Board Certified Pharmacotherapy Specialist (BCPS) Exam 2026:
Professional Certification Practice Test — Pharmacotherapy,
Disease Management, Drug Therapy, Patient Care & Clinical
Decision-Making — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Domain 1: Patient-Centered Pharmacotherapy (~55% — 105 Questions)
Question 1
A 58-year-old male with heart failure with reduced ejection fraction (HFrEF, EF 28%) is on
guideline-directed medical therapy including sacubitril/valsartan, carvedilol, and
spironolactone. He presents with worsening dyspnea and is found to have a potassium of 5.8
mEq/L and creatinine of 2.4 mg/dL. Which intervention is most appropriate?
A. Add furosemide 40 mg IV push
B. Hold spironolactone and initiate patiromer
C. Discontinue sacubitril/valsartan and start lisinopril
D. Initiate sodium polystyrene sulfonate 30 g PO
Correct Answer: B
Explanation: Hyperkalemia with renal impairment requires holding the potassium-sparing
agent; patiromer enables continuation of RAAS therapy when clinically necessary.
Question 2
A 34-year-old female with type 1 diabetes and asthma is admitted with diabetic ketoacidosis.
Her home regimen includes insulin glargine and insulin aspart. Which insulin strategy is most
appropriate during the acute management phase?
,A. Continue glargine at home dose and use correctional aspart only
B. Transition to regular insulin infusion and discontinue glargine
C. Hold all long-acting insulin until anion gap closes
D. Use NPH insulin twice daily with sliding-scale regular insulin
Correct Answer: B
Explanation: IV regular insulin infusion is standard for DKA; glargine should be held initially
but subcutaneous basal insulin must be initiated before infusion discontinuation.
Question 3
A 67-year-old male with atrial fibrillation and stage 4 chronic kidney disease (CrCl 22
mL/min) requires anticoagulation. His CHA₂DS₂-VASc score is 5. Which anticoagulant is most
appropriate?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily
C. Warfarin with INR goal 2–3
D. Dabigatran 150 mg twice daily
Correct Answer: C
Explanation: Warfarin remains the preferred anticoagulant in severe CKD; DOACs require
dose adjustment or are contraindicated, and apixaban requires 2.5 mg BID in this
population.
Question 4
,A 45-year-old female with major depressive disorder has failed adequate trials of sertraline
and escitalopram. She has a history of seasonal affective disorder and reports significant
fatigue. Which augmentation strategy is best supported by evidence?
A. Add aripiprazole 5 mg daily
B. Add bupropion XL 150 mg daily
C. Switch to venlafaxine XR 75 mg daily
D. Add liothyronine 25 mcg daily
Correct Answer: B
Explanation: Bupropion augmentation addresses residual fatigue and anhedonia while
avoiding serotonergic side effects; it is particularly beneficial in patients with seasonal
patterns.
Question 5
A 72-year-old male with COPD (GOLD Stage 3) presents with an acute exacerbation. He is
started on prednisone 40 mg daily, azithromycin, and bronchodilators. Which additional
intervention reduces mortality in this setting?
A. Initiating roflumilast
B. Adding inhaled corticosteroid
C. Antibiotic therapy with a beta-lactam
D. Low-dose theophylline
Correct Answer: C
, Explanation: Antibiotics targeting common bacterial pathogens (Haemophilus,
Streptococcus, Moraxella) reduce treatment failure and mortality in moderate-to-severe
COPD exacerbations.
Question 6
A 29-year-old female with epilepsy controlled on lamotrigine is planning pregnancy. She is
currently on folic acid 400 mcg daily. Which intervention is most appropriate?
A. Continue current regimen unchanged
B. Increase folic acid to 4 mg daily and continue lamotrigine
C. Switch to valproic acid due to lower teratogenicity
D. Discontinue lamotrigine and start levetiracetam
Correct Answer: B
Explanation: High-dose folic acid (4 mg) is recommended for women on antiepileptic drugs;
lamotrigine has favorable pregnancy safety data compared to valproate.
Question 7
A 55-year-old male with type 2 diabetes, hypertension, and albuminuria is on lisinopril 20
mg daily, metformin 1000 mg BID, and amlodipine 10 mg daily. His BP is 152/94 mmHg and
A1c is 7.8%. Which addition best addresses both blood pressure and renal protection?
A. Add hydrochlorothiazide 25 mg daily
B. Add dapagliflozin 10 mg daily
C. Add carvedilol 12.5 mg BID
D. Add hydralazine 25 mg TID
Professional Certification Practice Test — Pharmacotherapy,
Disease Management, Drug Therapy, Patient Care & Clinical
Decision-Making — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Domain 1: Patient-Centered Pharmacotherapy (~55% — 105 Questions)
Question 1
A 58-year-old male with heart failure with reduced ejection fraction (HFrEF, EF 28%) is on
guideline-directed medical therapy including sacubitril/valsartan, carvedilol, and
spironolactone. He presents with worsening dyspnea and is found to have a potassium of 5.8
mEq/L and creatinine of 2.4 mg/dL. Which intervention is most appropriate?
A. Add furosemide 40 mg IV push
B. Hold spironolactone and initiate patiromer
C. Discontinue sacubitril/valsartan and start lisinopril
D. Initiate sodium polystyrene sulfonate 30 g PO
Correct Answer: B
Explanation: Hyperkalemia with renal impairment requires holding the potassium-sparing
agent; patiromer enables continuation of RAAS therapy when clinically necessary.
Question 2
A 34-year-old female with type 1 diabetes and asthma is admitted with diabetic ketoacidosis.
Her home regimen includes insulin glargine and insulin aspart. Which insulin strategy is most
appropriate during the acute management phase?
,A. Continue glargine at home dose and use correctional aspart only
B. Transition to regular insulin infusion and discontinue glargine
C. Hold all long-acting insulin until anion gap closes
D. Use NPH insulin twice daily with sliding-scale regular insulin
Correct Answer: B
Explanation: IV regular insulin infusion is standard for DKA; glargine should be held initially
but subcutaneous basal insulin must be initiated before infusion discontinuation.
Question 3
A 67-year-old male with atrial fibrillation and stage 4 chronic kidney disease (CrCl 22
mL/min) requires anticoagulation. His CHA₂DS₂-VASc score is 5. Which anticoagulant is most
appropriate?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily
C. Warfarin with INR goal 2–3
D. Dabigatran 150 mg twice daily
Correct Answer: C
Explanation: Warfarin remains the preferred anticoagulant in severe CKD; DOACs require
dose adjustment or are contraindicated, and apixaban requires 2.5 mg BID in this
population.
Question 4
,A 45-year-old female with major depressive disorder has failed adequate trials of sertraline
and escitalopram. She has a history of seasonal affective disorder and reports significant
fatigue. Which augmentation strategy is best supported by evidence?
A. Add aripiprazole 5 mg daily
B. Add bupropion XL 150 mg daily
C. Switch to venlafaxine XR 75 mg daily
D. Add liothyronine 25 mcg daily
Correct Answer: B
Explanation: Bupropion augmentation addresses residual fatigue and anhedonia while
avoiding serotonergic side effects; it is particularly beneficial in patients with seasonal
patterns.
Question 5
A 72-year-old male with COPD (GOLD Stage 3) presents with an acute exacerbation. He is
started on prednisone 40 mg daily, azithromycin, and bronchodilators. Which additional
intervention reduces mortality in this setting?
A. Initiating roflumilast
B. Adding inhaled corticosteroid
C. Antibiotic therapy with a beta-lactam
D. Low-dose theophylline
Correct Answer: C
, Explanation: Antibiotics targeting common bacterial pathogens (Haemophilus,
Streptococcus, Moraxella) reduce treatment failure and mortality in moderate-to-severe
COPD exacerbations.
Question 6
A 29-year-old female with epilepsy controlled on lamotrigine is planning pregnancy. She is
currently on folic acid 400 mcg daily. Which intervention is most appropriate?
A. Continue current regimen unchanged
B. Increase folic acid to 4 mg daily and continue lamotrigine
C. Switch to valproic acid due to lower teratogenicity
D. Discontinue lamotrigine and start levetiracetam
Correct Answer: B
Explanation: High-dose folic acid (4 mg) is recommended for women on antiepileptic drugs;
lamotrigine has favorable pregnancy safety data compared to valproate.
Question 7
A 55-year-old male with type 2 diabetes, hypertension, and albuminuria is on lisinopril 20
mg daily, metformin 1000 mg BID, and amlodipine 10 mg daily. His BP is 152/94 mmHg and
A1c is 7.8%. Which addition best addresses both blood pressure and renal protection?
A. Add hydrochlorothiazide 25 mg daily
B. Add dapagliflozin 10 mg daily
C. Add carvedilol 12.5 mg BID
D. Add hydralazine 25 mg TID
