Iraqi Board Clinical Pharmacy flashcards

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

Volume of distribution

Apparent volume relating the amount of drug in the body to its plasma concentration (Vd = dose/C0); a large Vd indicates extensive tissue distribution and limits removal by dialysis.

Clearance

Volume of plasma cleared of drug per unit time; determines the maintenance dose needed to achieve a target steady-state concentration, independent of dose size in first-order kinetics.

Michaelis-Menten kinetics

Saturable elimination described by rate = Vmax × C/(Km + C); at high concentrations clearance falls and small dose increases produce disproportionate rises in plasma level, as with phenytoin.

Therapeutic drug monitoring

Measurement of plasma drug concentrations for narrow-therapeutic-index drugs to individualize dosing; interpretation requires correct sampling time, steady state, and knowledge of interacting factors.

ARNI in heart failure

Sacubitril/valsartan replaces an ACE inhibitor in HFrEF to reduce mortality; a 36-hour washout is required when switching from an ACE inhibitor to avoid angioedema.

CHA2DS2-VASc score

Stroke risk score in atrial fibrillation: congestive failure, hypertension, age ≥75 (2 points), diabetes, stroke (2 points), vascular disease, age 65–74, female sex; guides anticoagulation.

Cockcroft-Gault equation

Estimates creatinine clearance from age, weight, and serum creatinine, with a 0.85 factor for women; used for renal drug dosing even though eGFR is used for CKD staging.

RAAS inhibitor monitoring

After starting an ACE inhibitor or ARB, check creatinine and potassium within 1–2 weeks; a creatinine rise up to 30% is acceptable, but greater rises warrant investigation.

Extended-interval aminoglycosides

Once-daily dosing uses high peaks for concentration-dependent killing and a low trough to reduce nephrotoxicity; monitor levels in renal impairment, obesity, and pregnancy.

Antimicrobial de-escalation

Narrowing empiric therapy once culture and susceptibility results are available, stopping redundant agents, and switching to oral therapy when clinically stable.

Surgical prophylaxis timing

Give a single preoperative antibiotic dose within 60 minutes of incision (vancomycin and fluoroquinolones within 120 minutes); redose for long procedures and stop within 24 hours.

Penicillin allergy delabeling

A detailed history identifies low-risk reactions; direct oral challenge or graded challenge can remove an inaccurate penicillin allergy label and reduce use of broader-spectrum antibiotics.

Metformin first-line therapy

First-line pharmacotherapy for type 2 diabetes unless contraindicated; SGLT2 inhibitors or GLP-1 receptor agonists are added when atherosclerotic cardiovascular disease, heart failure, or CKD is present.

Diabetic ketoacidosis management

Isotonic fluids, insulin infusion after potassium is at least 3.3 mmol/L, potassium replacement, and glucose monitoring; bicarbonate is reserved for pH below 6.9.

Levothyroxine administration

Take on an empty stomach 30–60 minutes before food and separate by 4 hours from calcium, iron, and proton pump inhibitors; titrate using TSH every 6–8 weeks.

Steroid equivalence

Hydrocortisone 20 mg equals prednisone 5 mg, methylprednisolone 4 mg, and dexamethasone 0.75 mg; prolonged use requires tapering to prevent adrenal insufficiency.

Asthma MART regimen

Maintenance and reliever therapy using low-dose inhaled corticosteroid-formoterol; SABA-only treatment is no longer recommended because undertreated inflammation increases exacerbation and death risk.

H. pylori quadruple therapy

A 14-day regimen of proton pump inhibitor, bismuth, tetracycline, and metronidazole, preferred where clarithromycin resistance is high; confirm eradication after treatment.

N-acetylcysteine for acetaminophen

Antidote for acetaminophen overdose, most effective within 8 hours of ingestion; the Rumack-Matthew nomogram guides treatment for acute single ingestions.

R ratio in liver injury

R = (ALT/upper limit of normal) ÷ (ALP/upper limit of normal); R ≥5 indicates hepatocellular, R ≤2 cholestatic, and 2–5 mixed drug-induced liver injury.

Serotonin syndrome

Life-threatening toxidrome with clonus, hyperreflexia, agitation, and hyperthermia after serotonergic drugs; stop offending agents, give benzodiazepines, and use cyproheptadine in severe cases.

Lithium therapeutic range

Trough level of 0.6–1.0 mmol/L drawn 12 hours after the dose; dehydration, NSAIDs, and thiazides raise levels and risk toxicity, so monitor renal and thyroid function.

Alcohol withdrawal treatment

Benzodiazepines are first-line, dosed by symptom-triggered CIWA-Ar scoring; thiamine is given before glucose to prevent Wernicke encephalopathy.

Febrile neutropenia

Fever with absolute neutrophil count below 500 cells/µL; start empiric antipseudomonal beta-lactam within 1 hour; add vancomycin for line infection or instability.

Tumor lysis syndrome

Metabolic emergency with hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia after rapid tumor breakdown; prevent with hydration and allopurinol or rasburicase.

Leucovorin rescue

Folinic acid given after high-dose methotrexate to bypass dihydrofolate reductase blockade and reduce toxicity; glucarpidase is used for toxic levels with renal impairment.

Heparin-induced thrombocytopenia

Immune-mediated platelet activation causing thrombocytopenia and thrombosis; stop heparin and start a non-heparin anticoagulant such as argatroban or fondaparinux.

Anion gap

Calculated as sodium minus chloride minus bicarbonate, normally 8–12 mmol/L; an elevated gap suggests ketoacidosis, lactic acidosis, renal failure, or toxin ingestion.

Corrected calcium

Measured calcium plus 0.8 × (4.0 − albumin in g/dL); ionized calcium is preferred in critical illness or when albumin is abnormal.

Number needed to treat

The reciprocal of the absolute risk reduction; it estimates how many patients must be treated to prevent one additional adverse outcome and depends on baseline risk.

Sensitivity and specificity

Sensitivity is the proportion of diseased patients testing positive; specificity is the proportion of nondiseased patients testing negative; predictive values also depend on disease prevalence.

Pharmacovigilance reporting

Systematic detection, assessment, and prevention of adverse drug reactions; serious, unexpected, and new-drug reactions are reported to the national center, with causality assessed by validated scales.