A guide to BPS study (a personal view)

Board certified pharmacist

AT THE beginning, I would like to thank all the group members for their
great effort during the last year; really, all of you are the basic cause that
made me pass the exam (after Allah willing of course)
The following points are just personal advices, may be it will be suitable for
one and not for another, but in all cases, I hope it will give you a general
idea about the board
I studied the board in almost 10 months (Jan 2012 to October 2012)
during these months, I was able to finish studying the board 2 times (one as
a general view to understand the points and one as a final study) (I
studied alone),
My source for the study was mainly the Board book, except some parts that
I had to listen to some lectures to understand it, which are (Stat, clinical
trial, regulatory, kinetics and economics); I already uploaded the lectures I
used in the group,
I used the internet too much for more understanding, specially for the
regulatory part,, I used the internet websites that mentioned at the last
page of every chapter in the board book (References pages) to get more
data and specially to understand the regulatory chapter
I also studied 2 more parts from the ambulatory care speciality board book
(immunization and dermatology) because they ask about these parts in the
exam (you can find the book uploaded already in the group)
Take care of the questions answers at the end of each part, because it
contains important information that he did not mention in the chapter
Focus on drug interactions, special uses, side effects.
I prefer the following chapter arrangement for the study:

Stat, clinical trials, economics, regulatory, Kinetics, Nephrology,

Electrolytes and nutrition, Endocrine, critical care, ambulatory care,
Neurology and psychiatry, cardiology, then you can study the other
chapters in any order you want.
Why I used this order???
1. the first 4 chapters have new information (most of us have no idea about
it) and the book is using a lot of information mentioned in these parts to
explain other parts, so it is important to understand these chapters before
anything else, also the book is asking about these parts in the other
chapters as well (in the self assessment Questions) so it is good to make a
revision for these parts while studying other parts, also these parts consist
25% of the questions coming in the exam so, as a psychological point, when
you find yourself finish these parts you can feel that you finish 25% of the
board .
2. Kinetics and nephrology have some data in common, so it is good to take
these 2 parts together.
3. Electrolyte, endocrine, critical care and ambulatory care are containing a
lot of essential knowledge that you have to know it before studying the
cardiology parts.
4. A special way to study the cardiology parts which is to study the
cardiology parts as one part (for example > take heart failure and
compensated heart failure together so you will be able to know what are
the medicines used by heart failure patients as outpatients and what will
happen if there cases are become a decompensate case, also the same way
you can apply it to AF and arrhythmia and also hypertension and HT crisis)..

About the exam:

The exam is 2 parts (each part is containing 100 questions (MSQ) and you
have to answer it in 2.5 hours) so you have to answer every question in
one and half minute only>>>
The exam is divided to 3 domains:
Domain 1 120 points pharmacotherapy cases
Domain 2 50 points the 4 chapters I mentioned earlier.
Domain 3... 30 points... Regulatory and external knowledge.
During the exam, stay calm and do not panic, you will find some questions
that are not related to the board book (again do not panic...) try to
understand the question carefully but do not waste your time, put any
answer you want and proceed to the following one
Most of the questions are containing tricks, so read every word carefully
also it is important to keep the important values in your mind, (like serum
creatnin, Na, K etc), there is no time to use the papers he is giving .
TRY to solve a lot of questions before the exam; it will help you, also try to
read the book even if you have external sources for the study.
The exam is measuring your understanding, it is not measuring the amount
of data you are keeping in mind so try to understand the objects in the
book clearly
Do not forget to answer the questions available in BPS site, try to answer all
the questions in all specialities (pharmacotherapy, ambulatory, psychiatric
...), keep the answers in your mind, some of these questions are coming
every year in the exam...

2012 exam hints and sources for answers:

I am very sorry to say that I do not remember THE questions exactly (AND I
DO NOT THINK THAT SOMEONE CAN), but I remember only what are the
QUESTIONS talking about, so I will try to mention the headlines of the
questions and its answers from the book (pharmacotherapy 2012 book) or
from internet (if available)>>
Treatment for A PREGNANT woman with Migraine headache, choices
mentioned (triptans and other migraine treatments) but the correct
answer is paracetamol.
Using of folic acid in woman who suffered neural tube defects
before, and ask about the correct regimen of folic acid >>> the
correct answer is to use 4 milligrams (4000 micrograms) of folic acid
daily beginning one month before they start trying to get pregnant
and continuing through the first three months of pregnancy.
( http://www.cdc.gov/ncbddd/folicacid/recommendations.html)
Benefit of using combined estrogrn and progesterone in menopausal
woman, the correct answer is decreasing hot flushes and fractures
(page. 2-35 & 2-36).
One question about Orphan drug act... cant remember the
question exactly ,,, (http://en.wikipedia.org/wiki/Orphan_drug) &
(http://www.fda.gov/regulatoryinformation/legislation/federalfoodd
rugandcosmeticactfdcact/significantamendmentstothefdcact/orphan
drugact/default.htm) (2-277)
One patient in a trial died due to some reasons (death not from the
drug in trial), the researchers decided that they will include all the
events that happened to the patients in the trial including this death
in the final analysis of the trial...so this analysis called.... (per protocol
intention to treat....etc)... intention to treat is correct (2-158 & 2159)
When to use oral or injection vitamin K for high INR during warfarin
treatment (page 1-264)

 A menopausal woman need to use a medicine for high triglycerides

can use fibrate and not niacin because it causes flushes (may worsen
the flushes already present in menopausal women (page 2-224)
The board is asking about Acne every year so I recommend studying
this part from the dermatology part in ambulatory care book... this
year question was about a simple acne case without any previous
treatment.... the correct answer was benzyl peroxide cream that
used as first line treatment, the other choices are used only in
resistant cases.
Compensated alkalosis was an answer for one of the questions, the
question provided a lab values (PH, carbonate...etc), and you have to
determine the problem if it is alkalosis or acidosis... (page 1-195
&196)
Using of non selective b-blocker (propranolol) in treatment of
hyperthyroidism (page 1-288)
Using of aspirin as first line agent in prevention of stroke (page 1349)
Using of aspirin and clopidrogel together can cause (increase
haemorrhage can be used normally...etc) the correct answer is
increase haemorrhage (page1-349)
LDL target for people is very important.... you have to recognize the
risk factors for the patient and determine his category (page 2-216)
Influenza vaccine is recommended to be used yearly in (healthcare
workers pregnant woman elderly...etc) a healthcare worker is
correct.
COPD Patient received pneumococcal vaccine 3 years ago and
influenza vaccine this year in Mars, we are now in October, which
vaccines should he receive (flu only pneumococcal only both
vaccinations has to be taken no need for vaccination)... the correct
answer is flu vaccine only... (Flu vaccine is taken every year but it has
to be taken only in sept. Or October (new version of vaccine), in the
question the patient receive it in Mars so it is useless)

 A patient received filgrastim, after sometimes he suffered a bone

pain, why? The correct answer was side effect of filgrastim... page
2-17
One question about INFLIXIMAB AND ITS side effect, I cannot
remember the question, but it can be found in page 1-95
The type of data used in a classification of the severity of a disease...
ordinal...
One question about Sentinel event... the correct answer is removal of
wrong breast (this question is coming every year, he is just changing
the body parts e.g. wrong knee or wrong eye)
(http://en.wikipedia.org/wiki/Sentinel_event) also you can find
detailed data about it in the files I shared before in the group.
Using of IV IRON In case of Anaemia in kidney failure patients... THIS
part is very important, I think we had 2 or 3 questions in the exam
related to this part, you have to know the exact normal values of
Iron, Ca, Ph... In kidney patients, so you can identify the problem and
its solution.
Treatment of opioid constipation... Senna (stimulant laxative),,, page
2-13
The cost saving treatment for UTI (septrin amoxil cipro...)... i think
septrin...
Dumping syndrome treatment.... Fibres (coming every year)
Patient with leukaemia, he is going to take cisplatin, the doctor
orders to hydrate the patient before the session, why? (to avoid
cisplatin toxicity for tumour lysis syndrome...) cisplatin toxicity 1 513
3 questions (I cannot remember it) related to the table in page 2-178
Patient suffered from allergy from vancomycin after the 3 rd dose,
what to do? (Stop it reduce the rate of infusion and
continue...)????
One question about informed consent and one about IRB

 Difference between ACE inhibitors and AR BLOCKERS regarding its

side effects.
Psoriasis treatment (no idea about the question)
Treatment of metabolic acidosis 1-196
Carbamazapine and its side effects (blood dyskarisis)
You are in a hospital and you want to notify the doctors about new
procedures or indications for a medicine what to do? (face to face
meeting flyers phone ...),, face to face (may be)
Peer Review????
Exenatide and its proper storage conditions... inside or outside the
fridge???
After how many days we have to check for thyroxin in a patient with
hypothyroidism who just start using levothyroxin (after 6 days, 6
weeks , 6 months) 6 weeks page 1-289 (6 months for
hyperthyroidism patient who start using PTU or methimazol)
Difference between DTap and TdaP
Lyme disease???
3 questions asking to calculate relative risk Or RRR.
Contraception emergency, what is the difference between yuzpe
method and progestin only method (page 2-69), progestin only is
offering more protection and fewer side effects.
When ethanol is used for antidote for methanol toxicity, which
enzyme in the body is included,,,, alcohol dehydrogenase is correct
Contraindication for combined hormonal contraception (page 2-57)
2 questions regarding Diabetic ketoacidosis treatment, one asked
about the correct regimen of normal saline, insulin and potassium,
and the other one asked about a patient treated for diabetic
ketacidosis with normal saline and his blood sugar is 250, and his
doctor is asking if he can convert the patient to dextrose and 0.45%
saline (the correct answer is (continue normal saline and do not
convert now), he has to wait until blood sugar is 200 or less. Page (1316)

Pioglitazone and precaution for use.

Cold preparation and ability to use it with hypertensive patients.
Medwatch.
Importance of randomization in clinical trials.
Randomized clinical trial (why it is better than other types)
Azithromicin (cause no interaction)
One patient is going to make PCI, he is taking some medicines, which
medicines has to be stopped before PCI (metformin is correct), why?
Because iodinated contrast media has to be used, and it can affect
the kidney and elevate creatinine (page 1-307)
3 questions asking about the type of analysis that has to be used
(cost utility, cost effective...etc)
3 or 4 questions in schizophrenia, asking mainly about the difference
in side effects, and if it cause heart problems, these types of
questions are coming every year, tables in page (1-400) (1-395)and
(1-396), read carefully every single word in pages from 1-396 to page
1-401.
One female patient is complaining from over growth of hair in her
face, what medicine can cause this (phenytoin) page 1-338 (in
neurology, take care of side effects and drug drug interaction)
Which medicine can cause increasing in QT interval...? (citalopram)
page 1-385
A Patient on warfarin, and he will start using (gabapentin), so what
we have to do (decrease dose of warfarin remain in the same dose
increase warfarin dose-...) remain in the same dose is correct (no
drug interaction between these medicines)
Patient is suffering from a decrease in his sexual activity because of
using antidepressive medicine, so it is advisable to use....?
(Bupropione) page 1-386
Which drug can cause interaction with cyp2D6? Codeine (page 1-415)
from the answer of the question no.1 and table in page 2-116

 3 kinetics questions, very similar to the questions in the book, try to

keep only the simple equations in your mind (first order equations
only).
4 or 5 stat. questions about the table page 2-139
3 questions (NNT)
SOME OF STAT QUESTIONS ASKED ABOUT (REGRESSION, SUB GROUP
ANALYSIS, TYPE 2 ERRORS, non inferiority study)
In a trial the researchers could not find any diff. between the drugs,
another group of researchers repeat the trial and found a significant
diff., what type of errors can be related to the first group of
researchers? (type 2)
Woman with stress incontinence , what medicine has to be used
(estrogen vaginal cream) page 1-51
Bacterial vaginosis in pregnant woman and treatment of PID. Page 278
Types of acute tubular necrosis.
A patient with myasthenia gravis and UTI , which drug is
contraindicated (cipro-septrin-gentamicin...) ciprofloxacin is correct
3 cases in pneumonia, very simple and direct, just keep in your mind
which drugs can be used in case of CAP or HAP, and if the patient is
hospitalized or not and if he has any co morbidities.
In UTI, take care of the duration that has to be used with each
medicine.
One case of endocarditis.
Two cases of Tuberculosis (asking about the correct treatment
regimen (types of drugs and duration), and only one case of HIV.
Child with RSV infection, what medicine has to be used...? (only
supportive care is required like oxygen, do not use AB except in
special cases) page 1-9
2 questions about stress ulcer protection (SUP), one high risk patient
(need sup) and the other patient without any risk factors (no need),
page 1-216

 Flu and its vaccination, intranasal vaccination is used only for healthy
man (one question), another question stated that someone is
complaining from flu symptoms and ask for treatment (the correct
answer is only supportive care)
Meningitis case.
An elderly patient complaining from extra pyramidal symptoms, he is
taking some medicines including (metoclopramide), he is asking for
treatment of his condition, the correct answer is stop taking
metoclopramide, the other choices was mainly used for Parkinson
disease.
Treatment of Gastroparesis... metoclopramide ... page 1-317
2 0r 3 Asthma questions, all can be answered using the table in page
1-238, the question is direct, similar to the questions in the book, you
just have to determine the asthma stage or if asthma is controlled or
not.
2 COPD questions, a patient had an exacerbation of his copd 1 week
ago, now he return to his doctor for follow up (he is already on
anticholinergics & LABA), the doctor want to try something new with
the patient (the patient is group c or d), what medicine can be used ?
(oral steroids inhaled steroids- add new LABA-..), the correct choice
is inhaled steroid, page 1-252 & 1-253
In which trial phase, the medicine will be tested for its effectiveness
(phase 1 2- 3- 4) phase 2 (page2-278)
Which medicine can be used in intensive care unit to treat delirium...
haldol... page 1-212
Every year he is asking a question similar to the following one : a
nurse or doctor want to give a drug to a patient, what data has to be
verified before giving the drug (first name of the patient file
number room number age of the patient and family name),,,
always the correct answer is the one with word (and), because in
hospitals 2 specific data for a patient have to be verified before giving
the medicine to him.

 Normal saline is always a correct answer in one or more of the

questions in the exam.
Heart failure exacerbation (Adhf) sign... (S2 gallop s3 galloprales...)... rales is correct page 2-168
Amiodarone side effect (and the tests that has to be done before
taking the medicine and drug interaction) page 2-255
Table in page 2-257
4 hypertension question page 2-261 & 2-262 & 2-263
African American hypertensive patients.
Digoxin blood level (2 question), one case with high level and the
other one low level.
ADHF (2 QUESTIONS)
TAKE CARE OF THE BENEFITS OF EACH DRUG USED IN HEART
FAILURE, this year , he asked about digoxin (decrease hospitalization)
Uses of TOF , page 1-213
2 cases of potassium problems, a patient with low level of Potassium,
we gave potassium injection but no response (after you check his
blood Mg level, you will find it low), so correct answer is to give
Magnesium (page 1-163)
Patient, hospitalized with abnormal heart ECG, what we have to do>>
(after you check his blood K level, you will find it VERY HIGH), so
correct answer is to give CALCIUM (page 1-164)
JOINT COMISSION AND FDA.
DVT patient, he started warfarin and LMWH, 3 days ago, for the
treatment of his DVT, his INR now is 2.3, what we have to do next
(stop LMWH- stop warfarin-stop both-continue both)... continue
both is correct (he has to use LMWH for at least 5 days until warfarin
is fully effective)... warfarin tables ambulatory care DVT
treatment