General Pharmaceutical Council Registration Assessment (GPhC Assessment) Clinical Therapeutics and Disease Management Syllabus

Clinical Therapeutics and Disease Management syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Clinical Therapeutics and Disease Management in General Pharmaceutical Council Registration Assessment (GPhC Assessment), not a summary of it.

1. 1

   Cardiovascular System

   5 topics

   • Hypertension
     • ACE inhibitors, ARBs, calcium-channel blockers and diuretics
     • NICE/BHS step-wise treatment algorithm
   • Heart Failure
     • Guideline-directed medical therapy
     • Monitoring and titration
   • Ischaemic Heart Disease and Acute Coronary Syndrome
     • Antiplatelets and dual antiplatelet therapy
     • Secondary prevention
   • Anticoagulation and Atrial Fibrillation
     • Warfarin and INR monitoring
     • DOACs and CHA2DS2-VASc/ORBIT scoring
   • Lipid Modification
     • Statin intensity and QRISK
     • Adjuncts and intolerance management
2. 2

   Respiratory, Endocrine and Metabolic

   4 topics

   • Asthma
     • BTS/SIGN/NICE stepwise management
     • Inhaler technique and devices
   • COPD
     • Bronchodilator and ICS use
     • Exacerbation management
   • Diabetes Mellitus
     • Type 1 and Type 2 treatment pathways
     • Insulin regimens and hypoglycaemia
     • Sick-day rules and SGLT2 inhibitor cautions
   • Thyroid Disorders
     • Levothyroxine dosing and monitoring
     • Antithyroid drugs
3. 3

   Gastrointestinal, Renal and Genitourinary

   5 topics

   • Dyspepsia, GORD and Peptic Ulcer Disease
     • PPIs, H2 antagonists and H. pylori eradication
   • Inflammatory Bowel Disease and IBS
     • Aminosalicylates and biologics overview
   • Constipation and Diarrhoea
     • Laxative classes and selection
   • Chronic Kidney Disease
     • Drug handling and dose adjustment
     • Nephrotoxin avoidance
   • Urinary Tract Infections and Continence
     • Antibiotic selection and resistance
4. 4

   Central Nervous System and Mental Health

   5 topics

   • Depression and Anxiety
     • SSRIs, SNRIs and serotonin syndrome
     • Switching and withdrawal
   • Psychosis and Bipolar Disorder
     • Antipsychotics and monitoring
     • Lithium therapeutic range and toxicity
   • Epilepsy
     • Anti-epileptic drug selection
     • Pregnancy risks (valproate) and brand consistency
   • Pain and Palliative Care
     • WHO analgesic ladder
     • Opioid conversion and breakthrough dosing
   • Parkinson's Disease and Dementia
     • Levodopa and timing of doses
5. 5

   Infection, Immunology and Malignancy

   4 topics

   • Antimicrobial Therapy
     • Antibiotic classes and spectrum
     • Antimicrobial stewardship and resistance
   • Specific Infections
     • Sepsis recognition and Sepsis Six
     • Tuberculosis and HIV overview
   • Vaccination and Immunisation
     • UK immunisation schedule
     • Patient Group Directions for vaccines
   • Oncology and Supportive Care
     • Cytotoxic handling and extravasation
     • Managing nausea and neutropenia

Clinical Therapeutics and Disease Management flashcards for General Pharmaceutical Council Registration Assessment (GPhC Assessment)

19 of 61 cards from the Clinical Therapeutics and Disease Management deck — real questions with worked answers.

1. According to NICE, what blood pressure reading (clinic) defines Stage 1 hypertension, and what threshold confirms it on ambulatory/home monitoring (ABPM/HBPM)?

   Stage 1 hypertension is a clinic BP of $\geq 140/90$ mmHg, confirmed by an ABPM/HBPM average of $\geq 135/85$ mmHg.

2. In the NICE hypertension treatment algorithm, what is first-line therapy for a patient aged under 55 with no type 2 diabetes, versus a patient who is over 55 or of Black African/Caribbean origin?

   Under 55 without type 2 diabetes (or any patient with type 2 diabetes): an ACE inhibitor or ARB. Over 55 or Black African/Caribbean (without diabetes): a calcium channel blocker (CCB).

3. What is the recommended clinic blood pressure treatment target for a hypertensive patient aged under 80, and for a patient aged 80 or over?

   Under 80: clinic BP target $<140/90$ mmHg. Aged $\geq 80$: clinic BP target $<150/90$ mmHg.

4. In step 4 (resistant) hypertension, how does NICE guide the choice of add-on therapy based on serum potassium?

   If potassium is $\leq 4.5$ mmol/L, add low-dose spironolactone (off-label). If potassium is $>4.5$ mmol/L, add an alpha- or beta-blocker instead (higher hyperkalaemia risk with spironolactone).

5. What are the four pharmacological pillars of guideline-directed therapy for heart failure with reduced ejection fraction (HFrEF)?

   ACE inhibitor (or ARB)/ARNI, beta-blocker, mineralocorticoid receptor antagonist (spironolactone/eplerenone), and an SGLT2 inhibitor (dapagliflozin/empagliflozin).

6. Which three beta-blockers are licensed for the treatment of heart failure in the UK?

   Bisoprolol, carvedilol, and nebivolol (nebivolol licensed in stable mild-to-moderate HF in patients $\geq 70$ years).

7. What is sacubitril/valsartan (an ARNI), and what important washout is required when switching from an ACE inhibitor?

   It combines a neprilysin inhibitor (sacubitril) with an ARB (valsartan), used in HFrEF. A 36-hour washout is needed between stopping an ACE inhibitor and starting it, to avoid angioedema.

8. In acute coronary syndrome, how is STEMI distinguished from NSTEMI/unstable angina on initial assessment?

   STEMI shows persistent ST-elevation (or new LBBB) on ECG, requiring immediate reperfusion. NSTEMI shows raised troponin without ST-elevation; unstable angina has ischaemic symptoms with normal troponin.

9. What is the standard secondary-prevention drug regimen after a myocardial infarction (the 'cardioprotective' combination)?

   Dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor such as ticagrelor/clopidogrel/prasugrel), a beta-blocker, an ACE inhibitor, and a high-intensity statin (atorvastatin 80 mg).

10. What is the standard immediate ('MONA'-type) management for a patient presenting with a STEMI awaiting reperfusion?

    Aspirin 300 mg loading dose, a second antiplatelet (e.g. ticagrelor/prasugrel), pain relief with GTN and IV morphine, anti-emetic, and oxygen only if $\text{SpO}_2 < 94\%$. Primary PCI is the preferred reperfusion.

11. For most patients with non-valvular atrial fibrillation, which class of anticoagulant does NICE now recommend first-line over warfarin?

    A direct oral anticoagulant (DOAC) such as apixaban, rivaroxaban, edoxaban, or dabigatran is recommended first-line in preference to warfarin.

12. State the components of the CHA₂DS₂-VASc score used to assess stroke risk in atrial fibrillation.

    Congestive HF (1), Hypertension (1), Age $\geq 75$ (2), Diabetes (1), prior Stroke/TIA/thromboembolism (2), Vascular disease (1), Age 65–74 (1), Sex category female (1).

13. What does the ORBIT (or HAS-BLED) score assess in atrial fibrillation management, and what is its purpose?

    It estimates bleeding risk on anticoagulation. Its purpose is to identify and correct modifiable bleeding risk factors, NOT to withhold anticoagulation.

14. What is the target INR range for most patients on warfarin (e.g. AF, DVT/PE treatment), and which clotting factors does warfarin inhibit?

    Target INR is typically $2.5$ (range $2.0$–$3.0$). Warfarin inhibits vitamin K–dependent clotting factors II, VII, IX and X (and proteins C and S).

15. In primary prevention of cardiovascular disease, at what QRISK3 10-year risk threshold does NICE recommend offering a statin, and which statin/dose?

    Offer atorvastatin 20 mg when the QRISK3 10-year CVD risk is $\geq 10\%$.

16. What is the NICE target reduction in non-HDL cholesterol after starting a statin for primary prevention, assessed at 3 months?

    A greater than $40\%$ reduction in non-HDL cholesterol from baseline.

17. What statin and dose is used for secondary prevention of CVD, and what non-statin add-on options exist if targets are not met?

    Atorvastatin 80 mg for secondary prevention. Add-ons include ezetimibe, then PCSK9 inhibitors (alirocumab/evolocumab), bempedoic acid, or inclisiran.

18. In the SIGN/BTS-NICE asthma pathway, what defines good control assessed by inhaler step-up, and what is the modern preferred reliever approach (MART)?

    MART (Maintenance And Reliever Therapy) uses a single combination inhaler of an inhaled corticosteroid plus formoterol for both daily maintenance and as-needed relief, replacing a separate SABA reliever.

19. List the features used to assess severity of an acute asthma attack distinguishing 'acute severe' from 'life-threatening'.

    Acute severe: PEF 33–50% best/predicted, RR $\geq 25$, HR $\geq 110$, unable to complete sentences. Life-threatening: PEF $<33\%$, $\text{SpO}_2 <92\%$, silent chest, cyanosis, exhaustion, hypotension, normal/rising $\text{PaCO}_2$.

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