Hospital formulary is a curated list of approved drugs and therapeutic guidelines used in a hospital to ensure safe, effective and cost‑efficient medication use. For B. Pharm students, understanding formulary definition, typical contents (drug monographs, dosing, interactions, storage, procurement and therapeutic interchange policies) and the systematic preparation process (evidence review, pharmacoeconomics, formulary/P&T committee decisions and periodic review) is essential. A robust formulary supports rational drug use, antimicrobial stewardship, inventory control and regulatory compliance. This topic links clinical pharmacology, pharmaceutics, hospital pharmacy practice and drug policy—key for future pharmacists involved in formulary management. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary purpose of a hospital formulary?
- To list all over‑the‑counter products sold at the hospital shop
- To identify approved medications and therapeutic guidelines for safe, effective and cost‑efficient patient care
- To replace national drug regulatory agency approvals
- To provide advertising space for pharmaceutical companies
Correct Answer: To identify approved medications and therapeutic guidelines for safe, effective and cost‑efficient patient care
Q2. Which of the following is typically included in a formulary drug monograph?
- Physician personal preferences without evidence
- Indications, dosing, contraindications, interactions and monitoring parameters
- Hospital architectural plans
- Staff rota schedules
Correct Answer: Indications, dosing, contraindications, interactions and monitoring parameters
Q3. Who usually chairs the hospital Pharmacy and Therapeutics (P&T) committee?
- Chief Financial Officer
- Head of Nursing
- Medical director or senior clinician with pharmacy representation
- Hospital chaplain
Correct Answer: Medical director or senior clinician with pharmacy representation
Q4. Which formulary type restricts use of certain drugs to specific prescribers or indications?
- Open formulary
- Closed formulary
- Non‑binding formulary
- Retail formulary
Correct Answer: Closed formulary
Q5. Pharmacoeconomic evaluation in formulary preparation primarily assesses what?
- The color of the drug packaging
- Clinical effectiveness relative to cost, including cost‑effectiveness and budget impact
- Only the cheapest available drug irrespective of outcomes
- Patient preferences about packaging design
Correct Answer: Clinical effectiveness relative to cost, including cost‑effectiveness and budget impact
Q6. Therapeutic interchange policy in a formulary allows pharmacists to do what?
- Substitute a chemically different drug within the same therapeutic class according to established guidelines
- Change the diagnosis recorded in medical records
- Dispense expired medications in emergencies
- Perform surgical procedures without consent
Correct Answer: Substitute a chemically different drug within the same therapeutic class according to established guidelines
Q7. Which document is essential for safe handling of cytotoxic drugs in the formulary?
- Drug monograph without safety data
- Material Safety Data Sheet (MSDS) and handling protocols
- Pharmacy social event calendar
- Brand marketing brochure
Correct Answer: Material Safety Data Sheet (MSDS) and handling protocols
Q8. How often should a hospital formulary typically be reviewed and updated?
- Every 50 years
- Periodically, often annually or as new evidence and products emerge
- Never; once created it stays permanent
- Only when the pharmacy runs out of stock
Correct Answer: Periodically, often annually or as new evidence and products emerge
Q9. Which of the following best describes an evidence‑based approach in formulary decision‑making?
- Decisions based solely on pharmaceutical company promotions
- Systematic review of clinical trials, guidelines and safety data to guide selection
- Selection based on alphabetical order of drug names
- Voting by non‑clinical staff without data
Correct Answer: Systematic review of clinical trials, guidelines and safety data to guide selection
Q10. Which committee member is critical for providing cost and budget impact information during formulary decisions?
- Hospital cook
- Pharmacist with pharmacoeconomics or finance input
- Head of maintenance
- External marketing agent
Correct Answer: Pharmacist with pharmacoeconomics or finance input
Q11. An essential medicines list differs from a hospital formulary in that:
- Essential medicines list is global/national guidance focusing on priority medicines; formulary is tailored to local hospital needs
- Formulary contains only herbal remedies
- Essential list is for non‑medical products
- Formulary is legally binding for all hospitals in a country
Correct Answer: Essential medicines list is global/national guidance focusing on priority medicines; formulary is tailored to local hospital needs
Q12. Which section of a formulary addresses antimicrobial stewardship?
- Therapeutic guidelines and restricted antibiotic list with dosing, duration and review criteria
- Only drug prices
- Laboratory bench cleaning instructions
- Hospital visitor policy
Correct Answer: Therapeutic guidelines and restricted antibiotic list with dosing, duration and review criteria
Q13. What role does adverse drug reaction (ADR) data play in formulary management?
- No role; ADRs are ignored
- It informs safety decisions, monitoring requirements and potential removal of drugs
- Used only for marketing purposes
- Determines staff cafeteria menus
Correct Answer: It informs safety decisions, monitoring requirements and potential removal of drugs
Q14. Which item is NOT a usual content of hospital formulary entries?
- Dosing and route of administration
- Stability and storage conditions
- Detailed patient medical histories
- Known drug interactions
Correct Answer: Detailed patient medical histories
Q15. In formulary preparation, “therapeutic class review” means:
- Comparing drugs within a therapeutic class based on efficacy, safety and cost to select preferred agents
- Reviewing only drug colors within a shelf
- Picking the most expensive drug as preferred
- Listing drugs randomly without comparison
Correct Answer: Comparing drugs within a therapeutic class based on efficacy, safety and cost to select preferred agents
Q16. Which regulatory consideration must pharmacy staff check before adding a drug to the hospital formulary?
- Whether the drug is approved by national drug regulatory authority for intended use
- Whether the drug packaging is aesthetically pleasing
- Whether the drug company sponsors hospital events
- Whether the drug has the same name as a local celebrity
Correct Answer: Whether the drug is approved by national drug regulatory authority for intended use
Q17. What is a key advantage of an electronic formulary over a paper formulary?
- Electronic formulary cannot be updated
- Real‑time updates, searchable drug monographs and integration with electronic prescribing systems
- Requires more physical storage space
- Only accessible by pharmaceutical reps
Correct Answer: Real‑time updates, searchable drug monographs and integration with electronic prescribing systems
Q18. Which metric can be used to evaluate formulary performance?
- Antibiotic consumption rates, medication errors, formulary adherence and cost savings
- Number of vending machines on hospital premises
- Average rainfall in the hospital city
- Number of posters in staff rooms
Correct Answer: Antibiotic consumption rates, medication errors, formulary adherence and cost savings
Q19. What is the role of clinical pharmacists in formulary implementation?
- Provide clinical expertise, educate prescribers, monitor outcomes and enforce therapeutic interchange protocols
- Create hospital logos
- Only stock shelves without clinical input
- Design hospital linen patterns
Correct Answer: Provide clinical expertise, educate prescribers, monitor outcomes and enforce therapeutic interchange protocols
Q20. Which practice helps ensure safe use of high‑risk drugs listed in a formulary?
- Provide specific dosing protocols, monitoring parameters and double‑check procedures
- Keep the drug unlabelled
- Allow any staff member to administer without instruction
- Store them in public areas for easy access
Correct Answer: Provide specific dosing protocols, monitoring parameters and double‑check procedures
Q21. A formulary restriction for controlled substances often requires:
- Prescriber justification, limited dispensing quantities and enhanced documentation
- Free distribution to all visitors
- Prescription without record keeping
- Use only for promotional giveaways
Correct Answer: Prescriber justification, limited dispensing quantities and enhanced documentation
Q22. Which factor is LEAST likely to influence a formulary deletion decision?
- New safety concerns or severe ADRs
- Lack of efficacy compared with alternatives
- Formulary committee’s change in coffee preference
- Cost‑ineffectiveness compared with alternatives
Correct Answer: Formulary committee’s change in coffee preference
Q23. How does formulary management support antimicrobial stewardship?
- By restricting certain antibiotics, defining indications, durations and requiring review for continuation
- By encouraging indiscriminate use of broad‑spectrum agents
- By removing all infection treatment guidelines
- By making antibiotics available without prescription
Correct Answer: By restricting certain antibiotics, defining indications, durations and requiring review for continuation
Q24. Which element improves prescriber adherence to formulary recommendations?
- Engaging clinicians in selection, providing clear guidelines and easy access to formulary information
- Keeping formulary inaccessible and secret
- Forcing staff without education
- Changing recommendations daily without notice
Correct Answer: Engaging clinicians in selection, providing clear guidelines and easy access to formulary information
Q25. What role does drug stability data play in formulary content?
- Guides storage, preparation, beyond‑use dating and safe administration practices
- Is irrelevant to medication safety
- Only affects marketing strategies
- Determines the hospital logo color
Correct Answer: Guides storage, preparation, beyond‑use dating and safe administration practices
Q26. Which of the following indicates a well‑prepared formulary monograph?
- Balanced summary of clinical evidence, dosing, contraindications, monitoring, cost and references
- A single sentence stating the drug exists
- Only manufacturer promotional claims without references
- Handwritten notes with no references
Correct Answer: Balanced summary of clinical evidence, dosing, contraindications, monitoring, cost and references
Q27. In the formulary approval process, conflict of interest is best managed by:
- Not disclosing any affiliations
- Full disclosure and recusal of members with significant financial ties during decision‑making
- Allowing only pharmaceutical sales reps to vote
- Deciding by random selection
Correct Answer: Full disclosure and recusal of members with significant financial ties during decision‑making
Q28. Which technology aids medication reconciliation with the formulary at admission and discharge?
- Electronic Health Record (EHR) integrated with the hospital formulary
- Paper-only bulletin boards
- Staff handwritten notes hidden in lockers
- Telephone directory
Correct Answer: Electronic Health Record (EHR) integrated with the hospital formulary
Q29. What is the impact of including therapeutic guidelines in a formulary?
- Provides standardized, evidence‑based treatment pathways, reducing variability and improving outcomes
- Makes prescribing more chaotic
- Eliminates the need for clinical judgement
- Only increases paperwork without clinical benefit
Correct Answer: Provides standardized, evidence‑based treatment pathways, reducing variability and improving outcomes
Q30. Which performance indicator would signal the need to review a formulary antimicrobial policy?
- Rising rates of resistant organisms and increased antibiotic consumption of restricted agents
- Decline in coffee consumption by staff
- Stable bed occupancy rates
- Number of parking spaces available
Correct Answer: Rising rates of resistant organisms and increased antibiotic consumption of restricted agents
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com