APP Exam Blue Print

Total Questions: 325 (300 scored + 25 pilot)
Exam Time: 5 hours

Passing Standard: Competency-based, similar to NP/PA national exams
I. FOUNDATIONAL CLINICAL KNOWLEDGE (15% – ~45 Questions)

A. Biomedical & Pharmaceutical Sciences

Physiology, pathophysiology of major organ systems

Pharmacokinetics, pharmacodynamics

Pharmacogenomics, CYP450 pathways

Therapeutic drug monitoring

Medication safety systems (REMS, iPLEDGE, DEA schedules)
 

B. Evidence-Based Practice

Levels of evidence; guideline interpretation

Study design, statistics, absolute vs. relative risk

Clinical practice guideline navigation (ADA, ACC/AHA, GOLD, KDIGO, ACR, IDSA)

C. Public Health, Ethics, Regulatory Practice

California APP scope of practice

Collaborative practice models with physicians and other providers

OSHA, HIPAA, FDA frameworks

Social determinants of health & health equity
 

II. PATIENT ASSESSMENT & DIAGNOSTICS (20% ~60 Questions)
(Modeled after PANCE “History & Physical” + NP “Assessment”)
A. History Taking

Focused & comprehensive medication-focused history

Allergies, adverse drug reactions, drug intolerance

Dietary supplements, herbals, drug–food interactions

B. Physical Examination

Recognition of abnormal clinical findings

Cardiopulmonary, HEENT, abdominal, musculoskeletal, skin

C. Diagnostic Interpretation

CBC, CMP, lipid panel, liver panel

A1c, glucose tolerance test

EKG basics, chest X-ray interpretation

Renal function calculation (CrCl, eGFR)

Urinalysis interpretation

Infectious disease diagnostics (CBC shift, CRP/ESR, PCR, cultures)
 

III. CLINICAL PHARMACOTHERAPY & DISEASE MANAGEMENT (40% – ~120 Questions)
(Largest section—mirrors NP/PA emphasis on diagnosis + management)
A. CARDIOLOGY (≈15% of section)

Hypertension (ACC/AHA)

Hyperlipidemia (Statins, PCSK9, fibrates; drug interactions)

Heart failure (GDMT: ARNI, SGLT2i, MRA, beta-blockers)

Arrhythmias: atrial fibrillation, rate vs. rhythm management

Anticoagulation therapy (DOACs, warfarin, bridging, monitoring)

B. ENDOCRINOLOGY

Diabetes Type 1 & 2: ADA guidelines, insulin intensification

Hypo-/Hyperthyroidism

Obesity pharmacotherapy

C. PULMONOLOGY

Asthma (GINA)

COPD (GOLD)

Pneumonia (CAP/HAP therapy: IDSA)

D. INFECTIOUS DISEASE

Antibiotic stewardship

Cellulitis, UTI, sinusitis, STI treatment

HIV PrEP/PEP, ART basics

Vaccinations & immunization guidelines

E. NEPHROLOGY

CKD stages & medication dosing

Electrolyte management (K+, Mg2+, Na+)

Renal-safe medications, nephrotoxic risks

F. GASTROENTEROLOGY

GERD management

Peptic ulcer, H. pylori therapy

Constipation/IBS/IBD pharmacotherapy

Liver disease dosing adjustments

G. RHEUMATOLOGY

Gout – acute & chronic management

RA, OA – guideline-based therapy

Steroid tapering, DMARD monitoring

H. DERMATOLOGY

Acne: isotretinoin REMS

Atopic dermatitis, psoriasis

Cellulitis vs. abscess management

Steroid potency selection

I. PSYCHIATRY

Depression, anxiety, insomnia

SSRIs, SNRIs, TCAs, mood stabilizers

Suicide risk screening

Controlled substances prescribing

IV. MEDICATION MANAGEMENT & THERAPEUTIC DECISION-MAKING (15% – ~45 Questions)
(Mirrors NP/PA “Management” domain)
A. Polypharmacy Management

Deprescribing frameworks

Beers Criteria

Frailty and geriatric dosing

B. Adverse Event Recognition

Type A vs. Type B reactions

Anaphylaxis management

Drug-induced QT prolongation

Hepatotoxicity, nephrotoxicity

C. Drug Interactions

CYP3A4 interactions (statins + grapefruit, antifungals, macrolides)

Pharmacodynamic interactions (duplication of therapy)

D. Therapeutic Monitoring

INR, vancomycin AUC, aminoglycosides

Insulin titration

Biologic therapy monitoring

V. CLINICAL CASE ANALYSIS & PRACTICE COMPETENCY (10% – ~30 Questions)
(Similar to AANP/ANCC “Clinical Judgment” section)
Includes multi-step clinical cases requiring:

Differential diagnosis

Selecting first-line vs. second-line therapy

Adjusting medication for age, renal/hepatic function

Monitoring & follow-up

Patient counseling and adherence strategies

Cost-effective and guideline-based prescribing

VI. PHARMACY-BASED PROCEDURES & PRACTICE SKILLS (5% – ~15 Questions)
A. Point-of-Care Testing

Glucose, A1c and UA

Lipid testing

Flu, COVID, strep tests

B. Immunization Skills

ACIP guidelines (adult & pediatric)

Contraindications

C. Emergency Response

Anaphylaxis (Epi use)

Hypoglycemia protocol

Basic triage skills (urgent vs. emergent referral)

QUESTION TYPES
Single-best-answer multiple choice
Clinical vignettes (5–10 sentences)
Tables/graphs interpretation
Case-based medication selection
Pharmacokinetic calculations