General Pharmaceutical Council Registration Assessment (GPhC Assessment) Patient Care, Consultation and Public Health Syllabus

What is meant by 'signposting' versus 'referral' when a patient's needs cannot be met in the pharmacy?

Signposting directs a patient to another service or information source without a formal handover (e.g. to a website, helpline, or self-care). Referral is a formal recommendation/handover to another healthcare professional or service for assessment and management.

What is the structure of the '5 A's' framework for smoking cessation brief intervention?

Ask (about tobacco use), Advise (to quit), Assess (willingness to quit), Assist (with a quit plan/treatment), and Arrange (follow-up).

What is the 'Very Brief Advice' (VBA) model for smoking, and what are its three elements?

A 30-second evidence-based intervention: ASK and record smoking status; ADVISE on the best way to stop (with support and medication); ACT by offering referral to a stop-smoking service and/or pharmacotherapy.

Compare the mechanisms of nicotine replacement therapy (NRT), varenicline, and bupropion in smoking cessation.

NRT supplies nicotine without tobacco toxins to reduce withdrawal/cravings; varenicline is a partial agonist at alpha-4 beta-2 nicotinic receptors (reduces cravings and blocks reward); bupropion is a noradrenaline/dopamine reuptake inhibitor that reduces cravings.

Why is combination NRT (e.g. a patch plus a faster-acting form) often recommended over a single product?

A long-acting patch provides steady baseline nicotine to control background cravings, while a fast-acting form (gum, lozenge, inhalator, spray) handles acute breakthrough cravings; the combination is more effective than a single product.

For emergency hormonal contraception, compare the time windows and mechanisms of levonorgestrel (LNG) and ulipristal acetate (UPA).

Levonorgestrel 1.5 mg is licensed up to 72 hours after unprotected sex and works mainly by delaying/inhibiting ovulation. Ulipristal acetate 30 mg is effective up to 120 hours; as a selective progesterone receptor modulator it can delay ovulation even after the LH surge has begun, making it more effective closer to ovulation.

What is the most effective form of emergency contraception, and within what timeframe must it be fitted?

The copper intrauterine device (Cu-IUD), which can be fitted up to 120 hours after unprotected intercourse (or up to 5 days after the earliest estimated ovulation); it is over 99% effective and also provides ongoing contraception.

What interaction limits the use of ulipristal acetate with regular hormonal contraception, and how is it managed?

Ulipristal (a progesterone receptor modulator) can reduce the efficacy of progestogen-containing contraception, and progestogens reduce UPA's effect. Hormonal contraception should be started/restarted only 5 days after taking UPA, with condoms used in the interim.

Using the UK Medical Eligibility Criteria (UKMEC), what UKMEC category means a contraceptive method's risks generally outweigh the benefits (use not usually recommended)?

UKMEC Category 3. (Category 1 = no restriction; 2 = benefits generally outweigh risks; 3 = risks usually outweigh benefits; 4 = unacceptable health risk, method must not be used.)

Why is the combined oral contraceptive pill (containing oestrogen) contraindicated in women with a history of venous thromboembolism or migraine with aura?

Oestrogen increases the risk of VTE and arterial thrombosis/ischaemic stroke. In women with prior VTE or migraine with aura (UKMEC 4), this risk is unacceptable, so progestogen-only or non-hormonal methods are preferred.

In sexual health, what does 'window period' mean for an HIV test?

The time between exposure to HIV and when a test can reliably detect infection. Modern 4th-generation antigen/antibody lab tests are reliable from about 45 days; results before the window closes may be falsely negative and need repeat testing.

What harm-reduction service do community pharmacies provide for people who inject drugs, and what is its purpose?

Needle and syringe programmes (NSP), which provide sterile injecting equipment and safe disposal to reduce transmission of blood-borne viruses (HIV, hepatitis B and C) and other injecting-related harm.

In opioid substitution therapy, compare methadone and buprenorphine in terms of receptor activity and overdose risk.

Methadone is a full mu-opioid receptor agonist with no ceiling on respiratory depression (higher overdose risk). Buprenorphine is a partial mu agonist with a ceiling effect on respiratory depression (safer in overdose) and high receptor affinity, which can precipitate withdrawal if given too soon after other opioids.

What is naloxone, and why is 'take-home naloxone' supplied to people at risk of opioid overdose?

Naloxone is a competitive mu-opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression. Take-home naloxone allows bystanders to treat an overdose while waiting for emergency services, reducing opioid-related deaths.

What lifestyle/screening service do pharmacies offer for cardiovascular risk, and what core measurements does an NHS Health Check include?

Pharmacies offer blood pressure checks and NHS Health Checks (for those aged 40-74). A Health Check assesses BMI, blood pressure, cholesterol, blood glucose/diabetes risk, smoking and alcohol use, physical activity and family history to estimate cardiovascular risk.

What are the UK 'low-risk' alcohol guidelines for adults?

Both men and women should drink no more than 14 units per week on a regular basis, spread over three or more days, with several drink-free days, and avoid 'saving up' units for a single session.

What is the standard advice on folic acid supplementation before and during early pregnancy, and the higher-risk dose?

400 micrograms daily before conception and until 12 weeks of pregnancy to reduce neural tube defects. A higher dose of 5 mg daily is recommended for higher-risk women (e.g. diabetes, BMI >30, on antiepileptics, previous NTD-affected pregnancy, sickle cell).

Why is sodium valproate contraindicated in pregnancy, and what programme governs its use in women of childbearing potential?

Valproate is highly teratogenic, causing congenital malformations and neurodevelopmental disorders. The Pregnancy Prevention Programme (valproate PPP) requires highly effective contraception and annual specialist review; it must not be used in pregnancy unless no alternative exists.

Which common medicines should be avoided in the third trimester of pregnancy, and why?

NSAIDs (e.g. ibuprofen) can cause premature closure of the ductus arteriosus and oligohydramnios; ACE inhibitors/ARBs cause fetal renal damage and oligohydramnios. Both are best avoided, especially in the third trimester.

Why is aspirin generally avoided in children under 16, and what is the exception?

Aspirin is linked with Reye's syndrome (acute encephalopathy and liver failure) in children. It is contraindicated under 16 except for specific uses such as Kawasaki disease, where it is used under specialist supervision.

How are paediatric medicine doses most accurately calculated, and why is body weight preferred over age?

Doses are usually calculated per kilogram of body weight (mg/kg) or by body surface area, because children of the same age vary widely in weight; weight-based dosing gives a more accurate, individualised dose. Always check against the maximum adult dose.

State the formula relating an oral liquid dose volume to the prescribed dose and the medicine's concentration.

$$\text{Volume} = \frac{\text{Dose required (mg)}}{\text{Concentration (mg/mL)}}$$ For example, a 250 mg dose from a 125 mg/5 mL suspension needs $\frac{250}{25} = 10\ \text{mL}$.

Define 'polypharmacy' and distinguish 'appropriate' from 'problematic' polypharmacy.

Polypharmacy is the concurrent use of multiple medicines (often defined as 5 or more). Appropriate polypharmacy optimises therapy for complex/multiple conditions in line with evidence; problematic polypharmacy is when medicines cause more harm than benefit (interactions, poor adherence, increased adverse effects).

What is a 'structured medication review' (SMR) and what is its main aim in older people on multiple medicines?

A comprehensive, patient-centred clinical review of all of a patient's medicines, undertaken with the patient. It aims to optimise medicines use, deprescribe inappropriate or unnecessary drugs, reduce harm and adverse effects, and align treatment with the patient's goals.

Name two validated screening tools used to identify potentially inappropriate prescribing in older adults.

The STOPP/START criteria (Screening Tool of Older People's Prescriptions / Screening Tool to Alert to Right Treatment) and the Beers Criteria. They flag drugs to stop and drugs that should be considered/started in older people.

In older patients, why are anticholinergic medicines a concern, and what term describes their cumulative effect?

Anticholinergics cause confusion, falls, urinary retention, constipation, dry mouth and cognitive impairment, and are linked with increased dementia risk. The cumulative effect of multiple such drugs is the 'anticholinergic burden', which should be minimised in the elderly.

Which equations are used to estimate renal function, and which is preferred for drug dose adjustment of renally-cleared, narrow-therapeutic-index drugs?

eGFR (CKD-EPI or MDRD, reported per 1.73 m^2) is used to stage CKD, while the Cockcroft-Gault estimate of creatinine clearance is preferred for dosing many renally-cleared drugs (especially toxic/narrow-index drugs and in extremes of body weight).

State the Cockcroft-Gault equation for estimating creatinine clearance.

$$\text{CrCl} = \frac{(140 - \text{age}) \times \text{weight (kg)} \times F}{\text{serum creatinine (}\mu mol/L)} \times 1.23$$ where $F = 1.04$ for females and $1.23$ is replaced so that males use a factor of $1.23$ ($F=1$ female adjustment). In practice: multiply by 1.23 for men and 1.04 for women.

In renal impairment, which common analgesics and antidiabetic drugs require caution, and why?

NSAIDs reduce renal perfusion and can worsen kidney function; opioids like morphine accumulate active metabolites causing toxicity. Metformin risks lactic acidosis and should be reviewed/stopped at low eGFR (avoid if eGFR <30 mL/min/1.73 m^2).

In significant hepatic impairment, why must drugs such as warfarin, opioids, and statins be used with caution?

The liver synthesises clotting factors (enhancing warfarin's effect and bleeding risk), metabolises many drugs (so opioids and sedatives accumulate, risking encephalopathy), and is the site of statin metabolism and a target for hepatotoxicity, so reduced or avoided dosing and monitoring are needed.