1Thresholds, reversal agents and formulas
Say the answer before you open a card. Several guidelines on the backs changed in 2025 or 2026, and BPS notes that exam forms are assembled months ahead and avoid fast-moving practice changes, so learn the current guideline and what it replaced.
01Blood pressure goal for most adults (2025 AHA/ACC)
Below 130/80 mm Hg. The 2025 guideline also replaces the pooled cohort equations with PREVENT and favors single-pill combinations for stage 2. The JNC 8 goal of below 150/90 for adults 60 and older is the legacy answer.
02LDL-C goals in the 2026 ACC/AHA dyslipidemia guideline
Numeric goals return: for example, below 55 mg/dL in very high-risk secondary prevention and below 70 mg/dL in high-risk primary prevention by PREVENT. The 2018 guideline used percentage LDL-C reduction instead.
03The four pillars of HFrEF therapy (2022 AHA/ACC/HFSA)
ARNI, ACE inhibitor or ARB; an evidence-based beta-blocker; an MRA; an SGLT2 inhibitor. Loop diuretics and digoxin treat symptoms and are not among the mortality-reducing pillars.
04When warfarin is still chosen over a DOAC
Mechanical heart valve and moderate to severe mitral stenosis (2023 ACC/AHA/ACCP/HRS AF guideline); triple-positive antiphospholipid syndrome (product labeling).
05VTE treatment phase (CHEST 2021)
A DOAC is preferred over warfarin for VTE without cancer. Treat for 3 months, then reassess whether extended therapy is warranted.
06SGLT2 inhibitor or GLP-1 RA in type 2 diabetes (ADA Standards of Care 2026)
Choose by comorbidity, independent of A1c: heart failure or CKD points to an SGLT2 inhibitor; ASCVD, weight goals or MASLD point to a GLP-1 receptor agonist.
07Cockcroft-Gault CrCl vs CKD-EPI eGFR
Most older labels dose by Cockcroft-Gault CrCl; newer ones (metformin, SGLT2 inhibitors, finerenone) use eGFR. CKD-EPI eGFR stages CKD (KDIGO 2024). Watch BSA-indexed vs absolute values when you switch between them.
08CKD in type 2 diabetes: the drug classes KDIGO builds on
An SGLT2 inhibitor, a RAS inhibitor titrated to the maximum tolerated dose, and finerenone in type 2 diabetes with CKD (KDIGO 2024 CKD; KDIGO 2022 Diabetes in CKD).
09Vancomycin monitoring for serious MRSA infection (2020 consensus)
AUC-guided dosing with a target AUC of 400–600, replacing trough-only targets of 15–20 (2020 ASHP/IDSA/PIDS/SIDP vancomycin consensus).
10Initial C. difficile infection in adults (IDSA/SHEA 2021)
Fidaxomicin is preferred. Metronidazole is no longer a first-line choice for an initial episode in adults.
11Complicated UTI course length (IDSA 2025)
5–7 days with a fluoroquinolone, 7 days with other agents, with an IV-to-oral switch once the patient qualifies.
12Preferred LTBI regimens (CDC/NTCA 2020)
3HP, 4R and 3HR. 3HP is not for pregnancy or children under 2, and the rifamycins interact with antiretroviral therapy.
13Septic shock: antimicrobial timing (Surviving Sepsis Campaign 2026)
Within 1 hour when shock is possible.
14Septic shock: vasopressors, steroids and the new MAP suggestion (SSC 2026)
Norepinephrine first line, vasopressin as the add-on, corticosteroids when vasopressor need continues. New in 2026: a suggested MAP of 60–65 mm Hg for patients 65 and older.
15GINA 2026 Track 1 reliever
As-needed ICS-formoterol, alone or as maintenance-and-reliever therapy. SABA-only treatment is not recommended, and a LABA without an ICS is wrong in asthma.
16GOLD 2026: who counts as an exacerbator
A patient with one or more moderate or severe exacerbation (changed from two or more). ICS monotherapy is not a COPD regimen.
17Morphine milligram equivalents (CDC 2022 opioid guideline)
A caution signal, not a hard cap. Non-opioid therapy comes first for many pain conditions, and conversions must allow for incomplete cross-tolerance.
18Beers Criteria 2023: four classes to spot on an older adult’s list
Anticholinergics, sulfonylureas, PPIs continued past 8 weeks, and benzodiazepines (AGS Beers Criteria 2023). The 2023 update widened the sulfonylurea entry from long-acting agents to the whole class as first- or second-line therapy; if one is used, a short-acting agent is preferred.
19CYP inhibition vs induction: the time course
Inhibition is fast. Induction, with rifampin as the classic example, takes 1–2 weeks to appear and 1–2 weeks to fade after the inducer stops.
20Intensifying basal insulin in type 2 diabetes (ADA Standards of Care 2026)
Pair it with a GLP-1 receptor agonist: the 2026 Standards support GLP-1 RA plus basal insulin as a combination, and also favor GLP-1 RAs in MASLD.
21Reversal agent for dabigatran
Idarucizumab, a monoclonal antibody fragment that binds dabigatran (FDA product label).
22Reversal agent for unfractionated heparin
Protamine sulfate, labeled for heparin overdose (FDA product label).
23Benzodiazepine reversal agent
Flumazenil (FDA product label). Its boxed warning covers seizures, most often after long-term benzodiazepine use or with a serious cyclic antidepressant overdose.
24Number needed to treat (NNT)
1 ÷ absolute risk reduction (ARR), rounded up to a whole patient, and always quoted with the trial’s time frame.
25Number needed to harm (NNH)
1 ÷ absolute risk increase (ARI), rounded up.
26Relative risk reduction (RRR) vs absolute risk reduction (ARR)
RRR = ARR ÷ control event rate. A large RRR can sit on a tiny ARR when baseline risk is low; NNT comes from ARR, never from RRR.
27Line of no effect: ratio vs difference
A ratio (RR, OR, HR) shows no effect at 1; a difference (ARR, mean difference) at 0. A 95% CI that crosses its line is not statistically significant.
28Noninferiority: what the confidence interval is compared with
The prespecified margin. A CI of the difference that stays clear of the margin means not inferior, which is not the same as equivalent. Intention-to-treat is not the conservative analysis here, so per-protocol is reported too (FDA noninferiority guidance 2016; CONSORT).
29Which study design yields an odds ratio
Case-control. Participants are selected by outcome, so incidence and relative risk cannot be calculated.
30Sensitivity, specificity and prevalence
Sensitivity and specificity hold as prevalence changes; PPV rises and NPV falls as prevalence goes up.
2From card to case
The reversal-agent cards are a starting point for toxidromes and antidotes, which works through recognizing the syndrome before choosing a treatment. The formula cards pair with NNT, NNH and absolute risk reduction, where the arithmetic is applied to trial results.
A card checks recall; a case checks whether the threshold survives a patient with three other problems. Once a card feels easy, take its topic into the free BCPS practice test. The BCPS study guide lists every domain and concept page the deck draws on, and the study plan sets a daily pass through the deck inside each week.
Next step
Turn reading into recall
Reading a monograph is half the work; answering cases is the other half.
Pharmacotherapy Exam Prep 2026 is an app for iPhone and iPad only; there is no Android version. On any other phone or a computer, use the free practice set on this site in your browser.