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BCPS Cheat Sheet

Practice this exam

Patient Care Specialty Areas

  • 36% of exam
  • Infectious Diseases Cardiology Renal & Endocrine Critical Care GI & Toxicology Onc & Peds

Therapeutics & Patient Management

  • 36% of exam
  • Treatment Planning Therapeutic Implementation Outcomes & Monitoring PK/PD

Professional Practice

  • 28% of exam
  • Quality of Care Evidence-Based Practice Practice Management Patient Safety

Quick Facts

  • Exam BCPS
  • Credential Board Certified Pharmacotherapy Specialist
  • Questions 150 (125 scored + 25 unscored)
  • Time 3 hours 45 minutes
  • Pass Score 500/800 scaled
  • Format CBT at Pearson VUE
  • Level Specialty certification
  • Blueprint Sept 2024 (current)

Sepsis Hour-1 Bundle PA

  • Lactate | Cultures | Antibiotics | Fluids | Pressors
  • Lactate: measure level Cultures: before antibiotics Antibiotics: within one hour Fluids: 30 mL/kg bolus Pressors: if still hypotensive

Antidote Picker PA

  • Acetaminophen overdose → N-acetylcysteine ( Give early )
  • Opioid overdose → Naloxone ( IV, IM, or IN )
  • Benzodiazepine overdose → Flumazenil ( Seizure risk caution )
  • Warfarin major bleed → Vitamin K plus PCC
  • Heparin overdose → Protamine sulfate
  • Iron overdose → Deferoxamine
  • Methanol or ethylene glycol → Fomepizole

Infectious Diseases Pearls PA

  • Vancomycin AUC 400-600 (mg*h/L) target
  • Vancomycin trough 15-20 mg/L serious infection
  • MRSA coverage Vancomycin, linezolid, daptomycin
  • Daptomycin lung use Inactivated by pulmonary surfactant
  • C. diff first-line Oral vancomycin or fidaxomicin
  • Empiric sepsis timing Antibiotics within one hour
  • Beta-lactam cross-reactivity Less than 1 percent

Warfarin INR Targets PA

  • Standard 2-3 | Mechanical valve 2.5-3.5
  • Standard indications: INR 2-3 Mechanical mitral valve: 2.5-3.5 Atrial fibrillation: INR 2-3 VTE treatment: INR 2-3

Vasopressor & Shock Drug Picker PA

  • Septic shock first-line → Norepinephrine
  • Refractory septic shock → Add vasopressin
  • Cardiogenic shock → Dobutamine
  • Anaphylactic shock → IM epinephrine
  • Unstable bradycardia → Atropine
  • Post-arrest hypotension → Norepinephrine or dopamine

Cardiology Pearls PA

  • Warfarin INR Target range 2-3
  • Mechanical valve INR Target range 2.5-3.5
  • HFrEF core therapy ARNI, beta-blocker, MRA, SGLT2i
  • HF beta-blockers Carvedilol, succinate metoprolol, bisoprolol
  • High-intensity statins Atorvastatin 40-80, rosuvastatin 20-40
  • Stroke risk tool CHA2DS2-VASc score
  • Bleeding risk tool HAS-BLED score
  • Digoxin toxicity Level above 2 ng/mL

Renal, Pain & Endocrine PA

  • CrCl equation Cockcroft-Gault formula
  • GFR equation CKD-EPI formula
  • Opioid reversal Naloxone
  • A1c goal Below 7 percent typical
  • Metformin renal caution Avoid if CrCl below 30
  • Chronic pain first-line Non-opioid therapy preferred

Critical Care, Neuro & Pulm PA

  • Sepsis lactate threshold Above 2 mmol/L
  • First-line vasopressor Norepinephrine
  • Status epilepticus first-line IV benzodiazepine
  • COPD exacerbation therapy Bronchodilator plus corticosteroid
  • Severe asthma therapy Systemic corticosteroids
  • ARDS ventilation strategy Low tidal volume, 6 mL/kg

GI, Psych & Toxicology PA

  • Acetaminophen antidote N-acetylcysteine
  • Benzodiazepine antidote Flumazenil, use cautiously
  • H. pylori regimen PPI plus two antibiotics
  • Serotonin syndrome triad Autonomic, neuromuscular, mental changes
  • Lithium therapeutic level 0.6-1.2 mEq/L

Onc, Peds & Immune PA

  • Neutropenic fever threshold ANC below 500
  • Highly emetogenic prophylaxis NK1, 5-HT3, steroid combo
  • ACEi/ARB in pregnancy Teratogenic, avoid entirely
  • Anaphylaxis first-line IM epinephrine

Strong CYP3A4 Inhibitors TH

  • Azoles, macrolides, protease inhibitors, grapefruit juice
  • Ketoconazole: azole antifungal Clarithromycin: macrolide antibiotic Ritonavir: protease inhibitor Grapefruit juice: dietary source

ADE vs ADR TH

ADE

  • Any harm from medication
  • Includes preventable errors
  • Broader definition overall

ADR

  • Drug-specific adverse response
  • Occurs at normal dose
  • Excludes error causation
  • Errors included vs excluded

TDM Sampling Timing TH

  • Vancomycin level → Trough before dose 4 ( or AUC-based )
  • Aminoglycoside level → Peak and trough
  • Phenytoin level → Trough, check albumin
  • Lithium level → Trough, 12h post-dose
  • Digoxin level → Trough, 6-8h post-dose

Treatment Planning & PK TH

  • Volume of distribution Apparent distribution space
  • High Vd drugs Lipophilic, tissue-bound agents
  • First-order kinetics Constant fraction eliminated
  • Zero-order kinetics Constant amount, saturable
  • Steady state timing About 5 half-lives
  • Loading dose formula Vd times target level

First-Order vs Zero-Order TH

First-Order

  • Constant fraction eliminated
  • Most drugs follow this
  • Proportional to concentration

Zero-Order

  • Constant amount eliminated
  • Phenytoin and ethanol
  • Enzyme pathway saturates
  • Proportional vs fixed rate

Therapeutic Implementation TH

  • Fastest onset route IV push administration
  • Oral bioavailability Usually below 100 percent
  • Medication reconciliation timing Every care transition point
  • High-alert medications Insulin, anticoagulants, opioids
  • Tall man lettering Reduces look-alike errors

CrCl vs eGFR TH

CrCl (Cockcroft-Gault)

  • Estimates creatinine clearance
  • Uses actual weight
  • Standard for drug dosing

eGFR (CKD-EPI)

  • Estimates glomerular filtration
  • No weight required
  • Standard for CKD staging
  • Dosing vs staging use

Outcomes & Monitoring TH

  • Beers Criteria Flags risky elderly meds
  • STOPP/START tool Elderly prescribing screen
  • ADE definition Any harm from medication
  • ADR definition Drug-specific adverse response
  • Strong CYP3A4 inhibitors Azoles, macrolides, ritonavir
  • TDM drug list Vanc, aminoglycosides, phenytoin, lithium
  • Adherence metric PDC or MPR ratio

Bioavailability vs Bioequivalence TH

Bioavailability

  • Fraction reaching systemic circulation
  • IV route equals 100%
  • Depends on administration route

Bioequivalence

  • Compares two drug products
  • Generic versus brand comparison
  • Same rate and extent
  • Absorption vs product comparison

Beers Criteria Focus PR

  • Avoid high-risk meds in older adults
  • Benzodiazepines: fall risk Anticholinergics: cognitive risk NSAIDs: renal and GI risk First-gen antihistamines: avoid use

Sensitivity vs Specificity PR

Sensitivity

  • True positive rate
  • Rules out disease
  • High value means few false-negatives

Specificity

  • True negative rate
  • Rules in disease
  • High value means few false-positives
  • SnNout vs SpPin

Quality of Care & Safety PR

  • Common error type Wrong-dose errors frequent
  • Sentinel event Serious reportable harm event
  • Root cause analysis Systems-based error review
  • Guideline sources AHA/ACC, ADA, IDSA
  • Preventive care focus Immunizations and screenings

NNT vs NNH PR

NNT

  • Number needed to treat
  • Lower value is better
  • Measures treatment benefit

NNH

  • Number needed to harm
  • Higher value is better
  • Measures treatment risk
  • Benefit measure vs harm measure

Evidence-Based Practice PR

  • Statistical significance P-value below 0.05
  • NNT meaning Patients treated per benefit
  • NNH meaning Patients treated per harm
  • Top evidence level Systematic review, meta-analysis
  • Bias control methods Randomization and blinding
  • Confidence interval use Shows estimate precision

Efficacy vs Effectiveness PR

Efficacy

  • Ideal controlled trial conditions
  • Measured in RCT setting
  • Best-case treatment result

Effectiveness

  • Real-world practice conditions
  • Measured in routine care
  • Actual patient outcome
  • Trial result vs real-world result

Practice Management PR

  • CPOE purpose Reduces prescribing errors
  • Clinical decision support Point-of-care alerts
  • Formulary oversight P&T committee decides
  • Cost-effectiveness analysis Cost per health outcome
  • MUE meaning Medication use evaluation
  • Emergency preparedness role Maintain pharmacy service continuity

Common Traps

Scored vs Unscored Items

  • 125 items scored ≠ 25 items unscored pretest

Recertification Cycles Differ

  • Pre-2024 cycle: exam only ≠ 2024+ cycle: exam plus 20 CPD

Practice Experience vs Residency

  • 3 years practice needed ≠ PGY1 residency alternative path

Domain Weight Confusion

  • Areas 1 and 2 tie ≠ Both weighted 36 percent

CrCl vs eGFR Use

  • CrCl for drug dosing ≠ eGFR for CKD staging

Efficacy vs Effectiveness

  • Efficacy is trial result ≠ Effectiveness is real-world result

First-Time vs Overall Pass Rate

  • First-time rate higher typically ≠ Overall rate includes retakes

Last Minute

  • 1. 150 items: 125 scored, 25 unscored
  • 2. Exam time: 3h45m total
  • 3. Passing score: 500 of 800
  • 4. Weights: 36/36/28 percent
  • 5. Area 1: Patient Care Specialty
  • 6. Area 2: Therapeutics and Management
  • 7. Area 3: Professional Practice topics
  • 8. Eligibility: license plus 3-year practice
  • 9. Alt pathway: PGY1 residency accepted
  • 10. Recertify every 7 years
  • 11. Fee: $600 initial, $300 retake

BCPS

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