Drug utilisation evaluation MCQs With Answer

Introduction: Drug Utilisation Evaluation (DUE) is an essential component of clinical pharmacy practice that systematically assesses how medicines are prescribed, dispensed and used in real-world settings. For M.Pharm students, understanding DUE methodologies, indicators and interventions is crucial to improve therapeutic outcomes, promote rational drug use and optimize healthcare resources. This blog provides a focused series of challenging MCQs covering core DUE concepts — study design (prospective, concurrent, retrospective), quality indicators (WHO prescribing indicators, DU90%), outcome measures, sampling and statistical considerations, audit cycles, computerized DUE systems, and pharmacoeconomic implications. These questions aim to deepen analytical skills and prepare students for academic and clinical responsibilities in drug-use evaluation.

Q1. What is the primary objective of a Drug Utilisation Evaluation (DUE)?

• To exclusively study pharmacokinetic properties of new drugs
• To assess and improve the quality, safety and effectiveness of medication use
• To replace clinical trials for drug approval
• To determine the chemical stability of drug formulations

Correct Answer: To assess and improve the quality, safety and effectiveness of medication use

Q2. Which of the following best describes a prospective DUE?

• Review of prescribing data after patient discharge
• Real-time assessment of prescribing and immediate intervention during therapy
• Collection of drug utilization data from historical records only
• Meta-analysis of published drug utilization studies

Correct Answer: Real-time assessment of prescribing and immediate intervention during therapy

Q3. DU90% is a metric used in drug utilisation research. What does it represent?

• The top 90% cost-saving measures in a formulary
• The number of defined daily doses required for 90% of patients
• The set of drugs that account for 90% of total defined daily doses (DDD) dispensed
• The proportion of prescriptions compliant with guidelines above 90%

Correct Answer: The set of drugs that account for 90% of total defined daily doses (DDD) dispensed

Q4. Which indicator is NOT one of the WHO core drug use indicators for outpatient care?

• Average number of drugs per encounter
• Percentage of medicines prescribed by generic name
• Patient satisfaction score
• Percentage of encounters with an antibiotic prescribed

Correct Answer: Patient satisfaction score

Q5. In designing a retrospective DUE on antibiotic prescribing, what is the primary limitation to consider?

• High cost of data collection
• Inability to capture prescriber intent or undocumented clinical reasoning
• Requirement for patient interviews during therapy
• Real-time modification of therapy based on findings

Correct Answer: Inability to capture prescriber intent or undocumented clinical reasoning

Q6. Which statistical approach is most appropriate to compare pre- and post-intervention rates of guideline-concordant prescribing in a DUE?

• Kaplan–Meier survival analysis
• Chi-square test for proportions or logistic regression
• ANOVA for repeated measures of continuous blood levels
• Principal component analysis

Correct Answer: Chi-square test for proportions or logistic regression

Q7. When calculating sample size for a DUE aiming to detect a 15% absolute improvement in guideline adherence with 80% power and alpha 0.05, which factor most increases required sample size?

• Higher baseline adherence rate
• Smaller expected effect size
• Use of retrospective data versus prospective
• Stratifying by multiple wards

Correct Answer: Smaller expected effect size

Q8. Which of the following is a core component of a DUE audit cycle?

• Randomized allocation of patients to new drugs
• Assessing current practice, implementing interventions, and re-auditing
• Manufacturing quality control testing
• Developing new active pharmaceutical ingredients

Correct Answer: Assessing current practice, implementing interventions, and re-auditing

Q9. In DUE reporting, what role does ATC/DDD classification play?

• Serves only for cost accounting and billing
• Provides standardized drug classification and consumption measurement for comparisons
• Is primarily used for pharmacogenomic profiling
• Dictates local prescribing guidelines

Correct Answer: Provides standardized drug classification and consumption measurement for comparisons

Q10. Which intervention is considered most effective for changing prescriber behavior in DUEs according to evidence-based reviews?

• Passive distribution of printed guidelines only
• Educational outreach (academic detailing) combined with audit and feedback
• Sole reliance on computerized alerts without local adaptation
• Financial penalties for non-adherence without educational support

Correct Answer: Educational outreach (academic detailing) combined with audit and feedback

Q11. Which outcome measure would best reflect clinical impact in a DUE evaluating anticoagulant use?

• Number of prescriptions written
• Rates of major bleeding and thromboembolic events
• Formulary substitution rates
• Time spent by pharmacists on counseling

Correct Answer: Rates of major bleeding and thromboembolic events

Q12. During a DUE, you find high variation between prescribers in dose adjustments for renal impairment. What is the most appropriate immediate next step?

• Remove the drug from the formulary
• Develop and disseminate clear renal dosing guidelines and provide targeted education
• Start automated dispensing without checking renal function
• Ignore variation since clinical judgment varies

Correct Answer: Develop and disseminate clear renal dosing guidelines and provide targeted education

Q13. Which ethical consideration is particularly relevant when conducting a prospective, concurrent DUE with direct interventions?

• Ensuring patient blinding to the intervention
• Obtaining appropriate institutional approval and, when required, informed consent for interventions
• Manufacturing investigational products locally
• Maximizing sample heterogeneity irrespective of consent

Correct Answer: Obtaining appropriate institutional approval and, when required, informed consent for interventions

Q14. What is a key advantage of computerized physician order entry (CPOE) with embedded DUE rules?

• It eliminates the need for multidisciplinary collaboration
• It enables real-time prescribing checks, dose-range alerts and standardized data capture for DUE analysis
• It guarantees 100% adherence to guidelines
• It reduces need for training clinical staff

Correct Answer: It enables real-time prescribing checks, dose-range alerts and standardized data capture for DUE analysis

Q15. In an economic DUE, which metric combines both cost and clinical outcomes to compare two interventions?

• Defined Daily Dose (DDD)
• Incremental Cost-Effectiveness Ratio (ICER)
• Drug utilization 90% (DU90%)
• Medication Possession Ratio (MPR)

Correct Answer: Incremental Cost-Effectiveness Ratio (ICER)

Q16. Which sampling strategy reduces selection bias when reviewing inpatient medication charts for a DUE?

• Selecting the first 50 charts from the medical record room
• Systematic random sampling across the study period and wards
• Only choosing charts from the specialty with best outcomes
• Convenience sampling by the clinical pharmacist

Correct Answer: Systematic random sampling across the study period and wards

Q17. Which key performance indicator would be most appropriate for a DUE focused on opioid stewardship?

• Proportion of patients receiving antiemetics
• Percentage of opioid prescriptions with documented pain assessment and opioid agreement when indicated
• Average cost per inpatient day
• Number of branded opioid products stocked

Correct Answer: Percentage of opioid prescriptions with documented pain assessment and opioid agreement when indicated

Q18. What limitation should be considered when using DDD to compare drug use between populations?

• DDD reflects individual prescribed doses for pediatrics accurately
• DDD is based on assumed average adult maintenance dose and may not reflect actual prescribed doses in specific populations
• DDD measures quality of prescribing directly
• DDD is only applicable to injectable formulations

Correct Answer: DDD is based on assumed average adult maintenance dose and may not reflect actual prescribed doses in specific populations

Q19. In reporting DUE results to stakeholders, which approach maximizes implementation of recommended changes?

• Publishing only in an internal technical report with no discussion
• Providing tailored feedback, presenting data clearly to clinicians, and co-developing feasible action plans
• Imposing mandatory changes without clinician input
• Sharing raw data without interpretation

Correct Answer: Providing tailored feedback, presenting data clearly to clinicians, and co-developing feasible action plans

Q20. Which research question is most suitable for a DUE rather than for a randomized controlled trial (RCT)?

• Does Drug X reduce mortality compared to placebo in a controlled population?
• How often and why is Drug Y prescribed off-label in routine hospital practice, and what are associated outcomes?
• What is the maximum tolerated dose of a new chemical entity?
• Can a novel formulation pass stability testing under accelerated conditions?

Correct Answer: How often and why is Drug Y prescribed off-label in routine hospital practice, and what are associated outcomes?

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