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Free BCPS Practice Questions

10 free, exam-style Board Certified Pharmacotherapy Specialist (BCPS) practice questions with answers and explanations. No signup required. Work through them below, then take the full free BCPS practice test to study every exam domain.

Question 1

A 58-year-old man with HFrEF (LVEF 28%) is currently on sacubitril/valsartan 97/103 mg twice daily, carvedilol 25 mg twice daily, and spironolactone 25 mg daily. He is euvolemic with a BP of 118/72 mmHg and SCr of 1.1 mg/dL. Which intervention BEST completes his guideline-directed medical therapy per ACC/AHA/HFSA 2022?

  1. Add digoxin 0.125 mg daily for symptomatic benefit
  2. Add dapagliflozin 10 mg daily
  3. Increase spironolactone to 50 mg daily
  4. Switch carvedilol to metoprolol succinate 25 mg daily
Show answer & explanation

Correct answer: B - Add dapagliflozin 10 mg daily

Question 2

A 55-year-old woman presents with her SECOND recurrence of Clostridioides difficile infection. Her first recurrence was treated with oral fidaxomicin, completed 8 weeks ago. She now has new-onset watery diarrhea, a positive C. difficile PCR, and non-severe disease criteria. Which treatment is MOST appropriate per IDSA/SHEA 2021 guidelines?

  1. Fecal microbiota transplant (FMT)
  2. Oral fidaxomicin 200 mg twice daily for 10 days
  3. Oral vancomycin 125 mg four times daily for 10 days
  4. Oral metronidazole 500 mg three times daily for 14 days
Show answer & explanation

Correct answer: A - Fecal microbiota transplant (FMT)

Question 3

A 64-year-old woman with type 2 diabetes, HFrEF (LVEF 35%), and CKD (eGFR 38 mL/min/1.73m²) has an A1C of 8.4% on metformin 500 mg twice daily. Which agent provides the MOST comprehensive cardiorenal benefit and is appropriate at her current eGFR?

  1. Pioglitazone 15 mg daily
  2. Liraglutide 1.8 mg subcutaneous once weekly
  3. Sitagliptin 50 mg daily (renally adjusted)
  4. Dapagliflozin 10 mg daily
Show answer & explanation

Correct answer: D - Dapagliflozin 10 mg daily

Question 4

A 45-year-old woman arrives in the ED after a large intentional diltiazem overdose. Her HR is 34 bpm and BP is 72/40 mmHg. She has not responded to IV atropine 1 mg, calcium gluconate 3 g, or glucagon 5 mg. Which intervention has the STRONGEST evidence for refractory calcium channel blocker toxicity?

  1. Sodium bicarbonate 1-2 mEq/kg IV bolus, repeat as needed for hemodynamic instability
  2. High-dose insulin euglycemia therapy (HIE)
  3. Activated charcoal 50 g via nasogastric tube
  4. Digoxin immune Fab 40 mg IV for bradycardia refractory to atropine
Show answer & explanation

Correct answer: B - High-dose insulin euglycemia therapy (HIE)

Question 5

An 84-year-old woman with moderate Alzheimer's disease is prescribed oxybutynin immediate-release 5 mg three times daily for urge urinary incontinence. The consulting pharmacist recommends against this choice. What is the PRIMARY reason oxybutynin appears in the AGS Beers Criteria for patients of this age?

  1. Narrow therapeutic index requiring regular serum concentration monitoring to prevent dose-related cardiac toxicity
  2. High potential for urinary retention that paradoxically worsens incontinence and increases catheter-associated infection risk in older women
  3. Anticholinergic properties that increase the risk of delirium, falls, and worsening cognitive impairment
  4. Extensive hepatic first-pass metabolism and pronounced CYP3A4 induction that substantially reduces the efficacy of her dementia medications
Show answer & explanation

Correct answer: C - Anticholinergic properties that increase the risk of delirium, falls, and worsening cognitive impairment

Question 6

A 52-year-old man with epilepsy and cirrhosis has a measured serum phenytoin level of 6 mcg/mL and an albumin of 2.0 g/dL. He is not on dialysis. Using the Sheiner-Tozer equation for non-dialysis patients, what is his corrected phenytoin level?

  1. 6 mcg/mL - the measured level is accurate and no mathematical correction is necessary
  2. 10 mcg/mL
  3. 12 mcg/mL
  4. 18 mcg/mL - above the therapeutic range; recommend dose reduction
Show answer & explanation

Correct answer: C - 12 mcg/mL

Question 7

A patient with atrial fibrillation has maintained a stable warfarin INR of 2.4 for six months. Amiodarone is added for rhythm control. Four weeks later, his INR is 4.9 with no dietary changes reported. What is the PRIMARY mechanism responsible for this interaction?

  1. Amiodarone competes with warfarin for albumin-binding sites, substantially increasing warfarin's free fraction and prolonging its distribution half-life
  2. Amiodarone inhibits CYP2C9, reducing metabolism of the more pharmacologically potent S-warfarin enantiomer
  3. Amiodarone induces CYP3A4, paradoxically activating warfarin's pharmacologically inert R-enantiomer into a more potent anticoagulant form
  4. Amiodarone directly inhibits vitamin K epoxide reductase (VKOR), the same enzyme targeted by warfarin, creating a synergistic anticoagulant effect
Show answer & explanation

Correct answer: B - Amiodarone inhibits CYP2C9, reducing metabolism of the more pharmacologically potent S-warfarin enantiomer

Question 8

A randomized controlled trial evaluating a new antiplatelet agent for secondary stroke prevention reports a 2-year stroke rate of 10% in the treatment group and 25% in the placebo group. What is the Number Needed to Treat (NNT) to prevent one stroke over 2 years?

  1. 5
  2. 15
  3. 7
  4. 40
Show answer & explanation

Correct answer: C - 7

Question 9

A non-inferiority trial compares a new oral anticoagulant to warfarin for stroke prevention in atrial fibrillation. The pre-specified non-inferiority margin is +1.5%. The trial reports a risk difference of −0.4% (new agent vs. warfarin) with a 95% confidence interval of −1.2% to +1.1%. Which conclusion is MOST appropriate?

  1. The new agent is statistically superior to warfarin for stroke prevention
  2. Non-inferiority has NOT been demonstrated because the confidence interval spans both negative and positive values, indicating the new agent may be inferior to warfarin in some patient subgroups
  3. The trial result is inconclusive because the p-value was not reported alongside the confidence interval
  4. Non-inferiority has been demonstrated; the new agent is not unacceptably worse than warfarin
Show answer & explanation

Correct answer: D - Non-inferiority has been demonstrated; the new agent is not unacceptably worse than warfarin

Question 10

A 31-year-old man with treatment-resistant schizophrenia has been stable on clozapine 300 mg daily for 18 continuous months. His most recent ANC drawn 6 weeks ago was 1,750 cells/mm³. Per the clozapine REMS program, what is the REQUIRED ANC monitoring frequency for this patient?

  1. Monthly
  2. Every 2 weeks
  3. Weekly
  4. Only if the patient develops signs or symptoms of infection
Show answer & explanation

Correct answer: A - Monthly

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