CMCC External Pharmacist Exam cheat sheet

Prescription validity elements: prescriber name, license/registration number, date, patient identifiers, drug name, strength, dosage form, quantity, directions, and signature; a missing legal element makes the order non-dispensable until verified with the prescriber.

Dispensing workflow order: receive and screen the order, verify legality and clinical appropriateness, interpret and calculate, compound or select product, label, perform a final check, then counsel and document.

The 'rights' of dispensing: right patient, right drug, right dose, right route, right time, right dosage form, right documentation, and right to refuse.

Percentage concentration rules: %w/v = g per 100 mL, %v/v = mL per 100 mL, %w/w = g per 100 g; converting between w/w and w/v requires the density of the preparation.

Ratio strength conversion: 1:1000 = 0.1% w/v; 1:10,000 = 0.01% w/v; 1:100 = 1% w/v, so divide 100 by the ratio denominator to obtain percent.

Alligation for mixing two strengths: ratio of parts taken = (higher % − desired %) : (desired % − lower %); use it for dilutions, triturations, and IV admixture adjustments.

A prescription is legally a controlled substance order only if it contains the prescriber's manual or permitted electronic signature, the patient's full name and address, and the drug name, strength, dosage form, quantity, and directions.

Reconstituted oral suspensions: record the reconstitution date and beyond-use date on the label, and instruct the patient on refrigeration and the discard date.

Beta-lactam mechanism: acylation of penicillin-binding proteins blocks peptidoglycan cross-linking; bactericidal and time-dependent killing, so the fraction of time above MIC (fT>MIC) drives efficacy.

Aminoglycosides bind the bacterial 30S ribosomal subunit, are concentration-dependent killers, and are nephrotoxic and ototoxic; monitor trough concentrations and renal function.

Warfarin inhibits vitamin K epoxide reductase, reducing synthesis of factors II, VII, IX, and X; onset takes several days because existing factors must decay; monitor INR.

Heparin accelerates antithrombin III activity, prolonging aPTT; protamine sulfate reverses it; low-molecular-weight heparins have more predictable kinetics and are monitored with anti-Xa when needed.

ACE inhibitors reduce angiotensin II formation and increase bradykinin, causing dry cough and angioedema; ARBs avoid bradykinin accumulation and are alternatives when cough occurs.

Metformin decreases hepatic gluconeogenesis and improves insulin sensitivity; it does not cause hypoglycemia alone but carries a risk of lactic acidosis in severe renal impairment.

Corticosteroids act on cytoplasmic glucocorticoid receptors to alter gene transcription, suppressing inflammatory mediators; long-term use causes osteoporosis, hyperglycemia, and adrenal suppression on abrupt withdrawal.

Opioid analgesia acts on mu receptors, causing respiratory depression, constipation, and tolerance; naloxone is a competitive antagonist used for overdose reversal.

Arrhenius degradation: k = A·e^(−Ea/RT); a 10 °C rise typically increases degradation rate 2–3 fold, so shelf-life shortens correspondingly.

First-order drug degradation: ln(Ct/C0) = −kt; half-life t½ = 0.693/k and is independent of initial concentration.

Zero-order degradation: Ct = C0 − kt; half-life t½ = C0/(2k) and depends on the starting concentration.

pH-rate profile: ester hydrolysis is catalyzed by both hydrogen and hydroxide ions, giving a U-shaped stability curve with a pH of maximum stability for each drug.

Excipient roles: diluents add bulk, binders promote granulation, disintegrants aid tablet breakup, glidants improve powder flow, and lubricants reduce die-wall friction.

Suspension stability is governed by Stokes' law: sedimentation rate is proportional to particle diameter squared and to density difference, and inversely proportional to vehicle viscosity.

Ointment bases: hydrocarbon (oleaginous), absorption (anhydrous lanolin), water-removable (emulsifying), and water-soluble (PEG) bases differ in occlusion, washability, and drug release.

Prodrug design masks a polar group to improve absorption or targeting; the active drug is released by enzymatic or chemical conversion after administration.

Pharmacist duties: dispense only on a valid order, verify and intervene on clinically inappropriate therapy, maintain records, protect patient confidentiality, and report adverse drug reactions.

Controlled substance schedules: schedule I drugs have no accepted medical use; schedules II–V have accepted medical use with decreasing abuse potential and increasing refill allowance.

Prescription retention and record-keeping requirements differ by jurisdiction and by schedule; refill limits, partial fills, and emergency oral orders follow specific legal rules.

Ethical principles: beneficence (act in the patient's interest), non-maleficence (avoid harm), autonomy (respect informed choice), justice (fair access), and confidentiality.

Informed consent requires capacity, disclosure of material risks and alternatives, comprehension, and voluntariness; it may be withdrawn at any time.

Errors and near misses are reported through non-punitive incident reporting systems; disclosure to the patient and documentation are professional obligations.

Conflict of interest: gifts or incentives that could bias therapeutic recommendations should be declined or disclosed, and prescribing decisions must rest on clinical evidence.

Scope of practice: tasks delegated to pharmacy technicians must be within their legal competence, with the pharmacist retaining responsibility for final verification and counseling.

Alkaloids are nitrogen-containing basic plant compounds; examples include morphine from opium poppy, quinine from Cinchona bark, atropine from Atropa belladonna, and caffeine from tea and coffee.

Cardiac glycosides (digoxin from Digitalis lanata) contain a steroid nucleus with a lactone ring; they inhibit Na+/K+-ATPase and have a narrow therapeutic index.

Flavonoids and tannins are polyphenolic; tannins precipitate proteins and are astringent, while flavonoids contribute antioxidant and vascular effects.

Essential oils are volatile terpenoid mixtures obtained by distillation; they are stored in tightly closed, light-resistant containers because they oxidize and evaporate.

Gums and mucilages are polysaccharide hydrocolloids that swell in water; acacia and tragacanth are used as emulsifiers and suspending agents.

Standardization of herbal material uses a marker compound or biological assay to ensure batch-to-batch consistency, since plant content varies with species, season, and harvest.

Herb–drug interactions: St John's wort induces CYP3A4 and P-glycoprotein, reducing concentrations of many drugs; ginkgo and garlic may increase bleeding risk with anticoagulants.

Resins and oleoresins are hydrophobic plant exudates; examples include colophony and capsicum oleoresin, used topically for counterirritant effects.

Bioavailability: F = (AUCoral × DoseIV)/(AUCIV × Doseoral); absolute F compares an extravascular dose with IV, relative F compares two extravascular products.

Volume of distribution: Vd = Dose/C0; a large Vd indicates extensive tissue distribution, and Vd links dose to loading dose (Loading dose = Vd × target concentration).

Clearance: CL = Dose/AUC = k × Vd; steady-state concentration on repeated dosing is Css = (F × Dose)/(CL × τ).

Half-life: t½ = 0.693 × Vd/CL; it determines the time to steady state (about 4–5 half-lives) and the accumulation ratio.

First-pass metabolism reduces oral bioavailability when drug is extracted by gut wall or liver before reaching systemic circulation; it explains low oral F for drugs such as lidocaine.

Renal clearance: CLr = (Urine concentration × Urine flow)/Plasma concentration; it reflects filtration, secretion, and reabsorption.

Absorption rate constant ka and elimination rate constant k govern the plasma profile; the elimination rate is first-order when a constant fraction is removed per unit time.

Zero-order (saturable) elimination occurs when enzymes or transporters are saturated, so a constant amount is eliminated per unit time and concentrations rise disproportionately with dose.

Counseling structure: confirm patient identity, state the drug name and purpose, explain dose, timing, and duration, review key adverse effects and what to do, then confirm understanding with teach-back.

Asthma inhaler technique: shake, exhale fully, seal lips, actuate at the start of a slow deep inhalation, hold breath about 10 seconds, and rinse the mouth after inhaled corticosteroids.

Warfarin counseling: consistent vitamin K intake, INR monitoring schedule, bleeding warning signs, and interaction checks with antibiotics, NSAIDs, and herbal products.

Antibiotic adherence: complete the prescribed course, space doses evenly, and report severe diarrhea, rash, or signs of allergy; missed doses are taken when remembered unless near the next dose.

Diabetes counseling: recognize hypoglycemia symptoms (sweating, tremor, confusion), carry fast-acting carbohydrate, rotate injection sites, and store insulin correctly.

Adverse drug reaction assessment uses causality tools such as the Naranjo scale and considers temporal relationship, dechallenge, rechallenge, and alternative causes.

Therapeutic drug monitoring applies to drugs with narrow therapeutic index and good concentration–effect correlation, such as digoxin, phenytoin, lithium, and vancomycin.

Medication reconciliation: obtain a best possible medication history, compare it with prescribed orders at transitions of care, and resolve discrepancies before discharge.