BCACP Ambulatory Care Pharmacy Specialist Exam 2026:
Comprehensive Board Certification Practice Test — Patient-
Centered Care, Evidence-Based Practice & Practice Advancement
— 150 Multiple-Choice Questions with Answers & Detailed
Rationales
Domain 1: Patient-Centered Ambulatory Care
Cardiovascular Disorders
Question 1
A 62-year-old male with a history of myocardial infarction 8 months ago presents for follow-
up. His current medications include aspirin 81 mg daily, metoprolol succinate 50 mg daily,
and lisinopril 20 mg daily. His LDL-C is 142 mg/dL. According to the 2018 AHA/ACC
Cholesterol Guidelines, which therapy should be initiated?
A. Atorvastatin 10 mg daily
B. Atorvastatin 40 mg daily
C. Ezetimibe 10 mg daily
D. PCSK9 inhibitor
Correct Answer: B
Explanation: Clinical ASCVD requires high-intensity statin therapy (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) to reduce LDL-C by ≥50%. Atorvastatin 10 mg is moderate-intensity
and insufficient.
Question 2
A 58-year-old female with heart failure with reduced ejection fraction (HFrEF, LVEF 30%) is
on lisinopril, carvedilol, and spironolactone. She remains symptomatic. Which agent should
be added next per 2022 AHA/ACC/HFSA guidelines?
,A. Digoxin
B. Ivabradine
C. Dapagliflozin
D. Hydralazine
Correct Answer: C
Explanation: SGLT2 inhibitors (dapagliflozin, empagliflozin) are the fourth pillar of guideline-
directed medical therapy for HFrEF and reduce mortality and hospitalizations.
Question 3
A 70-year-old male with atrial fibrillation and a CHA₂DS₂-VASc score of 5 has a creatinine
clearance of 28 mL/min. Which anticoagulant is most appropriate?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily
C. Warfarin with INR goal 2.0-3.0
D. Dabigatran 150 mg twice daily
Correct Answer: C
Explanation: Warfarin remains appropriate for severe renal impairment (CrCl <30 mL/min)
where DOACs require dose adjustment or are contraindicated.
Question 4
A 55-year-old male with hypertension and type 2 diabetes has a urine albumin-to-creatinine
ratio of 420 mg/g. Which antihypertensive class is preferred first-line?
A. Thiazide diuretic
,B. Calcium channel blocker
C. ACE inhibitor
D. Beta-blocker
Correct Answer: C
Explanation: ACE inhibitors or ARBs are first-line for hypertension with albuminuria (UACR
≥300 mg/g) due to proven renal protection and cardiovascular benefits.
Question 5
A 68-year-old female with heart failure with preserved ejection fraction (HFpEF) and obesity
presents for management. Which medication class has demonstrated benefit in reducing
heart failure hospitalizations?
A. ACE inhibitors
B. SGLT2 inhibitors
C. Beta-blockers
D. Digoxin
Correct Answer: B
Explanation: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce HF hospitalizations in
HFpEF regardless of diabetes status, per EMPEROR-Preserved and DELIVER trials.
Question 6
A patient on warfarin for mechanical mitral valve has an INR of 1.6. What is the appropriate
management?
A. Continue current dose and recheck in 1 week
, B. Increase warfarin dose by 10-20% and recheck in 3-7 days
C. Administer vitamin K 10 mg IV
D. Hold warfarin for 2 days
Correct Answer: B
Explanation: Subtherapeutic INR without bleeding is managed by dose increase with close
monitoring; mechanical valves require INR 2.5-3.5.
Question 7
A 45-year-old male with resistant hypertension is on lisinopril, amlodipine, and
hydrochlorothiazide at maximally tolerated doses. His BP remains 152/94 mmHg. Which
agent should be added?
A. Clonidine
B. Spironolactone
C. Metoprolol
D. Hydralazine
Correct Answer: B
Explanation: Spironolactone is the preferred fourth-line agent for resistant hypertension per
PATHWAY-2 trial, especially with low renin activity.
Question 8
A patient with statin intolerance due to myalgias has an LDL-C of 165 mg/dL and 10-year
ASCVD risk of 18%. What is the best alternative?
A. Ezetimibe
Comprehensive Board Certification Practice Test — Patient-
Centered Care, Evidence-Based Practice & Practice Advancement
— 150 Multiple-Choice Questions with Answers & Detailed
Rationales
Domain 1: Patient-Centered Ambulatory Care
Cardiovascular Disorders
Question 1
A 62-year-old male with a history of myocardial infarction 8 months ago presents for follow-
up. His current medications include aspirin 81 mg daily, metoprolol succinate 50 mg daily,
and lisinopril 20 mg daily. His LDL-C is 142 mg/dL. According to the 2018 AHA/ACC
Cholesterol Guidelines, which therapy should be initiated?
A. Atorvastatin 10 mg daily
B. Atorvastatin 40 mg daily
C. Ezetimibe 10 mg daily
D. PCSK9 inhibitor
Correct Answer: B
Explanation: Clinical ASCVD requires high-intensity statin therapy (atorvastatin 40-80 mg or
rosuvastatin 20-40 mg) to reduce LDL-C by ≥50%. Atorvastatin 10 mg is moderate-intensity
and insufficient.
Question 2
A 58-year-old female with heart failure with reduced ejection fraction (HFrEF, LVEF 30%) is
on lisinopril, carvedilol, and spironolactone. She remains symptomatic. Which agent should
be added next per 2022 AHA/ACC/HFSA guidelines?
,A. Digoxin
B. Ivabradine
C. Dapagliflozin
D. Hydralazine
Correct Answer: C
Explanation: SGLT2 inhibitors (dapagliflozin, empagliflozin) are the fourth pillar of guideline-
directed medical therapy for HFrEF and reduce mortality and hospitalizations.
Question 3
A 70-year-old male with atrial fibrillation and a CHA₂DS₂-VASc score of 5 has a creatinine
clearance of 28 mL/min. Which anticoagulant is most appropriate?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily
C. Warfarin with INR goal 2.0-3.0
D. Dabigatran 150 mg twice daily
Correct Answer: C
Explanation: Warfarin remains appropriate for severe renal impairment (CrCl <30 mL/min)
where DOACs require dose adjustment or are contraindicated.
Question 4
A 55-year-old male with hypertension and type 2 diabetes has a urine albumin-to-creatinine
ratio of 420 mg/g. Which antihypertensive class is preferred first-line?
A. Thiazide diuretic
,B. Calcium channel blocker
C. ACE inhibitor
D. Beta-blocker
Correct Answer: C
Explanation: ACE inhibitors or ARBs are first-line for hypertension with albuminuria (UACR
≥300 mg/g) due to proven renal protection and cardiovascular benefits.
Question 5
A 68-year-old female with heart failure with preserved ejection fraction (HFpEF) and obesity
presents for management. Which medication class has demonstrated benefit in reducing
heart failure hospitalizations?
A. ACE inhibitors
B. SGLT2 inhibitors
C. Beta-blockers
D. Digoxin
Correct Answer: B
Explanation: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce HF hospitalizations in
HFpEF regardless of diabetes status, per EMPEROR-Preserved and DELIVER trials.
Question 6
A patient on warfarin for mechanical mitral valve has an INR of 1.6. What is the appropriate
management?
A. Continue current dose and recheck in 1 week
, B. Increase warfarin dose by 10-20% and recheck in 3-7 days
C. Administer vitamin K 10 mg IV
D. Hold warfarin for 2 days
Correct Answer: B
Explanation: Subtherapeutic INR without bleeding is managed by dose increase with close
monitoring; mechanical valves require INR 2.5-3.5.
Question 7
A 45-year-old male with resistant hypertension is on lisinopril, amlodipine, and
hydrochlorothiazide at maximally tolerated doses. His BP remains 152/94 mmHg. Which
agent should be added?
A. Clonidine
B. Spironolactone
C. Metoprolol
D. Hydralazine
Correct Answer: B
Explanation: Spironolactone is the preferred fourth-line agent for resistant hypertension per
PATHWAY-2 trial, especially with low renin activity.
Question 8
A patient with statin intolerance due to myalgias has an LDL-C of 165 mg/dL and 10-year
ASCVD risk of 18%. What is the best alternative?
A. Ezetimibe
