CPJE Flashcards
(177 cards)
1
Q
1 gr = __ mg
A
64.8 mg
2
Q
1 fl oz = __ mL
A
29.6 mL
3
Q
1 cup = __ oz
A
8 oz
4
Q
1 pint = __ mL
A
473 mL
5
Q
1 quart = __ mL
A
946 mL
6
Q
1 gallon = __ mL
A
3785 mL
7
Q
1 oz = __ g
A
28.4 g
8
Q
1 lb = __ g
A
454 g
9
Q
How do you convert aminophylline to theophylline?
A
Aminophylline x 0.8 = theophylline
10
Q
Amount of elemental Fe in FeSO4
A
20%
11
Q
1 ppm
A
1 mg/L
12
Q
1 ppb
A
1 mcg/L
13
Q
High risk waist size for women
A
> 35”
14
Q
High risk waist size for men
A
> 40”
15
Q
BMI formula
A
BMI = weight (kg) / height (m2)
16
Q
Underweight BMI
A
< 18.5
17
Q
Normal BMI
A
18.5 - 24.9
18
Q
Overweight BMI
A
25 - 29.9
19
Q
Obese BMI
A
30 or higher
20
Q
When to use IBW
A
With hydrophilic drugs that don’t get distributed much into fat (e.g., AG’s, theophylline); using ABW for a drug that stays in the blood can cause an overdose
21
Q
IBW formula (men)
A
50 kg + 2.3 kg per inch over 5 feet
22
Q
IBW formula (women)
A
45.5 kg + 2.3 kg per inch over 5 feet
23
Q
Normal range SCr
A
0.6 - 1.2 mg/dL
24
Q
S/S of dehydration
A
BUN:SCr >20 Decreased urine output Tachycardia / tachypnea Dry mouth, dry mucous membranes Dry skin w/tenting
25
Cockcroft-Gault equation
CrCl (mL/min) = [ (140 - age) / (72 x SCr) ] x wt (kg)
| x 0.85 (females only)
26
CrCl levels
```
>90 = normal
60-90 = mild insufficiency
30-59 = moderate insufficiency
15-29 = severe insufficiency
<15 = renal failure or dialysis
```
27
Specific gravity
g/mL (same as density)
28
When is BSA used for dosing?
Chemo & pediatrics
29
BSA formula
BSA (m2) = sq rt of: (cm x kg) / 3600
30
Formula for changing the concentration or quantity
Q1 x C1 = Q2 x C2
31
Half-life formula
t1/2 = 0.693 / ke
32
Dextrose kcal
3.4 kcal/g
33
Amino acids kcal
4 kcal/g
34
Lipids kcal
9 kcal/g
35
Glucose kcal
4 kcal/g
36
10% lipid emulsion kcal
1.1 kcal/mL
37
20% lipid emulsion kcal
2 kcal/mL
38
Daily fluid needs
(when weight >20 kg):
| 1500 mL + (20)(kg - 20)
39
Protein requirements for non-stressed outpatient
0.8-1 g/kg/day
40
Protein requirements for inpatient or malnourished
1.2-2 g/kg/day
41
Basal energy expenditure
(BEE): aka basal metabolic rate (BMR); amount of energy used in the resting state, exclusive of eating & activity; non-protein calories only; uses the Harris-Benedict equation
42
Total energy expenditure
(TEE): aka total daily expenditure (TDE); BEE x activity factor (energy used for activity) x stress factor (excess metabolic demands from stress); non-protein calories only
43
How much nitrogen does the patient receive from protein?
1 g nitrogen per 6.25 g protein
44
Normal range for K+
3.5 - 5.0 mEq/L
45
Normal range for calcium
8.5 - 10.5 mg/dL
46
Formula for corrected calcium
Ca(corr) = (Ca) + [ (4 - albumin) (0.8) ]
47
Things to know about phosphorus + calcium in a TPN
- Calcium gluconate is less reactive w/phosphate than calcium chloride, so has less risk of precipitation
- Add phosphate first, then other components, then calcium toward the end
- Do not exceed a total (Ca + PO4) of 45 mEq/L
- Keep refrigerated so less Ca & PO4 can dissociate & form a precipitate with each other
48
Statute vs. regulation
Statutes are created by the state legislature; regulations are developed & enacted by state agencies empowered by the state legislature & the governor; Board of Pharmacy is one of these state agencies
49
Mandatory vs. permissive language in a law
```
Mandatory = "must" or "shall"
Permissive = "may" or "can" (allows judgment by the pharmacist)
```
50
The CA BoP is under the jurisdiction of which department of the state gov't?
Dept. of Consumer Affairs
51
Number of members on the CA BoP?
How many appointed by the governor?
How many are pharmacists?
13 members, 11 appointed by the governor; 7 of the governor's appointments are RPh, 5 of whom are actively practicing
52
How long is the term for a member of the CA BoP?
| How often do they meet?
4 year terms, max 2 terms; meet at least every 4 months
53
Who can prescribe without a protocol?
MD, DO, DDM, DPM, DVM
54
MVI-13
Fat soluble ADEK + water-soluble thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, C, folic acid, B12, & biotin (MVI-12 does not have K)
55
Trace elements given in TPN
Zinc, copper, chromium, manganese (and sometimes selenium); iron not usually given
56
Trace elements to be withheld w/severe liver disease
Manganese & copper
57
Trace elements to be withheld w/severe renal disease
Chromium, molybdenum, selenium
58
How much insulin is usually added to TPN?
50% or less of normal requirement + sliding scale; minimum is 10 units, and gets increased 10 units at a time
59
Separation between enteral nutrition & drugs with interactions
Hold feedings 1 hour before or 2 hrs after drug is administered
60
Drug interactions w/enteral nutrition
1. Warfarin - drug gets bound by EN, lowering the INR
2. FQ's & TCN's - chelate metals
3. Phenytoin suspension - drug gets bound to EN, causing sub-therapeutic levels
61
Osmolarity definition
Total number of solutes per liter of solution (mOsmol/L); can be ionic (NaCl disassociated into the solutes Na+ and Cl-) or non-ionic that do not dissociate (glucose, urea)
62
Osmolarity of body fluids
Called "tonicity"; isotonic (same osmolarity as blood) is ~300 mOsmol/L)
63
Dissociation of dextrose
1 dissociation particle
64
Dissociation of mannitol
1 dissociation particle
65
Dissociation of KCl
2 dissociation particles
66
Dissociation of NaCl
2 dissociation particles
67
Dissociation of sodium acetate
2 dissociation particles
68
Dissociation of calcium chloride
3 dissociation particles
69
Dissociation of sodium citrate
4 dissociation particles
70
Osmolarity formula
mOsmol/L = [ (wt in g/L) / (MW in g/mole) ] x # of dissociation particles x 1000
71
MW (molecular weight)
g/mole
72
Dissociation factors
```
1 dissociation particle (non-ionic): i = 1
2 dissociation particles: i = 1.8
3 dissociation particles: i = 2.6
4 dissociation particles: i = 3.4
5 dissociation particles: i = 4.2
```
73
E-value definition
"NaCl equivalent" for a drug; determines how much additional NaCl must be added to make the drug isotonic
74
E-value formula
```
E = (58.5)(i) / (MW)(1.8)
58.5 = MW of NaCl, i = 1.8
```
75
Steps to calculate isotonicity
1. Calculate the drug's E-value & multiply it by the weight of the drug
2. Calculate how much NaCl alone would make the drug isotonic
3. Subtract 1 from 2 to calculate how much more NaCl needs to be added
76
Equation for moles
mols = g/MW
77
Equation for mmol
mmols = mg/MW
78
Milliequivalent definition
The amount in mg of a solute equal to 1/1000th of its gram equivalent weight, taking into account the valence of the ions
79
How to determine the valence
Divide the compound into its positive & negative components, then count either the positive or the negative charges (almost always 1 or 2)
80
mEq equation
```
mEq = (mg)(valence) / MW or
mEq = mmols/valence
```
81
Celsius to Fahrenheit
C = (F - 32) / 1.8
82
Calcium carbonate vs. citrate
Carbonate: acid-dependant absorption (take w/meals); 40% elemental calcium
Citrate: acid-independant absorption (take with or without food); 21% elemental calcium
83
Average life span of RBC's
120 days
84
Term for low WBC count
Leukopenia
85
Term for high WBC count
Leukocytosis
86
Average life span of platelets
7-10 days
87
Term for low platelet count
Thrombocytopenia
88
Normal range for ANC
2200-8000 per microliter (can't refill clozapine if <2000)
89
Calculation of ANC
Multiply WBC by the percentage of neutrophils (segs + bands)
90
BMP includes...
Sodium, potassium, bicarb, chloride, calcium, BUN, SCr, glucose
91
CMP includes...
The 8 from the BMP + albumin, t-bili, bili, ALT, AST, Alk phos
92
Normal blood pH
7.35 - 7.45
93
Anion gap
[Na+] - [Cl- + HCO3-]
>12 = gap acidosis
Causes: "CUTE DIMPLES" (cyanide, uremia, toluene, ethanol (alcoholic ketoacidosis), diabetic ketoacidosis, INH, methanol, propylene glycol, lactic acidosis, ethylene glycol, salicylates)
94
pH vs. pKa
- If pH = pKa, there are equal amounts of ionized & unionized
- If pH > pKa, more of the acid is ionized
- If pH < pKa, more of the acid is unionized
95
Ionized vs. unionized drugs
Ionized drugs are soluble, but can't cross the lipid membrane; unionized drugs are not soluble, but can cross the lipid membrane; most drugs are weak acids, meaning they are soluble, but can then pick up a proton in order to cross the membrane.
96
Henderson-Hasselbach
```
pH = pKa + log (salt/acid)
pH = pKa + log (base/salt)
pH = 14 - pKb + log (base/salt)
```
97
SR for a Class A balance
6 mg
98
MWQ equation
MWQ = SR / % error (usually 0.05)
99
HLB number (hydrophilic - lipophilic balance)
Range is 0-20; >10 is water-soluble; <10 is lipid-soluble
100
Potency of cream vs. ointment
Ointment is more potent than cream or lotion
101
% of oil & water in creams & ointments
Creams are about 50/50; ointments are about 80% oil, 20% water
102
First-order kinetics
The amount of drug given is proportional to the increase in plasma concentration; the more drug that is given, the higher the drug concentration; most drugs follow first-order kinetics
103
Drugs with Michaelis-Menten kinetics
Phenytoin, theophylline, voriconazole
104
ODT's for elderly
Donepezil (Aricept ODT), carbidopa/levodopa (Parcopa), mirtazapine (Remeron SolTab)
105
Long-acting antipsychotics
Haloperidol (Haldol decanoate - q4wks), risperidone (Risperdal Consta - q2wks), fluphenazine (Prolixin decanoate)
106
Drugs that can be sprinkled on food
(Consume right after sprinkling); montelukast (Singulair packets), lisdexamfetamine (Vyvanse caps), divalproex (Depakote Sprinkles for bipolar pts who need mood stabilization, allowing them to take the meds without knowing it)
107
Which are the only patches that can be cut?
Lidoderm; some pts are instructed to cut fentanyl, but this is not advisable
108
Testosterone patch
Androderm; nightly; never apply to scrotum
109
Clonidine patch
Catapres-TTS; once a week
110
Estradiol patch
Climara, Menostar - once a week
Alora, Vivelle - twice a week
Usually lower abdomen or upper buttocks, but never on breasts
111
Estradiol/norethindrone patch
Climara Pro; once a week, but not on breasts
112
Fentanyl patch
Duragesic; q72h, but change to q48h if it runs out after 2 days; hold for 30 sec when applying
113
Diclofenac patch
Flector; twice daily over painful area
114
Lidoderm patch
On 12 hrs, off 12 hrs; use 1-3 patches over painful areas
115
Methylphenidate patch
Daytrana; apply every morning, 2 hrs before school; alternate hips daily
116
Nicotine patch
NicoDerm CQ; once daily
117
NTG patch
On 12-14 hrs, off 10-12 hrs
118
Oxybutinin patch
Oxytrol; twice a week
119
Rivastigmine patch
Exelon; once daily; if it causes nausea, remove it or use a lower strength
120
Rotigotine patch
Neupro; once daily
121
Scopolamine patch
Transderm Scop; apply 4 hrs before expected need behind the ear; alternate ears; remove after 3 days if not sooner
122
Selegiline patch
Emsam; once daily
123
Standard Deviation
How much variation there is from the mean; can only be used for continuous data; in a normal distribution, 68% of values are within 1 SD & 95% are within 2 SD's
124
Confidence Interval
Probability that a population's true value falls within this range
125
What can OD's prescribe in CA?
Only those with a 'T' at the end of their license number: topical anti-allergy or anti-inflammatory; systemic steroids (must consult ophthalmologist if condition worsens in 72 hrs), glaucoma meds, oral antihistamines, oral ABX (consult if condition worsens in 72 hrs or isn't better within 10 days), topical antivirals (3 wks max), oral acyclovir (10 days max), codeine/APAP or hydrocodone/APAP (3 days max for both).
126
What can ND's (naturopaths) prescribe in CA without a protocol?
Epiniphrine, hormones; since testosterone is a C-III, it has to be under a protocol in CA, & the ND has to have a DEA #; no C-II's for ND's
127
Prescriptive authority for PA's & NP's in CA
Cannot prescribe! Can administer & can "furnish" prescriptions under a protocol; for scheduled drugs, only the PA signature is required, although the Rx blank has to have the supervising physician's printed on it; on the Rx label, only one or the other's info is required (either the PA or the supervising physician)
128
p-value
The probability that a result was obtained by chance; usually, if the p-value is <0.05, there is less than a 5% chance that the result was obtained by chance, and the result is statistically significant.
129
Type I error
False positive; the null hypothesis was rejected in error; alpha
130
Type II error
False negative; null hypothesis was accepted in error; beta, which measures a test's sensitivity, or its ability to ID positive results
131
Power
Probability that a test will not make a type II error; the higher the power, the less chance a type II error will occur; power = 1 - beta
132
RR
Relative risk; risk in the exposed group as a percentage of the risk in the control group; if it's 1 the intervention increased the risk; RR = incidence exposed / incidence control
133
RRR
Relative risk reduction; how much the risk in the intervention group was reduced compared to the control group; RRR = 1 - RR
134
ARR
Absolute risk reduction; the difference in incidence between the groups; ARR = incidence control - incidence exposed
135
NNT
Number needed to treat; the number of people who would have to be exposed to the intervention in order to prevent 1 adverse event; NNT = 1 / ARR
136
Risk vs. Odds
Risk is the probability of an event happening, but odds is the probability of an event happening compared to the probability of the event NOT happening; if 40 smokers get lung cancer while 60 smokers do not, the risk is 40/100 (40%), while the odds are 40/60 (66%)
137
OR
Odds ratio; odds treatment group / odds control group; if 40/100 smokers got lung cancer and 10/100 non-smokers got lung cancer, the OR is (40/60) / (10/90) = 0.66/0.11 = 6 (smokers are 6 times as likely as non-smokers to get lung cancer)
138
Discrete data
Finite set of values with whole numbers only; nominal & ordinal
139
Nominal data
Categories (gender, etc)
140
Ordinal data
Ranked categories, with unequal differences between them (Likert scale)
141
Continuous data
Infinite number of values within a defined range; interval & ratio
142
Interval data
Arbitrary zero point (temperature)
143
Ratio data
Meaningful zero point (height, weight, time)
144
Observational study
Observe effect in the general population in a non-controlled environment
145
Case-control study
Compare groups retroactively to look for contributing factors; compare otherwise similar groups that have the condition vs. those that don't have it
146
Cohort study
Longitudinal study comparing outcomes in group that was exposed to an intervention to those who were not exposed; distinguishes cause & effect
147
Cross-sectional study
Used to determine prevalence, but cannot determine cause & effect; looks at a single point in time
148
Single-blinded controlled trial
Subjects don't know what they got
149
Double-blinded controlled trial
Subjects & researchers don't know who got what
150
Cross-over trial
Once subjects finish a course of treatment, they get switched to another one after a washout period
151
Non-inferiority trial
Uses an active control, rather than placebo, to see whether the new drug is not less effective than the current treatment (the active control)
152
ECHO model
Pharmacoeconomic analysis using economic outcomes (drug costs compared to a medical intervention), clinical outcomes (medical events resulting from the treatment), & humanistic outcomes (patient satisfaction, QOL as a consequence of the disease or treatment)
153
Direct medical costs
Meds, administration, hospitalization, etc
154
Direct non-medical costs
Travel, childcare, etc
155
Indirect costs
Loss of productivity
156
Intangible costs
Pain & suffering, anxiety, etc
157
CEA
Cost-effectiveness analysis; outcomes per dollar; most common method used, but can't directly compare different types of outcomes
158
CMA
Cost-minimization analysis; compares the costs of two or more interventions that are already shown to have equivalent outcomes
159
CBA
Cost-benefit analysis; converts the costs & benefits from an intervention & converts them to current dollars
160
CUA
Cost-utility analysis; type of CEA that includes quality of life; uses QALY's (quality-adjusted life years) & DALY's (disability-adjusted life years)
161
SNP
Single nucleotide polymorphism; single base difference between 2 people, resulting in two possible alleles; they are the most common genetic variations in DNA
162
Polymorphism
DNA variation that is too common to be a new mutation; present in at least 1% of the population
163
Abacavir pharmacogenomics
Ziagen (also in Epzicom & Trizivir); test for HLA-B*5701; hypersensitivity rxn w/2 or more of: fever, rash, GI distress, respiratory distress, malaise
164
Clopidogrel pharmacogenomics
Plavix; test for 2C19; active metabolite depends on 2C19, so poor metabolizers get less benefit from the drug
165
Carbamazepine pharmacogenomics
Tegretol; test Asians for HLA-B*1502; TEN or SJS skin rxns
166
Trastuzumab pharmacogenomics
Herceptin (also in Tykerb & Perjeta); test for HER2/neu; over-expression required for the tumor to respond to the drug
167
Phenytoin pharmacogenomics
Dilantin; test Asians for HLA-B*1502; TEN or SJS skin rxns
168
Warfarin pharmacogenomics
Coumadin, Jantoven; test for 2C9 & VKORC1; 2C9*2 & 2C9*3 are loss of function alleles & can cause increased risk of bleeding
169
Prescriptive authority for CNM's in CA
(Certified Nurse Midwife) Same as PA's & NP's, but may only furnish prescriptions for drugs within the scope of their practice (family planning, prenatal care, childbirth); may furnish ABX for partners of a pt w/STD without examining the partner; Rx label can say "patient name & partner" (this rule also applies to physicians, PA's, & NP's)
170
How many PA's or NP's can a physician supervise?
Max total of 4 in any combination
171
How long do you have to notify the CA BoP of a change in PIC?
30 days in writing
172
Max number of pharmacies for which one pharmacist can be PIC?
Two, and only if they are within 50 miles of each other
173
How long can there be an interim PIC?
120 days
174
Requirements for a preceptor?
License must not be revoked, suspended, or on probation
175
CE requirements?
30 credit hours every two years
176
Keep CE certificates for how long?
4 years
177
Inactive license vs. retired license
Inactive: pharmacist retains the license but cannot practice; can be renewed every 2 years (no CE's required); can be converted back to active w/proof of 30 hrs of CE; automatically inactive if you fail to renew or complete CE's; you have 15 days to correct either deficiency once notified by the Board; retired: to become active again, have to pass NAPLEX & CPJE; any active or inactive license is cancelled after 3 years without renewing it
