PHARMD / THERAPEUTICS REVIEW / 2026–2027
PharmD Clinical Case Studies
2026–2027 | Therapeutics Review & Practice Examination
110 original patient-centered multiple-choice cases • 11 therapeutic areas • answers and clinical rationales
Independent educational resource. Not an official PharmD program assessment, board examination, or proprietary
test bank.
How to use this review
For each clinical case, select the one best answer (A–D), then check the explanation beneath the options. Each
incorrect choice is addressed individually.
Adult scenarios are presumed unless an age is specified. Case details and laboratory findings are fictional.
Prescribing decisions require local formulary verification, patient-specific information and professional
judgment.
Some scenarios address time-sensitive emergencies; the correct educational action includes urgent escalation
rather than a self-treatment instruction.
Updated reference orientation: ADA 2026, GINA 2026, AHA/ACC ACS 2025, IDSA resistant gram-negative guidance,
and other established pharmacotherapy principles. Guidance may evolve.
Coverage map
01 Cardiovascular & Heart Failure — 10 original cases
02 Thrombosis, Stroke & Acute Coronary Care — 10 original cases
03 Diabetes & Other Endocrine Disorders — 10 original cases
04 Infectious Diseases & Antimicrobial Stewardship — 10 original cases
05 Respiratory & Allergy Therapeutics — 10 original cases
06 Renal, Electrolytes & Fluid Management — 10 original cases
07 Gastrointestinal, Hepatic & Nutrition Therapeutics — 10 original cases
08 Neurology, Psychiatry & Behavioral Health — 10 original cases
09 Pain, Rheumatology & Bone Health — 10 original cases
10 Oncology, Immunology & Transplantation — 10 original cases
11 Special Populations, Safety & Applied Calculations — 10 original cases
Instructions
• Suggested testing time: 140–165 minutes before reviewing rationales.
• Use a calculator for questions 101–103 and 107.
• Target broad clinical reasoning, not memorization of a single institution’s exam.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 1
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
01 Cardiovascular & Heart Failure
Cases 1–10
Question 1. A 62-year-old with symptomatic HFrEF (LVEF 30%), normal potassium, eGFR 65, and
stable blood pressure is taking lisinopril and carvedilol. Which additional disease-modifying drug
class is appropriate?
A. Chronic oral milrinone
B. Regular ibuprofen
C. SGLT2 inhibitor such as dapagliflozin
D. Short-acting nifedipine alone
Correct answer: C — SGLT2 inhibitor such as dapagliflozin
Clinical rationale: SGLT2 inhibition lowers HF hospitalization risk in symptomatic HFrEF even without
diabetes; evaluate volume status and contraindications.
Why the other options are incorrect:
A. Long-term oral positive inotropes are not routine disease-modifying therapy.
B. NSAIDs can promote fluid retention and worsen heart failure.
D. Short-acting nifedipine is not foundational HFrEF therapy.
Question 2. A 70-year-old taking lisinopril for hypertension develops a persistent dry cough, with no
airway infection or angioedema. What is the best medication change?
A. Replace with potassium chloride
B. Switch to losartan after clinical review
C. Add dextromethorphan indefinitely
D. Double the lisinopril dose
Correct answer: B — Switch to losartan after clinical review
Clinical rationale: An ARB can control blood pressure without the bradykinin-related cough associated
with ACE inhibitors.
Why the other options are incorrect:
A. Potassium supplementation is not an antihypertensive and may cause hyperkalemia.
C. Cough suppression does not address the likely adverse drug reaction.
D. More ACE inhibitor increases exposure and may worsen the cough.
Question 3. A 59-year-old with prior myocardial infarction has LDL-C 150 mg/dL and takes no lipid-
lowering medication. Which intervention is most appropriate?
A. Initiate high-intensity statin therapy
B. Start niacin alone as first-line therapy
C. Use fish oil as the only LDL-lowering therapy
D. Delay drug therapy until LDL-C exceeds 190 mg/dL
Correct answer: A — Initiate high-intensity statin therapy
Clinical rationale: Established ASCVD warrants intensive LDL-C lowering as secondary prevention; reassess
response and tolerability.
Why the other options are incorrect:
ORIGINAL EDUCATIONAL PRACTICE • PAGE 2
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
B. Niacin does not replace proven statin-based secondary prevention.
C. Fish oil alone is not a substitute for LDL reduction.
D. The 190 mg/dL threshold is not required in established ASCVD.
Question 4. A 67-year-old taking furosemide for edema reports weakness; potassium is 2.9 mEq/L and
magnesium is low. What is the priority?
A. Increase furosemide immediately
B. Add another potassium-wasting diuretic
C. Restrict all electrolyte replacement
D. Evaluate and replace potassium and magnesium with cardiac monitoring as indicated
Correct answer: D — Evaluate and replace potassium and magnesium with cardiac monitoring as indicated
Clinical rationale: Loop diuretics cause potassium and magnesium wasting, creating arrhythmia risk;
investigate severity and replete safely.
Why the other options are incorrect:
A. Increasing the loop diuretic worsens electrolyte losses.
B. Another potassium-wasting agent can aggravate the deficit.
C. Untreated marked electrolyte depletion raises cardiac risk.
Question 5. A patient starts spironolactone while taking an ACE inhibitor for HFrEF. Which
laboratory parameters require particular monitoring?
A. Hemoglobin A1c and uric acid only
B. Platelet count only
C. Serum amylase only
D. Potassium and serum creatinine
Correct answer: D — Potassium and serum creatinine
Clinical rationale: Mineralocorticoid antagonists plus ACE inhibition increase hyperkalemia and renal-
function risk.
Why the other options are incorrect:
A. Glycemia and urate do not replace potassium and renal monitoring.
B. Platelets alone do not capture the main risk.
C. Amylase is unrelated to routine spironolactone toxicity monitoring.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 3
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
Question 6. A 52-year-old with blood pressure 154/94 mmHg and albuminuric CKD needs medication
selection. Which class commonly offers kidney-protective benefits?
A. Immediate-release nifedipine as needed
B. Potassium supplements alone
C. ACE inhibitor or ARB as tolerated
D. Alpha-1 blocker only
Correct answer: C — ACE inhibitor or ARB as tolerated
Clinical rationale: RAAS blockade can lower BP and albuminuria; monitor potassium and kidney function
after initiation.
Why the other options are incorrect:
A. Short-acting PRN nifedipine is inappropriate for chronic BP control.
B. Potassium does not treat hypertension and could be dangerous.
D. Alpha-1 blockers do not provide comparable albuminuria benefit.
Question 7. A patient receiving amlodipine for hypertension develops bilateral ankle edema but has
no dyspnea or crackles. What counseling best explains the effect?
A. Amlodipine commonly causes potassium depletion
B. Dihydropyridine arteriolar dilation can cause peripheral edema
C. Edema proves acute renal failure
D. Edema always requires more sodium intake
Correct answer: B — Dihydropyridine arteriolar dilation can cause peripheral edema
Clinical rationale: Vasodilatory edema is a recognized dose-related adverse effect; reassess therapy rather
than assuming fluid overload.
Why the other options are incorrect:
A. Amlodipine is not a typical potassium-wasting agent.
C. A normal examination and timing do not establish acute renal failure.
D. Increasing sodium does not treat vasodilatory edema.
Question 8. A 64-year-old with HFrEF was hospitalized for fluid overload and is now euvolemic and
stable. Which medication principally treats congestion, rather than proven mortality reduction?
A. Furosemide
B. Sacubitril/valsartan
C. Evidence-based beta blocker
D. Spironolactone
Correct answer: A — Furosemide
Clinical rationale: Loop diuretics relieve sodium and water retention and improve symptoms, while other
listed classes provide disease-modifying effects when indicated.
Why the other options are incorrect:
B. ARNI therapy is used for outcome benefit, not solely diuresis.
C. Selected beta blockers lower mortality in HFrEF.
D. MRAs improve HFrEF outcomes beyond congestion control.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 4
PharmD Clinical Case Studies
2026–2027 | Therapeutics Review & Practice Examination
110 original patient-centered multiple-choice cases • 11 therapeutic areas • answers and clinical rationales
Independent educational resource. Not an official PharmD program assessment, board examination, or proprietary
test bank.
How to use this review
For each clinical case, select the one best answer (A–D), then check the explanation beneath the options. Each
incorrect choice is addressed individually.
Adult scenarios are presumed unless an age is specified. Case details and laboratory findings are fictional.
Prescribing decisions require local formulary verification, patient-specific information and professional
judgment.
Some scenarios address time-sensitive emergencies; the correct educational action includes urgent escalation
rather than a self-treatment instruction.
Updated reference orientation: ADA 2026, GINA 2026, AHA/ACC ACS 2025, IDSA resistant gram-negative guidance,
and other established pharmacotherapy principles. Guidance may evolve.
Coverage map
01 Cardiovascular & Heart Failure — 10 original cases
02 Thrombosis, Stroke & Acute Coronary Care — 10 original cases
03 Diabetes & Other Endocrine Disorders — 10 original cases
04 Infectious Diseases & Antimicrobial Stewardship — 10 original cases
05 Respiratory & Allergy Therapeutics — 10 original cases
06 Renal, Electrolytes & Fluid Management — 10 original cases
07 Gastrointestinal, Hepatic & Nutrition Therapeutics — 10 original cases
08 Neurology, Psychiatry & Behavioral Health — 10 original cases
09 Pain, Rheumatology & Bone Health — 10 original cases
10 Oncology, Immunology & Transplantation — 10 original cases
11 Special Populations, Safety & Applied Calculations — 10 original cases
Instructions
• Suggested testing time: 140–165 minutes before reviewing rationales.
• Use a calculator for questions 101–103 and 107.
• Target broad clinical reasoning, not memorization of a single institution’s exam.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 1
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
01 Cardiovascular & Heart Failure
Cases 1–10
Question 1. A 62-year-old with symptomatic HFrEF (LVEF 30%), normal potassium, eGFR 65, and
stable blood pressure is taking lisinopril and carvedilol. Which additional disease-modifying drug
class is appropriate?
A. Chronic oral milrinone
B. Regular ibuprofen
C. SGLT2 inhibitor such as dapagliflozin
D. Short-acting nifedipine alone
Correct answer: C — SGLT2 inhibitor such as dapagliflozin
Clinical rationale: SGLT2 inhibition lowers HF hospitalization risk in symptomatic HFrEF even without
diabetes; evaluate volume status and contraindications.
Why the other options are incorrect:
A. Long-term oral positive inotropes are not routine disease-modifying therapy.
B. NSAIDs can promote fluid retention and worsen heart failure.
D. Short-acting nifedipine is not foundational HFrEF therapy.
Question 2. A 70-year-old taking lisinopril for hypertension develops a persistent dry cough, with no
airway infection or angioedema. What is the best medication change?
A. Replace with potassium chloride
B. Switch to losartan after clinical review
C. Add dextromethorphan indefinitely
D. Double the lisinopril dose
Correct answer: B — Switch to losartan after clinical review
Clinical rationale: An ARB can control blood pressure without the bradykinin-related cough associated
with ACE inhibitors.
Why the other options are incorrect:
A. Potassium supplementation is not an antihypertensive and may cause hyperkalemia.
C. Cough suppression does not address the likely adverse drug reaction.
D. More ACE inhibitor increases exposure and may worsen the cough.
Question 3. A 59-year-old with prior myocardial infarction has LDL-C 150 mg/dL and takes no lipid-
lowering medication. Which intervention is most appropriate?
A. Initiate high-intensity statin therapy
B. Start niacin alone as first-line therapy
C. Use fish oil as the only LDL-lowering therapy
D. Delay drug therapy until LDL-C exceeds 190 mg/dL
Correct answer: A — Initiate high-intensity statin therapy
Clinical rationale: Established ASCVD warrants intensive LDL-C lowering as secondary prevention; reassess
response and tolerability.
Why the other options are incorrect:
ORIGINAL EDUCATIONAL PRACTICE • PAGE 2
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
B. Niacin does not replace proven statin-based secondary prevention.
C. Fish oil alone is not a substitute for LDL reduction.
D. The 190 mg/dL threshold is not required in established ASCVD.
Question 4. A 67-year-old taking furosemide for edema reports weakness; potassium is 2.9 mEq/L and
magnesium is low. What is the priority?
A. Increase furosemide immediately
B. Add another potassium-wasting diuretic
C. Restrict all electrolyte replacement
D. Evaluate and replace potassium and magnesium with cardiac monitoring as indicated
Correct answer: D — Evaluate and replace potassium and magnesium with cardiac monitoring as indicated
Clinical rationale: Loop diuretics cause potassium and magnesium wasting, creating arrhythmia risk;
investigate severity and replete safely.
Why the other options are incorrect:
A. Increasing the loop diuretic worsens electrolyte losses.
B. Another potassium-wasting agent can aggravate the deficit.
C. Untreated marked electrolyte depletion raises cardiac risk.
Question 5. A patient starts spironolactone while taking an ACE inhibitor for HFrEF. Which
laboratory parameters require particular monitoring?
A. Hemoglobin A1c and uric acid only
B. Platelet count only
C. Serum amylase only
D. Potassium and serum creatinine
Correct answer: D — Potassium and serum creatinine
Clinical rationale: Mineralocorticoid antagonists plus ACE inhibition increase hyperkalemia and renal-
function risk.
Why the other options are incorrect:
A. Glycemia and urate do not replace potassium and renal monitoring.
B. Platelets alone do not capture the main risk.
C. Amylase is unrelated to routine spironolactone toxicity monitoring.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 3
, PHARMD / THERAPEUTICS REVIEW / 2026–2027
Question 6. A 52-year-old with blood pressure 154/94 mmHg and albuminuric CKD needs medication
selection. Which class commonly offers kidney-protective benefits?
A. Immediate-release nifedipine as needed
B. Potassium supplements alone
C. ACE inhibitor or ARB as tolerated
D. Alpha-1 blocker only
Correct answer: C — ACE inhibitor or ARB as tolerated
Clinical rationale: RAAS blockade can lower BP and albuminuria; monitor potassium and kidney function
after initiation.
Why the other options are incorrect:
A. Short-acting PRN nifedipine is inappropriate for chronic BP control.
B. Potassium does not treat hypertension and could be dangerous.
D. Alpha-1 blockers do not provide comparable albuminuria benefit.
Question 7. A patient receiving amlodipine for hypertension develops bilateral ankle edema but has
no dyspnea or crackles. What counseling best explains the effect?
A. Amlodipine commonly causes potassium depletion
B. Dihydropyridine arteriolar dilation can cause peripheral edema
C. Edema proves acute renal failure
D. Edema always requires more sodium intake
Correct answer: B — Dihydropyridine arteriolar dilation can cause peripheral edema
Clinical rationale: Vasodilatory edema is a recognized dose-related adverse effect; reassess therapy rather
than assuming fluid overload.
Why the other options are incorrect:
A. Amlodipine is not a typical potassium-wasting agent.
C. A normal examination and timing do not establish acute renal failure.
D. Increasing sodium does not treat vasodilatory edema.
Question 8. A 64-year-old with HFrEF was hospitalized for fluid overload and is now euvolemic and
stable. Which medication principally treats congestion, rather than proven mortality reduction?
A. Furosemide
B. Sacubitril/valsartan
C. Evidence-based beta blocker
D. Spironolactone
Correct answer: A — Furosemide
Clinical rationale: Loop diuretics relieve sodium and water retention and improve symptoms, while other
listed classes provide disease-modifying effects when indicated.
Why the other options are incorrect:
B. ARNI therapy is used for outcome benefit, not solely diuresis.
C. Selected beta blockers lower mortality in HFrEF.
D. MRAs improve HFrEF outcomes beyond congestion control.
ORIGINAL EDUCATIONAL PRACTICE • PAGE 4
