Albania Pharmacist Certification Exam (Provimi i Certifikimit) cheat sheet

Henderson–Hasselbalch: pH = pKa + log([base]/[acid]); for a weak acid, percent ionized = 100/(1 + 10^(pKa − pH)).

Lipinski's rule of five: MW ≤ 500, logP ≤ 5, H-bond donors ≤ 5, H-bond acceptors ≤ 10; violation of two or more predicts poor oral bioavailability.

Bioisosteres: replace −OH with −NH2 or −CH3, or a carboxyl with a tetrazole, to preserve activity while altering metabolism or pKa.

Prodrugs are inactive derivatives metabolized to the active drug, e.g., enalapril to enalaprilat, or ester prodrugs of carboxylic acids to improve absorption.

Racemic mixtures: enantiomers may differ in potency and toxicity (e.g., S-warfarin is more potent than R-warfarin; thalidomide enantiomers differ in teratogenicity).

Structure–activity relationships: chain length, ring substitution pattern, and stereochemistry at the chiral center are the most common determinants of receptor affinity.

β-Lactam antibiotics act by acylating penicillin-binding proteins; the strained β-lactam ring is essential, and β-lactamase cleavage destroys activity.

Phase I metabolism (oxidation, reduction, hydrolysis) introduces or exposes polar groups; Phase II (glucuronidation, sulfation, acetylation) conjugates them for excretion.

pKa governs ionization and thus absorption: an acidic drug is largely unionized and absorbable in the stomach, whereas a basic drug is more unionized in the small intestine.

Bioavailability F = (AUCoral × DOSEiv)/(AUCiv × DOSEoral); it expresses the fraction of the dose reaching systemic circulation unchanged.

First-pass metabolism reduces oral bioavailability; routes avoiding it include sublingual, rectal (partly), transdermal, and parenteral.

Tablet compression stages: die filling, metering, compaction (viscoelastic deformation), and ejection; capping and lamination result from entrapped air or excessive elastic recovery.

Dissolution testing: USP Apparatus I (basket) and II (paddle) are standard; similarity factor f2 ≥ 50 indicates comparable dissolution profiles.

Suspensions require a suspending agent and controlled flocculation to prevent caking; Stokes' law shows sedimentation rate rises with particle diameter squared.

Sterile products: terminal sterilization by moist heat at 121 °C for 15 min (F0 ≥ 8 min); aseptic processing is used for heat-labile products.

Emulsions are stabilized by surfactants reducing interfacial tension; HLB 8–18 favors oil-in-water, HLB 3–6 favors water-in-oil.

Zero-order release delivers drug at a constant rate independent of concentration; first-order release rate is proportional to remaining concentration.

Osmotic pump (OROS) tablets release drug by osmotic pressure through a semipermeable membrane at a near zero-order rate.

Receptor types: ligand-gated ion channels (fast, ms), G-protein-coupled receptors (seconds), kinase-linked receptors (minutes), and nuclear receptors (hours, gene transcription).

Agonists activate receptors; competitive antagonists shift the dose–response curve right without reducing Emax; non-competitive antagonists lower Emax.

Therapeutic index = TD50/ED50; a narrow index (e.g., digoxin, warfarin, lithium) requires therapeutic drug monitoring.

Pharmacokinetic equations: Vd = Dose/C0; CL = ke × Vd; t½ = 0.693/ke; steady state is reached in about 4–5 half-lives.

Loading dose = (Vd × target concentration)/bioavailability; maintenance dose = (CL × target concentration)/bioavailability.

ACE inhibitors cause cough and hyperkalemia and are contraindicated in pregnancy; ARBs are an alternative when cough occurs.

β-Blockers reduce heart rate and myocardial oxygen demand; cardioselective agents (e.g., metoprolol) are preferred in asthma.

Aminoglycosides are bactericidal, concentration-dependent, and nephro/ototoxic; they require dose adjustment in renal impairment.

Opioid overdose is reversed by naloxone, a competitive μ-opioid antagonist; benzodiazepine overdose by flumazenil.

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

Cardiac glycosides (digoxin from Digitalis lanata) inhibit Na+/K+-ATPase; their aglycone (genin) determines activity and the sugar moiety affects solubility and kinetics.

Tannins are polyphenols that precipitate proteins; they are astringent and used topically for hemostasis and in wound healing.

Essential oils are volatile terpenoids obtained by steam distillation; they are stored in tightly closed containers away from light and heat.

St. John's wort (Hypericum perforatum) induces CYP3A4 and reduces concentrations of oral contraceptives, warfarin, and ciclosporin.

Ginkgo biloba may increase bleeding risk with anticoagulants; its standardized extract is quantified by flavonoid glycosides and terpene lactones.

Senna and cascara contain anthraquinone glycosides with laxative action; long-term use risks electrolyte loss and dependence.

Standardization expresses the content of a marker compound per unit (e.g., 'standardized to 4% hypericin'); it ensures batch-to-batch consistency.

Paracetamol overdose: N-acetylcysteine restores glutathione; the Rumack–Matthew nomogram guides treatment based on the 4-hour plasma concentration.

Organophosphate poisoning: acetylcholinesterase inhibition causes SLUDGE/ DUMBELS; treat with atropine plus pralidoxime before enzyme 'aging'.

Methanol and ethylene glycol poisoning: fomepizole (or ethanol) inhibits alcohol dehydrogenase; severe cases need hemodialysis.

Iron poisoning: deferoxamine chelates iron; activated charcoal does not bind iron or lithium effectively.

Salicylate toxicity causes mixed respiratory alkalosis and metabolic acidosis; urinary alkalinization with sodium bicarbonate enhances elimination.

Cyanide toxicity: hydroxocobalamin or sodium thiosulfate plus sodium nitrite; it blocks cytochrome oxidase and cellular respiration.

Digoxin toxicity: treat with digoxin-specific Fab antibody fragments; hypokalemia increases toxicity risk.

Poisoning management principles: ABC stabilization, decontamination only if within 1 hour (activated charcoal 1 g/kg), and antidote when indicated.

Lead poisoning: chelate with calcium disodium edetate or dimercaptosuccinic acid (succimer); blood lead level guides severity.

Pharmaceutical care is the responsible provision of drug therapy to achieve definite outcomes that improve a patient's quality of life.

Medication reconciliation compares the patient's pre-admission list with current orders at admission, transfer, and discharge to prevent discrepancies.

The SOAP note format: Subjective, Objective, Assessment, and Plan; each problem is documented separately with measurable endpoints.

Adverse drug reaction causality: the Naranjo algorithm scores temporal relationship, dechallenge, rechallenge, and alternative causes.

Therapeutic drug monitoring is indicated for narrow-index drugs (digoxin, lithium, phenytoin, vancomycin, aminoglycosides) and for suspected non-adherence.

Counselling on inhalers: shake the device, exhale fully, actuate while inhaling, hold breath 10 seconds, and rinse mouth after inhaled corticosteroids.

Anticoagulation counselling: warfarin requires INR monitoring and consistent vitamin K intake; DOACs require renal function checks.

Medication adherence can be assessed with the Morisky scale; pill counts and refill records are objective alternatives.

Pharmacist interventions should follow the pharmaceutical care process: assessment, care plan, follow-up, and documentation of outcomes.

Prescription requirements generally include prescriber identification, patient data, drug name, strength, dosage form, quantity, directions, and date/signature.

Narcotic and controlled substances require special prescription forms, limited quantities, and strict record-keeping with secure storage.

Pharmacists must maintain confidentiality of patient information and disclose it only with consent or legal requirement.

Good Distribution Practice requires temperature-controlled storage, validated transport, and traceability records for medicinal products.

Dispensing errors must be documented and reported through pharmacovigilance; adverse drug reactions are reported to the national regulatory authority.

Generic substitution is permitted only where legally authorized; the pharmacist must inform the patient and the prescriber when required.

The pharmacist's ethical duty includes competence maintenance through continuing education and avoidance of conflicts of interest.

Medicines must be stored according to label (e.g., 2–8 °C cold chain, below 25 °C ambient); expired stock is quarantined and destroyed per regulation.

Cost-minimization analysis compares alternatives with equivalent clinical outcomes and considers only cost differences.

Cost-effectiveness analysis reports cost per unit of clinical outcome (e.g., cost per life-year or per mmHg reduction); lower ICER is more favorable.

Incremental cost-effectiveness ratio: ICER = (CostA − CostB)/(EffectA − EffectB); interpret against a willingness-to-pay threshold.

Cost–benefit analysis expresses both costs and outcomes in monetary units, yielding a net benefit or benefit-to-cost ratio.

Cost–utility analysis uses quality-adjusted life years (QALYs), where QALY = life expectancy × utility (0–1).

Inventory management: economic order quantity balances ordering and holding costs; ABC analysis classifies stock by value and turnover.

Break-even point in units = fixed costs/(price per unit − variable cost per unit).

Budget variance = actual cost − budgeted cost; a positive variance indicates overspending.

Pharmacy revenue components include dispensing margin, OTC sales, and clinical services; gross margin = revenue − cost of goods sold.

Glycolysis yields 2 ATP and 2 NADH per glucose; the complete oxidation of glucose yields about 30–32 ATP.

The sodium–potassium ATPase pumps 3 Na+ out and 2 K+ in per ATP, maintaining resting membrane potential.

The Henderson–Hasselbalch equation applied to bicarbonate: pH = 6.1 + log([HCO3−]/(0.03 × PaCO2)); normal pH 7.35–7.45.

Insulin lowers blood glucose by promoting glucose uptake and glycogen synthesis; glucagon raises it via glycogenolysis and gluconeogenesis.

The nephron: glomerular filtration, proximal tubular reabsorption (~65% of Na+ and water), loop of Henle concentration, distal and collecting duct regulation by aldosterone and ADH.

Atherosclerosis involves endothelial injury, LDL oxidation, macrophage foam-cell formation, and plaque rupture causing thrombosis.

Type 2 diabetes arises from insulin resistance plus progressive β-cell failure; HbA1c reflects average glycemia over about 3 months.

Liver function tests: ALT and AST reflect hepatocellular injury, ALP and GGT reflect cholestasis, and albumin and INR reflect synthetic function.

The renin–angiotensin–aldosterone system raises blood pressure via vasoconstriction and sodium retention; ACE inhibitors and ARBs block it.

Gram-positive bacteria have a thick peptidoglycan layer and stain purple; Gram-negative bacteria have a thin layer plus an outer membrane and stain pink.

Bacterial growth phases: lag, exponential (log), stationary, and death; the exponential phase is targeted by most antibiotics.

Sterilization kills all microorganisms including spores; disinfection reduces pathogens on inanimate surfaces but may not kill spores.

Autoclaving at 121 °C, 15 psi for 15 min achieves sterility; dry heat at 160–180 °C is used for glassware and powders.

Hand hygiene is the single most effective measure to prevent healthcare-associated infection; alcohol-based rubs are preferred when hands are not visibly soiled.

Antibiotic resistance mechanisms include enzymatic inactivation (β-lactamases), efflux pumps, target modification, and reduced permeability.

Aseptic technique requires a sterile field, sterile gloves, and avoidance of contact with non-sterile surfaces during preparation.

Standard precautions apply to all patients: gloves for body-fluid contact, gowns and masks when splash risk exists, and safe sharps disposal.

Vaccines induce immunity through inactivated, live-attenuated, toxoid, or subunit antigens; live vaccines are generally contraindicated in immunocompromised patients.