BCPS Clinical Pharmacy Specialist Board Certification Exam 2026:
Advanced Pharmacotherapy Practice Test — Disease Management,
Clinical Decision-Making, Medication Safety & Evidence-Based
Therapeutics — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Patient-Centered Pharmacotherapy
Cardiology
Question 1
A 58-year-old male with HFrEF (EF 28%) is on lisinopril, carvedilol, and furosemide. BP
122/76, HR 72, K⁺ 4.6. Which addition reduces mortality?
A. Amlodipine
B. Sacubitril/valsartan
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Explanation: Sacubitril/valsartan reduces cardiovascular death and HF hospitalization
compared to enalapril; requires 36-hour ACE inhibitor washout before initiation.
Question 2
A 64-year-old female with non-valvular atrial fibrillation, CHA₂DS₂-VASc 4, CrCl 38 mL/min.
Which anticoagulant is most appropriate?
A. Rivaroxaban 20 mg daily
B. Dabigatran 150 mg BID
,C. Apixaban 5 mg BID
D. Warfarin with INR target 2-3
Correct Answer: D
Explanation: Warfarin remains appropriate for CrCl <50; DOACs require dose reduction or
are contraindicated at this renal function in many cases.
Question 3
A patient on warfarin has INR 7.8 without bleeding. What is the most appropriate
management?
A. Hold warfarin only
B. Hold warfarin and give vitamin K 2.5 mg PO
C. Give FFP immediately
D. Continue warfarin at reduced dose
Correct Answer: B
Explanation: For INR 5-9 without bleeding, hold warfarin and consider low-dose oral vitamin
K if bleeding risk is elevated.
Question 4
Which medication reduces mortality in chronic HFrEF when added to standard therapy?
A. Digoxin
B. Furosemide
C. Spironolactone
D. Hydralazine
,Correct Answer: C
Explanation: Aldosterone antagonists reduce mortality and HF hospitalization in NYHA II-IV
HFrEF when added to standard therapy.
Question 5
A 72-year-old with hypertension, CKD stage 3, and gout. Which antihypertensive is
preferred?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Correct Answer: B
Explanation: ACE inhibitors are preferred in CKD with proteinuria and lower uric acid, making
them beneficial in gout comorbidity.
Question 6
Which statin provides the greatest LDL reduction per milligram?
A. Atorvastatin
B. Rosuvastatin
C. Simvastatin
D. Pravastatin
Correct Answer: B
, Explanation: Rosuvastatin has the highest potency per milligram, achieving ~50% LDL
reduction at 10 mg daily.
Question 7
A post-MI patient has LDL 92 mg/dL on atorvastatin 80 mg. What is the most appropriate
addition?
A. Ezetimibe
B. Niacin
C. Fenofibrate
D. Omega-3 fatty acids
Correct Answer: A
Explanation: Ezetimibe added to high-intensity statin provides additional LDL reduction and
outcome benefit in post-MI patients.
Question 8
A patient develops myalgias on simvastatin 40 mg. CK is normal. What is the best next step?
A. Discontinue statin permanently
B. Reduce simvastatin to 20 mg
C. Switch to pravastatin
D. Add coenzyme Q10
Correct Answer: C
Advanced Pharmacotherapy Practice Test — Disease Management,
Clinical Decision-Making, Medication Safety & Evidence-Based
Therapeutics — 190 Multiple-Choice Questions with Answers &
Detailed Rationales
Section 1: Patient-Centered Pharmacotherapy
Cardiology
Question 1
A 58-year-old male with HFrEF (EF 28%) is on lisinopril, carvedilol, and furosemide. BP
122/76, HR 72, K⁺ 4.6. Which addition reduces mortality?
A. Amlodipine
B. Sacubitril/valsartan
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Explanation: Sacubitril/valsartan reduces cardiovascular death and HF hospitalization
compared to enalapril; requires 36-hour ACE inhibitor washout before initiation.
Question 2
A 64-year-old female with non-valvular atrial fibrillation, CHA₂DS₂-VASc 4, CrCl 38 mL/min.
Which anticoagulant is most appropriate?
A. Rivaroxaban 20 mg daily
B. Dabigatran 150 mg BID
,C. Apixaban 5 mg BID
D. Warfarin with INR target 2-3
Correct Answer: D
Explanation: Warfarin remains appropriate for CrCl <50; DOACs require dose reduction or
are contraindicated at this renal function in many cases.
Question 3
A patient on warfarin has INR 7.8 without bleeding. What is the most appropriate
management?
A. Hold warfarin only
B. Hold warfarin and give vitamin K 2.5 mg PO
C. Give FFP immediately
D. Continue warfarin at reduced dose
Correct Answer: B
Explanation: For INR 5-9 without bleeding, hold warfarin and consider low-dose oral vitamin
K if bleeding risk is elevated.
Question 4
Which medication reduces mortality in chronic HFrEF when added to standard therapy?
A. Digoxin
B. Furosemide
C. Spironolactone
D. Hydralazine
,Correct Answer: C
Explanation: Aldosterone antagonists reduce mortality and HF hospitalization in NYHA II-IV
HFrEF when added to standard therapy.
Question 5
A 72-year-old with hypertension, CKD stage 3, and gout. Which antihypertensive is
preferred?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Correct Answer: B
Explanation: ACE inhibitors are preferred in CKD with proteinuria and lower uric acid, making
them beneficial in gout comorbidity.
Question 6
Which statin provides the greatest LDL reduction per milligram?
A. Atorvastatin
B. Rosuvastatin
C. Simvastatin
D. Pravastatin
Correct Answer: B
, Explanation: Rosuvastatin has the highest potency per milligram, achieving ~50% LDL
reduction at 10 mg daily.
Question 7
A post-MI patient has LDL 92 mg/dL on atorvastatin 80 mg. What is the most appropriate
addition?
A. Ezetimibe
B. Niacin
C. Fenofibrate
D. Omega-3 fatty acids
Correct Answer: A
Explanation: Ezetimibe added to high-intensity statin provides additional LDL reduction and
outcome benefit in post-MI patients.
Question 8
A patient develops myalgias on simvastatin 40 mg. CK is normal. What is the best next step?
A. Discontinue statin permanently
B. Reduce simvastatin to 20 mg
C. Switch to pravastatin
D. Add coenzyme Q10
Correct Answer: C
