DOH Pharmacist Exam cheat sheet

Bioisosteres replace a group with one of similar size, shape, and electronic properties (e.g., -OH/-NH2, -Cl/-CF3) to retain activity while altering metabolism.

LogP (octanol-water partition coefficient) quantifies lipophilicity; optimal oral drug LogP is typically 1-5, and high LogP raises hepatic clearance and tissue sequestration.

Lipinski Rule of Five: MW <=500, LogP <=5, H-bond donors <=5, H-bond acceptors <=10; two or more violations predict poor oral absorption.

Henderson-Hasselbalch: for weak acids pH = pKa + log([A-]/[HA]); for weak bases pH = pKa + log([B]/[BH+]). Ionization governs absorption and renal reabsorption.

Prodrugs are inactive derivatives requiring enzymatic or chemical conversion (e.g., ester hydrolysis, phosphate cleavage) to improve solubility, stability, or permeability.

Chirality: enantiomers differ in receptor affinity and disposition; the eutomer is the active enantiomer and the distomer is less active, as in S- vs R-warfarin.

Phase I metabolism (CYP450 oxidation, reduction, hydrolysis) introduces or exposes polar groups; Phase II conjugation (glucuronidation, sulfation, acetylation) increases water solubility for excretion.

A competitive antagonist raises EC50 without changing Emax; a noncompetitive antagonist lowers Emax; a partial agonist produces submaximal Emax regardless of dose.

Alkaloids are nitrogen-containing basic plant secondary metabolites (e.g., morphine from Papaver somniferum, quinine from Cinchona, atropine from Atropa belladonna).

Glycosides yield a sugar plus aglycone on hydrolysis; cardiac glycosides (digoxin from Digitalis lanata) inhibit Na+/K+-ATPase and increase cardiac contractility.

Tannins are polyphenolic compounds that precipitate proteins; they are astringent and used in wound healing and as antidotes for alkaloid poisoning.

Volatile oils (essential oils) are terpenoid/phenylpropanoid mixtures obtained by steam or hydrodistillation (e.g., menthol from Mentha, eugenol from clove).

Resins and oleoresins are hydrophobic plant exudates (e.g., colophony, ginger oleoresin); gum-resins include myrrh and asafoetida.

Standardization of herbal material requires assay of a marker compound and control of identity, foreign matter, ash value, and microbial/pesticide limits.

Biosynthetic classes: terpenoids derive from the mevalonate/deoxyxylulose pathway, phenylpropanoids from the shikimate pathway, and alkaloids from amino acid precursors.

Collection and drying conditions affect secondary metabolite yield; excessive heat degrades volatile oils and heat-labile glycosides.

Bioavailability (F) = (AUC_test/AUC_IV) x (Dose_IV/Dose_test); for a non-IV reference, relative bioavailability compares AUC and dose between products.

Tablet compression involves filling, metering, compression, and ejection; common defects include capping, lamination, and picking/sticking.

Immediate-release vs. controlled-release: controlled systems use matrix, reservoir/membrane, or osmotic pump designs to achieve zero-order or prolonged release.

Suspensions require a suspending agent and control of sedimentation, caking, and particle-size growth; flocculated systems settle rapidly but redisperse easily.

Sterile products: isotonicity is ~0.9% w/v NaCl; terminal sterilization by moist heat (121 C, 15 min, 15 psi) achieves a sterility assurance level of 10^-6.

Suppositories: theobroma oil (cocoa butter) melts near 34-36 C; PEG bases are water-soluble and suitable for hot climates; displacement value corrects for drug volume.

Emulsions are stabilized by surfactants classified by HLB: low HLB (3-6) favors w/o, high HLB (8-18) favors o/w emulsions.

Powder flow is assessed by angle of repose, Carr's compressibility index, and Hausner ratio; glidants such as colloidal silicon dioxide improve flow.

Receptor families: ligand-gated ion channels (fastest), G-protein-coupled receptors (second messengers), kinase-linked receptors, and nuclear receptors (slowest, gene transcription).

Dose-response: ED50 is the dose producing 50% of maximal effect; therapeutic index = TD50/ED50, and a low index (e.g., digoxin, warfarin, lithium) demands monitoring.

Autonomic pharmacology: muscarinic blockade causes dry mouth, mydriasis, tachycardia, and urinary retention; beta-1 blockade reduces heart rate and contractility.

Antidotes: N-acetylcysteine for acetaminophen, naloxone for opioids, flumazenil for benzodiazepines, atropine/pralidoxime for organophosphate poisoning, deferoxamine for iron.

CYP450 interactions: inhibitors include ketoconazole, erythromycin, and grapefruit components; inducers include rifampin, carbamazepine, and St. John's wort.

Toxicology: the LD50 is the dose lethal to 50% of test animals; chronic exposure is assessed by NOAEL and acceptable daily intake derived from it.

Pharmacogenomics: CYP2D6 poor metabolizers accumulate codeine's parent drug and lack analgesia, while ultrarapid metabolizers risk morphine toxicity.

Adverse drug reactions: Type A are dose-dependent and predictable; Type B are idiosyncratic and unpredictable (e.g., anaphylaxis, Stevens-Johnson syndrome).

Hypertension: first-line agents include thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers; ACE inhibitors are preferred with diabetes or proteinuria.

Diabetes: metformin is first-line for type 2 diabetes; HbA1c target is generally <7%; monitor for lactic acidosis risk in renal impairment.

Asthma: stepwise therapy uses inhaled corticosteroids as controller and short-acting beta-2 agonists as reliever; severe exacerbations require systemic steroids.

Heart failure: guideline-directed therapy includes ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Anticoagulation: warfarin is monitored by INR (target 2-3 for most indications); DOACs require renal function assessment and have specific reversal agents.

Antibiotic stewardship: select agent by culture/susceptibility, use narrowest effective spectrum, and complete the prescribed course to limit resistance.

Pharmacovigilance: report suspected serious adverse reactions to the national pharmacovigilance center; causality assessment uses WHO-UMC or Naranjo scales.

Therapeutic drug monitoring is indicated for drugs with narrow therapeutic index and good concentration-effect correlation (e.g., digoxin, phenytoin, vancomycin, lithium).

A prescription is legally valid only with prescriber identification, patient identification, drug name, strength, quantity, directions, and prescriber signature/date.

Dispensing errors are prevented by the 'five rights': right patient, drug, dose, route, and time, plus independent double-check for high-alert medications.

Controlled substances are scheduled by abuse potential (Schedule I highest, no accepted medical use; Schedule V lowest); records must be kept and secured.

Look-alike/sound-alike (LASA) drug names require tall-man lettering and separate storage to reduce selection errors.

Patient counseling must cover drug name/purpose, dose and administration, common adverse effects, interactions, and storage; documentation is required.

Ethical principles: autonomy (informed consent), beneficence, nonmaleficence, justice, and confidentiality (protected health information).

Expired or recalled drugs must be quarantined, documented, and returned per manufacturer or regulatory procedures; never dispensed.

Prescription abbreviations to avoid: 'U' (write units), 'QD'/'QOD' (write daily/every other day), and trailing zeros (write 5 mg, not 5.0 mg).

Clearance CL = Dose/AUC (IV) and CL = k x Vd; half-life t1/2 = 0.693 x Vd / CL.

Volume of distribution Vd = Amount in body / plasma concentration; large Vd indicates extensive tissue distribution.

Zero-order elimination has constant rate (k0) and dose-dependent half-life; first-order elimination has rate proportional to concentration and constant half-life.

Steady state is reached after ~4-5 half-lives; loading dose = (Vd x target concentration)/bioavailability.

Maintenance dose rate = (CL x target concentration)/bioavailability.

Absorption: Cmax and Tmax describe rate; AUC describes extent; Ka is the absorption rate constant.

Renal clearance CLr = (U x V)/P; creatinine clearance via Cockcroft-Gault estimates renal function for dose adjustment.

Bioequivalence requires 90% confidence interval of the ratio of AUC and Cmax within 80-125% of the reference product.

Inventory control: ABC analysis classifies items by annual value, VED by criticality; economic order quantity balances ordering and holding costs.

Drug use evaluation and formulary management promote rational, cost-effective prescribing; the P&T committee oversees formulary decisions.

Pharmacoeconomics: cost-minimization compares equal-outcome alternatives; cost-effectiveness uses cost per clinical outcome (e.g., cost per life-year gained).

Cost-benefit analysis expresses both costs and outcomes in monetary terms; cost-utility uses quality-adjusted life-years (QALYs).

Public health: herd immunity threshold depends on basic reproduction number R0; immunization programs reduce transmission and protect susceptible groups.

Pharmacoepidemiology uses cohort, case-control, and cross-sectional designs to assess drug effects in populations; confounding and bias must be controlled.

Health promotion uses primary (prevent disease), secondary (early detection), and tertiary (rehabilitation) prevention levels.

Medication adherence is improved by simplifying regimens, using adherence aids, and providing clear counseling and follow-up.

Bioisosteres replace a group with one of similar size, shape, and electronic properties (e.g., -OH/-NH2, -Cl/-CF3) to retain activity while altering metabolism.

LogP (octanol-water partition coefficient) quantifies lipophilicity; optimal oral drug LogP is typically 1-5, and high LogP raises hepatic clearance and tissue sequestration.

Lipinski Rule of Five: MW <=500, LogP <=5, H-bond donors <=5, H-bond acceptors <=10; two or more violations predict poor oral absorption.

Henderson-Hasselbalch: for weak acids pH = pKa + log([A-]/[HA]); for weak bases pH = pKa + log([B]/[BH+]). Ionization governs absorption and renal reabsorption.

Prodrugs are inactive derivatives requiring enzymatic or chemical conversion (e.g., ester hydrolysis, phosphate cleavage) to improve solubility, stability, or permeability.

Chirality: enantiomers differ in receptor affinity and disposition; the eutomer is the active enantiomer and the distomer is less active, as in S- vs R-warfarin.

Phase I metabolism (CYP450 oxidation, reduction, hydrolysis) introduces or exposes polar groups; Phase II conjugation (glucuronidation, sulfation, acetylation) increases water solubility for excretion.

A competitive antagonist raises EC50 without changing Emax; a noncompetitive antagonist lowers Emax; a partial agonist produces submaximal Emax regardless of dose.

Alkaloids are nitrogen-containing basic plant secondary metabolites (e.g., morphine from Papaver somniferum, quinine from Cinchona, atropine from Atropa belladonna).

Glycosides yield a sugar plus aglycone on hydrolysis; cardiac glycosides (digoxin from Digitalis lanata) inhibit Na+/K+-ATPase and increase cardiac contractility.

Tannins are polyphenolic compounds that precipitate proteins; they are astringent and used in wound healing and as antidotes for alkaloid poisoning.

Volatile oils (essential oils) are terpenoid/phenylpropanoid mixtures obtained by steam or hydrodistillation (e.g., menthol from Mentha, eugenol from clove).

Resins and oleoresins are hydrophobic plant exudates (e.g., colophony, ginger oleoresin); gum-resins include myrrh and asafoetida.

Standardization of herbal material requires assay of a marker compound and control of identity, foreign matter, ash value, and microbial/pesticide limits.

Biosynthetic classes: terpenoids derive from the mevalonate/deoxyxylulose pathway, phenylpropanoids from the shikimate pathway, and alkaloids from amino acid precursors.

Collection and drying conditions affect secondary metabolite yield; excessive heat degrades volatile oils and heat-labile glycosides.

Bioavailability (F) = (AUC_test/AUC_IV) x (Dose_IV/Dose_test); for a non-IV reference, relative bioavailability compares AUC and dose between products.

Tablet compression involves filling, metering, compression, and ejection; common defects include capping, lamination, and picking/sticking.

Immediate-release vs. controlled-release: controlled systems use matrix, reservoir/membrane, or osmotic pump designs to achieve zero-order or prolonged release.

Suspensions require a suspending agent and control of sedimentation, caking, and particle-size growth; flocculated systems settle rapidly but redisperse easily.

Sterile products: isotonicity is ~0.9% w/v NaCl; terminal sterilization by moist heat (121 C, 15 min, 15 psi) achieves a sterility assurance level of 10^-6.

Suppositories: theobroma oil (cocoa butter) melts near 34-36 C; PEG bases are water-soluble and suitable for hot climates; displacement value corrects for drug volume.

Emulsions are stabilized by surfactants classified by HLB: low HLB (3-6) favors w/o, high HLB (8-18) favors o/w emulsions.

Powder flow is assessed by angle of repose, Carr's compressibility index, and Hausner ratio; glidants such as colloidal silicon dioxide improve flow.

Receptor families: ligand-gated ion channels (fastest), G-protein-coupled receptors (second messengers), kinase-linked receptors, and nuclear receptors (slowest, gene transcription).

Dose-response: ED50 is the dose producing 50% of maximal effect; therapeutic index = TD50/ED50, and a low index (e.g., digoxin, warfarin, lithium) demands monitoring.

Autonomic pharmacology: muscarinic blockade causes dry mouth, mydriasis, tachycardia, and urinary retention; beta-1 blockade reduces heart rate and contractility.

Antidotes: N-acetylcysteine for acetaminophen, naloxone for opioids, flumazenil for benzodiazepines, atropine/pralidoxime for organophosphate poisoning, deferoxamine for iron.

CYP450 interactions: inhibitors include ketoconazole, erythromycin, and grapefruit components; inducers include rifampin, carbamazepine, and St. John's wort.

Toxicology: the LD50 is the dose lethal to 50% of test animals; chronic exposure is assessed by NOAEL and acceptable daily intake derived from it.

Pharmacogenomics: CYP2D6 poor metabolizers accumulate codeine's parent drug and lack analgesia, while ultrarapid metabolizers risk morphine toxicity.

Adverse drug reactions: Type A are dose-dependent and predictable; Type B are idiosyncratic and unpredictable (e.g., anaphylaxis, Stevens-Johnson syndrome).

Hypertension: first-line agents include thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers; ACE inhibitors are preferred with diabetes or proteinuria.

Diabetes: metformin is first-line for type 2 diabetes; HbA1c target is generally <7%; monitor for lactic acidosis risk in renal impairment.

Asthma: stepwise therapy uses inhaled corticosteroids as controller and short-acting beta-2 agonists as reliever; severe exacerbations require systemic steroids.

Heart failure: guideline-directed therapy includes ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Anticoagulation: warfarin is monitored by INR (target 2-3 for most indications); DOACs require renal function assessment and have specific reversal agents.

Antibiotic stewardship: select agent by culture/susceptibility, use narrowest effective spectrum, and complete the prescribed course to limit resistance.

Pharmacovigilance: report suspected serious adverse reactions to the national pharmacovigilance center; causality assessment uses WHO-UMC or Naranjo scales.

Therapeutic drug monitoring is indicated for drugs with narrow therapeutic index and good concentration-effect correlation (e.g., digoxin, phenytoin, vancomycin, lithium).

A prescription is legally valid only with prescriber identification, patient identification, drug name, strength, quantity, directions, and prescriber signature/date.

Dispensing errors are prevented by the 'five rights': right patient, drug, dose, route, and time, plus independent double-check for high-alert medications.

Controlled substances are scheduled by abuse potential (Schedule I highest, no accepted medical use; Schedule V lowest); records must be kept and secured.

Look-alike/sound-alike (LASA) drug names require tall-man lettering and separate storage to reduce selection errors.

Patient counseling must cover drug name/purpose, dose and administration, common adverse effects, interactions, and storage; documentation is required.

Ethical principles: autonomy (informed consent), beneficence, nonmaleficence, justice, and confidentiality (protected health information).

Expired or recalled drugs must be quarantined, documented, and returned per manufacturer or regulatory procedures; never dispensed.

Prescription abbreviations to avoid: 'U' (write units), 'QD'/'QOD' (write daily/every other day), and trailing zeros (write 5 mg, not 5.0 mg).

Clearance CL = Dose/AUC (IV) and CL = k x Vd; half-life t1/2 = 0.693 x Vd / CL.

Volume of distribution Vd = Amount in body / plasma concentration; large Vd indicates extensive tissue distribution.

Zero-order elimination has constant rate (k0) and dose-dependent half-life; first-order elimination has rate proportional to concentration and constant half-life.

Steady state is reached after ~4-5 half-lives; loading dose = (Vd x target concentration)/bioavailability.

Maintenance dose rate = (CL x target concentration)/bioavailability.

Absorption: Cmax and Tmax describe rate; AUC describes extent; Ka is the absorption rate constant.

Renal clearance CLr = (U x V)/P; creatinine clearance via Cockcroft-Gault estimates renal function for dose adjustment.

Bioequivalence requires 90% confidence interval of the ratio of AUC and Cmax within 80-125% of the reference product.

Inventory control: ABC analysis classifies items by annual value, VED by criticality; economic order quantity balances ordering and holding costs.

Drug use evaluation and formulary management promote rational, cost-effective prescribing; the P&T committee oversees formulary decisions.

Pharmacoeconomics: cost-minimization compares equal-outcome alternatives; cost-effectiveness uses cost per clinical outcome (e.g., cost per life-year gained).

Cost-benefit analysis expresses both costs and outcomes in monetary terms; cost-utility uses quality-adjusted life-years (QALYs).

Public health: herd immunity threshold depends on basic reproduction number R0; immunization programs reduce transmission and protect susceptible groups.

Pharmacoepidemiology uses cohort, case-control, and cross-sectional designs to assess drug effects in populations; confounding and bias must be controlled.

Health promotion uses primary (prevent disease), secondary (early detection), and tertiary (rehabilitation) prevention levels.

Medication adherence is improved by simplifying regimens, using adherence aids, and providing clear counseling and follow-up.