This Is Why with Dr. Busti

BPS specialty board exams are challenging — and the data proves it. But knowing what drives success can make all the difference.

In this episode of This Is Why, Dr. Busti reviews national BPS pass rate trends and explores what separates first-time test takers who succeed from those who don’t. Using data from multiple specialties, he highlights how residency training, study strategy, and preparation methods predict success — and why relying solely on memorization or guesswork fails so many candidates.

You’ll learn how to interpret your own readiness, avoid common traps like overemphasizing blueprints or anecdota...

Duration: 00:14:24

Passing a BPS specialty exam takes more than hard work — it takes strategy and understanding.

In this episode of This Is Why, Dr. Busti breaks down how BPS exams are built, what “testable” really means, and why focusing on validated, evidence-based concepts gives you a major advantage. Drawing on decades of experience as a pharmacist, educator, and exam review developer, he explains the multi-step process used to create fair, reliable, and job-related BPS exams.

Listeners will learn why not all new or clinically relevant content appears on the test, how to interpret the exam blueprint effect...

Duration: 00:14:27

What predicts success on the NAPLEX? It’s not chance — it’s about understanding the factors that matter most.

In this episode of This Is Why, Dr. Busti unpacks the key predictors of NAPLEX performance based on data and published literature. You’ll learn how GPA, pre-admission metrics, clinical performance, study effort, and test timing correlate with first-time pass rates — and how to interpret these factors to improve your own odds.

Drawing from decades of experience teaching pharmacy and preparing students for licensing exams, Dr. Busti helps listeners identify what’s within their control and how to act o...

Duration: 00:09:32

Over the past decade, NAPLEX pass rates have dropped — sparking concern across pharmacy education. But what’s really driving this decline?

In this episode of This Is Why, Dr. Busti breaks down the data behind NAPLEX performance trends, exploring factors such as the rapid growth of pharmacy schools, shifts in applicant pools, and the impact of the COVID-19 pandemic on learning and assessment.

Drawing from decades of experience as a pharmacist, physician, and nurse, Dr. Busti helps listeners understand how these changes have shaped the profession — and what students can do to overcome them. You’ll learn...

Duration: 00:13:25

The NAPLEX isn’t testing everything you’ve ever learned — it’s measuring what matters most for entry-level pharmacist competence.

In this episode of This Is Why, Dr. Busti explains how the NAPLEX is built by the NABP, why understanding its blueprint helps you focus your studying, and how to avoid wasting time on untested or emerging content. Drawing on his own experience as a pharmacist, physician, and nurse — and decades teaching pharmacy students — he reveals the process behind question validation, exam updates, and psychometric testing.

Listeners will learn how to identify high-yield, testable concepts that align w...

Duration: 00:12:26

Passing the NCLEX-RN isn’t about memorizing more — it’s about understanding what truly matters and how the exam is built to measure it. In this episode of This Is Why, Dr. Busti, a physician and pharmacist who began his healthcare career as a registered nurse, breaks down how the NCLEX-RN is developed by the National Council of State Boards of Nursing (NCSBN) — and what that means for your study plan.

You’ll learn how to recognize high-yield, testable concepts, why some new content won’t appear on the exam, and how to focus your preparation on what can act...

Duration: 00:08:30

In this episode of This Is Why, Dr. Busti walks through a real-world board-style question on community-acquired pneumonia — connecting core pathophysiology to exam reasoning and clinical judgment. Using a 54-year-old patient case, you’ll learn how to differentiate inpatient versus outpatient management, apply CURB-65 and PSI scoring tools, and identify sepsis criteria that drive treatment decisions.

Dr. Busti also unpacks the rationale behind antibiotic selection, comparing macrolide monotherapy, beta-lactam combinations, and fluoroquinolone alternatives — all while reinforcing how understanding why each answer choice is correct or incorrect leads to long-term mastery.

If you’re preparing for your boa...

Duration: 00:21:43

Dr. Busti reviews pharmacologic options for smoking cessation—bupropion, nicotine replacement therapy, and varenicline—highlighting mechanisms, dosing strategies, and safety considerations. Learn how to integrate these therapies with behavioral approaches, tailor choices to patient comorbidities, and monitor for clinically relevant risks.

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Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advi...

Duration: 00:35:50

Dr. Busti reviews tricyclic antidepressants (TCAs)—their history, evolving role, and why they remain relevant today. Learn how tertiary vs. secondary amines differ, why lower doses are effective for pain and insomnia, and how overdose risks tie back to sodium channel blockade. Practical monitoring, counseling tips, and clinical pearls are highlighted to help you apply TCAs safely and effectively.

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Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or ot...

Duration: 00:39:17

Dr. Busti reviews selective serotonin reuptake inhibitors (SSRIs)—their mechanism, first-line indications, key side effects, and clinical pearls. Learn why SSRIs are widely used for depression and anxiety, how to avoid pitfalls like QT prolongation and drug interactions, and what to monitor to optimize patient care.

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Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical co...

Duration: 00:34:05

Discover serotonin-norepinephrine reuptake inhibitors (SNRIs)—safe, effective antidepressants for depression, anxiety, and pain syndromes. 

In this episode, you’ll learn:
- How SNRIs work in the brain and differ from SSRIs, TCAs, and MAOIs
- Key medications: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran
- Important side effects, including blood pressure changes and SIADH in older adults
- Tips for safe switching, monitoring, and counseling patients

💡 Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosi...

Duration: 00:29:20

Dr. Busti breaks down monoamine oxidase inhibitors (MAOIs)—where they still fit in modern care, how they work, and how to use them safely.

In this episode you’ll learn:

Why MAOIs remain relevant for treatment-resistant depressionHow irreversible MAO-A/B inhibition elevates serotonin, norepinephrine, and dopaminePractical washout rules (why 14 days after MAOI, generally 7 days before starting an MAOI; longer with fluoxetine)High-yield differences (e.g., selegiline transdermal for depression vs. oral formulations for Parkinson’s disease)Key drug–drug risks (serotonergic agents, certain opioids like tramadol, linezolid/methylene blue)Tyramine-containing foods and counseling to prevent hypertensive crisis Duration: 00:37:54

Dr. Busti explores the atypical antidepressants—bupropion, mirtazapine, trazodone, vilazodone, and vortioxetine. Learn how these agents differ from SSRIs/SNRIs, when to use them, and how their unique side effect profiles can actually guide therapy.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it be...

Duration: 00:36:25

In this episode of This Is Why, Dr. Busti unpacks the pharmacology and clinical relevance of the potassium-competitive acid blocker (P-CAB) class—featuring vonoprazan, the newest option in acid suppression therapy.

You’ll learn how P-CABs compare to H₂ receptor antagonists and proton pump inhibitors (PPIs) in terms of mechanism, onset, and duration of acid control. Dr. Busti explains the unique pharmacodynamic and pharmacokinetic properties that make vonoprazan a valuable alternative for patients who do not adequately respond to PPIs.

The discussion connects the drug’s molecular action a...

Duration: 00:37:43

Dr. Busti reviews Proton Pump Inhibitors (PPIs)—how they work, why they outperformed H2 blockers, key clinical uses, and important risks. From GERD to GI bleeds, learn the why behind PPIs so you can apply them safely in practice.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or de...

Duration: 00:48:10

A practical pharmacology review of inhaled corticosteroids (ICS) in asthma and COPD. Dr. Busti explains why ICS are first-line therapy in asthma, their selective role in COPD, key mechanisms, dosing strategies, side effects, and patient counseling points to improve adherence and outcomes.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional...

Duration: 00:44:25

Levothyroxine is first-line for hypothyroidism, but getting it right requires precision. In this episode, Dr. Busti explains the TSH–T4–T3 feedback loop, why T4 is preferred over T3 or desiccated thyroid, and how half-life and protein binding shape dosing and monitoring. We cover steady-state timing (6–8 weeks), dose step sizes, manufacturer switches, and how food and cation supplements (calcium, iron, magnesium) alter absorption. You’ll also learn how anticonvulsants, rifampin, beta-blockers, steroids, and amiodarone affect levels or peripheral conversion.

Special populations receive focused guidance: immediate dose increases in pregnancy, careful titration in cardiovascular disease, and intentional TSH suppress...

Duration: 00:44:06

In this personal reflection, Dr. Busti shares a formative moment of cognitive dissonance that reshaped his approach to evidence-based medicine. When a simple question exposed a knowledge gap, it sparked a lifelong commitment to understanding the “why” behind clinical decisions—and to teaching with honesty and humility.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medica...

Duration: 00:15:04

Cognitive dissonance—the moment we realize we don’t know something we should—can either hinder or grow us. In this episode, Dr. Busti explains how understanding and managing dissonance within the Evidence-Based Medicine framework strengthens humility, reflection, and better patient care. Learn to turn uncertainty into growth and develop true cognitive resonance.

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Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other...

Duration: 00:18:40

The final two steps of Evidence-Based Medicine—Apply and Assess—focus on turning knowledge into better patient outcomes. Dr. Busti explains how to apply evidence to real-world practice, integrate patient preferences, and assess the impact of your decisions to continually improve care. Discover how adapting your approach over time creates a more patient-centered, evidence-driven practice.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your phys...

Duration: 00:16:07

Step 3 of Evidence-Based Medicine focuses on appraising the evidence. Dr. Busti explains how to systematically evaluate research using validated critical appraisal tools (CATs), detect bias, and interpret the quality of data before applying it to patient care. Learn to distinguish strong evidence from weak studies and develop a reliable, reproducible process for evidence-based decision-making.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek the advice of your physician...

Duration: 00:21:12

Step 2 of the EBM process is all about how to acquire evidence efficiently. Dr. Busti explains how to turn your PICO question into an effective search strategy, use Boolean logic and MESH terms, and select the best databases for your clinical question. Learn to differentiate primary, secondary, and tertiary literature and find the most relevant evidence quickly without missing key studies.

Access bonus materials and downloads at https://thisiswhy.health

Disclaimer: This content is for educational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always seek...

Duration: 00:38:21

Evidence-Based Medicine (EBM) has been shaping clinical decision-making for more than three decades. In this episode, Dr. Busti walks through Step 1 of the 5 A’s — Ask, focusing on how to craft clear, answerable clinical questions that drive better evidence searches and stronger patient care decisions.

You’ll learn the difference between background and foreground questions, explore the structure of PICO (Population, Intervention, Comparison, Outcome), and understand how extensions like PICOT and PICOTS add precision by incorporating time and setting. Using practical clinical examples—from asthma and hypertension to acute coronary syndromes—Dr. Busti demonstrates how well-formed questions save time...

Duration: 00:27:53

Thiazide diuretics have been essential in managing hypertension and remain one of the most widely prescribed drug classes today. But their value becomes clearer when you understand the “why.”

In this episode, Dr. Busti explains the mechanism of thiazides at the distal convoluted tubule, how this drives sodium handling, and why their clinical effects differ from loop diuretics. We cover the key agents — hydrochlorothiazide, chlorthalidone, indapamide, and metolazone — and discuss their use in hypertension, edema, and special populations.

Practical insights include why chlorthalidone often has stronger evidence than HCTZ, why higher HCTZ doses don’t yield more...

Duration: 01:03:44

MRAs—spironolactone, eplerenone, and finerenone—do far more than nudge blood pressure. They improve outcomes in heart failure, offer targeted benefits in CKD with T2D, and play a unique role in cirrhosis-related ascites. In this focused review, Dr. Busti walks through the why behind the what: aldosterone receptor blockade, tissue selectivity (kidney vs heart), and how those differences drive real-world choices, dosing, and safety.

We compare agents head-to-head, unpack RAAS physiology, and translate it into exam-ready pearls and bedside judgment—covering hyperkalemia risk, gynecomastia, CYP3A4 interactions, ACEi/ARB combinations, and how to counsel on potassium-containing salt s...

Duration: 01:12:07

MRAs—spironolactone, eplerenone, and finerenone—do far more than nudge blood pressure. They improve outcomes in heart failure, offer targeted benefits in CKD with T2D, and play a unique role in cirrhosis-related ascites. In this focused review, Dr. Busti walks through the why behind the what: aldosterone receptor blockade, tissue selectivity (kidney vs heart), and how those differences drive real-world choices, dosing, and safety.

We compare agents head-to-head, unpack RAAS physiology, and translate it into exam-ready pearls and bedside judgment—covering hyperkalemia risk, gynecomastia, CYP3A4 interactions, ACEi/ARB combinations, and how to counsel on potassium-containing salt s...

Duration: 01:01:11

H₂ receptor antagonists like famotidine and cimetidine have been around for decades, but they still play an important role in managing GERD, dyspepsia, ulcers, and even acute GI bleeding. In this episode, Dr. Busti reviews the history, pharmacology, and clinical relevance of this class, including the withdrawal of ranitidine.

You’ll learn how H₂ blockers fit into the larger category of antacid therapy, why they’re effective for mild cases but limited in long-term control, and how tolerance can reduce effectiveness. Cimetidine’s drug interaction profile is explored in detail, including CYP450 effects and alcohol metabolism. Practical dosing con...

Duration: 00:42:57

In this introductory episode of This Is Why, Dr. Busti shares the powerful story behind the creation of the podcast — and the mission driving it. With over 30 years of experience spanning nursing, pharmacy, medicine, and education, Dr. Busti offers a rare 360-degree perspective on healthcare.

He discusses the common gap in medical training: being taught what to do and how to do it, but not always why. Through his own journey — from the ICU and emergency department to academic medicine and beyond — Dr. Busti explains how understanding the “why” transforms clinical decision-making, patient outcomes, and professional confidence.

Liste...

Duration: 00:05:09

Evidence-Based Medicine (EBM) is a cornerstone of clinical training, but why is it so difficult to practice and teach consistently? In this deep dive, Dr. Busti unpacks the foundation of EBM, the five A’s, and why application often falls short in practice. Drawing from his training at Oxford and years of teaching across medicine, pharmacy, and nursing, he highlights misconceptions, barriers, and practical strategies to bridge the gap between evidence, education, and patient care.

This episode also uses a real-world case example—the ISIS-2 trial of aspirin in acute myocardial infarction—to illustrate how evidence should be und...

Duration: 00:38:05

In this kickoff episode on Evidence-Based Medicine (EBM), Dr. Busti explains what EBM is—and what it isn’t. You’ll learn why the classic Venn diagram (evidence, expertise, and patient factors) matters, and how the "Five A’s"—Ask, Acquire, Appraise, Apply, Assess—create a practical framework for clinical decision-making. We also unpack related terms like evidence-based practice, practitioner, and expert, showing how they fit together and why balance between literature, training, and patient preferences is essential. Perfect for students and early-career clinicians ready to ground their practice in the why behind the how.

Access the video plus b...

Duration: 00:28:56