PharmNerd

The American Pharmacists Association has just released the first edition of "The APhA Complete Review for the FPGEE" which exactly follows the blueprint and relieves you from skipping chapters in the CPR. You can find the book and order it online from the APhA Bookstore on this link: Shop APhA : home Good luck September test-takers!

Hebes123, are you in WA? Where? I am in Pullman.

Beta blockers (BBs) should be avoided in Prinzmetal's angina (vasospastic angina) because they worsen the coronary spasm through unopposed alpha-mediated vasoconstriction. Also they can mediate vasospasm through blockade of smooth muscle beta 2 receptors. Related to that, they also cause bronchospasm through airway beta 2 blockade. In Prinzmetal angina (or cocaine-induced angina), BBs should be avoided and CCBs should be given, especially the dihydropyridine amlodipine. If there is cardiac involvement, a nondihydropyridine (verapamil or diltiazem) should be given instead. Hope this helps!

If you can memorize the brand names, go for it, if you cannot, just do not worry about it!! You will have to memorize them any way for the NAPLEX inshaa Allah, so do the work sooner or later.

Yeah, alhamdulellah. It's just out of a lot of practice, watching untranslated movies, reading, listening to scientific lectures (you can find plenty of those online). For preparation, I had very bad days around both the TOEFL and the FPGEE so my experience regarding the length and strength of preparation for either is not gonna be definitive, just a couple of days!!

Here is what I think is important, generally, and for the FPGEE: - Statistics is very important, especially significance tests, and the CPR is not enough at all for that, try Remington and wikipedia. Tests like Chi Square, Student t, Pearson, Confidence Interval, etc. Also, look at how this relates to the published clinical research. This also is very important for your understanding of primary literature, e.g., clinical trials, meta-analyses, etc. - Historical stages of pharmacy profession development and what marks the initiation of a certain area. You can find all this in Remington’s first couple of chapters, there is a nice chapter on history of pharmacy and a list of chronology. - Ethical principles in pharmacy practice and patient rights, including, confidentiality, informed consent, clinical trials research, principles of patient care, like beneficence, non-maleficence, autonomy, etc. You can find those in the late chapters in Remington. Also, related to that, patient counseling and communication principles are EXTREMELY important to understand. It seem like you can think about this in a common sense but actually there are rules on how to deal with these things. - Pharmacoeconomic principles: Cost analyses like CBA, CMA, CEA, COI, CUA, etc. All these are outlined briefly in the last chapter of the CPR. In addition, you will need to know about pharmacy inventory (stock) management, different types of associated costs (direct, indirect, medical, nonmedical, incremental, etc). All these extra things are illustrated in Manan Shroff's management, in addition to Morris Cody HealthCare guide, in a better way I guess than Shroff’s. - The Federal Law, especially controlled substances, types of healthcare organizations, especially MANAGED CARE ORGANIZATIONS (like HMOs, PPOs, IPAs, etc). Also, the rule of federal organizations, especially the FDA, and other organizations involved in the regulation of pharmacy profession in the US. - Pharmaceutics probably is not that important: do not try to memorize how different dosage forms are prepared. Just understand the general guidelines and especially what suspending/emulsifying agents are used, particularly, Spans, Tweens, PEG, etc, I mean the advanced ones. - Calculations, only simple t1/2, concentration conversion calculations, pH calculations, and simple ones. Do not bother yourself with complicated things that would require the use of calculators. Calculators are not allowed, by the way. Now the clinical part: - Clinical pharmacokinetics (therapeutic drug monitoring) is VERY IMPORTANT, MEMORIZE the peak and trough levels of TDM drugs that you can find in the CPR, they are listed in a table in the Clinical Pharmacokinetics chapter. This is also important for your practice afterwords. - Clinical Toxicology: MEMORIZE the toxic doses of common drugs, like acetaminophen, antidotes and manifestations of toxicity. - Drug Information Resources: there is a good chapter covering most of that in the CPR but it also helps to look that up in Remington, like what journals, what handbooks, compendia, etc for drug information, especially incompatibility information (esp. Injectables), primary literature (peer-reviewed journals). You MUST know which source to lookup in order to find a certain piece of information. This also is particularly important for your practice. - DRUG INTERACTIONS: CYP inducers and inhibitors, especially the ones affecting anitcoagulants, also absorption delaying and promoting drugs, like Ca-Tetracycline interactions. CPR chapter is good but not very enough. Also, make sure you know herbal-drug interactions, like what effects have garlic, Ginkgo, Genseng, St. John's wart, Grapefruit Juice, Black Cohosh, Ma Huang, etc on various drugs. The CPR chapter is great at that. Also drug interactions involving antibiotics is EXTREMELY important. - Pharmacogenetics, idiosyncratic drug reactions, tolerance, slow vs. fast acetylators, etc. - DRUG USE IN SPECIAL POPULATIONS: what can be used in geriatric, pediatric and pregnant patients. There is a good chapter on that in the CPR, it helps too to look up additional information. - Laboratory Tests and their interpretations: it's VERY IMPORTANT to understand what lab test results suggest. Examples include International Normalized Ration (INR) which is the international equivalent of Prothrombin Time (PT), what are the therapeutic, subtherapeutic and bleeding ranges, what should you give as antidotes for oral anticoagulants and how you should give it. Example therapeutic INR is 2-3, below 2 there is a risk for thrombosis, above 3 there is a risk for bleeding. So if a patient has an INR of 6.5, what's the proper thing to do? and so on. This is detailed in anticoagulation chapter of the CPR. Same thing holds for HbA1c, glycated Hemoglobin, as a way to monitor diabetic patients. You need to know which values correlate with drug dosing, like if it's 6-7% what would you use, rosiglitazone or repaglinide? so you need to know which drug is more efficacious. Also, related to all this, therapeutic goals or endpoints are important, including, as examples, 5-6mg/dL in hyperuricemia, 7% HbA1c in diabetes, 2-3 INR in all indications except prosthetic valves and systemic TE risk, LDL cholesterol - Disease Pathophysiology and Optimal Pharmacotherapy: Focus on Cardiovascular, CNS and Endocrinology disorders. They are all detailed in the clinical chapters of the CPR, which unfortunately I did not have time to review!! - Also, renal dysfunction is important as well because it determines which drugs to use and which not, for example, you can use an ACE inhibitor NOT a thiazide diuretic for a renally compromised hypertensive patient, because ACEIs can improve the renal function. Also certain drugs are contraindicated in renal and/or hepatic failure. Know those! - Drug side effects, especially those related to the pharmacological effects of drugs, for example, atropine would cause xerostomia (dry mouth) because of anticholinergic effects, metoclopramide would cause extrapyramidal side effects b/c of dopamine antagonism, and so on. - Antimicrobial and Anticancer chemotherapy are EXTREMELY important in the following aspects: which is bactericial vs. bacteriostatic???? what is the differences between different generations, like, Ceph generations I, II, III and IV?? which is contraindicated in children? for example: fluoroquinolones are contraindicated in children because they cannot metabolize them, chloramphenicol is contraindicated b/c of grey baby syndrome, tetracyclines b/c of teeth degenration, etc. For generations: ceph generations increase in targeting Gram -ve bacteria more than G+ve ones, except cefipime; fluoroquinolone generations are becoming more systemic than just for urinary tract, and so on. Major side effects like Pseudomembranous Colitis, peripheral neuritis, livedo reticularis (which drug causes this?) hepatotoxicity, nephrotoxicity are very important. There is a very important clinical antiviral combination for HIV treatment. The HIV protease inhibitor combination of Ritonavir/Lopinavir: Ritonavir is a very potent CYP inhibitor and it's not a potent antiviral but Lopinavir is, so ritonavir inhibits the metabolism of Lopinavir. Also, one of the most iportant side effects associated with antivirals/antibacterials is life-threatening PANCREATITIS, and it's also detailed in the antimicrobial part of the CPR. Side effects and how you treat them for anticancer chemotherapy is EXTREMELY important. Examples include: Cyclophosphamide-induced hemorrhagic cystitis, ttt w/ mesna, urinary tract protective; anticancer-induced febrile neutropenia, 3rd generation ceph; route of administration of vincristine, vincristine cause sudden DEATH if given intra-thecally; Paclitaxel and docetaxel, taxol derivatives, induce life-threatening anaphylaxis; doxorubicin can cause life-threatening cardiotoxicity and heart failure. Immunosuppressants (like DMARDs) are also very important, like cyclosporine and tacrolimus. - OTC brand names, But of course you do not have to memorize every thing. If you end up having very unclear memory of those, that's not a problem. - Structures: Please, see this post http://www.www.urch.com/forums/fpgee/120474-question-chapter-12-pharmacodynamics-cpr.html#post797341 Ultimately: - The CPR is the BEST reference. No need for Lippincott's because it's not as clinically emphasized as the CPR and you DO need the clinical information in it. Lippincott’s is just good for reviewing the basic pharmacology, which is illustrated briefly, and you do not need more, in the pharmacology and medicinal chemistry chapters of the CPR. Also, do not forget Remington (important for the sociobehavioral, administrative part), Morris Cody or Manan Shroff. - Questions and Answers in the back of each chapter of the CPR are of paramount importance. Unfortunately, I did not have time to do any other questions and answers but as a first glance, I think Appleton & Lange should be helpful. I do not know about Manan Shroff’s 1000 Q&A. Good luck to all future test takers!

Here is what I think is important, generally, and for the FPGEE: - Statistics is very important, especially significance tests, and the CPR is not enough at all for that, try Remington and wikipedia. Tests like Chi Square, Student t, Pearson, Confidence Interval, etc. Also, look at how this relates to the published clinical research. This also is very important for your understanding of primary literature, e.g., clinical trials, meta-analyses, etc. - Historical stages of pharmacy profession development and what marks the initiation of a certain area. You can find all this in Remington’s first couple of chapters, there is a nice chapter on history of pharmacy and a list of chronology. - Ethical principles in pharmacy practice and patient rights, including, confidentiality, informed consent, clinical trials research, principles of patient care, like beneficence, non-maleficence, autonomy, etc. You can find those in the late chapters in Remington. Also, related to that, patient counseling and communication principles are EXTREMELY important to understand. It seem like you can think about this in a common sense but actually there are rules on how to deal with these things. - Pharmacoeconomic principles: Cost analyses like CBA, CMA, CEA, COI, CUA, etc. All these are outlined briefly in the last chapter of the CPR. In addition, you will need to know about pharmacy inventory (stock) management, different types of associated costs (direct, indirect, medical, nonmedical, incremental, etc). All these extra things are illustrated in Manan Shroff's management, in addition to Morris Cody HealthCare guide, in a better way I guess than Shroff’s. - The Federal Law, especially controlled substances, types of healthcare organizations, especially MANAGED CARE ORGANIZATIONS (like HMOs, PPOs, IPAs, etc). Also, the rule of federal organizations, especially the FDA, and other organizations involved in the regulation of pharmacy profession in the US. - Pharmaceutics probably is not that important: do not try to memorize how different dosage forms are prepared. Just understand the general guidelines and especially what suspending/emulsifying agents are used, particularly, Spans, Tweens, PEG, etc, I mean the advanced ones. - Calculations, only simple t1/2, concentration conversion calculations, pH calculations, and simple ones. Do not bother yourself with complicated things that would require the use of calculators. Calculators are not allowed, by the way. Now the clinical part: - Clinical pharmacokinetics (therapeutic drug monitoring) is VERY IMPORTANT, MEMORIZE the peak and trough levels of TDM drugs that you can find in the CPR, they are listed in a table in the Clinical Pharmacokinetics chapter. This is also important for your practice afterwords. - Clinical Toxicology: MEMORIZE the toxic doses of common drugs, like acetaminophen, antidotes and manifestations of toxicity. - Drug Information Resources: there is a good chapter covering most of that in the CPR but it also helps to look that up in Remington, like what journals, what handbooks, compendia, etc for drug information, especially incompatibility information (esp. Injectables), primary literature (peer-reviewed journals). You MUST know which source to lookup in order to find a certain piece of information. This also is particularly important for your practice. - DRUG INTERACTIONS: CYP inducers and inhibitors, especially the ones affecting anitcoagulants, also absorption delaying and promoting drugs, like Ca-Tetracycline interactions. CPR chapter is good but not very enough. Also, make sure you know herbal-drug interactions, like what effects have garlic, Ginkgo, Genseng, St. John's wart, Grapefruit Juice, Black Cohosh, Ma Huang, etc on various drugs. The CPR chapter is great at that. Also drug interactions involving antibiotics is EXTREMELY important. - Pharmacogenetics, idiosyncratic drug reactions, tolerance, slow vs. fast acetylators, etc. - DRUG USE IN SPECIAL POPULATIONS: what can be used in geriatric, pediatric and pregnant patients. There is a good chapter on that in the CPR, it helps too to look up additional information. - Laboratory Tests and their interpretations: it's VERY IMPORTANT to understand what lab test results suggest. Examples include International Normalized Ration (INR) which is the international equivalent of Prothrombin Time (PT), what are the therapeutic, subtherapeutic and bleeding ranges, what should you give as antidotes for oral anticoagulants and how you should give it. Example therapeutic INR is 2-3, below 2 there is a risk for thrombosis, above 3 there is a risk for bleeding. So if a patient has an INR of 6.5, what's the proper thing to do? and so on. This is detailed in anticoagulation chapter of the CPR. Same thing holds for HbA1c, glycated Hemoglobin, as a way to monitor diabetic patients. You need to know which values correlate with drug dosing, like if it's 6-7% what would you use, rosiglitazone or repaglinide? so you need to know which drug is more efficacious. Also, related to all this, therapeutic goals or endpoints are important, including, as examples, 5-6mg/dL in hyperuricemia, 7% HbA1c in diabetes, 2-3 INR in all indications except prosthetic valves and systemic TE risk, LDL cholesterol - Disease Pathophysiology and Optimal Pharmacotherapy: Focus on Cardiovascular, CNS and Endocrinology disorders. They are all detailed in the clinical chapters of the CPR, which unfortunately I did not have time to review!! - Also, renal dysfunction is important as well because it determines which drugs to use and which not, for example, you can use an ACE inhibitor NOT a thiazide diuretic for a renally compromised hypertensive patient, because ACEIs can improve the renal function. Also certain drugs are contraindicated in renal and/or hepatic failure. Know those! - Drug side effects, especially those related to the pharmacological effects of drugs, for example, atropine would cause xerostomia (dry mouth) because of anticholinergic effects, metoclopramide would cause extrapyramidal side effects b/c of dopamine antagonism, and so on. - Antimicrobial and Anticancer chemotherapy are EXTREMELY important in the following aspects: which is bactericial vs. bacteriostatic???? what is the differences between different generations, like, Ceph generations I, II, III and IV?? which is contraindicated in children? for example: fluoroquinolones are contraindicated in children because they cannot metabolize them, chloramphenicol is contraindicated b/c of grey baby syndrome, tetracyclines b/c of teeth degenration, etc. For generations: ceph generations increase in targeting Gram -ve bacteria more than G+ve ones, except cefipime; fluoroquinolone generations are becoming more systemic than just for urinary tract, and so on. Major side effects like Pseudomembranous Colitis, peripheral neuritis, livedo reticularis (which drug causes this?) hepatotoxicity, nephrotoxicity are very important. There is a very important clinical antiviral combination for HIV treatment. The HIV protease inhibitor combination of Ritonavir/Lopinavir: Ritonavir is a very potent CYP inhibitor and it's not a potent antiviral but Lopinavir is, so ritonavir inhibits the metabolism of Lopinavir. Also, one of the most iportant side effects associated with antivirals/antibacterials is life-threatening PANCREATITIS, and it's also detailed in the antimicrobial part of the CPR. Side effects and how you treat them for anticancer chemotherapy is EXTREMELY important. Examples include: Cyclophosphamide-induced hemorrhagic cystitis, ttt w/ mesna, urinary tract protective; anticancer-induced febrile neutropenia, 3rd generation ceph; route of administration of vincristine, vincristine cause sudden DEATH if given intra-thecally; Paclitaxel and docetaxel, taxol derivatives, induce life-threatening anaphylaxis; doxorubicin can cause life-threatening cardiotoxicity and heart failure. Immunosuppressants (like DMARDs) are also very important, like cyclosporine and tacrolimus. - OTC brand names, But of course you do not have to memorize every thing. If you end up having very unclear memory of those, that's not a problem. - Structures: Please, see this post http://www.www.urch.com/forums/fpgee/120474-question-chapter-12-pharmacodynamics-cpr.html#post797341 Ultimately: - The CPR is the BEST reference. No need for Lippincott's because it's not as clinically emphasized as the CPR and you DO need the clinical information in it. Lippincott’s is just good for reviewing the basic pharmacology, which is illustrated briefly, and you do not need more, in the pharmacology and medicinal chemistry chapters of the CPR. Also, do not forget Remington (important for the sociobehavioral, administrative part), Morris Cody or Manan Shroff. - Questions and Answers in the back of each chapter of the CPR are of paramount importance. Unfortunately, I did not have time to do any other questions and answers but as a first glance, I think Appleton & Lange should be helpful. I do not know about Manan Shroff’s 1000 Q&A. Good luck to all future test takers!

I am Egyptian, currently in the US. Allah, SWT, has endowed me with passing the FPGEE with 132 and the TOEFL (S29, total 117). I need these high scores for very different career goals, so I needed to work hard and get every thing done in the best shape from the first time. And it was not that hard!! The thing I find very disappointing about us in general is that we ALWAYS rely on getting "educated" by others even if we spent 5 years of hard work in the college of pharmacy. I saw people talking about "Dr Yasser's course". I do not know what that is, at any rate, it's a piece of crap that looks exactly like the very inappropriate (I am trying to be polite) "droos" people were taking when in pharmacy and medicine in Egyptian universities. Guys, this FPGEC program is a life chance to know yourself and develop into a responsible professional. The key is to STRUGGLE in teaching yourself how to speak good English and how to be a knowledgeable professional, ie pharmacist. If you are the kind of person who relies on taking courses in the AUC, Amideast or the British Council to "pass" the TOEFL and take a course at "Dr Yasser's" to pass the FPGEE, you are just screwed. You will not become a responsible professional if you keep doing this thing that you have been doing since "thanaweya 3ammah", maybe before. Things here does not work this way. You really have to do YOUR best in assimilating information. Get the help YOU NEED from your colleagues, friends who have had a comparable experience. Have a clear goal why you wanna do all this and what's the best way to do it. Remember, be realistic about what you are going to learn from those courses. The TOEFL course at the AUC is not gonna teach you how to speak English, and you do not know how many people have take it and they did not pass, you just know the very few who passed. Also, always relate cause and effect in a logical way, if somebody in Dr Yasser's course passed, this does not mean at all that everybody who took this course will pass. Maybe there are so many who took that course and did not pass. By the way, I do not have any conflict of interest with either Dr Yasser or any other entity. Finally, always remember, if you wanna make the best use of this chance to have good English, do it yourself. If you wanna develop your pharmacy knowledge in a real way, do it yourself and do it appropriately. Good luck

Hi all, Congratulations to everybody who passed and hopefully this will give all of us a leap towards achieving our life and career goals. I have been thinking about positive and negative experience we had throughout this whole process from careful planning of every thing to almost nervous breakdown before the results showed up. I would love for every body to share this "humanitarian" and professional experience so that we learn more about and evaluate ourselves and help the newcomers. Thanks PharmNerd

Do you guys know what the equivalent percentiles are (it's not a percentage) to our scaled scores?

Log on into this with your EE and DOB: https://oraweb1.nabp.net/apex2/f?p=101:1

Guys, the scores are up theeeeeeeeeeeeeeeeeree!! Go go go go go go it !!!!!!!

Guys, Could you, please, stop this!! You are just making yourselves and others more nervous. We should disregard waiting for this exam score and try to care about something else in our lives, there is a lot out there to think about, this exam is not the end of the world. Please, again, try to maintain self-restraint and not to post any thing provoking nervousness and anxiety to every body. Thanks!

Memorizing all the structures right away will ultimately result in forgetting all of them. What I think is a good strategy to remember structures even beyond the exam, which is also the way that can help correlate the structural differences with clinical effects is to look for a SAR pattern. Questions involving structures that I saw on the April FPGEE exam did not ask what's this drug, rather, which of the above structures would have the longest duration of action, the highest bioavailability, suitable for parenteral injection, having side effects similar to another drug. To illustrate this, typical phenothiazine and dibenzoazepine antischizophrenics share a common nucleus. You would expected fluorine-substituted and piperazine-substituted drugs (e.g., fluphenazine, trifluoperazine) to share a common efficacy and side effects profile compared to other drugs that have no fluorine or just have a propylamine substituent on the heterocyclic nitrogen (ex. chlorpromazine, promazine). You can find similar "patterns" across antidepressants, anti-histamines, etc. This becomes important in cases of allergic drug reactions, for example, phenobarb and pyrimidone would cause the same allergic reactions because phenobarb is a metabolite of primidone and it share the structural part of barbituric acid. Phenytoin would not cause this type of reaction. Also, this is important when you consider the related side effects and protein binding characteristics of sulfonamide antibacterials, thiazide diuretics, PPIs and sulfonylureas which share some structural motifs. The best source ever for pharmacy review (esp. for the FPGEE) is the Comprehensive Pharmacy Review!! Good luck!