P.h.a.r.m.a.c.y L.a.

Pure food and D act  protect from unsanitary & poorly labeled food.

Food, D, and cosmetic act  no new D should be marketed until proven by FDA for public use.

Omnibus Budget Reconciliation (OBRA) act  pharmacists must offer a patient counseling.

Orphan D Act  Tax relief & incentives for manufacturers to develop & market them.

Durham Humphrey Amendment  . Differentiate btw prescription Ds and OTC

Or Prescription D amendment . Allow oral prescription and prescription refill.
. label “Caution: Federal law prohibits dispensing without a prescription.”

Kefauver Harris Amendment  . all new D must be SAFE and EFFECTIVE.

Or D efficacy Amendment . requirements for GMP.

D price competition & patent term restoration  . generic D more available to public.
Or Waxman Hatch Amendment . encourage ph. Companies to develop new D.

OTC Drugs have 3 categories:-

Catg. 1  safe, effective, not misbranded.
Catg. 2  not safe, not effective, misbranded.
Catg. 3.  insufficient data.

Drugs that require dispensing with PPI (patient package insert) :-

1. Estrogen.
2. Progesterone.
3. IUD.
4. Isotretinoin.
5. Oral Contraceptive.
6. Isoproterinol.
7. Ticlopidine.

Drugs that exempt from the poison prevention packaging act. (all D must be in child proof cont.)
1. Methylprednisolone tab < 84 mg.
2. SL nitroglycerine. (unit dose)
3. Mebendazole tab < 600 mg.
4. prednisone <105 mg.
5. K – supplements. (unit dose)
6. Oral Contraceptives.
7. Colestipol powder.
8. Cholesteramine powder.
9. SL, Chewable Isosorbid dinitrate < 10 mg.
10. erythromycin ethyl-succinate liq & granules < 8 mg.
11. erythromycin ethyl-succinate tab < 16 mg.
12. pancrelipase.

NDC = 11
DEA = 9
 CONTROLLED SUBSTANCE ACT

Schedule II Controlled Drugs.

Never refilled.
Partial supply of pharmacy within 60 days.
Partial filling within 72 hours of initial.
DEA form 41 for destroying CII
DEA form 106 for theft.
DEA form 222 req. to order them.

Cont. II Drugs.
1. Oxycodone.
2. Oxycodone + APAP.
3. Oxycodone + Aspirin.
4. Morphine sulfate.
5. Hydromorphine.
6. Dextroamphetamine.
7. Amphetamine + Dextroamphetamine.
8. Methadone.
9. Fentanyl.
10. Methylphenidate.
11. Meperidine.

Schedule III, IV, V Controlled Drugs

. Cannot be refilled more than 5 times.
. Cannot be filled for the prescription older than 6 months.
. Do not require DEA 22 to order.

Con. III Drugs.

1. Hydrocodone.
2. Hydrocodone + APAP.
3. APAP + Codeine.
4. Butalbital + APAP + Caffeine + Codeine.
5. Butalbital + Aspirin + Caffeine + Codeine.

Con. IV Drugs. Mostly Antidepressants

1. Pentazocaine.
2. Propoxyphene.
3. Meprobamate.
4. Chorodiazepoxide.
5. Diazepame.
6. Oxazepam.
7. Chlorazepate.
8. Flurazepam.
9. Clonazepam.
10. Lorazepam.
11. Estazolam.
12. Temazepam. Con. V Drugs.
13. Triazolam. 1. Diphenoxylate.
14. Alprazolam. 2. Buprenorphone.
15. Zolpedime
16. Pemolin.
 COST 1. Coinsurance  ptns pay spc. Percentage.
SHARING 2. Copayment  ptns pay spc. Amount each time (fixed).
PLANS 3. Deductable  ptns pay spc. Amount during spc. Period of time.
4. Capitation  prospective form of reimbursement.

Nonverbal Communication  1. Kinesics (body language)

2. Proxemics (distance btw ppl)

AAC  Actual Acquisition Coast  price paid by the pharmacy after everything.
AWP  Average Wholesale Price  the published “List Price”
EAC  Estimated Acquisition Cost  the third party’s estimate of the price paid by the pharmacy.
MAC  Maximum Allowable Coast  the max. amount to be paid by third party to pharmacy for a D.

HBM  Health  3 Behaviors  1. Health  preventing illness.

Brief 2. Illness  may be ill.
Model 3. Sick-Role  being ill.

DRG  Diagnosis Related Groups  . Prospective reimbursement

. medical problems costs precalculated.
. helps cut down healthcare cost.

List of ACIDS
Most Acidic
1. Perchloric Acid ……………….HCIO4
2. Hydroionic Acid ………………HI
3. Hydrobromic Acid ………...….HBr
4. Hydrochloric Acid ………..…..HCl
5. Sulfuric Acid …………….……H2SO4
6. Nitric Acid …………….………HNO2
7. Hydronium Ion ………………..H3O
8. Hydrogen sulfate ion ....……….HSO4-
9. Nitrous Acid …………………..HNO2
10. Acetic Acid …………..……….CH3COOH
11. Carboni Acid ……..…………..H2CO3
12. Ammonium Ion ………….……NH4
13. Water ……………………...…..H2O
14. Methanol …………………..….CH3OH
15. Ammonia ………………….….NH3 Least Acidic

NP:NW  net profit to net worth  the best ratio for Profitability.
NP:IN  net profit to inventory  for both profitability and efficiency.
TL:TW  most direct measure of financial position of the pharmacy.

1. Acid test ratio  the quick ratio  = (sum of cash accounts / liabilities)  must be 1:1
Liquidity
2. Current ratio  = (current assets / current liabilities)  2:1
& Solvency 3. Inventory to networking capital  indirect measure of liquidity and solvency  80 %
 high ratio  low liquidity + high inventory.

Demands  A. Elastic  change in revenue > change in price.

B. Inelastic  change in revenue < change in price.
Eye  o.s = left  o.d = right  o.u = both
Ear  a.s = left  a.d = right  a.u = both
 Immunology

Haptens  LMW cmpds that act as immunogenic ater binding to a larger molecule. (penicillin)

Tolerogens  chemicals produce spc non-responsiveness. !

Humoral Imm. = B cells 15 %

Cellular Imm. = T cells 75 %

B cells  synth. In bone marrow  activated  memory b cells  IgA + IgE + AgG
nonactivated  virgin B cells  IgM + IgD

T cells  synth in bone marrow  need to mature in the thymus gland  virgin T cells.

NK  destroy tumors.

IgM  20 %
The 1st one sec. during primary immune response.
The 1st produced by the fetus.

IgG  70 %
The only one that crosses the placenta.
The predominant one after the primary response, and in memory responses.

IgE  < 1%
Also known as Reagin.
Imp. In fighting Helminths.

IgA  10 %
Present in extracellular fluids as saliva, urine, and tears.
Large quantities across mucosal surfaces.
The buffer capacity  B = .0576 X C
pH = pKa + Log {salt/acid)
rate constant  K= (2.303 /t) X (log Co /C)
Normal ESR  0 – 15 mm/hour
P1V1/T1 = P2V2/T2
From C to T  + 273
Electrlolytes values (mEq/L)  K= 4-6 , NA= 135 – 155, Cl= 95-106, Mg= 1.2-2.4
Each gram of fat  9 calories
1 tsp = 5 mL
In dilution  use reverse proportion.
Most common noncompliant dis  Arthritis, Diabetes.
Most common noncompliant reason  Forgetness, then side effects.
IgE  can cross the placenta.
Drug allergens acting as  haptens, Rh dis., hashimato, mysthemia graves,  Type II hypersensitivity.
Coefficient of Elasticity  E = Q/P (quantity, Price in % )
Medicare is for patients who are at least 65 yrs old.
Amoxicillin, Dexicillin, Minocycline, Penicillin V  not affected by the presence of food in stomach.
Probenecide and keptotrofen  inhibit Methotrexate secretion.

SLE  Malar Rash  Type 3 Hypersensitivity

autoimmune disorder
Antinuclear antibodies and antibodies to native double-stranded DNA are spc diagnosis of SLE
1 case per 2000 population
African Americans have a high prevalence

The partial filling of CII drugs should be done within 72 hours.

Sunscreen products should cover  310 nm
Nonsedating antihistamines  loratidine, fexofinidine, Ceterizine.
Vit. A  sources are carrots, milk, eggs, liver oil, fish  its deficiency causes night blindness
Nimodipine is a Ca-Channel Blocker  Rx Cerebral Spasm.
Capitation is a form of prospective reimbursement in which the pharmacy is paid specific amount of money
each month for each of its patients.
Normal Anion Gap in healthy adults  10-12 mEq/L
Anticoagulants used in storage of blood  NIH A (Acid-citrate dextrose) or B (ACD-phosphate)
Degree of fredomo in chi-square  (R-1)X(C-1)
The anterior pitutiry secretes 3 hormones  FSH, LH, LTH
Epinephrine, ascorbic acid and vit. A  are oxidized readily.
Phenothiazines and riboflavins are extremely photosensitive.
The closeness of measures to their true values is defined as accuracy.
Boric acid stabilize epinephrine when added to it.
Properties of flocculated system, 1. particles form loose aggregates, 2. high rate of sedimentation, 3. the
sedimentation forms very rapidly, 4. sediments can be easily redisperse
Carbohydrates 1. Monosaccharides (dextrose & fructose)
2. Disaccharides (Lactose & succarose )
3. Polysaccharides (starch, cotton, dextran, inulin, collagen)

Glycoprotein  protein + carbohydrates (Mucin).

Chromoprotein  proteins contain colored prosthetic groups (hemoglobin, Casein)
Lipoprotein  protein + lipid material (sterol, fatty acid, lecithin)

Parathyroid hormone  regulate Calcium ion in blood.

BMI  = (wt. Kg) / (hgt. M)2

pH = - Log [H+]
Microplastic anemia  have iron – deficiency
Pernicious anemia  have folic acid deficiency or (B12)
List of compounds that direct meta position  COOR, COOH, COR, CHO, SO3H, NO2
RNA rRNA = 80% , tRNA = 15% , mRNA = 5 %.
Griesofluvin  MOA similar to colchicine  Rx Gout  highly bound to keratin.
PRN  can be refilled up to 1 year.

FIXED FIGURES
1. SUSP particles size  >0.5 µm
2. Emul. Particle size  0.1 – 100 µm
3. External pressure  760 mm.Hg
4. tablet thickness  +/- 5% µm

Laws & Equations Names

1. Stocks  sedmentation
2. Raoult’s  partial pressure  PA=PA֩ × XA
3. Van’t Hoff  Osmotic pressure
4. Handerson HAzelbach  ration btw inonized and unionized.
5. Noyes Whitney  dissolution
 Antihypertensive agents

I. Diuretics
1. Thiazide diuretics.
1) Chlorothiazide.
2) Chlorothalidone.
3) Hydrochlorothiazide.
4) Indapamide.
5) Methyclothiazide.
6) Metolazone.

2. Loop Diuretics.
1) Bumetanide.
2) Ethacrynic acid.
3) Furosemide.
4) Torsemide.

3. Potassium-sparing diuretics.
1) Amiloride.
2) Spironolactone.
3) Triamterene.

II. Vasodilators (direct acting)

1. Diazoxide.
2. Hydralazine.
3. Minoxidil.
4. Nitroprusside.

III. Angiotensin-Converting enzyme inhibitors (ACE)

1. Enalaprilat.
2. Enalapril.
3. Benazepril.
4. Captopril.
5. Fosinopril.
6. Lisinopril.
7. Moexipril.
8. Perindopril.
9. Quinapril.
10. Ramipril.
11. Trandolapril.

IV. Angiotensin II Recebtor antagonist.

1. Candesartan.
2. Eprosartan.
3. Irbesartan.
4. Losartan.
5. Olmesartan.
6. Telmisartan.
7. Valsartan.
V. Sympatholytics.

1. β-Blocking agent.
1) Acebutolol.
2) Atenolol.
3) Betaxolol.
4) Bisoprolol.
5) Carteolol.
6) Carvediolol.
7) Labetalol.
8) Metoprolol.
9) Nadolol.
10) Penbutolol.
11) Pindolol.
12) Propranolol.
13) Timolol.

2. Centrally acting α-agonists.

1) Clonidine.
2) Guanabenz.
3) Guanafacine.
4) Methyldopa.

3. Postganglionic adrenergic neuron blocker.

1) Reserpine.

4. α- Adrenergic blocking agents.

1) Doxazosin.
2) Prazosin.
3) Terazosin.

5. Calcium-Channel Blockers.
1) Diltiazem. (Benzodiazepine )
2) Verapamil. (Diphenylalkylamine)
3) Amlodipine. (Dihydropyridine)
4) Felodipine. (Dihydropyridine)
5) Isradipine. (Dihydropyridine)
6) Nicradipine. (Dihydropyridine)
7) Nifedipine. (Dihydropyridine)
8) Nisoldipine. (Dihydropyridine)
B. gram negative

1. Bdellovibrios
2. Pseudomonads
3. Rhizobium
4. Azotobacter
5. Enterobacteria
6. Vibrios
7. Pasteurellas
8. Bacteroides
9. Veillonella
10. Myxobacteria

Griseofluvin:-
. deposit in the skin (bind to keratin)
 . MOA similar to Colchicine  Rx GOUT
. Posses vasodilator activity  Rx Raynaud’s Dis.
. Rx Tinea Infections.
. only in oral forms.
. inc. metabolism of Warfarin.
. Barbiturates red. Its Abs.
. With Oral Contraceptives  Amenorrhea, inc. Bleeding.

Imidazoles:-

1. Ketoconazole:-
. Rx systemic and vaginal Candidiasis, Oral thrush.
. Slow acting and need long duration of tjerapy.
. inc. warfarin activity.
. Antagonize amphotericin B.
. inc. levels of terfenadine and astemizole (antihistamines).
. Need the presence of stomach acids to be abs.
. Abdominal pain and constipation.

2. Miconazole:-
. Topical agent.
. Rx Vulvovaginal candidiasis, Ringworm.
. inc. warfarin activity.

3. Fluconazole:-
. Oral and parenteral forms.
. used in systemic and CNS infections.
. Rx Cryptococus, Candida..
. inc. levels of warfarin, phenytoin, cyclosporins, and sulfonylurea.
. GI disturbences.

4. Itraconazole:-
. oral agent.
. Rx. Pulmonary aspergillosis.
. needs stomach acids to be abs.
. inc. levels of terfenadine and astemizole (antihistamines).
.Hypertriglycerdemia, hypokalemia.

5. Voriconazole:-
. IV and oral agent.
. causes visual disturbances, sepsis, alter liver fuxn.
. Inhibit CYT P450.

. MOA of all antifungals  inhibit ergosterols in the cell membrane, which is resp for the CYP450
. All antifungals are enzymatic inhibitors,  inc level of drugs,  dec. its metabolism.
 OTC agents for pain

Aspirin alone (but not other salysilates, Acetaminophen, NSAIDs)  irreversible inhibit formation of
cyclooxiginase in platelets 

Anti-inflammatory dose of Aspirin = 4000 – 6000 mg/day

Anti-inflammatory dose of ibuprofen = 1200 – 3200 mg/day

Salicylates potentiate the action of hypoglycemic at the anti-inflammatory doses.

Aspirin and acetaminophen, inhibit zidovudine (anti HIV) metabolism  inc. its toxicity.

Caffeine inc. analgesic effect of salysilates.

. Acetaminophen is the 1st line therapy of the osteoarthritis of the knee and hip.
. Acetaminophen is commonly used in ptns hypersensitive to salysilates, or prone to bleeding disorders.

. NSAID that are OTC = Ibuprofen, Naproxen, and Ketoprofen.

Common Cold

. Causes. Frequent :-Corona virus, RSV, Rhinovirus (most frequently involved).

Others :- adenovirus, influenza, Parainfluenza.

. September, October, march, and April most commonly happens.

. psudeophedrine is not an OTC.

.
Liabilities  mas2oliat
Capital  ra2s el mal
Inventory  ka2emet el ma5zon
Revenue  da5el. / Aw darebet el da5l
Prospective  mo7tamal.
Retrospective  belmade
Reimbursement  sadad