BCPS Pharmacotherapy Recertification Exam 2026: Professional
Practice Test — Patient-Specific Therapy, Evidence-Based Medicine,
Drug Information & Population Health — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Domain 1: Patient-Specific Pharmacotherapy
Question 1
A 68-year-old male with HFrEF (EF 30%), NYHA class III symptoms, and eGFR 45
mL/min/1.73m² is on lisinopril 20 mg daily, carvedilol 12.5 mg BID, and furosemide 40 mg
daily. He remains symptomatic. Which addition provides the greatest mortality benefit?
A. Spironolactone 25 mg daily
B. Sacubitril/valsartan 24/26 mg BID
C. Digoxin 0.125 mg daily
D. Hydralazine 25 mg TID
Correct Answer: B
Explanation: Sacubitril/valsartan reduces cardiovascular death and HF hospitalization
compared with enalapril in HFrEF. Requires 36-hour ACE inhibitor washout before initiation.
Question 2
A 72-year-old female on stable warfarin (INR 2.5) is started on amiodarone for atrial
fibrillation. Which warfarin adjustment is most appropriate?
,A. No change
B. Reduce warfarin dose by 30–50% and monitor INR closely
C. Increase warfarin dose by 30–50%
D. Discontinue warfarin and start apixaban
Correct Answer: B
Explanation: Amiodarone inhibits CYP2C9 and displaces warfarin from protein binding,
increasing INR. Empiric dose reduction of 30–50% with close monitoring is standard.
Question 3
A 58-year-old male with T2DM (A1c 8.4% on metformin 1000 mg BID), ASCVD, and BMI 32.
Which add-on agent provides cardiovascular mortality benefit?
A. Glipizide
B. Empagliflozin
C. Pioglitazone
D. Sitagliptin
Correct Answer: B
Explanation: SGLT2 inhibitors like empagliflozin reduce cardiovascular death and HF
hospitalization in T2DM with ASCVD. This benefit is independent of glycemic control.
Question 4
,A 45-year-old male with latent tuberculosis (positive IGRA, normal CXR) is HIV-positive (CD4
450, viral load undetectable on ART). Which LTBI regimen is contraindicated due to drug
interactions?
A. 4 months rifampin daily
B. 3 months isoniazid/rifapentine weekly
C. 6 months isoniazid daily
D. 4 months rifampin daily is safest
Correct Answer: B
Explanation: Rifapentine is a potent CYP3A4 inducer and significantly reduces protease
inhibitor and integrase inhibitor levels. Alternative regimens are preferred.
Question 5
A 62-year-old female with AF and severe mitral stenosis (valve area 1.0 cm²). CHA₂DS₂-VASc
score is 4. Which anticoagulation is recommended?
A. Apixaban 5 mg BID
B. Rivaroxaban 20 mg daily
C. Warfarin (INR 2.0–3.0)
D. Dabigatran 150 mg BID
Correct Answer: C
Explanation: DOACs are not recommended in patients with mechanical valves or moderate-
to-severe mitral stenosis (rheumatic). Warfarin remains the standard of care.
, Question 6
A 55-year-old male with COPD (GOLD Group E, 2 exacerbations in past year) and no asthma
history. Which initial maintenance therapy is most appropriate?
A. LABA monotherapy
B. LAMA monotherapy
C. LABA/LAMA combination
D. Triple therapy (ICS/LABA/LAMA)
Correct Answer: C
Explanation: GOLD 2026 recommends LABA/LAMA as initial therapy for Group E patients
without blood eosinophil indication for ICS. Triple therapy is for those with eosinophilia or
asthma overlap.
Question 7
A 34-year-old pregnant female at 28 weeks with uncomplicated pyelonephritis. Which oral
antibiotic is safest?
A. Ciprofloxacin
B. TMP-SMX
C. Cephalexin
D. Doxycycline
Correct Answer: C
Practice Test — Patient-Specific Therapy, Evidence-Based Medicine,
Drug Information & Population Health — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Domain 1: Patient-Specific Pharmacotherapy
Question 1
A 68-year-old male with HFrEF (EF 30%), NYHA class III symptoms, and eGFR 45
mL/min/1.73m² is on lisinopril 20 mg daily, carvedilol 12.5 mg BID, and furosemide 40 mg
daily. He remains symptomatic. Which addition provides the greatest mortality benefit?
A. Spironolactone 25 mg daily
B. Sacubitril/valsartan 24/26 mg BID
C. Digoxin 0.125 mg daily
D. Hydralazine 25 mg TID
Correct Answer: B
Explanation: Sacubitril/valsartan reduces cardiovascular death and HF hospitalization
compared with enalapril in HFrEF. Requires 36-hour ACE inhibitor washout before initiation.
Question 2
A 72-year-old female on stable warfarin (INR 2.5) is started on amiodarone for atrial
fibrillation. Which warfarin adjustment is most appropriate?
,A. No change
B. Reduce warfarin dose by 30–50% and monitor INR closely
C. Increase warfarin dose by 30–50%
D. Discontinue warfarin and start apixaban
Correct Answer: B
Explanation: Amiodarone inhibits CYP2C9 and displaces warfarin from protein binding,
increasing INR. Empiric dose reduction of 30–50% with close monitoring is standard.
Question 3
A 58-year-old male with T2DM (A1c 8.4% on metformin 1000 mg BID), ASCVD, and BMI 32.
Which add-on agent provides cardiovascular mortality benefit?
A. Glipizide
B. Empagliflozin
C. Pioglitazone
D. Sitagliptin
Correct Answer: B
Explanation: SGLT2 inhibitors like empagliflozin reduce cardiovascular death and HF
hospitalization in T2DM with ASCVD. This benefit is independent of glycemic control.
Question 4
,A 45-year-old male with latent tuberculosis (positive IGRA, normal CXR) is HIV-positive (CD4
450, viral load undetectable on ART). Which LTBI regimen is contraindicated due to drug
interactions?
A. 4 months rifampin daily
B. 3 months isoniazid/rifapentine weekly
C. 6 months isoniazid daily
D. 4 months rifampin daily is safest
Correct Answer: B
Explanation: Rifapentine is a potent CYP3A4 inducer and significantly reduces protease
inhibitor and integrase inhibitor levels. Alternative regimens are preferred.
Question 5
A 62-year-old female with AF and severe mitral stenosis (valve area 1.0 cm²). CHA₂DS₂-VASc
score is 4. Which anticoagulation is recommended?
A. Apixaban 5 mg BID
B. Rivaroxaban 20 mg daily
C. Warfarin (INR 2.0–3.0)
D. Dabigatran 150 mg BID
Correct Answer: C
Explanation: DOACs are not recommended in patients with mechanical valves or moderate-
to-severe mitral stenosis (rheumatic). Warfarin remains the standard of care.
, Question 6
A 55-year-old male with COPD (GOLD Group E, 2 exacerbations in past year) and no asthma
history. Which initial maintenance therapy is most appropriate?
A. LABA monotherapy
B. LAMA monotherapy
C. LABA/LAMA combination
D. Triple therapy (ICS/LABA/LAMA)
Correct Answer: C
Explanation: GOLD 2026 recommends LABA/LAMA as initial therapy for Group E patients
without blood eosinophil indication for ICS. Triple therapy is for those with eosinophilia or
asthma overlap.
Question 7
A 34-year-old pregnant female at 28 weeks with uncomplicated pyelonephritis. Which oral
antibiotic is safest?
A. Ciprofloxacin
B. TMP-SMX
C. Cephalexin
D. Doxycycline
Correct Answer: C
