Mongolia Pharmacy Technician Licensing Exam cheat sheet

In Mongolia, pharmacy activity is licensed under the Law on Medicines and Medical Devices; retail and hospital pharmacies require a special permit (license) issued through the state administrative body responsible for health.

A pharmacist-in-charge (эмийн сангийн эрхлэгч) must hold a pharmacist diploma and valid professional license; the license is renewed periodically and can be suspended for dispensing violations.

Prescription-only medicines (Rx) may be dispensed only against a valid prescription; a defined list of medicines is approved for over-the-counter (OTC) sale without prescription.

Narcotic and psychotropic substances are subject to stricter accounting: separate record-keeping, secure storage, and reporting to the state authority; dispensing requires a specially issued prescription form.

Prescriptions have a validity period (commonly limited to days from issue) and a maximum quantity per prescription; expired prescriptions must not be dispensed.

Ethical duties: confidentiality of patient health information, informed consent, avoiding conflicts of interest, and refusing to dispense when the prescription is forged or clinically unsafe.

Pharmacists must report suspected falsified/substandard medicines and serious safety signals to the national regulatory authority rather than resolving them internally.

Advertising of prescription medicines to the public is prohibited; only OTC products may be advertised with approved content.

Enteral solid forms: tablets (immediate-release, enteric-coated, sustained-release), capsules (hard gelatin, soft gelatin), powders, granules; enteric coatings protect against gastric acid and delay release to the intestine.

Parenteral forms: solutions, suspensions, emulsions, and powders for reconstitution for IV, IM, or SC use; suspensions must never be given IV.

Topical and local forms: creams (oil-in-water or water-in-oil), ointments (oleaginous, water-soluble), gels, lotions, suppositories, and transdermal patches.

Inhalation forms: metered-dose inhalers (suspension or solution in propellant), dry-powder inhalers, and nebulizer solutions; particle size determines lung deposition.

Nomenclature: INN (international nonproprietary name) is the generic name; brand/trade name is manufacturer-specific; the same INN may appear under many brand names.

Classification by source: synthetic, semisynthetic, biological (vaccines, insulin, monoclonal antibodies), and herbal/traditional preparations.

ATC classification groups drugs by anatomical, therapeutic, and chemical criteria; it is used for statistics and procurement, not for clinical dosing.

Bioavailability differs by route: IV = 100% by definition; oral forms undergo first-pass hepatic metabolism, reducing systemic availability.

Percentage concentrations: % w/v = g per 100 mL; % w/w = g per 100 g; % v/v = mL per 100 mL. Convert carefully between w/v and w/w using density.

Dilution formula: C1 × V1 = C2 × V2; use for preparing diluted solutions and for alligation-type mixing problems.

Dose by body weight: dose (mg) = dose per kg × body weight (kg); check against the maximum recommended single and daily dose.

Dose by body surface area: BSA (m²) from height and weight (Mosteller: √(height cm × weight kg / 3600)); dose = dose/m² × BSA.

IV drip rate: drops/min = (volume mL × drop factor gtt/mL) ÷ time in minutes; infusion rate mL/h = volume ÷ hours.

Ratio strength: 1:1000 means 1 g or 1 mL of solute in 1000 mL/g of preparation = 0.1% w/v.

Milliequivalent calculations: mEq = (mg × valence) ÷ atomic or molecular weight; used for electrolyte replacement (Na, K, Ca).

Significant figures and unit conversion: 1 g = 1000 mg = 1,000,000 µg; 1 L = 1000 mL; always state units in the final answer.

A complete prescription includes patient name and age, date, drug name (INN or brand), strength, dosage form, dose, frequency, duration, route, and prescriber's signature and stamp.

Legibility check: if the drug name, strength, or dose is ambiguous, the pharmacist must contact the prescriber - never guess or substitute silently.

Screening: check for allergies, duplicate therapy, clinically significant interactions, contraindications (e.g., pregnancy, renal impairment), and dose appropriateness for age/weight.

The 'five rights' at dispensing: right patient, right drug, right dose, right route, right time (plus correct documentation).

Labeling must include patient name, drug name and strength, directions, quantity, storage instructions, expiry date, and pharmacy identification.

The dispensing record (prescription log) must be retained for the period required by regulation and be retrievable for audit or recall.

Counseling at handover: explain purpose, dose schedule, key side effects, what to do if a dose is missed, and storage; confirm patient understanding.

Refills and repeats are allowed only where the prescription authorizes them; controlled medicines require separate documentation.

Standard storage: controlled room temperature (typically 15–25 °C), cool place (8–15 °C), refrigerator (2–8 °C), freezer (−10 to −25 °C); avoid freezing products labeled 'do not freeze'.

Cold chain: vaccines and insulin require continuous 2–8 °C; monitor with a data logger and record temperature twice daily; excursions require assessment before use.

Light-sensitive drugs (e.g., nitroglycerin, some vitamins) need amber containers or opaque packaging; moisture-sensitive products need desiccants and sealed containers.

Expiry management: FEFO (first-expired, first-out) rotation; expired stock is quarantined, labeled, and removed from the dispensing shelf.

Reconstituted products (e.g., oral suspensions, some injectables) have a short beyond-use date after mixing; label with the date and time of preparation.

Inventory control methods: minimum/maximum stock levels, ABC analysis for high-value items, and periodic physical counts reconciled against records.

Recall handling: identify affected batch numbers, quarantine stock, notify patients where traceable, and document the action taken.

Narcotics and psychotropics require double-locked storage, restricted access, and a running balance record reconciled at each shift.

Pharmacokinetics: absorption, distribution, metabolism (mainly hepatic CYP450), excretion (mainly renal); half-life determines dosing interval and time to steady state (≈4–5 half-lives).

Agonists activate receptors; antagonists block them; partial agonists produce submaximal response; competitive antagonism can be overcome by increasing agonist concentration.

First-pass metabolism reduces oral bioavailability of drugs such as nitroglycerin and propranolol; sublingual or parenteral routes bypass it.

NSAIDs inhibit COX and reduce prostaglandin synthesis: analgesic, antipyretic, anti-inflammatory, but risk of GI ulceration and renal impairment.

Antibiotics: beta-lactams inhibit cell wall synthesis; macrolides and tetracyclines inhibit protein synthesis; fluoroquinolones inhibit DNA gyrase.

Antihypertensives: ACE inhibitors (cough, hyperkalemia), ARBs, calcium channel blockers, thiazides (hypokalemia), beta-blockers (bradycardia, bronchospasm).

Antidiabetics: metformin (GI upset, lactic acidosis risk in renal failure), sulfonylureas (hypoglycemia), insulin (hypoglycemia, injection-site reactions).

Warfarin inhibits vitamin K–dependent clotting factors; monitor INR; many drug and food interactions (e.g., with NSAIDs, antibiotics, leafy greens).

Use plain, non-technical language; confirm literacy level and language (Mongolian or other) and offer written instructions when helpful.

Teach-back method: ask the patient to repeat how they will take the medicine; correct misunderstandings before handover.

For inhalers, demonstrate technique (shake, exhale, actuate, inhale slowly, hold breath, rinse mouth after corticosteroid) and have the patient demonstrate.

Adherence support: simplify regimens where possible, link doses to daily routines, use pill organizers, and discuss cost barriers.

Special populations: adjust counseling for elderly (vision, hearing, polypharmacy), children (weight-based dosing, caregiver instructions), and pregnant/breastfeeding women.

Report adverse effects: explain how to recognize serious reactions and when to seek urgent care; provide pharmacy contact details.

Document counseling in the patient record; maintain confidentiality in the counseling area.

Handle complaints and medication errors transparently: listen, assess, correct the problem, and report internally per policy.

Aseptic technique: hand hygiene, sterile gloves, sterile field, no talking/coughing over the field, and minimal air turbulence in the work area.

Laminar airflow hoods: horizontal flow for non-hazardous sterile compounding; biological safety cabinets (Class II) for hazardous drugs and cytotoxic preparations.

Cleanroom classification: ISO 5 (Grade A) critical zone for exposed product; ISO 7/8 (Grade B/C) surrounding background; monitor with particle counts and microbial sampling.

Compounding records must include formula, ingredients and lot numbers, quantities, method, equipment, preparer identity, and beyond-use date.

Sterile filtration uses 0.22 µm filters for solutions; terminal sterilization by autoclave (121 °C, 15–20 min) where the product is heat-stable.

Cytotoxic handling: prepare in a biological safety cabinet, use closed-system transfer devices, double gloves, and dispose of waste in labeled cytotoxic containers.

Infection control: hand hygiene before and after patient contact, correct use of PPE, sharps disposal in puncture-resistant containers, and spills managed per protocol.

Compounding must not be used to circumvent licensing; only approved formulas and verified ingredients are used, and the final product is checked for appearance and labeling.

ADR classification: Type A (dose-related, predictable, e.g., bleeding with warfarin), Type B (idiosyncratic, unpredictable, e.g., anaphylaxis), plus Type C/D/E/F for chronic, delayed, withdrawal, and failure effects.

Serious ADR: death, life-threatening, hospitalization or prolongation, persistent disability, congenital anomaly, or medically important event.

Reporting: submit suspected serious and unexpected ADRs to the national pharmacovigilance authority using the standard reporting form; include drug, dose, timing, reaction, outcome, and concomitant medicines.

Causality assessment uses criteria such as temporal relationship, dechallenge/rechallenge, and alternative explanations (e.g., WHO-UMC or Naranjo scale).

High-alert medicines (insulin, heparin, opioids, concentrated electrolytes) require double-checks, clear labeling, and separated storage to prevent errors.

Look-alike/sound-alike (LASA) drug names need tall-man lettering, separated shelf placement, and reading back orders.

Medication error reporting is non-punitive and focused on system improvement; near misses should also be recorded.

Signal detection: clusters of similar reports or an unexpected increase in frequency should be reviewed and escalated.

Traditional Mongolian medicine (TMM) uses herbal, mineral, and animal-derived ingredients; many preparations are multi-component formulas rather than single herbs.

Common traditional herbs include sea buckthorn (облепиха), rhodiola, milk vetch (Astragalus), and various Artemisia species; efficacy claims should be evidence-based.

Herbal products can interact with conventional drugs: St John's wort induces CYP3A4 and reduces efficacy of oral contraceptives and some antiretrovirals; ginkgo increases bleeding risk with anticoagulants.

Quality issues: herbal products may vary in active content, be adulterated, or contain heavy metals; purchase from licensed sources with documented quality.

Regulation: traditional/herbal medicines are registered under national rules; claims for serious disease treatment require evidence and are restricted.

Counseling: ask patients specifically about herbal and traditional product use, as they often do not volunteer it; document in the medication history.

Pregnancy and children: avoid unverified herbal preparations; some traditional ingredients are contraindicated in pregnancy.

Storage: herbal products are moisture- and light-sensitive; keep in sealed containers away from heat and record expiry dates.