Kuwait MOH Pharmacist Exam cheat sheet

Beta-1 selective blockers (atenolol, metoprolol, bisoprolol) lower heart rate and myocardial oxygen demand; cardioselectivity is lost at high doses.

Heparin acts through antithrombin III, accelerating inactivation of thrombin and factor Xa; effect is monitored by aPTT and reversed by protamine sulfate.

Warfarin inhibits vitamin K epoxide reductase (VKORC1), reducing factors II, VII, IX, X and proteins C and S; monitored by INR and reversed by vitamin K1.

ACE inhibitors lower angiotensin II and aldosterone, causing hyperkalemia, and produce cough through bradykinin accumulation; ARBs do not cause cough.

Loop diuretics block the Na-K-2Cl cotransporter in the thick ascending limb; adverse effects include hypokalemia, hypocalcemia, hyperuricemia and ototoxicity.

Aminoglycosides are bactericidal, concentration-dependent killers that bind the 30S ribosomal subunit; nephrotoxicity and ototoxicity are dose-limiting.

First-order elimination removes a constant fraction of drug per unit time, so half-life is constant: t1/2 = 0.693/Ke.

Saturable (zero-order) kinetics occur with phenytoin, ethanol and high-dose salicylates; a constant amount is eliminated per unit time.

Oral bioavailability: F = (AUC oral / AUC IV) x (Dose IV / Dose oral).

Metformin is first-line for type 2 diabetes and is contraindicated in severe renal impairment (eGFR below 30 mL/min/1.73 m2) because of lactic acidosis risk.

Diabetic ketoacidosis: start with isotonic saline, add an IV insulin infusion, and give potassium when serum K is below 5.2 mEq/L with adequate urine output.

Heart failure with reduced ejection fraction: ARNI or ACE inhibitor + beta-blocker + mineralocorticoid receptor antagonist + SGLT2 inhibitor each reduce mortality.

Warfarin target INR is 2.0-3.0 for atrial fibrillation and venous thromboembolism, and 2.5-3.5 for mechanical mitral valves.

Total phenytoin therapeutic range is 10-20 mcg/mL; correct for hypoalbuminemia using the Sheiner-Tozer equation because free drug drives toxicity.

Lithium maintenance range is 0.6-1.2 mEq/L; toxicity shows coarse tremor, ataxia, vomiting and confusion, with renal and thyroid monitoring required.

Uncomplicated cystitis: nitrofurantoin for 5 days or trimethoprim-sulfamethoxazole for 3 days; fluoroquinolones are reserved for resistant cases.

Statin-associated muscle symptoms: check CK when symptoms are severe; risk increases with fibrates, macrolides and ciclosporin.

A legal prescription includes patient identifiers, date, drug name, strength, dose, route, frequency, duration, quantity, and prescriber signature with license number.

Avoid error-prone abbreviations: write 'units' instead of 'U', 'daily' instead of 'qd', specify 'morphine sulfate', and never use trailing zeros (write 5 mg, not 5.0 mg).

High-alert medicines include insulin, heparin, opioids, concentrated potassium chloride and chemotherapy; they need independent double-checks and separate storage.

Tall man lettering (DOBUTamine versus DOPamine) highlights look-alike/sound-alike names to reduce selection errors.

Medication reconciliation formally compares the pre-admission medication list with current orders at admission, transfer and discharge.

Inhaler counselling: shake, exhale fully, actuate at the start of a slow deep inhalation, hold breath about 10 seconds, rinse mouth after inhaled corticosteroids, use a spacer if needed.

Dispensing sequence: confirm legality and authenticity, screen for allergy, duplication, interaction, dose and renal function, then label, record and counsel.

Unit-dose distribution and automated dispensing cabinets reduce errors by limiting floor stock and improving traceability.

First-order degradation shelf life: t90 = 0.105/k; zero-order degradation: t90 = 0.1 x C0/k0.

Arrhenius equation: log k = log A - Ea/(2.303RT); a 10 degrees Celsius rise roughly doubles to triples the degradation rate.

Bioequivalence requires the 90% confidence intervals of the AUC and Cmax ratios to fall within 0.80-1.25 of the reference product.

Noyes-Whitney: dissolution rate is proportional to surface area and to (Cs - C) and inversely proportional to diffusion layer thickness; micronization increases dissolution.

Tablet excipients: diluent (lactose), binder (PVP), disintegrant (croscarmellose sodium), lubricant (magnesium stearate), glidant (colloidal silicon dioxide).

Hydrophilic matrix tablets (HPMC) release drug by diffusion and erosion; osmotic pump systems deliver zero-order release.

Cocoa butter melts at 30-36 degrees Celsius; PEG suppository bases dissolve in rectal fluid and are preferred in hot climates.

Percentage conversions: 1% w/v = 10 mg/mL; 1:1000 solution = 1 mg/mL.

Beta-lactam activity depends on the strained lactam ring acylating penicillin-binding proteins; ring opening or beta-lactamase hydrolysis abolishes activity.

Sulfonamide SAR requires a free para-amino group and an unsubstituted sulfonamide nitrogen; the drugs inhibit dihydropteroate synthase in folate synthesis.

Prodrug examples: enalapril to enalaprilat, simvastatin lactone to hydroxy acid, codeine to morphine via CYP2D6.

Ester local anesthetics (procaine, benzocaine) are hydrolyzed by plasma esterases and may cause PABA-related allergy; amide agents are more stable and hepatically metabolized.

S-warfarin is about 3-5 times more potent than R-warfarin and is metabolized by CYP2C9, the main site of interaction; S-propranolol is also more active.

Catecholamines are inactivated by COMT and MAO; N-methylation increases oral activity and CNS penetration, as in pseudoephedrine.

Aspirin irreversibly acetylates COX-1; hydrolysis of the ester yields salicylic acid and acetic acid.

Henderson-Hasselbalch: pH = pKa + log([A-]/[HA]) for weak acids; the ionized species is poorly absorbed across lipid membranes.

Medicines must be registered with the Kuwait Ministry of Health (Kuwait Drug and Food Control Administration) before import, promotion or sale.

Pharmacies require a Ministry of Health licence, and only licensed pharmacists may dispense or supervise dispensing.

Narcotic and controlled drug prescriptions are not refillable and require dedicated register entries available for inspection.

Before dispensing, the pharmacist must confirm prescription authenticity, the prescriber's licence and legal validity of the order.

Generic substitution is permitted only where regulations allow, with appropriate prescriber and patient communication; unauthorized brand substitution is not allowed.

Patient information is confidential; disclosure requires patient consent or a clear legal obligation.

Suspected adverse drug reactions and quality defects must be reported to the national pharmacovigilance and regulatory authority.

Advertising prescription-only medicines to the public is prohibited; promotion must be accurate, balanced and evidence-based.

Expired, recalled or damaged stock is quarantined and destroyed according to authority-approved procedures.

Moist heat sterilization: 121 degrees Celsius at 15 psi for 15-20 minutes, with Bacillus stearothermophilus spores as the biological indicator.

Dry heat uses 160 degrees Celsius for 2 hours; ethylene oxide and gamma irradiation suit heat-labile items.

0.22 micrometer membrane filters sterilize heat-labile solutions; 0.45 micrometer filters only clarify and do not guarantee sterility.

Hazardous and cytotoxic drugs are prepared in a Class II biological safety cabinet; non-hazardous sterile products in a laminar airflow hood.

Aseptic technique: hand hygiene, sterile gloves, 70% isopropyl alcohol disinfection of stoppers and necks, no-touch technique, and no disruption of unidirectional airflow.

Beyond-use dates: nonaqueous compounded preparations up to 180 days; water-containing oral preparations 14 days refrigerated; water-containing topical preparations 30 days.

Preservative-free sterile products are required for intrathecal, intraocular and neonatal use.

Sterility testing incubates for 14 days; visual inspection checks for particulates, discoloration, leaks and container-closure integrity.

MRSA resistance is mediated by mecA, which encodes PBP2a with reduced beta-lactam affinity.

Digitalis purpurea leaf yields digitoxin and digoxin, cardiac glycosides that inhibit Na+/K+-ATPase and raise intracellular calcium and contractility.

Atropa belladonna yields atropine and hyoscyamine, tropane alkaloids that competitively block muscarinic receptors.

Papaver somniferum yields morphine and codeine (opioid agonists) plus papaverine, a smooth-muscle relaxant acting independently of opioid receptors.

Cinchona bark yields quinine (antimalarial) and quinidine (antiarrhythmic), both quinoline alkaloids.

Taxus brevifolia gives paclitaxel and Catharanthus roseus gives vincristine and vinblastine; all are antimitotic tubulin-binding agents.

Alkaloids are basic nitrogen-containing plant compounds precipitated by Dragendorff, Mayer and Wagner reagents.

A cardiac glycoside consists of an aglycone (genin) plus sugar; the aglycone determines activity and the sugar improves solubility and binding.

Senna anthraquinone glycosides are hydrolyzed by colonic flora to rhein anthrone, which stimulates colonic motility.