Sample Questions from our BCPS Exam Q-Bank


The sample BCPS questions below were taken directly from OUR BCPS Exam Q-Bank.  They represent over a 2,000 other BCPS style practice test questions you will encounter with the use of our BCPS Q-Bank.  The BCPS questions specifically target high-yield core content in the 3 main domains as outlined by the board of pharmacy specialities® (BPS) for BCPS exam. 


Choose a Subscription

Sample BCPS Question 1

CT is a 47-year-old male that was admitted to the ICU after a motor vehicle accident. On Day 2 of his stay, the nurse notes that the patient has palpitations, anxiety, and high fevers. CT has a past medical history of hypertension and GERD. His home medications consist of hydrochlorothiazide 25 mg PO daily and famotidine 20 mg PO BID. His labs are as follows: Na 135 K 3.7, Cl 97, HCO3 25, BUN 21, Glucose 134 and SCr 1.0, WBC 15.6, procalcitonin 2.5 ng/mL, TSH undetectable, free T4 12 ng/dL, and cortisol 15 mcg/dL. His vitals are BP 168/96, HR 128 and Temp 102.9 F. Which of the following would be the most appropriate therapy to initiate first?

  1. Methimazole 60 mg PO Q6 hours
  2. Levothyroxine 300 mcg IV x 1, then 100 mcg IV daily
  3. Propylthiouracil 500 mg PO x 1 then 250 mg PO Q 4 hours
  4. Saturated solution of potassium iodide (SSKI) 5 drops PO Q 6 hours

Answer = C

Rationale:

  • Propylthiouracil is the preferred initial therapy for the management of thyroid storm. It works by blocking new thyroid hormone production and blocks the peripheral conversion of T4 to T3. 
  • Option A is an appropriate therapy for blocking thyroid hormone synthesis but unlike propylthiouracil, it does not block the conversion of T4 to T3.  The recommended dose of methimazole for thyroid storm is a total of 60-80 mg/day not 60 mg PO Q6 hours.
  • Option B is not an appropriate therapy because the patient has hyperthyroidism and exogenous thyroid hormone supplementation would further worsen the patient's thyrotoxicosis.
  • Option D should not be administered first in the management of thyroid storm. It should be administered at least 1 hour after the administration of a thionamide (i.e., propylthiouracil or methimazole). If iodide is administered prior to a thionamide, it can stimulate thyroid hormone production and further worsen the thyrotoxicosis.

High-Yield Core Concepts:  

  • The 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism outline a multi-modal approach for the management of thyroid storm. The guidelines recommend that patients receive therapy that decreases thyroid hormone production/secretion and prevents the peripheral effects of excess thyroid hormone. Steps should also be taken to correct any systemic decompensation, identify and treat the precipitating event and establish maintenance therapy.
  • The mainstay of therapy is the use of a thionamide which inhibits new thyroid hormone production. Propylthiouracil is preferred because it has the added benefit of blocking the conversion of T4 to T3 in the peripheral tissues.
  • After administration of a thionamide, potassium iodide can be used to inhibit thyroid hormone release.
  • The guidelines recommend initiation of a beta-adrenergic blocking agent for symptom management (e.g., heart rate > 90 BPM, tremor). Propranolol is the most commonly used beta blocker because in addition to controlling the adrenergic symptoms, it is known to inhibit type 1 deiodinase which prevents the conversion of T4 to T3.
  • Glucocorticoids may be used as well to prevent the conversion of T4 to T3 and to treat a potential concurrent adrenal insufficiency.

High-Yield Fast Facts:

  • Propylthiouracil and methimazole tablets may be crushed and administered via the nasogastric tube.
  • Because the duration of action for methimazole is less than 24 hours, it may be more effective to divide the dose rather than administer it once daily when treating thyroid storm.
  • Propylthiouracil has a greater risk for hepatotoxicity than methimazole, and therefore, methimazole is the preferred anti-thyroid agent for maintenance therapy.

Reference:

  • Thyroid 2016;26(10):1343-1421.


Sample BCPS Question 2

BR is a 36 year old male who presents to the ED by ambulance after ingesting 90 lithium carbonate immediate release 300 mg tablets in an attempt to kill himself. He vomited once prior to arrival, and there were visible tablet fragments.  He is currently awake, alert and oriented, and all vital signs are within normal limits. The appropriate laboratory samples are drawn, and a technician is setting up for an ECG. The team is discussing GI decontamination, and would like to know what would be the most appropriate GI decontamination for this patient?

  1. Activated charcoal
  2. Polyethylene glycol 3350
  3. Sodium polystyrene sulfonate
  4. No GI decontamination

Correct answer = D

Rationale:

  • Lithium is not absorbed by activated charcoal and therefore not recommended, unless there is strong suspicion of co-ingestants that may be absorbed by charcoal.
  • Activated charcoal is not without risk; aspiration and pneumonitis can occur, as well as ischemic colitis has been associated with charcoal products containing sorbitol.
  • Whole bowel irrigation with polyethylene glycol is only suggested if there has been a life threatening overdose of extended release lithium and have a functioning GI tract.
  • Sodium polystyrene sulfonate exchange resin may reduce lithium levels, it also reduces potassium potentially worsening cardiac conduction, and is not recommended to be used. 

High-Yield Core Concept:

  • Lithium is not absorbed by activated charcoal.

High-Yield Fast Facts:

  • Lithium is a monovalent cation that is clinically used to treat bipolar disorder
  • It has a very narrow therapeutic window of 0.6 to 1 mmol/L, and chronic toxicity can develop despite normal therapeutic levels.
  • In acute overdose, a useful tool in predicting the lithium concentration is for every 300 mg of lithium ingested, the level should increase by 0.1 to 0.3 mmol/L.
  • Hemodialysis may be used to enhance elimination of lithium.

Reference:

  • Greller HA. Lithium. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank's Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015.


Sample BCPS Question 3

14 month old male with no past medical history comes in with the mother who reports her son has been having a cough that sounds like a seal and is dry.  He is walking around on his own as normal and appears not himself.  Denies any vomiting, fever but has some mild stridor sounds on lung exam and small intercostal retractions.  Which of the following treatments are recommended based on this clinical presentation?

  1. Amoxicillin 20 mg/kg po bid x 10 days
  2. Dexamethasone 0.3 mg/kg po x 1 dose
  3. Ceftriaxone 25 mg/kg IM x 1
  4. Prednisolone 1 mg/kg po x 1

Answer = B

Rationale:

  • This is a classic case of laryngotracheitis (croup) which affects children most commonly 6 months to 3 years of age and is most commonly cause by Human parainfluenza virus type 1, 2, or 3. 
  • Since croup is caused by a viral infection, antibiotics will not help.
  • The treatment of choice is to use dexamethasone 0.15 mg/kg, 0.3 mg/kg, or 0.6 mg/kg by mouth as a 1-time dose.  Historically, clinicians have used 0.6 mg/kg given by mouth, IV, or IM, but smaller doses have been shown to be equally effective.
  • The other steroid recommended is budesonide 2 mg given as a nebulized treatment x 1 dose. 
  • Both dexamethasone and budesonide are corticosteroids that lack mineralocorticoid effects and thus will not contribute to the subglottic narrowing. 

High-Yield Core Concept:

  • Croup or laryngotracheitis is caused by a viral infection resulting in subglottic narrowing that is most commonly treated with single dose of dexamethasone or budesonide.

High-Yield Fast Fact(s):

  • A soft tissue AP radiographic view classically demonstrates a "steeple" sign due to the subglottic narrowing caused by the viral infection.

Reference:

  • Pediatr Pulmonol 1995;20:362-8.
  • Acta Paediatri Scand 1988;77:99-104.
  • Arch Pediatri Adolesc Med 2001;155:1340-5.
  • Cochrane Database Syst Rev 2011; CD001955
  • BMJ 1999;319:595-600.


Sample BCPS Question 4

Which of the follow medications are known to exhibit zero-order elimination kinetics where the rate of elimination is independent on the drug concentration initially given?

  1. Aspirin
  2. Diazepam
  3. Gentamicin
  4. Vancomycin

Answer = A

Rationale:

  • Aspirin is the only medication listed that exhibits zero-order elimination kinetics. 
  • Similar to most FDA-approved medications, diazepam, gentamicin, vancomycin all exhibit first-order elimination kinetics.
  • Drugs that follow first-order elimination kinetics have a rate of elimination that is "DEPENDENT" on the drug concentration (i.e., the more drug you give the patient the more that will be eliminated per hour), whereas a drug that exhibits zero-order elimination kinetics will eliminate only a set amount of drug per hour and is "INDEPENDENT" of the drug concentration.

High-Yield Core Concept:

  • Aspirin is classically known to exhibit zero-order elimination kinetics, which implies that only so much of the drug concentration can be eliminated per hour. 

High-Yield Fast Fact(s):

  • Other drugs that exhibit zero-order elimination kinetics include ethanol and higher doses of phenytoin.
  • The average clearance of alcohol from patients in the emergency department for intoxication is about 20 mg/dL/hr.

Reference:

  • Br J Pharmacol 1965;24:418-431.
  • Br J Clin Pharmacol 1974;1(2):155-161.
  • Br J Clin Pharmacol 1975;2(3):233-238. 
  • Clin Pharmacol Ther 1979;26(4):445-8.
  • Forensic Sci Int 1984;25(3):159-66.