71.2 📚 國考版醫垫國考 / PGY OSCE

71.2.0.1 📌 Cram Sheet

71.2.0.1.1 🔥 高 yield 12
  1. PK = ADME
  2. F = AUC PO / AUC IVIV F = 100%
  3. Vdlipophilic 倧、hydrophilic 小
  4. tÂœ = 0.693 × Vd / Cl
  5. 5 半衰期 達 steady state
  6. CYP3A4 涉 50% 藥 + grapefruit
  7. Codeine → morphine 靠 CYP2D6
  8. Warfarin = CYP2C9 (sulfa, metronidazole, fluconazole 升 INR)
  9. Clopidogrel = CYP2C19 (omeprazole 降效)
  10. TDM 6 藥: vanco, aminoglycoside, Li, digoxin, phenytoin, theophylline
  11. Beers Criteria = 老人避甚藥
  12. Cockcroft-Gault 䌰 CrCl
71.2.0.1.2 🔢 必背 TDM 範圍
Drug Range
Vancomycin trough 15-20 (severe)
Aminoglycoside trough < 1
Lithium 0.6-1.2 mEq/L
Digoxin 0.5-2 ng/mL (老人 0.8-2)
Phenytoin 10-20 ÎŒg/mL
Theophylline 8-12 ÎŒg/mL
Cyclosporine depends on indication
Tacrolimus 5-15 ng/mL
71.2.0.1.3 CYP450 速蚘
  • 3A4: 50% drug, grapefruit, statin, CCB
  • 2D6: codeine, tamoxifen, antidepressant
  • 2C9: warfarin
  • 2C19: clopidogrel, omeprazole
  • 1A2: theophylline, caffeine

71.2.0.2 ⭐ 高 yield

71.2.0.2.1 Bioavailability Variants
  • IV: F = 100%
  • Sublingual: bypass first-pass (nitroglycerin)
  • Rectal: partial bypass first-pass
  • Oral: full first-pass
71.2.0.2.2 Order Kinetics
  • Zero-order: constant amount cleared per timealcohol, phenytoin (high dose), aspirin (high dose)
  • First-order: constant fraction cleared per time倚敞藥物
71.2.0.2.3 Loading Dose vs Maintenance
  • Loading = Vd × target Css / F達 quick steady state
  • Maintenance = Cl × target Css / F
71.2.0.2.4 Drug Disposition Special
  • Hepatic high extraction (flow-limited): lidocaine, propranolol, morphine (與 hepatic blood flow 盾關)
  • Hepatic low extraction (capacity-limited): warfarin, phenytoin (與酶掻性盞關)
  • Severe liver dysfunction → low extraction drugs 圱響倧
71.2.0.2.5 Beers Criteria 範䟋
  • BZDfall risk
  • Anticholinergic (diphenhydramine, oxybutynin, TCA)
  • Long-acting sulfonylurea (glyburide)
  • Muscle relaxant
  • Long-acting NSAID (avoid > 2 week)
71.2.0.2.6 Pregnancy Categories (PLLR 2015)
  • 改為 narrative summary
  • 8.1 Pregnancy + 8.2 Lactation + 8.3 Females and Males of Reproductive Potential
71.2.0.2.7 CYP3A4 Inducers (CRAP GPS)
  • Carbamazepine, Rifampin, Alcohol chronic, Phenytoin/Phenobarbital, Griseofulvin, Protease inhibitor, St. John’s wort
71.2.0.2.8 CYP3A4 Inhibitors (GRACE GIM)
  • Grapefruit, Ritonavir, Azole, Cimetidine, Erythromycin/clarithromycin, Gestagen, Isoniazid, Metronidazole

71.2.0.3 🎯 自我檢枬

  1. F definition? → AUC PO / AUC IV
  2. Vd lipophilic vs hydrophilic? → Lipo 倧, hydro 小
  3. tÂœ formula? → 0.693 × Vd / Cl
  4. 5 half-lives? → Steady state (~97%)
  5. Zero-order kinetics 3 drugs? → Alcohol, phenytoin (high), aspirin (high)
  6. Codeine activation? → CYP2D6
  7. Warfarin CYP? → 2C9
  8. Clopidogrel CYP? → 2C19
  9. CYP3A4 inducer 6? → Carbamazepine, rifampin, phenytoin, phenobarbital, St. John’s, alcohol chronic
  10. CYP3A4 inhibitor 6? → Grapefruit, azole, macrolide, ritonavir, cimetidine, metronidazole
  11. Vancomycin trough? → 15-20 severe
  12. Beers Criteria avoid in elderly? → Long BZD, anticholinergic, glyburide, long NSAID

⚠ AI 草皿。