Afghanistan Pharmacy Technician Exit Exam cheat sheet

A prescription is valid only if it contains prescriber name and signature, patient name, drug name, strength, dosage form, quantity, directions, and date.

Schedule II-type controlled substances (e.g., morphine, pethidine) require a written prescription, no refills, and must be dispensed within the legal time window set by national regulation.

Refills are permitted only when the prescriber authorizes them in writing; the total quantity dispensed may not exceed the authorized amount.

A pharmacist may substitute a generic product only when local law permits and the prescriber has not written 'no substitution' (dispense as written).

Patient records must be kept confidential; disclosure requires patient consent or a legal order, and records are retained per national retention rules.

Prescriptions must be retained on file for the legally required period and be available for inspection by authorized inspectors.

A technician must never independently counsel, verify, or release a prescription; those acts remain the pharmacist's legal responsibility.

Reporting of suspected counterfeit, substandard, or falsified medicines to the national regulatory authority is a professional obligation.

Conflict of interest: gifts or incentives from suppliers that could influence purchasing decisions must be declined or disclosed.

Beta-lactams (penicillins, cephalosporins) inhibit bacterial cell wall synthesis; aminoglycosides bind the 30S ribosome and are nephrotoxic and ototoxic.

NSAIDs inhibit cyclooxygenase, reducing prostaglandin synthesis; they cause gastric irritation and can worsen renal function and asthma.

Opioids act on mu receptors producing analgesia, respiratory depression, constipation, and dependence; naloxone reverses opioid overdose.

ACE inhibitors lower blood pressure by blocking angiotensin II formation; a dry cough and hyperkalemia are characteristic adverse effects.

Statins inhibit HMG-CoA reductase; myopathy and elevated liver enzymes are key monitoring concerns.

Anticoagulants: warfarin inhibits vitamin K-dependent clotting factors and is monitored by INR; heparin is monitored by aPTT.

Corticosteroids suppress inflammation and immunity; long-term use causes hyperglycemia, osteoporosis, and adrenal suppression on abrupt withdrawal.

Antituberculosis therapy uses combination regimens (e.g., isoniazid, rifampicin, pyrazinamide, ethambutol) to prevent resistance; isoniazid causes peripheral neuropathy.

Antimalarials and antidiabetics (insulin, metformin) must be classified by mechanism, onset, and key adverse effects before dispensing.

Dose = (desired dose / stock strength) x stock volume, keeping units consistent before calculating.

Percentage solutions: % w/v = grams per 100 mL; % w/w = grams per 100 g; % v/v = mL per 100 mL.

Dilution formula: C1 x V1 = C2 x V2, used for reconstituting or diluting stock solutions.

Alligation method: ratio of parts = (higher % - desired %) : (desired % - lower %).

Body surface area (BSA) by Mosteller = square root of (height in cm x weight in kg / 3600); BSA-based dosing uses mg/m2.

Pediatric dose by Clark's rule = (weight in kg / 70) x adult dose; Young's rule uses age in years.

IV drip rate (drops/min) = (volume in mL x drop factor in drops/mL) / time in minutes.

Unit conversions: 1 g = 1000 mg; 1 mg = 1000 mcg; 1 L = 1000 mL; 1 kg = 2.2 lb.

Always round final measured quantities to the precision the dosage form and measuring device can deliver.

Processing order: receive and validate prescription, check patient record and allergies, interpret, prepare, label, pharmacist check, then release.

The label must show patient name, drug name and strength, directions, quantity, date, pharmacy identity, and any cautionary or storage statements.

Auxiliary labels must be applied for specific risks: 'take with food', 'avoid alcohol', 'shake well', 'for external use only', 'keep out of reach of children'.

Prescription interpretation errors (illegible handwriting, missing strength, ambiguous abbreviations) require clarification with the prescriber, not guessing.

Abbreviations that must be avoided: 'U' (write 'units'), 'QD'/'OD' (write 'once daily'), and trailing zeros (write 5 mg, not 5.0 mg).

Dispensing containers must be appropriate to the product: light-resistant for photosensitive drugs, tight-closing for volatile or hygroscopic products, child-resistant where required.

The final check compares the prescription against the prepared product: drug, strength, dosage form, quantity, label, and expiry date.

Dispensing records must allow traceability of the batch number dispensed to the patient.

Tablets may be compressed, coated, chewable, sublingual, or effervescent; enteric coatings protect against gastric acid and must not be crushed.

Capsules are gelatin shells containing powder, granules, or liquid; they must be stored away from moisture and heat to avoid shell softening.

Suspensions are biphasic and must be shaken before use; emulsions are oil-in-water or water-in-oil and can crack on freezing or incompatible additives.

Suppositories are solid at room temperature and melt or dissolve in body cavities; bases include cocoa butter and polyethylene glycol.

Sterile products (injections, eye drops) require aseptic technique, preservative considerations, and, for multi-dose vials, a defined in-use expiry.

Compounding follows a master formula: ingredients, quantities, method, equipment, and quality checks are documented for each preparation.

Incompatibilities to check when compounding: pH-dependent precipitation, oxidation, complexation, and physical separation of emulsion phases.

Geometric dilution is used to mix a small quantity of potent powder uniformly with a larger diluent.

Compounded preparations require a beyond-use date based on the product's stability, preservative content, and storage conditions.

Pharmacodynamic interactions occur at the same receptor or physiological system (e.g., two sedatives causing additive CNS depression).

Pharmacokinetic interactions alter absorption, distribution, metabolism, or excretion (e.g., enzyme inducers like rifampicin lower warfarin effect).

Warfarin interactions: NSAIDs, aspirin, and many antibiotics increase bleeding risk; INR monitoring is required.

MAO inhibitors with tyramine-rich foods or sympathomimetics can precipitate hypertensive crisis.

Adverse effects to counsel on: drowsiness with antihistamines, photosensitivity with tetracyclines, and GI upset with oral iron.

Counseling must cover dose, frequency, route, timing relative to food, missed-dose handling, and duration of therapy.

Patients should be told to report serious adverse effects and to avoid doubling doses to make up for a missed dose.

Special populations (pregnancy, breastfeeding, children, elderly, renal or hepatic impairment) require dose adjustment and extra counseling.

Storage counseling: keep medicines out of reach of children, away from heat and moisture, and never share prescription medicines.

First Expiry First Out (FEFO) rotation ensures the earliest-expiring stock is dispensed first; First In First Out (FIFO) is used when expiry dates are uniform.

Stock records must track receipt, issue, balance, batch number, and expiry date for every product.

Cold-chain products (e.g., insulin, some vaccines) require 2-8 degrees C storage with continuous temperature monitoring and a documented excursion procedure.

Expired, damaged, or recalled stock must be segregated in a labeled quarantine area and disposed of according to national regulations.

Narcotics and controlled substances require locked storage, restricted access, and a running balance record with periodic reconciliation.

Physical inventory counts are reconciled against records; discrepancies above a defined threshold trigger investigation.

Signs of quality failure: discoloration, change in odor or texture, caking, leakage, cracked tablets, and particulate matter in solutions.

Storage conditions to control: temperature, humidity, light exposure, and ventilation; direct sunlight degrades many photosensitive drugs.

Hand hygiene is the single most effective measure against cross-infection; wash with soap and water or use alcohol-based rub before and after contact.

Standard precautions apply to all patients: gloves for body fluid contact, eye protection when splashing is possible, and safe sharps handling.

Sharps must never be recapped by hand; place them immediately in a puncture-resistant, labeled sharps container.

Spills of blood or body fluids are cleaned with absorbent material and disinfected with an appropriate agent such as sodium hypochlorite solution.

Vaccination reduces disease transmission; cold-chain integrity and correct administration technique are essential for vaccine effectiveness.

Antimicrobial resistance is slowed by completing prescribed courses, avoiding unnecessary antibiotics, and not sharing antibiotics.

Public health reporting: certain infectious diseases and serious adverse drug reactions must be reported to health authorities.

Hazardous drug handling (e.g., cytotoxic medicines) requires protective equipment and dedicated preparation areas.