The Foreign Pharmacy Graduate Equivalency Examination® (FPGEE ®) is an exam that is required as a part of the FPGEC program. The FPGEE ® is offered twice a year throughout the continental United States. Everyone who is eligible during the FPGEC application process can take the exam.
FPGEE ® Exam Distribution
FPGEE ® exam consists of 250 questions. These questions are divided into four content areas.
- Basic biomedical sciences – 21%
- Pharmaceutical Sciences – 29%
- Social, behavioral, administrative pharmacy sciences – 15%
- Clinical sciences – 35%
Syllabus of FPGEE ®
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Basic Biomedical Sciences – 21%
A. Anatomy & Physiology
1. Structure and function of major body systems; integumentary, muscular-skeletal, cardiovascular, lymphatic, respiratory, digestive, nervous, endocrine, urinary, reproductive and body fluid and electrolytes
2. Molecular aspects of cell biology
3. Cell physiology and cellular structure and organization
B. Pathology/Pathophysiology
1. Basic principles and mechanisms of disease including i. Inflammation and repair ii. Degeneration iii. Disturbances and hemodynamics iv. Developmental defects v. Neoplasia
2. Pathophysiology of disease states amenable to pharmacist intervention
C. Microbiology
1. General principles of microbial concepts
2. Principles of infectious disease
3. Host-parasite relationships
4. Pathogenic micro-organisms of man
5. Inflammatory responses to infectious agents
6. Clinical aspects of infection
D. Immunology
1. Human immunity and immune responses
2. Principles of antigen-antibody relationships
3. Molecular biology of immune responses
4. The Genetic basis for antibody synthesis, development, function, and immunopathology
E. Biochemistry/Biotechnology
1. Chemistry of biomacromolecules (proteins, lipids, carbohydrates, and DNA)
2. Enzymology and co-enzymes and kinetics
3. Metabolic pathways to energy utilization
4. Nucleic acid metabolism including DNA replication and repair, RNA and protein synthesis
5. Recombinant DNA technology
F. Molecular Biology/Genetics
1. Cell structure and components
2. Ion channels and receptor physiology
3. Mitosis and meiosis
4. Chromosomes and DNA
5. Gene transcription and translation processes
6. Recombinant DNA technology
G. Biostatistics
1. Understanding commonly used statistical tests and their basis
2. Management of data sets
3. Evaluation of statistical results
4. Understanding of statistical versus clinical significance
Pharmaceutical Sciences – 29%
A. Medicinal Chemistry
1. Physio-chemical properties of drug molecules in relation to drug absorption, distribution, metabolism, and excretion (ADME)
2. Chemical basis and pharmacology and therapeutics
3. Fundamental pharmacophores for drugs used to treat disease
4. Structure-activity relationships in relation to drug-target interactions
5. Chemical pathways of drug metabolism
6. Application making drug therapy decisions
B. Pharmacology
1. Mechanism of action of drugs of various categories
2. Role of pharmacology in drug choice and the treatment of disease
3. Pharmacodynamics of drug action and absorption, distribution, metabolism, and elimination
4. Adverse effects and side-effects of drugs
5. Drug-target interactions 6. Drug-drug, drug-food, drug-lab test interactions
7. Drug discovery and development
C. Pharmacognosy and Alternative and Complementary Treatments
1. Concepts of crude drugs, semi-purified, and purified natural products
2. Variability of occurrence of pharmacologically active substances in plants and impact on regulatory aspects of herbal products
3. Overview of classes of pharmacologically active natural products
4. Dietary supplements (vitamins, minerals, and herbals)
5. Alternative medical treatments
6. Evaluation of alternative and complementary medicine purity, bioavailability, safety, and efficacy
7. Herbal-drug interactions
8. Dietary Health Supplement and Education Act and impact on the regulation of dietary supplements and herbal products
D. Toxicology
1. Mechanism of toxicity and toxicokinetics
2. Acute and chronic toxic effect of xenobiotics on the body including drug or chemical overdose and toxic signs of drugs of abuse
3. Interpretation of drug screens
4. Antidotes and approaches to toxic exposures
5. Functions of poison control centers
6. Bioterrorism and disaster preparedness and management
E. Bioanalysis/Clinical Chemistry
1. Fundamentals of laboratory medicine and its importance to screening, diagnosis, and evaluation of patients
2. Clinical data relevant to disease state management
F. Pharmaceutics/Biopharmaceutics
1. Physical-chemical principles of dosage forms
2. Biological principles of dosage forms
3. Principles of drug delivery via dosage forms (eg, liquid, solid, semi-solid, controlled release, patches, and implants)
4. Principles of dosage form stability and drug degradation in dosage forms
5. Materials and methods used in the preparation and use of drug forms
G. Pharmacokinetics/Clinical Pharmacokinetics
1. Basic principles of in vivo drug kinetics (linear and nonlinear)
2. Principles of bioavailability/bioequivalence
3. Physiologic determinates of drug onset and duration
4. Drug, disease, and dietary influences on absorption, distribution, metabolism, and excretion
5. Clinical pharmacokinetics of commonly used and low-therapeutic-index drugs
6. The pharmacokinetic-pharmacodynamic interface
H. Pharmacogenomics/Genetics
1. The Genetic basis for disease and drug action
2. The Genetic basis for alteration and drug metabolism
3. Genome and proteomic principles in relation to disease and drug development
4. The Genetic basis for individualizing drug doses
I. Extemporaneous Compounding/Parenteral/Enteral
1. United States Pharmacopeia (USP) guidance on compounding and Food and Drug Administration (FDA) Compliance Policy Guidelines
2. Techniques and principles used to prepare and dispense individual extemporaneous prescriptions including the dating of compounded dosage forms
3. Liquid (parenteral, enteral), solid, semi-solid, and topical preparations
4. Dosage form preparation calculations 5. Sterile admixture techniques
a. USP Chapter 797
b. Stability and sterility testing and dating
c. Clean room requirements
d. Infusion devices and catheters
Social/Behavioral/Administrative Pharmacy Sciences – 15%
A. Health Care Delivery Systems
1. Introduction to United States, state, and local health care delivery systems and their interfaces
2. Social, political, and economic factors of the US health care delivery system
3. Principles that influence the distribution of pharmaceutical products and services
4. Role of public and private insurers, pharmaceutical industry, and managed care on health care delivery in the United States
5. Medicare and Medicaid
6. Indigent care programs
7. Incidence of and problems associated with drug overuse, underuse, and misuse in the US health care system
B. Economics/Pharmacoeconomics
1. Economic principles in relation to pharmacoeconomic analysis
2. Concepts of pharmacoeconomics in relation to patient care
3. Applications of economic theories and health-related quality-of-life concepts to improve allocation of limited health care resources
C. Practice Management
1. Management principles (planning, organizing, directing, and controlling pharmacy resources) applied to various pharmacy practice setting and patient outcomes
2. Management of staff within the practice setting including pharmacists, technicians, and other supportive personnel
3. Principles of planning, organizing, directing, and controlling pharmacy resources
4. Tools, including informatics, needed to assess and address change, increase competitiveness, improve quality, and optimize patient services
5. Management of medication use safety systems
6. Strategies to improve continuity of patient care as patients move between health care settings
7. Marketing principles
8. Basic accounting principles
9. Infection control
10. Project management
11. Managing and improving the medicationuse process
12. Third-party administration and managed care systems
13. Health care improvement mechanisms at the micro- and macro-system levels
D. Pharmacoepidemiology
1. Application of principles of epidemiology to the study of drug use and outcomes in large populations
2. Studies that provide an estimate of the probability of beneficial effects in populations, or the probability of adverse effects in populations, and other parameters relating to drug use may benefit
3. Methods for continual monitoring for unwanted effects and other safety-related aspects of drugs
E. Pharmacy Law and Regulatory Affairs
1. Legal basis for pharmacy practice
2. Pharmacist’s responsibilities and limits under the law
3. Pharmacist’s role in reducing liability by reducing drug-related misadventure 4. Civil versus criminal liability
5. Business contract law
F. History of Pharmacy
1. Overview of the evolution of pharmacy as a distinct profession
2. Moving from focus on the drug to focus on the patient and the drug, including clinical, pharmaceutical care and other aspects of patient-provided pharmacist care
3. Major milestones and contributors in the evolution of pharmacy
G. Ethics
1. Principles of professional behavior
2. Ethical issues related to the development, promotion, sales, prescription, and use of drugs
3. Dealing with ethical dilemmas
4. Conflict of interest
5. Ethical issues in delivery of patientcentered care and clinical research
6. Principles of end-of-life care
7. Ethical issues in teamwork
H. Professional Communications
1. Effective verbal and written interpersonal communication
2. Health literacy
3. Communicating with diverse patients, families, pharmacists, and other health professionals in a variety of settings both individually and as a member of a team
4. Interviewing techniques
5. Active listening and empathy
6. Assertiveness and problem-solving techniques
7. Cultural influences on communication of health information
8. Group presentation skills
9. Strategies for handling difficult situations
10. Documentation of pharmacist recommendations and consultations
11. Principles of behavior modification
I. Social and Behavioral Aspects of Practice
1. Pharmacy as a patient-centered profession
2. Patient and other health care providers perceptions of pharmacists’ capabilities
3. Role of pharmacist related to patient care
4. Role of pharmacist related to interaction with other health care professionals 5. Development of leadership skills
6. Importance of involvement in pharmacy organizational, regulatory, state, and federal issues
Clinical Sciences – 35%
A. Pharmacy Practice and Pharmacist-Provided Care
1. Overview of the pharmacy profession
2. Issues of contemporary practice
3. Emerging and unique roles for the pharmacist on the health care team
4. Concepts of pharmacist-provided patient care and medication therapy management services
5. Principles of pharmacist-managed, patientcentered pharmacy services
6. Methods of outcome monitoring and assessment techniques
7. Problem identification (eg, duplication, dosage, drug interactions, adverse drug reactions and interactions, frequency, dosage form, indication mismatches) and resolution
8. Role of pharmacy care plans in patient care
9. Monitoring for positive and negative drug therapy outcomes
10. Principles of clinical management of drug toxicity and overdosage
11. Home diagnostic devices
B. Medication Dispensing and Distribution Systems
1. Preparation and dispensing of prescriptions
2. Development and maintenance of patient medication profiles
3. Identification and prevention of medication errors
4. Identification and prevention of drug toxicity
5. Issues of distribution systems associated with all types of practice settings
6. Role of automation and technology in workload efficiency and patient safety
7. Assurance of safety in the medication-use process
8. Medication error reduction programs
9. Continuous quality improvement programs
C. Pharmacotherapy – Practice Guidelines and Clinical Trials
1. Principles of clinical practice guidelines for various disease states and their interpretation in the clinical setting
2. Integration of core scientific and systemsbased knowledge in patient care decisions
3. Reinforcement of basic science principles relative to drug treatment protocols and clinical practice guidelines
4. Evaluation of clinical trials that validate treatment usefulness
D. Pharmacotherapy – Health Promotion/Disease Prevention
1. Promotion of wellness and nonpharmacologic therapies
2. Disease prevention and monitoring
E. Pharmacotherapy – Pharmaceutical Care
1. Application of evidence-based decision making to patient care
2. Drug monitoring for positive and negative outcomes
3. Diagnostic tests in the diagnosis, staging, and monitoring of various disease states
4. Concepts of pain management and palliative care
5. Nonprescription drug therapies
6. Dietary drug therapies
7. Designing of patient-centered, culturally relevant treatment plans
8. Drug-induced disease
F. Pharmacist-provided Care for Special Populations
1. Pathophysiologic and pharmacotherapy alterations specific for special population patients (eg, pediatric, geriatric, pregnant, cystic fibrosis, sickle cell anemia, celiac disease, genetic disorders, and others) for prescription and nonprescription medications
2. Dosage calculation and adjustment in specialpopulation patients
3. Drug monitoring for positive/negative outcomes in special-population patients
G. Drug Information
1. Fundamentals of the practice of drug information
2. Application of drug information skills for delivery of pharmaceutical care
3. Technology of drug information retrieval for quality assurance
4. The ability to judge the reliability of various sources of information
H. Medication Safety
1. Causes of medication errors/systems approaches
2. Human factors in errors
3. Strategies for reducing errors
4. Pharmacy leadership in medication safety
I. Literature Evaluation and Research Design
1. Fundamentals of research design and methodology
2. Principles of evaluation of the primary literature
3. Practical implications of the primary literature
4. Principles of research design and analysis in practicing evidence-based pharmacy
J. Patient Assessment Laboratory
1. Obtaining a comprehensive patient history
2. Familiarity with basic assessment techniques (inspection, palpation, percussion, auscultation), terminology, and the modifications caused by common disease states and drug therapy
3. Triage and referral skills
4. Knowledge of therapeutic drug concentrations and their interpretation
5. Knowledge of the basis for common clinical laboratory values and diagnostic tests and the influences of common disease states
6. False positive and false negative results
7. Over-the-counter point-of-care testing devices (eg, glucometers, pregnancy tests, home testing for HbA1c, drug screening)
8. Principles of electrocardiography and common EKG abnormalities
9. Advanced cardiac life support
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