Board Certified Psychiatric Pharmacist (BCPP) Exam 2026:
Professional Certification Practice Test — Psychopharmacology,
Mental Health Disorders, Medication Management & Patient Care —
190 Multiple-Choice Questions with Answers & Detailed Rationales
Section 1: Mood Disorders — Depressive Disorders
Question 1
A 34-year-old woman with major depressive disorder has failed adequate trials of sertraline
and escitalopram. She has no psychotic features and no history of mania or hypomania.
Which agent is most appropriate to augment her current antidepressant?
A. Lithium
B. Lamotrigine
C. Aripiprazole
D. Buspirone
Correct Answer: C
Explanation: Aripiprazole is FDA-approved as adjunctive therapy for MDD and has robust
evidence for augmentation. Lithium has weaker evidence for MDD augmentation.
Question 2
A patient with major depressive disorder and concurrent seizure disorder requires an
antidepressant that will not lower his seizure threshold. Which agent is most appropriate?
A. Bupropion
,B. Clomipramine
C. Sertraline
D. Amoxapine
Correct Answer: C
Explanation: SSRIs like sertraline are generally safe in epilepsy and may raise seizure
threshold. Bupropion and tricyclics lower seizure threshold.
Question 3
A 28-year-old woman with MDD is currently taking an oral contraceptive and reports new-
onset breakthrough bleeding after starting an antidepressant. Which antidepressant is most
likely responsible?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Bupropion
Correct Answer: D
Explanation: Bupropion induces CYP3A4, accelerating oral contraceptive metabolism and
reducing efficacy. SSRIs and SNRIs generally do not significantly affect OC efficacy.
Question 4
A patient with treatment-resistant depression has failed SSRIs, SNRIs, and augmentation
with atypical antipsychotics. Which agent, when added to an MAOI, requires a washout
period due to risk of serotonin syndrome?
,A. Lithium
B. Mirtazapine
C. Sertraline
D. Bupropion
Correct Answer: C
Explanation: SSRIs and MAOIs both increase serotonergic activity; combination causes
potentially fatal serotonin syndrome. Requires 2-week washout.
Question 5
A 45-year-old man with MDD and chronic neuropathic pain is being initiated on duloxetine.
What baseline monitoring is most important?
A. Serum sodium
B. Blood pressure
C. Liver function tests
D. Complete blood count
Correct Answer: B
Explanation: SNRIs like duloxetine cause dose-dependent blood pressure elevation. Baseline
and periodic BP monitoring is essential.
Question 6
, A pregnant patient in her third trimester has severe MDD and is considering antidepressant
continuation. Which neonatal complication is most associated with late-trimester SSRI
exposure?
A. Neural tube defects
B. Persistent pulmonary hypertension
C. Ebstein anomaly
D. Limb malformations
Correct Answer: B
Explanation: Late-trimester SSRI exposure is associated with persistent pulmonary
hypertension of the newborn (PPHN). Neural tube defects are linked to first-trimester
exposure.
Question 7
A 62-year-old man with MDD and BPH is concerned about urinary retention. Which
antidepressant is most appropriate to avoid?
A. Duloxetine
B. Sertraline
C. Amitriptyline
D. Bupropion
Correct Answer: C
Explanation: Tricyclic antidepressants like amitriptyline have strong anticholinergic effects
that worsen urinary retention. SNRIs and SSRIs have minimal anticholinergic activity.
Professional Certification Practice Test — Psychopharmacology,
Mental Health Disorders, Medication Management & Patient Care —
190 Multiple-Choice Questions with Answers & Detailed Rationales
Section 1: Mood Disorders — Depressive Disorders
Question 1
A 34-year-old woman with major depressive disorder has failed adequate trials of sertraline
and escitalopram. She has no psychotic features and no history of mania or hypomania.
Which agent is most appropriate to augment her current antidepressant?
A. Lithium
B. Lamotrigine
C. Aripiprazole
D. Buspirone
Correct Answer: C
Explanation: Aripiprazole is FDA-approved as adjunctive therapy for MDD and has robust
evidence for augmentation. Lithium has weaker evidence for MDD augmentation.
Question 2
A patient with major depressive disorder and concurrent seizure disorder requires an
antidepressant that will not lower his seizure threshold. Which agent is most appropriate?
A. Bupropion
,B. Clomipramine
C. Sertraline
D. Amoxapine
Correct Answer: C
Explanation: SSRIs like sertraline are generally safe in epilepsy and may raise seizure
threshold. Bupropion and tricyclics lower seizure threshold.
Question 3
A 28-year-old woman with MDD is currently taking an oral contraceptive and reports new-
onset breakthrough bleeding after starting an antidepressant. Which antidepressant is most
likely responsible?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Bupropion
Correct Answer: D
Explanation: Bupropion induces CYP3A4, accelerating oral contraceptive metabolism and
reducing efficacy. SSRIs and SNRIs generally do not significantly affect OC efficacy.
Question 4
A patient with treatment-resistant depression has failed SSRIs, SNRIs, and augmentation
with atypical antipsychotics. Which agent, when added to an MAOI, requires a washout
period due to risk of serotonin syndrome?
,A. Lithium
B. Mirtazapine
C. Sertraline
D. Bupropion
Correct Answer: C
Explanation: SSRIs and MAOIs both increase serotonergic activity; combination causes
potentially fatal serotonin syndrome. Requires 2-week washout.
Question 5
A 45-year-old man with MDD and chronic neuropathic pain is being initiated on duloxetine.
What baseline monitoring is most important?
A. Serum sodium
B. Blood pressure
C. Liver function tests
D. Complete blood count
Correct Answer: B
Explanation: SNRIs like duloxetine cause dose-dependent blood pressure elevation. Baseline
and periodic BP monitoring is essential.
Question 6
, A pregnant patient in her third trimester has severe MDD and is considering antidepressant
continuation. Which neonatal complication is most associated with late-trimester SSRI
exposure?
A. Neural tube defects
B. Persistent pulmonary hypertension
C. Ebstein anomaly
D. Limb malformations
Correct Answer: B
Explanation: Late-trimester SSRI exposure is associated with persistent pulmonary
hypertension of the newborn (PPHN). Neural tube defects are linked to first-trimester
exposure.
Question 7
A 62-year-old man with MDD and BPH is concerned about urinary retention. Which
antidepressant is most appropriate to avoid?
A. Duloxetine
B. Sertraline
C. Amitriptyline
D. Bupropion
Correct Answer: C
Explanation: Tricyclic antidepressants like amitriptyline have strong anticholinergic effects
that worsen urinary retention. SNRIs and SSRIs have minimal anticholinergic activity.
