Key Therapeutic Areas for the PEBC MCQ

The PEBC Qualifying Examination Part 1 focuses on these major therapeutic categories:

Cardiovascular Therapeutics: Key Concepts

Cardiovascular disorders represent approximately 20-25% of the PEBC Qualifying Examination Part 1 content. Focus on these critical concepts:

• Hypertension management: Know the Hypertension Canada guidelines, including target blood pressures for different patient populations (diabetes, elderly, CKD), first-line agents, and compelling indications for specific antihypertensive classes.
• Heart failure: Understand the differences between HFrEF and HFpEF treatment approaches. For HFrEF, know the four pillars of therapy (ACEi/ARB/ARNI, beta-blockers, MRAs, and SGLT2 inhibitors) and their mortality benefits.
• Atrial fibrillation: Master the CCS algorithm for rate vs. rhythm control, anticoagulation decision-making using the CHADS₂-VASc and HAS-BLED scores, and direct oral anticoagulant (DOAC) selection criteria.
• Dyslipidemia: Know the Canadian Cardiovascular Society guidelines for statin therapy, including primary vs. secondary prevention, risk calculation, and treatment targets.

Endocrine Therapeutics: Focus Areas

Diabetes management is heavily tested on the PEBC exam. Key areas to master include:

• Diabetes Canada guidelines: Know the A1C targets for different patient populations, the stepwise approach to pharmacotherapy, and cardiovascular risk reduction strategies.
• Medication selection: Understand the place in therapy for metformin, SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, and insulin. Know which agents have proven cardiovascular and renal benefits.
• Insulin management: Master insulin initiation, titration strategies, and calculations for adjusting doses based on blood glucose patterns.
• Thyroid disorders: Know the approach to hypothyroidism management, including dosing considerations, monitoring parameters, and medication interactions.

Essential Canadian Guidelines

The PEBC Qualifying Examination Part 1 emphasizes Canadian clinical practice guidelines. Prioritize these key guidelines:

When studying these guidelines, focus on:

• First-line treatment recommendations
• Specific Canadian recommendations that differ from international guidelines
• Treatment algorithms and decision points
• Special population considerations (elderly, pediatric, pregnancy, renal/hepatic impairment)

Clinical Decision-Making Strategies

The PEBC Qualifying Examination Part 1 tests your ability to apply therapeutic knowledge to clinical scenarios. Develop these critical thinking skills:

1. Systematic Patient Assessment

When approaching clinical scenarios, use this structured framework:

1. Identify the primary problem: What is the main therapeutic issue that needs to be addressed?
2. Assess patient-specific factors: Age, comorbidities, renal/hepatic function, pregnancy status, allergies
3. Review current medications: Look for drug interactions, therapeutic duplications, or inappropriate therapies
4. Apply guidelines: What do Canadian guidelines recommend for this specific situation?
5. Consider alternatives: What are the pros and cons of each potential intervention?

2. Therapeutic Decision-Making

When selecting optimal drug therapy, consider these factors:

• Efficacy: Is there evidence supporting the use of this medication for this indication?
• Safety: What are the potential adverse effects? Are they significant for this specific patient?
• Patient factors: How do age, renal/hepatic function, comorbidities, and other patient-specific factors influence this decision?
• Drug interactions: Are there potential interactions with current medications?
• Practicality: Consider cost, dosing frequency, and other factors that may affect adherence

3. Monitoring and Follow-up

The PEBC exam often tests knowledge of appropriate monitoring parameters:

• Know the specific parameters to monitor for each drug class
• Understand the timing of monitoring (baseline, early therapy, maintenance)
• Recognize signs/symptoms that suggest adverse effects or treatment failure
• Know when to adjust therapy based on monitoring results

Clinical Pearls and High-Yield Facts

These high-yield clinical pearls are frequently tested on the PEBC Qualifying Examination Part 1:

Drug Interactions to Remember

These high-yield drug interactions are frequently tested:

• Warfarin interactions (antibiotics, amiodarone, NSAIDs, herbal products)
• Statin interactions (clarithromycin, cyclosporine, gemfibrozil)
• QT-prolonging drug combinations
• Serotonin syndrome risk factors (MAOIs, SSRIs, SNRIs, tramadol, triptans)
• Potassium-sparing diuretic combinations with ACEIs/ARBs
• Digoxin interactions (amiodarone, verapamil, clarithromycin)