Manshrof Theory Part 1

Reference Guide For TheForeign PharmacyLicensing Exam- Theory

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REFERENCE GUIDEFOR THE FOREIGNPHARMACYLICENSING EXAM

?

THEORY

(VOLUME I)

MANAN H. SHROFF

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Refereneeifsmde for the Foreign PharmacyLicensing Exam -Theory

This bo~-i\not intended as a substitute for the advise of physicians. Students or readers mustconsult tbeii physician about any existing problem. Do not use information in this book for anykind of s@}.f.1heatment.Do not administer any dose of mentioned drugs in this book withoutconsulting your physician. This is only a review guide for the preparation of the Foreign PharmacyLicensing Exam (FPGEE )

The author is not responsible for any kind of misinterpreted, incorrect, or misleadinginformation or any typographical errors in this book. Any doubtful or questionable answers shouldbe checked in other available reference sources.

All rights reserved.

No part of this book may be reproduced or transmitted in any form or by any means, electronicallyphotocopying, recording, or otherwise, without prior written permission of the publisher.

RXEXAM is a registered trademark of Pharmacy Exam of Krishna Publications inc. Any unauthorized use of this trade mark will be considered a violation of law.

NAPLEX and FPGEE are registered trademarks of the National Association of Boards ofPharmacy (NABP). This reference guide is in no way authorized by or sponsored by NABP.

Referellce,e.nide for the Foreign Pharmacy -::... ,..~;:;!(~_!\::. ,-' ,;1 ,Y~')KriStnanLicensing Exam -Theory .--,'~d~--

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Reference/GUide for the Foreign PharmacyLicensing Exam -Theory

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PREFACE:

I am very pleased to introduce this Reference Guide for the Foreign PharmacyLicensing Exam-Theory. After the overwhelming interest in the Reference Guide for ForeignPharmacy Licensing Exam-Second Edition, it encouraged me to write another short and compre-hensi ve guide that would help the reader to prepare for and succeed at the FPGEE.

I tried my best to cover as much of the course as possible which is outlined in the FPGEE-syllabus.I would still recommend that students give more attention to clinical pharmacology, pharmacymanagement and pharmacoeconomics.

I hope my efforts will bring you much success.

Best of luck,

Manan H. Shroff

Reference-Guide for the Foreign PharmacyLicensing Exam -Theory ,,-~_ ..." lp

TABLE OFCONTENTS

A Pharmaceutical Services Management & -1)~.Social and Behavioral Sciences ....-...... - ....... ,-.-

:t( Pharmacy Law 8~ Pharmacy Management a 16 L .~ Pharmacoeconorrrics ~ 25 '.1 :" : __ :~;X U.S.HealthCare Delivery stem 29 ~1'.;5.. New Drug Approval 34-e; Clinical Drug Literature 36 , " .. ". ~.'

B Preclinical Sciences~ ".~ i; i , '. .~

Organic/General Cherrristry 40Natural Products 51Cell Biology 55

~ Human Endocrine System 58Microbiology and Pathology 62

~. Blood 64~. Human Digestive System 68~ Inborn Error Of Metabolism 73

Metabolism 75

C Pharmaceutical Sciences

1f: Suspension and Emulsion 78Pharmaceutical Additives 86)(. Rheology 94~. Colloids 96~ Solution of Electrolytes and 98

/'P(Concentration ExpressionPharmacokinetics 104

~ Kinetic Principles and Order of Reactions 10926.- Bioavailability and Bioequivalence 114


Reference Glide for the Foreign PharmacyLicensing Exam -Theory

. ' " '. . -'. Krisrnan',,- \ ..~..... -

TABLE OF CONTENTS (Cont'~)DNAandRNAVitamins and Their SourcesTeratogenic DrugsTPN (Total Parenteral Nutrition)Acid Base DisorderOral ContraceptiveFamily planning _Interpretation of Clinical Laboratory TestsAnti-infective and Their Poteiitial Side Effects.Renal FailureCystic fibrosisDrugs and their side effects~ ,

116118119123125127130132136138146147

n Biomedical Sciences~ Accidental Poisoning and Antidotes;;( Statistics .38. Immunology \39. Microorganisms and Drugs of Choice

158161170178

E Pharmacology

...J. Questions/~;

Answers181200


Reference Guide for the Foreign PharmacyLicensing Exam -Theory

Krisman

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PHARMACEUTICAL SERVICE MANAGEMENT-" ,'"& -.

SOCIAL AND BEHAVIORAL SCIENCES

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I-Pharmacy Law

A PURE FOOD ANDDRUG ACT OF 1906

* Congress passed this law in 1906 to protect peo le from unsanitary and poorl labeled fOQd.f" --B FOOD, DRUG AND COSMETIC ACT OF 1938

*....

This law suggests that no new drug can be marketed until proven safe by the FDA for public use.duAhw. ~o~ - - -~JJ\ -c~~~ -~-DURHAM HUMPHREY AMENDMENT OF 1951

*I;

This law is also known as " Prescription DrugAmendment".

* ~ It diffe~ates between prescription and 0.4 drugs.Jfo .>~ \ ;:P-~(,.rk'

* It also authorizes or&l2rescri tions and PLe . tion refills.

* It suggests that ea~g should be labeled" Caution: Federal law prohibits dispensing withouta prescription." ~ -K'e 9-~ve.... ~r n' sKEFAUVER HARRIS AMENDMENT OF 1962

* It is also known as the ''Drug Efficacy Amendment".

This law indicates that n~w a roved drugs must be~afe as well as ~eciv_e.*

* It also establishes Good Manufacturing Practjye requir~ents.

E MEDICAL DEVICE AMENDMENT OF 1976

* '" This law passed in 1976, and ~s:

IIT

The classification of medical devicesSafery and efficacy of medical devices

O(?~ -

ORPHAN DRUG ACT OF 1983

This law was passed fO~' han druCgs ~s that affect very few people). Congresspassed this act to prgvidetax relief and other Mt:'entives for the manufacturers to de~p andm-!!iet orphan drugs.

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Reference Guide for the Foreign Pharmacy KrismanLicensing Exam -Theory \ ~\ D~ _\-\~ ~~ CUv\U\-!e ~ ', ~ l~ ~ ~ aTC & 11-

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G DRUG PRICE COMPETITION AND PATENT TERM RESTORATION ACT OF1984 -=

'This law was passed to make g~c dru sm..Q!:..ereadily a~e to the public.--=--

).1...1:1'\.'Thislaw also provides more incentive to innovative pharmaceutical com anies and encourages---- ~them to develop new dru s.

\2 ~dec\d~ w' ~ ~ aTe) w- o::: ~H$NATIONAL DRUG CODE NUMBER (NDCl---" G_\18 ...,J, 1"* The NDC generally co~f ten to eleven letters: 4 -+ + 2.

T~e FDA passed this law in 1970 that states certain dru .~e. a Patient Packa e Insert ~indicating the uses, risks and precautions of such dru s. The list of such drugs are :

LfMt\i"\j: ~'(I';'" ~c.~ ""::.~'Y\ i>dV',,:,:ti J.;; pYl::O"'tANVt ,:)orl\~Y'.* Isotretinoin.. (.'"1 ~(, I'D* Oral contraceptives I C '( Cf"\ ~ laJoJ.

G * 206"_) IsoRr~u:ren?1 (f\Wo.L.o- (WCLYn;~: D~L. ex.Ce~o\ ~ d.os~ r~;* Ticlopidine ..:g cl~f,c....fB rUsiU;) W

'\Reference Guide for the Foreign PharmacyLicensing Exam -Theory

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J OBRAACT OF 1990

, * Subljpgt!aldosage form of nitro! 1 cerine .-/I * SubliJ.k,oualand che~ble form ofIsosorbide dinitrate (less than 1Omg)

., ~AJI'~ -Choles amme powder " "'a. r;.....fLo... &. ta.b.* ....Q Methyli rednisolone tablets (less tpan 84mg)* Mebendazole. tablets (less than 600 mg of drug) J011 t l du-.)~ lJJ~ a'~* K Potassium supplements (unitdosef0rm)Vi'c:tbI\~~II.'dwt LJI'''fpeJ '11)' 0.0. J p01I1 p.c.K C. '* om cin eth 1succina~_ . and granules not mo"rethan 8 gtJ!of drug)* Col~sti 01 in powder form ~ \of ~ .u..6p. .* ,~omycin ethyl succinate (tablets no more than 16gm of drug)* Pancreli ase preparations ~ ta.-b,) wp. 0(' powdex pcr.-n.* Prednisone (tablets no more than 105mg) Beta 'C - JY'\e .t~' \

Q,2,05.* Oralcontrace tives ,){eJyo ?(C>t~V'~ ~ ~'I Not'+: (V"*& p~s;~ ~~ Su.b..(V) eo~ 0. p\'ebUUftl:it)\..o .~: _CD (\Jot 'i"A.OV' ~ .2..~OCc. of4?!, ~'d o


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M CONTROLLEDSUBSTANCEACT(~SA)

* ~ = Controlled Substance Act 5~ = Drug EnforcementAdministration . . l' to ~'

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KrismanReference Guide for the Foreign PharmacyLicensing Exam -Theory

DISPENSING OF cmCIV and CV, DRUGSnt-i"Ur rc;

* Jj(? "'Cannot be refilled ~fCthan five times. ;:,"1'\ b """'V\..~.sr~ ~ ~~I~ ~r \,"~'HI'

Cannot be filled for the prescQI2!!..0nolder thtlfl ix months

oDo not re.gmre any DEA 222 form to fill the order.-- ~--

*

*

Controlled illdrugs:

* Lortab = ~bodone +APAP* T lenol # 3 = Acetaininophen + C e #"* FioricetlC~ine = Butalbi +APAP+ Caffeine + Codeine* Fiorinal / Codeine = Butalbital +Aspirin + Caffeine + Cod~ine* Vicoflin = Hydrqcodoneat, 61::; ---") 700 Cd

Controlled IV drugs:-') ~~~b~I'W

----* Talwin = Pentazocine* TalwinNX = Pentazocine + Naloxone* Talacen = Pentazocine +APAP* Talwin compound = LYentazocine +Aspirin* Darvon = 'Propoxyphcnc* Darvon compound = Propoxyphene +Aspirin* Darvocet = Propoxyphene +APAP* Equanil = ';Meprobamate* Librimn = Chlordiazepoxide* Valimn = Diazepam* Serax = Oxazepam* Tranxene = Clorazepate* Dalmane = F1urazepam~* Klonopin = ao~pam* Ativan = Lorazepam* Prosom = Estazolam* Restoril = ~pam~* Halcion = TriazolamI* Xanax = AI razolam* Ambien = Zolpidem Gi. 16(, . , p' t* Cylert = Pemoline -'} deLls'. 01

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EMERGENCY DISPENSING OF Cll DRUGS REQUIRES CERTAIN CONDITIONS0iiJ:!:

* The dispensing quantity of the drug should be ~ to cover em~q~encysituations.,.

The prescriRtionsis immediately reduced to a written grescription by the pharmacist with complete........ ---- --information abC!utthe ordering physician's neK\.'!. P &. \'NL a).l... QFAXINGOFCllDRUGS ~ 0('01 ~"-'2~'~ p~~. ""'-~IoQ.1:vw.J\:..

~ '?-U ~"'.... Ol. ~ccl.. '

*

*

* Apharmacist can fill the crr prescriptionby using afax prescri12tio under the condition that beforedispensing of the drug,onemust receive the ori . al rescription. The faxing of ell prescriptionsshould be considered the ori&nal crr prescription onl ,und,Erthe follo~g conditions:

I When aprescription is faxed by a prescriber that needs to be compounded and administered to apatient viill, g:., I.M. or intrasp~al infusi9n. LT

c.. \-~When a prescription is faxed by pre~criber for,a p~nt liv~g in long-term care(m~i${ ,-C f')n

* Me~adone can be used for pai~ as well as for treatment of drug detoxific~t!0n.A phann!cy no~regijtered with the DEA narco~ cannot dispense Methadone for treatment of drug! .detoxification. -

. THE FILING METHOD FOR CONTROLLED SUBSTANCES

1 QmUlle for crrSe nd file for cm, CN and CVThirdfilefornoncontrolledsubstances (UN\sched..J.... ~~c.~~~)

2 O~forcrrS~~ file for em. CN .CV and non-cQ!!!rolled substances . I ~

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Reference Guide for the Foreign Pharmacy KrismanLicensing Exam -Theor , 1\ ....1L' ~f\ 01. It.. co.u- is, .A~ Sw~.

'\t\ tt ..\h. f'~l$tr~ ~ ~ ~o~oJ(. ~I.)U'-ce \ c . \) l~ rlL ~-~~ re{Jal't ~t bE. d.oY\~ \..Uol ~ 'DEA ~ol'l"V'\ lOb:DESTRUCTION OF CONTROLLED DRUGS

(

*

*

The request to destroy controlled substances should be done on a ~~~~~

~\If the institution has a past history of v~ low drug abuse, the DEA may authorize registrant todestroy the drug without a DEA representative.

OR

* The dru that needs to be destrQy~d can be forwarded to a state e cy.

OR

* The drugs that needs to be destroyed can be forward~d to a DEA field offic~.

*


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Reference Guide for the Foreign PharmacyLicensing Exam -Theory ({ /"\ . I r \I;:' .\ _,' ')0)(0 ~\~ ~ J ~.f ..v~ ~ -lJ ~Jb cv..J

): ~-Pharmacy Management ~LtPIYVV k..~ l"," ~u.~~ -s nCo Q..j' . ~ pVt'ce, PY-Odu..Cf/~\~a.\ pro~

u.:>Lo* coFunctions o~atios in financi~ analysis: The~e a few important ratios that indicate the

tprofitability, efficiency and overall financial ~tions of a pharmacy. ~ L \ ~ L, l ;;t~ .c/-c;' CV\.('(.ed ~S~- ~ ~'Ratios indicating profitability: - N vv 0: To W ('\\sd:- To-t..J \,;,.1,;~J,/Net profit to net sales (NP:NS)Net profit to net worth (NP:NW)Net profit to total assets (NP:TA)Net profit to inventory (NP:IN)

~\

Net profit to net sales (NP:NS): It can be calculated by dividing net profit by net sales. It isexpressed as a percentage. The normal ratio lies between 3 to 70/,: ) ~ ('oi..o ",t.,) S'I en ~~ ~

,:;~\ \~ d"0clP~~':i b.&(MS.2. Net profit to net worth CNP:NW): It can be calculated by dividing net profit by net worth. It

~ is considered e bes among other ratios for calculating pmfitabili~e ratio lies between 20 to~\ ~ ': '2dI,~25%. A 15% is acceptable for older pharmacies and 40% is JfJm,fJIe for ne~ phannacies. ,\;:,-,\~ ~ ". ~ .....\C "6 pSwtrru:UJ"'-'t,)J: ~ Net sales to inventory: It can be calculated by dividing net sales by net inventory. The ratio

normally ranges from 6 to 9. -t\u. w.cd: vaJJ.JJl. ~cr ~ ra.tw 'N

lCt("o~ ~ ~ \;.obi \~b~ u ~~t~cK"V\.-d ~;W(~!>e.ts>= C,oxY-e.n.t cus~ - Cur'Net sales to networkin~pital: The networking capital tuff{6~eris computed by dividing net sales-------by net working capital. Networking capital assets is current assets minus current liabilities. Th~L J

::.0 ~~ d\..normal ratio range is 4 to 8. Ratios greater th.a'il8are considered ina9%illate capitali~atio~ U" '/e- aoock . overtrading. A value belo~indicates unde ailing or too much ca , italization. .

~;--:!'-Ie, L0..-t;R.:::. t~w o...1Se c;.- toW L0>...b;Ll~ .Net sales to net worth: This is normally calculated by dividing net sales by net worth. Net~orth is normally exp~sse~ by t~tal asseti minu~ to~al ~abilities 2.The ~onnal.ratio rangeISfrom 3 to 8. Greater ~ 8 ISconsidered un er capitalization and 0 ertrading while belo 3indi -d din ~ill cates un ertra g. .


Krisman

3.

4.

5. AccountSeIva~ collection time: It is normally calculated by dividing year end accounts receiv-

,(- able by mean credit sales per day. This ratio is a direct measure of efficient credit management. o};, ~\

Normally, a 0 a collection period is a reasonable target.

6.

AIR = Year end account receivableMean credit l~ per day

. f~(',.s -;/~~.Accounuiayafi1remittance time: This is normally calculated by dividing year end accounts 0..6' btJJpayabledividedbymeancreditp~~eperdaYJ Ro-c~ cJ1_~ a..CCo~ ~ le.~~"rL..Q~k.

- ~ '(t:..~, 'l'" '2\. O~'t--COM.. ~ r-::...~NP = Year end account payable ~

Mean credit urchase per day -

*

* (S9IY@Wueasures a harrn.a~ 's ability to meet c rrent liabiliti~ with moderate change inthe com osition 0 urrent assets

c Ratio indicating liquidity and solvency:1.

2.3.

Acid test ratio :=. ~...c.U.dCurrent ratioInventoryto net working capital (IN:NWC) SW""'- oj Oaoh Sr.a..CCoi.,Lr'\ r-e.cei V'O.(:). 11.

@..2Z., .::'0:-- .j.. -- - v : \ ,\l;t:.io.JM, '1 R':::: ~ tta. J:'-"" wo--\:)r Y" wl''ret bb~ _ 1

Acid test ratio: It is also known as uick ratio. It is normally calculated by dividing the sumof ~ash and accounts receivable by .the current.liabili~Whe normal ra& is l:l:(~ctf~~

'rctt..'o ~ Cl $.v..C.cess~ ~k~ M. \ \ \ ~~ o.Lu.u.JtIM. Poa1~I Y\~ p4c..bjt. [i i i"ClI> 1. e.cc r~:tCurrent ratio: It is calculat by dividing cUf,~asset.s by current liabilities. The ~nimurl! ..>..standard value ist::1. Cu..ffC.,f'I.,;t ,4..~~-!..l!-'> \t\..cL.cle. C,M\.-...i o..Uo~ ~\ J~~' &.

~. r-./ L,~\t;..iA H.~.Hl lr'lve.tov"Cf pT- ~

Inventory to networking capital: It is calculated by dividingrr::e~ninventor{b~'kwc. Mean0invento .s the average of the beginning and ending inventorW~r the accounting period~ratio is an incilrectlD:easureofli uidi and solvency.~ '(\D-C~ -.Jck- d. ~ v-o:t.Q tv. 'lA.o ,..-.Jf c;rcJ t:;: t-. ~ __

...J. Nwc.~ \)Ji\.0J\.~reJ. ?~'" c.,..,('f~ a ~U: .' (i) X :\ ~vc.Jo(u 17) ~o:,J sJ.e - ~~ ~o ~ Q~ ~ ~ '0 ~ \V\.d.:c.cvtu-40lo\",)~~~~~) .':.)&V\C~ ~rsQ.

1.

2.

3.

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1. Tot~ liabilities to net@ This ratio can be calculated by dividing total liabilities by networth. It is expressed as a pe~age. t is the most d.iJ:ectmeasure of the financial p~

7 ? of the pharmacy. A ratio of 50% or owe is acceptable. ~ ~.' .~.}f~\t GL405 ~ :rJc II~

4f 2. Roundeddebt to net working capital: It is normally calculated by dividing long term liabilitiesby networking ca ital. It is also expressed as a ~rcentage. ~ng ~rm liabilitie~ed as liabilities

\;Ll.,b'II;~,/xtendin onger tharibne y~~. The normal acceptable value of a ratio is 20 to 2~./j ~ :{ ~c.:..o.t.J ~ S{4---

3. I&ixedassets to net worth: This is calculated by dividing ~preciated fixed assets byJet worth. Ithelps to identify overinvestment in fixed assets.Ahi v~ indicates overinvestmeiitin fixedassets while a low alue indicates there is a need for remodeling. The target value would be 20%or less. - d? -

(if),.J Demand and Price ElasticityElastic demand: If the relative change in r~~ is gre~?r than the relative change inbe defined as elastic demand.

r,\e. pnc.e :Y\~tL:5 ~DUR: It is the process of quantitatively and systematically reviewing prescription claims Sdata to evaluate the appropriateness of druz therapy.

Prospective DURRetrospective DUR

cC~ - L~ Jscl.....=J) ,1.- ros ective DUR: This type of DUR study is normally don e or at he time of

dlsellsln,"& the c4:ug,e.g. dispensing drugs to a patient at-;;Y retail pharmacy-store,;;v/d.&Vt~u.~L.~Js. ~ - ~D.A C '::>,Ia{ite 'd,du.o..\"\e're.

.. ). r- L Retrospective DUR: This type of DUR study is normally don after dispensing the drug.~ zr- e.g. review of drug utilization for a patient admitted to a hospital for sulfa hy~rsensiti~ity.Q.'2..'-t~ ~\

G;(b

'1.

~'.., 15-4%Q = The relative change in quantity as a percentage = 85 x 100/55 = (~)= (135-100) = 35% - , ~

1"':> ""2. ~I~ ..J...)'..J 0

P = The relative change in rice as a percentage = 2.8 x 100/3 = (93%)= (100-93) = 7~

E = QIP = 35/7 = 5

*

*

* It is normally divided into following subcategories:Q,~ .. f... . ~l (JJ.- ("I': l/-. k3'; ..v t .. .A..D~ tfv.. ~. ~ ~-...:j t4 ~

d.e... .

Advantages of DUR:sp~ ./;;....\J ~..fhi G:-'~

It helps to identify the physician's prescriQ,ing ~nd the patient's dru~ ug!izatio:Q.pattern.

2. ItjJ' ~~~ the dru therWJ1roce.,ss by e~~g previously occurring medica' on regimenproblems.~

*

j~ ISO-:'-. I"'C'", '~'-;:>~,RG(Dia ..~nosis Related Groups)

'-"',f, . ..y ~1\2::..N.....DRG: It is known as diag~~~ ...re ated",groups. It helps c t down healthcare cost. It is a61choice of payment for most third paItYpayers. The reimbur~em~nt under DRG is~ Qi considered prospectiv~eimbursement. cJ" > [. ,-,,!,.J>V ..

~~~ ~\:)Ii\. (

~. Retrospective and Prospective payment systems G. "l '-tS +- '2. L( b + G. '14- f 'G;>.- 0 b Q- ~~ ~ Qd..vtvt\cc ~ SvLvl'ceo tLt ~ vu.t ban pfov,ol~J yRi dL Y"~ bLfY'o.t!ft!.- .;_* r::---. Prospective reimbursement! A form of reimbursement in which a healthcare service /

e: p~ovider is paid in advance e.g. payillg a health-insurance comp~ny fixed amounts everymonth.(~;l(u\ ~p're..\'Y\.i.Wrf\ 0-b\~}\ c-P fr ;';;';-crl').') , .

Gt 19\ ~~~" ~o~ P't) ~ SlN/iu ~ SR/uJice. ~@r~ll\

XIX~ ' Medicaid: It is title 19 of the Social Security Act. or ~ wd ~

H.~J: t::k. oO~~yy\.ud:: lD ~ ~ p ~~~ ?t.'::.* It is funded and administered by the federa and state zovemments and administered by

8governments uE~~r direct su .. n of th fed:::.al government. i'

* # It is a joint federal and state government program that provides healthcare coverage forpoor and medicall indi ent patients.

o/.,.s>D....:L.. (? Ct1'J" --

Medicaid benefits are more comprehensive than medicare benefits.\ \:s ,., - O.1-4~@ .

Medicaid services include: .


Krisman

*

*l.2.3.4.5.

Inpatient and outpatient hos ital servicesLab and X-ra servicesPh_ sician se icesSkilled Nursing Facility services @Home Healthcare services.

Health Blief Model (HBM) -?Q. 0 'n!Nlo r

* It was first pro osed b Rode I tock and later .fied b Becker. According to this model,the authors have hypothesized that people generally do not en age in preventive healthcarepractices o~ articilfatein health detection and screening,.programsunless they view themselves

\ erable d/or hav~certain kinds of health relevant roblems.t ---E\l

* Age* Cost of medication* Disease (psychiatric)*--- Satisfaction with care* Side effects of prescribed medication

~

*Belief in efficacy of treatment* Education* Satisfaction of care* Frequency of administration* Multiple drug therapies* Family size* ,Duration of therapy* npleasant taste of medication* Kn~ledge of the disease

D~

G~ - { -,,,~

AAC (Actual Acquisition Cost): The actual price paid band cash discounts,

q\yJ" * .[" AWP (Average WholesaJ.~ ublished'~ price" of a particular drug product.

c"..-/ AwP~ l5i'.) ,q 0P-' '5""" wo.Jcl OJMAu.J. to 0.. 'te.ivvvb....rsevne.rJ: o-t a.pr("lC;~ 0.. JJ o~ ell) (W)v,pJ '() ~EAC (Estimated Acquisition Cost): The third's estimate 01 the rice paid byharmacles for a particular drug product. ~..-...-


**

Se~ng to deteExperimenting wi

Sick-role behavior: It is defined as an activit undertaken by an individual who onsidersthemselves tt01?e)ill@who have been dia nose !)by a health professional ~s beinj ill..;

~

**

Following medical.adviceTaking medication as prescribed

~Selecti g an appropriate


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* MAC (Maximum Allowable Cost): The maximum amount that will be.paid b t4ird party{t pharmacy for a particular product.

* Capitation: A ros ective form of rei e in which pharmacy receives a specificJt amount of mone~or each patient who is eligible to receive prescrip~regardless of service provided.

*%

Cdinsurance: It is one type of ~o~~~~diiI!l~an~in which patients ay a specified percentageof1all o~s incurred. ~~\ C'.;LV"\\

~ .

* Co a ent: It is one type of cost shari cr Ian' which the patient has t~ pay a f~ ~ _ount each time a service is provide ."1ts~: s.,;1" Ie C.

Reference Guide for the Foreign Pharmacy Krisman.Licensing Exam -Theory . ~ t .1: ~~~-,M yYLo'~ pM.d k (M...$L "",.6 ~tr j '"

0#~ '(e.5.c>wCe ..! ~)c.'..w;Direct cost: It involves a transfer o~. If money is exchanged for the use of a resource, I' ~ J,..w,it is defmedas direct cost-> cP>h ~ ve1.a1J to prol/lolt./fY"o~cQ. S4J\...1I'1C.~aY "..,.t~ b." I C1

~ _, c.,st I s.u.ppL G! ~"f fbr rr-:;'':-, ~Iw..Indir I d,$ ~l I ~~.)bfl.d . id vect cost: toes not m..YQ..Y.e'!lly !ll~ney. tIS unpg; resource comrmtment, e.g. unpmassis1:a!!cefrom a family m~mber.

Fixed cost: It does not ch~ue with increas~ or decreasqin oumut, e.g. an employee's salary, or v-oJ, . tr~)C depreciation of a plant and equipment, ct.JI'Y\ i(\\s~ c;, -:;ts .X -:J..Or~c,..:.o1:c,.. ~ cJVariable cost: It does vary or change with a change in(volumeiof au ut, e.g sales cornrrJrsion andcost of goods sold ,r.1-e'/ WOo es , 'S.uf1-~r.C~r:- Q.sr ~ ~~~ c-wt(l-uk)Average cost: It is the resources consumed per unit of IUtpUt.1t can be calc ated by dividingtotal cost by volume or quantity of o~.tput. . -toW (p~ ./

,....L VJ:.. 'Jt a1~ 1'It!-t~ 1:0 :Utot~ _

-------------_ .._--------- :.....

Reference Guide for the Foreign Pharmacy. KrismanLicensing Exam -Theory _

~'> ~ Q",.st c{ ~ o-b f'u.n;uirut 0.--", t:A...Y\.Cl.~ ~ cA. o..~'r

In the above example, Drus B .s m~o.;.;,re"""b,","e.,.,n~ialto society compared to DrugA.

2 ~ost-effeCti';~~~alYSiS (CEA): This technique is used to make a decision to s~ the .' _~ostc tive intervention from th, availablealternative~ ~t per-- ~ b b,(-I~'~~ C, or

, :. \; J.P..;, JerC- W~\~


Krisman

U)General Health Status Instruments: They normally evaluate health-related informationapplicable to all ages, races, s~xes and sociceconomic background.

J~

* General Health Status Instruments normally concentrate on four ke health conce ts:~~~~~-=~~.1.

2.3.4.

PhysicalfunctionisgSocial ~ functiomngMental healthGeneral health perceptions

* %'~ is the most commonly used General Health Status Instrument.. Disease-Spec!!ic~ealth-Statu~Instruments: They normally focus on the effect of a::::( c.~. particular disease on atients. It requests detailed inform(!tion about effects of a djse~e and (' ..,fur ob PSJ ~~_..w. treatment on atients. ~.~} -1;..1~"t{~--'jQJW\.~ ?'(o\'.).~\ ~ tU t-~~o..b;\;5& ~. \~\o~t.- ~ \(\sVw..'rl'lvt. tf~~~/::;&.

l? " 4-Healthc~re Delivery System f>, kos?\t~ot~ -.:; f.- h~ ~ l4ea_H~ ~ e~~~-

Themajor healthcare activities in the United States are consolidated with the De artment of Heal~and Human Services HHS' .One of the principal components of this department is HealthcareFinancingAdministration CPA. It is charged with the responsibilities of administeringMedicareand Medicaid. ' --

ee,)1:h..1- There are thr~ important characteristics of an HMO; ,. &- ~ ~ b too..:c.lUh\C1u.. (""~ r~ ~s') ~Mo ~ Sit yv\\Y\. ~ pa..ck"" c1. Membership is volun!illJ'. ?'I"'~ ~ ~., "'~ ~ e '. a D ~ ,,",' -'- (s'f.l. 'i" r' :;.x.;....

w r;:--;-------3. /r.;. Each mel)1berhas to p~ ed amount of monthly fees regardless of the service provided.

So:

* An HMO is subdivided into the following categories: G. 6 '-16~

l.

2.3.

Staff Model HMOGroup Model HMOIndependent PracticeAssociation (IPA)

Reference Guide for the Foreign Pharmacy KrismanLicensing Exam -Theory

@ k.,.;. r per"""( ",t H,aliI: p,:.~ ~cJ- u: P 5i&.. ., t "r i'rov;k "vaM.512. \Yt'GrOUPMOdelHMO:@~'~ SeJL\I/Ceb(~:~l'"om ir'\cUV\, p-Ya.~~~tc s.wt-6!tp~u:~t

~ ..;\.;;j CD~~\~)?\vv-..""-A.~~,ce prov,olul . ,-J&.* They co~tract directly with I ewell tablished h sician groups to pr v' s~es to

members for capitation fees or a fee-for -service.( f ~s)*.ros.'fX~~ (f ~3 Q..b4{,n .

3. ~ Independent Practice Association: (T pA ~ fu:~ 0;0 1~ (alJ 67-~Haf;Jno.

- L.::;;-* It is the fastest growin e of HMO. In this type of HMO, an org~tion c15'ntractsindividual

, CD, phy'sicians to provide service on a discounted fee-for-service basis plus pfttfit sJ;;ring. t~~t-~o..K~~~ - oWr\/b...t ~~,~!Ci)~~ P~SI~&ffi2q~@~.~p l~~ ~ ~~ Preferred Provider Or2anizatiori!,d~ p~SI'~ D


Krisman

A Nursing Homes:

* It is defined as a nonhos ital institution which provides ~sin and other health and~ial r~supp-ortiveservices to the chronically ill and the elderly.They are subdivided into three different- ~ ~categories:

1.

2.3.

Extended Care Facilities (ECF)Skilled Nursing Facilities (SNF)Intermediate Care Facilities (ICF)

rI)~~~ (J)VIt/ ~Vft\/

rt1 ~1. ECF (Extended Care Facilities):

* It was used in the earl ears of the Medicare program.

A nursing home has to ~t certain criJeria in order to be certified as an extended care facility.

~. ~* "ff Medicare covers only up to 100 da s ofinostLhospital extended care services.*

*2. SNF (Skilled Nursing Facilities):

* bothIt is a nursing home that ~ts the r~ emen or the conditions fo ~--_./Medicare and Medicaid programs.3. Intermediate Care Facilities (ICF): _ J-


Krisman

3.4.

A.

*l.2.

B.

*l.2.

**C.

*

D.

*l.2.3.4.5.6.7.

G*

OwnershipBed capacity

Type of service:

It is normally divided into two subcategories:

General hospitalospital (Cancer, Psychiatric or Pediatric)- - -

Length of stay:

It is also divided into two different categories:

~term hospitalsLong-term hospitals

ChQtl7term hospitals: The average length of stay is le~ than 3 da s~n term hospitals: The average length of stay is mor.> than 30 da s.

Type of ownership:(D 6)

Hospitals are also classified by the type of ownership and usually gQy~nt or non-government,e.g. Federal, State or County hospitals, individual, partnership OF$-corporations.

eJ/c._('L.. -

Bed capacity:

Hospitals are also classified according to their bed capacity.

Under 50 beds50-99 beds100-199 beds200- 299 beds300-399 beds400-499 beds500 beds and over

Retail Pharmacies:

They are also considered one of the important cO!!!p'onen!s&{ the healthcare delivery system.;However, health related services are primarily limited to dispensing medications and patient C!:J-~~~ ~counseling, e.g. Rite Aid, Giant, and CVS pharmacy.- - -



Krisman

/

* They can be subdivided into three categories:

1. Chain-retail pharmacy services, e.g. CVS and RiteAid pharmacy2. Individuallyowned pharmacies3. Mail order pharmacies

J .

,www.pharmacyexam.com 33


Krisman

* rPhase illtrial: This trial involves hundreds or thousands of atients. The study is oftenconducted at a physician's office or hospitals that have contracted with the manufacturer to

O (32. ,- conduct studies.

iL ~. ~~ ~..cro/~ct ~l!~O~ :- d.u..c ' ()Z~ 'f~L6 06 Ct./~./' ~ r-O'r ~ ~,.../.> r"f'.

~ p~ - ~ ewww.pharmacyexam.com .,;;;;;;;;:~~

;vDA5-New Drug Awroval

* No new drug can be legally marketed in the U.S. without approval by the FDA.

~

. 't4-U:F~ ,Je.-w d~The innovator company must submit an _. otice of Claimed Inve~tigational Exemption for aNew Drug) for approval.After an appro v ofJND from the FDA, the manufacturer may thenconduct clinical studies of its investigational new drug.

The ~uires the man!lfacturer to submit the following information:

*

*1.

2.3.4.

The name of the drug ,/Its composition vMethods of manufacturing and quality control /Information from preclinical investigations regarding pharmacological, pharmacokinetic, andtoxicological evaluation.

* The FDA may answer within 30 d s from the date the IND is filled. If the FDA approvesthe JND, the innovator company may start human clinical testing of the new drug.

* The testing proceeds through three different phases:1.

2.3.

Phase I clinical trialPhase ITclinical trialPhase III clinical trial

*S-t-

Phas !trial: The purpose of phase I clinical trial is to detec the adverse ete.cts of the new "-drug. ) ~~ ~~ c..,...cLk ~ (!.M~ tri~ ~ -1k ~ lM- ~A> ( W 10';..11 ,tw

This phase involves a small number of subjects for study of the drug's tog city, bioavailabi}ity,metabolism, elimination and pharmacolo .cal action of the drug.' -

*

* Initially, a number of subjects receive .' ....-.,~,-once safety of the new drug is assured.

* Phase IT trial: The new drug is now tested on a!imited numger of atients who actually sufferfrom the disease for which the new drug is claimed for.

G) Phase ITclinical trial helps to de rmine the efficacy of the drug and dosa e at which efficacy mayoccur.

*

sq


Krisman

ADouble Blind Study is normally conducted in this phase. It is a type of study in which thenature of the drug is concealed from patients as well as attending physicians. In this type ofstudy, one group of patients receive the testing drug and the other group of patients receivethe placebo; the result of both groups is then compared to find out the true effectiveness of-=- -the drug. ev>d (eI""\ eJ.

~ 1'J.,1-.~., o--n* 4- If the phase ill studies are favorable, the drug sponsor's may submit anND 'to the FDA.* AnQcontains a complete report including the drug's ~ety and e ~acy which has been noted

on an IND.

*

* By law the FDA has 180 days to review anNDAand to answer~e.~pp.n.M>r'scompan . ik----------'>~cJ ~) ~ ~ ~

Phase IV trial: It is also known as ostmarketin surveillance. t.O ~ hjtI...t., LA.Once the new~g~pplication has been a roved, the innovator company may legally distributethe drug in interstate commerce.

*

*

* Manufacturers must maintain and keep adequate postmarket:iJ:.!greport and records._I ...-_

* Manufacturers must submit any new information regarding a drug's safety and effi~y or any-= -serious drug interactions to the FDA.

* The importance of postmarketing surveillance:

1. To com~a drug's safety and e ectiveness in a vast range or group of patients.. --~~~--~2.

5.- -To find out the Ion -term as ects of to~~ty and adverse effects of the ~g.--

www.pharmacyexam.com 35/'


Primary literatureSecondary literature ~ -t - ci. ~\_ 0.. ,..l,'_ a

. . tU- ~~ slip ~ .\) CL ~'i]Tertiary literature ~~ g.,~ , e.J:Al ~ J.~ C'Jk.~~"-'\'~< '2.t.;o

(i) CV\ ko/! do\ifruJz ~~%8:::c..X1~i ~~.j.t ~ ex~" - .\rPrimary literature: Articles appearing in pharmaceutical and medical journals have the most~

0. L ... current and ac~te health related information. They are classified as primary literature .. 5c ---'> w o rie - i \~t- f' .__A- Cu.r s: '~ L 6

Li'\A.. ---u' 0< "~ (t.II.,\. \ ~'(', -c:..~L,-o

~-Clinical Drug Literature

* It is defined as an extensive, heterogenous collection of resources which provide information aboutdrugs.

Drug information sources can be classified into three important categories:

*

1. The most current and accurate health related .

* Disadvantages:

1. Indexin..g(qiblio~c)2. Abstracting

* \~. Th th .. /~\ fli ~lib -"X' ey represent e ~ost ex nsive mvestment 0 terant rary.

* Several considerations should be applied before selecting secondary sources:.: ~."..AJ .Y'.>'J .Lagtime~tk ~v.J W. pw6~c~? ~ cJ:At ~~ ~~Coverage of literature .Selectivity of indexing and abstractingCo~ .X , 0

~-raJ. Q..w\ oAt.tk V-> ~Jf'\;,)~ ~~~ ~o-r ~rj -. 'oW:J.h'La2 time: It is defined as time elapsed between documents published in journals versus when itwas abstracted or indexed. The article with a prolonged la time may ac pdated or current

~ ------ - ~info~tion. *


Krisman

*

*

*1. More current and u~ information com ared to terti~ literature.

* Disadvantages:


~tkS~i~~bCU~o.\CCD.Yera2.eof literature eJectivi ofindexin and abstractin : One should pay close-- ~ -----.... ........-..attention when selecting secondary literature from journals, e.g. pharmac.r~ted io~alsare less likely to provide article information on cardiac or neurosurgery.~ ~ =~ The dru . formation is availabldi!! different sources. e.g. s..tJ,\l15


0._ '2 SI. !(Adverse effects -e b.-" (~p~~ 3.

~ &wt-LLl-e(.4.

1. "TextbookofADR (o..O..~ ~ ~'J 5.(. f" f'\e.~.la/~ Sid effectsofdrugs G>~eO-~.(fDIS) 6.

. ~ In..d.vc Jl.L..aJ..'~.

\livestigational drugs Hc

. . .Th . APipeline @ li )lj.tid elr11. t

.' 2 I I 'rug Facts and Comparisons;s. I }(.I Y(I\.~I.tttgdc~ ~ ~ Matriandale: The Extra Pharmocopoeiav o..voJo.\:!t. ~ u..sf\l~ ~~v


[ PRECLINICAL SCIENCES1

po


Krisman

7-Organic/General Chemistry

* Organic chemistry is the chemistry of the compound carbon.

Atomic orbitals: The region in space where an electron is likely to be found is called anorbital. There are different kinds of orbitals. They have different sizes, shapes and electronoccupancies.

* The orbital at the lowest energy level is known as 'Is orbital. It is a s~ with its centerat the atomic nucelous and therefore has less tlectron density and morelst~ility.

The next higher energy level orbital is@'. It is larger than the "Is" orbital. Followingthese there are ~ orbitals of equal energy calle 2p 'orbitals. They are dumbbell-shaped.They are known as "2px", "2py" and "2pz".

*

Electron configuration (Pauli exclusion principal):

* According to Pauli, only two electrons can occupy any atomic orbital, and they must haveopposite spins.

Hybrid orbitals Bond angle Shape Example

SP hybridization 180 linear BeCl2

SP2 hybridization 120 Trigonial BF3

SP3 hybridization 109.5 Tetrahedral CH4

Polarity of bonds:

* Normally, two nuclei share the electrons in covalent bonds, however many times theelectron cloud is denser at one atom than the other, depending on the electron withdrawalpower of the atom. This will make o~the bondJ.elati~ neg~tive and the otherend relatively positive; such a bond is said to be polar and possess polarity.

EB eExample: H -- F

* We can expect cov ent bonds to possess polarit when joined atoms have differenttendencies to attract electron. Below is the list of electronegative elements; fluorine (F)posseses the highest electronegativity. -

F> 0 > CI, N > Br > C, H



. Krisman

Polarity of molecules:

*.~ -ve..

A molecule is co~~ered to be~if the center of ne ative char e does not coincide withthe ce~ of positive charge. Molecules like H2' N2, O2, Cl2 and Br2have zero dipo~movement and are considered to be nonpolarJ

* CH3CI has the dipole movement of 1.86 D, whereas CCl4 has the dipole movement~.Both molecules have a similar tetrahedral structure, however, in carbon tetrachloride

~_ t _

(CCI4) dipole movement is exactly opposite to one another,

CItl/C",,-H

H H

Carbon tetrachloride8=OD

Methy!Chloride8 = 1.86 D

Isomer: : tifferent comp _undsthat represent the~ molecular formula but possess differentmolecule structure, an p ysical and


Krisman

* Stereoisomers can be further divided into two different categories:

1.2.

EnantiomersDiastereomers

1. Enantiomers: Stereoisomers that are mirror ima_gesof each other are defined asenantiomers.

2. Diastereoisomers: Stereoisomers that are not mirror ima~es of each other are defined asdiastereomers.

* Chiral: Molecules that are not su osable on their mirror images are defined as chiral.

* Configuration: The arrangement of atoms that characterize a particular stereoisomer is calledits configuration.

Geometric isomer: The particular kind of diastereomers that owe their existence tohindered rotation about double bonds are called geometric isomers. They are normallyprefixed by "cis" (on the same side) and "trans" (across).

H rc0---C~IIC

H~~

H~~C

II(-------xC~ ~H

Cis 2-ButeneCis = same side

Trans 2-ButeneTrans = across

* There is an interesting characteristic about the above two model.@iSomerof2-Butene is '(less stable)than the trans isomer of 2-Butene. The reason behind this is that methyl groupsare well separated in trans isomer, however they are closel enoug,h i cis position to causecrowding and instability.

***

Confi urational isomers: They are interconverted by inversion' at the chiral enter.CQ!L..- ational isomers: They are interconverted by rotation about single bonds.Geometric isomers: They are interconverted by rotation about double bonds..-IUPAC Rules:

-1. Select the parent structure as th onges continuous chain. In numbering the parent carbonchain, start at whichever end results in the use of the lowest number.


"f"pl''Pnce Guide for the Foreign Pharmacy-":r1lI!iing Exam -Theory

Krisman

_-CH3"CHi" CHi" CH- CH3ICH3

correct name = 2 methylpentanewrong name = 4 methylpentane

If the same alkayl group occurs more than once as a side chain, indicate this by the prefixdi, tri tetra etc.

CH3I

CT-T-CH-CH-C-CH~"'3 I 2 I 3

CH3

CH3

e.g.

2,2,4-trimethylpentane

If there are several different alkayl groups attached to the parent chain, name them inalphahe ical order.

e.g.

H CH3 H

5 I '-I I 3 I'LCH- C- C- C- CH

3 I I I 3CH H CH

/ \ 25

C~ ca,

2-ethyl-4-isopropyl-3-methylpentane

4. If there is a presence of a double bond in the parent chain, designate its position by thenumber of the first doubly bonded carbon encountered when numbering from theend of chain nearest the double bonds.

e.g. CH- CH-CH=CH322

correct name = l-buteneincorrect name = 4-butene

A. Different types of bondine:

1. Ion-ion bonds2. Dipole-dipole bonds3. Van der walls forces4. Ion-dipole bonds



1. Ion-ion bonds: It is described as the attraction between the opposite charges on a ~andan an

2. Dipole-dipole bonds: It is described as the attraction between positive end of one.'pol amolecule and the negative end of anothe olar olecule. In hydrogen chloride, the r~afivelypositive hydrogen of one molecule is attracted to the relatively negative chloride of another.

*

c -=:>c- +::>The most powerful of these dipole-dipole bonds is the hydrogen bond. In this type of bond,

. ---- .a hydrogen atom serves as a ridge between two electronegative atoms (F, N, 0), holdingone y a covalent bond and the other by electrostatic attraction.

,.-- Hydrogen bond (covalent bond)I

example: H-- F--------H- F


Krisman

I

BrClR isomer S isomer

I> Br >Cl > H

*r- .!.

Y9< Try to arrange other ligands in order of highest priority to least riority in a clo_ck sdirection; this type of configuration is known as 'configuration. When we arrangecounte clockwise, it would be known as'S' configuration.

* For above example, 'H' atom has the lowest atomic number and therefore has the lowestpriority; so we should move away hydrogen atom from us. Now, we need to arrange ligandof the highest priority to the least priority in clockwise direction, this will give us 'R'configuration. When the same ligands have arranged in counterclockwise, it will give us'S' configuration.

C Sequence rule for Rand S configurations:

1. If the four atoms attached to the chiral center are all different, r>riori depends on theGrtornic number the atom with the highef\ilUmber getting higher priority. If two atoms areisotopes of the same element, the atom of higher mass number has the higher priority.

T~ Chiral centerH- C -SOHI 3

I

Chloroiodoethanoic acid

* In Chloroiodoethanoic acid, the sequence is I, Cl, S, H.--- -2. If the relative priority of two groups cannot be determined by rule 1, one should compare

the next atom in the group.

HI

Cl-ICH -C-CH~~ 2 I 3

Cl

Sec-butylchloride

www.phannacyexam.com 45 r


Krisman

* In sec-butylchloride, two atoms are attached to the chiral center are themselves carbon,however in methyl (CH3) groups the second atoms are H, H, H. In ethyl groups (C2Hs)' theyare C, H, H. Since c~n has a higheriatornic number compared'to hy~en, C2HShas thehigher priority over CH

3 The sequence should be Cl, C2Hs' CH3, H.

3. When there is a double or triple bond, both atoms are considered to be dupli~ted ortriplicated. Therefore; H H

I I IC = A equals - C - A -CH = CH2 C- C-C

I I I IA C C H

C =A equals A CI IC-AI IA C

* tFOrexample, in glyceraldehyde the OH group has the highest priority of all sincehas the highestatmoic number among all. ~

HIC=OI

H-C-OHIC~OH

HI

where C = equalsHIC-OI Io C

* Now, between CHO and CH20H; 0, 0, H of -CHO takes priority over 0, H, H of -CH20H.The sequence should be OH,~, CH

20H, H

* For example, in l-amino-2methyl-l-phenylpropane, the C, C, C of phenyl takes priorityover the C, C, H of isopropyl, but not over N, which has a higher atomic number. Thesequence should be NH2, C6Hs' C3H7 and H---

H

@- f - CH (CH3)2NH2

l-amino-z-methyl-I phenylpropane

D eso compound: It is one whose molecules are superimposable on their mirror images# .:. ------

e '-::> ugh they contain chiral centers. It can be easily identified by the fact that one halfof - olecule is the mi 0 .mage of the other half. Meso compound is optically inactive.

www.ptbalrm~l!X.lnn.com 46


Krisman

C~

H CI

H CI

CH3

~compound

E SNI and SN2 Reaction Summary: SNI and SN2 reactions are characteristics 06.They play an important role in organic chemistry.* SN1 h . db ;-,~.:;\ Nl),j)~breactlO~ are c aractenze y: r t: -' -'

1. First order kinetic2. Rac zation3. Rearrangement4. ~ The reactivity sequence is

Example: ---"7) R OCOCF3 + H-W

* The react" . e of a compound:

CH3 CH3 HI I I

CH-C-W>CH-C-W>CH-C-W>3 I 3 I 3 I

CH3 H HTert-butyl Isopropyl Ethyl~ carbon) (2 carbon) (1 carbon)..,

HI

H-C-WIHMethyl

* 3 carbon = When central carbon is attached with three other carbons.* 2 carbon = When central carbon is attached with two other carbons.

SN2 reactions are characterized by:1. Second order kinetic2. Complete stereo6hemical inversion

IX3. Absence of rearranzement- --4. ~ The reactivity sequence is CH3W >

*

Example:~-->~R- CI + BrR-Br + Cl

www.pharmacyexam.com. 47


* The reactivity sequence of a compound in SN2:

H H CH3

CH3

I I I IH-C-W >CH-C-W> CH-C-W >CH-C-WI 3 I 3 I 3 I

H H H CH3

Methyl Ethyl(10 carbon)

Tertbutyl(3 carbon)

Isopropyl(2 carbon)

F -Cis and Trans Isomers (Z and E configuration) : The particular~.! diastereomersthat owe their existence to hindered rotation about double bond are called geometric- - ----- ----------------isomers ....-.

* ?fThe an ement of atoms that characterize a particular stereoisomer is called its- confi uration.

1. In Cis 2-Butene, methyl groups are on the same side of the molecule, whereas in Trans 2-Butene, methyl groups are on opposite sides of a molecule.

Cis 2-ButeneCis = same side

Trans 2-ButeneTrans = across

(Examples of cis and trans 2-Butene)

Z and E isomers: The specification of Z and E isomers can be explained as follows:

*~ /J"o...

In order to specify, we need to find out the group of higher riority (higher\atomic number)on the one carbon atom and the group of higher priority on the other carbon atom.

*

www.phmmacyexam.com 48

Gi .~So(Ortho_para directo!U->j ~A~ (* I - OCo R

BrCIOHCH~R

~3

F:!iHCOC~


Krisman

CH3 H~/CIIC.r >:

Br CI

CH3 H~/CIIC

/'"CI Br

I-bromo-I chloropropene}

I-bromo-lchloropropene

CH3 > HBr > Cl therefore

Gisomer

CH3 > HCI < Br thereforeE~somer

G Effects of substituent groups: Sulfonation of toluene generally yields ortho and paratoluene sulfonic acid. Meta isomers of this compounds are very difficult to obtain. This canbe explained by the effects of substituents.

* The substituent groups that offer ortho and para isomers of the parent compound arecalled ortho-para directors.

ott, C..,t"\1, - NHCocHg-.-******

~Sulfonation of Toluene: f

@ CH3 CH3IS03H @~jtl) +~

S03H. 3

Toluene Para Toluene Ortho Toluene( Sulfonic acid Sulfonic acid

* This will explain why the sulfonation of toluene yields ortho and para isomers; since themethyl group present in the ring is a ortho-para director.



Krisman

* The substituent groups that offer meta isomers are know as meta-director.

* ***

-S03H:JsoH-CN-COOHCc. R - Co 0 R

eta-directors

**

Nitration of benzaldehyde:

CHOI

Nitration >CHO

~NO2

Benzaldehyde M-Nitrobenzaldehyde

* In the above example, nitration of benzaldehyde will yield meta nitro benzaldehyde becausethe CHO group present in the ring is a meta director.


Documents

Manshrof Theory Part 1