One question from each topic in our bank, with the answer and a worked explanation. Like the real Part I, each has four options (a to d) and one best answer. All questions are original; PEBC publishes its own sample questions and does not publish past papers (what exists).
PK is a 52 year old male newly diagnosed with hypertension after home monitoring averaged 148/94 mm Hg. He has no other medical conditions and takes no medications. According to Hypertension Canada's 2025 primary care guideline, which initial treatment is most appropriate?
Why: Hypertension Canada's 2025 guideline recommends starting drug therapy at BP 140/90 mm Hg or higher and using low-dose combination therapy, ideally a single-pill combination, from two of three classes: ACEI or ARB, thiazide or thiazide-like diuretic, and long-acting dihydropyridine CCB. Beta-blockers are not first line without a specific indication, and an ACEI plus ARB increases hyperkalemia and kidney injury with no added benefit. Source: Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care (Goupil R et al. CMAJ 2025;197:E549), recommendations on pharmacotherapy initiation and initial combination therapy.
DL, 68, has heart failure with reduced ejection fraction (LVEF 30%), NYHA class II. He takes sacubitril/valsartan 49/51 mg twice daily, bisoprolol 5 mg daily and furosemide 20 mg daily. Potassium is 4.3 mmol/L and eGFR 55 mL/min/1.73 m2. Which addition is most appropriate?
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Start practicing →Original practice material, not past or real exam questions. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC). Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.
Why: The CCS/CHFS heart failure guidelines recommend four foundational drug classes for HFrEF: an ARNI (or ACEI/ARB), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor, each of which reduces mortality or hospitalization. DL lacks the MRA and SGLT2 inhibitor, and his potassium and eGFR allow both. Non-dihydropyridine CCBs such as diltiazem worsen HFrEF, and digoxin does not reduce mortality. Source: McDonald M et al. CCS/CHFS Heart Failure Guidelines Update: defining a new pharmacologic standard of care for HFrEF (Can J Cardiol 2021;37:531); spironolactone and dapagliflozin product monographs (DPD, checked 2026).
The husband of NM, 67, who uses insulin, calls the pharmacy: she is unconscious and cannot swallow, and her glucose meter reads 2.1 mmol/L. They have a glucagon kit at home. What should he be told to do?
Why: In severe hypoglycemia with an unconscious person, Diabetes Canada recommends glucagon 1 mg subcutaneously or intramuscularly (or nasal glucagon 3 mg where available) and calling emergency services. Nothing should be given by mouth, including buccal gel or honey, because of choking and aspiration risk. The 0.5 mg glucagon dose is for young children, and waiting for paramedics before giving available glucagon delays treatment that the family can give safely. Once awake and able to swallow, she should eat. Source: Diabetes Canada CPG, ch. 14 Hypoglycemia (Can J Diabetes 2018;42:S104); glucagon for injection product monograph (DPD, checked 2026).
GN, 28, has asthma and uses salbutamol 2 to 3 times a week for symptoms during exercise and colds. She has no night waking and has never needed oral corticosteroids. She uses no controller. According to the CTS 2021 asthma update, what is the most appropriate change?
Why: The 2021 CTS focused update no longer recommends SABA-only treatment for adults and adolescents with asthma, because it is linked to more severe exacerbations and deaths. Mild asthma is treated with as-needed budesonide-formoterol or with a daily low-dose ICS plus an as-needed reliever. A LABA without an ICS is unsafe in asthma, and montelukast is less effective than ICS as a controller. Source: Yang CL et al. Canadian Thoracic Society 2021 Guideline update: diagnosis and management of asthma in preschoolers, children and adults (Can J Respir Crit Care Sleep Med 2021;5:348); budesonide/formoterol (Symbicort) product monograph (DPD, checked 2026).
ML, 32, healthy and not pregnant, has had dysuria, frequency and urgency for 2 days without fever, flank pain or vaginal discharge. She has no drug allergies and normal kidney function. Which treatment is most appropriate?
Why: For acute uncomplicated cystitis in non-pregnant women, first-line options are nitrofurantoin 100 mg twice daily for 5 days, TMP-SMX DS twice daily for 3 days where local E. coli resistance is acceptable, or fosfomycin 3 g once. Fluoroquinolones are reserved because of collateral damage and serious adverse effects, amoxicillin alone has high E. coli resistance, and 14 days of cephalexin is longer than needed. Source: Alberta Health Services Bugs & Drugs, Urinary tract infection in adults (bugsanddrugs.org, checked 2026); AMMI Canada position statement on antimicrobial stewardship in UTI (2020); nitrofurantoin (Macrobid) product monograph (DPD, checked 2026).
A prescription for citalopram 40 mg daily is received for EH, 72, with major depression who has been on 20 mg daily for 6 weeks with a partial response. Her ECG and electrolytes are normal. Which of the following should the pharmacist recommend?
Why: Because citalopram causes dose-dependent QT prolongation, Health Canada limits the maximum dose to 20 mg daily in patients over 65 (and 40 mg in younger adults). For a partial response in EH, options include optimising other factors, switching to another antidepressant or augmenting, rather than exceeding the age-based maximum; a normal baseline ECG does not remove the dose limit. Source: Health Canada, Celexa (citalopram) and QT prolongation advisory (2012); citalopram product monograph, Dosage: elderly (DPD, checked 2026); CANMAT 2023 MDD update (Lam RW et al. Can J Psychiatry 2024;69:641).
PS, 64, asks for an over-the-counter acid reducer. He has had heartburn for 3 months, now with food sticking in his throat and a 5 kg weight loss he did not intend. Which of the following is the most appropriate recommendation?
Why: Dysphagia and unintentional weight loss are alarm features that may indicate esophageal stricture or cancer, and new symptoms after about age 60 also call for investigation. Canadian guidance advises referral for prompt endoscopic evaluation rather than self-treatment. Acid suppression could mask symptoms and delay diagnosis. Source: Moayyedi PM et al. ACG and CAG Clinical Guideline: Management of Dyspepsia (Am J Gastroenterol 2017;112:988); omeprazole nonprescription labelling (DPD, checked 2026).
TM, 45, healthy, takes 2 extra-strength acetaminophen 500 mg tablets every 4 hours while awake (about 6 doses a day) for a sprained ankle, plus a nighttime cold remedy containing acetaminophen 650 mg. Which counselling point is most important?
Why: Six doses of 1,000 mg (6 g) plus 650 mg from the cold product totals about 6.65 g/day, well above the 4 g/day maximum in Health Canada's acetaminophen labelling for adults, raising the risk of liver injury. Even without the cold remedy, 6 g a day exceeds the maximum; regular-strength 325 mg tablets on the same schedule still total about 4.55 g with the cold remedy; and taking acetaminophen with food does not protect the liver. Patients should check all products for hidden acetaminophen. Source: Health Canada, Acetaminophen labelling standard: maximum 4,000 mg in 24 hours (2016 update; checked 2026); acetaminophen product monograph (DPD, checked 2026).
LO, 28, wears soft contact lenses and has a painful red left eye, sensitivity to light and blurred vision since yesterday. He asks for antibiotic eye drops. Which of the following is the most appropriate action?
Why: Pain, photophobia and reduced vision are red flags for keratitis, iritis or other serious eye disease, and contact lens wearers are at particular risk of bacterial (including Pseudomonas) and Acanthamoeba keratitis, which can threaten vision. He needs same-day assessment by an optometrist, ophthalmologist or physician and should remove his lenses. Self-treatment with OTC antibiotic or vasoconstrictor drops is inappropriate. Source: Canadian Ophthalmological Society, red eye referral guidance (2023); polymyxin B/gramicidin ophthalmic product labelling: consult a doctor if eye pain or vision changes (checked 2026).
AJ, 29, healthy, with no history of neural tube defects, plans to conceive in the next few months. What folic acid supplementation does SOGC recommend?
Why: For people at low risk, SOGC recommends a daily multivitamin containing 0.4 mg folic acid starting at least 2-3 months before conception and continuing through pregnancy and breastfeeding, because the neural tube closes by about 28 days after conception, often before pregnancy is recognised. Higher doses are for higher-risk groups (such as previous NTD, some antiseizure drugs or diabetes). Diet alone is not considered sufficient. Source: Wilson RD, O'Connor DL. SOGC Guideline No. 427, Folic acid and multivitamin supplementation for prevention of folic acid-sensitive congenital anomalies (J Obstet Gynaecol Can 2022;44:707).
