- Drug half-life (t½)
- The time for plasma concentration to fall by 50%. About 4–5 half-lives are needed to reach steady state or to effectively eliminate a drug.
- First-order kinetics
- A constant FRACTION of drug is eliminated per unit time; amount eliminated rises with concentration and half-life is constant. Most drugs.
- Zero-order kinetics
- A constant AMOUNT is eliminated per unit time regardless of concentration (saturated enzymes). Examples: phenytoin, ethanol, high-dose aspirin.
- Bioavailability (F)
- The fraction of an administered dose that reaches systemic circulation unchanged. IV = 100% (F = 1); oral is reduced by first-pass metabolism.
- Volume of distribution (Vd)
- Apparent volume relating amount of drug in the body to plasma concentration. High Vd = drug distributes widely into tissues (lipophilic).
- Clearance (CL)
- Volume of plasma cleared of drug per unit time. Determines maintenance dose. CL = dose rate ÷ steady-state concentration.
- Loading dose formula
- Loading dose = (Vd × target concentration) ÷ F. Used to reach therapeutic levels quickly without waiting 4–5 half-lives.
- First-pass metabolism
- Metabolism of an oral drug by the gut wall and liver before it reaches systemic circulation, reducing bioavailability.
- Pharmacokinetics vs pharmacodynamics
- Pharmacokinetics = what the body does to the drug (ADME). Pharmacodynamics = what the drug does to the body (effect, receptors).
- ADME
- The four pharmacokinetic processes: Absorption, Distribution, Metabolism, Excretion.
- CYP3A4
- The most abundant drug-metabolizing CYP enzyme. Inhibited by grapefruit, azole antifungals, and macrolides; induced by rifampin and carbamazepine.
- Enzyme inhibitor effect
- A CYP inhibitor RAISES levels of drugs metabolized by that enzyme, increasing toxicity risk. Mnemonic inhibitors: -azoles, macrolides, grapefruit.
- Enzyme inducer effect
- A CYP inducer LOWERS levels of drugs metabolized by that enzyme, risking treatment failure. Inducers: rifampin, phenytoin, carbamazepine, St. John's wort.
- Prodrug
- An inactive compound metabolized in the body to its active form. Example: clopidogrel activated by CYP2C19; codeine to morphine by CYP2D6.
- Pharmacogenomics: clopidogrel + CYP2C19
- CYP2C19 poor metabolizers activate less clopidogrel → reduced antiplatelet effect and higher cardiovascular risk (clopidogrel boxed warning).
- Therapeutic index (TI)
- Ratio of toxic dose to effective dose. A narrow TI (warfarin, digoxin, lithium, phenytoin, theophylline) requires monitoring.
- Agonist vs antagonist
- An agonist binds and activates a receptor to produce an effect. An antagonist binds and blocks the receptor, producing no effect itself.
- Cockcroft-Gault CrCl
- CrCl = [(140 − age) × weight kg] ÷ (72 × SCr), × 0.85 if female. Standard equation for renal drug dosing.
- USP <795>
- Standards for NONSTERILE compounding (capsules, creams, oral liquids). Sets beyond-use dates by formulation type.
- USP <797>
- Standards for STERILE compounding (IV admixtures, injections, ophthalmics). Requires ISO-classified air, garbing, and aseptic technique.
- USP <800>
- Standards for handling HAZARDOUS drugs: containment, negative-pressure rooms, and personal protective equipment to protect personnel.
- Beyond-use date (BUD)
- The date after which a compounded preparation should not be used, based on the chapter (795/797), formulation, and storage conditions.
- Phase I clinical trial
- First in humans; small healthy-volunteer group tests SAFETY, dosing, and pharmacokinetics.
- Phase II clinical trial
- Tests EFFICACY and side effects in patients who have the target disease (larger than Phase I).
- Phase III clinical trial
- Large, randomized, often placebo-controlled trial confirming efficacy and monitoring adverse effects before FDA approval.
- Phase IV clinical trial
- Post-marketing surveillance after approval to detect rare or long-term adverse effects in the general population.
- Number needed to treat (NNT)
- The number of patients who must be treated to prevent one additional bad outcome. NNT = 1 ÷ absolute risk reduction. Lower is better.
- Relative vs absolute risk reduction
- Relative risk reduction is the proportional drop in risk; absolute risk reduction is the actual percentage-point drop. ARR drives NNT.
- p-value (statistical significance)
- The probability the result occurred by chance. A p-value below 0.05 is conventionally considered statistically significant.
- Confidence interval
- A range likely to contain the true value. For a ratio (RR/OR), if the 95% CI crosses 1.0 the result is not statistically significant.
- Randomization (in trials)
- Random assignment to treatment groups to balance known and unknown confounders, reducing selection bias.
- Blinding
- Concealing group assignment. Single-blind = subjects unaware; double-blind = subjects and investigators unaware — reduces bias.
- Intention-to-treat analysis
- Analyzes participants in the group they were randomized to, regardless of adherence or dropout — preserves randomization and reflects real-world use.
- Tertiary resource
- A summarized, compiled reference (textbooks, Lexicomp, Micromedex). Best starting point for general drug information.
- Primary literature
- Original research published as a study (clinical trial, cohort). Most current but requires critical appraisal.
- Henderson-Hasselbalch concept
- Relates a drug's pKa and the surrounding pH to its ionization. Weak acids are absorbed better in acidic environments; weak bases in basic.
- Osmolarity
- The concentration of osmotically active particles per liter of solution (mOsm/L). Important for IV fluids and TPN tonicity.
- Ratio strength
- A way to express concentration, e.g. 1:1000 means 1 g per 1000 mL (or 1 g per 1000 g). Used for epinephrine and antiseptics.
- Steady state
- When the rate of drug in equals the rate of drug out, so concentration plateaus. Reached in about 4–5 half-lives of regular dosing.
- Aminoglycoside pharmacokinetics
- Concentration-dependent killing with a post-antibiotic effect; often dosed once daily (extended interval). Nephro- and ototoxic — monitor levels and renal function.
- The medication use process (5 steps)
- Prescribing → Transcribing/Documenting → Dispensing → Administering → Monitoring. The pharmacist's safety role spans all five.
- Boxed warning
- The FDA's strongest labeling warning, set off by a black border, highlighting serious or life-threatening risks of a drug.
- REMS
- Risk Evaluation and Mitigation Strategy: an FDA-required safety program (e.g., clozapine, isotretinoin) that may require prescriber/pharmacy certification or monitoring.
- Biosimilar
- A biologic highly similar to a reference biologic with no clinically meaningful differences. Only an INTERCHANGEABLE biosimilar may be auto-substituted.
- Generic substitution
- Dispensing an AB-rated generic that is therapeutically equivalent to the brand. Narrow-therapeutic-index drugs may need prescriber approval per state law.
- Schedule II controlled substance
- High abuse potential with accepted medical use (oxycodone, fentanyl, Adderall). No refills allowed; requires a written/e-prescription.
- Schedule III–V controlled substances
- Decreasing abuse potential. C-III to C-V may be refilled up to 5 times within 6 months if authorized.
- Sig: 'po bid'
- By mouth (per os) twice a day. Common prescription abbreviations the pharmacist interprets during transcribing.
- Sig: 'prn'
- Pro re nata — as needed. The pharmacist confirms a maximum dose/frequency is specified.
- Error-prone abbreviations (avoid)
- Avoid 'U' (units), 'IU', 'QD/QOD', and trailing zeros (write 5 mg, not 5.0 mg) — they cause tenfold dosing errors. Use a leading zero (0.5 mg).
- Live attenuated vaccine contraindications
- Avoid in significant immunocompromise and pregnancy (MMR, varicella, LAIV) because the weakened organism could cause disease.
- Influenza vaccine timing
- Annual vaccination is recommended for everyone 6 months and older, ideally by the end of October each season.
- Vaccine storage: refrigerated
- Most inactivated vaccines are stored at 2–8°C (refrigerator). Never freeze them — freezing inactivates many vaccines.
- Vaccine cold chain
- The temperature-controlled storage and handling from manufacturer to administration; a break in the chain can ruin potency.
- IM injection site for adults
- The deltoid muscle for most adult vaccines, given at a 90° angle with a 1–1.5 inch needle depending on patient size.
- Hazardous drug disposal
- Hazardous drugs (many chemotherapy agents) require special containment and disposal per USP <800> and EPA rules — not the regular trash.
- Controlled substance disposal
- Patients should use DEA take-back programs or authorized collectors; pharmacies follow DEA reverse-distribution rules for expired stock.
- Drug recall: Class I
- The most serious FDA recall — reasonable probability the product will cause serious harm or death.
- Refrigerated drugs (examples)
- Insulin (unopened), many vaccines, some antibiotics after reconstitution, and certain biologics require 2–8°C storage.
- Therapeutic interchange
- Substituting a therapeutically equivalent alternative within a class per a formulary protocol (e.g., switching one PPI for another), distinct from generic substitution.
- Drug shortage management
- Pharmacists conserve supply, identify therapeutic alternatives, and prioritize critical patients — a tested skill under medication use and management.
- Look-alike/sound-alike (LASA) drugs
- Drug pairs easily confused (hydroxyzine/hydralazine). Use tall-man lettering and separation to prevent dispensing errors.
- High-alert medications
- Drugs with a high risk of harm if used in error (insulin, anticoagulants, opioids, concentrated electrolytes). Require extra safeguards.
- Insulin storage after opening
- Once in use, most insulin vials/pens can be kept at room temperature for about 28 days; check the specific product labeling.
- Medication reconciliation
- Building the most accurate list of all a patient's medications and comparing it to new orders at every transition of care to prevent errors.
- First-line type 2 diabetes therapy
- Metformin plus lifestyle change. It lowers hepatic glucose output, is weight-neutral, and does not cause hypoglycemia alone.
- Metformin caution
- Hold around iodinated contrast and in significant renal impairment due to lactic-acidosis risk; common GI side effects.
- Warfarin target INR
- Usually 2–3 (atrial fibrillation, VTE); 2.5–3.5 for certain mechanical heart valves. A rising INR raises bleeding risk.
- Warfarin reversal
- Vitamin K for elevated INR; for serious bleeding, 4-factor prothrombin complex concentrate (PCC). FFP if PCC unavailable.
- Heparin monitoring and reversal
- Unfractionated heparin is monitored with aPTT (or anti-Xa) and reversed with protamine sulfate.
- Vancomycin monitoring
- Narrow therapeutic window; AUC/MIC ~400–600 for serious MRSA. Nephrotoxic — follow renal function closely.
- First-line hypertension (general)
- Thiazide diuretic, ACE inhibitor or ARB, or calcium channel blocker. ACE/ARB preferred with diabetes or chronic kidney disease.
- ACE inhibitor key adverse effects
- Dry cough, hyperkalemia, angioedema, and acute kidney injury. Contraindicated in pregnancy (teratogenic).
- ARB vs ACE inhibitor
- ARBs (-sartans) block the angiotensin II receptor and do NOT cause the cough; used when ACE inhibitors are not tolerated. Still avoid in pregnancy.
- Statin monitoring
- Check a baseline lipid panel; statins can rarely cause myopathy/rhabdomyolysis (muscle pain + high CK) and transaminase elevation.
- Beta-blocker caution
- Can mask hypoglycemia symptoms in diabetics, cause bradycardia, and should not be stopped abruptly (rebound). Caution in decompensated heart failure.
- Digoxin toxicity signs
- Nausea, visual changes (yellow-green halos), confusion, arrhythmias. Risk rises with hypokalemia. Reverse with digoxin immune Fab.
- Lithium monitoring
- Narrow therapeutic index (~0.6–1.2 mEq/L). Levels rise with dehydration, NSAIDs, ACE inhibitors, and thiazides. Watch tremor, confusion.
- Phenytoin notes
- Zero-order kinetics, narrow therapeutic index, many interactions; monitor levels (correct for low albumin). Causes gingival hyperplasia.
- SSRI key counseling
- Takes 4–6 weeks for full antidepressant effect; do not stop abruptly (discontinuation syndrome); watch for serotonin syndrome with other serotonergic drugs.
- Serotonin syndrome
- Agitation, hyperreflexia, clonus, hyperthermia, and autonomic instability from excess serotonergic activity (e.g., SSRI + MAOI or tramadol).
- Warfarin + amiodarone interaction
- Amiodarone inhibits warfarin metabolism, raising INR and bleeding risk — reduce the warfarin dose and monitor INR closely.
- NSAID drug-disease interactions
- NSAIDs worsen heart failure, hypertension, chronic kidney disease, and peptic ulcer disease, and raise bleeding risk with anticoagulants.
- Five interaction types
- Drug-drug, drug-food, drug-condition (disease), drug-allergy, and drug-laboratory — all screened in a prospective drug-utilization review.
- Acetaminophen overdose antidote
- N-acetylcysteine (NAC), most effective within 8 hours. Use the Rumack-Matthew nomogram to decide treatment.
- Opioid overdose antidote
- Naloxone, an opioid antagonist. May need repeat dosing because its duration can be shorter than the opioid's.
- Benzodiazepine overdose antidote
- Flumazenil — used cautiously because it can precipitate seizures in chronic users or mixed overdoses.
- Iron overdose antidote
- Deferoxamine, an iron chelator. Iron overdose is a leading cause of pediatric poisoning deaths.
- Beta-blocker / calcium channel blocker overdose
- Glucagon (for beta-blockers), high-dose insulin therapy, calcium, and IV fluids for hypotension and bradycardia.
- Heparin-induced thrombocytopenia (HIT)
- An immune drop in platelets with paradoxical clotting after heparin. Stop all heparin and switch to a direct thrombin inhibitor (argatroban).
- Hyperkalemia and ACE inhibitors
- ACE inhibitors, ARBs, and potassium-sparing diuretics raise serum potassium; monitor K⁺ and renal function, especially together.
- First-line community-acquired pneumonia (outpatient)
- For healthy adults, amoxicillin or doxycycline; a macrolide where local resistance is low. Comorbidities add a respiratory fluoroquinolone or combination therapy.
- Asthma rescue vs controller
- Rescue = short-acting beta-agonist (albuterol) for acute symptoms. Controller = inhaled corticosteroid for daily prevention.
- Inhaled corticosteroid counseling
- Rinse the mouth after use to prevent oral thrush; a spacer improves delivery; it is preventive, not a rescue inhaler.
- MDI inhaler technique
- Shake, exhale fully, seal lips, press while inhaling slowly and deeply, then hold breath ~10 seconds. A spacer improves delivery.
- Levothyroxine counseling
- Take on an empty stomach, 30–60 minutes before breakfast; separate from calcium, iron, and antacids. Monitor TSH ~6–8 weeks after dose changes.
- Pregnancy-contraindicated drugs (examples)
- ACE inhibitors/ARBs, warfarin, isotretinoin, methotrexate, and statins are teratogenic and avoided in pregnancy.
- Renal dose adjustment principle
- As creatinine clearance falls, reduce the dose or extend the interval for renally cleared drugs; some are contraindicated below a CrCl threshold.
- Aminoglycoside / vancomycin toxicities
- Both are nephrotoxic; aminoglycosides are also ototoxic. Monitor renal function and levels in serious infections.
- QT-prolonging drugs
- Many antiarrhythmics, certain antibiotics (macrolides, fluoroquinolones), antipsychotics, and ondansetron prolong QT — additive risk increases torsades de pointes.
- Anticholinergic side effects
- Dry mouth, blurred vision, constipation, urinary retention, confusion. Mnemonic: 'dry as a bone, blind as a bat, mad as a hatter.'
- Adherence assessment
- Reviewing refill records, patient-reported barriers (cost, side effects, beliefs), and gaps; nonadherence is a leading cause of treatment failure.
- Teach-back method
- Asking the patient to restate instructions in their own words to confirm understanding — a core patient-education and health-literacy technique.
- Allergy vs intolerance
- An allergy is an immune-mediated reaction (rash, anaphylaxis); an intolerance is a non-immune side effect (e.g., GI upset). Document the difference.
- Penicillin / cephalosporin cross-reactivity
- Cross-reactivity is low (~1–2%) and mainly with shared side chains. A true anaphylactic penicillin allergy warrants caution with cephalosporins.
- Warfarin patient counseling
- Keep vitamin K intake consistent, avoid alcohol excess, report unusual bleeding, and keep INR appointments; many drugs interact.
- Direct oral anticoagulants (DOACs)
- Apixaban, rivaroxaban, dabigatran, edoxaban. No routine INR monitoring; dose-adjusted by renal function; idarucizumab reverses dabigatran, andexanet the Xa inhibitors.
- Methotrexate dosing pitfall
- For rheumatoid arthritis and psoriasis it is dosed WEEKLY; accidental daily dosing causes fatal toxicity. Supplement folic acid.
- Opioid + benzodiazepine combination
- Carries a boxed warning for profound sedation, respiratory depression, and death; avoid or use the lowest doses with monitoring and naloxone.
- Steroid taper
- Long-term corticosteroids must be tapered, not stopped abruptly, to avoid adrenal insufficiency from HPA-axis suppression.
- Common OTC analgesic limits
- Acetaminophen max ~3–4 g/day (less with liver disease/alcohol); NSAIDs risk GI bleed and kidney injury. Screen for duplications and interactions.
- St. John's wort interactions
- A potent CYP3A4 inducer; lowers levels of many drugs (oral contraceptives, warfarin, immunosuppressants) and adds serotonergic risk.
- Therapeutic goal / clinical endpoint
- The measurable target of therapy (e.g., A1c < 7%, blood pressure < 130/80) used to evaluate effectiveness and modify the plan.
- Special population: geriatric dosing
- Start low and go slow; reduced renal/hepatic function and polypharmacy raise adverse-event risk. Use Beers Criteria for potentially inappropriate medications.
- Special population: pediatric dosing
- Doses are weight-based (mg/kg) with maximums; verify the calculation and concentration to avoid tenfold errors.
- MedWatch
- The FDA's voluntary reporting program for serious adverse events, product-quality problems, and medication errors for drugs, biologics, and devices.
- VAERS
- Vaccine Adverse Event Reporting System — the program for reporting adverse events after vaccination (separate from MedWatch).
- Antimicrobial stewardship
- Coordinated efforts to use antibiotics only when needed, with the right drug, dose, route, and duration — slowing resistance.
- Opioid stewardship
- Practices to reduce opioid harm: lowest effective dose, naloxone co-prescribing, PDMP checks, and patient education.
- PDMP
- Prescription Drug Monitoring Program — a state database pharmacists check to detect duplicate or excessive controlled-substance prescriptions.
- Tobacco cessation pharmacotherapy
- Nicotine replacement therapy, bupropion, and varenicline are first-line aids; pharmacists provide counseling and the 5 A's.
- Social determinants of health
- Non-medical conditions (economic stability, education, health-care access, environment, social context) that strongly shape health outcomes and adherence.
- Informed consent
- A patient's voluntary agreement to treatment after being told its nature, benefits, risks, and alternatives, given by someone with capacity.
- Patient confidentiality / HIPAA
- Protects health information; share only the minimum necessary. Treatment, payment, and operations are permitted disclosures.
- Ethical principle: autonomy
- Respecting the patient's right to make their own informed decisions about their care.
- Ethical principle: beneficence
- Acting in the patient's best interest; doing good.
- Ethical principle: nonmaleficence
- 'Do no harm' — avoiding actions that injure the patient.
- Ethical principle: justice
- Fair, equitable treatment and allocation of resources among patients.
- Health screening role
- Pharmacists perform point-of-care screenings (blood pressure, glucose, lipids, A1c) and refer patients for follow-up — a public-health initiative.
- Professional responsibility
- Practicing within scope, maintaining competence, and reporting errors honestly under a non-punitive, systems-based safety culture.
- Pharmacist's corresponding responsibility
- The legal duty to ensure a controlled-substance prescription is for a legitimate medical purpose before dispensing it.
- Naloxone access role
- Pharmacists in most states can dispense naloxone under standing orders or collaborative agreements as a public-health overdose intervention.
- Medication use evaluation (MUE)
- A criteria-based, ongoing quality process that reviews how a drug is prescribed, dispensed, and monitored against best-practice standards, then drives improvement.
- Root-cause analysis (RCA)
- A structured, retrospective review after an error to find the underlying system cause — not blame an individual — and fix the process.
- Continuous quality improvement (CQI)
- An ongoing, data-driven approach (e.g., Plan-Do-Study-Act cycles) to improve pharmacy processes and patient outcomes.
- Failure mode and effects analysis (FMEA)
- A PROACTIVE risk-assessment method that maps a process to find where it could fail before an error happens, then adds safeguards.
- Sentinel event
- An unexpected occurrence involving death or serious harm; triggers an immediate investigation and root-cause analysis.
- Barcode medication administration
- Scanning the drug and patient wristband to verify the 'five rights' at the point of care — a key error-prevention technology.
- Formulary
- A managed list of preferred medications a health system or plan covers, balancing efficacy, safety, and cost; managed by the P&T committee.
- Pharmacy and Therapeutics (P&T) committee
- A multidisciplinary group that manages the formulary, reviews drug safety, and sets medication-use policy.
- Inventory turnover
- How many times inventory is sold and replaced in a period. Higher turnover ties up less cash but risks shortages; managed with par levels.
- Par level
- The minimum stock quantity that triggers reordering, balancing stockouts against carrying cost and expiration waste.
- Drug shortage response (operations)
- Identify alternatives, allocate to highest-need patients, communicate with prescribers, and document — coordinated through pharmacy leadership.
- Drug recall handling
- Quarantine affected stock, notify patients/prescribers as needed by recall class, and arrange return per FDA and manufacturer instructions.
- Preceptor role
- An experienced pharmacist who teaches, models practice, and gives feedback to students and trainees during experiential rotations.
- Constructive feedback
- Specific, timely, behavior-focused feedback aimed at improvement; a tested mentorship and preceptorship skill.
- Delegation of work
- Assigning appropriate tasks to technicians and staff within their scope while the pharmacist retains professional responsibility.
- Just culture
- A safety culture that distinguishes human error, at-risk behavior, and reckless conduct — supporting reporting without blame for honest mistakes.
- Risk management
- Identifying, assessing, and reducing risks to patients and the pharmacy — from dispensing errors to regulatory and operational hazards.
- Health informatics in pharmacy
- Use of technology — e-prescribing, clinical decision support, automated dispensing — to improve safety and efficiency in the medication use process.
- Michaelis-Menten kinetics
- Mixed kinetics where elimination is first-order at low concentrations but becomes zero-order once enzymes saturate — phenytoin is the classic example.
- Protein binding and drug interactions
- Highly protein-bound drugs (warfarin, phenytoin) can be displaced by another bound drug, transiently raising free (active) drug levels.
- Lipophilic vs hydrophilic drugs
- Lipophilic drugs cross membranes easily, have a high Vd, and are hepatically metabolized; hydrophilic drugs stay in plasma and are renally cleared.
- Maintenance dose formula
- Maintenance dose rate = clearance × target steady-state concentration ÷ F. Clearance, not Vd, governs the maintenance dose.
- Allometric / mg/kg dosing
- Weight-based dosing scales the dose to body weight; verify whether to use total, ideal, or adjusted body weight for the drug.
- Alligation
- A calculation method to mix two concentrations of the same drug to get a desired intermediate strength.
- Specific gravity
- The ratio of a substance's weight to the weight of an equal volume of water; converts between weight and volume in compounding.
- Tonicity (isotonic IV)
- Normal saline (0.9% NaCl) and lactated Ringer's are isotonic; matching tonicity prevents red-cell lysis or crenation.
- Pharmaceutics
- The science of formulating and delivering drugs — dosage forms, dissolution, stability, and release mechanisms (immediate vs extended release).
- Emergency Use Authorization (EUA)
- An FDA mechanism to allow use of an unapproved product during a declared emergency when no adequate approved alternative exists.
- Odds ratio vs relative risk
- Relative risk is used in cohort/RCT designs; odds ratio is used in case-control studies. Both are 'no effect' at 1.0.
- Sensitivity vs specificity
- Sensitivity = ability of a test to correctly identify those WITH disease; specificity = correctly identify those WITHOUT it.
- Pharmacoeconomics: cost-effectiveness analysis
- Compares the cost of interventions per unit of clinical outcome (e.g., cost per life-year gained), expressed in natural units.
- Pharmacoeconomics: cost-utility analysis
- Measures outcomes in quality-adjusted life-years (QALYs), allowing comparison across very different therapies.
- Receptor: partial agonist
- Binds and activates a receptor but produces a submaximal effect even at full occupancy (e.g., buprenorphine, varenicline).
- Bioequivalence
- Two products with the same rate and extent of absorption (AUC and Cmax within accepted limits); the basis for generic AB ratings.
- Verbal order requirements
- Verbal/telephone orders should be read back to confirm accuracy and documented; C-II verbal orders are limited to emergencies with a written follow-up.
- DEA number validity check
- A valid DEA number's check digit equals the last digit of [(sum of 1st,3rd,5th) + 2×(sum of 2nd,4th,6th)].
- C-II partial fill
- A C-II prescription may be partially filled, with the remainder dispensed within set time limits per federal and state rules.
- Transfer of controlled-substance refills
- C-III to C-V prescriptions may generally be transferred one time between pharmacies (or freely if pharmacies share a real-time database).
- Medication guide
- FDA-required patient handout for drugs with serious risks (e.g., NSAIDs, antidepressants); must be given with each dispense.
- Tall-man lettering
- Capitalizing distinguishing letters of look-alike names (predniSONE vs prednisoLONE) to reduce mix-ups.
- Five rights of medication
- Right patient, right drug, right dose, right route, right time — the core check during dispensing and administration.
- Pneumococcal vaccines (adult)
- PCV (conjugate) and PPSV23 (polysaccharide) protect against pneumococcal disease; sequencing depends on age and risk per ACIP.
- Shingles vaccine (RZV)
- Recombinant zoster vaccine (Shingrix), 2 doses, recommended for adults 50+ to prevent shingles; it is not a live vaccine.
- Tdap vs Td
- Tdap includes acellular pertussis and is given once (and each pregnancy); Td is the tetanus-diphtheria booster every 10 years.
- Refrigerated vaccine excursion
- If a vaccine is exposed outside 2–8°C, quarantine it, label 'do not use,' and contact the manufacturer/health department before discarding or using.
- Reconstituted antibiotic stability
- Many oral suspensions (e.g., amoxicillin) are stable only ~10–14 days refrigerated after reconstitution; counsel the patient on the discard date.
- Hazardous drug spill
- Use a spill kit, don PPE, contain and clean from the outside in, and dispose per USP <800> and facility policy.
- Auxiliary label: 'take with food'
- Reduces GI irritation (NSAIDs, metformin, steroids) or improves absorption for some drugs; matched to the drug during dispensing.
- Auxiliary label: 'avoid sunlight'
- Photosensitizing drugs (tetracyclines, fluoroquinolones, sulfonamides, amiodarone) warrant sun-protection counseling.
- E-prescribing of controlled substances (EPCS)
- Allowed under DEA rules with identity proofing and two-factor authentication; now required for many C-II prescriptions.
- Heart failure with reduced EF therapy
- Guideline-directed therapy: an ARNI/ACE/ARB, beta-blocker, mineralocorticoid antagonist, and an SGLT2 inhibitor reduce mortality.
- Atrial fibrillation anticoagulation
- Use CHA2DS2-VASc to assess stroke risk; anticoagulate (DOAC or warfarin) when the score warrants it, weighing bleeding risk (HAS-BLED).
- Statin intensity
- High-intensity statins (atorvastatin 40–80, rosuvastatin 20–40) for ASCVD or high risk; moderate-intensity for lower risk.
- Diabetes with CKD or heart failure
- Add an SGLT2 inhibitor for kidney/heart protection, or a GLP-1 agonist for ASCVD, beyond metformin.
- Hypoglycemia treatment
- Give 15 g fast-acting carbohydrate, recheck glucose in 15 minutes (rule of 15s); glucagon if the patient cannot take oral.
- DKA management basics
- IV fluids, IV insulin, and careful potassium repletion (insulin drives K⁺ into cells); correct the precipitating cause.
- COPD maintenance therapy
- Long-acting bronchodilators (LAMA and/or LABA); inhaled corticosteroids added for frequent exacerbations or high eosinophils.
- Depression first-line
- An SSRI or SNRI is first-line; allow 4–6 weeks for full effect, monitor for suicidality early, and avoid abrupt discontinuation.
- MAOI dietary caution
- Avoid tyramine-rich foods (aged cheese, cured meats) to prevent hypertensive crisis; many drug interactions.
- GERD therapy
- Proton pump inhibitors are most effective; take 30–60 minutes before a meal. Long-term use risks B12, magnesium, and fracture concerns.
- Opioid-induced constipation
- Start a stimulant laxative (senna) ± stool softener prophylactically; bulk-forming laxatives alone are inadequate.
- Gout: acute vs chronic
- Acute flare: NSAIDs, colchicine, or steroids. Chronic prevention: allopurinol or febuxostat to lower uric acid (do not start during a flare without cover).
- Seizure: status epilepticus
- First-line is a benzodiazepine (IV lorazepam or IM midazolam), followed by a longer-acting antiepileptic such as levetiracetam or fosphenytoin.
- Anticoagulation in pregnancy
- Low-molecular-weight heparin is preferred; warfarin and DOACs are avoided due to teratogenicity and placental crossing.
- Aminoglycoside + loop diuretic
- Combining increases ototoxicity and nephrotoxicity risk — monitor hearing and renal function.
- Tetracycline / fluoroquinolone chelation
- Di- and trivalent cations (calcium, iron, magnesium, antacids, dairy) bind these antibiotics and block absorption — separate dosing.
- Vancomycin infusion reaction
- Rapid IV infusion causes flushing of the upper body (vancomycin flushing/'red man' syndrome) from histamine release — slow the infusion rate.
- SSRI + NSAID/anticoagulant
- Increases GI bleeding risk because serotonin contributes to platelet function — counsel and monitor.
- Macrolide / azole + statin
- CYP3A4 inhibition raises levels of simvastatin/lovastatin, increasing myopathy and rhabdomyolysis risk — hold or switch the statin.
- Beers Criteria
- A list of potentially inappropriate medications in older adults (e.g., certain anticholinergics, long-acting benzodiazepines) to avoid or use cautiously.
- Pharmacotherapy for opioid use disorder
- Buprenorphine (partial agonist), methadone (full agonist), and naltrexone (antagonist) are evidence-based treatments.
- Warfarin onset / bridging
- Warfarin's full effect takes days (factor II depletion); bridge with heparin/LMWH for acute clots until INR is therapeutic.
- Corticosteroid adverse effects
- Hyperglycemia, weight gain, osteoporosis, infection risk, mood changes, and adrenal suppression with long-term use.
- Potassium-sparing diuretics
- Spironolactone, eplerenone, amiloride, triamterene; raise potassium — avoid combining with ACE inhibitors/ARBs without monitoring.
- Loop diuretic monitoring
- Furosemide can cause hypokalemia, hypomagnesemia, dehydration, and ototoxicity at high doses; monitor electrolytes and renal function.
- Antiepileptic + oral contraceptive
- Enzyme-inducing antiepileptics (carbamazepine, phenytoin) lower contraceptive effectiveness — advise an alternative or backup method.
- Calcium channel blocker classes
- Dihydropyridines (amlodipine) act on vessels (edema, flushing); non-dihydropyridines (verapamil, diltiazem) slow the heart rate.
- Insulin types: rapid vs long
- Rapid-acting (lispro, aspart) covers meals; long-acting (glargine, detemir, degludec) provides basal coverage. Never mix glargine with other insulins.
- Sulfonylurea caution
- Glipizide, glyburide stimulate insulin release and can cause hypoglycemia and weight gain, especially in the elderly or renal impairment.
- Toxic ingestion: activated charcoal
- May reduce absorption if given soon after ingestion; not used for caustics, hydrocarbons, alcohols, metals, or a compromised airway.
- Anaphylaxis treatment
- Intramuscular epinephrine (1 mg/mL) into the anterolateral thigh is first-line; adjuncts include antihistamines, steroids, and oxygen.
- Drug-induced QT + electrolytes
- Hypokalemia and hypomagnesemia worsen QT prolongation; correct electrolytes and avoid additive QT-prolonging drugs.
- Continuing education for licensure
- Pharmacists must complete state-required CE hours to maintain licensure and current clinical competence.
- Collaborative practice agreement
- A formal agreement letting pharmacists provide defined patient-care services (e.g., adjust therapy) under a physician's protocol.
- Adverse drug event vs adverse drug reaction
- An ADE is any harm related to medication use (including errors); an ADR is harm from a drug used appropriately.
- Naloxone counseling
- Teach recognition of overdose, how to administer intranasal/IM naloxone, to call emergency services, and that repeat dosing may be needed.
- Health literacy
- The degree to which a person can obtain, process, and understand health information; low literacy increases nonadherence and errors.
- Cultural competence
- Delivering care that respects a patient's language, beliefs, and values to improve trust, communication, and adherence.
- Mandatory reporting
- Pharmacists must report certain events (suspected abuse, specific communicable diseases) per state law as part of public-health duty.
- Medication therapy management (MTM)
- A pharmacist-led service reviewing a patient's full regimen to optimize outcomes — includes a comprehensive medication review and action plan.
- Plan-Do-Study-Act (PDSA)
- The iterative CQI cycle: plan a small change, do it, study the results, then act — adopt, adapt, or abandon — and repeat.
- Lean methodology
- A quality approach focused on eliminating waste and non-value-added steps to improve efficiency and safety.
- Six Sigma
- A data-driven method to reduce process variation and defects, often using the DMAIC framework.
- Automated dispensing cabinet
- A secure, computerized cabinet that stores and tracks medications on a unit, improving access control and inventory accuracy.
- Clinical decision support (CDS)
- Software alerts (interaction, allergy, dose) integrated into prescribing/dispensing systems to catch errors at the point of care.
- Medication error vs near miss
- An error reaches the patient; a near miss is caught before reaching the patient. Both are reported to improve the system.
- ISMP
- The Institute for Safe Medication Practices — publishes best-practice and high-alert-medication guidance for error prevention.
- The Joint Commission
- Accredits hospitals and health systems on safety and quality, including National Patient Safety Goals for medication safety.
- Operational planning
- Setting workflow, staffing, and resource plans to meet patient-care demand safely and efficiently within the pharmacy.
- Drug diversion prevention
- Controls — inventory audits, access limits, surveillance — to detect and prevent theft of controlled substances by staff.
- Perpetual inventory (C-II)
- A real-time running count of Schedule II controlled substances to detect discrepancies and diversion.
- Technician scope and supervision
- Technicians perform delegated tasks (data entry, counting) under the pharmacist's supervision; final verification stays with the pharmacist.
