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ACSAP 2026


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The latest release in ACCP’s popular Ambulatory Care Self-Assessment Program (ACSAP) features comprehensive reviews, timely updates, and case series on various topics relating to cardiology, geriatric and pediatric care, gastrointestinal issues, and pharmacogenomics. The target audience for ACSAP 2026 is board-certified and advanced-level ambulatory care clinical pharmacists who provide care for patients with a wide range of disorders related to cardiology, gastrointestinal issues, pharmacogenomics, and conditions that affect geriatric and pediatric patients.

Andrew N. Schmelz, Pharm.D., BCACP
Schmelz

The book contains 8 learning elements offering a total of 16.0 available continuing pharmacy education (CPE) and/or BCACP recertification credits. Each learning activity may be taken individually for CPE credit. The book content was developed under the leadership of Faculty Panel Chair Andrew N. Schmelz, Pharm.D., BCACP, Associate Professor, Butler University, Indianapolis, Indiana.

Continuing education activities in ACSAP cover the most recent published data (past 3–5 years) on a specific therapeutic area or patient-care problem. Learning content is provided as an electronic book (interactive PDF) with high-level updates in up to three formats, as appropriate to the topic:

  • Traditional chapters review the latest published evidence on a therapeutic or practice-related topic
  • Case series deliver learning content in sections, with each section bookended by a sample case and its explained answer
  • Recorded webcasts provide learning content as a PowerPoint presentation, accessed as an MP4 file as well as a PDF of slides and transcribed narrative

Every ACSAP release comes in two full-color online formats: (1) interactive PDFs you can save to your desktop or print; and (2) an e-media version you can view on an e-reader, tablet, iOS or Android smart phone.

All ACSAP learning elements are fully referenced, with clickable hyperlinks to literature compilers such as PubMed. Other links provide ready access to clinical practice guidelines, official recommendations, and patient assessment tools. Graphic features focus on pivotal studies, patient care scenarios, and take-home points that can be readily integrated into clinical practice.

Release Date: March 16, 2026
BCACP Deadline: March 16, 2027
ACPE Deadline: March 16, 2029

Editor(s): Irons BK, Meredith AH
ISBN: 978-1-964074-33-7
Publication Year: 2026
Format: PDF and ePub

Contents

Chapter: Resistant Hypertension

This chapter reviews the diagnosis and management of resistant hypertension, highlighting recent advances such as the proven role of spironolactone as fourth‑line therapy and the emergence of newer agents, including aprocitentan, aldosterone synthase inhibitors, and angiotensinogen‑lowering therapies. Kidney denervation has also gained FDA approval as an adjunct option. Despite these developments, major clinical challenges persist: inaccurate BP measurement, high rates of medication nonadherence, limited access to ambulatory monitoring, and barriers to identifying and treating secondary causes, all of which complicate effective, guideline‑based care.

Chapter: Heart Failure with Mildly Reduced or Preserved Ejection Fraction

This chapter highlights major therapeutic advances for heart failure (HF) with mildly reduced or preserved ejection fraction, including strong evidence for SGLT2 inhibitors and emerging benefits of MRAs and incretin mimetics, particularly in patients with obesity. Despite these developments, no therapy has demonstrated mortality reduction, and benefits largely center on decreased HF hospitalizations and improved quality of life. Applying evidence in practice remains challenging because of heterogeneous guideline recommendations, polypharmacy, clinical inertia, volume‑management complexity, and patient-specific trade-offs involving cost, tolerability, and comorbidities. Effective care requires individualized sequencing and shared decision-making.

Case Series: Cardiovascular Risk Stratification

This case series reviews contemporary cardiovascular risk‑stratification tools, including the updated PREVENT equations, which offer more accurate, race‑free risk estimation but may lower predicted ASCVD risk and alter treatment eligibility. It highlights expanding roles of biomarkers (eg, Lp(a), hs‑CRP) and imaging (CAC scoring) to refine decisions. Newer therapies such as GLP‑1 receptor agonists, SGLT‑2 inhibitors, PCSK9 inhibitors, bempedoic acid, and icosapent ethyl expand prevention options. Key challenges include choosing the right risk calculator, balancing therapy costs and access, avoiding overtreatment or undertreatment due to risk‑estimate variability, and integrating multifactorial lifestyle and pharmacologic strategies into individualized care.

Chapter: Attention-Deficit/Hyperactivity Disorder

This chapter outlines evolving attention-deficit/hyperactivity disorder diagnosis and treatment, highlighting newer stimulant technologies (microparticle systems, prodrugs like lisdexamfetamine and serdexmethylphenidate, and transdermal systems) that extend duration and improve adherence. It also reviews expanding evidence for non‑stimulants such as viloxazine, which may offer faster symptom improvement and improved tolerability compared with atomoxetine. Clinical practice challenges include managing supply‑chain–driven medication shortages, complex dose conversions, cardiovascular and growth‑related adverse effects, sleep disruption, misuse risk, and limited adult-specific diagnostic tools. Implementing guideline‑aligned, individualized therapy across age groups requires careful monitoring, comorbidity assessment, and frequent follow‑up.

Chapter: Pediatric Substance Use

This chapter highlights rising concerns in pediatric substance use, including sharply increased fentanyl‑related overdose deaths and evolving patterns such as greater nicotine pouch use. It details updated evidence supporting pharmacologic options—naltrexone for alcohol use disorder, acetylcysteine for cannabis use disorder, and buprenorphine for opioid use disorder—alongside SBIRT as a core screening and intervention framework. Key challenges include underuse of medications, limited pediatric‑specific guidelines, stigma, confidentiality constraints, regulatory barriers (eg, methadone access), and the need to integrate harm‑reduction tools like naloxone and drug‑checking strips. Ambulatory pharmacists are positioned to expand access, provide education, and improve treatment retention.

Chapter: Management of Frail Patients

This chapter reviews modern approaches to identifying and managing frailty, highlighting updated tools such as the Clinical Frailty Scale, STOPP/START v3, and the 2023 AGS Beers Criteria. Emerging evidence supports individualized blood‑pressure and glycemic targets, careful use of SGLT2 inhibitors and GLP‑1 receptor agonists in frail adults, and orexin‑receptor antagonists as safer insomnia therapies. Key challenges include polypharmacy, heightened bleeding and fall risk, clinical inertia in intensifying or de‑escalating therapy, and balancing benefits with adverse‑effect vulnerability. Practical implementation requires frequent reassessment, shared decision-making, deprescribing, and integration of nutrition and mobility interventions.

Chapter: Management of Overweight and Obesity

This chapter outlines updated diagnostic criteria for clinical obesity and highlights rapidly expanding evidence for incretin‑based therapies, particularly semaglutide and tirzepatide, which now demonstrate substantial weight loss, cardiometabolic benefits, and disease‑specific advantages such as improvements in heart failure, obstructive sleep apnea, and metabolic dysfunction‑associated steatohepatitis. Challenges include limited insurance coverage for anti‑obesity medications, managing GI and rare safety concerns, preserving lean mass during significant weight loss, and integrating pharmacotherapy with lifestyle changes. Clinicians must also navigate complex comorbidity‑driven treatment selection and adjust regimens after bariatric surgery due to altered pharmacokinetics.

Chapter: Integrating Pharmacogenomics into Primary Care

This chapter highlights growing evidence that pharmacogenomics can reduce adverse drug reactions and improve prescribing for common primary‑care medications, supported by recent CPIC and FDA updates and studies demonstrating benefits in depression, cardiovascular disease, and pain management. Implementation remains challenging: laboratories vary widely in test interpretation, phenoconversion from drug interactions complicates phenotype accuracy, and clinicians face workflow, education, reimbursement, and EHR‑integration barriers. Ethical issues such as incidental findings, consent, and genetic privacy, and the need for consistent documentation and clinical decision support tools further complicate routine clinical adoption.

Chapter: Resistant Hypertension

Faculty

Sweta M. Patel, Pharm.D., BCPS
Clinical Pharmacist
Clinical Pharmacy Services – Outpatient Pharmacy Anticoagulation Service
Kaiser Permanente – Georgia
Tucker, Georgia

Reviewers

Anthony Ishak, Pharm.D., BCPS
Clinical Pharmacist
Department of Pharmacy
Massachusetts General Hospital
Lecturer on Medicine
Harvard Medical School
Boston, Massachusetts
Maeghan M. Troyer, Pharm.D., BCACP, CDCES, CPP
Clinical Pharmacist Specialist
Medication Management, Division of Pharmacy Services
Atrium Health
Charlotte, North Carolina
Devin Lavender, Pharm.D., BCPS, BCACP
Clinical Assistant Professor
Department of Clinical and Administrative Pharmacy
University of Georgia College of Pharmacy
Athens, Georgia

Chapter: Heart Failure with Mildly Reduced or Preserved Ejection Fraction

Faculty

Ricky Turgeon, Pharm.D., BSPharm, ACPR
Associate Professor
Clinical Pharmacy Specialist
Faculty of Pharmaceutical Sciences
University of British Columbia
Vancouver, British Columbia
Sheri L. Koshman, Pharm.D., BScPharm, ACPR
Professor
Department of Medicine (Cardiology)
Faculty of Medicine and Dentistry
University of Alberta
Edmonton, Alberta, Canada

Reviewers

Michelle Fine, Pharm.D., BCPS, BCACP
Clinical Assistant Professor
Borra College of Health Sciences
Dominican University
River Forest, Illinois
Jennifer LaPreze, Pharm.D., BCACP, CDCES, CPP
Clinical Pharmacist Specialist
Ambulatory Pharmacy
Atrium Health
Fort Mill, South Carolina

Case Series: Cardiovascular Risk Stratification

Faculty

Shelby Albertson, Pharm.D., BCACP
Pharmacy Manager – Ambulatory Care Services
Department of Pharmacy
Eskenazi Health
Indianapolis, Indiana

Reviewers

Azita H. Talasaz, Pharm.D., PhD, FCCP, FACC, BCPS, BCCP, HF-Cert
Clinical Pharmacy Manager – Heart Failure
Department of Pharmacy/Heart Failure
New York Presbyterian Columbia University Irving Medical Center
New York, New York
T. Levi Lancaster, Pharm.D., BCACP, BC-ADM
Faculty Pharmacist
Providence Medical Group
Providence St. Peter Family Medicine
Olympia, Washington
Elizabeth S. Yett, Pharm.D., BCACP, TTS
Assistant Professor
Department of Clinical Pharmacy and Translational Science
The University of Tennessee Health Science Center
Memphis, Tennessee

Chapter: Attention-Deficit/Hyperactivity Disorder

Faculty

Sandra Mitchell, Pharm.D., FAAPP, BCPP
Clinical Pharmacy Specialist – Psychiatry
Clinical Associate Professor
Department of Pharmacy
Virginia Treatment Center for Children, Children’s Hospital of Richmond, Virginia Commonwealth University Health System
Richmond, Virginia

Reviewers

Erica F. Crannage, Pharm.D., FCCP, BCACP
Professor
Department of Pharmacy Practice
University of Health Sciences & Pharmacy in St. Louis
St. Louis, Missouri
Patricia Lambro, Pharm.D., BCACP
Clinical Pharmacist
Department of Pharmacy
Peninsula Community Health Services
Bremerton, Washington

Chapter: Pediatric Substance Use

Faculty

Danielle L. Stutzman, Pharm.D., BCPP
Psychiatric Pharmacist – Child and Adolescent Psychiatry
Pediatric Mental Health Institute, Department of Pharmacy, Children’s Hospital Colorado
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Child and Adolescent Mental Health Division, Department of Psychiatry, University of Colorado School of Medicine
Aurora, Colorado

Reviewers

Allison M. Chung, Pharm.D., FCCP, FPPA, BCPPS
Clinical Professor
Department of Pharmacy Practice
Auburn University, Harrison College of Pharmacy
Mobile, Alabama
Eman Mohammed Shorog, MSc, BCACP, BCPS, GCDF
Assistant Professor
Clinical Pharmacy
King Khalid University
Abha, Asir Region, Saudi Arabia
Lauren M. Cook, Pharm.D., BCPS, BCACP, CDCES
Primary Care Clinical Pharmacy Specialist
Department of Pharmacy
Valor Healthcare
Columbia, Tennessee

Chapter: Management of Frail Patients

Faculty

Michelle L. Balli, Pharm.D., BCACP
Associate Professor
Department of Pharmacy Practice
University of Arkansas for Medical Sciences College of Pharmacy – Northwest Campus
Clinical Pharmacy Practitioner
Pharmacy Department
Veterans Health Care System of the Ozarks
Fayetteville, Arkansas
Jessica Cowart Binz, Pharm.D., BCACP
Assistant Professor
Department of Pharmacy Practice
UAMS College of Pharmacy Northwest Regional Campus
Clinical Pharmacy Specialist
Family Medical Center – Fayetteville
UAMS Health
Fayetteville, Arkansas

Reviewers

Kacey West, Pharm.D., BCACP, BCGP
Associate Professor
Department of Pharmacy Practice
Butler University
Indianapolis, Indiana
Scott M. Pearson, Pharm.D., BCACP
Clinical Pharmacist Specialist
Department of Internal Medicine
Abbott Northwestern General Medicine Associates
Minneapolis, Minnesota

Chapter: Management of Overweight and Obesity

Faculty

Abby Lennon, Pharm.D., BCACP, CDCES
Clinical Pharmacy Specialist
Inova
Fairfax, Virginia

Reviewers

Michael S. Kelly, Pharm.D., FNLA, BCACP, CDCES, CLS
Associate Professor
Department of Pharmacy Practice
Jefferson College of Pharmacy
Philadelphia, Pennsylvania
Rick Hess, Pharm.D., BCACP, CDCES
Professor
Department of Pharmacy Practice
Bill Gatton College of Pharmacy at East Tennessee State University
Johnson City, Tennessee

Chapter: Integrating Pharmacogenomics into Primary Care

Faculty

Amy L. Pasternak, Pharm.D., BCPS
Clinical Associate Professor
Department of Clinical Pharmacy
University of Michigan College of Pharmacy
Clinical Pharmacist
Department of Pharmacy
Michigan Medicine
Ann Arbor, Michigan

Reviewers

Eric T. Matey, Pharm.D., BCACP
Clinical Pharmacogenomics Pharmacist
Department of Pharmacy
Mayo Clinic College of Medicine and Science
Rochester, Minnesota
Pamela L. Stamm, Pharm.D., FCCP, FASHP, BCPS, BCACP, CDCES
Associate Professor Emerita, Instructor
Department of Pharmacy Practice
Auburn University, Harrison College of Pharmacy
Auburn, Alabama

CPE Credit

The American College of Clinical Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.

The American College of Clinical Pharmacy and the American Society of Health-System Pharmacists are approved by BPS as a provider for the recertification of BCACP.

BPS is an autonomous division of the American Pharmacists Association. To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for board certification examinations. BPS, through its specialty councils, is responsible for specialty examination content, administration, scoring, and all other aspects of its certification programs. BPS is totally separate and distinct from ACCP. For information about BPS specialty recertification the BPS recertification process, go to: www.bpsweb.org/

To receive recertification credit, posttests must be submitted prior to the recertification posttest deadline (see above). Only completed tests are eligible for credit; no partial or incomplete tests will be processed. You may complete one or all available posttests for credit.

The passing point to earn recertification credit is based on an expert analysis of the assessment items in each posttest. Any posttest submitted before the recertification test deadline that meets this passing point will earn recertification credits. These credits will be assigned as of the date of test submission and reported within 48 hours to BPS. For statements of recertification credit, visit www.bpsweb.org.

In accordance with BPS guidelines concerning remediation for products launched in 2024 and after, posttests that do not reach the passing point for recertification credit will generate a second-chance test option. This test will automatically appear in the learner’s My Account page and will have assessment items presented in a different order. To qualify for recertification credit, the second-chance test must be submitted before the recertification deadline stated above.

The ACCP Recertification Dashboard is a free online tool that can track recertification credits as they are earned through ACCP and schedule new opportunities for credits from upcoming ACCP professional development programs. Questions regarding the number of hours required for recertification should be directed to BPS at www.bpsweb.org.

Target Audience: The target audience for ACSAP 2026 is board-certified and advanced-level ambulatory care clinical pharmacists who provide care for patients with a wide range of disorders related to cardiology, gastrointestinal issues, pharmacogenomics, and conditions that affect geriatric and pediatric patients.

Contents

Chapter: Resistant Hypertension

Activity Number: 0217-9999-26-037-H01-P
Contact Hour(s): 1.50
Activity Type: Application Based
Learning Objectives

1. Classify the importance of accurate blood pressure measurement, medication adherence, and lifestyle modifications that impact blood pressure.

2. Evaluate secondary causes of resistant hypertension (RHTN).

3. Assess the drug therapy options for treatment of RHTN.

4. Analyze the newly approved and in-pipeline pharmacologic treatment options for RHTN.

5. Assess the different procedural interventions approved or in-pipeline for managing RHTN.

6. Develop a pharmacologic treatment plan for a patient with RHTN based on the latest guideline recommendations.

Chapter: Heart Failure with Mildly Reduced or Preserved Ejection Fraction

Activity Number: 0217-9999-26-032-H01-P
Contact Hour(s): 2.00
Activity Type: Application Based
Learning Objectives

1. Assess drug therapies for heart failure (HF) with ejection fraction (EF) greater than 40%.

2. Distinguish the differences in the drug therapy recommendations from the latest and leading guidelines for HF with EF greater than 40%, and distinguish from recommendations for HF with reduced EF.

3. Develop a pharmacologic treatment plan for HF with EF greater than 40% that optimizes the use of guideline-directed medical therapy.

4. Develop an outpatient diuretic and fluid management plan for HF.

5. Resolve practical issues in the pharmacologic management of HF.

Case Series: Cardiovascular Risk Stratification

Activity Number: 0217-9999-26-031-H01-P
Contact Hour(s): 1.50
Activity Type: Application Based
Learning Objectives

1. Evaluate the clinical use of cardiovascular risk stratification methods to guide preventive and therapeutic recommendations.

2. Assess cardiovascular risk to determine actionable risk modification strategies.

3. Design patient-specific care plans that include nonpharmacologic therapies to reduce cardiovascular risk.

4. Justify cardiovascular risk modification strategies in patients with comorbid chronic disease states such as type 2 diabetes, hypertension, dyslipidemia, and tobacco use disorder.

Chapter: Attention-Deficit/Hyperactivity Disorder

Activity Number: 0217-9999-26-030-H01-P
Contact Hour(s): 2.00
Activity Type: Application Based
Learning Objectives

1. Assess the differences between attention-deficit/hyperactivity disorder (ADHD) between adult and pediatric presentations.

2. Analyze the available treatment guidelines for adult and pediatric ADHD.

3. Distinguish the difference between newer pharmacologic options and older agents.

4. Evaluate current evidence-based literature comparing ADHD medications to establish an appropriate treatment plan.

5. Devise a treatment plan for ADHD accounting for adverse effects and monitoring.

Chapter: Pediatric Substance Use

Activity Number: 0217-9999-26-036-H01-P
Contact Hour(s): 1.50
Activity Type: Application Based
Learning Objectives

1. Evaluate the screening, brief intervention, referral to treatment (SBIRT) model for youth with substance use disorders (SUDs).

2. Distinguish between hallmark features of cannabis use disorder, nicotine use disorder, alcohol use disorder, opioid use disorder, and stimulant use disorder.

3. Analyze the role of medication treatment for SUD.

4. Develop a monitoring plan and appropriate treatment/supportive care recommendations for withdrawal symptoms.

5. Evaluate the role of harm reduction strategies to support pediatric patients.

Chapter: Management of Frail Patients

Activity Number: 0217-9999-26-034-H01-P
Contact Hour(s): 2.00
Activity Type: Application Based
Learning Objectives

1. Estimate frailty through evaluation of patient risk factors and available screening tools.

2. Evaluate a patient’s medication regimen for appropriate and potentially inappropriate medications.

3. Design a tailored plan considering nonpharmacologic and pharmacologic interventions for a frail patient with hypertension, diabetes, or insomnia.

4. Analyze fall, fracture, or bleeding risk for a frail patient to implement appropriate risk mitigation strategies.

Chapter: Management of Overweight and Obesity

Activity Number: 0217-9999-26-035-H01-P
Contact Hour(s): 2.50
Activity Type: Application Based
Learning Objectives

1. Distinguish the differences in treatments for the management of overweight and obesity.

2. Assess and design a pharmacotherapy plan for a patient with overweight or obesity given patient-specific factors.

3. Devise monitoring values to determine the efficacy and safety of anti-obesity pharmacotherapy.

4. Evaluate available literature to bridge gaps in knowledge with emerging evidence.

Chapter: Integrating Pharmacogenomics into Primary Care

Activity Number: 0217-9999-26-033-H01-P
Contact Hour(s): 3.00
Activity Type: Application Based
Learning Objectives

1. Discover resources for interpreting and applying pharmacogenomic results to prescribing decisions.

2. Assess the impact of a pharmacogenomic result on a medication outcome.

3. Design a pharmacogenomic-informed care-plan for personalized treatment.

4. Evaluate strategies and best practices for integrating pharmacogenomic results into primary care workflows.

5. Detect ethical, legal, and social considerations for integrating pharmacogenomics in primary care.


Commercial Support

The American College of Clinical Pharmacy does not solicit or accept external commercial/financial support for its continuing pharmacy education activities. No commercial/financial support has been solicited or accepted for this activity.

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