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Greek Pharmacist License study materials
Greek Pharmacist License study resources

Greek Pharmacist License: Pharmacotherapy and Clinical Pharmacy

Greek Pharmacist License · Work through your exam, one topic at a time.

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Pharmacotherapy and Clinical Pharmacy

This domain tests the application of guideline-based therapy to individual patients, with emphasis on treatment targets, drug selection, dose individualisation in renal and hepatic impairment, and monitoring. Questions are usually short clinical vignettes.

Core guideline targets

  • Hypertension (ESC/ESH): treat to below 140/90 mmHg initially, and to 130/80 mmHg if tolerated, especially under 65 years. First-line combinations pair an ACE inhibitor or ARB with a calcium channel blocker or a thiazide-like diuretic. Never combine an ACE inhibitor with an ARB.
  • Type 2 diabetes: metformin remains first line; add an SGLT2 inhibitor or GLP-1 receptor agonist early when atherosclerotic cardiovascular disease, heart failure or chronic kidney disease is present.
  • Asthma (GINA): short-acting beta-2 agonist monotherapy is no longer recommended; low-dose inhaled corticosteroid-formoterol as reliever and controller is preferred.
  • Atrial fibrillation: anticoagulate when CHA2DS2-VASc is 2 or more in men and 3 or more in women; direct oral anticoagulants are preferred except with mechanical valves or moderate-to-severe mitral stenosis. HAS-BLED guides monitoring, not withholding therapy.

Dose individualisation

  • Cockcroft–Gault uses actual body weight and serum creatinine for drug dosing; CKD-EPI eGFR is used for staging chronic kidney disease. Most renal dosing tables are based on Cockcroft–Gault.
  • Hepatic impairment is graded by Child–Pugh; a high extraction ratio drug loses first-pass metabolism and may become more bioavailable.
  • Therapeutic drug monitoring is standard for digoxin, lithium, phenytoin, valproate, aminoglycosides, vancomycin and ciclosporin.

Worked example

A 72-year-old woman weighing 65 kg has serum creatinine 1.2 mg/dL. Calculate creatinine clearance. Cockcroft–Gault: CrCl = [(140 − 72) × 65] / (72 × 1.2) × 0.85. Numerator 68 × 65 = 4420; denominator 86.4; quotient 51.2 mL/min; multiplied by 0.85 gives 43.5 mL/min. Reasoning: 43.5 mL/min is moderate renal impairment, so renally cleared drugs such as metformin, gabapentin or many antibiotics need dose reduction, and some are contraindicated.

Traps that cost marks

Using eGFR interchangeably with Cockcroft–Gault for drug labelling; forgetting that apixaban dosing uses age, weight and creatinine criteria rather than a single clearance threshold; treating asymptomatic bacteriuria in the elderly; missing that a supratherapeutic INR after starting an antibiotic is an interaction, not non-adherence.