If you are sitting the PEBC Qualifying Exam Part 1 in the 2026 to 2027 cycle, some of what your study notes say is no longer the Canadian recommendation. Guidance on blood pressure, heart failure, stroke, sexually transmitted infections and smoking cessation has all moved, and on October 1, 2026 the federal rules for controlled substances change completely.
This article collects twelve updates that are worth checking against your own notes. Each entry states the current Canadian position, how older material tends to describe it, and the guideline it comes from. Treat it as a checklist: for each one, open your notes and see which version you have been studying.
The twelve updates at a glance
| # | Topic | The point to check | Guidance |
|---|---|---|---|
| 1 | Hypertension | Diagnosis at 130/80; systolic target below 130 | Hypertension Canada 2025 |
| 2 | Heart failure, ejection fraction above 40% | SGLT2 inhibitor and MRA recommended | CCS/CHFS 2025 |
| 3 | Acute coronary syndromes | Ticagrelor held 2 to 3 days before bypass surgery | Canadian Cardiovascular Society |
| 4 | Acute ischemic stroke | Tenecteplase authorized; 0.25 mg/kg, maximum 25 mg | Canadian Stroke Best Practice Recommendations, 2025 update |
| 5 | Lipids in established cardiovascular disease | Intensify at LDL-C 1.8 mmol/L or above | CCS 2021 |
| 6 | Gonorrhea | Ceftriaxone 500 mg IM alone | PHAC STI guidance, 2026 |
| 7 | Anaphylaxis after immunization | Epinephrine 0.01 mg/kg, maximum 0.5 mg | Canadian Immunization Guide, 2026 |
| 8 | Calf (distal) deep vein thrombosis | Serial ultrasound is an option in low-risk patients | Thrombosis Canada guides, 2026 |
| 9 | Smoking cessation | Cytisine joins the list of options | Canadian Task Force on Preventive Health Care, 2025 |
| 10 | Osteoporosis | Bisphosphonate first; denosumab when one cannot be used | Osteoporosis Canada 2023 |
| 11 | Depression | Continue 6 to 12 months after remission | CANMAT 2024 |
| 12 | Controlled substances | New regulations from October 1, 2026 | Controlled Substances Regulations, SOR/2025-242 |
Cardiovascular: five updates
1. Hypertension is diagnosed at 130/80
Current position: hypertension is diagnosed at 130/80 mm Hg in any setting, the systolic target is below 130 mm Hg for adults on treatment, and therapy starts with first-line classes combined in a single pill.
What older material says: a higher threshold for diagnosis, and a menu of different targets depending on whether the patient has diabetes, kidney disease or frailty.
Source: Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care, 2025.
2. Heart failure with ejection fraction above 40% now has recommended drug therapy
Current position: in symptomatic heart failure with an ejection fraction above 40%, an SGLT2 inhibitor and a mineralocorticoid receptor antagonist (spironolactone, eplerenone or finerenone) are recommended. A potassium above 5.0 mmol/L is a reason not to start the MRA.
What older material says: that proven therapy exists only for reduced ejection fraction, and that treatment above 40% is limited to relieving congestion and managing risk factors.
Source: Canadian Cardiovascular Society and Canadian Heart Failure Society guideline for heart failure with non-reduced ejection fraction, 2025.
3. Ticagrelor is held for 2 to 3 days before bypass surgery
Current position: before non-urgent coronary bypass surgery, ticagrelor is held for 2 to 3 days, clopidogrel for 5 days and prasugrel for 7 days.
What older material says: 5 days for both clopidogrel and ticagrelor. These intervals are a classic exam target, so an old figure here is costly.
Source: Canadian Cardiovascular Society guidance on antiplatelet therapy and acute coronary syndromes.
4. Tenecteplase is authorized for acute ischemic stroke
Current position: tenecteplase is authorized by Health Canada for acute ischemic stroke as a single-bolus alternative to alteplase, at 0.25 mg/kg to a maximum of 25 mg, within 4.5 hours. This is not the dose used for myocardial infarction or pulmonary embolism.
What older material says: that tenecteplase is promising but not approved in Canada for stroke.
Source: Canadian Stroke Best Practice Recommendations, with the 2025 update.
5. The lipid threshold is lower in established cardiovascular disease
Current position: in established atherosclerotic cardiovascular disease, therapy is intensified when LDL-C remains at or above 1.8 mmol/L, non-HDL-C at or above 2.4 mmol/L, or ApoB at or above 0.7 g/L on the maximally tolerated statin, by adding ezetimibe, a PCSK9 inhibitor or both.
What older material says: one threshold of 2.0 mmol/L for every treated patient.
Source: Canadian Cardiovascular Society dyslipidemia guideline, 2021.
Infection and immunization: two updates
6. Gonorrhea is treated with ceftriaxone 500 mg alone
Current position: uncomplicated gonorrhea is treated with ceftriaxone 500 mg intramuscularly as a single dose, on its own. Chlamydia is covered at the same time only where it has not been excluded. Fluoroquinolones are not recommended.
What older material says: ceftriaxone 250 mg with azithromycin 1 g as routine dual therapy, with oral cefixime as an equal alternative.
Source: Public Health Agency of Canada sexually transmitted infection guidance, 2026.
7. Epinephrine for anaphylaxis is dosed by weight, to a maximum of 0.5 mg
Current position: for anaphylaxis, epinephrine 1 mg/mL is given intramuscularly into the anterolateral thigh at 0.01 mg/kg to a maximum of 0.5 mg (0.5 mL), repeated every 5 minutes if symptoms persist. The site is the thigh, not the deltoid, and the route is intramuscular, not subcutaneous.
What older material says: a fixed adult dose of 0.3 mL.
Source: Canadian Immunization Guide, 2026.
Other therapeutics: four updates
8. A calf clot is not always anticoagulated
Current position: for an isolated distal (calf) deep vein thrombosis, anticoagulation may be withheld in favour of serial ultrasound, weekly for two weeks, where symptoms are mild, the risk of extension is low and the patient can return. Severe symptoms or risk factors for extension are reasons to anticoagulate.
What older material says: every distal clot is anticoagulated and the only decision is for how long.
Source: Thrombosis Canada clinical guides, 2026.
9. Cytisine is a smoking cessation option
Current position: the effective pharmacological options are nicotine replacement (single or combined), varenicline, bupropion and cytisine. Short-acting nicotine replacement now includes pouches alongside gum, lozenge, inhaler and spray.
What older material says: exactly four options, with no mention of cytisine.
Source: Canadian Task Force on Preventive Health Care recommendations on smoking cessation, 2025.
10. A bisphosphonate comes first in osteoporosis
Current position: a bisphosphonate (alendronate, risedronate or zoledronic acid) is first-line for most people starting treatment. Denosumab is for those who cannot use a bisphosphonate.
What older material says: denosumab as an equal first-line agent.
Source: Osteoporosis Canada clinical practice guideline, 2023 update.
11. Antidepressants continue for 6 to 12 months after remission
Current position: after symptomatic remission, the antidepressant continues for 6 to 12 months at the dose that achieved remission. For recurrent episodes, severe or chronic illness, or significant residual symptoms, maintenance runs 2 years or longer and is sometimes indefinite.
What older material says: 6 to 9 months for everyone.
Source: Canadian Network for Mood and Anxiety Treatments (CANMAT) guideline, 2024.
Pharmacy law: one update that rewrites a chapter
12. The Controlled Substances Regulations take effect on October 1, 2026
Current position: on October 1, 2026 the Controlled Substances Regulations (SOR/2025-242) replace the Narcotic Control Regulations, the Benzodiazepines and Other Targeted Substances Regulations and Parts G and J of the Food and Drug Regulations. Under the new regulations a prescription for any class of controlled substance may be written or verbal, refills are permitted as the prescriber authorizes, and a prescription may be transferred within two years of the day the pharmacy received it. Provinces can still set stricter rules.
What older material says: separate rules for each class, with written-only prescriptions and no refills for narcotics, and a single transfer for benzodiazepines.
Why it matters: almost every controlled-substances fact in older notes is affected. If your exam date falls after October 1, 2026, study the new regulations, and learn where your province is stricter than the federal rule.
How to use this list
- Check each point against your notes today. Mark any that differ and correct them with the guideline name and year beside the correction.
- Review the whole topic, not only the line. A chapter written before one of these changes is likely to carry other facts from the same era.
- Relearn with questions. An old answer you memorized will return under pressure. Practise the corrected point until the current answer comes first.
- Read the source for anything you will rely on. This is a summary for exam preparation. The guidelines themselves are free online and are the authority.
This article is for exam preparation and is not clinical or legal advice. Always confirm recommendations in the current guideline, product monograph or legislation.
Update, October 8, 2026: Every passMCQ question is up to date with the current Canadian guidelines, including all twelve updates above. Read the announcement.
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