FPGEE case studies
FPGEE · Put your knowledge to work in context.
The Foreign Pharmacy Graduate Equivalency Examination (FPGEE) is the assessment the National Association of Boards of Pharmacy (NABP) uses to judge whether a pharmacist educated outside the United States holds knowledge comparable to that of a US-educated entry-level practitioner. Passing it is not a license: it is one step that foreign graduates complete before a state or territorial board of pharmacy will consider them for licensure, along with whatever other requirements that board sets. The FPGEE case studies are 5 cases and about 4,638 words.
1Vancomycin AUC Assessment in a Patient with a Rising Creatinine
A 68-year-old man (95 kg, SCr 1.6 mg/dL, estimated CrCl 38 mL/min) is receiving vancomycin 1250 mg IV every 12 hours, each dose infused over 1.5 hours, for MRSA bacteremia. The isolate's vancomycin MIC is 1 mg/L by broth microdilution.
890 words, about 4 min2Hyperkalemia and Worsening Renal Function During Heart Failure Titration
A 72-year-old woman with HFrEF (LVEF 28%), CKD stage 3b (baseline eGFR 42), type 2 diabetes, and atrial fibrillation is admitted with 3 kg weight gain and dyspnea. Home regimen: sacubitril/valsartan 97/103 mg BID, carvedilol 12.5 mg BID, spironolactone 25 mg daily, dapagliflozin 10 mg daily, furosemide 40 mg daily.
798 words, about 4 min3Early Opioid Refill and a Levothyroxine Strength Error in the Same Shift
A 34-year-old man presents at 6:40 pm on day 18 of a 30-day oxycodone 30 mg q6h PRN prescription (180 tablets dispensed) requesting an early refill, stating the bottle was stolen from his car. He pays cash and lives in a neighboring state; the prescription was written by a family physician 90 minutes away who is not his primary care provider.
1,062 words, about 5 min4Formulary Decision for Apixaban Versus Warfarin Under a Cost-Neutrality Mandate
A 1.2-million-member commercial plan's P&T committee is reviewing apixaban versus warfarin for new starts in nonvalvular atrial fibrillation. Actuarial inputs: 12,000 eligible members; warfarin annual cost per patient 1,150 (drug, INR monitoring, clinic visits); apixaban 5,600 per year; stroke rate 2.3 per 100 patient-years on warfarin and 1.4 per 100 on apixaban; first-year cost of a stroke 38,000; major bleeding cost 14,000 with rates of 3.1 versus 2.5 per 100 patient-years.
944 words, about 5 min5Clonus, Hyperthermia, and a New Antibiotic in a Patient on Sertraline and Tramadol
A 29-year-old woman with depression (sertraline 100 mg daily) and chronic back pain (tramadol 100 mg four times daily) is admitted with 12 hours of agitation, diaphoresis, and diffuse tremor. Two days ago an urgent care clinician added linezolid 600 mg twice daily for cellulitis; she also took two doses of sumatriptan for headache.
944 words, about 5 min