Israel Pharmacist Licensing Exam flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Therapeutic index

Ratio of the toxic dose (TD50) to the effective dose (ED50). A narrow index, as with warfarin, digoxin, lithium, and phenytoin, means small blood-level changes can cause toxicity and justify therapeutic drug monitoring.

Competitive antagonist

A ligand that binds reversibly at the same site as the agonist and shifts the dose-response curve to the right without lowering maximal effect. Higher agonist concentrations can overcome the block, unlike non-competitive antagonism.

CYP3A4 inhibition

Azole antifungals, macrolides, ritonavir, and grapefruit juice inhibit this enzyme and rapidly raise levels of substrates such as statins, ciclosporin, and calcium-channel blockers, increasing toxicity risk within days of starting the inhibitor.

Lipinski rule of five

Predicts oral bioavailability: molecular weight at or below 500, logP at or below 5, no more than 5 hydrogen-bond donors, and no more than 10 acceptors. Two or more violations predict poor absorption.

Prodrug

An inactive derivative converted in the body to the active drug, usually by hydrolysis or hepatic metabolism. Examples include enalapril to enalaprilat, oseltamivir to its carboxylate, and clopidogrel to its thiol metabolite.

Bioisosteric replacement

Substituting a group with similar size and electronic properties, such as hydroxyl for amino or methyl for chlorine, to preserve receptor binding while improving metabolic stability, solubility, or potency during lead optimization.

S-warfarin potency

The S-enantiomer of warfarin is three to five times more potent as a vitamin K antagonist than the R form and is metabolized mainly by CYP2C9, so CYP2C9 inhibitors and polymorphisms strongly affect INR.

BCS Class II

Low solubility and high permeability. Absorption is limited by dissolution rate, so particle-size reduction, salts, or amorphous forms improve bioavailability, and in-vitro–in-vivo correlation is most reliable for these drugs.

Noyes-Whitney equation

Describes dissolution rate as proportional to surface area and drug solubility and inversely related to particle size and diffusion-layer thickness. It explains why micronization and surfactants increase dissolution of poorly soluble drugs.

Hausner ratio

Tapped bulk density divided by bulk density. Values below 1.25 indicate good powder flow, values above 1.5 indicate poor flow, which affects tablet weight uniformity and content uniformity during compression.

Dose dumping

Rapid release of the entire dose from a modified-release product when the release mechanism is disrupted by crushing, splitting, or alcohol, risking toxicity. It is the main safety concern with such dosage forms.

Half-life formula

For first-order elimination, half-life equals 0.693 multiplied by volume of distribution divided by clearance. It determines time to steady state, roughly four to five half-lives, and the washout period after stopping.

Volume of distribution

Apparent volume calculated as dose divided by extrapolated initial concentration. Values above about 1 L/kg indicate extensive tissue binding, as with digoxin and chloroquine, and predict poor removal by hemodialysis.

Loading dose calculation

Loading dose equals volume of distribution times target concentration divided by bioavailability. It rapidly achieves therapeutic levels when the half-life is long, while the maintenance dose depends on clearance instead.

Vancomycin AUC target

For serious MRSA infection, the recommended target is AUC24/MIC between 400 and 600, estimated by Bayesian software. Trough-only monitoring of 10-15 mg/L is an alternative when AUC tools are unavailable.

Phenytoin saturable metabolism

Phenytoin follows Michaelis-Menten kinetics, so a modest dose increase can cause a disproportionate serum-level rise and toxicity. Free phenytoin should be measured when albumin is low.

Pharmacists' Ordinance

The Israeli statute, Pekudat HaRokechim, that governs pharmacist licensure, pharmacy permits, and dispensing. The Ministry of Health Pharmaceutical Division administers it through district health offices.

Dangerous Drugs Ordinance

Israeli law controlling narcotics and psychotropics. It requires special prescription forms, secure storage, documented receipt and dispensing records, and reporting of discrepancies to the Ministry of Health.

Patient confidentiality duty

Under the Patient's Rights Law of 1996, pharmacists must protect patient information. Disclosure without consent is allowed only for defined exceptions such as a court order, statutory reporting, or immediate danger to others.

Look-alike sound-alike pairs

Name pairs easily confused, such as Losec and Lasix, hydralazine and hydroxyzine, or glipizide and glyburide. Verify by spelling back and confirming the indication, especially for telephone orders.

Medication reconciliation

A structured comparison of a patient's medicines before admission, during transfer, and at discharge to identify duplications, omissions, and dose changes. It reduces preventable adverse events at care transitions.

High-alert medications

Drugs carrying heightened risk of serious harm when misused, including concentrated electrolytes, insulin, heparin, opioids, neuromuscular blockers, and chemotherapy. Independent double-checks and standardized concentrations reduce errors.

Naranjo adverse reaction scale

A validated ten-item score estimating the probability that a drug caused an adverse event, classifying it as definite, probable, possible, or doubtful. It supports causality assessment before reporting to pharmacovigilance.

Beers criteria

A list of medicines potentially inappropriate in adults over 65, including benzodiazepines, long-acting sulfonylureas, first-generation antihistamines, and anticholinergics, because they increase falls, confusion, and hypoglycemia.

Cockcroft-Gault creatinine clearance

Estimates renal function from age, weight, sex, and serum creatinine for drug dosing. It is preferred over eGFR for adjusting renally cleared drugs such as metformin, nitrofurantoin, and aminoglycosides.

Monoclonal antibody suffix

The stem -mab denotes a monoclonal antibody. Prefixes indicate origin: -omab mouse, -ximab chimeric, -zumab humanized, and -mumab fully human, which helps predict immunogenicity risk.

Biosimilar approval basis

A biologic approved through comparability with a reference product using analytical, functional, nonclinical, and clinical similarity data. It is not a generic small molecule, and immunogenicity is monitored after approval.

Vaccine cold chain

The temperature-controlled storage and transport system keeping most vaccines at 2-8 degrees Celsius without freezing. mRNA vaccines need stricter frozen conditions, and excursions are assessed against manufacturer stability data.

ISO Class 5 hood

The laminar-airflow critical zone in which sterile compounding occurs, providing first air over critical sites. The surrounding buffer room is ISO 7 and the ante-room ISO 8 under USP 797 principles.

USP 797 risk levels

Low-risk compounding uses fewer than three sterile products with closed transfer, medium-risk involves multiple additives or pooling, and high-risk uses non-sterile starting materials or open systems. Risk level determines beyond-use dating.

Hazardous drug handling

USP 800 requires closed-system transfer devices, a biological safety cabinet or containment ventilated enclosure, chemotherapy-rated double gloves, gowns, and surface decontamination to limit occupational exposure to hazardous medicines.

Herd immunity threshold

The proportion of a population that must be immune to interrupt transmission, calculated as 1 minus 1/R0. Measles with an R0 of 12-18 needs roughly 92-95 percent two-dose coverage.