100+ Free BCTXP Practice Questions

Pass your Board Certified Toxicology Pharmacist exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

55-65% Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

What is the appropriate adult dose of activated charcoal for a suitable ingestion presenting within 1 hour?

0.1 g/kg

1 g/kg

10 g/kg

100 g/kg

to track

2026 Statistics

Key Facts: BCTXP Exam

150

Total Questions

125 scored + 25 pretest

3h 45m

Exam Time

BCTXP format

500/800

Passing Score

BPS scaled scoring

$600

Exam Fee

BPS 2026 ($300 retake)

2024

First Exam Year

Specialty approved 2023

7 years

Certification Valid

Recertification cycle

The BCTXP exam tests advanced toxicology pharmacy practice with 150 multiple-choice items (125 scored) over 3 hours 45 minutes. BPS uses scaled scoring with 500 (on a 200-800 scale) required to pass. Early cohort pass rates run 55-65%. Eligibility requires an active pharmacist license plus one pathway: PGY1 + PGY2 toxicology residency, PGY1 + 2 years toxicology practice (50%+ scope), or 4 years toxicology practice (50%+ scope). The exam fee is $600 (retake $300). Certification is valid 7 years with recertification beginning in 2031.

Sample BCTXP Practice Questions

Try these sample questions to test your BCTXP exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1What is the appropriate adult dose of activated charcoal for a suitable ingestion presenting within 1 hour?

A.0.1 g/kg

B.1 g/kg

C.10 g/kg

D.100 g/kg

Explanation: Activated charcoal is dosed at 1 g/kg (typical adult dose 25-100 g) and is most effective within 1 hour of ingestion of a toxin that binds to charcoal.

2Which of the following is NOT bound effectively by activated charcoal?

A.Acetaminophen

B.Carbamazepine

C.Lithium

D.Theophylline

Explanation: Lithium (a small, charged ion) is poorly adsorbed by activated charcoal, along with other metals, alcohols, acids/alkalis, and hydrocarbons (PHAILS mnemonic).

3Which decontamination method is currently NOT recommended for routine use in poisoned patients?

A.Activated charcoal

B.Whole bowel irrigation

C.Syrup of ipecac

D.Skin irrigation with water

Explanation: Syrup of ipecac is no longer recommended due to lack of outcome benefit, risk of aspiration, and interference with other therapies. AAP and AACT position statements discourage routine home or hospital use.

4Whole bowel irrigation with polyethylene glycol is indicated for all EXCEPT:

A.Body packers (drug smugglers)

B.Iron overdose

C.Sustained-release verapamil

D.Acetaminophen ingestion 30 min prior

Explanation: WBI is not indicated for simple acetaminophen ingestion — activated charcoal (if early) is preferred. WBI is reserved for substances not bound by charcoal (iron, lithium) or for sustained-release/enteric-coated products and body packers.

5Which toxin is most appropriately treated with urine alkalinization using sodium bicarbonate?

A.Salicylates

B.Methanol

C.Tricyclic antidepressants

D.Cocaine

Explanation: Urine alkalinization (pH 7.5-8.5) with sodium bicarbonate ion-traps salicylate in the urine, dramatically increasing renal elimination. Target urine pH is 7.5-8.5.

6The ISTUMBLED mnemonic identifies toxins removable by hemodialysis. Which agent is NOT included?

A.Lithium

B.Methanol

C.Digoxin

D.Salicylate

Explanation: Digoxin has a large volume of distribution (~6 L/kg) and high protein/tissue binding, making it NOT dialyzable. DigiFab (digoxin immune Fab) is the treatment.

7Which toxidrome is characterized by mydriasis, dry mucous membranes, urinary retention, hyperthermia, and delirium?

A.Cholinergic

B.Anticholinergic

C.Sympathomimetic

D.Opioid

Explanation: Anticholinergic toxidrome: 'Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask' — hyperthermia, anhidrosis, flushing, mydriasis, delirium, urinary retention.

8SLUDGE and DUMBELS describe which toxidrome?

A.Anticholinergic

B.Cholinergic/muscarinic

C.Serotonin syndrome

D.Sedative-hypnotic

Explanation: SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis) and DUMBELS (Defecation, Urination, Miosis, Bradycardia/Bronchorrhea/Bronchospasm, Emesis, Lacrimation, Salivation) describe muscarinic/cholinergic excess (OP, carbamates, physostigmine).

9The Rumack-Matthew nomogram is used to determine treatment for:

A.Salicylate toxicity

B.Acetaminophen toxicity

C.Methanol poisoning

D.Iron overdose

Explanation: The Rumack-Matthew nomogram plots acetaminophen level vs time post-ingestion (starting at 4 hours) against a treatment line (150 mcg/mL at 4 hours in the US). Levels above the line trigger NAC therapy.

10The classic 21-hour IV NAC (Prescott) regimen for acetaminophen toxicity consists of which loading dose?

A.50 mg/kg over 4 hours

B.100 mg/kg over 16 hours

C.150 mg/kg over 60 minutes

D.70 mg/kg every 4 hours

Explanation: The Prescott 21-hour IV protocol: 150 mg/kg loading dose over 60 minutes, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours (total 300 mg/kg over 21 hours).

About the BCTXP Exam

The BCTXP certification is the newest BPS specialty credential, approved in 2023 with the first exam administered in 2024. It validates advanced knowledge in clinical and applied toxicology including poisoning assessment, decontamination, antidote selection, enhanced elimination (hemodialysis, urine alkalinization), pharmaceutical overdose management, drug-of-abuse intoxication, envenomation, occupational and environmental exposures, and chemical/radiological/biological toxicology. The exam consists of 150 items (125 scored, 25 unscored pretest).

Questions

150 scored questions

Time Limit

3 hours 45 minutes

Passing Score

500/800 (scaled)

Exam Fee

$600 (Board of Pharmacy Specialties (BPS))

BCTXP Exam Content Outline

30%

Pharmaceutical Poisonings and Drug-of-Abuse Intoxication

Acetaminophen (NAC, Rumack-Matthew), salicylates, TCAs, beta-blockers/CCBs (HIET, glucagon, lipid emulsion), digoxin (DigiFab), lithium, iron, opioids (naloxone), benzodiazepines (flumazenil risks), anticoagulant reversal (idarucizumab, andexanet, 4F-PCC, vitamin K), pediatric one-pill-can-kill, stimulants (cocaine, methamphetamine, MDMA), alcohol withdrawal, serotonin syndrome, NMS, anticholinergic/cholinergic toxidromes.

25%

General Toxicology, Decontamination, and Enhanced Elimination

Initial assessment and toxidrome recognition, activated charcoal (1 g/kg within 1 hr), whole bowel irrigation indications, contraindications to gastric lavage and ipecac, urine alkalinization for salicylates, hemodialysis indications (I STUMBLED mnemonic), fomepizole and ethanol blockade, lipid rescue pharmacology.

20%

Chemical, Environmental, and Occupational Toxicology

Toxic alcohols (methanol, ethylene glycol, isopropanol), carbon monoxide (hyperbaric indications), cyanide (hydroxocobalamin), methemoglobinemia (methylene blue, G6PD caveat), H2S, heavy metals (lead, arsenic, mercury, thallium), organophosphate/carbamate (atropine, 2-PAM), chemical warfare agents (nerve, vesicants), chlorine/ammonia/industrial exposures, occupational exposure limits.

15%

Natural Toxins, Envenomations, and Biological Threats

Pit viper and coral snake envenomation (CroFab, ANAVIP), scorpion (Anascorp), spiders (black widow, brown recluse), marine envenomations, plant toxins (cardiac glycosides, anticholinergics, hemlock), mushroom poisoning (amatoxin, gyromitrin, muscarinic), bioterrorism agents (anthrax, botulism, smallpox/tecovirimat, plague), radiation (potassium iodide, Prussian blue, DTPA).

10%

Professional Practice and Evidence-Based Toxicology

Poison control center collaboration (AAPCC 1-800-222-1222), toxicosurveillance, ED antidote stocking (ACMT/ACEP recommendations), forensic toxicology, drug-of-abuse testing interpretation, pregnancy and pediatric toxicology considerations, Wernicke prophylaxis, toxicologic investigation, research methods and evidence interpretation.

How to Pass the BCTXP Exam

What You Need to Know

Passing score: 500/800 (scaled)
Exam length: 150 questions
Time limit: 3 hours 45 minutes
Exam fee: $600

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

BCTXP Study Tips from Top Performers

1Memorize the I STUMBLED mnemonic for hemodialysis indications: Isopropanol, Salicylates, Theophylline, Uremia, Methanol/Methotrexate, Barbiturates, Lithium, Ethylene glycol/Ethanol, Dabigatran, Depakote

2Master the Rumack-Matthew nomogram and NAC protocols cold - IV 21-hour Prescott, oral 72-hour, and when to extend or escalate

3Drill cardiovascular antidotes including HIET (1 U/kg bolus then 1-10 U/kg/hr), glucagon for beta-blockers, calcium for CCB, lipid emulsion 20%, and DigiFab dosing

4Review toxic alcohol treatment: fomepizole 15 mg/kg then 10 mg/kg q12h (increase during HD), ethanol alternative, and HD thresholds (level >25, severe acidosis, renal failure)

5Know antivenin dosing: CroFab 4-6 vials initial + 2 vials q6h x3, ANAVIP 10 vials, Anascorp for Centruroides, and that coral snake antivenin is unavailable (supportive + respiratory support)

Frequently Asked Questions

What is the BCTXP pass rate?

BCTXP is a new specialty (approved 2023, first examination 2024), so official pass rate data is still emerging. Early cohort pass rates appear to run 55-65%, with stronger performance among PGY2 toxicology residency graduates. BPS uses scaled scoring from 200-800, with 500 required to pass, which normalizes for question difficulty across forms.

How many questions are on the BCTXP exam?

The BCTXP exam has 150 multiple-choice questions (125 scored, 25 unscored pretest). You have 3 hours and 45 minutes of testing time. BCTXP moved to continuous testing in 2025, with candidates receiving 90 days to schedule after receiving their Authorization to Test (ATT).

Who is eligible for the BCTXP exam?

Candidates must hold an active pharmacist license plus ONE of three pathways: (1) PGY1 pharmacy residency plus PGY2 toxicology residency completed within the past 7 years, (2) PGY1 pharmacy residency within the past 7 years plus at least 2 years of toxicology practice with 50%+ scope, or (3) at least 4 years of practice with 50%+ scope in clinical or applied toxicology (including medical/poison center toxicology, forensic toxicology, or occupational toxicology).

How much does the BCTXP exam cost?

The BCTXP exam application fee is $600 USD for initial certification and $300 USD for retakes within 12 months of a failed attempt. BPS-certified pharmacists also pay a $125 annual certification maintenance fee during years 1-6 of the 7-year cycle. Costs do not include review courses or study materials.

When was BCTXP established and is it available now?

BPS approved toxicology pharmacy as a recognized specialty in 2023 after petition by the American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT). The first BCTXP examination was administered in 2024. Exam registration is currently open and continuous testing appointments can be scheduled at Pearson VUE. Recertification examinations begin in 2031.

How should I prepare for the BCTXP exam?

Plan 150-250 hours over 3-6 months. High-yield focus areas: acetaminophen NAC protocols and Rumack-Matthew nomogram, toxic alcohol fomepizole dosing, cardiovascular overdose (HIET, glucagon, lipid emulsion), anticoagulant reversal, organophosphate antidotes, envenomation antivenins, and enhanced elimination (I STUMBLED mnemonic for HD). Use Goldfrank's Toxicologic Emergencies, Poisoning and Drug Overdose (Olson), ACCP/ACMT review materials, and 1,000+ case-based practice questions.

How long is BCTXP certification valid?

BCTXP certification is valid for 7 years. Recertification requires either passing the recertification examination OR completing 100 hours of BPS-approved professional development through organizations like ACCP, ACMT, or AACT during the 7-year cycle. The first BCTXP recertification window opens in 2031.