MCQ Quiz: Special Pharmacies

Beyond the familiar community and hospital settings, pharmacy practice encompasses a variety of specialized areas designed to meet unique patient needs, each with its own set of regulations and operational challenges. From the high-touch management of complex biologics in specialty pharmacy to the stringent rules of sterile compounding and nuclear pharmacy, these fields represent unique career paths for pharmacists. The principles governing these practices are found within the Principles of Pharmacy Law and Ethics and *Sterile Compounding* courses. This quiz will test your knowledge on the distinct roles, regulations, and functions of these special pharmacies.

1. A “specialty pharmacy” is best defined as a pharmacy that:

• a. Only dispenses over-the-counter medications.
• b. Manages high-cost, high-touch medication therapies for patients with complex or rare diseases.
• c. Is located inside a grocery store.
• d. Only performs non-sterile compounding.

Answer: b. Manages high-cost, high-touch medication therapies for patients with complex or rare diseases.

2. Which of the following disease states is most likely to be managed by a specialty pharmacy?

• a. Uncomplicated hypertension
• b. Seasonal allergies
• c. Rheumatoid arthritis treated with a biologic agent
• d. A common cold

Answer: c. Rheumatoid arthritis treated with a biologic agent

3. The preparation of a customized oral suspension from crushed tablets for a child is an example of:

• a. Sterile compounding
• b. Non-sterile compounding
• c. Manufacturing
• d. A medication error

Answer: b. Non-sterile compounding

4. Which USP Chapter provides the primary standards for non-sterile compounding?

• a. USP <797>
• b. USP <800>
• c. USP <795>
• d. USP <71>

Answer: c. USP <795>

5. Which USP Chapter provides the primary standards for sterile compounding?

• a. USP <797>
• b. USP <800>
• c. USP <795>
• d. USP <1160>

Answer: a. USP <797>

6. A nuclear pharmacy is a specialized practice setting that handles:

• a. Only controlled substances.
• b. Only hazardous chemotherapy drugs.
• c. Only over-the-counter medications.
• d. Radioactive materials (radiopharmaceuticals).

Answer: d. Radioactive materials (radiopharmaceuticals).

7. In addition to the State Board of Pharmacy, nuclear pharmacies are heavily regulated by which federal agency?

• a. The Food and Drug Administration (FDA)
• b. The Drug Enforcement Administration (DEA)
• c. The Nuclear Regulatory Commission (NRC)
• d. The Federal Trade Commission (FTC)

Answer: c. The Nuclear Regulatory Commission (NRC)

8. A key service provided by a long-term care (LTCF) pharmacy to a skilled nursing facility is:

• a. Providing emergency room services.
• b. Performing a drug regimen review (DRR) for each resident.
• c. Managing the facility’s food service.
• d. Prescribing all medications for residents.

Answer: b. Performing a drug regimen review (DRR) for each resident.

9. The pharmacist providing services to a nursing home is often referred to as a(n):

• a. Investigational drug pharmacist
• b. Nuclear pharmacist
• c. Consultant pharmacist
• d. Informatics pharmacist

Answer: c. Consultant pharmacist

10. A “503B Outsourcing Facility” differs from a traditional “503A” compounding pharmacy in that it:

• a. Can compound large batches of sterile products without patient-specific prescriptions.
• b. Is not subject to FDA oversight.
• c. Only performs non-sterile compounding.
• d. Does not need to follow Good Manufacturing Practices (GMP).

Answer: a. Can compound large batches of sterile products without patient-specific prescriptions.

11. The Sterile Compounding course provides the foundation for working in specialized compounding pharmacies.

• a. True
• b. False

Answer: a. True

12. The “triad relationship” is a cornerstone of traditional compounding and refers to the relationship between the:

• a. Pharmacist, technician, and patient.
• b. Patient, prescriber, and pharmacist.
• c. Wholesaler, pharmacy, and insurance company.
• d. FDA, DEA, and Board of Pharmacy.

Answer: b. Patient, prescriber, and pharmacist.

13. A key characteristic of specialty pharmacy services is:

• a. A low-touch, high-volume dispensing model.
• b. A focus on minimizing patient communication.
• c. A high-touch model involving intensive patient monitoring, education, and adherence management.
• d. Selling only over-the-counter medications.

Answer: c. A high-touch model involving intensive patient monitoring, education, and adherence management.

14. A radiopharmaceutical used for a PET scan is an example of a product dispensed from a:

• a. Compounding pharmacy
• b. Specialty pharmacy
• c. LTCF pharmacy
• d. Nuclear pharmacy

Answer: d. Nuclear pharmacy

15. Performing compounding techniques in accordance with USP standards is a key objective in the IPPE courses.

• a. True
• b. False

Answer: a. True

16. Which of the following is NOT typically dispensed from a specialty pharmacy?

• a. Oral oncology agents
• b. Self-injectable biologics for psoriasis
• c. Common antibiotics like amoxicillin
• d. Growth hormone

Answer: c. Common antibiotics like amoxicillin

17. The principles of pharmacy law are foundational for operating any type of special pharmacy.

• a. True
• b. False

Answer: a. True

18. A key safety principle in nuclear pharmacy is managing:

• a. The cost of the drugs.
• b. Patient adherence.
• c. Radiation exposure to the staff (ALARA principle).
• d. Drug shortages.

Answer: c. Radiation exposure to the staff (ALARA principle).

19. A pharmacist working in a LTCF pharmacy would be very familiar with the medication needs of which population?

• a. Pediatric patients
• b. Geriatric patients
• c. Healthy young adults
• d. Pregnant patients

Answer: b. Geriatric patients

20. A “drug regimen review” (DRR) in a nursing home involves:

• a. A pharmacist retrospectively reviewing a resident’s medication chart to identify and resolve potential problems.
• b. The nurse checking the MAR before giving a medication.
• c. The physician writing a new prescription.
• d. The patient reviewing their own medications.

Answer: a. A pharmacist retrospectively reviewing a resident’s medication chart to identify and resolve potential problems.

21. A pharmacy that only prepares patient-specific prescriptions would be classified as a:

• a. 503A Pharmacy
• b. 503B Outsourcing Facility
• c. Manufacturer
• d. Wholesaler

Answer: a. 503A Pharmacy

22. A key component of specialty pharmacy care is assisting patients with:

• a. Finding the nearest grocery store.
• b. Navigating complex insurance requirements and securing financial assistance.
• c. Choosing a primary care physician.
• d. Compounding their own medications.

Answer: b. Navigating complex insurance requirements and securing financial assistance.

23. The law course PHA5703 provides the foundation for understanding the regulations of special pharmacies.

• a. True
• b. False

Answer: a. True

24. An active learning session on sterile compounding is part of which course?

• a. PHA5104 Sterile Compounding
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5104 Sterile Compounding

25. Which of the following is an example of non-sterile compounding?

• a. Preparing an IV bag of dopamine.
• b. Reconstituting an oral antibiotic suspension.
• c. Preparing a “magic mouthwash” from several ingredients.
• d. Drawing up a dose of insulin in a syringe.

Answer: c. Preparing a “magic mouthwash” from several ingredients.

26. The half-life of a radionuclide is a critical parameter in nuclear pharmacy because it determines:

• a. The drug’s efficacy.
• b. The drug’s expiration time, which is often hours or days.
• c. The drug’s cost.
• d. The drug’s route of administration.

Answer: b. The drug’s expiration time, which is often hours or days.

27. A key reason a physician might prescribe a compounded medication is:

• a. The patient needs a specific strength that is not commercially available.
• b. The patient is allergic to an inactive ingredient in a commercial product.
• c. The patient requires a different dosage form (e.g., a liquid instead of a tablet).
• d. All of the above.

Answer: d. All of the above.

28. An active learning session on medication safety would be relevant to all pharmacy practice settings.

• a. True
• b. False

Answer: a. True

29. Specialty pharmacies often have to manage and dispense medications with what special FDA requirement?

• a. A Risk Evaluation and Mitigation Strategy (REMS)
• b. A short expiration date.
• c. A requirement for refrigeration.
• d. A need for compounding.

Answer: a. A Risk Evaluation and Mitigation Strategy (REMS)

30. The “Geriatrics” module is particularly relevant to which special pharmacy practice?

• a. Nuclear pharmacy
• b. Long-Term Care (LTCF) pharmacy
• c. Specialty pharmacy for pediatric patients
• d. Compounding pharmacy

Answer: b. Long-Term Care (LTCF) pharmacy

31. What does “ALARA” stand for in nuclear pharmacy?

• a. As Low As Reasonably Achievable
• b. A Long And Risky Activity
• c. Always Label All Radioactive Articles
• d. A Low-Activity Radioactive Area

Answer: a. As Low As Reasonably Achievable

32. A pharmacist working in specialty pharmacy must have deep knowledge of:

• a. Only common primary care drugs.
• b. Complex disease states like oncology and immunology.
• c. Only over-the-counter medications.
• d. Only pharmacy law.

Answer: b. Complex disease states like oncology and immunology.

33. The principles of sterile compounding are covered in the PHA5104 course.

• a. True
• b. False

Answer: a. True

34. A long-term care pharmacy often dispenses medications in what type of packaging to help with administration in the nursing home?

• a. Standard 30-day vials
• b. Unit-dose blister packs or “bingo cards”
• c. Large stock bottles
• d. Inhalers

Answer: b. Unit-dose blister packs or “bingo cards”

35. A “consultant pharmacist” is one who:

• a. Dispenses medications in a community pharmacy.
• b. Works for a drug manufacturer.
• c. Performs drug regimen reviews and provides clinical guidance, typically in a setting like a nursing home.
• d. Works for the Board of Pharmacy.

Answer: c. Performs drug regimen reviews and provides clinical guidance, typically in a setting like a nursing home.

36. A significant challenge for specialty pharmacies is managing the:

• a. “Cold chain” for many biologic medications that require refrigeration.
• b. High cost of the medications they dispense.
• c. Complex prior authorization process.
• d. All of the above.

Answer: d. All of the above.

37. USP <800> provides standards for handling what type of drugs in a pharmacy?

• a. Sterile drugs
• b. Non-sterile drugs
• c. Hazardous drugs
• d. Controlled substances

Answer: c. Hazardous drugs

38. The IPPE courses require students to demonstrate competency in compounding.

• a. True
• b. False

Answer: a. True

39. A patient is prescribed a medication that is only available through a limited distribution network. They will likely need to get it from a:

• a. Standard community pharmacy
• b. Nuclear pharmacy
• c. Specialty pharmacy
• d. Compounding pharmacy

Answer: c. Specialty pharmacy

40. An active learning session on compounding is part of which course?

• a. PHA5104 Sterile Compounding
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5104 Sterile Compounding

41. The main difference in regulation between a 503A and 503B facility is that 503B facilities:

• a. Are subject to less regulation.
• b. Can compound for “office use” and are subject to FDA oversight and Current Good Manufacturing Practices (cGMP).
• c. Do not require a licensed pharmacist.
• d. Can only compound non-sterile products.

Answer: b. Can compound for “office use” and are subject to FDA oversight and Current Good Manufacturing Practices (cGMP).

42. Which of the following is NOT a characteristic of a specialty drug?

• a. High cost
• b. Treats a common, acute condition like a headache.
• c. Requires special handling or administration.
• d. Has a complex side effect profile requiring significant monitoring.

Answer: b. Treats a common, acute condition like a headache.

43. A pharmacist working in any special pharmacy setting must adhere to the laws and regulations of:

• a. The FDA
• b. The DEA
• c. Their State Board of Pharmacy
• d. All of the above

Answer: d. All of the above

44. “Radiopharmaceuticals” are unique because:

• a. They are not drugs.
• b. Their efficacy depends on their radioactive properties and they have very short expiration times.
• c. They can be handled by anyone without special training.
• d. They are only used to treat cancer.

Answer: b. Their efficacy depends on their radioactive properties and they have very short expiration times.

45. A key aspect of “high-touch” care in specialty pharmacy is:

• a. Regular, proactive outreach to the patient.
• b. Limiting all communication to email.
• c. Only talking to the patient’s physician.
• d. Dispensing the medication as quickly as possible with no follow-up.

Answer: a. Regular, proactive outreach to the patient.

46. Which of the following tasks would a consultant pharmacist perform during a drug regimen review?

• a. Check for unnecessary medications.
• b. Screen for drug interactions.
• c. Ensure appropriate dosing for the patient’s age and renal function.
• d. All of the above.

Answer: d. All of the above.

47. The curriculum’s coverage of geriatrics is highly relevant to LTCF pharmacy practice.

• a. True
• b. False

Answer: a. True

48. An active learning session on compounding is part of which course?

• a. PHA5104 Sterile Compounding
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5104 Sterile Compounding

49. The overall purpose of having different types of special pharmacies is to:

• a. Make the healthcare system more complicated.
• b. Provide the focused expertise, equipment, and processes needed to safely and effectively manage specific types of patients and therapies.
• c. Increase the cost of medications.
• d. Limit patient access to care.

Answer: b. Provide the focused expertise, equipment, and processes needed to safely and effectively manage specific types of patients and therapies.

50. The ultimate reason to learn about special pharmacies is to:

• a. Understand the diverse career paths available to pharmacists.
• b. Appreciate the unique regulatory and clinical challenges of different practice settings.
• c. Be able to provide competent care in any setting.
• d. All of the above.

Answer: d. All of the above.