PEBC Pharmacist MCQ Practice Test
Free · 140 Questions.

Question 1

According to Diabetes Canada clinical practice guidelines, what is the first-line initial pharmacotherapy of choice for most adult patients diagnosed with Type 2 Diabetes Mellitus (in conjunction with lifestyle management)?

• A. Meglitinide (e.g. repaglinide)
• B. Metformin.
• C. Sulfonylurea (e.g. gliclazide)
• D. Basal insulin glargine

Explanation: Diabetes Canada guidelines recommend Metformin as the initial first-line glucose-lowering therapy due to its proven efficacy, low hypoglycemia risk, weight neutrality, and long-term safety data.

Question 2

In patients with Type 2 Diabetes and established Atherosclerotic Cardiovascular Disease (ASCVD), which classes of antihyperglycemic agents have proven cardiovascular benefit and should be prioritized?

• A. Alpha-glucosidase inhibitors (e.g. acarbose) exclusively
• B. SGLT2 inhibitors or GLP-1 receptor agonists.
• C. Sulfonylureas and DPP-4 inhibitors
• D. Thiazolidinediones (e.g. pioglitazone) and Meglitinides

Explanation: SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated significant reductions in major adverse cardiovascular events (MACE), cardiovascular mortality, and heart failure hospitalizations in randomized controlled trials.

Question 3

According to Hypertension Canada guidelines, which drug classes are first-line agents for hypertension in adults who need drug therapy?

• A. ACE inhibitors/ARBs, thiazide-like diuretics and dihydropyridine CCBs.
• B. Direct renin inhibitors and aldosterone antagonists such as spironolactone
• C. Centrally acting alpha-2 agonists and potassium-sparing diuretics
• D. Beta-blockers, alpha-blockers, loop diuretics and direct vasodilators

Explanation: The 2025 Hypertension Canada primary care guideline states that ACE inhibitors or ARBs, thiazide or thiazide-like diuretics and dihydropyridine CCBs are well tolerated, give similar cardiovascular protection and should all be considered first-line agents. Beta-blockers are not first-line unless a specific indication such as heart failure or angina is present, and spironolactone is added later, for resistant hypertension.

Question 4

Why is the concurrent combination of an ACE Inhibitor (e.g. ramipril) and an Angiotensin Receptor Blocker (e.g. losartan) strictly NOT recommended in hypertension and heart failure management?

• A. Dual RAS blockade raises hyperkalemia and kidney injury risk without benefit.
• B. The combination causes angioedema in most patients, which makes any combined use unsafe
• C. Dual therapy causes severe hypokalemia and cardiac QT-interval prolongation
• D. The ARB blocks activation of the ACE inhibitor, so the combination loses its effect

Explanation: The Hypertension Canada 2025 primary care guideline states that ACE inhibitors and ARBs should not be used in combination, because they increase the risk of adverse events including hyperkalemia, acute kidney injury, hypotension and syncope, with no added clinical benefit.

Question 5

According to the Canadian Cardiovascular Society (CCS) heart failure guidelines, which four classes of therapy ('the four pillars') are recommended to reduce cardiovascular mortality and heart-failure hospitalization in heart failure with reduced ejection fraction (HFrEF)?

• A. An ACE inhibitor, a thiazide diuretic, a dihydropyridine CCB and a statin
• B. A loop diuretic, digoxin, a long-acting nitrate and hydralazine
• C. Ivabradine, vericiguat, digoxin and a loop diuretic (adjunct drugs)
• D. An ARNI (or ACEI/ARB), a beta-blocker, an MRA and an SGLT2 inhibitor.

Explanation: The 2021 CCS update recommends four standard therapies for HFrEF in the absence of contraindications: an ARNI (first line, or a switch from an ACEI/ARB), a beta-blocker, a mineralocorticoid receptor antagonist (MRA) and an SGLT2 inhibitor. Ivabradine, vericiguat and digoxin are additional medications for selected subgroups, not the four standard therapies.