose

• 400 mg÷2=200 mg/dose. 

3. IV Flow Rate 

Question: An IV infusion of 1,200 mL is to be administered over 8 hours. The drop factor is 10 drops/mL. What is the flow rate in drops per minute (gtt/min)? 

• A. 25 gtt/min

• B. 15 gtt/min

• C. 150 gtt/min

• D. 20 gtt/min

• Answer: A. 25 gtt/min.

• Explanation: Total time in minutes is

• 8 hours×60=480 minutes8 hours cross 60 equals 480 minutes

• 8 hours×60=480 minutes. Total drops is

• 1,200 mL×10 gtt/mL=12,000 drops1 comma 200 mL cross 10 gtt/mL equals 12 comma 000 drops

• 1,200 mL×10 gtt/mL=12,000 drops. Flow rate =

• 12,000 drops÷480 minutes=25 gtt/min12 comma 000 drops divided by 480 minutes equals 25 gtt/min

• 12,000 drops÷480 minutes=25 gtt/min. 

4. Percentage Strength/Concentration 

Question: How many grams of lidocaine powder are needed to prepare 240 mL of a 2% lidocaine solution? 

• A. 4.8 g

• B. 2.4 g

• C. 0.48 g

• D. 48 g

• Answer: A. 4.8 g.

• Explanation: A 2% solution means 2 g of drug per 100 mL. Set up a proportion:

• 2 g100 mL=x240 mLthe fraction with numerator 2 g and denominator 100 mL end-fraction equals the fraction with numerator x and denominator 240 mL end-fraction

• 2 g100 mL=𝑥240 mL. Solving for

• xx

• 𝑥:

• (2×240)÷100=4.8 gopen paren 2 cross 240 close paren divided by 100 equals 4.8 g

• (2×240)÷100=4.8 g. 

5. Alligation (Dilution) 

Question: How many mL of a 60% alcohol solution and a 30% alcohol solution are needed to prepare 50 mL of a 50% alcohol solution? 

• A. 25 mL of 60%, 25 mL of 30%

• B. 33.3 mL of 60%, 16.7 mL of 30%

• C. 20 mL of 60%, 30 mL of 30%

• D. 15 mL of 60%, 35 mL of 30%

• Answer: B. 33.3 mL of 60%, 16.7 mL of 30%.

• Explanation: Using the alligation method:

• 60−50=10 parts of 30%60 minus 50 equals 10 parts of 30%

• 60−50=10 parts of 30%;

• 50−30=20 parts of 60%50 minus 30 equals 20 parts of 60%

• 50−30=20 parts of 60%. Total parts =

• 10+20=3010 plus 20 equals 30

• 10+20=30. Volume of 60% =

• (2030)×50 mL=33.3 mLopen paren 20 over 30 end-fraction close paren cross 50 mL equals 33.3 mL

• (2030)×50 mL=33.3 mL. Volume of 30% =

• (1030)×50 mL=16.7 mLopen paren 10 over 30 end-fraction close paren cross 50 mL equals 16.7 mL

• (1030)×50 mL=16.7 mL. 

Quick Tips for 2025 Exam: 

• Calculate with a Tool: You will be provided with a basic handheld calculator; do not bring your own.

• Memorize Key Constants: 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 oz = 30 mL (approx.), 1 kg = 2.2 lbs.

• Check Official Resources: Use the Official PTCB Practice Tools for the most accurate simulation of the 2025 exam environment. 

1. Which of the following medications is classified as an ACE inhibitor?

• A. Metoprolol

• B. Lisinopril

• C. Amlodipine

D. Atorvastatin

Correct answer: B

• Explanation: Lisinopril is an ACE inhibitor used for hypertension.

2. Which DEA form is used to order Schedule II controlled substances?

• A. DEA Form 41

• B. DEA Form 106

• C. DEA Form 222

D. DEA Form 224

Correct answer: C

• Explanation: DEA Form 222 is required for ordering C‑II medications.

3. A prescription reads: Amoxicillin 250 mg PO TID x 10 days. How many capsules are needed?

• A. 20

• B. 30

• C. 40

D. 60

Correct answer: B

• Explanation: TID × 10 days = 30 doses.

4. Which of the following is a high‑alert medication?

• A. Ibuprofen

• B. Warfarin

• C. Loratadine

D. Metformin

Correct answer: B

• Explanation: Warfarin has a narrow therapeutic index and high risk of harm.

5. Which storage condition means a medication must be kept between 2°C and 8°C?

• A. Room temperature

• B. Cool

• C. Refrigerated

D. Frozen

Correct answer: C

• Explanation: Refrigerated medications are stored at 2–8°C.

6. What is the generic name for Zoloft?

• A. Fluoxetine

• B. Sertraline

• C. Paroxetine

D. Citalopram

Correct answer: B

• Explanation: Zoloft is the brand name for sertraline.

7. A patient is allergic to sulfa drugs. Which medication should be avoided?

• A. Hydrochlorothiazide

• B. Lisinopril

• C. Levothyroxine

D. Simvastatin

Correct answer: A

• Explanation: HCTZ contains a sulfonamide group.

8. Which of the following tasks may a pharmacy technician legally perform?

• A. Counsel a patient

• B. Recommend OTC therapy

• C. Transfer a prescription

D. Prepare unit‑dose packaging

Correct answer: D

• Explanation: Technicians may prepare medications but cannot counsel or recommend therapy.

9. What is the beyond‑use date for a reconstituted antibiotic suspension unless otherwise specified?

• A. 7 days

• B. 10 days

• C. 14 days

D. 30 days

Correct answer: C

• Explanation: Most reconstituted suspensions expire in 14 days refrigerated.

10. A prescription label must include which of the following?

• A. Patient’s insurance ID

• B. Prescriber’s DEA number

• C. Pharmacy phone number

D. Patient’s date of birth

Correct answer: C

• Explanation: Federal law requires pharmacy contact information on labels.

Sample Questions

1. A patient presents a prescription for Zocor. Which of the following is the generic name for this medication?

   • A) Atorvastatin

   • B) Simvastatin

   • C) Rosuvastatin

   • D) Pravastatin

   • Correct Answer: B (Simvastatin)

2. To which pharmacological classification does the medication Lisinopril belong?

   • A) Beta-Blocker

   • B) Calcium Channel Blocker

   • C) ACE Inhibitor

   • D) Thiazide Diuretic

   • Correct Answer: C (ACE Inhibitor)

3. What is the brand name for the generic medication Alprazolam?

   • A) Ativan

   • B) Valium

   • C) Klonopin

   • D) Xanax

   • Correct Answer: D (Xanax)

4. Which of the following medications is classified as a Proton-Pump Inhibitor (PPI)?

   • A) Omeprazole

   • B) Ranitidine

   • C) Famotidine

   • D) Metoclopramide

   • Correct Answer: A (Omeprazole / Brand: Prilosec)

5. A technician is pulling a medication for a prescription written for Tenormin. Which generic stock bottle should they select?

   • A) Metoprolol

   • B) Atenolol

   • C) Propranolol

   • D) Carvedilol

   • Correct Answer: B (Atenolol) 

Common Medication Study List (2025)

Generic Name 

Brand Name(s)

Classification

Atorvastatin

Lipitor

Statin (HMG-CoA Reductase Inhibitor)

Amoxicillin

Amoxil

Antibacterial (Penicillin)

Furosemide

Lasix

Loop Diuretic

Fluoxetine

Prozac

SSRI (Antidepressant)

Metformin

Glucophage

Oral Antidiabetic

Levothyroxine

Synthroid

Thyroid Hormone

Donepezil

Aricept

Acetylcholinesterase Inhibitor

Pantoprazole

Protonix

Proton-Pump Inhibitor

Sample PTCE Questions

1. A patient presents two new prescriptions: one for Cozaar and one for Diovan. Why should the pharmacy technician alert the pharmacist?

   • A) Possible drug-food interaction

   • B) Therapeutic duplication

   • C) Contraindicated for hypertension

   • D) Incorrect route of administration

   • Correct Answer: B (Both are ARBs—Angiotensin II Receptor Blockers)

2. Which of the following medication pairs represents a therapeutic duplication?

   • A) Lisinopril and Hydrochlorothiazide

   • B) Amoxicillin and Ibuprofen

   • C) Prilosec and Prevacid

   • D) Metoprolol and Warfarin

   • Correct Answer: C (Both are Proton-Pump Inhibitors)

3. A physician prescribes Glyburide for a patient who is already taking Chlorpropamide. What is the correct action for the technician?

   • A) Fill the prescription as written

   • B) Ask the patient which one they prefer

   • C) Notify the pharmacist about the duplication of therapy

   • D) Process the claim through insurance first

   • Correct Answer: C (Both are Sulfonylureas used for diabetes) 

Common Duplication Examples to Study

Drug Class 

Example Duplication Pairs

Beta-Blockers

Toprol XL (metoprolol) and Tenormin (atenolol)

PPIs

Prilosec (omeprazole) and Prevacid (lansoprazole)

NSAIDs

Ibuprofen and Naproxen (Anaprox DS)

Diabetes

GLP-1 receptor agonists and DPP-4 inhibitors

1. Which of the following medication pairs represents a life-threatening drug-drug interaction that can lead to severe hypotension?

   • A) Lisinopril and Hydrochlorothiazide

   • B) Sildenafil (Viagra) and Nitroglycerin

   • C) Amoxicillin and Ibuprofen

   • D) Metformin and Simvastatin

   • Correct Answer: B (Nitrates combined with PDE5 inhibitors cause severe, dangerous drops in blood pressure).

2. A patient taking Simvastatin should be advised to avoid which of the following to prevent an increased risk of muscle toxicity (rhabdomyolysis)?

   • A) Leafy green vegetables

   • B) Dairy products

   • C) Grapefruit juice

   • D) Multivitamins

   • Correct Answer: C (Grapefruit juice inhibits enzymes needed to metabolize many statins, leading to toxic levels).

3. Which of these is a significant drug-disease contraindication?

   • A) Beta-blockers in patients with asthma

   • B) Acetaminophen in patients with hypertension

   • C) Amoxicillin in patients with diabetes

   • D) Ibuprofen in patients with high cholesterol

   • Correct Answer: A (Beta-blockers can cause airway constriction/bronchospasm in asthmatic patients).

4. A patient is prescribed Tetracycline. Which dietary instruction is most important to ensure the drug's effectiveness?

   • A) Take with a high-fat meal

   • B) Avoid dairy products and antacids near dosing time

   • C) Increase intake of vitamin K

   • D) Take with a glass of orange juice

   • Correct Answer: B (Calcium, magnesium, and aluminum bind to tetracyclines and prevent absorption).

5. Taking Warfarin (Coumadin) with Aspirin or NSAIDs is considered a major interaction because it increases the risk of:

   • A) Kidney failure

   • B) Liver toxicity

   • C) Excessive bleeding

   • D) High blood pressure

   • Correct Answer: C (Both classes affect blood clotting/platelet function, leading to additive bleeding risks). 

High-Priority Interactions to Study (2025)

Interaction Type 

Interaction Pair

Potential Risk

Drug-Drug

Warfarin + NSAIDs

Severe Bleeding

Drug-Nutrient

ACE Inhibitors + Potassium

Hyperkalemia (High Potassium)

Drug-Supplement

St. John’s Wort + Birth Control

Reduced efficacy (Pregnancy risk)

Drug-Food

MAOIs + Tyramine (Aged cheese/wine)

Hypertensive Crisis

Drug-Disease

Pseudoephedrine + Hypertension

Severely high blood pressure

Drug-Lab

Cephalosporins + Urine Tests

False glucose/ketone results

For additional prep, the PTCB Official Practice Tools provide retired exam questions

1. Which route of administration provides the most rapid onset of action in an emergency?

   • A) Oral (PO)

   • B) Subcutaneous (SubQ)

   • C) Intravenous (IV)

   • D) Transdermal

   • Correct Answer: C (IV medications enter the bloodstream directly, bypassing absorption barriers)

2. A prescription for Timoptic (timolol) is written as "2 gtts os bid." Where should the patient apply the medication?

   • A) Right eye

   • B) Left eye

   • C) Both eyes

   • D) Both ears

   • Correct Answer: B (OS stands for oculus sinister, or left eye)

3. Which of the following dosage forms should be labeled with a "Shake Well" auxiliary label?

   • A) Elixir

   • B) Solution

   • C) Suspension

   • D) Syrup

   • Correct Answer: C (Suspensions contain undissolved particles that settle over time)

4. How should a patient be instructed to take a Nitroglycerin sublingual tablet?

   • A) Swallow with a full glass of water

   • B) Chew thoroughly before swallowing

   • C) Place under the tongue and let it dissolve

   • D) Dissolve in a small amount of juice

   • Correct Answer: C (Sublingual tablets are absorbed through the mucosal tissue under the tongue)

5. Which medication requires special handling and should not be handled by a pharmacy technician who is pregnant?

   • A) Amoxicillin

   • B) Finasteride

   • C) Lisinopril

   • D) Metformin

   • Correct Answer: B (Finasteride is a Category X drug that can be absorbed through the skin and cause birth defects)

6. A physician prescribes Ceclor 375 mg PO BID for 10 days. If the pharmacy only has 250 mg/5 mL suspension, how many milliliters are needed for the full duration of therapy?

   • A) 75 mL

   • B) 100 mL

   • C) 150 mL

   • D) 200 mL

   • Correct Answer: C (375 mg = 7.5 mL per dose. 7.5 mL x 2 doses/day x 10 days = 150 mL) 

Common Administration Terms to Study (2025)

Term / Abbreviation 

Meaning

Notes

Enteric-coated

Dissolves in the intestine

Do not crush; protects the stomach

Parenteral

Injection routes

Includes IV, IM, and SubQ (bypasses the GI tract)

Topical

Applied to skin/mucosa

Creams, ointments, and patches

Refrigeration

2°C to 8°C (36°F to 46°F)

Critical for most insulins and some reconstituted antibiotics

Room Temperature

15°C to 30°C (59°F to 86°F)

Standard storage for most solid dosage forms

1. Which side effect is most uniquely associated with ACE inhibitors like Lisinopril?

   • A) Photosensitivity

   • B) Persistent, dry cough

   • C) Yellowing of the skin

   • D) Weight gain

   • Correct Answer: B (Dry cough is a hallmark side effect due to bradykinin accumulation)

2. A patient taking a statin medication (e.g., Atorvastatin) reports unexplained muscle pain and tea-colored urine. This is a sign of which severe adverse effect?

   • A) Lactic acidosis

   • B) Hypokalemia

   • C) Rhabdomyolysis

   • D) Serotonin syndrome

   • Correct Answer: C (Rhabdomyolysis is a life-threatening breakdown of muscle tissue)

3. Which of the following symptoms would indicate a patient is experiencing anaphylaxis rather than a mild side effect?

   • A) Drowsiness and dry mouth

   • B) Nausea and mild headache

   • C) Swelling of the tongue and difficulty breathing

   • D) Constipation and dizziness

   • Correct Answer: C (Anaphylaxis is a severe, systemic allergic reaction requiring emergency care)

4. "Red man syndrome" is a severe infusion-related reaction most commonly associated with which antibiotic?

   • A) Amoxicillin

   • B) Vancomycin

   • C) Clindamycin

   • D) Ciprofloxacin

   • Correct Answer: B (Rapid infusion of Vancomycin causes a histamine release leading to a bright red rash on the upper body)

5. Which medication class is frequently associated with extrapyramidal side effects (EPS), such as involuntary muscle movements?

   • A) Antipsychotics

   • B) Beta-blockers

   • C) Statins

   • D) Anticoagulants

   • Correct Answer: A (Antipsychotics can cause movement disorders like tardive dyskinesia) 

Common Medication Effects to Know

Drug / Class 

Common Side Effect

Severe / Adverse Effect

Opioids

Constipation, drowsiness

Respiratory depression

NSAIDs

Stomach upset, heartburn

Gastrointestinal bleeding/ulcers

Tetracyclines

Photosensitivity

Fetal development harm (tooth/bone)

Metformin

Metallic taste, diarrhea

Lactic acidosis

Warfarin

Easy bruising

Excessive/uncontrolled bleeding

Anticholinergics

Dry mouth, blurred vision

Inability to urinate, confusion

In 2025, the PTCB exam domain 1.6 focuses on the clinical indications (primary uses) of medications and dietary supplements. Questions in this category often require matching a brand or generic drug name to the condition it is intended to treat. 

Sample PTCE Questions (2025)

1. Metformin is primarily indicated for the treatment of which condition?

   • A) Chronic insomnia

   • B) Type 2 diabetes

   • C) Hypertension

   • D) Bacterial infection

   • Correct Answer: B (Metformin is an oral antidiabetic drug used for type 2 diabetes management)

2. A patient presents a prescription for Albuterol. What is the primary indication for this medication?

   • A) Pain relief

   • B) Blood pressure reduction

   • C) Asthma symptom control

   • D) High cholesterol

   • Correct Answer: C (Albuterol is a bronchodilator used to treat/prevent bronchospasm in asthma)

3. The medication Eszopiclone (Lunesta) is indicated for which of the following?

   • A) ADHD

   • B) Insomnia

   • C) Depression

   • D) Anxiety

   • Correct Answer: B (Eszopiclone is a hypnotic "Z-drug" used to manage insomnia)

4. Which of these medications is indicated for the treatment of allergies?

   • A) Evista

   • B) Xyzal

   • C) Strattera

   • D) Travatan

   • Correct Answer: B (Xyzal—levocetirizine—is an antihistamine for allergy relief)

5. A patient is prescribed Mirabegron. This medication is used in the treatment of:

   • A) Kidney stones

   • B) Urinary tract infections

   • C) Overactive bladder

   • D) Gallstones

   • Correct Answer: C (Mirabegron is indicated specifically for overactive bladder symptoms) 

Common Drug Indications to Study (2025)

Medication (Brand/Generic) 

Primary Indication

Atorvastatin (Lipitor)

High cholesterol (Hyperlipidemia)

Lisinopril (Zestril/Prinivil)

High blood pressure (Hypertension)

Alprazolam (Xanax)

Anxiety and panic disorders

Omeprazole (Prilosec)

GERD / Gastric acid reduction

Gabapentin (Neurontin)

Neuropathic pain and seizures

Levothyroxine (Synthroid)

Hypothyroidism (Thyroid hormone deficiency)

Methylphenidate (Concerta)

Attention Deficit Hyperactivity Disorder (ADHD)

Warfarin (Coumadin)

Prevention of blood clots (Anticoagulant)

In 2025, the PTCB exam domain 1.7 focuses on how environmental factors like temperature, light, and moisture affect medication potency and safety. 

Sample PTCE Questions (2025)

1. Which of the following is the standard refrigeration temperature range for storing medications like insulin or reconstituted vaccines?

   • A) -13°F to 14°F (-25°C to -10°C)

   • B) 36°F to 46°F (2°C to 8°C)

   • C) 59°F to 86°F (15°C to 30°C)

   • D) 86°F to 104°F (30°C to 40°C)

   • Correct Answer: B (36°F to 46°F is the USP standard for refrigeration)

2. How long is a vial of Humulin N (insulin) typically stable at room temperature after its first use?

   • A) 7 days

   • B) 14 days

   • C) 28 days

   • D) 60 days

   • Correct Answer: C (Most insulin vials are stable for 28 days at room temperature once opened)

3. A technician reconstitutes an Augmentin (amoxicillin/clavulanate) oral suspension. What is the correct storage instruction and duration for this medication?

   • A) Store at room temperature; discard after 7 days

   • B) Store in the refrigerator; discard after 10 days

   • C) Store at room temperature; discard after 14 days

   • D) Store in the refrigerator; discard after 14 days

   • Correct Answer: B (Augmentin specifically requires refrigeration and is stable for 10 days)

4. Which of these visual signs indicates a loss of stability in a parenteral (injectable) solution?

   • A) A change in the liquid's color to a slightly darker amber

   • B) The presence of small, white precipitates or cloudiness

   • C) The solution remains clear after shaking

   • D) Condensation on the outside of the vial

   • Correct Answer: B (Precipitation or cloudiness in a clear injectable indicates a chemical change or contamination)

5. Most live vaccines, such as MMR, must be protected from light and stored in which manner?

   • A) Frozen at -50°C

   • B) Refrigerated immediately and kept in original packaging

   • C) Kept on the counter for no more than 48 hours

   • D) Stored in a glass container only

   • Correct Answer: B (Vaccines are light-sensitive and temperature-fragile, requiring immediate refrigeration) 

Key Stability Facts to Study (2025)

Medication Type 

Typical Storage/Stability Rule

Amoxicillin Suspension

Refrigeration preferred; stable for 14 days.

Nitroglycerin SL

Must stay in original amber glass bottle; sensitive to light/moisture.

Pradaxa (Dabigatran)

Must remain in original blister pack to prevent degradation by moisture.

Zostavax / Shingrix

Shingrix (refrigerate); Zostavax (freeze—note: Zostavax is largely discontinued in US but still a common exam topic).

Expired Tetracycline

Becomes toxic (can cause Fanconi syndrome) rather than just losing potency.

For 2025, ensure you are familiar with the USP <795> and <797> guidelines for non-sterile and sterile beyond-use dating.

In 2025, the PTCB exam focus area 1.8 covers the critical environmental and security requirements for maintaining medication integrity and legal compliance.

Sample PTCE Questions (2025)

1. According to USP standards, which temperature range is defined as "Controlled Room Temperature"?

   • A) 36°F to 46°F (2°C to 8°C)

   • B) 59°F to 86°F (15°C to 30°C)

   • C) 68°F to 77°F (20°C to 25°C)

   • D) 86°F to 104°F (30°C to 40°C)

   • Correct Answer: C (68°F to 77°F is the preferred range, though excursions between 59°F and 86°F are often permitted).

2. Which of the following medications must be stored in its original, amber glass bottle to protect it from light and moisture?

   • A) Amoxicillin

   • B) Nitroglycerin sublingual tablets

   • C) Lisinopril

   • D) Metformin

   • Correct Answer: B (Nitroglycerin is highly unstable and will lose potency if transferred to standard plastic prescription vials).

3. A pharmacy receives a shipment of Shingrix (Zoster vaccine). At what temperature must this vaccine be stored?

   • A) Frozen at -58°F to 5°F (-50°C to -15°C)

   • B) Refrigerated at 36°F to 46°F (2°C to 8°C)

   • C) Room temperature at 68°F to 77°F (20°C to 25°C)

   • D) Cool storage at 46°F to 59°F (8°C to 15°C)

   • Correct Answer: B (Unlike the older Zostavax, Shingrix must be refrigerated, not frozen).

4. What is the federal requirement for the storage of Schedule II (C-II) controlled substances in a retail pharmacy?

   • A) They must be kept on the open shelf with non-controlled drugs.

   • B) They must be stored in a locked safe or dispersed throughout non-controlled stock.

   • C) They must be stored in the refrigerator regardless of stability.

   • D) They can be kept in a drawer as long as the pharmacy door is locked.

   • Correct Answer: B (Federal law allows C-IIs to be either securely locked in a cabinet/safe or dispersed throughout the pharmacy to deter theft). 

Storage Summary Table (2025)

Storage Condition

Fahrenheit (F)

Celsius (C)

Examples

Freezer

-13°F to 14°F

-25°C to -10°C

Varicella vaccine, MMRV

Refrigerated

36°F to 46°F

2°C to 8°C

Insulin (unopened), most vaccines, NuvaRing

Room Temp

68°F to 77°F

20°C to 25°C

Most tablets/capsules (e.g., Lisinopril, Lipitor)

Light Sensitive

N/A

N/A

Nitroglycerin, Nitroprusside, Levothyroxine

Moisture Sensitive

N/A

N/A

Pradaxa (must stay in original blister)

For further study, review the USP <659> Packaging and Storage Requirements which defines these legal standards for 2025.

In 2025, the PTCE emphasizes Federal requirements from the EPA and OSHA for managing pharmacy waste. Domain 2.1 focuses on identifying, segregating, and disposing of substances according to Resource Conservation and Recovery Act (RCRA) standards. 

Sample PTCE Questions (2025)

1. Which of the following medications is classified as a "P-list" acutely hazardous waste by the EPA?

   • A) Amoxicillin

   • B) Warfarin

   • C) Lisinopril

   • D) Ibuprofen

   • Correct Answer: B (Warfarin—specifically at concentrations > 0.3%—and nicotine are primary examples of P-listed waste).

2. Where should trace chemotherapy waste, such as an empty IV bag that contained a hazardous drug, be disposed of?

   • A) Standard trash container

   • B) Red biohazard sharps container

   • C) Yellow chemotherapy waste container

   • D) Black hazardous waste bin

   • Correct Answer: C (Trace waste—containing <3% of the original quantity—goes into yellow bins for incineration).

3. According to federal regulations, healthcare facilities are strictly prohibited from disposing of hazardous waste pharmaceuticals by which method?

   • A) Incineration

   • B) Reverse distribution

   • C) Flushing down a sewer system (sewering)

   • D) Placing in a leakproof hazardous waste container

   • Correct Answer: C (EPA regulations prohibit flushing hazardous waste pharmaceuticals down the drain or toilet).

4. A pharmacy technician is handling a spilled hazardous substance. Which resource provides the most specific instructions for cleanup and required Personal Protective Equipment (PPE)?

   • A) The Orange Book

   • B) Safety Data Sheets (SDS)

   • C) The Merck Index

   • D) Pharmacy policy manual

   • Correct Answer: B (SDS contain essential handling, storage, and spill response data for hazardous chemicals). 

Key Waste Classifications to Study (2025)

Waste Type 

Disposal Requirement

Key Examples

Non-Hazardous

Trash or incineration; not RCRA-regulated.

Antibiotics, hormones, over-the-counter meds.

Hazardous (P-list)

Segregated, leakproof, labeled "Hazardous Waste."

Warfarin, Nicotine, Epinephrine.

Hazardous (U-list)

Toxic, flammable, or reactive waste.

Chloral hydrate, Cyclophosphamide.

Sharps

Puncture-resistant, leakproof container.

Used needles, syringes, glass ampules.

Important 2025 Updates

• P-List Exemption: As of recent EPA updates, empty warfarin stock bottles and unit-dose containers are no longer considered P-listed hazardous waste and may be disposed of in regular trash if emptied by standard practices.

• NIOSH List: The PTCE exam will be updated in March 2025 to reflect the 2024 NIOSH List of hazardous drugs. 

In 2025, the PTCB exam emphasizes current DEA regulations, specifically the 2023 update allowing electronic transfers for all controlled schedules (II-V) for initial filling and the extension of telemedicine flexibilities through December 31, 2025. 

Sample PTCE Questions (2025)

1. A patient requests to transfer an electronic prescription for Vyvanse (C-II) that has never been filled from Pharmacy A to Pharmacy B due to a stock shortage. According to federal law, which is true?

   • A) C-II prescriptions can never be transferred.

   • B) It can be transferred once electronically if the pharmacies share a real-time database.

   • C) It can be transferred once electronically between any two DEA-registered pharmacies if allowed by state law.

   • D) It can be transferred an unlimited number of times as long as it's the initial fill.

   • Correct Answer: C (Per the 2023 DEA rule, electronic prescriptions for Schedules II-V may be transferred once for the initial fill).

2. How many refills are permitted on a prescription for a Schedule III or IV controlled substance?

   • A) Zero; they must be written as a new prescription every time.

   • B) A maximum of 5 refills within 6 months of the date issued.

   • C) Up to 11 refills within 12 months.

   • D) Unlimited refills for 6 months.

   • Correct Answer: B (Federal Law limits C-III and C-IV to 5 refills within 6 months).

3. Which of the following is a mandatory requirement for transferring a controlled substance prescription between pharmacies?

   • A) The transfer must be performed by a certified pharmacy technician.

   • B) The original prescription must be kept on file for at least 10 years.

   • C) The transfer must be communicated directly between two licensed pharmacists.

   • D) The patient must provide written consent to the DEA before the transfer.

   • Correct Answer: C (Federal law requires transfers of controlled substances to occur directly between pharmacists).

4. A prescription for Xanax (C-IV) was issued on January 1, 2025. What is the latest date this prescription can be refilled?

   • A) January 1, 2026

   • B) July 1, 2025

   • C) June 1, 2025

   • D) December 31, 2025

   • Correct Answer: B (C-IV prescriptions expire 6 months from the date of issue). 

DEA Schedules & Refill Summary (2025)

Schedule 

Potential for Abuse

Refill Policy

Transfer Policy

I

Highest (No medical use)

N/A

N/A

II

High

Zero refills permitted

One-time transfer for initial fill only (electronic only)

III & IV

Moderate to Low

Max 5 refills in 6 months

One-time transfer (unless pharmacies share a real-time database)

V

Lowest

As authorized by prescriber (varies by state)

One-time transfer for initial fill or refills

Critical 2025 Practice Note

• Telemedicine: Under the Third Temporary Rule, practitioners can continue prescribing Schedules II-V via telemedicine without a prior in-person visit through December 31, 2025.

• Recordkeeping: Both the transferring and receiving pharmacy must maintain records of controlled substance transfers for at least two years. 

In 2025, the PTCB exam covers strict DEA and federal regulations regarding the lifecycle of a controlled substance, from ordering via CSOS to documentation of theft via DEA Form 106.

Sample PTCE Questions (2025)

1. When a pharmacy receives a shipment of Schedule II (C-II) controlled substances, what must the pharmacist record on the copy of the DEA Form 222?

   • A) The initials of the technician who opened the box

   • B) The actual number of packages received and the date received

   • C) The patient names assigned to each bottle

   • D) The expiration dates of every bottle in the shipment

   • Correct Answer: B (DEA regulations require the number of packages and date received to be recorded on Copy 3 or the electronic equivalent).

2. Upon discovering a "significant loss" of Oxycodone (C-II) tablets due to suspected internal theft, which DEA form must the pharmacy submit?

   • A) DEA Form 41

   • B) DEA Form 222

   • C) DEA Form 106

   • D) DEA Form 224

   • Correct Answer: C (DEA Form 106 is used to report significant loss or theft of controlled substances).

3. Which federal program allows patients to safely dispose of their unused or expired controlled substances at a pharmacy?

   • A) REED Act Disposal

   • B) DEA National Take-Back Initiative

   • C) FDA MedWatch Program

   • D) REMS Disposal Program

   • Correct Answer: B (The DEA National Take-Back Initiative and authorized collectors facilitate safe medication disposal).

4. A pharmacy technician is preparing to destroy expired Schedule II medications on-site. Which form must be completed and submitted to the DEA to document this destruction?

   • A) DEA Form 106

   • B) DEA Form 224

   • C) DEA Form 41

   • Correct Answer: C (DEA Form 41 is the "Registrants Inventory of Drugs Surrendered," used for the destruction of controlled substances).

5. What is the legal requirement for the "Caution" label on a dispensed controlled substance?

   • A) It must state "Store in a cool, dry place"

   • B) It must state "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed"

   • C) It must be printed in red ink

   • D) It is only required for Schedule II drugs

   • Correct Answer: B (This federal transfer warning is mandatory for all Schedule II, III, and IV prescriptions).

Key Controlled Substance Procedures (2025)

Action

Form / Requirement

Note

Ordering C-II

DEA Form 222 or CSOS

CSOS is the electronic equivalent.

Theft/Significant Loss

DEA Form 106

Notify DEA and local police immediately.

Destruction

DEA Form 41

Often handled by a Reverse Distributor.

Inventory (Annual/Biennial)

Manual count for C-II

C-III through C-V can be estimated if bottle < 1000.

Take-Back

Authorized Collection Bin

Technicians cannot handle the returned drugs directly.

Important 2025 Practice Note

• Electronic Records: While paper records are still common, the DEA's Controlled Substance Ordering System (CSOS) is now the primary method for high-volume pharmacies to order C-II through C-V substances digitally.

• Records Retention: Federal law requires all controlled substance records (invoices, forms, prescriptions) be kept for at least two years.

In 2025, the PTCB exam focus area 2.4 covers the legal restrictions on high-risk medications and the operational requirements for federal programs like the Combat Methamphetamine Epidemic Act (CMEA) and Risk Evaluation and Mitigation Strategies (REMS).

Sample PTCE Questions (2025)

1. Under the Combat Methamphetamine Epidemic Act (CMEA), what is the maximum amount of pseudoephedrine a customer can purchase in a single day?

   • A) 3.6 grams

   • B) 7.5 grams

   • C) 9 grams

   • D) 15 grams

   • Correct Answer: A (The daily limit is 3.6g; the 30-day mail-order limit is 7.5g; the 30-day retail limit is 9g).

2. Which REMS program requires both the prescriber and the patient to be enrolled to prevent severe birth defects?

   • A) iPLEDGE (Isotretinoin)

   • B) Clozapine REMS

   • C) TIRF (Transmucosal Immediate-Release Fentanyl)

   • D) THALOMID REMS

   • Correct Answer: A (iPLEDGE is the mandatory program for isotretinoin—formerly Accutane—to prevent fetal exposure).

3. A pharmacy technician is dispensing Clozapine. Which laboratory value must be verified in the REMS system before the medication can be released?

   • A) Hemoglobin A1c

   • B) Serum Creatinine

   • C) Absolute Neutrophil Count (ANC)

   • D) Potassium Level

   • Correct Answer: C (Clozapine carries a risk of severe neutropenia; the Clozapine REMS requires a current ANC).

4. According to federal law, which of the following is a requirement for the sale of pseudoephedrine?

   • A) The patient must have a valid prescription.

   • B) The product must be stored behind the counter or in a locked cabinet.

   • C) The pharmacy must keep the logbook for 1 year.

   • Correct Answer: B (CMEA requires restricted access and the logbook must be kept for 2 years).

Key REMS Programs to Study (2025)

Medication

REMS Program Name

Primary Goal / Requirement

Isotretinoin

iPLEDGE

Prevent pregnancy; requires monthly pregnancy tests.

Clozapine

Clozapine REMS

Monitor ANC to prevent severe neutropenia (infection risk).

Thalidomide

THALOMID REMS

Prevent severe birth defects (Phocomelia).

Buprenorphine

BTOD REMS

Mitigate risk of accidental overdose and addiction.

Adasuve

ADASUVE REMS

Mitigate risk of bronchospasm (only for hospital use).

Pseudoephedrine Sales Limits (2025)

For 2025, ensure you are using the federal limits unless your specific state has stricter laws (some states require a prescription for all pseudoephedrine):

• Daily: 3.6 grams per purchaser.

• 30-Day (Retail): 9 grams per purchaser.

• 30-Day (Mail-Order): 7.5 grams per purchaser.

• Logbook: Must record name, address, date/time, and signature. ID verification is mandatory.

For official updates on REMS, visit the FDA REMS Directory.

In 2025, the PTCB exam tests your ability to prioritize actions during a medication recall based on the FDA’s three-tier classification system. As of 2025, technicians must know that the primary responsibility is identifying the affected lot numbers and removing them from active inventory. 

Sample PTCE Questions (2025)

1. An FDA Class I recall has been issued for a specific lot of insulin. What does this classification signify?

   • A) The product is unlikely to cause adverse health consequences.

   • B) Use of the product may cause temporary or medically reversible health problems.

   • C) There is a reasonable probability that use of the product will cause serious adverse health consequences or death.

   • D) The product has a labeling error that does not affect the medication's safety.

   • Correct Answer: C (Class I is the most urgent and dangerous category).

2. A pharmacy receives a Class II recall notice for a bottle of Lisinopril. What is the first step the pharmacy technician should take?

   • A) Call every patient who has ever taken Lisinopril.

   • B) Check the inventory for the specific lot number(s) listed in the recall.

   • C) Immediately throw the bottles in the regular trash.

   • D) Contact the FDA to report the pharmacy's stock levels.

   • Correct Answer: B (Recalls are lot-specific; only affected lots must be pulled and quarantined).

3. Which type of recall is issued when a product is not likely to cause adverse health consequences, such as a minor container defect?

   • A) Class I

   • B) Class II

   • C) Class III

   • D) Market Withdrawal

   • Correct Answer: C (Class III recalls are for products unlikely to cause harm).

4. Who is responsible for notifying the pharmacy about a drug recall in 2025?

   • A) The patient

   • B) The manufacturer or the FDA

   • C) The local police department

   • D) The DEA

   • Correct Answer: B (The manufacturer usually initiates the recall and notifies wholesalers and pharmacies). 

FDA Recall Classification Table (2025)

Recall Class 

Risk Level

Example Scenario

Class I

High Risk

Label mix-up on a life-saving drug or contamination with a toxin.

Class II

Moderate Risk

Presence of a particle in a vial that may cause temporary illness.

Class III

Low Risk

Off-color tablets or strange odor where no health threat is expected.

Operational Requirements

• Quarantine: Once a recalled item is identified, it must be removed from the shelf and placed in a designated "Quarantine" area, separate from all dispensable stock.

• Documentation: Pharmacies must maintain records of the recall notice and the quantity of stock returned to the manufacturer or Reverse Distributor.

• Patient Notification: In Class I recalls, the pharmacy may be required to contact patients who received the specific lot to ensure they stop using the medication immediately. 

In 2025, the PTCE domain for the Drug Supply Chain Security Act (DSCSA) focuses on the "track and trace" system designed to protect the U.S. drug supply from counterfeit, contaminated, or stolen products. 

Sample PTCE Questions (2025)

1. Under the DSCSA, how long must a pharmacy store product tracing information (Transaction Information, History, and Statement)?

   • A) 2 years

   • B) 3 years

   • C) 6 years

   • D) 10 years

   • Correct Answer: C (Pharmacies must maintain these records for at least 6 years in paper or electronic format).

2. Which of the following is NOT a component of the "product identifier" required on a drug's 2D barcode under DSCSA?

   • A) National Drug Code (NDC)

   • B) Serial Number

   • C) Lot Number

   • D) Manufacturer's Address

   • Correct Answer: D (The identifier includes the NDC, serial number, lot number, and expiration date).

3. If a pharmacy technician identifies a "suspect product" (e.g., a bottle with a tampered seal), what is the first action required by the DSCSA?

   • A) Immediately return it to the manufacturer

   • B) Quarantine the product in a secure area

   • C) Throw it in the hazardous waste bin

   • D) Contact the local police department

   • Correct Answer: B (Suspect products must be quarantined and investigated to determine if they are illegitimate).

4. A "dispenser" (pharmacy) with 25 or fewer full-time employees is considered a "small dispenser." What is their final deadline for full DSCSA compliance?

   • A) May 27, 2025

   • B) August 27, 2025

   • C) November 27, 2025

   • D) November 27, 2026

   • Correct Answer: D (Large dispensers must comply by Nov 27, 2025; small dispensers have until Nov 27, 2026). 

Key DSCSA Concepts for 2025

Requirement 

Description

Product Identifier

A standardized graphic (2D barcode) containing the NDC, serial number, lot number, and expiration date.

The "3 Ts"

Transaction Information (TI), Transaction History (TH), and Transaction Statement (TS) must accompany every transfer of ownership.

Quarantine

Suspect or illegitimate products must be separated from stock to prevent them from reaching patients.

Notification

Pharmacies must notify the FDA (via Form FDA 3911) and immediate trading partners within 24 hours if a product is determined to be illegitimate.

Verification

Trading partners must be able to verify a product's serial number at the package level.

For 2025, verify the latest enforcement status on the FDA DSCSA Portal as stabilization periods for various "trading partners" (manufacturers, wholesalers, and dispensers) may differ. 

In 2025, the PTCB exam emphasizes the Institute for Safe Medication Practices (ISMP) lists for high-alert and confused drug names. These medications carry a heightened risk of causing significant patient harm if used in error. 

Sample PTCE Questions (2025)

1. Which of the following medications is classified as "high-alert" due to its potential to cause severe hypoglycemia if dosed incorrectly?

   • A) Lisinopril

   • B) Atorvastatin

   • C) Humulin R

   • D) Amoxicillin

   • Correct Answer: C (All forms of insulin are high-alert medications)

2. Tall Man lettering is most appropriately used for which look-alike/sound-alike (LASA) pair to prevent confusion?

   • A) Amoxicillin / Penicillin

   • B) hydrOXYzine / hydrALAZINE

   • C) Alprazolam / Diazepam

   • D) Metformin / Glipizide

   • Correct Answer: B (Tall Man lettering highlights the dissimilarities in drug names)

3. A technician is pulling medication for a prescription of Klonopin. Which LASA medication is most likely to be stored nearby, increasing the risk of an error?

   • A) Clonidine

   • B) Clozapine

   • C) Celebrex

   • D) Cyclosporine

   • Correct Answer: A (Clonidine and Klonopin/clonazepam are a frequent LASA pair)

4. Which class of high-alert medications requires careful monitoring due to the risk of life-threatening hemorrhage?

   • A) Antibiotics

   • B) Anticoagulants (e.g., Heparin, Warfarin)

   • C) Antivirals

   • D) Proton Pump Inhibitors

   • Correct Answer: B 

Common LASA Pairs & Tall Man Lettering (2025)

Medication A 

Medication B

Strategy Used

cloNIDine

clonazePAM

Tall Man Lettering

buPROPion

busPIRone

Tall Man Lettering

CeleBREX

CeleXA

Bolded dissimilarities

NovoLOG

NovoLIN

Separate storage / Bolded endings

vinCRIStine

vinBLAStine

Tall Man Lettering

ISMP High-Alert Categories (2025)

High-alert medications in community and acute care settings often include:

• Anticoagulants: Warfarin, Heparin, Enoxaparin.

• Insulins: All formulations (U-100 and concentrated U-500).

• Opioids: All formulations and routes.

• Chemotherapy Agents: Both oral and parenteral.

• Concentrated Electrolytes: Potassium chloride injection, Magnesium sulfate.

• Neuromuscular Blockers: Succinylcholine, Vecuronium. 

For the most current 2025 safety updates, consult the ISMP List of High-Alert Medications.

In 2025, the PTCE prioritizes standardized safety protocols established by the Institute for Safe Medication Practices (ISMP) and The Joint Commission. These strategies are designed to catch human errors before they reach the patient.

Sample PTCE Questions (2025)

1. According to ISMP guidelines, which of the following represents the correct way to express a decimal dose to prevent a tenfold medication error?

   • A) .5 mg

   • B) 5.0 mg

   • C) 0.5 mg

   • D) 5 mg.

   • Correct Answer: C (Always use a leading zero for decimals less than one; never use a trailing zero for whole numbers). [1], [3]

2. A pharmacy technician is stocking the shelves and notices that Prednisone and Prednisolone are stored side-by-side. What is the best error prevention strategy to apply here?

   • A) Label both with the same color sticker

   • B) Separate the inventory or use a "product alert" shelf talker

   • C) Store them in the refrigerator to keep them away from other drugs

   • D) Remove the labels from the stock bottles

   • Correct Answer: B (Physical separation of Look-Alike/Sound-Alike (LASA) drugs reduces selection errors). [1], [5]

3. Which of the following abbreviations is on the ISMP "Do Not Use" list because it is frequently mistaken for "four times daily"?

   • A) QID

   • B) QD

   • C) TID

   • D) BID

   • Correct Answer: B (QD—meaning "every day"—can be misread as QID, leading to a quadruple overdose). [2], [4]

4. What is the primary purpose of using Barcode Medication Administration (BCMA) or barcode scanning during the prescription filling process?

   • A) To track technician productivity

   • B) To ensure the drug being dispensed matches the drug selected in the computer system

   • C) To eliminate the need for a final pharmacist check

   • D) To determine the price of the medication

   • Correct Answer: B (Barcoding is the most effective way to verify product identity). [1], [6]

2025 Error Prevention Quick Reference

Strategy

Rule / Example

Goal

Leading Zeros

Use 0.5 mg, NOT .5 mg

Prevents misreading .5 as 5 mg.

Trailing Zeros

Use 5 mg, NOT 5.0 mg

Prevents misreading 5.0 as 50 mg.

Tall Man Lettering

EPINEPHrine vs. EPHEDrine

Highlights differences in LASA names.

Abbreviations

Avoid U, IU, QD, QOD, and MS

Avoids confusion with numbers or other drugs.

Separation

Separate HydrOXYzine and HydrALAZINE

Prevents "muscle memory" picking errors.

Operational Tips for 2025

• Double Check: Always use at least two patient identifiers (e.g., Name and DOB) when handing out prescriptions.

• Echo Technique: When taking a verbal order (if permitted by state law), use the "read-back" method to confirm accuracy. [1]

For updated 2025 safety resources, consult the ISMP List of Error-Prone Abbreviations.

In 2025, the PTCE emphasizes the technician’s role as the "first line of defense" in identifying clinical issues that must be legally and professionally handled by a pharmacist.

Sample PTCE Questions (2025)

1. A patient asks a pharmacy technician which over-the-counter (OTC) cough syrup is safe to take with their high blood pressure medication. What is the correct action?

   • A) Recommend a sugar-free syrup.

   • B) Point the patient to the "Cough and Cold" aisle.

   • C) Refer the patient to the pharmacist for a recommendation.

   • D) Tell the patient all OTC cough syrups are safe for hypertension.

   • Correct Answer: C (Technicians cannot give clinical advice or counsel on OTC products).

2. During the prescription entry process, a "Drug-Drug Interaction" alert appears on the screen for a new prescription. What must the technician do?

   • A) Bypass the alert and continue filling the order.

   • B) Delete the prescription and notify the doctor.

   • C) Print the screen and show it to the pharmacist for a Drug Utilization Review (DUR).

   • D) Tell the patient the medication is unsafe to take.

   • Correct Answer: C (Only a pharmacist can evaluate the clinical significance of a DUR alert).

3. A patient reports that they have developed a skin rash and "itchy throat" after taking the first dose of a new antibiotic. This is an example of:

   • A) A common side effect

   • B) An Adverse Drug Event (ADE) that requires immediate pharmacist intervention

   • C) Expected drug-food interaction

   • D) Normal therapeutic response

   • Correct Answer: B (Potential allergic reactions are ADEs that require clinical assessment by the pharmacist).

4. A patient's insurance company suggests a therapeutic substitution for a brand-name drug. Who is authorized to discuss this change with the prescriber and the patient?

   • A) The pharmacy technician

   • B) The pharmacy manager (non-pharmacist)

   • C) The pharmacist

   • D) The insurance billing specialist

   • Correct Answer: C (Therapeutic substitution involves changing the drug to a different chemical entity in the same class, requiring clinical judgment).

Technician vs. Pharmacist Roles (2025)

Scenario

Technician Action

Pharmacist Action

Allergies

Flag the profile; ask patient for details.

Screen for cross-sensitivity; decide if safe to fill.

Drug Misuse

Identify early refill requests or suspicious behavior.

Evaluate for potential "doctor shopping" or abuse.

Adherence

Ask "How are you taking this?" or identify late refills.

Counsel on the importance of the regimen.

Vaccinations

Process billing; provide VIS (Vaccine Information Statement).

Assess for contraindications; manage post-shot reactions.

DUR Alerts

Halt the filling process; alert the pharmacist.

Review clinical data and contact MD if necessary.

Key 2025 Clinical Red Flags

• OTC Recommendations: Even for "simple" items like aspirin or vitamins, the technician must defer to the pharmacist.

• Post-Immunization Care: If a patient feels faint or develops a rash after a 2025 flu or COVID-19 shot, the pharmacist must be notified immediately to provide care or refer to emergency services.

For additional prep on the 2025 exam domains, visit the PTCB Official Practice Tools.

In 2025, the PTCB exam emphasizes Continuous Quality Improvement (CQI) and the use of national reporting systems to enhance patient safety. Technicians are expected to understand how errors are analyzed and where to report specific types of incidents.

Sample PTCE Questions (2025)

1. A technician catches a mistake where the wrong drug was pulled, but the error was corrected before the medication reached the patient. What is this event called?

   • A) Adverse Drug Event (ADE)

   • B) Sentinel Event

   • C) Near Miss

   • D) Root-Cause Analysis

   • Correct Answer: C (A near miss is an error that is caught before it reaches the patient).

2. Which FDA-regulated program should be used to report a serious adverse reaction to a non-vaccine medication, such as a brand-name blood pressure pill?

   • A) VAERS

   • B) ISMP

   • C) MedWatch

   • D) OSHA

   • Correct Answer: C (MedWatch is the FDA Safety Information and Adverse Event Reporting Program for drugs and medical devices).

3. Following a major medication error, a pharmacy team meets to identify the fundamental reason why the error occurred rather than just blaming an individual. This process is known as:

   • A) Quality Control

   • B) Root-Cause Analysis (RCA)

   • C) Post-Marketing Surveillance

   • D) Medication Utilization Review

   • Correct Answer: B (RCA is a retrospective process used to identify the underlying system failures).

4. A patient experiences a fever and a rash 24 hours after receiving a 2025 influenza vaccination. To which system should this event be reported?

   • A) MedWatch

   • B) VAERS

   • C) DEA

   • D) USP

   • Correct Answer: B (The Vaccine Adverse Event Reporting System (VAERS) is specifically for vaccine-related incidents).

Key Reporting Systems & Procedures (2025)

Program / Term

Purpose

Managed By

MedWatch

Reporting adverse effects, product quality issues, or use errors for drugs and devices.

FDA

VAERS

Reporting any adverse events following vaccination.

CDC & FDA

ISMP VERP

National Vaccine Error Reporting Program (specifically for errors, not just side effects).

ISMP

CQI

Ongoing process to reduce errors and improve pharmacy workflow.

Pharmacy Internal

Sentinel Event

An unexpected occurrence involving death or serious physical/psychological injury.

Joint Commission

Important 2025 Practice Note

• Near Miss Reporting: In 2025, pharmacies are encouraged to track near misses just as closely as actual errors to identify patterns in LASA (Look-Alike/Sound-Alike) drugs or workflow bottlenecks.

• Product Integrity: If a product is suspected of being counterfeit or tampered with, it must be reported to the FDA and the manufacturer within 24 hours per DSCSA guidelines.

For more official practice, utilize the PTCB Official Practice Tools.

In 2025, the PTCE prioritizes the identification of the "Five Rights" of medication administration to prevent errors. Technicians must be able to categorize errors based on where the discrepancy occurs between the prescriber’s order and the final dispensed product.

Sample PTCE Questions (2025)

1. A prescription is written for Amoxicillin 500 mg, but the technician enters it as Amoxicillin 250 mg. What type of error has occurred?

   • A) Incorrect drug error

   • B) Incorrect dose error

   • C) Incorrect route error

   • D) Incorrect quantity error

   • Correct Answer: B (The strength/dose was changed during entry).

2. A technician labels a bottle of Tobradex Otic (ear drops) with instructions to "Place 2 drops in the right eye." Which type of error does this represent?

   • A) Incorrect patient error

   • B) Incorrect quantity error

   • C) Incorrect route of administration error

   • D) Omission error

   • Correct Answer: C (Using an otic [ear] product in the eye [ophthalmic] is a route error).

3. A patient named "John A. Smith" receives a prescription for Lisinopril that was actually intended for "John B. Smith." This is classified as what type of error?

   • A) Incorrect patient error

   • B) Incorrect drug error

   • C) Wrong time error

   • D) Unauthorized drug error

   • Correct Answer: A (This is often caused by failure to use two patient identifiers).

4. A prescription for Prednisone 10 mg is written as "Take 1 tablet daily for 10 days." The technician dispenses only 5 tablets. This is an example of which error?

   • A) Incorrect dose error

   • B) Incorrect quantity error

   • C) Omission error

   • D) Incorrect strength error

   • Correct Answer: B (The total amount of medication provided does not match the duration of therapy).

5. A physician orders a STAT dose of a medication to be given at 8:00 AM, but the pharmacy does not deliver it until 12:00 PM. This is classified as a:

   • A) Wrong time error

   • B) Omission error

   • C) Improper dose error

   • D) Unauthorized drug error

   • Correct Answer: A (Delays in STAT or time-sensitive medications are categorized as wrong time errors).

Categorizing Common Errors (2025)

Error Type

Description / Example

Incorrect Drug

Dispensing HydrOXYzine instead of HydrALAzine.

Omission Error

Failure to provide a dose or a medication that was ordered.

Wrong Strength

Dispensing a 10 mg tablet when a 20 mg tablet was prescribed.

Unauthorized Drug

Dispensing a medication for which there is no valid prescription.

Incorrect Dosage Form

Dispensing a capsule when the prescriber ordered a liquid suspension.

Safety Strategies for 2025

To prevent these errors, technicians should follow the ISMP Guidelines for the Five Rights:

1. Right Patient (Verify Name and DOB).

2. Right Drug (Check NDC and barcode scan).

3. Right Dose (Verify strength and calculations).

4. Right Route (Confirm eye vs. ear vs. oral).

5. Right Time (Ensure correct frequency like QD vs. QID).

For more official practice, utilize the PTCB Official Practice Tools.

In 2025, the PTCE domain for infection control focuses heavily on compliance with USP <795> (non-sterile), USP <797> (sterile), and OSHA guidelines. These procedures aim to minimize contamination and ensure a safe environment for both products and personnel.

Sample PTCE Questions (2025)

1. According to USP <797> sterile compounding guidelines, which item of personal protective equipment (PPE) must be donned first?

   • A) Gown

   • B) Gloves

   • C) Hair cover and shoe covers

   • D) Face mask

   • Correct Answer: C (Donning sequence is crucial: hair/shoe covers first, then mask, then gown, then sterile gloves last).

2. Which of the following is the most critical and effective infection prevention practice in any pharmacy setting?

   • A) Wiping down the countertops once daily

   • B) Wearing a face mask at all times

   • C) Proper, frequent handwashing

   • D) Using a clean counting tray for every prescription

   • Correct Answer: C (Hand hygiene is universally recognized as the single most effective way to prevent the spread of infection).

3. After counting amoxicillin tablets on a counting tray, what is the appropriate cleaning procedure before counting a different medication?

   • A) Wipe the tray with a dry paper towel.

   • B) Rinse the tray with sterile water only.

   • C) Wipe the tray with 70% isopropyl alcohol and let it air dry.

   • D) Use soap and water, then wipe with a dry cloth.

   • Correct Answer: C (70% IPA is the standard disinfectant for pharmacy surfaces and equipment).

4. A pharmacy technician is handling hazardous drugs (e.g., chemotherapy). What is the minimum required PPE?

   • A) Standard lab coat and gloves

   • B) Double gloves and a disposable gown

   • C) Surgical mask and safety glasses

   • D) Single gloves and hand sanitizer

   • Correct Answer: B (Specific handling requires additional protection, often including double gloving and a specific impermeable gown).

Key Infection Control Standards (2025)

Procedure

Standard / Guideline

Requirement

Handwashing

CDC/OSHA

Wash hands with soap and water for at least 20 seconds.

Cleaning Trays

USP <795>

Cleaned with 70% IPA between each use, especially sensitive medications (e.g., penicillins, sulfa drugs).

PPE Donning

USP <797>

Dirty to Clean; feet first (shoe covers) -> head (hair cover) -> face (mask) -> body (gown) -> hands (gloves).

Aseptic Area (Sterile)

USP <797>

Horizontal or vertical laminar flow hood must be cleaned with 70% IPA and lint-free wipes at the start of each shift and before each batch.

General Countertops

General Safety

Wiped daily with a standard disinfectant.

For detailed procedural guidelines applicable to the 2025 exam, review the requirements set by the U.S. Pharmacopeia (USP) and the CDC Hand Hygiene Guidelines.

In 2025, the PTCB exam places heavy weight on pharmacy calculations and "Sig" code interpretation. Accuracy in these areas is the primary defense against dosing errors.

Sample PTCE Questions (2025) 

1. A prescription is written for: "Augmentin 600 mg/5 mL, 1.5 tsp po bid x 10 days." What is the total quantity (mL) needed to fill this prescription?

   • A) 75 mL

   • B) 100 mL

   • C) 150 mL

   • D) 200 mL

   • Correct Answer: C (1.5 tsp = 7.5 mL. 7.5 mL x 2 doses/day x 10 days = 150 mL).

2. Convert the Roman numeral 'LXXIX' into an Arabic number.

   • A) 59

   • B) 69

   • C) 79

   • D) 89

   • Correct Answer: C (L=50, XX=20, IX=9).

3. A medication label reads "10% w/v." How many grams of active ingredient are in a 500 mL bag?

   • A) 5 g

   • B) 50 g

   • C) 100 g

   • D) 500 g

   • Correct Answer: B (10% w/v means 10g per 100mL. 10g/100mL = x/500mL. x = 50g).

4. A patient needs to take 30 mg of a medication that is available as a 15 mg/5 mL liquid. How many teaspoons should the patient take per dose?

   • A) 1 tsp

   • B) 2 tsp

   • C) 3 tsp

   • D) 0.5 tsp

   • Correct Answer: B (30 mg ÷ 15 mg = 2 units of 5 mL = 10 mL. Since 5 mL = 1 tsp, the dose is 2 tsp).

5. A 1-liter IV bag is running at a rate of 125 mL/hr. How many hours will the bag last?

   • A) 4 hours

   • B) 8 hours

   • C) 10 hours

   • D) 12 hours

   • Correct Answer: B (1000 mL ÷ 125 mL/hr = 8 hours). 

Essential 2025 Study Guide 

Common Conversions 

Measurement 

Equivalent

1 teaspoon (tsp)

5 mL

1 tablespoon (tbsp)

15 mL (3 tsp)

1 ounce (oz)

30 mL (approx. 29.57)

1 kilogram (kg)

2.2 lbs

1 grain (gr)

64.8 mg (often rounded to 60 or 65 mg)

1 pound (lb)

454 g

Common Sig Codes 

• ac / pc: Before meals / After meals

• ad / as / au: Right ear / Left ear / Both ears

• od / os / ou: Right eye / Left eye / Both eyes

• bid / tid / qid: Twice / Three / Four times a day

• po / sl / pr: By mouth / Sublingual / Rectally

• gtt: Drop 

Days Supply Calculation Formula 

Days Supply=Total Quantity DispensedDose×Frequency per DayDays Supply equals the fraction with numerator Total Quantity Dispensed and denominator Dose cross Frequency per Day end-fraction

Days Supply=Total Quantity DispensedDose×Frequency per Day

For additional practice with 2025 pharmacy math, utilize the PTCB Official Practice Tools or specialized math guides like Pharmacy Tech Letter. 

In 2025, the PTCE domain for administration equipment tests a technician's knowledge of the appropriate supplies needed for specific drug delivery systems and patient conditions.

Sample PTCE Questions (2025)

1. A patient receives a prescription for insulin to be administered via a KwikPen. What is essential for the technician to verify and potentially dispense alongside the pen?

   • A) An oral syringe

   • B) A nebulizer machine

   • C) Pen needles

   • D) An IV filter

   • Correct Answer: C (Insulin pens require specific pen needles, which are sold separately from the pen device itself).

2. Which type of syringe should always be recommended for administering liquid medication to a child via the mouth to prevent accidental injection?

   • A) Tuberculin syringe

   • B) Hypodermic syringe

   • C) Oral syringe

   • D) Insulin syringe

   • Correct Answer: C (Oral syringes do not have luer-lock tips that fit needles, making them the safest option for oral administration).

3. A prescription is written for Albuterol HFA MDI (inhaler). To maximize the effectiveness of the medication delivery to the lungs, what additional supply is often recommended, especially for children or the elderly?

   • A) A spacer device

   • B) A filter straw

   • C) A humidifier

   • D) An atomizer

   • Correct Answer: A (Spacers help patients coordinate their breathing with the inhaler puff, ensuring more medication reaches the lungs).

4. Which piece of equipment is specifically used to prepare IV medications for sterile compounding by removing particulate matter before infusion?

   • A) Nebulizer cup

   • B) Filter needle/syringe

   • C) Luer lock cap

   • D) Infusion pump

   • Correct Answer: B (Filter needles or filter straw needles are used to draw up or inject solutions that might contain glass particles from crushed ampules).

Equipment & Supplies Quick Reference (2025)

Medication/Condition

Required/Common Supplies

Key Feature

Diabetes (Insulin)

Pen needles, syringes, blood glucose monitor, test strips, lancets

Syringes measured in Units (U-100)

Oral Liquids

Oral Syringe, Dosing cup

Syringes marked in mL only

Inhalers (MDI)

Spacer, peak flow meter

Spacer improves delivery efficiency

Asthma (Nebulizer)

Nebulizer machine, nebulizer solution cup, tubing

Changes liquid medicine to mist

Injections (IV, IM, SubQ)

Hypodermic syringe, needles (various gauges and lengths), alcohol swabs

Needles specified by Gauge (higher gauge = thinner needle) and Length

Eye/Ear Drops

Dropper bottle

Ensure correct route (Otic vs. Ophthalmic)

For further 2025 practice, understand that the technician's role includes selecting the correct auxiliary supplies based on the patient's age and ability to use the administration device correctly.

In 2025, the PTCB exam emphasizes the use of lot numbers and NDCs as the primary tools for ensuring product integrity and preventing dispensing errors.

Sample PTCE Questions (2025)

1. A pharmacy technician is performing a final check on a medication bottle and notices the National Drug Code (NDC) is 00002-3227-30. What does the middle set of four digits (3227) represent?

   • A) The manufacturer or labeler

   • B) The product strength and dosage form

   • C) The package size

   • D) The expiration date

   • Correct Answer: B (The NDC segments are: Manufacturer - Product/Strength - Package Size).

2. A medication bottle has an expiration date listed as "12/2025." According to USP and FDA standards, what is the last day this medication can be legally dispensed?

   • A) December 1, 2025

   • B) November 30, 2025

   • C) December 31, 2025

   • D) January 1, 2026

   • Correct Answer: C (Medications expire on the last day of the month listed).

3. In the event of a drug recall, which piece of information on the stock bottle is used to identify the specific batch of medication affected?

   • A) NDC number

   • B) Lot number

   • C) Serial number

   • D) DEA number

   • Correct Answer: B (Lot numbers identify a specific production run from the manufacturer).

4. A technician is restocking the shelves and finds two bottles of the same medication. Bottle A expires 04/2026 and Bottle B expires 08/2025. Which bottle should be placed at the front of the shelf?

   • A) Bottle A

   • B) Bottle B

   • C) It does not matter as long as they are both in date.

   • D) Neither; both should be returned to the wholesaler.

   • Correct Answer: B (The "FEFO" rule—First Expired, First Out—should be followed).

Key Identifiers Quick Reference (2025)

Identifier

Format Example

Function

NDC (10 or 11 digits)

12345-6789-01

Identifies the Manufacturer (5), Product (4), and Package Size (2).

Lot Number

A1234B

Identifies a specific batch for recalls and quality control.

Expiration Date

MM/YYYY

Determines the final date of potency and safety.

2D Barcode

(DSCSA Requirement)

Contains the NDC, Lot, Expiration, and Serial Number for tracking.

Operational Rules for 2025

• NDC Matching: When filling a prescription, the technician must ensure the NDC on the stock bottle matches the NDC selected in the computer system to avoid billing and product errors.

• Expired Meds: Once a medication reaches its expiration date (e.g., today is Dec 29, 2025; a bottle dated 12/2025 is still valid for 2 more days), it must be removed from the shelf and quarantined for return.

• Recalls: If a lot number matches a recall notice, the product must be pulled immediately regardless of its expiration date.

For official updates, utilize the PTCB Official Practice Tools.

In 2025, the PTCB exam emphasizes the use of lot numbers and NDCs as the primary tools for ensuring product integrity and preventing dispensing errors.

Sample PTCE Questions (2025)

1. A pharmacy technician is performing a final check on a medication bottle and notices the National Drug Code (NDC) is 00002-3227-30. What does the middle set of four digits (3227) represent?

   • A) The manufacturer or labeler

   • B) The product strength and dosage form

   • C) The package size

   • D) The expiration date

   • Correct Answer: B (The NDC segments are: Manufacturer - Product/Strength - Package Size).

2. A medication bottle has an expiration date listed as "12/2025." According to USP and FDA standards, what is the last day this medication can be legally dispensed?

   • A) December 1, 2025

   • B) November 30, 2025

   • C) December 31, 2025

   • D) January 1, 2026

   • Correct Answer: C (Medications expire on the last day of the month listed).

3. In the event of a drug recall, which piece of information on the stock bottle is used to identify the specific batch of medication affected?

   • A) NDC number

   • B) Lot number

   • C) Serial number

   • D) DEA number

   • Correct Answer: B (Lot numbers identify a specific production run from the manufacturer).

4. A technician is restocking the shelves and finds two bottles of the same medication. Bottle A expires 04/2026 and Bottle B expires 08/2025. Which bottle should be placed at the front of the shelf?

   • A) Bottle A

   • B) Bottle B

   • C) It does not matter as long as they are both in date.

   • D) Neither; both should be returned to the wholesaler.

   • Correct Answer: B (The "FEFO" rule—First Expired, First Out—should be followed).

Key Identifiers Quick Reference (2025)

Identifier

Format Example

Function

NDC (10 or 11 digits)

12345-6789-01

Identifies the Manufacturer (5), Product (4), and Package Size (2).

Lot Number

A1234B

Identifies a specific batch for recalls and quality control.

Expiration Date

MM/YYYY

Determines the final date of potency and safety.

2D Barcode

(DSCSA Requirement)

Contains the NDC, Lot, Expiration, and Serial Number for tracking.

Operational Rules for 2025

• NDC Matching: When filling a prescription, the technician must ensure the NDC on the stock bottle matches the NDC selected in the computer system to avoid billing and product errors.

• Expired Meds: Once a medication reaches its expiration date (e.g., today is Dec 29, 2025; a bottle dated 12/2025 is still valid for 2 more days), it must be removed from the shelf and quarantined for return.

• Recalls: If a lot number matches a recall notice, the product must be pulled immediately regardless of its expiration date.

For official updates, utilize the PTCB Official Practice Tools.

4.4

Procedures for identifying and returning dispensable, non-dispensable, and expired

medications and supplies (e.g., credit return, return to stock, reverse distribution)

In 2025, the PTCE domain for medication returns focuses on inventory efficiency and regulatory compliance. Technicians must distinguish between returning prescriptions to active stock and returning unsalable inventory to wholesalers or third-party processors.

Sample PTCE Questions (2025)

1. A patient never picks up their finished prescription for Lisinopril. According to standard pharmacy procedures, what is the correct action?

   • A) Send the medication to a reverse distributor for credit.

   • B) Return the medication to the manufacturer for a refund.

   • C) Perform a "return to stock" (RTS) and credit the patient's insurance.

   • D) Place the bottle in the hazardous waste bin.

   • Correct Answer: C (Prescriptions not picked up are returned to stock to be dispensed to other patients).

2. What is the primary role of a "Reverse Distributor" in a pharmacy setting?

   • A) To deliver emergency medications from one pharmacy to another.

   • B) To process expired or damaged medications and coordinate credits with manufacturers.

   • C) To inspect the pharmacy for DEA compliance.

   • D) To manage the automated dispensing machines.

   • Correct Answer: B (Reverse distributors handle unsalable goods, sorting them for either destruction or manufacturer credit).

3. When returning expired Schedule II (C-II) controlled substances to a reverse distributor, which form must be issued by the reverse distributor to the pharmacy?

   • A) DEA Form 41

   • B) DEA Form 106

   • C) DEA Form 222

   • D) FDA Form 3911

   • Correct Answer: C (A DEA Form 222 must be used for any transfer of Schedule II drugs, even for returns).

4. A technician finds a bottle of tablets that were incorrectly reconstituted and are now unusable. Which of the following is true?

   • A) The bottle should be sent for reverse distribution for full credit.

   • B) The bottle cannot be returned for credit because it was altered/reconstituted.

   • C) The bottle should be returned to the wholesaler for a refund.

   • D) The bottle should be returned to the patient's stock.

   • Correct Answer: B (Medications that are opened, used, or contaminated are generally ineligible for reverse distribution credits). 

Key Return Procedures (2025)

Procedure 

Purpose

Key Requirement

Return to Stock (RTS)

For prescriptions filled but not picked up by the patient.

Insurance must be credited; original stock bottle info (NDC/Lot) should be tracked.

Reverse Distribution

For expired or damaged stock that is unsalable.

Segregate and quarantine from active stock before shipment.

Credit Return

Financial recovery for unsalable goods.

Credits are calculated based on manufacturer policies and product condition.

Controlled Return

Legal disposal of C-II through C-V.

Requires DEA Form 222 (for C-II) or detailed invoices (C-III to V).

Important 2025 Rules

• Quarantine: Expired medications must be stored in a clearly marked, separate area from active inventory to prevent accidental dispensing.

• "Non-Returnable" Waste: Items that are half-used, contaminated, or mixed (wastage) are typically considered waste and must be destroyed according to EPA/DEA standards, rather than returned for credit.

• Documentation: Maintain all records for returns and destructions (like DEA Form 41 or reverse distributor invoices) for at least two years.