APC Intern Written Exam cheat sheet

Prescription elements: patient name/address, date, drug name/strength/dosage form, quantity, directions, prescriber signature, and DEA number for controlled substances.

A prescription is invalid if it lacks the prescriber's signature, is outdated beyond state limits, or contains an unauthorized refill for a Schedule II drug.

Schedule II drugs require a written or electronic prescription; no refills are permitted. Schedule III-V drugs allow up to 5 refills within 6 months.

Medication reconciliation: compare the patient's current medication list with newly ordered medications at admission, transfer, and discharge to prevent discrepancies.

High-alert medications (e.g., insulin, heparin, chemotherapy, opioids) require independent double-checks and standardized concentrations to reduce errors.

The five rights of medication administration: right patient, right drug, right dose, right route, right time.

Pharmacists must counsel patients on new prescriptions, significant changes, and upon request; counseling includes purpose, administration, side effects, and storage.

Inventory management: use FIFO (first in, first out) for stock rotation; monitor expiration dates; controlled substances require perpetual inventory and biennial inventory.

Beta-blockers: nonselective (e.g., propranolol) block β1 and β2; cardioselective (e.g., metoprolol) block β1 at low doses; adverse effects include bradycardia and bronchospasm.

ACE inhibitors: end in -pril; inhibit angiotensin-converting enzyme, reducing angiotensin II and aldosterone; common adverse effects: dry cough, hyperkalemia, angioedema.

Warfarin: vitamin K antagonist; monitor INR; therapeutic range typically 2.0-3.0 for most indications; antidote is vitamin K (phytonadione).

Heparin: activates antithrombin III; monitor aPTT; antidote is protamine sulfate.

Metformin: first-line for type 2 diabetes; decreases hepatic glucose production and increases insulin sensitivity; risk of lactic acidosis in renal impairment; hold before contrast dye.

Statins: HMG-CoA reductase inhibitors; reduce LDL cholesterol; adverse effects include myopathy and elevated liver enzymes; monitor lipid panel and liver function.

Opioids: activate mu-opioid receptors; adverse effects include respiratory depression, constipation, and sedation; naloxone is the antidote for overdose.

Aminoglycosides (e.g., gentamicin): bactericidal, inhibit protein synthesis; require monitoring of renal function and drug levels due to nephrotoxicity and ototoxicity.

Concentration formula: C1 × V1 = C2 × V2 for dilution problems.

Dose calculation: Desired dose / Stock strength × Stock volume = Volume to administer.

Body surface area (BSA) via Mosteller formula: BSA (m²) = √[(height in cm × weight in kg) / 3600].

Ideal body weight (IBW): Males: 50 kg + 2.3 kg per inch over 5 feet; Females: 45.5 kg + 2.3 kg per inch over 5 feet.

Creatinine clearance (Cockcroft-Gault): CrCl (mL/min) = [(140 − age) × weight (kg)] / (72 × serum creatinine (mg/dL)); multiply by 0.85 for females.

Half-life: time for plasma concentration to decrease by 50%; after 5 half-lives, approximately 97% of drug is eliminated.

Flow rate: mL/hr = (volume in mL) / (time in hours); drops per minute = (volume in mL × drop factor in gtt/mL) / time in minutes.

Percentage strength: % w/v = grams of solute per 100 mL of solution; % w/w = grams of solute per 100 g of solution.

Alligation method: used to mix two solutions of different strengths to obtain a desired intermediate strength; ratio of parts = (higher % − desired %) : (desired % − lower %).

Patient confidentiality: protected under HIPAA; pharmacists may not disclose protected health information without patient authorization except for treatment, payment, or operations.

Controlled substances are regulated by the DEA; schedules range from I (no accepted medical use) to V (lowest abuse potential).

Pharmacists have a duty to report adverse drug reactions to the FDA MedWatch program and suspected prescription fraud to the DEA.

Informed consent: patient must be competent, receive full disclosure of risks/benefits/alternatives, and voluntarily consent.

Ethical principles: beneficence (do good), nonmaleficence (do no harm), autonomy (respect patient choice), justice (fair distribution of resources).

Medication errors must be documented and reported according to institutional policy and state law; some states require reporting to a patient safety organization.

The pharmacist's role in end-of-life care includes ensuring adequate pain relief and respecting patient autonomy while complying with controlled substance laws.

Professional boundaries: avoid conflicts of interest, maintain competence through continuing education, and adhere to the code of ethics of the profession.