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CPJE Flashcards

1
Q

1 gr = __ mg

A

64.8 mg

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2
Q

1 fl oz = __ mL

A

29.6 mL

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3
Q

1 cup = __ oz

A

8 oz

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4
Q

1 pint = __ mL

A

473 mL

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5
Q

1 quart = __ mL

A

946 mL

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6
Q

1 gallon = __ mL

A

3785 mL

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7
Q

1 oz = __ g

A

28.4 g

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8
Q

1 lb = __ g

A

454 g

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9
Q

How do you convert aminophylline to theophylline?

A

Aminophylline x 0.8 = theophylline

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10
Q

Amount of elemental Fe in FeSO4

A

20%

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11
Q

1 ppm

A

1 mg/L

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12
Q

1 ppb

A

1 mcg/L

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13
Q

High risk waist size for women

A

> 35”

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14
Q

High risk waist size for men

A

> 40”

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15
Q

BMI formula

A

BMI = weight (kg) / height (m2)

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16
Q

Underweight BMI

A

< 18.5

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17
Q

Normal BMI

A

18.5 - 24.9

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18
Q

Overweight BMI

A

25 - 29.9

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19
Q

Obese BMI

A

30 or higher

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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

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21
Q

IBW formula (men)

A

50 kg + 2.3 kg per inch over 5 feet

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22
Q

IBW formula (women)

A

45.5 kg + 2.3 kg per inch over 5 feet

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23
Q

Normal range SCr

A

0.6 - 1.2 mg/dL

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24
Q

S/S of dehydration

A 
BUN:SCr >20
Decreased urine output
Tachycardia / tachypnea
Dry mouth, dry mucous membranes
Dry skin w/tenting
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25
Q

Cockcroft-Gault equation

A

CrCl (mL/min) = [ (140 - age) / (72 x SCr) ] x wt (kg)

x 0.85 (females only)

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26
Q

CrCl levels

A 
>90 = normal
60-90 = mild insufficiency
30-59 = moderate insufficiency
15-29 = severe insufficiency
<15 = renal failure or dialysis
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27
Q

Specific gravity

A

g/mL (same as density)

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28
Q

When is BSA used for dosing?

A

Chemo & pediatrics

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29
Q

BSA formula

A

BSA (m2) = sq rt of: (cm x kg) / 3600

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30
Q

Formula for changing the concentration or quantity

A

Q1 x C1 = Q2 x C2

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31
Q

Half-life formula

A

t1/2 = 0.693 / ke

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32
Q

Dextrose kcal

A

3.4 kcal/g

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33
Q

Amino acids kcal

A

4 kcal/g

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34
Q

Lipids kcal

A

9 kcal/g

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35
Q

Glucose kcal

A

4 kcal/g

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36
Q

10% lipid emulsion kcal

A

1.1 kcal/mL

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37
Q

20% lipid emulsion kcal

A

2 kcal/mL

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38
Q

Daily fluid needs

A

(when weight >20 kg):

1500 mL + (20)(kg - 20)

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39
Q

Protein requirements for non-stressed outpatient

A

0.8-1 g/kg/day

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40
Q

Protein requirements for inpatient or malnourished

A

1.2-2 g/kg/day

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41
Q

Basal energy expenditure

A

(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

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42
Q

Total energy expenditure

A

(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

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43
Q

How much nitrogen does the patient receive from protein?

A

1 g nitrogen per 6.25 g protein

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44
Q

Normal range for K+

A

3.5 - 5.0 mEq/L

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45
Q

Normal range for calcium

A

8.5 - 10.5 mg/dL

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46
Q

Formula for corrected calcium

A

Ca(corr) = (Ca) + [ (4 - albumin) (0.8) ]

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47
Q

Things to know about phosphorus + calcium in a TPN

A
  • 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
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48
Q

Statute vs. regulation

A

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

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49
Q

Mandatory vs. permissive language in a law

A 
Mandatory = "must" or "shall"
Permissive = "may" or "can" (allows judgment by the pharmacist)
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50
Q

The CA BoP is under the jurisdiction of which department of the state gov’t?

A

Dept. of Consumer Affairs

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51
Q

Number of members on the CA BoP?
How many appointed by the governor?
How many are pharmacists?

A

13 members, 11 appointed by the governor; 7 of the governor’s appointments are RPh, 5 of whom are actively practicing

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52
Q

How long is the term for a member of the CA BoP?

How often do they meet?

A

4 year terms, max 2 terms; meet at least every 4 months

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53
Q

Who can prescribe without a protocol?

A

MD, DO, DDM, DPM, DVM

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54
Q

MVI-13

A

Fat soluble ADEK + water-soluble thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, C, folic acid, B12, & biotin (MVI-12 does not have K)

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55
Q

Trace elements given in TPN

A

Zinc, copper, chromium, manganese (and sometimes selenium); iron not usually given

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56
Q

Trace elements to be withheld w/severe liver disease

A

Manganese & copper

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57
Q

Trace elements to be withheld w/severe renal disease

A

Chromium, molybdenum, selenium

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58
Q

How much insulin is usually added to TPN?

A

50% or less of normal requirement + sliding scale; minimum is 10 units, and gets increased 10 units at a time

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59
Q

Separation between enteral nutrition & drugs with interactions

A

Hold feedings 1 hour before or 2 hrs after drug is administered

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60
Q

Drug interactions w/enteral nutrition

A
  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
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61
Q

Osmolarity definition

A

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)

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62
Q

Osmolarity of body fluids

A

Called “tonicity”; isotonic (same osmolarity as blood) is ~300 mOsmol/L)

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63
Q

Dissociation of dextrose

A

1 dissociation particle

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64
Q

Dissociation of mannitol

A

1 dissociation particle

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65
Q

Dissociation of KCl

A

2 dissociation particles

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66
Q

Dissociation of NaCl

A

2 dissociation particles

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67
Q

Dissociation of sodium acetate

A

2 dissociation particles

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68
Q

Dissociation of calcium chloride

A

3 dissociation particles

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69
Q

Dissociation of sodium citrate

A

4 dissociation particles

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70
Q

Osmolarity formula

A

mOsmol/L = [ (wt in g/L) / (MW in g/mole) ] x # of dissociation particles x 1000

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71
Q

MW (molecular weight)

A

g/mole

72
Q

Dissociation factors

A 
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
Q

E-value definition

A

“NaCl equivalent” for a drug; determines how much additional NaCl must be added to make the drug isotonic

74
Q

E-value formula

A 
E = (58.5)(i) / (MW)(1.8)
58.5 = MW of NaCl, i = 1.8
75
Q

Steps to calculate isotonicity

A
  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
Q

Equation for moles

A

mols = g/MW

77
Q

Equation for mmol

A

mmols = mg/MW

78
Q

Milliequivalent definition

A

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
Q

How to determine the valence

A

Divide the compound into its positive & negative components, then count either the positive or the negative charges (almost always 1 or 2)

80
Q

mEq equation

A 
mEq = (mg)(valence) / MW or
mEq = mmols/valence
81
Q

Celsius to Fahrenheit

A

C = (F - 32) / 1.8

82
Q

Calcium carbonate vs. citrate

A

Carbonate: acid-dependant absorption (take w/meals); 40% elemental calcium
Citrate: acid-independant absorption (take with or without food); 21% elemental calcium

83
Q

Average life span of RBC’s

A

120 days

84
Q

Term for low WBC count

A

Leukopenia

85
Q

Term for high WBC count

A

Leukocytosis

86
Q

Average life span of platelets

A

7-10 days

87
Q

Term for low platelet count

A

Thrombocytopenia

88
Q

Normal range for ANC

A

2200-8000 per microliter (can’t refill clozapine if <2000)

89
Q

Calculation of ANC

A

Multiply WBC by the percentage of neutrophils (segs + bands)

90
Q

BMP includes…

A

Sodium, potassium, bicarb, chloride, calcium, BUN, SCr, glucose

91
Q

CMP includes…

A

The 8 from the BMP + albumin, t-bili, bili, ALT, AST, Alk phos

92
Q

Normal blood pH

A

7.35 - 7.45

93
Q

Anion gap

A

[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
Q

pH vs. pKa

A
  • 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
Q

Ionized vs. unionized drugs

A

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
Q

Henderson-Hasselbach

A 
pH = pKa + log (salt/acid)
pH = pKa + log (base/salt)
pH = 14 - pKb + log (base/salt)
97
Q

SR for a Class A balance

A

6 mg

98
Q

MWQ equation

A

MWQ = SR / % error (usually 0.05)

99
Q

HLB number (hydrophilic - lipophilic balance)

A

Range is 0-20; >10 is water-soluble; <10 is lipid-soluble

100
Q

Potency of cream vs. ointment

A

Ointment is more potent than cream or lotion

101
Q

% of oil & water in creams & ointments

A

Creams are about 50/50; ointments are about 80% oil, 20% water

102
Q

First-order kinetics

A

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
Q

Drugs with Michaelis-Menten kinetics

A

Phenytoin, theophylline, voriconazole

104
Q

ODT’s for elderly

A

Donepezil (Aricept ODT), carbidopa/levodopa (Parcopa), mirtazapine (Remeron SolTab)

105
Q

Long-acting antipsychotics

A

Haloperidol (Haldol decanoate - q4wks), risperidone (Risperdal Consta - q2wks), fluphenazine (Prolixin decanoate)

106
Q

Drugs that can be sprinkled on food

A

(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
Q

Which are the only patches that can be cut?

A

Lidoderm; some pts are instructed to cut fentanyl, but this is not advisable

108
Q

Testosterone patch

A

Androderm; nightly; never apply to scrotum

109
Q

Clonidine patch

A

Catapres-TTS; once a week

110
Q

Estradiol patch

A

Climara, Menostar - once a week
Alora, Vivelle - twice a week
Usually lower abdomen or upper buttocks, but never on breasts

111
Q

Estradiol/norethindrone patch

A

Climara Pro; once a week, but not on breasts

112
Q

Fentanyl patch

A

Duragesic; q72h, but change to q48h if it runs out after 2 days; hold for 30 sec when applying

113
Q

Diclofenac patch

A

Flector; twice daily over painful area

114
Q

Lidoderm patch

A

On 12 hrs, off 12 hrs; use 1-3 patches over painful areas

115
Q

Methylphenidate patch

A

Daytrana; apply every morning, 2 hrs before school; alternate hips daily

116
Q

Nicotine patch

A

NicoDerm CQ; once daily

117
Q

NTG patch

A

On 12-14 hrs, off 10-12 hrs

118
Q

Oxybutinin patch

A

Oxytrol; twice a week

119
Q

Rivastigmine patch

A

Exelon; once daily; if it causes nausea, remove it or use a lower strength

120
Q

Rotigotine patch

A

Neupro; once daily

121
Q

Scopolamine patch

A

Transderm Scop; apply 4 hrs before expected need behind the ear; alternate ears; remove after 3 days if not sooner

122
Q

Selegiline patch

A

Emsam; once daily

123
Q

Standard Deviation

A

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
Q

Confidence Interval

A

Probability that a population’s true value falls within this range

125
Q

What can OD’s prescribe in CA?

A

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
Q

What can ND’s (naturopaths) prescribe in CA without a protocol?

A

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
Q

Prescriptive authority for PA’s & NP’s in CA

A

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
Q

p-value

A

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
Q

Type I error

A

False positive; the null hypothesis was rejected in error; alpha

130
Q

Type II error

A

False negative; null hypothesis was accepted in error; beta, which measures a test’s sensitivity, or its ability to ID positive results

131
Q

Power

A

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
Q

RR

A

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
Q

RRR

A

Relative risk reduction; how much the risk in the intervention group was reduced compared to the control group; RRR = 1 - RR

134
Q

ARR

A

Absolute risk reduction; the difference in incidence between the groups; ARR = incidence control - incidence exposed

135
Q

NNT

A

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
Q

Risk vs. Odds

A

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
Q

OR

A

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
Q

Discrete data

A

Finite set of values with whole numbers only; nominal & ordinal

139
Q

Nominal data

A

Categories (gender, etc)

140
Q

Ordinal data

A

Ranked categories, with unequal differences between them (Likert scale)

141
Q

Continuous data

A

Infinite number of values within a defined range; interval & ratio

142
Q

Interval data

A

Arbitrary zero point (temperature)

143
Q

Ratio data

A

Meaningful zero point (height, weight, time)

144
Q

Observational study

A

Observe effect in the general population in a non-controlled environment

145
Q

Case-control study

A

Compare groups retroactively to look for contributing factors; compare otherwise similar groups that have the condition vs. those that don’t have it

146
Q

Cohort study

A

Longitudinal study comparing outcomes in group that was exposed to an intervention to those who were not exposed; distinguishes cause & effect

147
Q

Cross-sectional study

A

Used to determine prevalence, but cannot determine cause & effect; looks at a single point in time

148
Q

Single-blinded controlled trial

A

Subjects don’t know what they got

149
Q

Double-blinded controlled trial

A

Subjects & researchers don’t know who got what

150
Q

Cross-over trial

A

Once subjects finish a course of treatment, they get switched to another one after a washout period

151
Q

Non-inferiority trial

A

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
Q

ECHO model

A

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
Q

Direct medical costs

A

Meds, administration, hospitalization, etc

154
Q

Direct non-medical costs

A

Travel, childcare, etc

155
Q

Indirect costs

A

Loss of productivity

156
Q

Intangible costs

A

Pain & suffering, anxiety, etc

157
Q

CEA

A

Cost-effectiveness analysis; outcomes per dollar; most common method used, but can’t directly compare different types of outcomes

158
Q

CMA

A

Cost-minimization analysis; compares the costs of two or more interventions that are already shown to have equivalent outcomes

159
Q

CBA

A

Cost-benefit analysis; converts the costs & benefits from an intervention & converts them to current dollars

160
Q

CUA

A

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
Q

SNP

A

Single nucleotide polymorphism; single base difference between 2 people, resulting in two possible alleles; they are the most common genetic variations in DNA

162
Q

Polymorphism

A

DNA variation that is too common to be a new mutation; present in at least 1% of the population

163
Q

Abacavir pharmacogenomics

A

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
Q

Clopidogrel pharmacogenomics

A

Plavix; test for 2C19; active metabolite depends on 2C19, so poor metabolizers get less benefit from the drug

165
Q

Carbamazepine pharmacogenomics

A

Tegretol; test Asians for HLA-B*1502; TEN or SJS skin rxns

166
Q

Trastuzumab pharmacogenomics

A

Herceptin (also in Tykerb & Perjeta); test for HER2/neu; over-expression required for the tumor to respond to the drug

167
Q

Phenytoin pharmacogenomics

A

Dilantin; test Asians for HLA-B*1502; TEN or SJS skin rxns

168
Q

Warfarin pharmacogenomics

A

Coumadin, Jantoven; test for 2C9 & VKORC1; 2C92 & 2C93 are loss of function alleles & can cause increased risk of bleeding

169
Q

Prescriptive authority for CNM’s in CA

A

(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
Q

How many PA’s or NP’s can a physician supervise?

A

Max total of 4 in any combination

171
Q

How long do you have to notify the CA BoP of a change in PIC?

A

30 days in writing

172
Q

Max number of pharmacies for which one pharmacist can be PIC?

A

Two, and only if they are within 50 miles of each other

173
Q

How long can there be an interim PIC?

A

120 days

174
Q

Requirements for a preceptor?

A

License must not be revoked, suspended, or on probation

175
Q

CE requirements?

A

30 credit hours every two years

176
Q

Keep CE certificates for how long?

A

4 years

177
Q

Inactive license vs. retired license

A

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

CPJE (1 decks)

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