BCPS Prep Course (BCPS): free quiz

1. Question 1 of 10

   A 68-year-old adult with atrial fibrillation is admitted for pneumonia. Home medications include warfarin 5 mg by mouth nightly, amiodarone 200 mg by mouth daily, and lisinopril 20 mg by mouth daily. The admitting team starts trimethoprim-sulfamethoxazole DS 1 tablet by mouth twice daily. As the pharmacist reviewing medication problems, which issue should be prioritized first?

   Choose one answer

   ARecommend switching amiodarone to an intravenous formulation because acute infection may reduce absorption of the oral product.BRecommend holding lisinopril because concurrent pneumonia may transiently reduce oral intake and could increase the risk of cough.CRecommend continuing all current medications and checking an INR at the next routine outpatient visit.DRecommend immediate review of the new trimethoprim-sulfamethoxazole order because it can markedly increase warfarin exposure and bleeding risk in a patient also receiving amiodarone.
2. Question 2 of 10A 79-year-old adult takes metformin 1000 mg by mouth twice daily, gabapentin 300 mg three times daily, and oxybutynin ER 10 mg daily. The pharmacist wants a more sensitive outpatient cognitive screen than a very brief test because mild impairment is suspected despite independent basic ADLs. Which tool is most appropriate?
   Choose one answer

   ARecommend the Katz ADL index because preserved bathing and feeding ability rules out mild cognitive impairment.BRecommend the Braden Scale because it is more sensitive than brief cognitive tests for mild memory deficits.CRecommend the Montreal Cognitive Assessment because it is commonly used to detect mild cognitive impairment and assesses multiple cognitive domains.DRecommend the Morse Fall Scale because executive function is best assessed through fall-risk scoring.
3. Question 3 of 10

   A 79-year-old woman with advanced heart failure and atrial fibrillation elects comfort-focused care. Current medications are metoprolol succinate 50 mg orally daily, digoxin 0.125 mg orally daily, torsemide 40 mg orally twice daily, and amiodarone 200 mg orally daily. She has marked nausea and bradycardia with heart rate 46 beats/min. Serum creatinine has risen from 1.0 to 1.8 mg/dL. As the pharmacist, which medication is most important to reassess first?

   Choose one answer

   AAmiodarone 200 mg orally daily, because it should always be the first drug stopped when heart rate is below 50 beats/min.BMetoprolol succinate 50 mg orally daily, because beta blockers are contraindicated in all palliative patients with atrial fibrillation.CDigoxin 0.125 mg orally daily, because renal decline and interacting drugs raise toxicity risk that can worsen nausea and bradycardia.DTorsemide 40 mg orally twice daily, because loop diuretics commonly cause immediate symptomatic nausea in comfort care.
4. Question 4 of 10A pharmacist reviews an order for duloxetine 60 mg by mouth once daily in a 59-year-old adult with painful diabetic neuropathy and chronic liver disease from alcohol-associated cirrhosis. Which recommendation is most appropriate?
   Choose one answer

   ARecommend avoiding duloxetine because substantial hepatic impairment and chronic liver disease increase concern for duloxetine-associated liver injury.BContinue duloxetine 60 mg by mouth once daily because neuropathy benefit outweighs all hepatic concerns.CRecommend reducing duloxetine to 30 mg by mouth once daily because lower doses remove the hepatic contraindication.DRecommend switching to venlafaxine extended release 225 mg by mouth once daily because all serotonin-norepinephrine reuptake inhibitors are equivalent in liver disease.
5. Question 5 of 10

   An adult with gram-negative bacteremia is receiving gentamicin 7 mg/kg IV every 24 hours in combination with another active agent. Serum creatinine rises from 0.8 to 1.5 mg/dL by day 3. A rapid susceptibility panel now shows the isolate is fully susceptible to ceftriaxone 2 g IV every 24 hours, which the patient is also receiving. As the pharmacist, which recommendation is most appropriate?

   Choose one answer

   AContinue gentamicin because bactericidal synergy should always be maintained through the entire treatment course for bloodstream infection.BSwitch ceftriaxone to meropenem because nephrotoxicity during aminoglycoside therapy suggests hidden resistance.CIncrease gentamicin interval to every 36 hours because the creatinine rise can be managed by PK adjustment while preserving synergy.DDiscontinue gentamicin because the biomarker-supported susceptibility to ceftriaxone allows narrower definitive therapy and reduces nephrotoxicity risk.
6. Question 6 of 10A pharmacist reviews repaglinide 1 mg orally three times daily before meals started in a 68-year-old man with type 2 diabetes who takes gemfibrozil 600 mg orally twice daily. Which recommendation is most appropriate?
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   AContinue repaglinide 1 mg orally three times daily because gemfibrozil mainly affects statins.BIncrease repaglinide to 2 mg orally three times daily because fibrates reduce postprandial insulin release.CUse repaglinide 0.5 mg orally three times daily with close glucose monitoring because gemfibrozil causes only a mild interaction.DAvoid repaglinide because gemfibrozil can markedly increase repaglinide exposure and severe hypoglycemia risk.
7. Question 7 of 10

   A 63-year-old adult with hypertension, type 2 diabetes, and albuminuric CKD has BP 154/88 mm Hg. Current medications include amlodipine 10 mg PO daily, hydrochlorothiazide 25 mg PO daily, metformin 500 mg PO twice daily, and trimethoprim-sulfamethoxazole DS 1 tablet PO twice daily started yesterday for cystitis. Labs: eGFR 42 mL/min/1.73 m², potassium 4.6 mEq/L, urine albumin-to-creatinine ratio 420 mg/g. As the clinical pharmacist, which antihypertensive recommendation is most appropriate?

   Choose one answer

   AStart lisinopril 10 mg PO daily immediately while continuing trimethoprim-sulfamethoxazole DS twice daily.BRecommend reviewing or changing trimethoprim-sulfamethoxazole if clinically appropriate, then start losartan 25 mg PO daily with serum creatinine and potassium monitoring in 1–2 weeks.CStart spironolactone 25 mg PO daily now and check potassium at the next routine follow-up visit in 1 month.DStart losartan 100 mg PO daily immediately and continue trimethoprim-sulfamethoxazole without additional early laboratory monitoring.
8. Question 8 of 10

   A 71-year-old adult with nonvalvular atrial fibrillation has Child-Pugh class C cirrhosis and is prescribed apixaban 5 mg by mouth twice daily. Serum creatinine is 0.9 mg/dL and weight is 84 kg. As the pharmacist, which recommendation is most appropriate?

   Choose one answer

   AContinue apixaban 5 mg by mouth twice daily because renal function is normal.BReduce apixaban to 2.5 mg by mouth twice daily because cirrhosis increases bleeding risk.CRecommend avoiding apixaban and consulting the prescriber for an alternative anticoagulation plan because severe hepatic impairment is a major limitation for use.DSwitch to rivaroxaban 20 mg by mouth daily because once-daily dosing is easier in cirrhosis.
9. Question 9 of 10

   A 79-year-old woman with ACS undergoes PCI after receiving aspirin 81 mg PO daily and clopidogrel 75 mg PO daily for several days. The interventional team asks the pharmacist whether prasugrel 10 mg PO daily should be used after a 60 mg load. She weighs 56 kg and has no history of stroke or TIA. Which recommendation is most appropriate?

   Choose one answer

   AUse prasugrel 10 mg PO daily because no prior stroke is present.BAvoid prasugrel entirely because age over 65 years is an absolute contraindication.CReplace prasugrel with ticagrelor only because clopidogrel exposure causes permanent cross-resistance to prasugrel.DIf prasugrel is selected, recommend 5 mg PO daily maintenance because age 75 years or older and weight under 60 kg increase bleeding risk.
10. Question 10 of 10

    A pharmacist is asked to recommend an oral add-on to metformin 1000 mg by mouth twice daily for a 67-year-old adult with type 2 diabetes, benign prostatic symptoms, and frequent urination. Which class comparison is most relevant to avoid worsening this symptom burden?

    Choose one answer

    AAvoid SGLT2 inhibitors because osmotic diuresis and increased urinary frequency may be bothersome in this patient.BPrefer sulfonylureas because they reduce urinary frequency through antidiuretic hormone release.CAvoid DPP-4 inhibitors because they commonly cause severe urinary retention through alpha-agonist activity.DPrefer alpha-glucosidase inhibitors because they have the same cardiorenal benefits as SGLT2 inhibitors without gastrointestinal effects.

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