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📋 FPGEE Blueprint — All 4 Domains — Updated 2026

FPGEE Syllabus 2026: Full Topic Breakdown

Complete content guide for all four FPGEE domains with topic lists, approximate weightings, study priority rankings, and difficulty ratings. Use this to build your study schedule.

6-Month Study Plan Practice Questions

Domain Overview & Study Priority

Domain ~Weight ~Questions Difficulty Study Priority
Clinical Sciences~32%~80⭐⭐⭐HIGH
Biomedical Sciences~27%~68⭐⭐⭐⭐HIGH
Pharmaceutical Sciences~27%~68⭐⭐⭐MEDIUM
Social/Administrative Sciences~14%~35⭐⭐STANDARD

Weightings are approximate estimates based on publicly available NABP information. NABP adjusts blueprints periodically — always check the current FPGEE Competency Statements at nabp.pharmacy.

DOMAIN 1

Biomedical Sciences (~27%)

Study note: This is typically the hardest domain for internationally-trained pharmacists. Many non-US pharmacy programs emphasize clinical application over basic biomedical sciences. Plan your heaviest initial study time here (Months 1–2).

Physiology

  • Cardiovascular physiology — cardiac output, preload/afterload, BP regulation
  • Renal physiology — GFR, tubular reabsorption, acid-base balance
  • Respiratory physiology — ventilation, gas exchange, acid-base
  • Endocrine physiology — hormone mechanisms, feedback loops
  • Neurophysiology — action potentials, neurotransmission
  • GI physiology — digestion, absorption, motility

Biochemistry

  • Enzyme kinetics — Michaelis-Menten, inhibition types
  • Carbohydrate metabolism — glycolysis, Krebs cycle, gluconeogenesis
  • Lipid metabolism — fatty acid synthesis/oxidation, cholesterol biosynthesis
  • Protein metabolism — amino acid catabolism, urea cycle
  • Nucleic acid metabolism — DNA replication, RNA transcription
  • Vitamins and cofactors — mechanisms and deficiency states

Microbiology

  • Bacterial classification — gram-positive, gram-negative, anaerobes
  • Bacterial virulence factors and pathogenesis
  • Antibiotic mechanisms of action and resistance
  • Viral replication and antiviral mechanisms
  • Fungal pathogens and antifungal mechanisms
  • Parasitology — clinically relevant parasites

Immunology

  • Innate vs adaptive immunity
  • T-cell and B-cell differentiation and activation
  • Antibody classes (IgG, IgA, IgM, IgE, IgD) and functions
  • Complement system — pathways and functions
  • Hypersensitivity reactions — Types I–IV mechanisms
  • Vaccine mechanisms and immunotherapy basics

Pathophysiology

  • Cellular injury and adaptation mechanisms
  • Inflammation — acute and chronic processes
  • Neoplasia — mechanisms of carcinogenesis
  • Hemodynamic disorders — edema, thrombosis, embolism
  • Disease-specific pathophysiology for major organ systems
DOMAIN 2

Pharmaceutical Sciences (~27%)

Pharmacology

  • Drug receptor theory — agonists, antagonists, partial agonists
  • CNS drugs — mechanisms by neurotransmitter system
  • Cardiovascular drugs — mechanism-based classification
  • Autonomic pharmacology — sympathetic vs parasympathetic
  • Anti-infective mechanisms — antibiotics, antivirals, antifungals
  • Endocrine pharmacology — insulin types, thyroid drugs, steroids

Pharmacokinetics

  • Absorption — bioavailability, first-pass effect, routes
  • Distribution — Vd, protein binding, blood-brain barrier
  • Metabolism — CYP enzymes, inducers/inhibitors, Phase I/II
  • Elimination — renal clearance, hepatic clearance, half-life
  • Special populations — renal/hepatic impairment dosing
  • Key calculations: CrCl (Cockcroft-Gault), AUC, Css

Medicinal Chemistry

  • Structure-activity relationships (SAR) for major drug classes
  • Functional groups and their pharmacological significance
  • Prodrugs and metabolic activation
  • Stereochemistry and drug activity (enantiomers, isomers)
  • Drug stability and storage requirements

Calculations & Dosage Forms

  • Percent strength, ratio strength, concentration calculations
  • Alligation — mixing solutions of different concentrations
  • IV flow rates, drip rates, infusion calculations
  • Pediatric dosing — mg/kg and BSA-based calculations
  • Oral solid and liquid dosage form properties
  • Sterile compounding principles — TPN, large-volume parenterals
→ Full Calculations Guide
DOMAIN 3

Social & Administrative Sciences (~14%)

Study note: This is the lowest-weighted domain but also the most reliably learnable — the regulatory and statistical concepts are finite and testable. It should not be neglected despite its lower weight.

Federal Pharmacy Law Basics

  • Controlled Substances Act — schedules, DEA registration
  • HIPAA privacy and security basics
  • Food, Drug, and Cosmetic Act fundamentals
  • Drug labeling requirements
  • Prescription requirements — federal basics
  • OTC vs prescription classification criteria
→ Full MPJE Law Coverage

Biostatistics

  • Study designs — RCT, cohort, case-control, cross-sectional
  • NNT and NNH calculations
  • Sensitivity, specificity, PPV, NPV
  • Relative risk and odds ratio
  • Confidence intervals and p-values
  • Types of bias and confounding
→ Free Biostatistics Quiz

Healthcare Systems & Pharmacoeconomics

  • US healthcare system structure — Medicare, Medicaid, PBMs
  • Pharmacoeconomic analysis types — CEA, CUA, CBA
  • Drug formulary management and P&T committees
  • Medication therapy management (MTM)
  • Patient counseling and communication principles
DOMAIN 4

Clinical Sciences (~32%)

Study note: This is the highest-weighted domain and the most familiar for practicing pharmacists. Focus on US-specific treatment guidelines — IDSA, AHA, JNC, GOLD, GINA — as international guidelines differ. Drug-drug interactions and OTC counseling are high-yield areas.

Cardiovascular

  • Hypertension first-line agents and step therapy
  • Heart failure — HFrEF GDMT (ACEi/ARB, BB, MRA, SGLT2)
  • Atrial fibrillation — rate/rhythm control, anticoagulation
  • ACS — STEMI vs NSTEMI management
  • Dyslipidemia — statin therapy, LDL targets
  • Anticoagulants — heparin, warfarin, DOACs
→ Free Cardiology Quiz

Infectious Disease

  • CAP and HAP empiric antibiotic selection
  • MRSA treatment — vancomycin AUC monitoring
  • C. difficile — fidaxomicin, vancomycin, FMT
  • UTI — nitrofurantoin, TMP-SMX resistance thresholds
  • HIV — preferred ART regimens (Biktarvy), OI prophylaxis
  • Antifungal selection by pathogen
→ Free ID Quiz

Endocrinology & Metabolic

  • Diabetes — insulin types, oral agents, GLP-1 agonists, SGLT2i
  • Hypothyroidism — levothyroxine dosing and monitoring
  • Hyperthyroidism — methimazole, PTU, RAI
  • Osteoporosis — bisphosphonates, denosumab, monitoring
  • Adrenal disorders — corticosteroid pharmacology

CNS & Psychiatry

  • Depression — SSRIs, SNRIs, mechanism differences
  • Bipolar disorder — lithium monitoring, mood stabilizers
  • Schizophrenia — atypical vs typical antipsychotics, EPS
  • Anxiety — benzodiazepine vs non-benzo options
  • Pain management — opioid equianalgesic dosing, adjuvants
  • Epilepsy — first-line agents by seizure type

OTC & Self-Care

  • Common cold and cough — appropriate OTC selection
  • Analgesics — acetaminophen, NSAIDs, dose limits
  • GI products — antacids, H2 blockers, loperamide
  • Allergy — antihistamine generations, counseling
  • Dermatology — topical antifungals, hydrocortisone
  • Contraindications for OTC use in special populations

Drug Interactions

  • CYP450 major inhibitors and inducers
  • Pharmacodynamic interactions — additive, synergistic, antagonistic
  • High-risk drug pairs — warfarin, lithium, digoxin combinations
  • QT-prolonging drug combinations
  • Food-drug interactions — grapefruit, tyramine, vitamin K

Ready to Practice FPGEE Questions?

Test your knowledge of all four domains with sample questions. PharmacyExam.com offers 1,200+ dedicated FPGEE questions with full explanations.

Free FPGEE Practice Questions Full Question Bank on PharmacyExam →

Frequently Asked Questions

What subjects are on the FPGEE?

The FPGEE covers four domains: Biomedical Sciences (~27%) including physiology, biochemistry, microbiology, immunology; Pharmaceutical Sciences (~27%) including pharmacology, pharmacokinetics, calculations; Social/Administrative Sciences (~14%) including pharmacy law basics and biostatistics; and Clinical Sciences (~32%) including therapeutics, disease management, OTC, and drug interactions.

What is the hardest part of the FPGEE?

Most internationally-trained pharmacists find the Biomedical Sciences domain hardest, particularly biochemistry, immunology, and pathophysiology. These are not always emphasized in non-US pharmacy programs. Clinical Sciences is usually easier for practicing pharmacists with clinical experience.

Is pharmacy law on the FPGEE?

Yes — the Social/Administrative Sciences domain includes federal pharmacy law basics including the CSA, HIPAA fundamentals, and FDA drug regulation concepts. It is not as deep as the MPJE — you will need separate law preparation for your state licensure exam.

How should I prioritize FPGEE topics?

Start with Biomedical Sciences (hardest, takes longest to learn), then Pharmaceutical Sciences + Calculations (need daily practice), then Clinical Sciences (most familiar for pharmacists but must focus on US guidelines), and Social/Administrative Sciences last (lowest weight, most learnable).

6-Month Study Plan Calculations Guide Best FPGEE Resources