Indiana Pharmacist Licensure Exam with
Practice Questions And Correct Answers
(Verified A
1. A pharmacist in Indiana receives a faxed prescription for a Schedule II controlled
substance from an out-of-state prescriber. Which statement most accurately reflects
Indiana and federal requirements for dispensing?
A. The prescription must be an original written or electronically transmitted prescription;
faxed Schedule II prescriptions are never valid.
B. A faxed Schedule II prescription is valid if the prescriber is DEA-registered and the
pharmacist verifies authenticity, but Indiana limits such dispensing to a 7-day supply.
C. An out-of-state prescriber must be registered with the Indiana Board of Pharmacy in
addition to DEA registration for the prescription to be valid.
D. A faxed Schedule II prescription may be dispensed only for a patient in hospice or
long-term care, or when the prescriber certifies a medical emergency.
Answer: D. A faxed Schedule II prescription may be dispensed only for a patient in
hospice or long-term care, or when the prescriber certifies a medical emergency.
Rationale: Federal DEA rules allow faxed Schedule II prescriptions only in limited
circumstances (hospice, LTC, or medical emergency with follow-up). Indiana adopts these
federal exceptions; blanket validity or state board registration is incorrect. Option A is too
absolute, B invents a 7-day limit, and C misstates Indiana registration requirements.
Page 1 of 78
,2. A patient with heart failure with reduced ejection fraction is optimized on
guideline-directed therapy but remains symptomatic. Which addition has the
strongest evidence for reducing cardiovascular death and heart failure
hospitalization?
A. Ivabradine
B. Dapagliflozin
C. Hydralazine/isosorbide dinitrate
D. Digoxin
Answer: B. Dapagliflozin
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have robust randomized
evidence for reducing CV death and HF hospitalization in HFrEF regardless of diabetes
status. Ivabradine reduces hospitalization but not mortality; hydralazine/ISDN is primarily
for self-identified Black patients or ACEi/ARB intolerance; digoxin reduces hospitalization
but not mortality.
Page 2 of 78
,3. A prescriber orders vancomycin 1.5 g IV q12h for a patient with a vancomycin
AUC target of 400-600 mg-h/L. Which monitoring strategy best reflects current
consensus guidelines?
A. Trough-only monitoring targeting 15-20 mcg/mL
B. Peak-only monitoring targeting 30-40 mcg/mL
C. AUC-guided dosing using two serum concentrations with Bayesian software
D. Routine monitoring of both peak and trough with a target peak of 20-30 mcg/mL
Answer: C. AUC-guided dosing using two serum concentrations with Bayesian
software
Rationale: The 2020 ASHP/IDSA/PIDS/SIDP vancomycin consensus guidelines recommend
AUC-guided dosing (AUC24 400-600 mg-h/L) over trough-only monitoring to reduce
nephrotoxicity while maintaining efficacy. Trough-only and peak-based strategies are
outdated; routine peak monitoring is not recommended.
4. A patient on warfarin for atrial fibrillation is prescribed a 7-day course of
fluconazole. Which INR monitoring approach is most appropriate?
A. No additional monitoring; fluconazole does not interact with warfarin.
B. Check INR in 3-5 days and consider empiric warfarin dose reduction due to CYP2C9
inhibition.
C. Check INR in 2 weeks; fluconazole only affects warfarin metabolism after 14 days.
D. Switch to a direct oral anticoagulant immediately to avoid interaction.
Answer: B. Check INR in 3-5 days and consider empiric warfarin dose reduction due
to CYP2C9 inhibition.
Rationale: Fluconazole is a potent CYP2C9 inhibitor and can significantly increase INR
within days; close monitoring and possible dose reduction are required. Option A is false,
C misstates the timeline, and D is not automatically indicated for a short antifungal course.
Page 3 of 78
, 5. A pharmacist is preparing a compounded sterile preparation (CSP) in a USP <797>
compliant facility. Which action is required for a medium-risk CSP with a beyond-use
date (BUD) exceeding 24 hours at room temperature?
A. Preparation must occur in an ISO Class 5 environment with no further requirements.
B. Preparation must occur in an ISO Class 5 PEC located in an ISO Class 7 buffer area,
and the CSP must be tested for sterility.
C. Preparation must occur in an ISO Class 5 PEC in an ISO Class 7 buffer area, with
demonstrated air quality and documented personnel competency.
D. Preparation must occur in an ISO Class 5 PEC in an ISO Class 8 clean room with
daily particle counts.
Answer: C. Preparation must occur in an ISO Class 5 PEC in an ISO Class 7 buffer
area, with demonstrated air quality and documented personnel competency.
Rationale: USP <797> requires medium-risk CSPs with extended BUDs to be prepared in
an ISO Class 5 PEC within an ISO Class 7 buffer area, with environmental monitoring and
validated personnel. Sterility testing is not routinely required for medium-risk CSPs, and
ISO Class 8 is insufficient for extended BUDs.
6. A patient is prescribed a continuous IV infusion of a drug with a narrow
therapeutic index. Which pharmacokinetic parameter is most critical to determine the
time to reach steady-state concentration?
A. Volume of distribution (Vd)
B. Clearance (CL)
C. Elimination half-life (t½)
D. Peak plasma concentration (Cmax)
Answer: C. Elimination half-life (t½)
Rationale: Time to steady state depends on elimination half-life (approximately 4-5
half-lives), which itself is determined by Vd and CL. Vd and CL individually do not directly
define time to steady state; Cmax is a result, not a determinant.
Page 4 of 78
Practice Questions And Correct Answers
(Verified A
1. A pharmacist in Indiana receives a faxed prescription for a Schedule II controlled
substance from an out-of-state prescriber. Which statement most accurately reflects
Indiana and federal requirements for dispensing?
A. The prescription must be an original written or electronically transmitted prescription;
faxed Schedule II prescriptions are never valid.
B. A faxed Schedule II prescription is valid if the prescriber is DEA-registered and the
pharmacist verifies authenticity, but Indiana limits such dispensing to a 7-day supply.
C. An out-of-state prescriber must be registered with the Indiana Board of Pharmacy in
addition to DEA registration for the prescription to be valid.
D. A faxed Schedule II prescription may be dispensed only for a patient in hospice or
long-term care, or when the prescriber certifies a medical emergency.
Answer: D. A faxed Schedule II prescription may be dispensed only for a patient in
hospice or long-term care, or when the prescriber certifies a medical emergency.
Rationale: Federal DEA rules allow faxed Schedule II prescriptions only in limited
circumstances (hospice, LTC, or medical emergency with follow-up). Indiana adopts these
federal exceptions; blanket validity or state board registration is incorrect. Option A is too
absolute, B invents a 7-day limit, and C misstates Indiana registration requirements.
Page 1 of 78
,2. A patient with heart failure with reduced ejection fraction is optimized on
guideline-directed therapy but remains symptomatic. Which addition has the
strongest evidence for reducing cardiovascular death and heart failure
hospitalization?
A. Ivabradine
B. Dapagliflozin
C. Hydralazine/isosorbide dinitrate
D. Digoxin
Answer: B. Dapagliflozin
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have robust randomized
evidence for reducing CV death and HF hospitalization in HFrEF regardless of diabetes
status. Ivabradine reduces hospitalization but not mortality; hydralazine/ISDN is primarily
for self-identified Black patients or ACEi/ARB intolerance; digoxin reduces hospitalization
but not mortality.
Page 2 of 78
,3. A prescriber orders vancomycin 1.5 g IV q12h for a patient with a vancomycin
AUC target of 400-600 mg-h/L. Which monitoring strategy best reflects current
consensus guidelines?
A. Trough-only monitoring targeting 15-20 mcg/mL
B. Peak-only monitoring targeting 30-40 mcg/mL
C. AUC-guided dosing using two serum concentrations with Bayesian software
D. Routine monitoring of both peak and trough with a target peak of 20-30 mcg/mL
Answer: C. AUC-guided dosing using two serum concentrations with Bayesian
software
Rationale: The 2020 ASHP/IDSA/PIDS/SIDP vancomycin consensus guidelines recommend
AUC-guided dosing (AUC24 400-600 mg-h/L) over trough-only monitoring to reduce
nephrotoxicity while maintaining efficacy. Trough-only and peak-based strategies are
outdated; routine peak monitoring is not recommended.
4. A patient on warfarin for atrial fibrillation is prescribed a 7-day course of
fluconazole. Which INR monitoring approach is most appropriate?
A. No additional monitoring; fluconazole does not interact with warfarin.
B. Check INR in 3-5 days and consider empiric warfarin dose reduction due to CYP2C9
inhibition.
C. Check INR in 2 weeks; fluconazole only affects warfarin metabolism after 14 days.
D. Switch to a direct oral anticoagulant immediately to avoid interaction.
Answer: B. Check INR in 3-5 days and consider empiric warfarin dose reduction due
to CYP2C9 inhibition.
Rationale: Fluconazole is a potent CYP2C9 inhibitor and can significantly increase INR
within days; close monitoring and possible dose reduction are required. Option A is false,
C misstates the timeline, and D is not automatically indicated for a short antifungal course.
Page 3 of 78
, 5. A pharmacist is preparing a compounded sterile preparation (CSP) in a USP <797>
compliant facility. Which action is required for a medium-risk CSP with a beyond-use
date (BUD) exceeding 24 hours at room temperature?
A. Preparation must occur in an ISO Class 5 environment with no further requirements.
B. Preparation must occur in an ISO Class 5 PEC located in an ISO Class 7 buffer area,
and the CSP must be tested for sterility.
C. Preparation must occur in an ISO Class 5 PEC in an ISO Class 7 buffer area, with
demonstrated air quality and documented personnel competency.
D. Preparation must occur in an ISO Class 5 PEC in an ISO Class 8 clean room with
daily particle counts.
Answer: C. Preparation must occur in an ISO Class 5 PEC in an ISO Class 7 buffer
area, with demonstrated air quality and documented personnel competency.
Rationale: USP <797> requires medium-risk CSPs with extended BUDs to be prepared in
an ISO Class 5 PEC within an ISO Class 7 buffer area, with environmental monitoring and
validated personnel. Sterility testing is not routinely required for medium-risk CSPs, and
ISO Class 8 is insufficient for extended BUDs.
6. A patient is prescribed a continuous IV infusion of a drug with a narrow
therapeutic index. Which pharmacokinetic parameter is most critical to determine the
time to reach steady-state concentration?
A. Volume of distribution (Vd)
B. Clearance (CL)
C. Elimination half-life (t½)
D. Peak plasma concentration (Cmax)
Answer: C. Elimination half-life (t½)
Rationale: Time to steady state depends on elimination half-life (approximately 4-5
half-lives), which itself is determined by Vd and CL. Vd and CL individually do not directly
define time to steady state; Cmax is a result, not a determinant.
Page 4 of 78
