Top 100 Facts for PTCB Certification and Concepts for the PTCB
Clinical Pharmacology and Therapeutic Classifications
Opioid Analgesics: These medications function as agonists at the mu-opioid receptors. Notable examples include codeine, dihydrocodeine, tramadol, meperidine, and morphine. Common side effects associated with this class are constipation, miosis (pupillary constriction), nausea, dizziness, euphoria, and respiratory depression.
Triptans: These are specialized drugs used specifically for the treatment and management of migraines.
Antitussive Medications: These drugs are used to treat coughs. Examples include codeine and dextromethorphan.
Calcium Channel Blockers: Primarily used to treat hypertension and the symptoms of stable angina, this class includes nifedipine, amlodipine, diltiazem, and verapamil.
Proton Pump Inhibitors (PPIs): Used to treat conditions caused by excess gastric acid production, these drugs are identifiable by the suffix -prazole. Examples are omeprazole, lansoprazole, and pantoprazole.
Bisphosphonates: These agents are utilized in the treatment of osteoporosis and include alendronic acid, pamidronate, and zoledronic acid.
Selective Serotonin Reuptake Inhibitors (SSRIs): These are used in the treatment of major depressive disorder (MDD). Members of this class include paroxetine, sertraline, citalopram, escitalopram, fluoxetine, and fluvoxamine.
Fluoroquinolones: This antibacterial drug class is characterized by the suffix -floxacin (e.g., ciprofloxacin, moxifloxacin). A notable and serious side effect is tendon damage and rupture. Patients must avoid taking these with multivalent ions such as calcium and iron.
Antiretroviral Therapy: Highly Active Anti-Retroviral Therapy (HAART) is used to treat HIV/AIDS. Drug classes include entry inhibitors, fusion inhibitors, integrase inhibitors, reverse transcriptase inhibitors, and protease inhibitors (such as lopinavir, ritonavir, darunavir, and atazanavir).
Aminoglycosides: This antibacterial class includes gentamicin and tobramycin. Significant side effects include ototoxicity (ear damage) and nephrotoxicity (kidney damage).
Benzodiazepines: These medications work by enhancing the binding of GABA to the GABA A receptor. They treat anxiety, insomnia, epilepsy, and seizures. Examples include diazepam, midazolam, and temazepam.
ACE Inhibitors: Used for hypertension and chronic heart failure, these often cause a persistent dry cough and hyperkalemia (). Examples include ramipril, lisinopril, and perindopril.
Statins: These lower blood cholesterol by inhibiting the enzyme HMG-CoA reductase. Side effects include muscle aches, elevated liver enzymes, and an increased risk of type II diabetes in at-risk patients. They interact with grapefruit juice, which inhibits CYP enzymes and increases the risk of adverse effects.
Biguanides: Metformin (Glucophage) is a first-line treatment for type 2 diabetes. Long-term use can lead to Vitamin deficiency. Unlike other diabetic medications, it may cause weight loss rather than weight gain.
PDE5 Inhibitors: These treat erectile dysfunction. Examples include tadalafil (Cialis) and sildenafil (Viagra).
Antifungals: These work by inhibiting ergosterol synthesis in the fungal cell membrane. Azole antifungals like ketoconazole and clotrimazole are common examples.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These inhibit the cyclooxygenase (COX) enzyme to reduce pain and inflammation. Examples include aspirin, ibuprofen (Advil), and diclofenac.
Beta Blockers: These end in the suffix -lol (e.g., bisoprolol, metoprolol, and emolol) and act as antagonists at beta receptors.
Beta-2 Agonists: Used for asthma and COPD, these include albuterol, salmeterol, formoterol, and terbutaline. They activate beta-2 receptors, causing smooth muscle relaxation in the lungs.
Diuretics: Promoting water and electrolyte loss, these include loop diuretics (furosemide, bumetanide), thiazide diuretics (hydrochlorothiazide), and potassium-sparing diuretics (amiloride, spironolactone).
Z-drugs: Used for short-term (fewer than weeks) treatment of insomnia, including zaleplon, zolpidem, and zopiclone.
Pharmacy Regulatory Standards and DEA Compliance
The Orange Book: Formally known as Approved Drug Products with Therapeutic Equivalence Evaluations, this resource identifies products that are therapeutically equivalent.
The Joint Commission (TJC): This body is responsible for accrediting and certifying healthcare organizations. They also issue a "DO NOT USE LIST" of pharmacy abbreviations and acronyms that pose patient safety risks.
USP Standards:
USP <800>: Sets standards for handling hazardous drugs to protect healthcare professionals, patients, and the environment.
United States Pharmacopeia (USP): All pharmacies are legally required to maintain a copy of the USP.
Drug Enforcement Administration (DEA) Forms and Regulations:
DEA Form 222: Used for ordering Schedule I and II controlled substances.
DEA Form 224: Required for pharmacies to be licensed to dispense controlled substances.
DEA Form 41: Used to report the destruction of controlled substances.
DEA Form 106: Used to report the theft or loss of controlled substances.
Inventory Requirement: Pharmacies must complete a controlled substance inventory every years.
REMS and iPLEDGE: The iPLEDGE program is a Risk Evaluation and Mitigation Strategy guide for isotretinoin due to its high risk of causing birth defects.
Prescription Refills:
Schedule II: No refills permitted.
Schedule III-V: Maximum of refills permitted.
Non-controlled substances: Permitted up to times; prescriptions are valid for up to year from the date of issuance.
FDA Drug Recalls:
Class 1: Most serious recall.
Class 3: Least serious recall.
Medicare Coverage:
Part A: Hospital insurance.
Part B: Outpatient or medical insurance.
Part C: Private health insurance plans (e.g., PPOs or HMOs).
Part D: Prescription drug coverage.
Compounding and Pharmacy Operations
Materials and Equipment:
Luer-lock syringes: Mandatory for compounding hazardous materials.
Wedgwood mortar: Tool used to grind and mix powders to create a uniform arrangement of active and non-active ingredients.
Needle Gauge: The lower the gauge size, the larger the diameter of the needle.
Ophthalmic Solutions: Must be sterilized using a micron filter.
Sharps Containers: Typically identified by a red color.
Class III Prescription Balance: Must be certified on an annual basis.
Aseptic Technique and Laminar Flow Hoods:
HEPA Filters: Remove particles that are at least microns in size.
Operating Zones: Aseptic procedures must be performed at least inches from the front of the hood.
Certification: Hood air quality must be certified every months.
Startup: The hood must be turned on for at least minutes before use.
Needle Recapping: Use the one-handed scoop technique to avoid needle stick injuries.
ISO Class 5 Environment: Must have no more than particles of microns or larger.
Pharmaceutical Processes:
Trituration: Grinding tablets or substances into a fine powder.
Spatulation: Using a spatula to mix substances against a smooth surface, often used for ointments.
Standard Concentrates: Alcohol USP refers to ethyl alcohol. Sodium chloride () is abbreviated as , while sodium chloride is .
Gowning Order: Correct sequence is shoe covers, followed by head/facial hair cover, then mask. Hands and forearms are washed next, followed by donning the non-shedding gown.
Safety: Isopropyl alcohol should be used to clean counting trays to prevent cross-contamination.
Clinical Definitions and Terminology
Pharmacodynamics: The study of what a drug does to the body (biochemical and physiological effects).
Pharmacokinetics: The study of how the body affects a drug, summarized by ADME: Absorption, Distribution, Metabolism, and Excretion.
Half-life: The time required for the total amount of drug in the body to reduce by .
Ex: If a drug has a half-life of , after , remains. After , remains. After , remains.
Excipients: Inactive ingredients such as preservatives, flavoring agents, and coloring agents.
Polypharmacy: Concurrent use of multiple medicines (typically more than ) at the same time.
Orphan Drugs: Medications used to treat rare diseases (orphan diseases), such as cystic fibrosis (treated by dornase alfa).
Tall Man Lettering: Used to differentiate look-alike sound-alike drugs (e.g., prednisONE vs. prednisOLONE).
Medical Abbreviations and Administration Routes
Abbreviations:
Prn: As needed.
Ud: As directed.
Ac: Before food.
Pc: After food.
c: With.
s: Without.
Po: Orally.
Gtts: Drops (e.g., eye drops).
Administration Routes:
Intrathecal: Into the spinal canal.
Intravitreal: Through the eye.
Buccal: Inside the cheek.
NDC Code Structure (Example: 00106-2315-45):
First 5 digits: Drug manufacturer.
Second 4 digits: Drug product/strength.
Final 2 digits: Packaging size.
Miscellaneous Clinical Facts and Patient Safety
Side Effects and Syndromes:
Cinchonism: Side effects from quinine, including fever, fatigue, visual disturbances, and deafness.
Vitamins: Vitamins B and C are water-soluble (not stored, need regular replenishment). Vitamins A, D, E, and K are fat-soluble.
Warfarin: The anticoagulant effects of warfarin are opposed by vitamin K (found in green leafy vegetables).
MAOIs: Patients must avoid tyramine-containing foods to prevent a hypertensive crisis.
Patient Safety Rules:
Decimal Points: Never follow a whole number with a decimal (use instead of ). Use a leading zero for decimals (use instead of ).
Beers’ List: Compiles risks of certain medicines for elderly patients.
DUR (Drug Utilization Review): Mandated by the Omnibus Budget Reconciliation Act of 1990 (OBRA 1990) to ensure past medications were correct.
Insulin Types:
Rapid-acting: Insulin aspart, lispro, and glulisine (peak time: ).
Intermediate-acting: Isophane insulin.
Long-acting: Insulin detemir and insulin glargine.