Hospital formulary development and guidelines MCQs With Answer

Introduction:

Hospital formularies are structured, evidence-based lists of medications selected to optimize patient care, safety, and cost-effectiveness within a healthcare facility. For M.Pharm students, understanding formulary development and guideline implementation is essential for roles in clinical pharmacy, drug policy, and therapeutic decision-making. This blog presents targeted multiple-choice questions with answers that probe core concepts such as formulary types, selection criteria, Pharmacy & Therapeutics (P&T) committee functions, therapeutic interchange, drug utilization evaluation, and stewardship principles. These MCQs are designed to deepen your grasp of practical processes, regulatory considerations, and strategies used to maintain an effective and safe hospital formulary aligned with institutional goals.

Q1. What is the primary purpose of a hospital formulary?

• To list every drug available on the market
• To provide an evidence-based, institution-specific list of approved medications for safe, effective, and cost-conscious patient care
• To mandate a fixed prescription pattern for all clinicians
• To act as a marketing tool for pharmaceutical companies

Correct Answer: To provide an evidence-based, institution-specific list of approved medications for safe, effective, and cost-conscious patient care

Q2. Which committee is primarily responsible for formulary development and maintenance in a hospital?

• Infection Control Committee
• Nutrition and Dietetics Committee
• Pharmacy and Therapeutics (P&T) Committee
• Biomedical Engineering Committee

Correct Answer: Pharmacy and Therapeutics (P&T) Committee

Q3. What is a closed formulary?

• A formulary that includes all available drugs without restriction
• A restrictive list where only selected medications are available for use, requiring approval for non-formulary items
• A formulary limited to generic drugs only
• A formulary used only for outpatient settings

Correct Answer: A restrictive list where only selected medications are available for use, requiring approval for non-formulary items

Q4. Which of the following is NOT a usual criterion for adding a drug to a hospital formulary?

• Clinical efficacy and safety evidence
• Cost-effectiveness and budget impact
• Manufacturer sales incentives to prescribers
• Availability of therapeutic alternatives

Correct Answer: Manufacturer sales incentives to prescribers

Q5. Therapeutic interchange in a formulary context means:

• Switching a patient from a prescription to an over-the-counter product without consultation
• Substituting a prescribed drug with a different drug within the same therapeutic class that is on the formulary, following policy
• Automatically substituting brand drugs with generics regardless of clinical equivalence
• Transferring medications between hospital departments

Correct Answer: Substituting a prescribed drug with a different drug within the same therapeutic class that is on the formulary, following policy

Q6. Drug Utilization Evaluation (DUE) in formulary management primarily aims to:

• Increase sales of new drugs
• Evaluate prescribing patterns to ensure appropriate, safe, and cost-effective use of medications
• Monitor only adverse drug reactions
• Standardize all prescriptions to a single dose for every patient

Correct Answer: Evaluate prescribing patterns to ensure appropriate, safe, and cost-effective use of medications

Q7. Which metric is most appropriate to assess the economic impact of a formulary decision?

• Number of formulary meetings held
• Drug acquisition cost per defined daily dose (DDD) and overall budget impact analysis
• Frequency of staff training sessions
• Number of non-formulary requests

Correct Answer: Drug acquisition cost per defined daily dose (DDD) and overall budget impact analysis

Q8. In electronic formulary systems, which feature most improves safe prescribing?

• Automatic promotional pop-ups from manufacturers
• Clinical decision support with dosing, allergy checks, and interaction alerts
• High-resolution drug images
• Unrestricted free-text drug entries

Correct Answer: Clinical decision support with dosing, allergy checks, and interaction alerts

Q9. Which statement best describes a therapeutic guideline associated with a formulary?

• A legal document forcing clinicians to prescribe only one drug
• An evidence-based recommendation that standardizes management of specific conditions and aligns with formulary choices
• A marketing leaflet for new drugs
• An administrative checklist for pharmacy inventory only

Correct Answer: An evidence-based recommendation that standardizes management of specific conditions and aligns with formulary choices

Q10. Which is a key role of clinical pharmacists in formulary development?

• Creating demand for branded products
• Conducting literature reviews, assessing therapeutic value, participating in P&T deliberations, and implementing guidelines
• Only dispensing medications as prescribed without input on formulary content
• Replacing physicians in diagnosis

Correct Answer: Conducting literature reviews, assessing therapeutic value, participating in P&T deliberations, and implementing guidelines

Q11. How should off-label drug use be managed within a hospital formulary?

• Always banned without exceptions
• Allowed without documentation if the prescriber feels confident
• Addressed with a documented policy, evidence review, informed consent when appropriate, and P&T approval for formulary inclusion
• Mandated as the first-line approach for new indications

Correct Answer: Addressed with a documented policy, evidence review, informed consent when appropriate, and P&T approval for formulary inclusion

Q12. Which process helps maintain currency of a formulary list?

• Annual or rolling review of medications, post-marketing safety updates, and feedback from clinical audits
• Freezing the formulary for five years
• Updating only when a drug is discontinued by the manufacturer
• Relying solely on sales data for changes

Correct Answer: Annual or rolling review of medications, post-marketing safety updates, and feedback from clinical audits

Q13. Which action is central to antimicrobial stewardship linked to the formulary?

• Allowing unrestricted use of broad-spectrum antibiotics
• Formulary restrictions for selected antibiotics, preauthorization, and guideline-driven empirical therapy
• Eliminating formulary controls for antimicrobials
• Substituting antibiotics based on brand preference

Correct Answer: Formulary restrictions for selected antibiotics, preauthorization, and guideline-driven empirical therapy

Q14. What is the difference between a formulary and a hospital stock list?

• There is no difference; both terms are interchangeable
• Formulary is an evidence-based list of approved therapies; stock list is the inventory of pharmaceuticals physically available at a given time
• Stock list is only used by clinicians for prescribing
• Formulary only contains over-the-counter products while stock list contains prescription drugs

Correct Answer: Formulary is an evidence-based list of approved therapies; stock list is the inventory of pharmaceuticals physically available at a given time

Q15. Which element is essential in a formulary submission dossier for a new drug?

• Only the manufacturer’s marketing brochure
• Comprehensive evidence summary including clinical trials, safety profile, cost-effectiveness, and proposed place in therapy
• Prescribers’ personal testimonials without supporting data
• Only local prescribing trends without clinical evidence

Correct Answer: Comprehensive evidence summary including clinical trials, safety profile, cost-effectiveness, and proposed place in therapy

Q16. Which outcome indicator is useful to evaluate clinical impact of a formulary intervention?

• Change in stockroom layout
• Rates of medication errors, clinical endpoints (e.g., infection clearance), length of stay, and readmission related to drug therapy
• Number of formulary pages printed
• Frequency of vendor visits

Correct Answer: Rates of medication errors, clinical endpoints (e.g., infection clearance), length of stay, and readmission related to drug therapy

Q17. How should conflicts of interest be managed in P&T committee decisions?

• Ignore declared conflicts as irrelevant
• Require disclosure, recusal from voting or discussion when conflicts exist, and transparent documentation
• Allow pharmaceutical representatives to vote on formulary items
• Delegate all decisions to marketing teams

Correct Answer: Require disclosure, recusal from voting or discussion when conflicts exist, and transparent documentation

Q18. Which strategy improves adherence to formulary guidelines among prescribers?

• Penalizing prescribers without education or feedback
• Combining education, easy access to guidelines, audit-and-feedback, and clinical decision support
• Restricting all prescribing to administrative staff
• Publishing guidelines only in archived paper form

Correct Answer: Combining education, easy access to guidelines, audit-and-feedback, and clinical decision support

Q19. During drug shortages, what is a key formulary role?

• Immediately removing all alternatives from the formulary
• Implementing substitution protocols, prioritizing use for critical indications, and communicating alternatives to clinicians
• Continuing usual prescribing with no communication
• Ordering excess stock regardless of need

Correct Answer: Implementing substitution protocols, prioritizing use for critical indications, and communicating alternatives to clinicians

Q20. Which practice supports pharmacoeconomic evaluations within formulary decisions?

• Relying solely on unit acquisition price without considering outcomes and total cost of care
• Performing cost-utility or cost-effectiveness analyses considering clinical outcomes, adverse events, and health system costs
• Using only international prices without local context
• Ignoring long-term costs to favor short-term savings

Correct Answer: Performing cost-utility or cost-effectiveness analyses considering clinical outcomes, adverse events, and health system costs

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