BCGP Geriatric Pharmacy Certification Exam 2026: Advanced
Professional Practice Test — Geriatric Syndromes,
Pharmacotherapy, Polypharmacy, Deprescribing, Medication Safety
& Patient-Centered Care — 190 Multiple-Choice Questions with
Answers & Detailed Rationales
Question 1
An 82-year-old woman presents with new-onset confusion and urinary retention after
starting a new medication. Which age-related physiological change most increases her
susceptibility to this presentation?
A. Decreased gastric acid production
B. Reduced hepatic blood flow
C. Increased body fat proportion
D. Decreased renal clearance
Correct Answer: B
Explanation: Reduced hepatic blood flow decreases first-pass metabolism, increasing drug
exposure; combined with anticholinergic effects, this can precipitate confusion and urinary
retention in older adults.
Question 2
A 78-year-old man has a creatinine clearance of 28 mL/min. Which medication should be
avoided according to the 2023 AGS Beers Criteria?
A. Apixaban
,B. Nitrofurantoin
C. Sertraline
D. Atorvastatin
Correct Answer: B
Explanation: Nitrofurantoin should be avoided when CrCl is below 30 mL/min due to
increased risk of toxicity and inadequate urinary concentrations for therapeutic effect.
Question 3
An 85-year-old patient with dementia and behavioral symptoms is prescribed an
antipsychotic. What is the primary concern according to the Beers Criteria?
A. Improved cognitive function
B. Reduced fall risk
C. Increased risk of stroke and mortality
D. Enhanced sleep quality
Correct Answer: C
Explanation: Antipsychotics in patients with dementia carry a boxed warning for increased
risk of cerebrovascular events and mortality; nonpharmacologic interventions should be
exhausted first.
Question 4
A 90-year-old woman is prescribed amitriptyline for neuropathic pain. Which adverse effect
is most concerning in this population?
,A. Diarrhea
B. Anticholinergic effects including confusion and urinary retention
C. Hypertension
D. Weight loss
Correct Answer: B
Explanation: Amitriptyline has significant anticholinergic properties, and older adults are
highly sensitive to effects such as confusion, constipation, dry mouth, and urinary retention.
Question 5
A 76-year-old man on warfarin for atrial fibrillation is being evaluated for anticoagulation
optimization. According to the 2023 Beers Criteria, which statement is correct regarding
anticoagulation?
A. Warfarin is now preferred over DOACs for initial therapy
B. Warfarin should be avoided unless DOACs are contraindicated for initial therapy of
nonvalvular AF
C. Aspirin is recommended for primary prevention
D. All anticoagulants are equally appropriate
Correct Answer: B
Explanation: The 2023 Beers Criteria advises against warfarin as initial therapy for
nonvalvular atrial fibrillation unless direct oral anticoagulants are contraindicated.
Question 6
, A frail 88-year-old woman with atrial fibrillation and a HAS-BLED score of 3 is being
considered for anticoagulation. Which agent is preferred?
A. Warfarin with INR target 2–3
B. Dabigatran 150 mg twice daily
C. Apixaban 5 mg twice daily
D. Rivaroxaban 20 mg daily
Correct Answer: C
Explanation: Apixaban has demonstrated the lowest bleeding risk among DOACs in elderly
patients; dose reduction to 2.5 mg twice daily is indicated when criteria are met.
Question 7
An older adult with heart failure with reduced ejection fraction (HFrEF) requires a beta-
blocker. Which agent requires dose adjustment due to renal excretion?
A. Carvedilol
B. Bisoprolol
C. Metoprolol
D. Nebivolol
Correct Answer: C
Explanation: Metoprolol is partially renally cleared; reduced renal function in older adults
may necessitate lower doses to avoid accumulation and bradycardia.
Professional Practice Test — Geriatric Syndromes,
Pharmacotherapy, Polypharmacy, Deprescribing, Medication Safety
& Patient-Centered Care — 190 Multiple-Choice Questions with
Answers & Detailed Rationales
Question 1
An 82-year-old woman presents with new-onset confusion and urinary retention after
starting a new medication. Which age-related physiological change most increases her
susceptibility to this presentation?
A. Decreased gastric acid production
B. Reduced hepatic blood flow
C. Increased body fat proportion
D. Decreased renal clearance
Correct Answer: B
Explanation: Reduced hepatic blood flow decreases first-pass metabolism, increasing drug
exposure; combined with anticholinergic effects, this can precipitate confusion and urinary
retention in older adults.
Question 2
A 78-year-old man has a creatinine clearance of 28 mL/min. Which medication should be
avoided according to the 2023 AGS Beers Criteria?
A. Apixaban
,B. Nitrofurantoin
C. Sertraline
D. Atorvastatin
Correct Answer: B
Explanation: Nitrofurantoin should be avoided when CrCl is below 30 mL/min due to
increased risk of toxicity and inadequate urinary concentrations for therapeutic effect.
Question 3
An 85-year-old patient with dementia and behavioral symptoms is prescribed an
antipsychotic. What is the primary concern according to the Beers Criteria?
A. Improved cognitive function
B. Reduced fall risk
C. Increased risk of stroke and mortality
D. Enhanced sleep quality
Correct Answer: C
Explanation: Antipsychotics in patients with dementia carry a boxed warning for increased
risk of cerebrovascular events and mortality; nonpharmacologic interventions should be
exhausted first.
Question 4
A 90-year-old woman is prescribed amitriptyline for neuropathic pain. Which adverse effect
is most concerning in this population?
,A. Diarrhea
B. Anticholinergic effects including confusion and urinary retention
C. Hypertension
D. Weight loss
Correct Answer: B
Explanation: Amitriptyline has significant anticholinergic properties, and older adults are
highly sensitive to effects such as confusion, constipation, dry mouth, and urinary retention.
Question 5
A 76-year-old man on warfarin for atrial fibrillation is being evaluated for anticoagulation
optimization. According to the 2023 Beers Criteria, which statement is correct regarding
anticoagulation?
A. Warfarin is now preferred over DOACs for initial therapy
B. Warfarin should be avoided unless DOACs are contraindicated for initial therapy of
nonvalvular AF
C. Aspirin is recommended for primary prevention
D. All anticoagulants are equally appropriate
Correct Answer: B
Explanation: The 2023 Beers Criteria advises against warfarin as initial therapy for
nonvalvular atrial fibrillation unless direct oral anticoagulants are contraindicated.
Question 6
, A frail 88-year-old woman with atrial fibrillation and a HAS-BLED score of 3 is being
considered for anticoagulation. Which agent is preferred?
A. Warfarin with INR target 2–3
B. Dabigatran 150 mg twice daily
C. Apixaban 5 mg twice daily
D. Rivaroxaban 20 mg daily
Correct Answer: C
Explanation: Apixaban has demonstrated the lowest bleeding risk among DOACs in elderly
patients; dose reduction to 2.5 mg twice daily is indicated when criteria are met.
Question 7
An older adult with heart failure with reduced ejection fraction (HFrEF) requires a beta-
blocker. Which agent requires dose adjustment due to renal excretion?
A. Carvedilol
B. Bisoprolol
C. Metoprolol
D. Nebivolol
Correct Answer: C
Explanation: Metoprolol is partially renally cleared; reduced renal function in older adults
may necessitate lower doses to avoid accumulation and bradycardia.
