Mongolia Pharmacist Licensing Exam cheat sheet

Henderson–Hasselbalch: pH = pKa + log([base]/[acid]); a weak acid is 50% ionized when pH = pKa, and each pH unit above pKa raises the ionized fraction tenfold.

Ionization controls distribution: acidic drugs (e.g., salicylates, NSAIDs) are largely unionized and better absorbed in gastric acid; basic drugs ionize in the stomach and are absorbed mainly in the small intestine.

Lipinski rule of five for oral drug-likeness: MW ≤ 500, logP ≤ 5, hydrogen-bond donors ≤ 5, hydrogen-bond acceptors ≤ 10; violation of two or more flags poor oral absorption.

Bioisosterism replaces a group with one of similar size, electronics, and hydrogen-bonding (e.g., –OH/–NH2, –Cl/–CF3, –O–/–S–) to retain activity while altering metabolism or solubility.

Prodrugs are inactive derivatives converted in vivo to the active drug; ester prodrugs (e.g., enalapril to enalaprilat, aspirin to salicylate) improve absorption or prolong action.

Chirality matters: enantiomers share physicochemical properties but differ in receptor affinity and metabolism; thalidomide's (R)-enantiomer is sedating while the (S)-enantiomer is teratogenic.

Phase I metabolism (oxidation, reduction, hydrolysis via CYP450) usually inactivates drugs and can create reactive metabolites; phase II conjugation (glucuronidation, sulfation, acetylation, glutathione) increases water solubility for excretion.

CYP3A4 metabolizes roughly half of marketed drugs; inhibitors (ketoconazole, erythromycin, grapefruit components) raise substrate levels, while inducers (rifampicin, carbamazepine, St John's wort) lower them.

Structure–activity relationships map chemical features to potency: adding halogen or alkyl groups increases lipophilicity and often potency, but excessive logP reduces solubility and raises metabolic liability.

Morphine and codeine are opium alkaloids from Papaver somniferum; morphine content is highest in the unripe capsule latex, and codeine is the 3-O-methyl derivative.

Atropine and scopolamine come from Atropa belladonna and Datura species; they are tropane alkaloids acting as muscarinic antagonists, and overdose causes anticholinergic toxicity (dry mouth, mydriasis, delirium).

Digoxin is a cardiac glycoside from Digitalis lanata; it inhibits Na+/K+-ATPase, and the therapeutic index is narrow (target trough roughly 0.5–1.0 ng/mL).

Quinine and quinidine are cinchona bark alkaloids; quinine treats malaria and quinidine is an antiarrhythmic, and cinchonism (tinnitus, headache, visual disturbance) signals toxicity.

Artemisinin from Artemisia annua is a sesquiterpene lactone antimalarial activated by its endoperoxide bridge; it is combined with a partner drug (ACT) to prevent resistance.

Ginkgo biloba leaf extracts (flavone glycosides, terpene lactones) are linked to bleeding risk with anticoagulants; St John's wort (Hypericum perforatum) induces CYP3A4 and reduces efficacy of many drugs.

Standardization expresses marker-compound content (e.g., % w/w of a named constituent) rather than total biological activity, so two standardized extracts are not automatically interchangeable.

Alkaloid extraction exploits base solubility: plant material is basified so free alkaloids become lipid-soluble for organic extraction, then re-extracted into acidified water as salts.

Essential oils are volatile terpenoid mixtures obtained by steam or hydrodistillation; they are stored in tightly closed, light-protected containers because oxidation and resinification degrade them.

Bioavailability F = (AUC_oral × Dose_IV) / (AUC_IV × Dose_oral); the absolute value compares an extravascular route with intravenous dosing.

Noyes–Whitney dissolution rate rises with surface area and solubility and falls with particle size; micronization or salt formation is used to speed dissolution of poorly soluble drugs.

First-pass hepatic metabolism reduces oral bioavailability; routes bypassing it include intravenous, sublingual, buccal, rectal (partly), and transdermal.

Suspensions require a suspending agent (e.g., methylcellulose, xanthan gum) to slow sedimentation; a flocculated system settles fast but redisperses easily, while a deflocculated one settles slowly but can cake.

Emulsions are stabilized by surfactants lowering interfacial tension; o/w emulsions are used for oral and topical delivery of lipophilic drugs, and phase inversion or creaming signals instability.

Sterile products: autoclaving at 121 °C for 15–20 minutes at 15 psi is standard terminal sterilization; heat-labile solutions require filtration through a 0.22 µm membrane.

Compounding calculations: % w/v = g per 100 mL, % w/w = g per 100 g, and ratio strength 1:1000 equals 0.1% w/v; alligation mixes two strengths to reach a target concentration.

Isotonicity: a 0.9% w/v sodium chloride solution is isotonic with plasma; the sodium chloride equivalent method converts a drug's osmotic contribution to an equivalent mass of NaCl.

Shelf life and stability: hydrolysis is accelerated by water and heat, oxidation by light and oxygen, so antioxidants (e.g., sodium metabisulfite) and amber glass are used accordingly.

Receptor theory: Kd is the concentration giving half-maximal occupancy, and a competitive antagonist shifts the agonist dose–response curve right without lowering the maximum response.

Pharmacokinetic equations: t1/2 = 0.693 × Vd / CL, and loading dose = (Vd × target concentration) / F; maintenance dose = (CL × target concentration × dosing interval) / F.

Steady state is reached after about four to five half-lives with constant dosing; a loading dose is used when the drug's half-life is long and rapid effect is needed.

Antihypertensives: ACE inhibitors reduce angiotensin II and raise bradykinin (cough, angioedema); ARBs avoid bradykinin effects; both are contraindicated in pregnancy.

Anticoagulation: warfarin inhibits vitamin K epoxide reductase (monitor INR), while direct oral anticoagulants inhibit factor Xa or thrombin and need no routine INR monitoring.

Antibiotic principles: aminoglycosides and fluoroquinolones are concentration-dependent killers; beta-lactams and vancomycin are time-dependent, so the fraction of time above MIC drives efficacy.

Diabetes: metformin lowers hepatic glucose output and is first-line in type 2 diabetes; it carries a risk of lactic acidosis in renal impairment and is withheld before contrast imaging.

Asthma and COPD: short-acting beta-2 agonists relieve acute bronchospasm; inhaled corticosteroids control airway inflammation and must be used regularly, with mouth rinsing to prevent oral candidiasis.

Opioid and paracetamol safety: opioids cause respiratory depression reversed by naloxone; paracetamol overdose depletes glutathione, and N-acetylcysteine restores it.

The pharmaceutical care process follows assessment, care plan, and follow-up: identify drug-related problems, set goals, then monitor outcomes and adherence.

A prescription must be legally complete: prescriber name and signature, patient identifiers, drug name, strength, dosage form, dose, frequency, duration, and date.

Counselling essentials for a new medicine: name and purpose, how and when to take it, expected benefit and time to onset, common and serious adverse effects, and what to do if a dose is missed.

High-alert medications (insulin, heparin, concentrated potassium chloride, chemotherapy, opioids) require independent double-checks and clear labeling to prevent harm.

Antimicrobial stewardship: confirm indication, choose the narrowest effective agent, use correct dose and duration, and counsel on completing the prescribed course.

Adherence support uses the fewest daily doses, simplified regimens, pill organizers, reminders, and addressing specific barriers such as cost, side effects, or health literacy.

Inhaler technique teaching: shake the device, exhale fully, actuate during a slow deep breath, hold the breath about 10 seconds, and rinse the mouth after corticosteroid inhalers.

Medication reconciliation compares the pre-admission list with current orders at admission, transfer, and discharge to catch omissions, duplications, and dose errors.

Mongolia regulates medicines under its national law on medicines and medical devices, administered by the Ministry of Health and the state agency responsible for health-sector regulation.

Marketing authorization requires demonstrated quality, safety, and efficacy; the manufacturer submits a dossier, and the regulator may accept or require local testing before approval.

Narcotic, psychotropic, and precursor substances are controlled under separate stricter rules with special prescribing, dispensing, storage, and record-keeping obligations.

Prescription-only versus over-the-counter status determines dispensing: prescription medicines are dispensed only on a valid prescription, while OTC products may be sold directly with counselling.

Pharmacist registration and licensing: practicing pharmacists must hold recognized qualifications and a valid license, and unlicensed practice is prohibited.

Pharmacovigilance obligations: license holders and health professionals report suspected serious adverse reactions to the national pharmacovigilance authority within the required timeframe.

Ethical duties include patient confidentiality, informed consent, avoiding conflicts of interest, refusing to dispense falsified or substandard products, and reporting suspected counterfeit medicines.

Advertising and promotion of prescription medicines to the public is restricted; promotion must be accurate, evidence-based, and free of misleading claims.

Record retention: prescriptions and controlled-drug transaction records must be kept for the period set by regulation and made available for inspection.

Pharmacoeconomic analysis types: cost-minimization (equal outcomes), cost-effectiveness (cost per natural unit such as life-year gained), cost-utility (cost per QALY), and cost-benefit (monetary outcomes).

Incremental cost-effectiveness ratio ICER = (Cost_new − Cost_old) / (Effect_new − Effect_old); a new therapy is 'dominant' when it costs less and works better.

ABC/VEN analysis classifies stock by value (A items are the small number of high-cost lines) and by vital, essential, or non-essential status to prioritize procurement.

Inventory control: safety stock covers demand variability and lead time; reorder point = average daily demand × lead time + safety stock.

Economic order quantity EOQ = √(2DS/H), where D is annual demand, S is ordering cost, and H is holding cost per unit per year.

Cold chain integrity requires validated storage and transport at 2–8 °C for refrigerated vaccines and biologics, with continuous temperature monitoring and documented excursions.

Good distribution practice: stock rotation with first-expiry-first-out, segregated quarantine areas for damaged or recalled stock, and full batch traceability.

Procurement transparency: competitive tendering, published selection criteria, and conflict-of-interest declarations reduce corruption in medicine purchasing.

Budget impact analysis estimates total affordability of adopting a therapy across the covered population, distinct from cost-effectiveness per patient.

Adverse drug reaction types: type A are dose-dependent and predictable (e.g., bleeding with warfarin), type B are idiosyncratic and unpredictable (e.g., anaphylaxis with penicillin).

Seriousness criteria: death, life-threatening, hospitalization or prolongation, persistent disability, congenital anomaly, or a medically important event; severity and seriousness are not the same.

Causality assessment uses structured tools such as WHO-UMC or Naranjo scoring, grading the link between drug and event as certain, probable, possible, unlikely, or unassessable.

The Uppsala Monitoring Centre maintains the global individual case safety report database; signals are detected by disproportionate reporting analysis, not proof of causation.

Poisoning management: activated charcoal within about one hour for many ingestions, antidotes where available (N-acetylcysteine for paracetamol, naloxone for opioids, flumazenil for benzodiazepines), and supportive care.

Antidote pairs to memorize: organophosphates–atropine plus pralidoxime, methanol or ethylene glycol–fomepizole or ethanol, iron–deferoxamine, cyanide–hydroxocobalamin.

Toxicokinetics: dialysis removes low-molecular-weight, low-protein-bound, low-volume-of-distribution drugs such as lithium, methanol, and salicylates.

Teratogen counselling: known human teratogens include isotretinoin, methotrexate, warfarin, valproate, and ACE inhibitors; pregnancy-prevention programs apply to the highest-risk drugs.

Medication error reporting is non-punitive and focuses on system failures (look-alike labels, ambiguous abbreviations) rather than individual blame.

Henderson–Hasselbalch: pH = pKa + log([base]/[acid]); a weak acid is 50% ionized when pH = pKa, and each pH unit above pKa raises the ionized fraction tenfold.

Ionization controls distribution: acidic drugs (e.g., salicylates, NSAIDs) are largely unionized and better absorbed in gastric acid; basic drugs ionize in the stomach and are absorbed mainly in the small intestine.

Lipinski rule of five for oral drug-likeness: MW ≤ 500, logP ≤ 5, hydrogen-bond donors ≤ 5, hydrogen-bond acceptors ≤ 10; violation of two or more flags poor oral absorption.

Bioisosterism replaces a group with one of similar size, electronics, and hydrogen-bonding (e.g., –OH/–NH2, –Cl/–CF3, –O–/–S–) to retain activity while altering metabolism or solubility.

Prodrugs are inactive derivatives converted in vivo to the active drug; ester prodrugs (e.g., enalapril to enalaprilat, aspirin to salicylate) improve absorption or prolong action.

Chirality matters: enantiomers share physicochemical properties but differ in receptor affinity and metabolism; thalidomide's (R)-enantiomer is sedating while the (S)-enantiomer is teratogenic.

Phase I metabolism (oxidation, reduction, hydrolysis via CYP450) usually inactivates drugs and can create reactive metabolites; phase II conjugation (glucuronidation, sulfation, acetylation, glutathione) increases water solubility for excretion.

CYP3A4 metabolizes roughly half of marketed drugs; inhibitors (ketoconazole, erythromycin, grapefruit components) raise substrate levels, while inducers (rifampicin, carbamazepine, St John's wort) lower them.

Structure–activity relationships map chemical features to potency: adding halogen or alkyl groups increases lipophilicity and often potency, but excessive logP reduces solubility and raises metabolic liability.

Morphine and codeine are opium alkaloids from Papaver somniferum; morphine content is highest in the unripe capsule latex, and codeine is the 3-O-methyl derivative.

Atropine and scopolamine come from Atropa belladonna and Datura species; they are tropane alkaloids acting as muscarinic antagonists, and overdose causes anticholinergic toxicity (dry mouth, mydriasis, delirium).

Digoxin is a cardiac glycoside from Digitalis lanata; it inhibits Na+/K+-ATPase, and the therapeutic index is narrow (target trough roughly 0.5–1.0 ng/mL).

Quinine and quinidine are cinchona bark alkaloids; quinine treats malaria and quinidine is an antiarrhythmic, and cinchonism (tinnitus, headache, visual disturbance) signals toxicity.

Artemisinin from Artemisia annua is a sesquiterpene lactone antimalarial activated by its endoperoxide bridge; it is combined with a partner drug (ACT) to prevent resistance.

Ginkgo biloba leaf extracts (flavone glycosides, terpene lactones) are linked to bleeding risk with anticoagulants; St John's wort (Hypericum perforatum) induces CYP3A4 and reduces efficacy of many drugs.

Standardization expresses marker-compound content (e.g., % w/w of a named constituent) rather than total biological activity, so two standardized extracts are not automatically interchangeable.

Alkaloid extraction exploits base solubility: plant material is basified so free alkaloids become lipid-soluble for organic extraction, then re-extracted into acidified water as salts.

Essential oils are volatile terpenoid mixtures obtained by steam or hydrodistillation; they are stored in tightly closed, light-protected containers because oxidation and resinification degrade them.

Bioavailability F = (AUC_oral × Dose_IV) / (AUC_IV × Dose_oral); the absolute value compares an extravascular route with intravenous dosing.

Noyes–Whitney dissolution rate rises with surface area and solubility and falls with particle size; micronization or salt formation is used to speed dissolution of poorly soluble drugs.

First-pass hepatic metabolism reduces oral bioavailability; routes bypassing it include intravenous, sublingual, buccal, rectal (partly), and transdermal.

Suspensions require a suspending agent (e.g., methylcellulose, xanthan gum) to slow sedimentation; a flocculated system settles fast but redisperses easily, while a deflocculated one settles slowly but can cake.

Emulsions are stabilized by surfactants lowering interfacial tension; o/w emulsions are used for oral and topical delivery of lipophilic drugs, and phase inversion or creaming signals instability.

Sterile products: autoclaving at 121 °C for 15–20 minutes at 15 psi is standard terminal sterilization; heat-labile solutions require filtration through a 0.22 µm membrane.

Compounding calculations: % w/v = g per 100 mL, % w/w = g per 100 g, and ratio strength 1:1000 equals 0.1% w/v; alligation mixes two strengths to reach a target concentration.

Isotonicity: a 0.9% w/v sodium chloride solution is isotonic with plasma; the sodium chloride equivalent method converts a drug's osmotic contribution to an equivalent mass of NaCl.

Shelf life and stability: hydrolysis is accelerated by water and heat, oxidation by light and oxygen, so antioxidants (e.g., sodium metabisulfite) and amber glass are used accordingly.

Receptor theory: Kd is the concentration giving half-maximal occupancy, and a competitive antagonist shifts the agonist dose–response curve right without lowering the maximum response.

Pharmacokinetic equations: t1/2 = 0.693 × Vd / CL, and loading dose = (Vd × target concentration) / F; maintenance dose = (CL × target concentration × dosing interval) / F.

Steady state is reached after about four to five half-lives with constant dosing; a loading dose is used when the drug's half-life is long and rapid effect is needed.

Antihypertensives: ACE inhibitors reduce angiotensin II and raise bradykinin (cough, angioedema); ARBs avoid bradykinin effects; both are contraindicated in pregnancy.

Anticoagulation: warfarin inhibits vitamin K epoxide reductase (monitor INR), while direct oral anticoagulants inhibit factor Xa or thrombin and need no routine INR monitoring.

Antibiotic principles: aminoglycosides and fluoroquinolones are concentration-dependent killers; beta-lactams and vancomycin are time-dependent, so the fraction of time above MIC drives efficacy.

Diabetes: metformin lowers hepatic glucose output and is first-line in type 2 diabetes; it carries a risk of lactic acidosis in renal impairment and is withheld before contrast imaging.

Asthma and COPD: short-acting beta-2 agonists relieve acute bronchospasm; inhaled corticosteroids control airway inflammation and must be used regularly, with mouth rinsing to prevent oral candidiasis.

Opioid and paracetamol safety: opioids cause respiratory depression reversed by naloxone; paracetamol overdose depletes glutathione, and N-acetylcysteine restores it.

The pharmaceutical care process follows assessment, care plan, and follow-up: identify drug-related problems, set goals, then monitor outcomes and adherence.

A prescription must be legally complete: prescriber name and signature, patient identifiers, drug name, strength, dosage form, dose, frequency, duration, and date.

Counselling essentials for a new medicine: name and purpose, how and when to take it, expected benefit and time to onset, common and serious adverse effects, and what to do if a dose is missed.

High-alert medications (insulin, heparin, concentrated potassium chloride, chemotherapy, opioids) require independent double-checks and clear labeling to prevent harm.

Antimicrobial stewardship: confirm indication, choose the narrowest effective agent, use correct dose and duration, and counsel on completing the prescribed course.

Adherence support uses the fewest daily doses, simplified regimens, pill organizers, reminders, and addressing specific barriers such as cost, side effects, or health literacy.

Inhaler technique teaching: shake the device, exhale fully, actuate during a slow deep breath, hold the breath about 10 seconds, and rinse the mouth after corticosteroid inhalers.

Medication reconciliation compares the pre-admission list with current orders at admission, transfer, and discharge to catch omissions, duplications, and dose errors.

Mongolia regulates medicines under its national law on medicines and medical devices, administered by the Ministry of Health and the state agency responsible for health-sector regulation.

Marketing authorization requires demonstrated quality, safety, and efficacy; the manufacturer submits a dossier, and the regulator may accept or require local testing before approval.

Narcotic, psychotropic, and precursor substances are controlled under separate stricter rules with special prescribing, dispensing, storage, and record-keeping obligations.

Prescription-only versus over-the-counter status determines dispensing: prescription medicines are dispensed only on a valid prescription, while OTC products may be sold directly with counselling.

Pharmacist registration and licensing: practicing pharmacists must hold recognized qualifications and a valid license, and unlicensed practice is prohibited.

Pharmacovigilance obligations: license holders and health professionals report suspected serious adverse reactions to the national pharmacovigilance authority within the required timeframe.

Ethical duties include patient confidentiality, informed consent, avoiding conflicts of interest, refusing to dispense falsified or substandard products, and reporting suspected counterfeit medicines.

Advertising and promotion of prescription medicines to the public is restricted; promotion must be accurate, evidence-based, and free of misleading claims.

Record retention: prescriptions and controlled-drug transaction records must be kept for the period set by regulation and made available for inspection.

Pharmacoeconomic analysis types: cost-minimization (equal outcomes), cost-effectiveness (cost per natural unit such as life-year gained), cost-utility (cost per QALY), and cost-benefit (monetary outcomes).

Incremental cost-effectiveness ratio ICER = (Cost_new − Cost_old) / (Effect_new − Effect_old); a new therapy is 'dominant' when it costs less and works better.

ABC/VEN analysis classifies stock by value (A items are the small number of high-cost lines) and by vital, essential, or non-essential status to prioritize procurement.

Inventory control: safety stock covers demand variability and lead time; reorder point = average daily demand × lead time + safety stock.

Economic order quantity EOQ = √(2DS/H), where D is annual demand, S is ordering cost, and H is holding cost per unit per year.

Cold chain integrity requires validated storage and transport at 2–8 °C for refrigerated vaccines and biologics, with continuous temperature monitoring and documented excursions.

Good distribution practice: stock rotation with first-expiry-first-out, segregated quarantine areas for damaged or recalled stock, and full batch traceability.

Procurement transparency: competitive tendering, published selection criteria, and conflict-of-interest declarations reduce corruption in medicine purchasing.

Budget impact analysis estimates total affordability of adopting a therapy across the covered population, distinct from cost-effectiveness per patient.

Adverse drug reaction types: type A are dose-dependent and predictable (e.g., bleeding with warfarin), type B are idiosyncratic and unpredictable (e.g., anaphylaxis with penicillin).

Seriousness criteria: death, life-threatening, hospitalization or prolongation, persistent disability, congenital anomaly, or a medically important event; severity and seriousness are not the same.

Causality assessment uses structured tools such as WHO-UMC or Naranjo scoring, grading the link between drug and event as certain, probable, possible, unlikely, or unassessable.

The Uppsala Monitoring Centre maintains the global individual case safety report database; signals are detected by disproportionate reporting analysis, not proof of causation.

Poisoning management: activated charcoal within about one hour for many ingestions, antidotes where available (N-acetylcysteine for paracetamol, naloxone for opioids, flumazenil for benzodiazepines), and supportive care.

Antidote pairs to memorize: organophosphates–atropine plus pralidoxime, methanol or ethylene glycol–fomepizole or ethanol, iron–deferoxamine, cyanide–hydroxocobalamin.

Toxicokinetics: dialysis removes low-molecular-weight, low-protein-bound, low-volume-of-distribution drugs such as lithium, methanol, and salicylates.

Teratogen counselling: known human teratogens include isotretinoin, methotrexate, warfarin, valproate, and ACE inhibitors; pregnancy-prevention programs apply to the highest-risk drugs.

Medication error reporting is non-punitive and focuses on system failures (look-alike labels, ambiguous abbreviations) rather than individual blame.