How to Study for the California Pharmacy Jurisprudence Exam (CPJE)
There was a period a few weeks ago where my inbox looked like this:
-"Do you have any advice on passing the CPJE??"
-"How do we prepare for CPJE? I'm so worried about the exam."
-"The process to pass the CPJE takes about four or five months. I took the test in January and failed. Help!"
I just can’t sit idly while my beloved tl;dr readers ask for help, but there is a SMALL problem. I don’t live in California. And as much as I love you all (and would do anything to help you), I have to draw the line at "Taking a licensing exam for a state I don't live in."
So I reached out to your fellow tl;dr pharmacy readers, and asked them about the CPJE. I reached out to people I personally know who've passed the CPJE. I researched online to learn everything I could about this beast of an exam. I asked a whole lot of questions
How do you pass the CPJE?
How long did you study for the CPJE?
What’s the best way to study?
What’s the breakdown of law vs. clinical questions?
And this article is the result of all of that research.
So for the obvious upfront disclaimer, I have never taken the California Pharmacy Jurisprudence Exam (CPJE). And what you read here will not be the only resource you need to pass. But what I'm hoping to do is to give you some key pointers to help guide your studying.
For some further tl;dr resources, we’ve made a super handy MPJE Cheat Sheet that can help you with the law portion of the CPJE (but it doesn’t cover your clinical bases). To help you study for the clinical portion of the CPJE, I recommend checking out our article on how to study for the NAPLEX.
So let's dig in, shall we?
BTW - If you’d like a downloadable (and printer-friendly!) copy of this article, you can get one here.
CPJE Background
The CPJE is the exam you must take (in addition to the NAPLEX) to practice pharmacy in the state of California. But I'm sure you knew that already.
I'm not going to get into the nitty gritty of how you apply, and what's required for your background check, etc... You can find all of that information here, and I'm pretty sure that's not why you're reading this article. That being said, law exams and testing centers can be notorious in how strict they are with ID requirements, so make sure you read through the requirements carefully.
If you’re interested, you can find historical CPJE pass rates here.
The first step to preparing for any exam is to know what you're being tested on. You need to study the outline of the test--similar to how a military general needs to study the layout of the land before going to battle. Otherwise, how are you going to know where to focus your study efforts?
You can snag an outline of the testing materials for the CPJE here (there's a lot of other info in that link, so you have to scroll down a bit to get to the outline. There's also some practice questions in that guide, so I highly encourage you to check it out).
Let's take the (many) bullet points that make up their test outline and break it down to its essentials:
Patient Medications (20 items)
Collect, organize, and evaluate information
Dispense medications
Patient Outcomes (33 items)
Determine a course of action
Educate patients and health care professionals
Promote public health
Pharmacy Operations (22 items)
Pharmaceuticals, Devices and supplies, and Inventory control
Perform quality assurance/improvement
Manage operations, human resources, and information systems
Manage formulary and medication use systems
All said, there are a total of 75 "real" questions (20 + 33 + 22). Then there are 15 additional questions that don't actually affect your score. The CPJE throws these in there to test out future exam questions (the NAPLEX does the same thing). All of the questions are multiple choice (and there may even be a few K-type or multiple-multiple choice questions thrown in for color).
So, in total, you've got 90 questions on the CPJE. And you've got 2 hours to complete it (so you have to work quickly if you're a slow test taker).
It's worth noting that you cannot skip around on the CPJE. Once you advance past a question, it's gone. If you decide you want to change your answer to a previous question after it's been submitted, you won't be able to.
So make sure you're double-checking every choice you make (unless you're running out of time and just answering questions randomly so you don't leave any blank). The way the test is scored, it's in your interest to answer every question, even if it's a blind guess. So make sure not to leave anything unanswered.
How to Study for (and pass) the CPJE
And so now we get to the crux of this article.
What is it about the CPJE that makes people fear it more than even the NAPLEX?
I think it boils down to a difference in expectations. You're "expecting" this to be a law test. That's what the "JE" part of CPJE is for, right? And if you've ever taken an MPJE, that line of reasoning holds up.
But this just isn't the case with the CPJE.
Overwhelmingly, the most common bit of CPJE advice I got from polling tl;dr readers and my personal connections was to "study for it like the NAPLEX."
Let's read that again to make sure it sinks in...
The best way to pass the CPJE is to study for it like you study for the NAPLEX.
The state of California even tells you that (indirectly). Scroll back up to the content breakdown above. The number of questions in each category is practically screaming at you that the CPJE is more "clinical" than a standard MPJE.
The majority of the test is dedicated to "Patient Outcomes" (which I'm guessing don't involve questions about how long a CII prescription is valid once signed).
Some of the people I spoke to said that there were less than 10 "law" questions on their exam. I keep emphasizing this point because it's that important. I’m not saying you should ignore the law portion of the exam, but you have to prioritize the clinical portion when studying. In fact, if you haven't taken the NAPLEX yet, you can save yourself a bunch of study time by scheduling it relatively close to the CPJE. That way the information is still fresh in your head.
If you need some help prepping for the NAPLEX, I wrote this post to get you up to speed. You should also check out this post on How to Study for the MPJE (plenty of the tips carry over to the CPJE).
How Long Does it Take to Study for the CPJE?
This is a tough question to answer, and so I’ll answer with a cop out…
"It depends."
That said, you're here because you want answers. So let me see what I can do.
Depending on how intensely you study, I think you can prep for the CPJE in 2 - 4 weeks on average. Can you do it in less (or more) time? Yes, but it really just depends on your study style. Some people are study sprinters and can retain information after marathon study sessions of 8 hours or more. Others can't. You really just need to be aware of what works for you (but you’ve been through 4 years of pharmacy school, so you should have a feel for this by now…right?).
I’m the sort of person that does some low level studying in the months prior to an exam, but I really put the pedal to the medal in the last few weeks. That works for me, but you may find that you need longer. Given the cost of the CPJE, and the fact that your residency/job requires you to pass this test as soon as possible, I recommend doing everything in your power to make sure you pass the first time. Why leave anything to chance? Give yourself enough of a buffer (and do as many practice questions as possible) to make sure you don’t have to retake the test.
So, my best advice is to study for the CPJE for as long as it takes you to feel over-prepared. Best to leave nothing to chance with so much at stake. For most people, this should be achievable in 2 - 4 weeks.
The Types of Clinical Questions on the CPJE
So, I've told you a few times now to study on "clinical" content. What do I mean by that?
For starters, you must know brand/generic.
I've mentioned this point before, but it's worth repeating. If you don't know what the brand name of a drug is, you'll never be able to answer a question about it. And the CPJE incorporates brand/generic questions in clever ways.
For example, you might be asked what auxiliary labels need to be included with a prescription for Mepron. If you don't know that Mepron is a suspension, you're probably not going to select the "Shake well before use" answer. And you'll get that question wrong.
Alternatively, you might be given a list of adverse effects and asked "which of the following side effects do you need to monitor for Multaq?" How can you possibly get that right if you don't know that Multaq is dronedarone?
I'd be familiar with at least the top 200 prescription drugs, as well as drugs that are available OTC.
You must also know renal dosing cut offs and therapeutic appropriateness.
You might be given a patient case with some background lab info such as height/weight, allergies, SCr or LFTs. You'll then be shown a picture of a written prescription, and asked if you would fill it for this patient.
This is a devious question, because you're probably going to start looking at the prescription from a "legal" perspective.
You'll make sure there's a patient name and date of birth, drug, strength, refills, and so on. Meanwhile, maybe the patient's CrCl is 25 ml/min and maybe the prescription is for Pradaxa 150 mg BID. The prescription might be 100% correct from a legal standpoint, but from a clinical standpoint, it should not be filled (we use the 75 mg BID dosing for CrCl < 30 ml/min for dabigatran).
If you can't tell, this is a picture of your clinical brain. (Image)
Sneaky right? But again, you have to bring your clinical brain along for the ride when you're taking the CPJE.
Now, what clinical content should you focus on? That's a tough call. Anything can be tested, of course. But it's probably best to focus on common disease states and areas of high impact for pharmacists. I'd spend most of my time looking at:
Hospital Acquired Pneumonia (HAP)
Asthma
COPD
Acute Coronary Syndrome (ACS) / STEMI
Dyslipidemia
What other clinical questions will you come across on the CPJE?
If I were studying for it, I'd brush up on the following areas:
IV Compatibility (can you Y-site norepinephrine and vancomycin?)
Drug Stability/storage (is Zostavax stored in the refrigerator, freezer, or at room temp?)
Basic Calculations (IV/PO, drip rates, how to make a bag of D25 when you only have D10 and D70, etc...)
Also be mindful about what diluent must be used when compounding a drug. A common example I've come across is amiodarone (which much be administered in D5W; and should be made in a non-PVC bag).
It's probably a good idea to make a list of common drugs that can ONLY be given in a certain fluid (such as amiodarone in D5W, or phenytoin in NS), because these are usually where test questions come from.
While you're making a list of diluent requirements, also make a list of IV drugs that must be protected from light. IV levothyroxine is a common example here.
You're not going to need to memorize Trissel's or anything to get through the test. But use your NAPLEX study guide (both RxPrep and High-Yield Med Reviews are great) to get your foundation.
The CPJE and REMS drugs
This is a borderline "clinical" and "law" study point, so I'll include it here as a segue into the next section of this article.
When studying for the CPJE, know which drugs are under a federal REMS program (and what dispensing requirements that entails for the pharmacist).
REMS drugs may have strict dispensing requirements (like checking a CBC before dispensing clozapine). There's also a natural restriction who you can borrow drugs from if your pharmacy runs out (you can't borrow a REMS drug from a pharmacy that isn't registered with the program, because they shouldn't be stocking it in the first place).
Here's a complete list of all current REMS drugs. I would mostly pay attention to the common "retail" ones such as isotretinoin, clozapine, and basically every formulation of testosterone.
The Types of Law Questions on the CPJE
Alright, that about covers the clinical side of the CPJE. Now let's jump into the law section.
For starters, we have the CPJE Law Cheat Sheet. This is the single most time-saving thing I can recommend to you. We took our blank MPJE Cheat Sheet, and filled it out with all of California’s pharmacy laws. Each answer is a hyperlink that takes you directly to that portion of the California law code online. That way you can read the full law in context (and validate the answer for yourself).
I know you really want to focus on the clinical side of the CPJE, but you still have to pass the law section. Our CPJE Law Cheat Sheet is the most efficient way I know of to do that.
I also want to mention a book recommended by your fellow tl;dr pharmacy readers — A Guide to California Community Pharmacy Law by Fred Weissman. From what I hear, it's clear and concise and there are a lot of practice questions to ensure you've got the major points down.
I recommend getting this book and working through all of the practice questions.
Even though law content doesn't seem to be emphasized as much on the CPJE as clinical content, you don't want to ignore it. There are still enough law questions that you will fail the exam if you miss too many of them. Law questions are specific enough that it's hard for me to make broad generalizations about how to study for them. Even still, there are some pointers I can give. For more info, check out our full post on How to Study for the MPJE.
Most law exams have a big emphasis controlled substances. So it's important to make note of all the requirements set by California.
I would go through one of the above law books and make note of things like:
Prescribing restrictions (which practitioners can prescribe which controlled substances?)
Can you dispense a limited supply of either/both opium tincture or codeine suspension without a prescription? (You can legally do this in many states as long as you keep a log book)
How long is a CII valid once written/signed?
What are the requirements for transferring controlled substances?
Can practitioners fax or e-prescribe CIIs?
What are the documentation requirements for record keeping (and how long must you maintain them) for controlled substances?
That list is not exhaustive, but you get the idea. Controlled substance laws are different for every state, so it's important to make sure you have California's laws down 100% before taking the CPJE.
If you really want to be thorough, we created an MPJE cheat sheet to help guide your law studying. If you're able to answer every question on the sheet, you'll be more than ready for the law portion of the CPJE (as mentioned above, you’ll still need to do a lot of additional clinical studying).
Something I've seen show up in the several MPJEs I have taken is the difference between Fioricet and Fiorinal. So let's quickly review:
Both drugs have 50 mg of butalbital (a controlled substance) and 40 mg of caffeine
Fioricet has 300 mg of acetaminophen, and Fiorinal has 325 mg of aspirin
The only difference between Fioricet and Fiorinal is that one has acetaminophen (Fioricet) and one has aspirin (Fiorinal).
Home sweet home. Where Fioricet is a C-III and crab cakes and football are "what you do."
So it may come as a surprise to you that (at least federally), Fiorinal is a C-III while Fioricet is listed as non-scheduled. Again, that's at the federal level. There are some states (for example, my home state of Maryland) where Fioricet is also a C-III.
The reason for this seeming contradiction is the relative amounts of non-narcotic. The Controlled Substance Act listed specific ratios of non-narcotic that could be mixed with narcotic to lower the abuse potential (and therefore make the controlled substance laws less strict).
This site does a phenomenal job at breaking down the ratio differences (with math!), so I'll let you read there if you're interested.
CPJE Study Tips and Practice Tests
My final bit of advice for the CPJE is to do as many practice problems as possible. That's the only way you'll get a true feel for what kind of questions will be asked (and you'll reverse engineer your way into learning California law in the process).
I’d start with one of the California Pharmacy law books mentioned above.
And here's a link again to the CPJE outline (which has 22 practice questions).
The beauty of these practice tests is that they’ll have the answers provided, so you're really doing yourself a disservice if you don't go through them. Don't shoot yourself in the foot. Do the practice questions (and go through them at least 2 or 3 times).
The State of California also has two self-assessment forms it provides for people that are starting up their own pharmacy. You can go through these documents to give yourself a handy checklist of potential testing points.
Here's the community pharmacy self-assessment.
And here's the compounding self-assessment.
There are some common multiple choice testing tricks to watch out for on the CPJE. These are common to every law test (and really, they're common to every multiple choice test). But it's worth reminding ourselves of them. In the high-stress environment of a test, it's easy to miss a key word that completely changes the meaning of the question.
Be careful of the words "should" versus "shall." In legalese, the word "shall" means that you must do whatever thing the law is saying. It's a requirement. "Should," on the other hand, is just a recommendation. When you're studying (and when you're taking the CPJE), make careful note of which word is used; and answer the question accordingly.
Also be mindful of questions that ask "All of the following do _____, EXCEPT." Or another version, "Which of the following is NOT true?"
I made it super obvious by capitalizing the words "except" and "not" in the examples above, but that doesn't necessarily mean the CPJE will. There may be no bolding, italicizing, or capitalizing on the test. So you've got to make yourself slow down and read the question carefully.
What I normally do before answering any test question is to quickly scan it looking only for exception words like "except" and "not." Then I make sure my answer is still true (because pretty much by definition, exception words make the opposite answer correct).
Another common tripping point on law exams is the word "best." Such as "Which of the following is the best choice?" These questions are the worst. You'll have several choices that seem correct (and maybe even technically are correct), but you have to choose the "best" one. I don't have an easy fix for these questions. Just try to be on the lookout for them, and take extra care in choosing your answer.
Conclusion
That should give you a pretty good starting point for how to approach the CPJE. Keep your studying primarily on the clinical aspect, and use the tools available to streamline your law studying as much as possible. Again, for a quick and easy way to learn the law portion of the CPJE, check out our CPJE Law Cheat Sheet.
Remember, I haven't actually taken the CPJE. All of the above is information I've sourced through tl;dr readers and friends who have passed the CPJE. And also a healthy dose of internet research.
I'd also like to give a huge shout out (and say thank you) to everyone that helped me write this article.
If you've taken/passed the CPJE and feel like I've missed something that could make this article more helpful for others, please email me at mail@tldrpharmacy.com.
I will update this page periodically as more readers email me more tips.