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Flashcards in Extemp Exam Deck (181):
0

What's the main aim of personalised medicine?

To ensure treatments meet the needs of INDIVIDUAL patients and to maximum efficacy of treatment, and significantly reduce the risk of undesirable side effects

1

Where are CYP450s found? What do they do?

Found on cells smooth endoplasmic reticulum
Highest conc in liver and small intestine
Add oxygen atoms to molecules, makes them more water soluble

2

10% of the population get little pain from codeine due to the enzyme _______

CYP2D6

3

What two variants are being tested to determine more accurate dosing of warfarin based on a patients genotype?

Gene variations for the CYP2C9 enzyme that metabolises warfarin
And in the gene for the vitamin K epoxide reductase enzyme

4

How can we personalise the treatment of cancer with Trastuzumab (Herceptin)?

Drug binds to HER2 proteins, it's a monoclonal antibody
We can Test cancer patients to see if they have over production of HER2 BEFORE treating with this drug as these are the only patients who will benefit from it

5

Definition of a special?

A non-licensed medicine manufactured to fulfil the prescribers requirements
Manufactured under a 'Special Manufacturing License'

6

Definition of an import?

A product that has a product license in its country of origin

7

Definition of extemporaneous preparation?

Made under the supervision of a pharmacist under section 10 of the Medicines Act 1968

8

Which regulations exempt the need for a MA for a relevant medicinal product, which is supplied to fulfill a 'special need'?

HMR 2012 part 10: exception to requirements for a marketing authorisation

9

When can doctors give unlicensed medication?

If the licensed form is inappropriate for the patient
If there's evidence the unlicensed form is SAFE
As long as they monitor and follow it up

Remember doctors are liable if the unlicensed med causes harm

10

It's a legal requirements that specials products are _________ by the requesting pharmacist

Commissioned/ signed off

11

Any unlicensed meds must be made up in licensed premises, that is they've been inspected by the _____

MHRA
E.g Registered pharmacies under supervision of a pharmacist

12

What are some of the risks associated with extemporaneous dispensing?

Feisty Cats Like Rapping Songs Quite Loudly 

F= Failure of Formulation : eg microbiological contamination, bioequivalence issues, dose uniformity (overdose or underdose), issues with stability
C = Calculation errors
L = Labelling errors
R = Raw material contamination
S = Safety and efficacy unknown
Q = QA and GMP issues
L= lack of standards and specifications

13

In extemporaneous dispensing there's some risks to staff. What are these?

Liability, they have a lot of responsibility
May be exposed to harmful substances when crushing tablets or weighing and pouring etc

14

How can we minimise risk in extemporaneous dispensing?

Do risk assessments to ensure a safe outcomes
Record keeping to safeguard patients
Train staff
Patient information- make sure pharmacy staff communicate with patients
Correct equipment and facilities available

15

How can we comply with quality requirements in extemp?

Make sure premises comply with GMP
Follow QA systems, eg following pharmacopeia monographs
Make sure batch testing systems are in place
Certificates of analysis for batchs
Yellow card ADR reporting schemes

16

When using a product within its licence, liability lies with the manufacturer if it all goes wrong. When using an unlicensed product, who does liability lie with?

The pharmacist AND the prescriber

17

What's an overall definition of specials and unlicensed medicines?

Medicinal products prescribed by doctors for specific indications for which a licensed product does not exist or is no longer available on the market.

18

Repackaged medicines are classed as specials/ unlicensed. Meds prepared by a manufacturer but aren't available in UK are also classed as this (unlicensed). What about medicines prepared for a specific patient, to use with doctors instructions?

This is classed as specials

19

Does a pharmacy require a specials manufacturing license?

No, all suppliers and manufacturers of specials must have one apart from pharmacies, as the law recognises that pharmacists should have the knowledge to safely prepare and supply medicines without a manufacturers license.

20

If a patient experiences an adverse effect for a product that has been prescribed within its terms of license, who can they prosecute?

The manufacturer
Ie the ones who created the sPc
if it's a special/ unlicensed then the prescriber gets the blame

21

Specials don't need a Marketing authorisation, and can be given by a practitioner in the UK. Who may these practitioners be?

Doctor
Dentist
Nurse independent prescriber
Pharmacist IP or supplementary prescriber

22

Specials manufacturers can advertise their _______ but not their _______

Can advertise their services
But not their products!! Cannot advertise specials
HMR 2012 makes the exception that a pricelist of products they usually make can be published by manufacturers, can't include bespoke products in this!

23

What does be-spoke mean?

Custom made, completely tailored to an individual patient!

24

The HMR 2012 requires anyone selling or supplying an unlicensed medicines to keep a record of supply for _______?

5 years

25

What are transmissible spongiform encephalopathys?

Also known as prion diseases, caused by prions (infectious agents composed of proteins in a mis-folded form)
Progressive conditions effecting brains and nervous system

26

What are the TSE guidelines?

Unlicensed medicines for human use (transmissible spongiform encephalopathies) safety regulations 2003
All manufacturers, importers AND exporters MUST comply with these, otherwise the import is not allowed.
If an unlicensed medication is supplied and proves a risk of TSE, those who manufactured and imported the medication should be held liable as they should have checked TSE guidelines have been followed in the manufacture.

27

When do TSE guidelines NOT apply?

Don't apply to pharmacists making up unlicensed medicines in the pharmacy

28

What are chief pharmacists and superintendent pharmacists responsible for?

Responsible for making sure systems are in place to safeguard public health and the safety of patients being supplied unlicensed medication

29

What different things could a product be in order to be classified as hazardous?

Carcinogenicity (cancerous)
Genotoxicity
Organ toxicity (at low doses)
Teratogenicity
Reproductive toxicity

30

What's the risk of cytotoxic chemotherapy agents to patients? Where's the riskiest place to make up cytotoxics?

Secondary neoplasms in patients
Preparing chemo on the wards

31

What engineering control can we use in grade C rooms? What should we use for hazardous substances?

Use biological safety cabinets in grade C rooms

Use ISOLATORS when handling hazardous materials

32

What is composite air flow?

Where airflow comes down and protects product from contamination
It is double filtered air

33

What types of gloves offer best protection?

Nitrile and neoprene gloves

34

What is the best practice with needles?

Using luer-lock syringes
Using vented needles or filter needles- these normalise vial pressures and minimise aerosols
Use chemo mats: these will absorb any spill ages

35

__________ of needles is not permitted in a healthcare setting

Re-sheathing

36

What's the process of decontamination?

Firstly remove organic matter using an aqueous cleaner or a detergent as this will inactive alcohol
Then do alcohol clean
Any biologics that may be present- denaturation is needed using liquid or gaseous chemicals

37

What will a PN bag contain?

Protein (AS AMINO ACIDS)
Carbohydrate (AS GLUCOSE)
Fat
Electrolytes
Trace elements
Vitamins
Water

38

What are micro nutrients?

Trace elements such as zinc
Vitamins
Water


Macro elements:
Protein
Carbohydrates
Fats
Electrolytes

39

What is the difference between a 2 in 1 TPN solution and a 3 in 1?

2 in 1: the aqueous mix (I.e amino acids and glucos etc) are in a seperate section to the lipids

3 in 1; the aqueous solution (amino acids, glucose etc) is in the same bag as the lipids, all ingredients in one

40

What's a triple chamber TPN bag?

3 different sections
One for glucose, one for amino acids, one for lipids

41

What's the problem with sunlight and TPN bags?

Sunlight can break down any vitamin A in the bag
Also if a lipid emulsion is exposed to both oxygen and sunlight, lipid peroxides may form which can be harmful

42

You need to be careful of oxidation of Amino acids in TPN bags. Why?

Tryptophan degradation products may cause cholestasis

If a solution is BROWN it usually means it has oxidised

43

Some trace elements may catalyse the breakdown of vitamins. What's an example?

Copper catalysing the breakdown of vitamin C

Vitamin C in TPN bags will oxidise to oxalic acid. Unless you can get all your oxygen from out your bag which isn't usually possible! Oxidation catalysed by copper ions and light

Oxalic acid will precipitate with calcium
The loss of vitamin C from the bag needs to be supplemented so need to calculate estimated loss

44

What's the link between precipitation in TPN bags and pulmonary embolisms?

Precipitation results in particles in the TPN bag
These can block small capillaries in the human
Results in pulmonary embolisms

45

When adding strong injections of calcium/ magnesium/ phosphate to a TPN bag whys it so important to MIX between additions or to DILUTE the solutions before adding to the TPN bag?

If this occurs you will get precipitation (insoluble precipitate forms)
You will therefore see cloudiness
This results in a risk of EMBOLISM

46

With calcium phosphate this precipitate formation depends on 4 factors, what are these?

Salt
Concentrations
pH
Other ingredients
(Also temperature, as precipitates more likely to form at high temp, so store in fridge!!)

47

What should the final pH of TPN mixtures be maintained at?

pH 5.00 and above!
should definitely be below 6 to reduce precipitation

48

Increasing temperature can also make formation of precipitates more likely. What can we use to stop precipitates forming?

In-line filters

49

What's the max concentration of glucose that should be used in peripheral veins? Why?

15%
This avoids phlebitis (inflammation of veins)
High concentrations destabilise fat emulsions (40-50% conc)
High concentrations cause hyperglycaemia

50

Why are lipid emulsion tiny droplets of fats immersed in water designed to be the same size as chylomicrons?

Chylomicrons are lipoprotein particles found naturally in the body, so we know these are an ok size and won't block capillaries etc

51

What are the three stages of lipid instability that can happen with lipid emulsions in TPN bags?

1) fat droplets start to join (aggregation)
2) creamy layers are seen (Reversible with mixing)
3) cracking: oily layers sat on top of aqueous phase, not able to mix again. Cracking = danger to patient!! Lipid micro-embolisms

52

What causes destabilisation in lipid emulsions?

Electrostatic effects causing repulsion between lipid particles is GOOD- keeps lipid particles seperate
Some factors may interfere with this repulsion
Eg positive ions like Al +++ bring lipid particles together
Or pH; over 6 we can get precipitation
Glucose concentrations (40-50%)
Time (if we leave for a long time we get precipitation)

53

Amino acids act as a _______ in TPN bags
They therefore stabilise other constituents
And they ______ with metal ions
_____ pHs can cause precipitation of amino acids

Act as a buffer
Can chelate metal ions
Low pHs cause precipitation

54

What is the best type of TPN bag (container) to use? Why?

Multilayer
It's a good barrier to oxygen
It reduces oxidation reactions and loss of ingredients and stabilises the formulation, doesn't leach

Others
PVC; problems with leaching
EVA; problems with letting in oxygen

55

We should seperate vitamins and trace elements in TPN bags. How can we do this?

Put vitamins in the lipids (fat emulsion) bag
Put trace elements in the amino acid/ glucose bag

As copper may catalyse breakdown of vitamin C !

56

Whys it important to allow PN feeds to warm up to room temperature ONE HOUR before use?

Cold infusions may cause cardiac arrest

57

Why do we need to be extra careful when adding calcium / magnesium to inorganic phosphates in TPN bags?

Precipitates are likely to form eg calcium phosphate
To stop this we need to MIX between additions
Would be good to use an inorganic phosphate SALT where possible

58

It's recommended that ALL PN bags are QC tested. What are some of the QC testing methods used?

Flame photometers
Atomic absorption
Electrolytes
Refractive index

59

Infusion bags may be needed for ____ drugs as in a syringe they're very concentrated whereas in a bag they're more dilute.

Irritant drugs
Infusion bags give the dose slower

60

What pH range do opthalmic solutions for the eyes need to be buffered at?

Need to be buffered in the pH range 4.5- 11.5

61

What TONICITY and osmolarity should be used for opthalmic solutions for the eye?

300 mOsm/ L is ideal
200-600mOsm/L is acceptable

TONICITY: 0.6- 1.8% sodium chloride is tolerated

62

Why should intrathecal formulations to be injected not really contain any other additives eg antimicrobials, antioxidants, pyrogens, preservatives?

They can be TOXIC to the CNS (intrathecal: going into spine)

Sodium chloride should be used as Tonicity agent

Particulates are ok (microspheres for slow release)

63

What is the ENDOTOXIN limit formula?

EL= K / M

K = max number of EU of endotoxin a patient may receive without suffering toxic reactions
M= maximum dose of substance per person (or per kg) per hour

64

What are the two values of K in the ENDOTOXIN limit equation?

K= 350 per person for parenteral preparations
K = 14 per person for intrathecal

This is because intrathecal injections are going into the spinal cord, therefore these will have a lower limit for endotoxins!! Don't want these on your nerves--ouch!

65

Fentanyl citrate has a bacterial endotoxin limit of 5.0 mg/L. Work out the maximum dose of it you can give for a parenteral formulation?

EL= K / M
M = K / EL

K for parenteral = 350 per person
350 / 5.0 = 70ml/ person/ hour

66

Fentanyl citrate has a bacterial endotoxin limit of 5.0 mg/L. Work out the maximum dose of it you can give for an intrathecal formulation?

EL = K / M
M = K / L
K for intrathecal = 14 per person

So M = 14 / 5,0 = 2.8 ml / person / hour

67

What does the orange guide set out?

Microbiological testing guidelines
Recommended limits for microbial contamination in rooms

68

Grade A = zero contamination, so that's inside an isolator
Grade B= ?

Open fronted cabinets

69

Grade C= room containing an isolator (the isolator itself is grade A)
What's grade D?

The room you get changed in

70

Settle plates are a passive technique using gravity to collect microbes. But they only represent 0.2% of the work surface. Contact plates are slightly better, the media includes a neutraliser, roll the plate on the surface for around __ seconds

5 seconds contact time

71

Why is sterility testing abit useless?

They take 14 days
Only tests the container for sampling
Poor indicators of low levels of contamination therefore no good for grade A rooms

72

What four environmental monitoring techniques could we use in grade A rooms?

Continuous particle monitoring
DOP (HEPA) filter testing (every 6 months)
Bubble point test
Visual inspection of products

73

What 5 things can we do to ensure we are contamination free? (All QA)

Use licensed starting materials
Use only CE marked devices
Seperate products and facilities (rooms)
Make sure you've got the appropriate shelf life, conduct stability studies
Validate cleaning procedures

74

What's the difference between luer lock and luer slip?

Luer lock: allows needle to be twisted onto the tip the locked into place, preventing accidental removal of the needle
Luer slip: allows needle to be pushed onto the tip not twisted, it's usually cheaper but less safe

75

What is the key difference between nuclear medicine and X. Rays

Nuclear med uses isotopes which show function. They show changes as they happen.

X rays only show structure. They show changes post event. Not whilst they're happening

76

What helps to give a clearer image with a gamma camera?

A Collimator
Allows only radioactivity from one angle to pass through, and absorbs the rest of the scatter

77

How do we make a radio pharmaceutical?

Mix radioactivity plus saline

78

What's a good radionuclide to use?

99m technetium
It has a 6 hour half life which is long enough to get a scan done but patient won't be radioactive when they leave
It's a gamma emitter
It decays to a stable isotope which is relatively low energy but suitable to be detected on a gamma camera
Also good as it combines to a large range of targeting tracers

79

What two radiopharmaceuticals are good to use in kidney transplants?

DMSA and MAG3

Can see renal scarring with DMSA
Used in children quite a lot

MAG3 used to see if kidney is functioning
Left kidney has poorer throughput of tracer

80

How can we use radiopharmacy to scan the lungs?

To look at breathing: patient inhales Krypton 81 gas

To look at perfusion: inject MAA

Look for mismatches between the two
Can diagnose pulmonary embolisms

81

What radiopharmaceutical is used in thyroid imaging?

Pertechnetate (technicium)

82

What radiopharmaceutical Is used for the stomach?

Meckels diverticulum

83

What radiopharmaceutical is used in the bones?

Organic phosphate complex

Uptake depends on bone turnover
Bone metastasis: increased uptake: see black spots on scan

84

Colloid scans are small scans often used for imaging the _______ system.

Lymph system
Lymphoscintigraphy

85

What's the difference between certificate of conformity and certificate of analysis?

Certificate of analysis should be avaiable for any batch manufactured as 'special' and is evidence that critical parameters have been confirmed by physical, chemical or microbiological assay of a sample of the final product.

Certificate of conformity is a signed statement by the manufacturer that they believe the product complies with the purchasers (pharmacists) specification.

86

What are the three types of non spore forming bacteria?

Staphylococcus streptococcus and micrococcus

87

Name 5 fungal spores

Penicillum
Aspergillus
Mucor
Candida
Cladosporum

88

What kinds of bacteria produce spores?

Bacillus
Clostridium

89

Yeast beginning with R

Rhodotorula

90

In Aseptics should the room be kept at a positive or negative pressure?

Positive
Doesn't let any outside air into the room

91

What kind of disinfectants need to be used in grades A and b and C and d areas?

STERILE disinfectants in grades A and B
Spore free disinfectants in grades C and D

92

How do you clean a laminar flow cabinet?

Use sterile neutral detergent at start and end
Use alcohol sprays
And weekly bleach

93

What's the maximum expiry of aseptic products?

7 days
Can be longer if made in a licensed facility
Can refrigerate

94

There are two disinfection methods of the Aseptics area (isolator/ cabinet) what are these?

1) gassing
2) spray-wipe-spray with 70% alcohol
Note: alcohol is not sporicidal so you need to Wipe in order to mop up any spores
Work in spray booths with fume extractors or drip trays and wear gloves
Use aerosol sprays
Wet all surfaces including labels (paper is a source of contamination)
Let the alcohol DRY or it won't work

95

What is process validation?

Competency of facilities and operators process simulation

96

What is operator validation?

Staffs competency in technique

97

Operator and process validation should be done at least ___ times initially and regularly thereafter

3 times

98

What kind of things does cleaning validation involve?

Surface sampling before and after cleaning
Swabs and contact plates
Remove chemical contamination
Incubate samples for 5 days

99

How long should agar plates be incubated for and at what temp?

Incubate for 5 days at 30-35 degrees

100

What's a Universal Operator Broth validation test?

Assesses an operators ability to maintain the sterility of materials during the preparation of Aseptically prepared injectables
It's a way operators can show competency in Aseptics

Can also do end of session broth tests

101

Clinical trials: if you're looking at a product already with a product licence, you only have to submit a ____.
New agents have to subunit an ______ ______ which is much more complex.

SPC

IMP dossier

102

What is the definition of an Investigational Medicinal Product?

A form of an active substance/ placebo being taste or used as a reference in a clinical trial including products already with a marketing authorisation but are used or assembled, or packaged in a different way to the authorised form or when used for an unauthorised indication, or used to get further information on an authorised form.

103

What is reconstitution with reference to IMPs?

Either dissolving the IMP for administration into the trial subject or diluting/ mixing the IMP with some other substance used as a vehicle for the purpose of administering
It is NOT mixing up several ingredients including the API as this is manufacture

104

When doles reconstitution need to be done?

As close to administration to a patient as possible

105

When is something classed as manufacture?

When you're mixing up several ingredients including the API

106

When you're dispensing / reconstituting an IMP do you need to label?

Nope

107

If something is classed as manufacture, what license is needed?

An IMP license

It's signed off before going to the trial patient

108

What do we usually use as a diluent in protein injectables?

Saline
But some proteins may be insoluble at high salt, so may require dilute saline.
Do not use dextrose, can react with Lysines and form Schiffs bases

109

What factors can denature proteins/ make them less stable / cause them to form aggregates?

Freezing or thawing
Agitation (mixing)
Low or high pHs
Low or high Salts: could poss make protein more stable

110

What 6 things can cause a protein to denature?

Heat
Charge repulsion
Salt bridges breaking/ moving
H bonds breaking
Structural water: getting in structure of protein
Hydrophobic surfaces (proteins are more hydrophillic)

111

What type of aggregate do insulin and growth hormone form? How can this be dissociated?

Reversible

Dilution or alter pH

112

What can irreversible non covalent protein aggregates be dissociated by?

Detergents

113

Can you filter out soluble aggregates of proteins using a 0.2 micron filter?

No
These have a very small aggregation number
So they are very small
Can't visually detect: I.e they won't make the solution turbid like insoluble aggregated

114

Liquid proteins should be shipped and stored at a temp of ____-. They should also be ______ before administration.

2-8 degrees
Should be mixed

115

What is lyophilisation?

Freeze drying
Dehydration process used to preserve a protein and it's excipients by removing all water and forming a solid powder. Requires reconstitution before administration.
Allows it to be shipped at ambient temperatures
Mix the powder before reconstitution, mix the solution after reconstitution.

116

With lyophilisation is there More or less risk of contamination ?

More risk of contamination

Due to additional manipulation being required

117

Genetic manipulation definition?

The manipulation through genetic engineering of living organisms or their components to produce useful products like pest controls and protein drugs

118

What are the 4 steps in cloning?

1) fragmentation (isolate your DNA fragment and amplify it using PCR)
2) ligation - glue together pieces of DNA in a desired sequence
3) transfection: insert new DNA into cells
4) screening and selection: select cells that have successfully been transferred with the new DNA

119

What two ways could we transfect DNA?

Could put recombinant DNA plasmids into E.coli and allow it to replicate
Could put our plasmid into a lipofection reagent, forming a DNA- lipid complex which can be endocytosed into mammalian cells and release DNA.

120

How can we increase the circulatory time of proteins?

Couple protein to albumin
Couple to PEG
Makes protein bigger so less likely to be cleared

121

Biosimilars are like generic versions of proteins
They increase access for patients as prices come down
Patents expire after ____ years

20

122

How can we come up with the whole genome assembly?

Overlap gene fragments from 5 different individuals
Combine these to make a big consensus sequence
Consensus sequence then connected together into scaffolds
Then mapped to genome with STS physical map information

123

What are strict orthologs?

Comparing human, fly and worm genomes
Looking for "best hits"

124

What is a transposon?

A DNA sequence that can change it's position in the genome

125

siRNA can lead to mRNA degredation by making it dsRNA
Directs degredation by enzymes ____________

Endonucleases and exonucleases

126

How can we improve absorption in biotechnology?

Alter the barriers (in lung or gut) eg penetration enhancers
Alter Formulation, eg shift to lymphatic uptake rather than venous
Overcome blood barriers
Improve retention time in tumours eg via the EPR effect

127

What's the difference between reproductive cloning and therapeutic cloning?

Reproductive cloning: generating an animal with the same nuclear DNA as another animal

Therapeutic cloning: involves human stem cells harvested from human embryos
Issues as it destroys the embryo

128

What is PQS?

A management system to direct and control an organisation with regards to QUALITY

129

What three main factors / aims does PQS involve?

Achieving product realisation so taking something from an idea and turning into a product
Establishing control of this transformation process
To enable continual improvement by reassessing procedures and following things up all the time

130

Definition of quality

The totality of characteristics satisfying the stated and implied needs
It's all about complying with the specification and meeting the needs of customers eg patients

131

What is the ICHQ10?

It is a model of an effective quality system
It describes a model PQS implemented throughout a products life cycle
Developed by the expert working group of harmonization of technical requirement for pharmaceuticals for human use

It states that implementing a quality system will enable a pharmaceutical organisation to meet ethical and regulatory obligations

132

GMP concerns ______ and ________

Production and quality control

133

GMP vs PQS?

GMP is compulsory, it's the bare minimum
PQS is not
GMP is not a system,
Following GMP does NOT lead to PQS, have to do extra as GMP is just QC and production only, no QA etc
PQS is a management tool

134

What are cold chain products?

Medicinal products that need to be stored and shipped at lower than ambient temperatures to ensure their quality and efficacy
So need to store at colder temperatures

135

Vaccines
Insulin
PN
Biotechnology medicines
Blood products
Are all at risk of damage from _______ as well as _______

From freezing as well as elevated temperatures

136

Temperatures and storage rooms need to be monitored and recorded how often?

Daily
Plus reviewed regularly too

137

With fridges, we should aim for __ oC
Pharmaceutical fridge _______oC
Blood bank fridge _________oC

5oC
Pharmaceutical fridge: 2-8oC
Blood bank fridge: 2-6oC

138

How can we monitor fridge temperatures?

Use a calibrated electronic min/max thermometer with an accuracy of +/- 0.5 oC
Should be able to read this without opening fridge door

139

Base of a fridge is not a shelf. Should be a gap of ~______ between bottom shelf and base.

3 inches

140

How can we control temperature during transport?

Can get validated temperature control systems such as thermal packaging that keeps the contents at a constant temp, temperature controlled containers, refrigerated vehicles

141

Hormone based medicines are very sensitive to ________
Diagnostic test strips are very sensitive to _________
Hydrocortisone is useless in the ________
___________ can cause stomach and kidney damage
_________ can kill

Sensitive to temperature changes
V sensitive to humidity
Useless in the heat
Decayed antibiotics can cause stomach/ kidney damage
Deteriorated insulin / GTN can kill

142

What medicines are most likely to be counterfeit?

High values drugs like Viagra
High volume mid priced drugs like Lipitor
High value IV lines like epogen

It's all about the money money money

143

What extra label must be on all creams?

For external use only

144

For a cream that is diluted, what's the expiry?

This is freshly prepared
2 week expiry

145

For creams that are non diluted, what is the usual expiry given?

4 weeks

146

What is trituration?

The grinding together of two or more substances to achieve a homogenous mixture.
Could be mixing two powders or two creams
Incorporation into the base

147

What powdered substance DONT you need to weigh excess of?

Sulphur

148

Cream or ointment, which is best for an emollient for dry skin etc?

Ointment, specifically hydrophobic ointments and water emulsifying ointments
Ointments act as emollients as they have a better occlusive action than creams, this means they provide hydration

149

Which is more prone to contamination, creams or ointment?

Creams
Higher water content

150

For a diluted ointment, what's the expiry?

2 weeks expiry
As it's classed as freshly prepared

151

For ointments that haven't been diluted, what's their expiry?

3 months

152

What extra label must be on all ointments?

For external use only

153

What is the classification of freely soluble?

1 in 1 to 1 in 10

154

What is classed as soluble?

1 in 10 to 1 in 30

155

What is classed as slightly soluble?

1 in 30 to 1 in 1000

156

What is classed as very slightly soluble?

1 in 1000 to 1 in 10,000

157

What's the order we should dissolve solute in?

Start with the LEAST soluble in the vehicle first
Then the next least soluble
The most soluble dissolved last

158

What should we dissolve solutes in?

Flat bottomed beaker to avoid caking

159

Double strength chloroform water strength:
Single strength chloroform water strength:

Double strength 1 in 20
Single strength 1 in 40

160

Max strength of chloroform as an antibacterial agent?

0.5% w/w or w/v

161

A solution that is freshly prepared ie made within the previous 24 hours usually has an expiry of?

14 days

162

Anything that is recently prepared must be discarded after _______

4 weeks

And stored at 15- 25 oC

163

Anything that is freshly prepared must not be more than 24 hours before it is issued for use. It is given an expiry of?

2 weeks

164

Do solutions need to be stored in vertical fluted bottles?

No since the HMR 2012

165

Store in fridge: what's the temp range?
Store in cool place: what's the temp range?

2-8 oC for fridge
8-15 oC for cool place

166

What is the usual expiry date of solutions?

4 weeks

167

What is generally on the label of solutions?

Shake well before use

Sometimes store in a cool place

168

What's the difference between a coarse and colloidal suspension?

Coarse: particle size is greater than 1mm diameter
Colloidal: particles are less than 1mm diameter

169

General expiry date for suspensions?

4 weeks

(2 if freshly prepared)

170

Label for suspensions?

Shake the bottle


(Not to be taken by mouth for inhalations)
(For external use only for any not oral)

171

Specials can be prescribed by doctors, dentists, nurse IPs, pharmacist IPs, supplementary prescribers.
Who can extemporaneous products be prescribed by?

Only a doctor or dentist
Not pharmacist IP nurse IP etc

172

How long must pharmacists keep records of extemporaneous supplies for?

5 years

173

What's the usual expiry of pharmaceutical powders?

2 weeks expiry

174

What's the inert diluent used to bulk out powders?

Lactose

175

What is the maximum one stage dilution in pharmaceutical powders?

1 in 20

176

What is a LEGAL requirement for the label of any product not intended for oral use?

For external use only

Or not to be taken by mouth on ear, eye, nasal, vaginal, rectal preparations

177

What label is advised on all products extemporaneously prepared unless otherwise stated?

Store in a cool dry place

178

What four kinds of organisms are we likely to find in a clean room?

Staphylococcus species
Micrococcus
Enterobacter aerogenes
Staph epidermis

179

A big white and quite dry colony is likely to be ?
What's bout yellow?
What about white?

Bacillus
Micrococcus
Staphylococcus

180

_____ ml of air is enough to kill a patient. Important to remove air bubbles

1.5 ml

Decks in Pharmacy flashcards Class (52):