Free BCPS Exam Flashcards

AUC24/MIC of 400-600 mg*h/L (assuming MIC=1) is the current consensus target, replacing trough-only monitoring; a trough of 15-20 mg/L is still used as a practical surrogate for serious infections when AUC-based dosing software isn't available.

Pulmonary surfactant binds and inactivates daptomycin, so it cannot treat community- or hospital-acquired pneumonia even against susceptible organisms; choose vancomycin or linezolid instead for MRSA pneumonia.

Oral vancomycin or fidaxomicin is first-line for an initial C. diff episode; fidaxomicin is favored by current IDSA/SHEA guidance for its lower recurrence rate. IV/oral metronidazole is reserved as an adjunct for fulminant disease.

Generally cited as under 1-2%, driven mainly by shared R1 side chains rather than the beta-lactam ring itself; most patients with a reported penicillin allergy can safely receive cephalosporins after appropriate risk assessment.

2.0-3.0 is the standard therapeutic range for most warfarin indications, including nonvalvular atrial fibrillation and venous thromboembolism treatment.

2.5-3.5 is the target for mechanical mitral valves (and higher-risk mechanical aortic valves), set higher than the standard 2-3 range because mitral prostheses carry greater thrombogenic risk.

ARNI (or ACEI/ARB if ARNI isn't feasible), an evidence-based beta-blocker, an MRA, and an SGLT2 inhibitor. All four should be initiated and up-titrated in parallel for HFrEF (EF <=40%) to reduce mortality and hospitalizations.

Atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily; these regimens are expected to lower LDL-C by 50% or more and are used for clinical ASCVD, LDL-C >=190 mg/dL, and diabetic patients age 40-75 with additional risk factors.

Cockcroft-Gault estimates creatinine clearance and is the standard reference for drug-dosing adjustments since most package inserts were validated against it. CKD-EPI estimates GFR and is preferred for staging chronic kidney disease.

CrCl below 30 mL/min is a contraindication due to lactic acidosis risk; dose reduction and closer monitoring are recommended once CrCl falls below 45 mL/min, per current FDA labeling.

Non-opioid and non-pharmacologic therapies (NSAIDs, acetaminophen, physical therapy, exercise, CBT) are preferred first-line; opioids are reserved for situations where expected benefits outweigh risks after other options are inadequate.

A lactate above 2 mmol/L signals hypoperfusion and should be remeasured; broad-spectrum antibiotics should be given within 1 hour of sepsis recognition, along with 30 mL/kg crystalloid for hypotension or lactate >=4 mmol/L.

Norepinephrine is first-line; vasopressin or epinephrine may be added as a second agent if the mean arterial pressure goal (>=65 mmHg) isn't reached on norepinephrine alone.

IV benzodiazepines (lorazepam or diazepam) are first-line; if seizures persist, a second-line agent (IV fosphenytoin, valproate, or levetiracetam) is given next, as these three showed comparable efficacy in the ESETT trial.

N-acetylcysteine (NAC) is the antidote; it is most effective when started within 8 hours of ingestion, guided by the Rumack-Matthew nomogram, but is still given later for delayed presentations or staggered/unknown-time overdoses.

Autonomic instability (hyperthermia, tachycardia, diaphoresis), neuromuscular abnormalities (clonus, hyperreflexia, tremor), and altered mental status. Management is supportive care plus stopping serotonergic agents; cyproheptadine is used for severe cases.

ANC below 500 cells/mm3 (or below 1000 with an expected drop below 500) plus a single temperature >=38.3 C (or >=38.0 C sustained over an hour) defines febrile neutropenia, warranting empiric antipseudomonal beta-lactam therapy within 1 hour.

They are teratogenic, particularly in the second and third trimesters, causing fetal renal dysgenesis, oligohydramnios, and skull/limb defects; they should be discontinued as soon as pregnancy is confirmed or planned.

Vd is a theoretical constant relating total drug in the body to plasma concentration, not a real physical volume. A high Vd (e.g., digoxin, amiodarone) suggests extensive tissue/lipid distribution and means the drug is poorly removed by dialysis or plasma exchange.

First-order: a constant fraction of drug is eliminated per unit time, so half-life stays constant regardless of dose (most drugs). Zero-order: a constant amount is eliminated per unit time because the elimination pathway is saturated (e.g., phenytoin, high-dose aspirin, ethanol), so half-life increases as dose increases.

Approximately 4-5 half-lives, regardless of the dose or dosing interval, because time to steady state depends only on the elimination half-life (assuming first-order kinetics and no loading dose).

Loading dose = Vd x target plasma concentration (divided by bioavailability F for oral dosing). Loading doses bypass the 4-5 half-life wait for steady state when a rapid therapeutic level is needed, as with vancomycin, phenytoin, or digoxin.

Time to benefit compares how long a therapy needs to produce measurable benefit against the patient's expected survival and goals of care; preventive therapies with long time-to-benefit (e.g., a statin for primary prevention) may be deprioritized if the patient is unlikely to live long enough to gain from them.

IV push/bolus, because it bypasses absorption entirely and delivers 100% bioavailability directly into systemic circulation, which is why emergency medications are given IV.

Oral drugs undergo first-pass hepatic (and sometimes gut wall) metabolism before reaching systemic circulation, reducing the fraction of the administered dose that becomes bioavailable; IV drugs have 100% bioavailability by definition.

At every transition of care - hospital admission, transfer between units or levels of care, and discharge - comparing the patient's current medication list against newly ordered medications to resolve discrepancies and prevent adverse events.

Insulin, anticoagulants (warfarin, heparin, DOACs), opioids, concentrated electrolytes (e.g., potassium chloride), and chemotherapy agents - ISMP designates these as high-alert because errors with them are more likely to cause serious patient harm.

It highlights distinguishing letters in look-alike drug names (e.g., hydrOXYzine vs. hydrALAZINE, DOPamine vs. DOBUTamine) to reduce selection errors caused by name confusion during prescribing, dispensing, and administration.

Teach-back asks patients to restate instructions in their own words (e.g., 'how will you take this medication?') to confirm understanding; it catches gaps in health literacy or comprehension before they cause nonadherence or medication errors.

Vancomycin, aminoglycosides (gentamicin, tobramycin), phenytoin, lithium, digoxin, and warfarin (via INR) - small changes in dose or clearance for these drugs can quickly cause toxicity or treatment failure.

0.6-1.2 mEq/L is the typical maintenance range (up to about 1.5 for acute mania). Lithium has a narrow therapeutic index, and levels rise with renal impairment, low sodium intake, and interacting drugs like NSAIDs, ACE inhibitors, and thiazide diuretics.

Above 2 ng/mL is generally considered toxic, though toxicity can occur within the broader 'therapeutic' range (roughly 0.5-2 ng/mL) especially with hypokalemia, hypomagnesemia, or renal impairment, which increase myocardial sensitivity to digoxin.

An ADE is any harm resulting from medication use, including preventable errors (e.g., a wrong dose) - a broad umbrella term. An ADR is a narrower subset: an unintended, noxious response occurring at normal doses used for prophylaxis, diagnosis, or therapy, not caused by an error.

Azole antifungals (ketoconazole, itraconazole), macrolide antibiotics (clarithromycin, erythromycin), protease inhibitors (ritonavir), and grapefruit juice are classic CYP3A4 inhibitors that can raise substrate drug levels and toxicity risk.

Proportion of Days Covered (PDC) or Medication Possession Ratio (MPR), calculated from refill data, are the standard measures; a PDC/MPR of 80% or higher is the widely used threshold for adequate adherence in chronic disease quality metrics like Medicare Star Ratings.

Therapeutic endpoints are clinical or surrogate markers tied directly to the treatment goal (A1c for glycemic control, INR for anticoagulation, blood pressure for hypertension); a drug level being in range doesn't guarantee the clinical response has actually been achieved.

A near miss (or 'good catch') is an error intercepted before reaching the patient, so no harm occurs. A sentinel event is a patient safety event resulting in death, permanent harm, or severe temporary harm requiring intervention - both should be reported to drive system-level improvement.

CPGs synthesize evidence into recommendations for a typical patient with a given condition; they must be individualized for comorbidities, patient preferences, limited life expectancy, and situations the underlying trials excluded, such as frail elderly or multimorbid patients.

Pharmacists have a duty to report suspected diversion through appropriate channels (supervisor, state board of pharmacy, DEA) to protect patient safety and public trust; professional ethics codes require action over silence, even when reporting a colleague.

Clear communication of medication changes, follow-up appointments, and monitoring plans to the patient, caregivers, and outpatient providers - typically via a discharge summary plus medication reconciliation - to prevent readmissions caused by care-transition errors.

Immunizations (influenza, pneumococcal, zoster, COVID-19, and others), along with screenings (blood pressure, A1c, cholesterol) and counseling such as smoking cessation - pharmacist-administered vaccination is a major public health access point.

Never events are serious, largely preventable patient safety incidents that should not occur if safeguards are followed (e.g., wrong-patient or wrong-drug administration); tracking them separately drives root-cause analysis and targeted systemic fixes rather than being averaged into general error rates.

NNT = 1 / Absolute Risk Reduction (ARR). It's the number of patients who must be treated to prevent one additional bad outcome - a lower NNT indicates a more impactful treatment effect.

NNH = 1 / Absolute Risk Increase (ARI). It's the number of patients treated before one additional patient experiences harm - a higher NNH is safer. Weighing NNT against NNH helps assess a therapy's overall benefit-risk balance.

SnNout: a highly SeNsitive test, when Negative, rules OUT disease (few false negatives). SpPin: a highly SPecific test, when Positive, rules IN disease (few false positives). Use sensitive tests to screen and specific tests to confirm.

RCTs rank near the top of primary study designs, above cohort, case-control, and other observational studies, because randomization minimizes confounding and bias. A systematic review or meta-analysis pooling multiple RCTs ranks above any single RCT.

An MUE is a structured, ongoing review of prescribing, dispensing, and administration practices for a specific drug or drug class against defined criteria, used to identify and correct patterns of inappropriate use and improve outcomes and cost-effectiveness.

CPOE lets providers enter orders directly into the EHR, reducing transcription and handwriting errors; paired CDS delivers real-time alerts for drug interactions, allergies, and renal dosing at the point of prescribing, catching errors before they reach the patient.

It compares the costs and health outcomes of two or more interventions, expressed as an incremental cost-effectiveness ratio (ICER) - often dollars per additional quality-adjusted life year (QALY) gained - to guide formulary placement and coverage decisions.

Maintaining emergency medication caches and formularies, ensuring continuity of medication supply during disasters, participating in mass-casualty and pandemic response protocols, and coordinating with public health authorities on stockpile distribution.