Free FPGEE Exam Flashcards

The proximal convoluted tubule (PCT) reabsorbs nearly all filtered glucose and amino acids along with most filtered sodium and water. SGLT2 inhibitors (the '-gliflozin' drugs) work by blocking glucose reabsorption at this exact segment.

Increased ventricular preload (venous return) stretches myocardial fibers and raises stroke volume, up to a physiologic limit. It explains why IV fluids raise cardiac output in hypovolemic shock but worsen congestion in decompensated heart failure.

A competitive inhibitor raises the apparent Km (lower substrate affinity) while Vmax is unchanged, because excess substrate can outcompete it. A noncompetitive inhibitor instead lowers Vmax while Km stays the same, since it cannot be overcome by more substrate.

Aerobically, pyruvate is converted to acetyl-CoA and enters the Krebs cycle for oxidative ATP production. Anaerobically (e.g., in maximally exercising muscle), pyruvate is instead reduced to lactate to regenerate NAD+ so glycolysis can continue.

IgG is the only immunoglobulin that crosses the placenta, giving passive immunity to a fetus/newborn. IgM is the first antibody produced during an acute immune response, appearing before IgG rises.

Gram-positive organisms retain crystal violet due to a thick peptidoglycan wall; Gram-negative organisms have a thinner wall plus an outer membrane containing lipopolysaccharide (LPS/endotoxin), which drives their risk of endotoxin-mediated septic shock.

Vd = Dose / C0 (initial plasma concentration). A high Vd (exceeding total body water) suggests extensive tissue binding or distribution outside plasma, as seen with digoxin; a low Vd suggests the drug stays mostly in plasma/extracellular fluid, as with warfarin.

Steady state is reached in 4-5 half-lives (about 94% at 4, 97% at 5) regardless of the dose or dosing interval used. This is why maintenance dosing without a loading dose (e.g., amiodarone) can take days to weeks to reach a stable level.

The Cockcroft-Gault equation: CrCl = [(140 - age) x weight(kg)] / (72 x SCr), multiplied by 0.85 for females. It uses age, weight, serum creatinine, and sex, and is commonly used to dose renally-cleared drugs like vancomycin and DOACs.

Zero-order kinetics eliminate a constant AMOUNT of drug per unit time because the elimination pathway is saturated, as seen with phenytoin, ethanol, and high-dose aspirin. First-order kinetics (most drugs) eliminate a constant FRACTION per unit time, giving a constant half-life.

Grapefruit juice inhibits intestinal CYP3A4, the enzyme responsible for first-pass metabolism of most CYP3A4 substrates. Inhibiting it increases oral bioavailability and can push levels into a toxic range, such as simvastatin-induced myopathy.

Codeine is a prodrug that requires CYP2D6 to convert it into active morphine. Poor metabolizers get little to no analgesic effect, while ultra-rapid metabolizers can generate dangerously high morphine levels, a documented risk in breastfeeding mothers.

'-sartan' identifies angiotensin II receptor blockers (ARBs), such as losartan. Unlike ACE inhibitors, ARBs block the AT1 receptor directly rather than reducing ACE-mediated bradykinin breakdown, so they rarely cause the dry cough seen with ACE inhibitors.

'-gliflozin' identifies SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin), which block proximal tubule glucose reabsorption. Beyond glycemic control, they have demonstrated cardiovascular and renal protective benefits in type 2 diabetes and heart failure.

'-floxacin' identifies fluoroquinolone antibiotics (ciprofloxacin, levofloxacin). The class carries an FDA boxed warning for tendinitis/tendon rupture, peripheral neuropathy, and CNS effects, so it should be reserved when other options are inadequate.

Alligation alternate: the difference between each stock strength and the desired strength sets the proportion (parts) of each solution needed, giving a quick mixing ratio without solving simultaneous equations.

0.9% w/v sodium chloride (normal saline) is the standard isotonic reference. Calculated osmolarity (or a sodium chloride equivalent/freezing-point method) is compared to it, and a tonicity agent is added as needed to avoid tissue irritation or hemolysis.

A balance has a minimum accurately weighable quantity. The aliquot method dilutes the potent ingredient with an inert diluent to reach a larger, accurately weighable total, then measures a proportional aliquot that contains the correct original dose.

USP <795> governs nonsterile compounding, such as oral suspensions and topical creams. USP <797> governs sterile compounding, such as IV admixtures and injections, with stricter environmental, garbing, and beyond-use-date requirements.

USP <800> specifically addresses safe handling of hazardous drugs, such as antineoplastics, across the entire handling chain: receiving, storage, compounding, administration, and disposal, protecting personnel regardless of whether the preparation is sterile or nonsterile.

An enteric coating resists dissolution in the acidic stomach and dissolves in the higher pH of the small intestine, protecting acid-labile drugs (e.g., omeprazole) or protecting the stomach from irritating drugs (e.g., enteric-coated aspirin).

Federal law (Controlled Substances Act) prohibits refills on Schedule II drugs entirely. The patient needs an entirely new written or electronic prescription for each fill, reflecting the CSA's tightest control tier for high-abuse-potential drugs.

Schedule III-V prescriptions may be refilled up to 5 times within 6 months of the date issued. After that limit or time window, a new prescription is required.

In a bona fide emergency, a prescriber may authorize a Schedule II drug orally. Under federal law (21 CFR 1306.11), the prescriber must then deliver a written or electronic prescription to the pharmacy within 7 days.

Schedule I drugs have no accepted medical use and a high abuse potential, so they cannot be legally prescribed. Schedule II drugs (e.g., oxycodone, amphetamine salts) also have high abuse potential but DO have an accepted medical use and can be prescribed under strict controls.

The Omnibus Budget Reconciliation Act of 1990 requires pharmacists to perform a prospective drug utilization review (screening for interactions, duplications, and contraindications) and to offer the patient counseling on new prescriptions.

DSCSA builds an electronic, interoperable system to trace prescription drugs as they move through the supply chain, helping identify and remove counterfeit, stolen, or otherwise unsafe products before they reach patients.

A Risk Evaluation and Mitigation Strategy (REMS) is a safety program the FDA can require for drugs with serious safety concerns, such as isotretinoin or clozapine, to ensure benefits outweigh risks through measures like prescriber certification or restricted distribution.

It means the probability of observing that result (or a more extreme one) by chance alone, if the null hypothesis were true, is under 5%, the conventional threshold for statistical significance. It does not, by itself, indicate clinical importance.

NNT is the number of patients who must receive a treatment for one additional patient to benefit versus control. A lower NNT means a more effective or more potent treatment effect.

Cost-effectiveness analysis compares cost per clinical outcome, such as cost per mmHg of blood pressure reduction. Cost-utility analysis standardizes outcomes using quality-adjusted life years (QALYs), allowing comparisons across different diseases and treatments.

An A1C of 6.5% or higher confirms diabetes per ADA criteria; 5.7% to 6.4% defines prediabetes. Diagnosis can also be confirmed with a fasting plasma glucose of 126 mg/dL or higher, or a 2-hour OGTT value of 200 mg/dL or higher.

Metformin remains first-line per ADA Standards of Care due to its efficacy, weight neutrality, low hypoglycemia risk, cardiovascular safety, and low cost, unless contraindicated (e.g., eGFR under 30 mL/min or conditions predisposing to lactic acidosis).

Both classes showed cardiovascular and renal outcome benefits beyond glycemic control in outcome trials. GLP-1 agonists reduce major adverse cardiac events, and SGLT2 inhibitors reduce heart failure hospitalization and slow CKD progression, so they are recommended regardless of A1C control.

DKA presents with hyperglycemia, ketosis, and metabolic acidosis, typically in type 1 diabetics. HHS presents with much higher glucose, minimal ketosis/acidosis, and severe dehydration, typically in type 2 diabetics; both are treated with IV fluids, insulin, and electrolyte correction.

That falls into Stage 1 hypertension (systolic 130-139 or diastolic 80-89 mmHg). Below 120/80 is normal, 120-129/under 80 is elevated, and 140/90 or higher is Stage 2 hypertension.

An INR of 2 to 3 is the target for most standard indications. Higher targets (2.5 to 3.5) apply to mechanical mitral valves and certain high-risk thrombotic conditions.

DOACs have a predictable pharmacokinetic and pharmacodynamic profile with fixed dosing and fewer food/drug interactions, so routine INR-style monitoring isn't needed, though renal function should still be checked since most DOACs undergo some renal clearance.

An ACE inhibitor/ARB or ARNI (sacubitril-valsartan), a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor together form the 4 pillars shown to reduce mortality and hospitalization in heart failure with reduced ejection fraction.

The 2020 ASHP/IDSA consensus guideline recommends an AUC/MIC ratio of 400-600 as the target, replacing the older trough-only approach (15-20 mcg/mL), because AUC-guided dosing better predicts efficacy while reducing nephrotoxicity risk.

CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, age 65+) assesses community-acquired pneumonia severity. A score of 2 or higher generally indicates a need for hospital admission, while 3 or higher suggests considering ICU-level care.

Oral vancomycin or fidaxomicin are first-line per IDSA/SHEA guidance, with fidaxomicin preferred for its lower recurrence rate. Metronidazole is now reserved as an alternative only when the preferred agents are unavailable.

Live vaccines, such as MMR and varicella, contain weakened but replicating pathogens that can cause actual disease in a patient whose immune system cannot control them. Inactivated or subunit vaccines are preferred in this population instead.

GOLD 1 (mild): FEV1 80% or more of predicted; GOLD 2 (moderate): 50-79%; GOLD 3 (severe): 30-49%; GOLD 4 (very severe): under 30% predicted, used alongside symptoms and exacerbation history to guide treatment intensity.

A long-acting muscarinic antagonist (LAMA) or long-acting beta-agonist (LABA), often combined, forms first-line maintenance therapy. Inhaled corticosteroids are added mainly for patients with frequent exacerbations or elevated eosinophils, not used alone in COPD.

Asthma (GINA guidelines) is managed by a stepwise approach based on symptom control and exacerbation risk, starting with as-needed ICS-formoterol. COPD (GOLD) is staged primarily by airflow limitation (FEV1) plus symptom/exacerbation grouping, since its obstruction is largely irreversible.

SSRIs are first-line for depression due to a favorable safety profile. Serotonin syndrome presents with altered mental status, autonomic instability (hyperthermia, tachycardia), and neuromuscular abnormalities (clonus, hyperreflexia), a risk when combining serotonergic agents.

Lithium's therapeutic range is 0.6-1.2 mEq/L. Because it is renally cleared with a narrow therapeutic index, dehydration, NSAIDs, and thiazide diuretics can precipitate toxicity, which starts with GI upset and tremor and can progress to confusion and seizures.

Myelosuppression (neutropenia, thrombocytopenia, anemia) is the most common dose-limiting toxicity, since chemotherapy targets rapidly dividing cells, including bone marrow precursors. Nadir counts typically occur 7-14 days after administration.

A neutropenic patient (ANC under 500-1000/mm3) with fever has a blunted immune response and can progress rapidly to sepsis, so empiric broad-spectrum antibiotics covering Pseudomonas should be started immediately, without waiting for culture results.