BCPP Board Certified Psychiatric Pharmacist Exam 2026
Latest Comprehensive Study Guide with Practice Questions
Psychiatric Pharmacotherapy Review, Detailed Rationales,
Verified Answers, Success Workbook
Key Pharmacotherapy Topics:
Schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders,
substance use disorders, ADHD, neurodegenerative disorders, sleep-wake
disorders, psychotropic pharmacokinetics, drug interactions, adverse effect
management (metabolic, movement, cardiac, hematologic), and pediatric/geriatric
considerations.
SECTION 1: PERSON-CENTERED CARE — SCHIZOPHRENIA &
OTHER PSYCHOTIC DISORDERS (Questions 1-15)
Schizophrenia and psychotic disorders are consistently high-yield topics on the
BCPP exam .
Question 1
A 32-year-old male with schizophrenia has been stable on paliperidone 6 mg daily
for 18 months. He reports new-onset excessive thirst, frequent urination, and a 4 kg
weight loss over 2 months. Fasting glucose is 165 mg/dL and HbA1c is 7.8%.
Which of the following is the most appropriate next step?
A) Increase paliperidone to 9 mg daily
B) Switch to aripiprazole 15 mg daily
C) Add metformin 500 mg twice daily
D) Continue paliperidone and start insulin
Answer: B) Switch to aripiprazole 15 mg daily
Rationale: Paliperidone (an SGRA) is associated with significant metabolic side
effects including hyperglycemia and weight gain. Aripiprazole has a lower
metabolic risk profile and is a reasonable alternative. While metformin could be
added, switching to a lower-risk antipsychotic is preferred when metabolic
,complications develop. Insulin is not first-line for antipsychotic-induced
hyperglycemia.
Question 2
Which of the following antipsychotics has the highest risk of QTc prolongation?
A) Aripiprazole
B) Ziprasidone
C) Risperidone
D) Olanzapine
Answer: B) Ziprasidone
Rationale: Ziprasidone is associated with the highest risk of QTc prolongation
among atypical antipsychotics. It should be used with caution in patients with
baseline QTc prolongation, electrolyte abnormalities, or concurrent use of other
QTc-prolonging medications. A baseline ECG and monitoring of electrolytes are
recommended.
Question 3
A 45-year-old patient with schizophrenia on clozapine 300 mg daily reports
increased salivation, especially at night. Which of the following is the most
appropriate intervention?
A) Increase clozapine dose
B) Add glycopyrrolate 1 mg twice daily
C) Add benztropine 1 mg daily
D) Discontinue clozapine
Answer: B) Add glycopyrrolate 1 mg twice daily
Rationale: Clozapine-induced hypersalivation (sialorrhea) is a common and
distressing side effect. Glycopyrrolate, a peripheral anticholinergic, is effective for
managing this symptom. Benztropine is centrally acting and can worsen cognitive
side effects. Dose reduction or discontinuation is not indicated for this side effect
alone.
,Question 4
A patient is started on clozapine. According to the REMS program, how frequently
must absolute neutrophil count (ANC) be monitored during the first 6 months of
therapy?
A) Monthly
B) Weekly
C) Every 2 weeks
D) Every 6 months
Answer: B) Weekly
Rationale: Clozapine REMS requires weekly ANC monitoring for the first 6
months of therapy. After 6 months, if the ANC remains stable, monitoring may be
reduced to every 2 weeks for the next 6 months, then monthly thereafter. Clozapine
carries a boxed warning for agranulocytosis, making this monitoring essential.
Question 5
A 28-year-old female with schizophrenia is on risperidone 4 mg daily. She reports
amenorrhea and galactorrhea. Prolactin level is 85 ng/mL (normal < 25). Which of
the following is the most appropriate next step?
A) Add bromocriptine
B) Switch to aripiprazole
C) Increase risperidone to 6 mg
D) Add metformin
Answer: B) Switch to aripiprazole
Rationale: Risperidone is associated with significant hyperprolactinemia due to its
strong D2 receptor antagonism. Aripiprazole, a partial D2 agonist, has a lower risk
of hyperprolactinemia and may even lower prolactin levels. Bromocriptine is a
dopamine agonist that can be used but does not address the underlying cause.
Question 6
A 55-year-old patient with schizophrenia on haloperidol 10 mg daily develops
rigidity, bradykinesia, and a shuffling gait. Which of the following is the most
appropriate intervention?
, A) Add amantadine
B) Add benztropine 1 mg twice daily
C) Increase haloperidol dose
D) Add propranolol
Answer: B) Add benztropine 1 mg twice daily
Rationale: These symptoms are consistent with antipsychotic-induced
parkinsonism, an extrapyramidal symptom (EPS). Anticholinergic agents like
benztropine are first-line for managing EPS. Amantadine is also used but is
typically second-line. Propranolol is used for akathisia, not parkinsonism.
Question 7
A patient is started on long-acting injectable risperidone (Risperdal Consta). What
is the appropriate dosing interval?
A) Monthly
B) Every 2 weeks
C) Every 4 weeks
D) Every 3 months
Answer: B) Every 2 weeks
Rationale: Risperidone long-acting injectable (Risperdal Consta) is administered
every 2 weeks. Paliperidone palmitate is administered monthly (or every 3 months
for the extended formulation). Aripiprazole lauroxil and long-acting injectable
aripiprazole have various dosing intervals.
Question 8
Which of the following laboratory tests is required before initiating clozapine
therapy?
A) Complete blood count (CBC) with differential
B) Baseline ANC and WBC
C) Liver function tests
D) Serum creatinine
Answer: B) Baseline ANC and WBC
Latest Comprehensive Study Guide with Practice Questions
Psychiatric Pharmacotherapy Review, Detailed Rationales,
Verified Answers, Success Workbook
Key Pharmacotherapy Topics:
Schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders,
substance use disorders, ADHD, neurodegenerative disorders, sleep-wake
disorders, psychotropic pharmacokinetics, drug interactions, adverse effect
management (metabolic, movement, cardiac, hematologic), and pediatric/geriatric
considerations.
SECTION 1: PERSON-CENTERED CARE — SCHIZOPHRENIA &
OTHER PSYCHOTIC DISORDERS (Questions 1-15)
Schizophrenia and psychotic disorders are consistently high-yield topics on the
BCPP exam .
Question 1
A 32-year-old male with schizophrenia has been stable on paliperidone 6 mg daily
for 18 months. He reports new-onset excessive thirst, frequent urination, and a 4 kg
weight loss over 2 months. Fasting glucose is 165 mg/dL and HbA1c is 7.8%.
Which of the following is the most appropriate next step?
A) Increase paliperidone to 9 mg daily
B) Switch to aripiprazole 15 mg daily
C) Add metformin 500 mg twice daily
D) Continue paliperidone and start insulin
Answer: B) Switch to aripiprazole 15 mg daily
Rationale: Paliperidone (an SGRA) is associated with significant metabolic side
effects including hyperglycemia and weight gain. Aripiprazole has a lower
metabolic risk profile and is a reasonable alternative. While metformin could be
added, switching to a lower-risk antipsychotic is preferred when metabolic
,complications develop. Insulin is not first-line for antipsychotic-induced
hyperglycemia.
Question 2
Which of the following antipsychotics has the highest risk of QTc prolongation?
A) Aripiprazole
B) Ziprasidone
C) Risperidone
D) Olanzapine
Answer: B) Ziprasidone
Rationale: Ziprasidone is associated with the highest risk of QTc prolongation
among atypical antipsychotics. It should be used with caution in patients with
baseline QTc prolongation, electrolyte abnormalities, or concurrent use of other
QTc-prolonging medications. A baseline ECG and monitoring of electrolytes are
recommended.
Question 3
A 45-year-old patient with schizophrenia on clozapine 300 mg daily reports
increased salivation, especially at night. Which of the following is the most
appropriate intervention?
A) Increase clozapine dose
B) Add glycopyrrolate 1 mg twice daily
C) Add benztropine 1 mg daily
D) Discontinue clozapine
Answer: B) Add glycopyrrolate 1 mg twice daily
Rationale: Clozapine-induced hypersalivation (sialorrhea) is a common and
distressing side effect. Glycopyrrolate, a peripheral anticholinergic, is effective for
managing this symptom. Benztropine is centrally acting and can worsen cognitive
side effects. Dose reduction or discontinuation is not indicated for this side effect
alone.
,Question 4
A patient is started on clozapine. According to the REMS program, how frequently
must absolute neutrophil count (ANC) be monitored during the first 6 months of
therapy?
A) Monthly
B) Weekly
C) Every 2 weeks
D) Every 6 months
Answer: B) Weekly
Rationale: Clozapine REMS requires weekly ANC monitoring for the first 6
months of therapy. After 6 months, if the ANC remains stable, monitoring may be
reduced to every 2 weeks for the next 6 months, then monthly thereafter. Clozapine
carries a boxed warning for agranulocytosis, making this monitoring essential.
Question 5
A 28-year-old female with schizophrenia is on risperidone 4 mg daily. She reports
amenorrhea and galactorrhea. Prolactin level is 85 ng/mL (normal < 25). Which of
the following is the most appropriate next step?
A) Add bromocriptine
B) Switch to aripiprazole
C) Increase risperidone to 6 mg
D) Add metformin
Answer: B) Switch to aripiprazole
Rationale: Risperidone is associated with significant hyperprolactinemia due to its
strong D2 receptor antagonism. Aripiprazole, a partial D2 agonist, has a lower risk
of hyperprolactinemia and may even lower prolactin levels. Bromocriptine is a
dopamine agonist that can be used but does not address the underlying cause.
Question 6
A 55-year-old patient with schizophrenia on haloperidol 10 mg daily develops
rigidity, bradykinesia, and a shuffling gait. Which of the following is the most
appropriate intervention?
, A) Add amantadine
B) Add benztropine 1 mg twice daily
C) Increase haloperidol dose
D) Add propranolol
Answer: B) Add benztropine 1 mg twice daily
Rationale: These symptoms are consistent with antipsychotic-induced
parkinsonism, an extrapyramidal symptom (EPS). Anticholinergic agents like
benztropine are first-line for managing EPS. Amantadine is also used but is
typically second-line. Propranolol is used for akathisia, not parkinsonism.
Question 7
A patient is started on long-acting injectable risperidone (Risperdal Consta). What
is the appropriate dosing interval?
A) Monthly
B) Every 2 weeks
C) Every 4 weeks
D) Every 3 months
Answer: B) Every 2 weeks
Rationale: Risperidone long-acting injectable (Risperdal Consta) is administered
every 2 weeks. Paliperidone palmitate is administered monthly (or every 3 months
for the extended formulation). Aripiprazole lauroxil and long-acting injectable
aripiprazole have various dosing intervals.
Question 8
Which of the following laboratory tests is required before initiating clozapine
therapy?
A) Complete blood count (CBC) with differential
B) Baseline ANC and WBC
C) Liver function tests
D) Serum creatinine
Answer: B) Baseline ANC and WBC
