BCEMP Emergency Medicine Pharmacy Certification Exam 2026:
Comprehensive Board Practice Test — Emergency
Pharmacotherapy, Toxicology, Resuscitation, Critical Care, Patient
Management & Therapeutic Monitoring — Multiple-Choice Questions
with Answers & Detailed Rationales
Question 1
A 68-year-old male (80 kg) presents in cardiac arrest with pulseless ventricular tachycardia.
After the second defibrillation attempt, which medication should be administered first?
A. Amiodarone 300 mg IV push
B. Epinephrine 1 mg IV every 3–5 minutes
C. Lidocaine 1.5 mg/kg IV push
D. Magnesium sulfate 2 g IV
Correct Answer: B
Explanation: Epinephrine is the first-line vasopressor in ACLS for cardiac arrest and should be
given after the first or second defibrillation attempt.
Question 2
A 28-year-old female presents with a suspected opioid overdose. She has a respiratory rate
of 6 breaths/min and pinpoint pupils. Which medication is first-line?
A. Flumazenil 0.2 mg IV
,B. Naltrexone 50 mg PO
C. Naloxone 0.4–2 mg IV/IM
D. Buprenorphine 2 mg SL
Correct Answer: C
Explanation: Naloxone is the opioid antagonist of choice for acute overdose with respiratory
depression; flumazenil is for benzodiazepine reversal.
Question 3
A 55-year-old male with known seizure disorder presents in status epilepticus. After two
adequate doses of IV lorazepam, seizures continue. Which medication is most appropriate
next?
A. Levetiracetam 60 mg/kg IV
B. Phenytoin 20 mg/kg IV
C. Propofol 2 mg/kg IV bolus
D. Midazolam 10 mg IM
Correct Answer: A
Explanation: Levetiracetam is a preferred second-line antiseizure medication after
benzodiazepines due to favorable safety and ease of administration.
Question 4
A 45-year-old female with severe asthma exacerbation is not responding to continuous
albuterol and ipratropium. Which adjunctive IV medication is most appropriate?
,A. Methylprednisolone 125 mg IV
B. Epinephrine 1 mg IV push
C. Ketamine 1 mg/kg IV
D. Magnesium sulfate 2 g IV over 20 minutes
Correct Answer: D
Explanation: IV magnesium provides additional bronchodilation via smooth muscle
relaxation in severe asthma not responding to standard therapy.
Question 5
A 72-year-old male with atrial fibrillation presents with acute decompensated heart failure
and heart rate of 148 bpm. Which medication is most appropriate for rate control?
A. Adenosine 6 mg IV push
B. Diltiazem 0.25 mg/kg IV bolus
C. Amiodarone 150 mg IV over 10 minutes
D. Digoxin 0.5 mg IV load
Correct Answer: C
Explanation: Amiodarone is preferred for rate control in AF with decompensated heart
failure; diltiazem is contraindicated due to negative inotropy.
Question 6
, A 62-year-old male on apixaban presents with life-threatening GI bleed. Which reversal
agent is most appropriate?
A. Andexanet alfa
B. Vitamin K
C. Protamine sulfate
D. Idarucizumab
Correct Answer: A
Explanation: Andexanet alfa is the specific reversal agent for direct factor Xa inhibitors
including apixaban and rivaroxaban.
Question 7
A 45-year-old male on dabigatran presents with intracranial hemorrhage. Which reversal
agent is indicated?
A. Andexanet alfa
B. Idarucizumab 5 g IV
C. Vitamin K 10 mg IV
D. Protamine sulfate 50 mg IV
Correct Answer: B
Explanation: Idarucizumab is the specific monoclonal antibody fragment for dabigatran
reversal in life-threatening bleeding.
Question 8
Comprehensive Board Practice Test — Emergency
Pharmacotherapy, Toxicology, Resuscitation, Critical Care, Patient
Management & Therapeutic Monitoring — Multiple-Choice Questions
with Answers & Detailed Rationales
Question 1
A 68-year-old male (80 kg) presents in cardiac arrest with pulseless ventricular tachycardia.
After the second defibrillation attempt, which medication should be administered first?
A. Amiodarone 300 mg IV push
B. Epinephrine 1 mg IV every 3–5 minutes
C. Lidocaine 1.5 mg/kg IV push
D. Magnesium sulfate 2 g IV
Correct Answer: B
Explanation: Epinephrine is the first-line vasopressor in ACLS for cardiac arrest and should be
given after the first or second defibrillation attempt.
Question 2
A 28-year-old female presents with a suspected opioid overdose. She has a respiratory rate
of 6 breaths/min and pinpoint pupils. Which medication is first-line?
A. Flumazenil 0.2 mg IV
,B. Naltrexone 50 mg PO
C. Naloxone 0.4–2 mg IV/IM
D. Buprenorphine 2 mg SL
Correct Answer: C
Explanation: Naloxone is the opioid antagonist of choice for acute overdose with respiratory
depression; flumazenil is for benzodiazepine reversal.
Question 3
A 55-year-old male with known seizure disorder presents in status epilepticus. After two
adequate doses of IV lorazepam, seizures continue. Which medication is most appropriate
next?
A. Levetiracetam 60 mg/kg IV
B. Phenytoin 20 mg/kg IV
C. Propofol 2 mg/kg IV bolus
D. Midazolam 10 mg IM
Correct Answer: A
Explanation: Levetiracetam is a preferred second-line antiseizure medication after
benzodiazepines due to favorable safety and ease of administration.
Question 4
A 45-year-old female with severe asthma exacerbation is not responding to continuous
albuterol and ipratropium. Which adjunctive IV medication is most appropriate?
,A. Methylprednisolone 125 mg IV
B. Epinephrine 1 mg IV push
C. Ketamine 1 mg/kg IV
D. Magnesium sulfate 2 g IV over 20 minutes
Correct Answer: D
Explanation: IV magnesium provides additional bronchodilation via smooth muscle
relaxation in severe asthma not responding to standard therapy.
Question 5
A 72-year-old male with atrial fibrillation presents with acute decompensated heart failure
and heart rate of 148 bpm. Which medication is most appropriate for rate control?
A. Adenosine 6 mg IV push
B. Diltiazem 0.25 mg/kg IV bolus
C. Amiodarone 150 mg IV over 10 minutes
D. Digoxin 0.5 mg IV load
Correct Answer: C
Explanation: Amiodarone is preferred for rate control in AF with decompensated heart
failure; diltiazem is contraindicated due to negative inotropy.
Question 6
, A 62-year-old male on apixaban presents with life-threatening GI bleed. Which reversal
agent is most appropriate?
A. Andexanet alfa
B. Vitamin K
C. Protamine sulfate
D. Idarucizumab
Correct Answer: A
Explanation: Andexanet alfa is the specific reversal agent for direct factor Xa inhibitors
including apixaban and rivaroxaban.
Question 7
A 45-year-old male on dabigatran presents with intracranial hemorrhage. Which reversal
agent is indicated?
A. Andexanet alfa
B. Idarucizumab 5 g IV
C. Vitamin K 10 mg IV
D. Protamine sulfate 50 mg IV
Correct Answer: B
Explanation: Idarucizumab is the specific monoclonal antibody fragment for dabigatran
reversal in life-threatening bleeding.
Question 8
