Basic Biomedical Sciences
12%of exam
Renal CV PhysiologyBiochemistryEnzyme KineticsImmunologyMicrobiology
Pharmaceutical Sciences
31%of exam
PharmacokineticsCYP450Drug Name StemsCalculationsCompounding
Social/Behavioral/Admin Sciences
20%of exam
Controlled SubstancesPharmacy LawBiostatisticsPharmacoeconomics
Pharmacy Practice & Clinical Sciences
37%of exam
DiabetesHypertensionInfectious DiseasePulmonologyPsychiatryOncology
Quick Facts
- Exam
- FPGEE
- Questions
- 200
- Time
- 4.5 hours
- Pass Score
- 75 (scaled)
- Format
- Computer, fixed-form
- Level
- Foreign pharmacy graduate
- Administrator
- NABP / Pearson VUE
- Attempts
- 5 lifetime maximum
Antibody Response Order
IgM first responder, then IgG for memory
IgM: acute phaseIgG: long-term memoryIgA: mucosal defenseIgE: allergy/parasites
Competitive vs Noncompetitive Inhibition
Competitive
- Raises Km value
- Same Vmax retained
- Overcome by more substrate
Noncompetitive
- Km stays same
- Lowers Vmax value
- Substrate cannot reverse it
Km shifts vs Vmax shifts
Renal & CV Physiology
- PCT
- Reabsorbs glucose, amino acids
- Loop of Henle
- Builds concentration gradient
- ADH
- Signals water reabsorption
- RAAS
- Regulates BP and volume
- Normal GFR
- ~120 mL/min
- Frank-Starling
- Preload raises stroke volume
IgE vs IgG Antibodies
IgE
- Drives allergic reactions
- Fights parasitic infection
IgG
- Crosses the placenta
- Provides lasting immunity
Allergy driver vs lasting immunity
Biochemistry & Enzyme Kinetics
- Glycolysis
- Glucose to pyruvate
- Krebs cycle
- Mitochondrial ATP production
- Km
- Lower means higher affinity
- Vmax
- Maximum reaction rate
- Competitive inhibitor
- Raises Km, same Vmax
- Noncompetitive inhibitor
- Lowers Vmax, same Km
Immunology & Microbiology
- IgG
- Crosses the placenta
- IgA
- Found in mucosal secretions
- IgE
- Allergy and parasite defense
- IgM
- First antibody responder
- Gram-positive
- Thick peptidoglycan wall
- Gram-negative
- LPS outer membrane
Common Drug Suffixes
-olol beta, -pril ACE, -sartan ARB
-olol: beta blocker-pril: ACE inhibitor-sartan: ARB-statin: cholesterol
Zero-Order vs First-Order Kinetics
Zero-order
- Constant amount eliminated
- Enzymes get saturated
- Phenytoin, ethanol, aspirin examples
First-order
- Constant fraction eliminated
- Most drugs follow
- Concentration-proportional elimination rate
Amount vs fraction removed
Pharmacokinetic Parameter Selection
- Need distribution volume estimate→Calculate Vd
- Need elimination rate estimate→Calculate half-life
- Renal dose adjustment needed→Cockcroft-Gault CrCl
- Narrow index drug dosed→Therapeutic drug monitoring
- High-risk vancomycin dosing→AUC/MIC monitoring
Pharmacokinetic Formulas
- Vd
- Dose divided by C0
- Half-life
- 0.693 x Vd over CL
- Cockcroft-Gault
- Estimates creatinine clearance
- Steady state
- Reached in 4-5 half-lives
- Loading dose
- Vd x target concentration
- Maintenance dose
- CL x Css x tau
- Zero-order kinetics
- Constant amount eliminated
- First-order kinetics
- Constant fraction eliminated
Steady State Rule
Steady state reached after 4-5 half-lives
4 half-lives: ~94%5 half-lives: ~97%Same for loading/elimination
Compounding Standard Selection
- Sterile IV preparation needed→Follow USP <797>
- Nonsterile capsule or cream→Follow USP <795>
- Hazardous chemo drug handled→Follow USP <800>
- Checking product expiration date→Confirm beyond-use date
CYP450 & Drug Interactions
- CYP3A4
- Metabolizes most drugs
- CYP2D6
- Activates codeine, tramadol
- Grapefruit juice
- Inhibits CYP3A4
- Rifampin
- Potent CYP inducer
- Narrow index drugs
- Warfarin, digoxin, lithium
USAN Drug Name Stems
- -olol
- Beta blocker
- -pril
- ACE inhibitor
- -sartan
- ARB
- -statin
- HMG-CoA reductase inhibitor
- -dipine
- Dihydropyridine CCB
- -azole
- Antifungal or PPI
- -floxacin
- Fluoroquinolone antibiotic
- -cillin
- Penicillin antibiotic
- -gliflozin
- SGLT2 inhibitor
Pharmaceutical Calculations
- Alligation
- Mixes two strengths
- % w/v
- Grams per 100 mL
- Osmolarity
- mOsm solute per liter
- Isotonic solution
- Equivalent to 0.9% NaCl
- Aliquot method
- Dilutes very small doses
Compounding & Dosage Forms
- USP <795>
- Nonsterile compounding standard
- USP <797>
- Sterile compounding standard
- USP <800>
- Hazardous drug handling
- Enteric coating
- Delays release past stomach
- Beyond-use date
- Compounded product expiration
Schedule II vs Schedule III-V Refills
Schedule II
- No refills allowed
- New Rx required
Schedule III-V
- Up to 5 refills
- Within 6 months
Refill rules differ by schedule
Controlled Substance Rx Rules
- Schedule II refill requested→Not allowed, new Rx
- Emergency Schedule II supply→Oral order permitted
- Schedule III-V refill requested→Up to 5 refills
- Suspected prescription diversion→Report per state law
Controlled Substance Schedules
- Schedule I
- No accepted medical use
- Schedule II
- High abuse, accepted use
- Schedule III
- Moderate abuse potential
- Schedule IV
- Low abuse potential
- Schedule V
- Lowest abuse potential
- CII prescriptions
- No refills allowed
Pharmacy Law Essentials
- HIPAA
- Protects patient privacy
- OBRA '90
- Requires patient counseling
- PPPA
- Child-resistant packaging law
- DSCSA
- Tracks drug supply chain
- REMS
- Manages high-risk drug safety
Biostatistics & Pharmacoeconomics
- p-value <0.05
- Statistically significant result
- 95% CI
- Range of confidence
- NNT
- Patients treated per benefit
- Cost-effectiveness analysis
- Cost per clinical outcome
- Cost-utility analysis
- Cost per QALY
- Type I error
- False positive finding
Blood Pressure Stages
120 elevated, 130 stage one, 140 stage two
<120/80: normal120-129: elevated130-139: stage 1≥140/90: stage 2
Trough Monitoring vs AUC/MIC
Trough-only (old)
- 15-20 mcg/mL target
- Higher nephrotoxicity risk
AUC/MIC (current)
- 400-600 target range
- 2020 ASHP/IDSA standard
AUC guides vancomycin dosing now
Drug Class Selection Logic
- T2DM first-line therapy needed→Metformin
- ASCVD risk reduction needed→High-intensity statin
- HFrEF maintenance therapy→ACEI/ARNI plus beta-blocker
- AFib stroke prevention needed→DOAC preferred agent
- MRSA skin infection→Vancomycin or linezolid
- H. pylori infection confirmed→Quadruple therapy regimen
Diabetes & Endocrine (ADA)
- A1C diagnosis
- ≥6.5% confirms diabetes
- Prediabetes A1C
- 5.7% to 6.4%
- Fasting glucose diagnosis
- ≥126 mg/dL
- Metformin
- First-line for T2DM
- GLP-1/SGLT2
- CV and renal benefit
ACE Inhibitor vs ARB
ACE inhibitor
- Blocks ACE enzyme
- Often causes dry cough
ARB
- Blocks receptor directly
- Rarely causes cough
Cough favors switching to ARB
Hypertension & Cardiology
- Normal BP
- Below 120/80
- Stage 1 HTN
- 130-139/80-89 mmHg
- Stage 2 HTN
- 140/90 mmHg or higher
- Warfarin INR target
- 2 to 3
- Digoxin range
- 0.5 to 2 ng/mL
- DOACs
- No routine INR monitoring
Infectious Disease & Immunizations
- Vancomycin target
- AUC/MIC 400-600
- CURB-65
- Pneumonia severity score
- MRSA therapy
- Vancomycin or linezolid
- C. diff first-line
- Vancomycin or fidaxomicin
- Live vaccines
- Avoid in immunosuppressed
- Penicillin allergy
- Use caution with cephalosporins
Pulmonology, Psychiatry & Oncology
- GOLD mild COPD
- FEV1 ≥80% predicted
- GOLD severe COPD
- FEV1 30-49% predicted
- SSRI
- First-line for depression
- Lithium range
- 0.6 to 1.2 mEq/L
- Serotonin syndrome
- Hyperthermia, clonus, agitation
- Myelosuppression
- Common chemo dose-limiting toxicity
Common Traps
Schedule II vs III Refills
CII = no refills ≠ CIII-V = up to 5
Trough vs AUC Vancomycin
Trough alone is outdated ≠ AUC/MIC is current standard
Km vs Vmax Inhibition
Competitive raises Km ≠ Noncompetitive lowers Vmax
Zero-Order vs First-Order
Zero-order = constant amount ≠ First-order = constant fraction
IgE vs IgG Function
IgE drives allergy ≠ IgG gives lasting immunity
Elevated vs Stage 1 BP
Elevated = under 130/80 ≠ Stage 1 = 130-139/80-89
ACEI Cough vs ARB
ACEI often causes cough ≠ ARB rarely causes cough
Last Minute
- 1.Weights: 12/31/20/37 percent
- 2.200 questions, 4.5 hours total
- 3.Scaled passing score is 75
- 4.Clinical Sciences is largest domain
- 5.CII drugs are never refillable
- 6.Vancomycin: AUC/MIC 400-600 target
- 7.A1C of 6.5%+ confirms diabetes
- 8.Stage 2 HTN: ≥140/90
- 9.Km up means competitive inhibition
- 10.First-order: constant fraction eliminated
- 11.FPGEE offered once per year
- 12.Maximum 5 lifetime FPGEE attempts
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