BCGP Prep Course (BCGP): free quiz

1. Question 1 of 10An 84-year-old woman in long-term care is receiving diazepam 5 mg by mouth at bedtime for insomnia. As the consultant pharmacist, you review her profile: weight 46 kg, serum creatinine 0.8 mg/dL, daytime sedation, and 1 recent fall. Which recommendation best reflects age-related pharmacokinetic changes affecting this medication?
   Choose one answer

   AContinue diazepam 5 mg nightly because the serum creatinine is normal and diazepam is not primarily renally cleared.BChange to clonazepam 1 mg nightly because its longer duration provides steadier sleep with less accumulation in older adults.CRecommend discontinuing diazepam and discussing a safer alternative because increased adipose tissue and reduced clearance can prolong half-life and drug accumulation.DIncrease diazepam to 10 mg nightly because older adults have a smaller volume of distribution for lipophilic drugs, reducing next-day effects.
2. Question 2 of 10

   An 83-year-old with chronic kidney disease and osteoarthritis takes naproxen 500 mg PO twice daily plus lisinopril 20 mg PO daily. BP is controlled; eGFR is 34 mL/min/1.73 m2. What is the best pharmacist recommendation?

   Choose one answer

   ARecommend avoiding chronic oral NSAID therapy and consider safer pain options with renal and BP monitoring.BAdd aspirin 325 mg daily to protect renal perfusion while continuing naproxen.CContinue naproxen because the dose is standard for adults.DSwitch to ibuprofen 800 mg three times daily because it has a shorter half-life.
3. Question 3 of 10

   An 89-year-old woman in long-term care with advanced frailty, 10-lb unintentional weight loss, slow gait, and dependence in 3 ADLs is taking atorvastatin 80 mg by mouth nightly for primary prevention. She has no history of myocardial infarction, stroke, or peripheral arterial disease. Current medications include lisinopril 10 mg daily, acetaminophen 650 mg by mouth three times daily, and calcium/vitamin D twice daily. As the consulting geriatric pharmacist, which recommendation is most appropriate to discuss with the prescriber?

   Choose one answer

   AReduce atorvastatin to 40 mg nightly because frailty alone requires moderate-intensity statin therapy rather than high-intensity therapy for primary prevention.BRecommend deprescribing atorvastatin after discussing prognosis, goals of care, and limited time to benefit for primary prevention in advanced frailty.CChange atorvastatin 80 mg nightly to simvastatin 40 mg nightly to maintain prevention benefit with a lower adverse-effect risk.DContinue atorvastatin 80 mg nightly because high-intensity statin therapy is routinely indicated in all adults older than 75 years for primary prevention.
4. Question 4 of 10

   An 81-year-old takes zolpidem 10 mg PO nightly for insomnia and sertraline 50 mg PO daily. Her caregiver reports nighttime wandering, morning confusion, and falls. As the pharmacist reviewing the regimen, what is the best recommendation?

   Choose one answer

   AIncrease zolpidem to 12.5 mg ER PO nightly because early awakening suggests inadequate exposure.BSwitch zolpidem to eszopiclone 3 mg PO nightly because it has a longer duration.CRecommend tapering and discontinuing zolpidem, with sleep-hygiene support and reassessment.DAdd lorazepam 0.5 mg PO nightly if zolpidem no longer maintains sleep.
5. Question 5 of 10

   A 81-year-old discharged after a fracture takes clonazepam 0.5 mg orally three times daily and new oxycodone 5 mg every 6 hours as needed. She needs a walker and help bathing. What medication-safety recommendation should the pharmacist prioritize?

   Choose one answer

   ARecommend a supervised clonazepam taper plan and opioid-risk mitigation because benzodiazepine-opioid co-use increases sedation and falls.BAdd diphenhydramine 25 mg at bedtime to improve sleep during fracture recovery.CIncrease clonazepam to 1 mg three times daily so anxiety does not interfere with rehabilitation.DSchedule oxycodone 5 mg every 6 hours around the clock while continuing clonazepam unchanged.
6. Question 6 of 10

   A 78-year-old with chronic insomnia and severe COPD takes temazepam 15 mg PO nightly. He has morning somnolence and oxygen desaturations. Which pharmacist recommendation is most appropriate?

   Choose one answer

   A

   Increase temazepam to 30 mg PO nightly to reduce nocturnal awakenings and oxygen demand.

   B

   Recommend gradual temazepam taper and nonpharmacologic insomnia therapy, with respiratory and withdrawal monitoring.

   C

   Add diphenhydramine 25 mg PO nightly and continue temazepam 15 mg PO nightly.

   D

   Switch to lorazepam 1 mg PO nightly because it lacks active metabolites.

7. Question 7 of 10

   An 87-year-old with chronic kidney disease takes allopurinol 300 mg orally daily for gout prevention. The caregiver reports rash and missed hydration because the patient dislikes drinking without reminders. eGFR is 28 mL/min/1.73 m2. What should the pharmacist recommend?

   Choose one answer

   A

   Hold/clarify allopurinol promptly because rash with renal impairment may signal serious hypersensitivity; reassess dose and caregiver hydration support.

   B

   Continue allopurinol 300 mg daily and treat the rash with diphenhydramine 25 mg every 6 hours.

   C

   Increase allopurinol to 600 mg daily because dehydration can trigger gout flares.

   D

   Add azathioprine 50 mg daily to reduce inflammation from gout and rash.

8. Question 8 of 10

   A pharmacist calls an 81-year-old after discharge for heart failure. The discharge list has furosemide 40 mg orally daily, but the patient also takes torsemide 20 mg orally daily from home because “both are water pills.” Weight is down 4 lb in 3 days and dizziness occurs on standing. What is the best recommendation?

   Choose one answer

   AAdd hydrochlorothiazide 25 mg orally daily to prevent loop-diuretic tolerance.BIdentify duplicate loop-diuretic therapy and clarify which single diuretic regimen the prescriber intended.CSwitch both loop diuretics to spironolactone 100 mg orally daily without lab review.DContinue both loop diuretics because they use different active ingredients.
9. Question 9 of 10

   A 76-year-old woman takes allopurinol 300 mg by mouth daily for gout. Her eGFR declined from 55 to 22 mL/min, and she was prescribed amoxicillin-clavulanate for sinusitis. She reports new rash and malaise. As the pharmacist, what should you recommend?

   Choose one answer

   ARecommend holding allopurinol and urgent prescriber assessment for hypersensitivity with renal-dose review.BStop the antibiotic only and continue allopurinol 300 mg daily.CContinue allopurinol unchanged and add azathioprine 50 mg daily for inflammation.DIncrease allopurinol to 600 mg daily because renal dysfunction raises uric acid.
10. Question 10 of 10

    Mr. Wallace, 90, has advanced dementia, dysphagia, and remote myocardial infarction 18 years ago. He takes atorvastatin 80 mg by mouth nightly. His surrogate reports comfort-focused goals and distress with swallowing tablets. As the consultant pharmacist, which recommendation best fits shared decision-making?

    Choose one answer

    ARecommend deprescribing atorvastatin after prescriber discussion, documenting comfort-focused goals and limited time-to-benefit.BContinue atorvastatin 80 mg nightly because high-intensity therapy is always required after myocardial infarction.CReduce to atorvastatin 40 mg nightly and document that LDL should remain below 70 mg/dL.DSwitch to rosuvastatin 40 mg by mouth daily to provide stronger LDL reduction with fewer tablets.

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