Greek Pharmacist License cheat sheet

Lipinski's Rule of Five: MW ≤ 500, logP ≤ 5, H-bond donors ≤ 5, H-bond acceptors ≤ 10; violation of ≥2 criteria predicts poor oral bioavailability.

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

Bioisosterism examples: -OH/-NH₂, -CH₃/-Cl/-CF₃ (size), -O-/-S-/-NH- (ring), tetrazole for carboxylic acid (metabolically stable, similar pKa ~4.9).

Prodrug design: ester prodrugs (enalapril, oseltamivir) improve absorption by masking polar groups; hydrolysis by carboxylesterases releases the active drug.

Chirality matters: S-(-)-propranolol is ~100-fold more potent at β-receptors than R-(+); thalidomide's S-enantiomer is teratogenic, R is sedative, and racemisation occurs in vivo.

Phase I metabolism = oxidation/reduction/hydrolysis via CYP450 (CYP3A4 metabolises >50% of drugs); Phase II = conjugation (glucuronidation, sulfation, acetylation, methylation, glutathione) increasing water solubility.

CYP inhibition (ketoconazole, ritonavir, grapefruit furanocoumarins) raises substrate levels; CYP induction (rifampicin, carbamazepine, St John's wort) lowers them - clinically relevant interaction rules.

SAR principle: adding a methyl group generally increases lipophilicity and metabolic stability but may create a new chiral centre or steric clash with the receptor pocket.

Alkaloid-bearing plants: Atropa belladonna (atropine/hyoscine), Papaver somniferum (morphine), Cinchona (quinine), Catharanthus roseus (vincristine/vinblastine), Colchicum autumnale (colchicine).

Cardiac glycosides (Digitalis purpurea, Digitalis lanata) consist of a steroidal aglycone + lactone ring + sugar chain; inhibit Na⁺/K⁺-ATPase, raising intracellular Ca²⁺.

Essential oil isolation: hydrodistillation (Clevenger apparatus), steam distillation, or supercritical CO₂; monoterpenes (C10) and sesquiterpenes (C15) dominate.

Gums and mucilages: acacia (Arabia gum), tragacanth, and alginates from brown algae; used as suspending and emulsifying agents.

Tannins are polyphenols that precipitate proteins and alkaloids; classified as hydrolysable (gallic/ellagic acid) or condensed (proanthocyanidins).

Standardisation of herbal preparations uses marker compounds (e.g. ginkgolides, hypericin, silymarin) and assay by HPLC or TLC fingerprinting.

Ginkgo biloba extract (EGb 761) is standardised to 24% flavonoid glycosides and 6% terpene lactones; it inhibits platelet-activating factor and may increase bleeding risk with anticoagulants.

St John's wort (Hypericum perforatum) contains hyperforin, a potent CYP3A4 and P-glycoprotein inducer; reduces efficacy of oral contraceptives, ciclosporin and warfarin.

Noyes–Whitney equation: dm/dt = (D·A/h)·(Cs − C); dissolution rate rises with surface area (smaller particle size) and solubility.

Stokes' law: v = (2r²(ρp − ρm)g)/(9η) - sedimentation velocity increases with particle radius and density difference, decreases with viscosity.

Bioavailability F = (AUCoral/AUCiv)×(Doseiv/Doseoral); absolute F uses IV reference, relative F uses a standard oral product.

Biopharmaceutics Classification System: Class I high solubility/high permeability (immediate release), II low solubility/high permeability (dissolution-limited), III high solubility/low permeability (permeability-limited), IV low/low.

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

Osmotic pump (OROS) delivers zero-order release driven by osmotic pressure; matrix tablets follow Higuchi (√t) or first-order kinetics.

Emulsion type identified by dilution, dye solubility, or conductivity: o/w conducts electricity and dilutes in water; w/o does the opposite.

Hydrophile–Lipophile Balance (HLB): 3–6 w/o emulsifier, 8–18 o/w emulsifier, 13–15 detergents, 15–18 solubilisers.

Compounding balance: weigh the smallest quantity accurately (minimum weighable amount typically 100 mg on a Class II balance); use aliquot (geometric dilution) for potent substances.

Sterile compounding requires a laminar-flow hood (Class II biological safety cabinet for cytotoxics), aseptic technique, and validated 0.22 µm filtration or terminal sterilisation at 121 °C for 15 min.

Terminal sterilisation by moist heat: 121 °C, 15 min, 1 atm overpressure (15 psi); dry heat 160–180 °C for 2 h for glassware and oils.

Tablet defects: capping/laminating (air entrapment, insufficient binder), picking/sticking (excess moisture or lubricant), mottling (dye migration), and lamination (over-compression).

Granulation methods: wet granulation (binder solution, improves flow and compressibility) vs dry granulation/roller compaction (for moisture- and heat-sensitive drugs).

Capsule filling: hard gelatin capsules sized 000–5; size 0 holds ~0.5 mL; use lactose or dibasic calcium phosphate as diluent and magnesium stearate as lubricant.

Suspension formulation: add suspending agent (e.g. xanthan gum, CMC), wetting agent, and preservative; shake well before use and label accordingly.

Quality control tests for tablets: weight uniformity, hardness (crushing strength), friability (<1% loss), disintegration time, and dissolution profile.

Receptor theory: Kd is the dissociation constant; potency = EC50 (lower EC50 = higher potency); efficacy = Emax; a partial agonist has submaximal Emax; an antagonist has affinity but zero intrinsic activity.

Competitive antagonism shifts the dose–response curve right with unchanged Emax; non-competitive antagonism reduces Emax.

Therapeutic index TI = TD50/ED50; a narrow TI (digoxin, warfarin, lithium, phenytoin) demands therapeutic drug monitoring.

Autonomic rules: α1 → vasoconstriction/mydriasis; β1 → tachycardia and increased contractility; β2 → bronchodilation and tremor; M2 → bradycardia; M3 → secretions and bronchoconstriction.

Toxicology antidotes: N-acetylcysteine (paracetamol), naloxone (opioids), flumazenil (benzodiazepines), atropine + pralidoxime (organophosphates), deferoxamine (iron), fomepizole (methanol/ethylene glycol).

Paracetamol overdose: glutathione depletion → NAPQI accumulation; treat with N-acetylcysteine within 8 h; use the Rumack–Matthew nomogram based on 4-h serum level.

Pharmacokinetic equations: Vd = Dose/C0; Cl = k·Vd; t½ = 0.693/k; steady state reached in ~4–5 half-lives; loading dose = (Vd × target concentration)/F.

Zero-order kinetics (saturation): phenytoin, ethanol, salicylates at high dose - elimination rate is constant, so small dose increases cause large plasma rises.

Hypertension first-line: ACE inhibitors/ARBs, calcium channel blockers, thiazides, or beta-blockers (younger patients); combine classes rather than maximising one drug.

Type 2 diabetes: metformin first-line unless contraindicated (eGFR <30); add SGLT2 inhibitors or GLP-1 agonists when cardiovascular or renal disease is present.

Asthma stepwise: SABA reliever plus low-dose ICS as controller; escalate to ICS/LABA; never use LABA monotherapy in asthma.

Heart failure with reduced EF: quadruple therapy - ACEi/ARB/ARNI, beta-blocker, mineralocorticoid antagonist, SGLT2 inhibitor - all reduce mortality.

Anticoagulation: warfarin monitored by INR (target 2–3 for AF, 2.5–3.5 for mechanical valves); DOACs (apixaban, rivaroxaban) require renal function checks and have specific reversal agents (andexanet alfa, idarucizumab for dabigatran).

Antibiotic stewardship: complete the prescribed course, de-escalate based on culture, avoid unnecessary broad-spectrum use; MRSA requires vancomycin or linezolid.

Therapeutic drug monitoring is indicated for digoxin, lithium, phenytoin, valproate, ciclosporin, tacrolimus, gentamicin, and vancomycin (trough levels).

Paediatric dosing uses weight-based mg/kg calculations; check renal and hepatic function before adjusting doses in the elderly (Beers criteria for potentially inappropriate drugs).

Pharmaceutical care process: assess the patient's medication-related needs, identify drug therapy problems, develop and implement a plan, then monitor and follow up.

Counselling structure: open the interview, confirm the prescription, explain indication and dosing, discuss key side effects and what to do, and check understanding by teach-back.

High-alert medications (insulin, anticoagulants, opioids, concentrated electrolytes, cytotoxics) require double-checking, clear labelling, and independent verification.

Dispensing checks: verify patient identity, drug name, strength, dose, route, quantity, expiry, and label instructions; record the dispensed batch for traceability.

Metformin should be taken with or after meals; bisphosphonates on an empty stomach with a full glass of water, remaining upright for 30 min; statins in the evening (short half-life).

Inhaler technique: shake the device, exhale fully, actuate while inhaling slowly and deeply, hold breath ~10 s, rinse mouth after ICS to prevent oral candidiasis.

Adherence support: simplify regimens, use pill organisers, align dosing with daily routines, and address cost or side-effect concerns explicitly.

Antibiotic counselling: complete the course, do not share, and expect possible GI upset; report severe diarrhoea (possible C. difficile).

Pharmacy practice in Greece is regulated by the Ministry of Health and the National Organization for Medicines (EOF); the Panhellenic Pharmaceutical Association (PFS) and regional associations govern professional conduct.

Prescription-only medicines require a valid prescription from a licensed physician; narcotic and psychotropic drugs follow special prescription requirements (e.g. special prescription forms, limited duration).

Pharmacists must maintain patient confidentiality, provide a professional service, avoid conflicts of interest, and refuse to dispense when a prescription is invalid or falsified.

Pharmacovigilance reporting in Greece is coordinated by EOF; suspected adverse reactions are reported through the national yellow-card system or the EU EudraVigilance network.

Good Distribution Practice (GDP) requires temperature-controlled storage, documented transport, and traceability of medicinal products from manufacturer to pharmacy.

Advertising of prescription-only medicines to the public is prohibited; only non-prescription products may be advertised under restrictions.

Dispensing records and narcotic registers must be retained for the period required by national law; destruction of expired narcotics requires documented, authorised procedures.

Emergency contraception and certain OTC switches are subject to specific Greek and EU rules; pharmacists must verify age and provide counselling where required.

Adverse drug reaction (ADR) definitions: Type A (dose-dependent, predictable, e.g. bleeding with warfarin), Type B (idiosyncratic, unpredictable, e.g. anaphylaxis), Type C (chronic), Type D (delayed), Type E (withdrawal), Type F (failure of therapy).

Serious ADR: death, life-threatening, hospitalisation or prolongation, persistent disability, congenital anomaly, or medically important event.

Signal detection uses disproportionality analysis (PRR, ROR, BCPNN) from spontaneous reporting databases; a signal requires validation and assessment of causality.

Causality assessment tools: WHO-UMC scale (certain, probable, possible, unlikely, conditional, unassessable) and Naranjo algorithm score.

Regulatory pathways: marketing authorisation via centralised EU procedure (EMA) or national/mutual recognition; generic approval requires bioequivalence demonstration.

Risk management plan (RMP) and periodic safety update reports (PSUR) are required post-authorisation; risk minimisation measures include patient leaflets, prescriber guides, and pregnancy prevention programmes.

Pharmacovigilance obligations: marketing authorisation holders must maintain a qualified person for pharmacovigilance (QPPV) and report serious unexpected ADRs within 15 days, non-serious within 90 days.

Black triangle (▼) symbol on EU product information indicates a medicine under additional monitoring; patients and healthcare professionals are encouraged to report all suspected reactions.

Glycolysis yields 2 ATP and 2 NADH per glucose; the Krebs cycle and oxidative phosphorylation yield ~30–32 ATP total per glucose under aerobic conditions.

Enzyme kinetics: Michaelis–Menten v = (Vmax·[S])/(Km + [S]); Km is the substrate concentration at half Vmax and inversely reflects enzyme affinity.

Haemoglobin: the oxygen dissociation curve is right-shifted (reduced affinity) by increased 2,3-BPG, CO₂, H⁺ (Bohr effect), and temperature; fetal Hb has higher affinity.

Acid–base: normal arterial pH 7.35–7.45, PaCO₂ 35–45 mmHg, HCO₃⁻ 22–26 mmol/L; respiratory disorders alter CO₂ first, metabolic disorders alter HCO₃⁻ first.

Renal physiology: GFR ≈ 125 mL/min; clearance = (U×V)/P; inulin measures GFR, PAH measures renal plasma flow; creatinine clearance estimates GFR by Cockcroft–Gault.

Electrolytes: normal Na⁺ 135–145, K⁺ 3.5–5.0, Ca²⁺ 2.1–2.6 mmol/L; hyperkalaemia is treated with calcium gluconate, insulin/glucose, and salbutamol.

Diabetes pathophysiology: type 1 = autoimmune β-cell destruction with absolute insulin deficiency; type 2 = insulin resistance with relative deficiency; HbA1c reflects ~3 months of glycaemia.

Liver function: albumin, bilirubin, and prothrombin time reflect synthetic function; ALT/AST reflect hepatocellular injury; cholestasis raises ALP and γ-GT.