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Saudi Pharmacist Licensure Examination (SPLE): free practice test

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Practice test questions with answers and explanations

Try the questions in the test above first, then open each one here to see the correct answer and why every other option is wrong.

01A resting patient has a heart rate of 75 beats/min and a stroke volume of 70 mL. What is the cardiac output?

Practice question Unit: Basic Biomedical Sciences

  1. A5.25 L/min ✓ Correct answer

    Cardiac output equals heart rate times stroke volume: 75 x 70 mL = 5250 mL/min, which is 5.25 L/min.

  2. B52.5 L/min

    This is a decimal error: 5250 mL/min is 5.25 L/min, not 52.5 L/min, which is far above any resting value.

  3. C0.93 L/min

    This comes from dividing stroke volume by heart rate. The two values must be multiplied.

  4. D0.525 L/min

    This is a unit conversion error by a factor of 10. 5250 mL is 5.25 L, not 0.525 L.

Reference: SCFHS SPLE Applicant Guide (2025), Basic Biomedical Sciences: Physiology, p. 9; Guyton and Hall, Textbook of Medical Physiology

02A weak acid drug has a pKa of 4.0. In gastric fluid at pH 2.0, approximately what percentage of the drug is un-ionized?

Practice question Unit: Pharmaceutical Sciences

  1. AAbout 1%

    That figure is the ionized fraction. The ratio was inverted when applying the equation.

  2. BAbout 10%

    A one-unit gap between pH and pKa gives a tenfold ratio. Here the gap is two units, so the ratio is 100-fold.

  3. CAbout 99% ✓ Correct answer

    For a weak acid, log(ionized/un-ionized) = pH − pKa = −2, so the ratio is 1:100. About 99% is un-ionized and can cross membranes.

  4. DAbout 50%

    The drug is half ionized only when the pH equals the pKa. Here the pH is two units below it.

Reference: SCFHS SPLE Applicant Guide (2025), Pharmaceutical Sciences: Medicinal Chemistry, p. 9; Lemke & Williams, Foye's Principles of Medicinal Chemistry

03A patient taking oxycodone around the clock develops acute withdrawal symptoms shortly after a first sublingual dose of buprenorphine. Which pharmacodynamic explanation is correct?

Practice question Unit: Pharmaceutical Sciences

  1. ABuprenorphine is an inverse agonist that suppresses basal mu receptor activity

    Incorrect. Buprenorphine is a partial agonist, not an inverse agonist; mu receptors have little constitutive activity to suppress.

  2. BBuprenorphine induces CYP3A4 and rapidly lowers oxycodone concentrations

    Incorrect. Buprenorphine does not induce CYP3A4, and enzyme induction would take days, not minutes to hours.

  3. CIt has high affinity but low intrinsic activity and displaces the full agonist ✓ Correct answer

    Correct. A high-affinity partial agonist displaces the full agonist and lowers net receptor activation, which precipitates withdrawal in a dependent patient.

  4. DBuprenorphine irreversibly alkylates the mu receptor and blocks oxycodone binding

    Incorrect. Buprenorphine binds reversibly; it is not an irreversible antagonist.

Reference: SCFHS SPLE Applicant Guide (2025), Pharmaceutical Sciences: Pharmacology and Toxicology, p. 10; Brunton et al., Goodman & Gilman's The Pharmacological Basis of Therapeutics

04Mrs. Noura, a kidney transplant recipient stable on tacrolimus, starts a St John's wort product for low mood. What is the most likely consequence?

Practice question Unit: Pharmaceutical Sciences

  1. ALower tacrolimus levels from CYP3A4 induction, risking graft rejection ✓ Correct answer

    St John's wort induces CYP3A4 and P-glycoprotein, which lowers calcineurin inhibitor exposure and can lead to rejection.

  2. BHigher tacrolimus levels from CYP3A4 inhibition, with a risk of nephrotoxicity

    The effect is induction, not inhibition; inhibitors such as clarithromycin raise tacrolimus levels.

  3. CHigher tacrolimus levels from displacement from plasma proteins

    Protein displacement is not the mechanism of this interaction.

  4. DLower tacrolimus levels because the herb chelates the drug in the gut lumen

    Chelation is not involved; the interaction is enzyme and transporter induction.

Reference: SCFHS SPLE Applicant Guide (2025), Pharmaceutical Sciences: Pharmacognosy and Dietary Supplements, p. 10; Therapeutic Research Center, Natural Medicines Database

05Mr. Saleh, 70 years old, has a nasogastric tube and takes metoprolol succinate extended-release 100 mg once daily. The nurse asks to crush the tablet. What is the most appropriate recommendation?

Practice question Unit: Pharmaceutical Sciences

  1. ADo not crush it; ask the prescriber about immediate-release metoprolol tartrate in divided doses ✓ Correct answer

    The immediate-release form can be crushed for the tube, and the same total daily dose is divided into two doses to keep coverage.

  2. BCrush the tablet finely and flush it down the tube with water, since it is dosed only once daily

    Crushing an extended-release tablet destroys its release control and dumps the full dose at once, risking bradycardia or severe hypotension.

  3. CDissolve the whole tablet in warm water for 30 minutes and give the suspension through the tube

    The extended-release tablet does not dissolve reliably in warm water, so the delivered dose is unpredictable.

  4. DOpen the tablet and give half of the powder twice daily through the nasogastric tube

    Powder from an opened tablet cannot be split reliably, and extended release is lost anyway.

Reference: SCFHS SPLE Applicant Guide (2025), Pharmaceutical Sciences: Pharmaceutics/Biopharmaceutics, p. 10; Allen, Popovich and Ansel, Ansel's Pharmaceutical Dosage Forms and Drug Delivery Systems

06A new screening programme detects a cancer 3 years earlier than clinical diagnosis would. Treatment does not change the course of disease, and patients die at the same age as before. Survival measured from the date of diagnosis nevertheless looks longer. Which bias explains this?

Practice question Unit: Social, Behavioral and Administrative Sciences

  1. ALength-time bias

    Length-time bias arises because screening preferentially finds slowly progressing disease, which is not described here.

  2. BLead-time bias ✓ Correct answer

    Earlier diagnosis starts the survival clock sooner without delaying death, which creates lead-time bias.

  3. CRecall bias

    Recall bias concerns inaccurate memory of past exposures in case-control studies.

  4. DVolunteer bias

    Volunteer bias arises when participants are healthier or more motivated than non-participants, which is not the issue here.

Reference: SCFHS SPLE Applicant Guide (2025), Social/Behavioral/Administrative Sciences: Health Care Delivery Systems and Public Health, p. 11; Gordis, Epidemiology

07In a cohort study, 40 of 2,000 patients exposed to drug X developed the outcome, compared with 30 of 3,000 unexposed patients. What is the relative risk?

Practice question Unit: Social, Behavioral and Administrative Sciences

  1. A1.3

    1.3 comes from dividing the raw counts (40/30), ignoring the different group sizes.

  2. B2.0 ✓ Correct answer

    Correct. Risk in exposed is 40/2000 = 0.020 and in unexposed 30/3000 = 0.010, so RR = 0.020/0.010 = 2.0.

  3. C0.5

    0.5 inverts the ratio by dividing the unexposed risk by the exposed risk.

  4. D4.0

    4.0 would be correct only if the 40 events had occurred among 1,000 exposed patients. It does not match the data given.

Reference: SCFHS SPLE Applicant Guide (2025), Social/Behavioral/Administrative Sciences: Population-Based Care and Pharmacoepidemiology, p. 11; Strom et al., Textbook of Pharmacoepidemiology

08A physician phones the pharmacy and asks, "What is the dose of vancomycin?" According to the modified systematic approach to drug information requests, what should the pharmacist do next, before searching the literature?

Practice question Unit: Clinical Sciences

  1. ALook up the usual adult dose in a tertiary source and report that dose to the physician immediately

    Answering the literal question can give a dose that does not fit the actual patient and so may cause harm.

  2. BAsk the physician to send the question in writing before any work begins

    Insisting on a written request does not clarify the question and needlessly delays patient care.

  3. CRefer the question to the product manufacturer's medical information department

    Referral skips the pharmacist's own assessment and is reserved for questions the available sources cannot answer.

  4. DCollect background details such as age, renal function, and indication to define the real question ✓ Correct answer

    The initial question is often incomplete, so background details are collected to uncover and classify the real (ultimate) question.

Reference: SCFHS SPLE Applicant Guide (2025), Clinical Sciences: Drug Information and Evidence-based Practice, p. 12; Malone

09Mr. Fahad receives gentamicin. Two concentrations are drawn in the elimination phase 6 hours apart: 8.0 mcg/mL then 2.0 mcg/mL. What is his approximate gentamicin half-life?

Practice question Unit: Clinical Sciences

  1. A2 hours

    Two hours would give a fall of eightfold over 6 hours, not fourfold.

  2. B3 hours ✓ Correct answer

    k = ln(8.0/2.0) / 6 h = 0.231 per hour, so t1/2 = 0.693 / 0.231 = 3 hours. The concentration fell fourfold, which is two half-lives in 6 hours.

  3. C4.5 hours

    4.5 hours would give a fall of only about 2.5-fold over 6 hours.

  4. D6 hours

    Six hours would mean the concentration only halved (from 8.0 to 4.0), not fell to 2.0.

Reference: SCFHS SPLE Applicant Guide (2025), Clinical Sciences: Clinical Pharmacokinetics, p. 13; Winter, Basic Clinical Pharmacokinetics

10Mr. Fahad, 58 years old, has an acute coronary syndrome treated with a drug-eluting stent. Genotyping shows CYP2C19 *2/*2, and he has no history of bleeding or stroke. Which P2Y12 inhibitor is most appropriate?

Practice question Unit: Clinical Sciences

  1. AClopidogrel 75 mg daily plus aspirin

    Clopidogrel is a prodrug that needs CYP2C19 to form its active metabolite. In a poor metabolizer very little forms, which raises the risk of stent thrombosis.

  2. BClopidogrel 150 mg daily plus aspirin

    A higher dose does not adequately make up for absent enzyme function, and CPIC recommends an alternative that does not depend on CYP2C19.

  3. CClopidogrel 75 mg plus omeprazole and aspirin

    Omeprazole inhibits CYP2C19 and reduces clopidogrel activation even further, making the situation worse.

  4. DTicagrelor 90 mg twice daily plus aspirin ✓ Correct answer

    Ticagrelor (like prasugrel) acts without CYP2C19 activation, so it is the recommended alternative when this enzyme is deficient and there is no bleeding contraindication.

Reference: SCFHS SPLE Applicant Guide (2025), Clinical Sciences: Clinical Pharmacogenomics, p. 13; Clinical Pharmacogenetics Implementation Consortium (CPIC), Guideline for CYP2C19 and Clopidogrel Therapy

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