Evidence-Based Medicine (EBM) and the effective use of drug information are fundamental skills for PharmD students and practicing pharmacists. EBM integrates the best research evidence with clinical expertise and patient values to optimize patient care. A core component of this is the ability to formulate answerable clinical questions, efficiently search for, critically appraise, and apply relevant drug information from various resources. Understanding the hierarchy of medical evidence, navigating literature databases like PubMed and Embase, and critically evaluating drug labeling and online health information are all essential for providing informed and patient-centered pharmaceutical care. This quiz will test your knowledge on the core principles of EBM and the practice of providing accurate drug information.
1. Evidence-Based Medicine (EBM) is best defined as the integration of:
- a) Clinical expertise, patient values, and the best research evidence.
- b) Manufacturer’s recommendations and physician’s preference only.
- c) The oldest, most established treatment protocols.
- d) Information found solely on the internet.
Answer: a) Clinical expertise, patient values, and the best research evidence.
2. The first step in the evidence-based medicine process is typically to:
- a) Appraise the evidence found.
- b) Apply the evidence to the patient.
- c) Formulate an answerable clinical question.
- d) Search for relevant literature.
Answer: c) Formulate an answerable clinical question.
3. The PICO framework is commonly used to formulate clinical questions. What does “P” stand for?
- a) Pharmacist
- b) Population, patient, or problem
- c) Protocol
- d) Placebo
Answer: b) Population, patient, or problem
4. Which type of drug information resource provides broad overviews of topics and is a good starting point for general information (e.g., textbooks, review articles)?
- a) Primary literature
- b) Secondary literature
- c) Tertiary literature
- d) Quaternary literature
Answer: c) Tertiary literature
5. Primary literature in drug information consists of:
- a) Textbooks and compendia.
- b) Indexing and abstracting services like PubMed.
- c) Original research articles, such as clinical trials and case reports.
- d) Clinical practice guidelines.
Answer: c) Original research articles, such as clinical trials and case reports.
6. PubMed and Embase are examples of which type of drug information resource?
- a) Primary literature
- b) Secondary literature (indexing/abstracting services that help locate primary literature)
- c) Tertiary literature
- d) Patient education pamphlets
Answer: b) Secondary literature (indexing/abstracting services that help locate primary literature)
7. A potential disadvantage of relying solely on tertiary drug information resources is that they:
- a) Are too difficult to access.
- b) May not be the most current source of information due to publication lag time.
- c) Are always biased.
- d) Do not provide any useful information.
Answer: b) May not be the most current source of information due to publication lag time.
8. When formulating an effective response to a drug information question, it is crucial to first:
- a) Provide your personal opinion.
- b) Identify the actual drug information needs of the requestor by understanding the context.
- c) Search for the answer in a general internet search engine.
- d) Recommend the most expensive drug.
Answer: b) Identify the actual drug information needs of the requestor by understanding the context.
9. MeSH (Medical Subject Headings) terms are used in which database to index articles and improve search precision?
- a) Google Scholar
- b) Embase
- c) PubMed
- d) Lexicomp
Answer: c) PubMed
10. Emtree is the controlled vocabulary thesaurus used for indexing articles in which database?
- a) PubMed
- b) Cochrane Library
- c) Embase
- d) Web of Science
Answer: c) Embase
11. The “drug labeling” or “package insert” for a prescription drug provides information that is:
- a) Primarily intended for direct-to-consumer advertising.
- b) Approved by the FDA and contains essential information for safe and effective use.
- c) Not legally binding.
- d) Updated daily.
Answer: b) Approved by the FDA and contains essential information for safe and effective use.
12. Which section of a prescription drug’s package insert typically describes its mechanism of action and pharmacokinetics?
- a) Indications and Usage
- b) Clinical Pharmacology
- c) Warnings and Precautions
- d) How Supplied/Storage and Handling
Answer: b) Clinical Pharmacology
13. When evaluating health information found on the internet, which of the following is an important criterion for assessing reliability?
- a) The website has flashy graphics and animations.
- b) The information is current, a
- c) The website sells the product it is describing.
- d) The information is presented by an anonymous author.
Answer: b) The information is current, a
14. A systematic approach to answering drug information questions typically involves which of the following steps?
- a) Guessing the answer based on prior knowledge.
- b) Securing demographics of the requestor, obtaining background information, categorizing the question, performing a search, evaluating evidence, and formulating a response.
- c) Only searching one database.
- d) Providing an answer without citing any sources.
Answer: b) Securing demographics of the requestor, obtaining background information, categorizing the question, performing a search, evaluating evidence, and formulating a response.
15. Which of the following is a critical factor to consider when formulating a response to a drug information query?
- a) The time of day the query is received.
- b) The urgency and context of the request.
- c) The pharmacist’s workload.
- d) The cost of the drug information resource used.
Answer: b) The urgency and context of the request.
16. The “analysis and synthesis” step in formulating a drug information response involves:
- a) Simply copying information from a textbook.
- b) Critically evaluating the information gathered from various sources and coherently combining it to directly address the query.
- c) Asking the requestor to find the answer themselves.
- d) Disregarding any conflicting information.
Answer: b) Critically evaluating the information gathered from various sources and coherently combining it to directly address the query.
17. The “Indications and Usage” section of a drug label lists:
- a) All known side effects of the drug.
- b) The FDA-approved conditions for which the drug can be used.
- c) The chemical structure of the drug.
- d) The cost of the drug.
Answer: b) The FDA-approved conditions for which the drug can be used.
18. Using Boolean operators (AND, OR, NOT) in a literature search helps to:
- a) Make the search results less relevant.
- b) Broaden or narrow the search to retrieve more specific and relevant results.
- c) Translate articles into different languages.
- d) Automatically appraise the quality of the articles.
Answer: b) Broaden or narrow the search to retrieve more specific and relevant results.
19. The “Adverse Reactions” section of a drug label contains information about:
- a) How to administer the drug.
- b) Undesirable effects observed in clinical trials or post-marketing surveillance.
- c) The drug’s mechanism of action.
- d) The available dosage forms.
Answer: b) Undesirable effects observed in clinical trials or post-marketing surveillance.
20. Which of the following is a characteristic of a high-quality health information website for patients?
- a) It primarily promotes a specific product.
- b) It clearly identifies the authors/sources of information and provides evidence to support claims.
- c) It uses highly technical medical jargon without explanation.
- d) It does not provide a date for when the information was last updated.
Answer: b) It clearly identifies the authors/sources of information and provides evidence to support claims.
21. What is a potential limitation of using Embase for a literature search compared to PubMed?
- a) Embase has a narrower scope of international journals.
- b) Embase may have more extensive coverage of European and international journals, but access might be subscription-based for some institutions.
- c) Embase does not use a controlled vocabulary.
- d) Embase only indexes articles published in English.
Answer: b) Embase may have more extensive coverage of European and international journals, but access might be subscription-based for some institutions.
22. “Pharmacological Action (PA)” headings in PubMed can be useful for finding drugs that:
- a) Are manufactured by a specific company.
- b) Have a particular mechanism of action or physiological effect.
- c) Are in a specific dosage form.
- d) Have been recently approved.
Answer: b) Have a particular mechanism of action or physiological effect.
23. What does the “Contraindications” section of a drug label specify?
- a) Situations in which the drug should be used.
- b) Situations in which the drug should NOT be used because the risk outweighs any potential therapeutic benefit.
- c) Recommended dosage adjustments.
- d) Available package sizes.
Answer: b) Situations in which the drug should NOT be used because the risk outweighs any potential therapeutic benefit.
24. One of the “best practices required to address drug information questions” as per PHA5244 objectives is to:
- a) Always provide the longest possible answer.
- b) Use a systematic approach to ensure accuracy and completeness.
- c) Rely solely on memory.
- d) Discourage follow-up questions.
Answer: b) Use a systematic approach to ensure accuracy and completeness.
25. Barriers to implementing evidence-based practices in healthcare can include:
- a) Too much high-quality evidence being available.
- b) Lack of time, resources, or skills to access and appraise evidence.
- c) Patients being overly informed.
- d) Guidelines being too easy to follow.
Answer: b) Lack of time, resources, or skills to access and appraise evidence.
26. What is a key consideration when using tertiary resources like textbooks for drug information?
- a) They are always the most up-to-date source.
- b) They are good for general background but should be supplemented with more current primary or secondary literature for specific or recent information.
- c) They are primarily opinion-based.
- d) They are free of any editorial bias.
Answer: b) They are good for general background but should be supplemented with more current primary or secondary literature for specific or recent information.
27. When evaluating an internet health information tutorial, what is one step you should summarize?
- a) How many advertisements are on the page.
- b) Steps involved in evaluating health information, such as checking the source, date, and author credentials.
- c) The download speed of the tutorial.
- d) The color scheme of the website.
Answer: b) Steps involved in evaluating health information, such as checking the source, date, and author credentials.
28. The “Warnings and Precautions” section of a drug label highlights:
- a) The drug’s approved uses.
- b) Clinically significant adverse reactions and other potential safety hazards that clinicians should be aware of.
- c) How to compound the medication.
- d) The patent information.
Answer: b) Clinically significant adverse reactions and other potential safety hazards that clinicians should be aware of.
29. According to PHA5244, “participatory medicine” describes a model where:
- a) Physicians make all decisions without patient input.
- b) The dynamic between the patient and healthcare professional changes, with patients being more involved in their care.
- c) Only pharmacists participate in patient care.
- d) Insurance companies dictate all treatment.
Answer: b) The dynamic between the patient and healthcare professional changes, with patients being more involved in their care.
30. When searching PubMed, using filters (e.g., for article type, publication date, species) can help to:
- a) Increase the number of irrelevant results.
- b) Refine the search results to be more specific to the clinical question.
- c) Slow down the search process significantly.
- d) Automatically synthesize the evidence.
Answer: b) Refine the search results to be more specific to the clinical question.
31. A “Black Box Warning” in a drug’s labeling is found in which section of the package insert?
- a) At the very end of the document.
- b) It is typically presented prominently, often at the beginning of the prescribing information, to highlight serious risks.
- c) Only in the patient package insert.
- d) Only in the adverse reactions section.
Answer: b) It is typically presented prominently, often at the beginning of the prescribing information, to highlight serious risks.
32. When providing drug information, it is important to communicate it in a way that is:
- a) As technical and complex as possible to demonstrate expertise.
- b) Clear, concise, accurate, and understandable to the requestor.
- c) Biased towards the most expensive option.
- d) Based solely on anecdotal evidence.
Answer: b) Clear, concise, accurate, and understandable to the requestor.
33. Which of the following resources is specifically known for its collection of systematic reviews?
- a) Micromedex
- b) The Cochrane Library
- c) Facts & Comparisons
- d) ClinicalKey
Answer: b) The Cochrane Library
34. The “Drug Interactions” section of a package insert provides information on:
- a) How the drug interacts with food coloring.
- b) Clinically significant interactions with other drugs, foods, or laboratory tests.
- c) The interaction between the drug and its packaging.
- d) The social interactions of patients taking the drug.
Answer: b) Clinically significant interactions with other drugs, foods, or laboratory tests.
35. A common pitfall in a PubMed search strategy can be:
- a) Using too many MeSH terms.
- b) Using overly broad search terms that yield too many irrelevant results, or overly narrow terms that miss relevant articles.
- c) Limiting the search to English language only.
- d) Sorting results by publication date.
Answer: b) Using overly broad search terms that yield too many irrelevant results, or overly narrow terms that miss relevant articles.
36. The overall goal of applying EBM principles in pharmacy practice is to:
- a) Reduce the pharmacist’s workload.
- b) Improve patient outcomes by making informed clinical decisions.
- c) Increase the sales of specific medications.
- d) Standardize all patient treatments regardless of individual differences.
Answer: b) Improve patient outcomes by making informed clinical decisions.
37. If a drug label contains information about use in specific populations (e.g., pediatrics, geriatrics, renal impairment), where is this typically found?
- a) Only in the “How Supplied” section.
- b) In a dedicated “Use in Specific Populations” section.
- c) It is usually omitted to save space.
- d) In the “Nonclinical Toxicology” section.
Answer: b) In a dedicated “Use in Specific Populations” section.
38. When faced with a drug information question about a very new or investigational drug, which type of literature might be most crucial?
- a) Older textbooks.
- b) Recent primary literature (e.g., newly published clinical trials, conference abstracts).
- c) General consumer websites.
- d) Historical archives.
Answer: b) Recent primary literature (e.g., newly published clinical trials, conference abstracts).
39. Why is it important to consider the date of information when using drug information resources?
- a) Older information is always more reliable.
- b) Medical knowledge and drug information are constantly evolving, so current information is generally preferred.
- c) The date helps determine the price of the resource.
- d) It is not important if the source is a textbook.
Answer: b) Medical knowledge and drug information are constantly evolving, so current information is generally preferred.
40. The “Dosage and Administration” section of a drug label provides information on:
- a) The drug’s cost.
- b) Recommended doses, routes of administration, and any necessary modifications for specific populations.
- c) The drug’s discovery process.
- d) The names of the clinical investigators.
Answer: b) Recommended doses, routes of administration, and any necessary modifications for specific populations.
41. One of the key skills in EBM is “critical appraisal,” which involves:
- a) Accepting all published research as truth.
- b) Systematically evaluating the validity, results, and relevance of research evidence.
- c) Only reading the abstract of an article.
- d) Memorizing drug names.
Answer: b) Systematically evaluating the validity, results, and relevance of research evidence.
42. Tertiary drug information resources often compile information from:
- a) Patient interviews only.
- b) Primary and secondary literature.
- c) Social media.
- d) Manufacturer advertisements.
Answer: b) Primary and secondary literature.
43. When searching for information on adverse effects, a useful strategy might be to use terms related to the specific adverse effect AND:
- a) The drug’s color.
- b) The drug’s name or class.
- c) The manufacturer’s stock price.
- d) The pharmacy’s location.
Answer: b) The drug’s name or class.
44. The limitations of drug labeling for dietary supplements include that they:
- a) Require FDA pre-approval for safety and efficacy similar to drugs.
- b) Cannot make disease claims (i.e., claim to diagnose, cure, mitigate, treat, or prevent disease) but can make structure/function claims.
- c) Are always more effective than prescription drugs.
- d) Must list all potential drug interactions.
Answer: b) Cannot make disease claims (i.e., claim to diagnose, cure, mitigate, treat, or prevent disease) but can make structure/function claims.
45. Effective communication of drug information to a patient involves:
- a) Using only complex medical terminology.
- b) Tailoring the information to the patient’s level of understanding and encouraging questions.
- c) Providing all information in written form only.
- d) Rushing through the explanation to save time.
Answer: b) Tailoring the information to the patient’s level of understanding and encouraging questions.
46. A “systematic review” aims to answer a specific clinical question by:
- a) Conducting new experiments.
- b) Summarizing all relevant primary research studies that meet pre-specified eligibility criteria.
- c) Polling experts for their opinions.
- d) Analyzing sales data for a particular drug.
Answer: b) Summarizing all relevant primary research studies that meet pre-specified eligibility criteria.
47. The hierarchy of evidence places which of the following study types near the top for questions about therapy effectiveness?
- a) Case reports.
- b) Expert opinion.
- c) Systematic reviews and meta-analyses of high-quality randomized controlled trials.
- d) Animal studies.
Answer: c) Systematic reviews and meta-analyses of high-quality randomized controlled trials.
48. When you “identify appropriate resources and search strategies to answer a specific patient care question” (PHA5244 objective), you are essentially:
- a) Randomly picking a database.
- b) Matching the type of question to the most suitable type of resource and using efficient search techniques.
- c) Asking colleagues for their opinions only.
- d) Only using Google.
Answer: b) Matching the type of question to the most suitable type of resource and using efficient search techniques.
49. One of the challenges in keeping up with drug information is:
- a) The slow pace of new drug development.
- b) The vast and rapidly expanding volume of medical literature.
- c) The lack of online resources.
- d) The static nature of medical knowledge.
Answer: b) The vast and rapidly expanding volume of medical literature.
50. The ultimate aim of providing evidence-based drug information is to:
- a) Demonstrate superior knowledge.
- b) Promote the rational and safe use of medications to optimize patient outcomes.
- c) Increase prescription volume.
- d) Confuse the requestor with too much data.
Answer: b) Promote the rational and safe use of medications to optimize patient outcomes.