Appleton Chapter 3: Pharmacy

Question 1

DIRECTIONS (Questions 1 through 203): Each of
the numbered items or incomplete statements in
this section is followed by answers or by comple-
tions of the statement. Select the ONE lettered an-
swer or completion that is BEST in each case.
1. Official standards for individual drugs and
chemicals formulated into dosage forms are
published in
(A) USP/NF
(B) USP DI Volume I
(C) USP DI Volume II
(D) USP DI Volume III
(E) PDR

Answer 1

1. (A) Official standards in the form of drug
   monographs are presented in the United
   States Pharmacopeia/National Formulary (USP/NF).
   These monographs may describe therapeuti-
   cally active drugs or other ingredients,
   known as excipients, that are essential for
   formulating a stable drug product. (24:9)

Question 2

2. The agency in the United States responsible
   for selecting appropriate nonproprietary
   names for drugs is the
   (A) AMA
   (B) APhA
   (C) FDA
   (D) USAN
   (E) USP

Answer 2

2. (0) The United States Adopted Names
   (USAN) Council establishes nonproprietary
   drug names. The Council is jointly sponsored
   by the AMA, United States Pharmacopoeial
   Convention, and the APhA. Because the
   USAN is not an official government agency,
   the chosen names are not formally recog-
   nized until they are published in the Federal
   Register. (24:32)

Question 3

3. Descriptions of the Federal Controlled Sub-
   stances Act, Approved Drug Products with
   Therapeutic Equivalence Evaluations, and
   USP/NF dispensing requirements may be
   found in the
   (A) USP DI Volume I
   (B) USP DI Volume II
   (C) USP DI Volume III
   (D) Facts and Comparisons
   (E) PDR

Answer 3

3. (C) Federal drug laws and regulations are
   described in the USP Dispensing Information
   (01), Volume III, which also contains listings
   of therapeutic equivalent drugs and drugs
   that are biologically inequivalent. The latter
   information is from the FDA’s “Orange
   Book.” (18c:VI-52)

Question 4

4. Prescription drug descriptions expressed in
   layperson’s terms and useful as handouts for
   patients may be photocopied from the
   (A) USP DI Volume I
   (B) USP DI Volume II
   (C) USP DI Volume III
   (D) Facts and Comparisons
   (E) Remington’s Pharmaceutical Sciences

Answer 4

4. (B) Volume II of the USP DI contains drug
   monographs written for the layperson. Phar-
   macists have permission to photocopy indi-
   vidual drug descriptions for distribution to
   the patient when dispensing the drug. Vol-
   ume I of the USP DI contains drug informa-
   tion for health professionals. It includes more
   detailed and more scientific information than
   Volume II. (1Sb; 18c)

Question 5

5. According to the USP, the instruction “pro-
   tect from light” in a monograph indicates
   storage in a
   (A) dark place
   (B) amber glass bottle
   (C) light-resistant container
   (D) hermetic container
   (E) tight glass container

Answer 5

5. (C) A container that reduces light transmis-
   sion in the range between 290 and 450
   nanometers to the level specified in the USP
   90
   may be considered light resistant and suit-
   able protection from light. The container may
   be constructed of glass or plastic. Although
   amber units are most common, other colored
   or opaque containers may meet the official
   requirements. (4:12.6; 18c:VI-5; 24:154)

Question 6

6. According to USP standards, a refrigerator
   can be used to store pharmaceuticals that
   specify storage in a
   I. freezer
   II. cool place
   III. cold place
   (A) I only
   (B) III only
   (C) I and II only
   (D) II and III only
   (E) I, II, and III

Answer 6

6. (B) A cold place indicates a temperature not
   exceeding 8° C (46° F). A refrigerator is a cold
   place in which the temperature is maintained
   between 2 and 8° C (36-46° F). A cool place
   refers to areas maintained between 8 and 15°
   C. A freezer is defined as a storage area held
   between _10° and -20°. (18c:VI-6; 24:146)

Question 7

7. The expiration date on a pharmaceutical con-
   tainer states “Expires July 2005.” This state-
   ment means that by that expiration date, the
   product may have lost

(A) up to 5% of its activity
(B) up to 10% of its activity the use of extremely small doses of drugs is
(C) up to 20% of its activity known as
(D) up to 50% of its activity
(E) sufficient activity to be outside USP
monograph requirements

Answer 7

7. (E) The expiration date for a pharmaceutical
   is based on the length of time during which
   the product continues to meet the specified
   monograph requirements. Requirements are
   stated in terms of amount of active ingredient
   that is present as determined by suitable as-
   say. Most drug products are considered us-
   able until approximately 10% of the drug or
   drug activity has been lost. However, some
   monographs specify other ranges. For exam-
   ple, digoxin tablets must assay between 92%
   and 108% of label claim. (1:639)

Question 8

8. If a bottle of tablets has an expiration date of “July 2002,” the pharmacist may continue to
   dispense the product
   (A) up to 1 year after the expiration date several ways.
   (B) only through July 1, 2002 of solubility is given in the USP,
   (C) only through July 15, 2002
   (D) only through July 31,2002 (A) g of solute soluble in 1 mL of solvent
   (E) if the pharmacist informs the patient to
   discard unused tablets in 6 months

Answer 8

8. (0) When expiration dates are expressed
   only in terms of month and year, the in-
   tended expiration date is the end of the last
   day of the stated month. (1:639; 4:4.1)

Question 9

9. A pharmacist has reconstituted a powder (D) mL of solvent required to dissolve 100 g dosage form to form a solution. Which of the of solute
   following statement(s) concerning a Beyond- (E) mL of solvent required to prepare 100 Use Date is (are) appropriate when determin- mL of saturated solution ing an expiration date for this product?
   I. The beyond-use date is identical to the
   manufacturer’s expiration date.
   II. The beyond-use date is never more than 10 days for reconstitute product’s
   III. The beyond-use date for nonsolid dosage forms shall not be greater than one
   year from the date of dispensing

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer 9

9. (B) Pharmacists are using beyond-use dating
   quite often as guidelines when dispensing
   prescriptions to limit prolonged use of the
   drug by the patient. This date is usually a
   shorter time span than the manufacturer’s
   expiration date found on the original pack age. The beyond-use date shall be no later
   than either the expiration date on the manu-
   facturer’s container or one year from the date
   of dispensing, whichever is earlier. For recon-
   stituted products, the beyond-use date will
   be of a significantly shorter duration and is
   based on the manufacturer’s recommenda-
   tion in the package insert or on the package.
   (4:4.1)

Question 10

10. Which one of the following practices would
    NOT be classified as “alternative medicine” in the US?

(A) allopathy
(B) chiropractic
(C) naturopathy
(D) nutraceutical
(E) reflexology

Answer 10

10. (A) Allopathy is the treating of disease by
    using remedies that produce effects on the
    body that differ from those produced by the
    disease. This new set of conditions is incom-
    patible with or antagonistic to the original
    symptoms of the disease. The term is now
    used when referring to standard or orthodox
    medical practice. Naturopathy indicates heal-
    ing by the exclusive use of natural remedies
    (heat, light, vegetables, fruits, etc.) but no
    surgery or drugs. Nutraceutical practice is
    one in which foods are used to promote heal-
    ing and health. (1:840; 27:69)

Question 11

11. An alternative medical practice that stresses the use of extremely small doses of drugs is
    (A) folk medicine
    (B) holistic medicine
    (C) homeopathic medicine
    (D) orthomolecular medicine
    (E) faith healing

Answer 11

11. (C) Homeopathy involves the use of sub-
    stances that produce symptoms similar to the
    symptoms of the disease (the law of similars).
    The drugs used, mainly herbals, are adminis-
    tered as very high dilutions, that is, in ex-
    tremely low doses. Holistic medicine refers to
    therapies that treat the whole person-both
    mind and body. (27:909; 1:840)

Question 12

12. Solubility of a substance may be expressed in

(A) g of solute soluble in 1 mL of solvent
(B) g of solute soluble in 100 mL of solvent
(C) mL of solvent required to dissolve 1 g of solute
(D) mL of solvent required to dissolve 100g of solute
(E) mL of solvent required to prepare 100ml of saturated solution

Answer 12

12. (C) For example, boric acid solubility in wa-
    ter is expressed as 1:18. This indicates that 1
    gram of boric acid added to exactly 18 mL of
    purified water will result in a saturated solu-
    tion. When compounding, it is advisable to
    use excess solvent because saturated solu-
    tions are difficult to prepare and may precipi-
    tate if there are changes in temperature.
    (1:194)

Question 13

13. Which of the following alkaloids exhibit good water solubility?
    I. morphine HCl
    II. cocaine
    III. atropine

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer 13

13. (A) Naturally occurring alkaloids, which are
    weak organic bases, have relatively poor wa-
    ter solubility but are soluble in alcohol. Most
    pharmaceutical products use the alkaloid
    salts such as morphine Hel, cocaine Hel, and
    atropine sulfate to increase the drugs’ water
    solubility. (1:398)

Question 14

14. Which of the following forms of the basic drug haloperidol will have good water solubility?

I. hydrochloride
II. lactate
III. decanoate
(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer 14

14. (C) Haloperidol is a butyrophenone deriva-
    tive and the base form has very poor water
    solubility (1 g in more than 10,000 mL). The
    hydrochloride salt is water soluble, as is the
    lactate salt, which is utilized in preparing the
    aqueous injection of haloperidol. Haloperidol
    decanoate is the ester form that is dissolved
    in an oil vehicle. This injection product is in-
    jected intramuscularly and has a half-life of
    approximately 3 weeks. (1:1184)

Question 15

15. Which one of the following chemicals is NOT
    suitable as a drug excipient?
    (A) methyl paraben
    (B) starch
    (C) glycerin
    (D) benzocaine
    (E) lactose

Answer 15

15. (D) Pharmaceutical excipients are selected
    for specific characteristics that will improve
    the drug formulation. These include solvents
    (glycerin), ointment bases (petrolatum), tablet
    diluents (lactose), antioxidants (sodium bi-
    sulfite), and antimicrobial preservatives (the
    parabens). Because they must be relatively in-
    ert therapeutically, the local anesthetic benzo-
    caine would not be suitable. (24:111)

Question 16

16. Which of the following chemicals may be in-
    cluded in a drug solution as a chelating
    agent?
    (A) ascorbic acid
    (B) hydroquinone
    (C) edetate
    (D) sodium bisulfite
    (E) fluorescein sodium

Question 17

17. Which of the following ions may be effec-
    tively chelated by EDTA?
    I. sodium
    II. lithium
    III. lead
    (A) I only
    (B) III only
    (C) I and II only
    (D) II and III only
    (E) I, II, and III

Answer 17

17. (B) Edetate calcium disodium (Versenate) is
    usually administered by intramuscular par-
    enteral injection to reduce blood levels and
    depot stores of lead in acute and chronic lead
    poisoning and lead encephalopathy. The
    chelate formed with lead is stable, water-
    soluble, and readily excreted by the kidneys.
    The other choices, lithium and sodium, are
    monovalent ions and will not complex with
    EDTA. (1:935)

Question 18

18. Although most drugs in pharmaceutical
    dosage forms are expected to decompose fol-
    lowing first-order kinetics, an exception are
    drugs formulated in
    (A) capsules
    (B) oral solutions
    (C) oral suspensions
    (D) tablets
    (E) suppositories

Answer 18

18. (C) Drugs in suspensions are likely to follow
    zero-order kinetics because the limiting fac-
    tor is the amount of drug actually in solution.
    The classic example is aspirin suspension.
    (12:286)

Question 19

19. An early sign of a decomposing epinephrine
    solution is the presence of a
    (A) brown precipitate
    (B) pink color
    (C) white precipitate
    (D) crystal
    (E) red color

Answer 19

19. (B) Epinephrine, a catecholamine, is very
    sensitive to oxidation, which results in bio-
    logically inactive products. The first indica-
    tion of oxidation is the development of a pink
    color that darkens to form a brown precipi-
    tate. (1:989; 24:83)

Question 20

20. On exposure to air, aminophylline solutions
    may develop
    (A) crystals of theophylline
    (B) a gas
    (C) a precipitate of aminophylline
    (D) a precipitate of ethylenediamine
    (E) a straw color

Answer 20

20. (A) Aminophylline consists of theophylline,
    which has been reacted with ethylenedi-
    amine to improve its water solubility. On ex-
    posure to air, carbon dioxide is absorbed and
    free theophylline forms. Addition of small
    amounts of ethylenediamine redissolves
    these crystals. A note in the monograph for
    Aminophylline Injection USP states: Do not
    use the injection if crystals have separated.
    (1:972)

Question 21

21. The process of grinding a substance to a very
    fine powder is termed
    (A) levigation
    (B) sublimation
    (C) trituration
    (D) pulverization by intervention
    (E) maceration

Answer 21

21. (C) The term trituration usually refers to re-
    ducing the particle size of powders often in a
    mortar and pestle. However, trituration has
    also been used to describe the simple mixing
    of two or more powders in the mortar. Levi-
    gation is the process of reducing the particle
    size of solids by adding a small amount of a
    liquid or an ointment base to make a paste,
    which is then rubbed with a spatula on an
    ointment tile. Sublimation is the conversion
    of a solid to a vapor without passing through
    a liquid phase. Pulverization by intervention
    is a process for reducing particle size by us-
    ing a second agent that can then be readily
    removed. For example, camphor is reduced
    by the intervention of alcohol. Maceration is
    an extraction process in which the ground
    drug is soaked in a solvent until the cellular
    structure is penetrated and the soluble con-
    stituents have been dissolved. (24:166; 1:1612;
    1:1521)

Question 22

22. The term “impalpable” refers to a substance
    that is
    (A) bad tasting
    (B) not perceptible to the touch
    (C) greasy
    (D) nongreasy
    (E) tasteless

Answer 22

22. (B) Powders that are either directly applied
    to the skin or are incorporated into topical
    products should be extremely fine or impal-
    pable. Trituration is often needed to reduce
    particles to an extremely fine size so that the
    patient will not discern individual particles
    when the product is rubbed on the skin. Usu-
    ally a particle size of 50 microns or smaller is
    desired.

Question 23

23. Which one of the following general charac-
    teristics is NOT true for alkaloids?
    (A) contain nitrogen in the molecule
    (B) have good alcohol solubility
    (C) have pKa’s less than 7
    (D) often exhibit stereoisomerism
    (E) have poor water solubility

Answer 23

23. (C) Most alkaloids have a pKa above 7;
    therefore, they are weak bases that will form
    salts with an acid (eg, pilocarpine hydrochlo-
    ride, morphine sulfate). Stereoisomerism is
    common in alkaloid structures; large differ-
    ences in therapeutic activity can be expected
    among isomers. (1:398)

Question 24

24. The term “chiral” is related to a drug’s
    (A) chelating ability
    (B) eutectic properties
    (C) stereoisomerism
    (D) partition coefficient
    (E) water solubility

Answer 24

24. (C) Chiral relates to the optical activity of a
    molecule. Stereoisomers of a specific drug
    may exhibit distinctly different degrees of
    therapeutic activity. For some drugs the ac-
    tivity or major side effects may be due to
    only one of the isomers present. (1:155)

Question 25

25. Different crystalline forms (polymorphs) of
    the same drug exhibit different
    I. metabolism rates
    II. melting points
    III. solubilities
    (A) I only
    (B) III only
    (C) I and II only
    (D) II and III only
    (E) I, II, and III

Answer 25

25. (D) Polymorphs differ in their melting
    points, x-ray diffractions, infrared spectra,
    and dissolution rates. For example, riboflavin
    has three polymorphs, each with significantly
    different solubilities. Theobroma oil (cocoa
    butter) can exist in four forms, each differing
    in melting points. Gentle heating of cocoa
    butter will favor the formation of the stable
    beta polymorph. This crystalline form is de-
    sired because it melts at 34.5 0 C, which is
    close to but lower than body temperature.
    Metabolic rates of a drug’s polymorphs will
    not vary because once the drug has dis-
    solved, the polymorphs no longer exist.
    (1:168)

Question 26

26. Benzalkonium chloride is a germicidal sur-
    factant that is rendered inactive in the pres-
    ence of
    (A) organic acids
    (B) gram-negative organisms
    (C) cationic surfactants
    (D) soaps
    (E) inorganic salts

Answer 26

(D) Benzalkonium chloride is a cationic sur-
face active agent. In the presence of anionic
agents such as soaps, benzalkonium chloride
and similar cationic agents are inactivated be-
cause the combination of large cations with
large anions of soaps form inactive products.
(1:1264)

Question 27

27. The shrinkage that occurs when alcohol and
    purified water are mixed is primarily due to
    (A) attractive van der Waals forces
    (B) covalent bonding
    (C) hydrogen bonding
    (D) ionic bonding
    (E) temperature changes

Answer 27

27. (C) Hydrogen bonding is an attractive force
    between hydrogen atoms and electronegative
    atoms such as oxygen, fluorine, and nitrogen.
    Although weak, hydrogen bonds can bring
    about the miscibility of certain solvents or the
    solubility of certain chemicals. Hydrogen
    bonding is also responsible for the shrinkage
    phenomenon that occurs when mixing cer-
    tain liquids. For example, when equal vol-
    umes of Alcohol USP and purified water are
    mixed, there is approximately 3% shrinkage from the theoretical volume. If one wishes to
    prepare 100 mL of Diluted Alcohol USP, a so-
    lution that contains 49% VIV ethanol plus
    purified water, equal volumes of each are
    used. However, one must also remember to
    use an excess of at least 3% of each ingredient
    to assure obtaining the required volume.
    (12:23,213)

Question 28

28. An example of a nonionic surfactant would
    be
    (A) ammonium laurate
    (B) cetylpyridinium chloride
    (C) dioctyl sodium sulfosuccinate
    (D) sorbitan monopalmitate
    (E) triethanolamine stearate

Answer 28

28. (D) Sorbitan monopalmitate is a sorbitan
    fatty acid ester, commercially available as
    Span 40. It is classified as nonionic because
    the molecules would not have the tendency
    to migrate to either pole in an electric field.
    Ammonium laurate, dioctyl sodium sulfo-
    succinate, and triethanolamine stearate are
    anionic surfactants. This designation implies
    that the large active portion of the surfactant
    molecule would bear a negative charge and,
    therefore, would migrate to the anode in an
    electric field. For example, the stearate por-
    tion of triethanolamine stearate is considered
    the active ion. Cetylpyridinium chloride is a
    cationic surfactant. The active surfactant por-
    tion, cetylpyridinium, has a positive charge
    and migrates to the cathode. (1:286)

Question 29

29. According to the Poiseuille equation, the fac-
    tor that has the relatively greatest influence
    on the rate of flow of liquid through a capil-
    lary tube is the
    (A) length of the tube
    (B) viscosity of the liquid
    (C) pressure differential on the tube
    (D) radius of the tube
    (E) temperature of the liquid

Answer 29

29. (D) The equation may be expressed as
    r4xtx~P
    V = 8xlxn
    The volume of liquid (V) passing during a
    unit of time (t) is directly proportional to the
    radius of the tube (r) and the pressure differ-
    ential (~P) at each end of the tube and in-
    versely proportional to the length of the tube
    (1) and the viscosity of the liquid (n). Because
    the radius is raised to the fourth power,
    doubling the radius would cause a 16-fold
    change in the flow provided all other factors
    remained constant. The capillary can be envi-
    sioned as a simple glass tube or a human
    blood vessel. (1:295; 12:462)

Question 30

30. Patients following low-sodium diets may re-
    sort to the use of sodium-free salt substitutes
    such as NoSalt. The major ingredient in these
    products is
    (A) ammonium chloride
    (B) calcium chloride
    (C) potassium chloride
    (D) potassium iodide
    (E) none of these

Answer 30

30. (C) Potassium chloride is an obvious substi-
    tute for sodium chloride because it has a sim-
    ilar salty taste, is crystalline, and is an elec-
    trolyte already present in the body. However,
    the use of these salt substitutes is contraindi-
    cated in patients with severe kidney disease
    or oliguria. Symptoms such as weakness,
    nausea, and muscle cramps indicate exces-
    sive sodium depletion. Increased sodium in-
    take is warranted.

Question 31

31. Potassium supplements are administered in
    all of the following manners EXCEPT
    (A) IV infusion
    (B) IVbolus
    (C) elixirs, po
    (D) effervescent tablets
    (E) slow-release tablets, po

Answer 31

31. (B) IV injection of high concentrations of
    potassium may cause cardiac arrest. Intra-
    venous administration must be by slow infu-
    sion to allow dilution of the potassium to oc-
    cur. When plasma potassium levels are above
    2.5 mEq/L, rates up to 10 mEq/h (total of 100
    to 200 mEqlday) may be set. In more serious
    conditions, with plasma levels below 2
    mEq/L, rates of 40 mEq/h (total of 400
    mEql day) have been employed. Available in-
    jection forms contain 10-80 mEq per vial. IV
    admixtures are prepared by diluting these so-
    lutions to 250-1000 mL. Oral dosage forms
    include Kay Ciel elixir, Kaon tablets, K-Lor,
    and K-Lyte packets. Slow-K tablets have a
    wax matrix from which the KCl slowly dis-
    solves in the GI tract. (1:930)

Question 32

32. Which of the following statements concern-
    ing fluorouracil is NOT true?
    (A) Its chemical structure is a modified
    pyrimidine similar to uracil and idoxuri-
    dine.
    (B) It is effective only when administered by
    injection.
    (C) Anorexia and nausea and vomiting are
    very common side effects.
    (D) The drug interferes with the synthesis of
    ribonucleic acid.
    (E) Leukopenia is a major clinical toxic ef-
    fect.

Answer 32

32. (B) Topical dosage forms are used. For exam-
    ple, both creams and solutions are available
    under the trade names of Efudex and Fluoro-
    plex. In fact, however, fluorouracil is usually
    administered by IV injection. It is not given
    orally because of irregular absorption from
    the GI tract. (3:2881; 6:1249)

Question 33

33. The product inserts for many drug products
    contain cautionary statements. Which one of
    the following sequences lists the three types
    of cautions in the order of least serious to
    most serious?
    (A) contraindication, precaution, warning
    (B) precaution, warning, contraindication
    (C) warning, contraindication, precaution
    (D) warning, precaution, contraindication
    (E) contraindication, warning, precaution

Answer 33

33. (B) A “precaution” is intended to advise the
    physician of possible problems that may oc-
    cur with the use of a drug. For example, the
    use of tetracycline may result in overgrowth
    of nonsusceptible microorganisms. A “warn-
    ing” signifies a more serious problem with
    greater potential for harm to a patient. For
    example, renal impairment may require re-
    duction in the drug dose. A “contraindica-
    tion” is the most restrictive limitation be-
    cause it refers to an absolute prohibition
    against the use of a drug under certain condi-
    tions. For example, the use of penicillin de-
    rivatives is prohibited in patients known to
    be sensitive to penicillin. (24:55)

Question 34

34. A comparison of individual amino acids
    present in commercial amino acids injection
    solutions may be found in
    I. Facts and Comparisons
    II. Trissel’s Handbook on Injectable Drugs
    III. Remington’s Pharmaceutical Sciences
    (A) I only
    (B) III only
    (C) I and II only
    (D) II and III only
    (D) I, II, and III

Answer 34

34. (C) Both Facts and Comparisons and the Hand-
    book on Injectable Drugs present tables comparing the commercial amino acid injections.
    (21:26-27; 10)

Question 35

35. The containers used to package drugs may
    consist of several components andlor be
    composed of several materials. The release of
    an ingredient from packaging components
    into the actual product is best described by
    the term
    (A) adsorption
    (B) absorption
    (C) leaching
    (D) permeation
    (E) porosity

Answer 35

35. (C) The term “leaching” is used specifically
    to designate the release of a container ingre-
    dient into the product itself. For example,
    zinc and accelerators may be leached from
    rubber closures into a parenteral vial. Ad-
    sorption would refer to the binding of a sub-
    stance onto the surface of the container wall.
    Diffusion is the passage of a substance
    through a second substance. For example,
    volatile oil or dye may diffuse from a solu-
    tion through the walls of a plastic container.
    Permeation would denote the solution of a
    substance in the cell wall followed by pas-
    sage through the wall. Porosity indicates
    small holes or passages through which a sub-
    stance could pass. (24:139-40)

Question 36

36. Hypodermic needle sizes are expressed by
    gauge numbers. The gauge number refers to
    the
    (A) bevel size
    (B) external diameter of the cannula
    (C) internal diameter of the cannula
    (D) length of the needle
    (E) size of the lumen opening

Answer 36

36. (B) Hypodermic needle sizes are expressed
    by a gauge system based on the external di-
    ameter of the cannula: the larger the number,
    the smaller the diameter of the needle. For
    example, the 21-gauge needle is smaller in di-
    ameter than the 19-9auge needle. Generally,
    the length of the cannula is also specified.
    This measurement, expressed in inches, rep-
    resents the distance from the needle tip to the
    junction with the hub. (13:325)

Question 37

37. “Winged” needles are most closely associated
    with which type of injections?
    (A) intradermal
    (B) intramuscular
    (C) intrathecal
    (D) intravenous
    (E) subcutaneous

Answer 37

37. (D) The winged (scalp-vein, scalp, or butter-
    fly) needle consists of a stainless steel needle
    with two flexible plastic winglike projections.
    The wings serve two purposes: They ease
    manipulation of the needle during insertion
    into the vein and then allow the needle to be
    anchored with tape to the skin. (13:326)

Question 38

38. Insulin preparations are usually adminis-
    tered by
    (A) intradermal injection
    (B) intramuscular injection
    (C) intravenous bolus
    (D) intravenous infusion
    (E) subcutaneous injection

Answer 38

38. (E) Insulin is usually administered by sub-
    cutaneous injection into the arm or thigh.
    Absorption of the insulin is good, and this
    route is both convenient and safe for self-
    administration of the drug. Some studies
    indicate that the absorption rate from the
    arm is 50% faster than from the thigh. (13:110)

Question 39

39. Which one of the following needles is most
    suited for the administration of insulin solu-
    tions?
    (A) 16G 5/8”
    (B) 21G 1/2”
    (C) 21G 5/8”
    (D) 25G 5/8”
    (E) 25G I”

Answer 39

(D) Insulin solutions have low viscosities,
and only small volumes are injected. There-
fore, small-bore needles (25G up to 30G) may
be used. Short (3/8” to 518”) needles are ade-
quate for the usual subcutaneous route of in-
sulin administration. (13:327)

Question 40

40. The term “venoclysis” is most closely associ-
    ated with
    (A) intravenous injections
    (B) intrathecal injections
    (C) intravenous infusions
    (D) intrapleural withdrawals
    (E) peritoneal dialysis

Question 41

41. The designation “minibottles” refers to
    (A) partially filled parenteral bottles with
    50- to 150-mL volumes
    (B) any parenteral bottle with a capacity of
    less than 1 L
    (C) 10 to 30 mL glass vials
    (D) prescription bottles with capacities of 4
    oz or less
    (E) vials with a capacity of less than 10 mL

Answer 41

41. (A) Partially filled glass containers (minibot-
    tIes) usually consist of 250-mL bottles con-
    taining 50, 100, or 150 mL of either DsW or
    NS. To these bottles one can easily add drug
    solutions, taking advantage of the vacuum
    present in the minibottle. Plastic bags are also
    employed for preparing parenteral admix-
    tures. The plastic units do not have a vacuum
    but are flexible enough to accommodate ad-
    ditionalliquids. (1:1551, 1553)

Question 42

42. The term “piggyback” is most commonly as-
    sociated with
    (A) intermittent therapy
    (B) intrathecal injections
    (C) intravenous bolus
    (D) slow intravenous infusions
    (E) total parenteral nutrition

Answer 42

42. (A) Intermittent therapy refers to adminis-
    tration of parenteral drugs at spaced inter-
    vals. One of the most convenient methods for
    administration is for the pharmacist to pre-
    pare a minibottle containing active drug solu-
    tion such as an antibiotic added to a diluent.
    This unit is attached to the tubing of a large-
    volume parenteral (LVP) bottle already hang-
    ing on the patient. This “piggyback” concept
    saves the patient from multiple injections and
    assures high blood levels of the additive drug
    because the minibottle solution is infused in
    a short period of time. (1:1551-53; 13:145)

Question 43

43. Which of the following acronyms refer to
    parenteral nutrition?
    I. TPN
    II. TNA
    III. PMN

(A) I only
(B) III only
(C) I and II only
(D) II and III only
(E) I, II, and III

Answer 43

43. (C) TPN (total parenteral nutrition) and
    TNA (total nutritional admixture) refer to so-
    lutions administered parenterally to provide
    calories, amino acids, and other nutrients by
    parenteral infusion. PMN is an abbreviation
    sometimes used for phenylmercuric nitrate,
    an antimicrobial preservative. (4:33.1)

Question 44

44. What is the approximate maximum volume of fluid that should be administered daily by intravenous infusion to a stabilized patient?
    (A) 1L
    (B) 4L
    (C) 8L
    (D) 12 L
    (E) 16 L

Answer 44

44. (B) Although the maximum volume will
    vary depending on the condition of the pa-
    tient, the normal daily water requirement is
    approximately 25 to 40 mL/kg of body
    weight or 2000 mL per square meter of body
    weight. Daily volumes greater than 3 to 4 L
    in normal (nondehydrated) patients may
    cause a fluid overload. A dehydrated patient
    will require larger quantities. Water replace-
    ment therapy (hydration therapy) in an adult

Question 45

45. Although isotonicity is desirable for almost all parenterals, it is particularly critical for
    (A) intra-articular injections
    (B) intradermal injections
    (C) intramuscular injections
    (D) intravenous injections
    (E) subcutaneous injections

Answer 45

45. (E) A subcutaneous injection will come into
    contact with a large number of nerve endings
    and may remain at the injection site for a
    long period of time. Pain will be experienced
    if the solution is not isotonic. The potential
    effects of hypotonic or hypertonic intra-
    venous solutions are offset by their dilution
    in the large volume of blood into which they
    are injected, provided the volume injected is
    not excessive and the rate of injection is slow.
    (1:61; 24:401)