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Syllabus Cruncher

The GPhC syllabus is now referred to as the ‘registration assessment framework’ effectively it indicates to
students the objectives that need to be met during their revision. In easier terms, the framework explains what will be
tested in the new style registration exam.

The framework should be used as a back-bone for your revision and you should take each topic and develop your
knowledge in that area, our cruncher will help you with that but will not cover all areas.

The assessment framework will cover learning objectives and topics that are indicative to each objective, although the
framework will not give everything away it will focus students in the correct direction for what they need to learn. To
guide students further the outcome has been given a colour code to give you an indication of the weighting that
particular topic may have in the exam. These are as follows:

 HIGH – Red; means high weighting and there will be approximately 60-70% of questions around these
topics
 MEDIUM – Orange; means a medium weighting and there will be approximately 25-35% of questions
around these topics
 LOW – Green; means a low weighting and there will be approximately up to 10% of questions around these
topics

We will now focus on the outcomes and some of the topics that are indicated and elaborate on areas which students
could look at, these are not a full list, however it can help students focus on different topics and use it as a check list
when revising!

Our syllabus cruncher will be divided according to the framework and we will break down each section according to
the highly weighted topics and the lower weighted topics. Our team have then added different points and questions
that will encourage you to consider when revising, the list can be built and added on or can simply be used as a check
list. If you have any questions about the syllabus then please contact us at info@teamprereg.co.uk

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10.1 Expectations of a pharmacy professional

HIGH Topics

Respond appropriately to medical emergencies, including provision of first aid

 What are responses to medical emergencies?


 What are the resuscitation guidelines for both adults and children and what are the key differences?
 What are the key signs and symptoms of anaphylaxis?
 What different types of adrenaline are there? What route is adrenaline administered through?
 Take a look at the Resuscitation Council UK guidelines - https://www.resus.org.uk/
 How to deal with hypo/hyperglycaemia, shock, burns, scalds, injuries to the head, allergic reactions, seizures, foreign bodies or
chemicals in the eye, minor bleeding and injuries to tissues or muscles.
 Overdosing and poisoning can also be looked at.

MEDIUM Topics

Recognise the duty to take action if a colleague’s health, performance or conduct is putting patients or the public at
risk
 Whistleblowing policy
 GPhC Standards – particularly vulnerable people or raising concerns? Do you know the guidance on vulnerable adults and
children?
 Who can you contact if you think someone is acting inappropriately or incorrectly?
 Standards of good professional practice – what are these standards? What is the professional responsibility of a pharmacist or
pharmacy personnel? What are the ethical responsibilities?
 What societies and councils are there for you to seek advice from and who can you sign post to?

Demonstrate how the science of pharmacy is applied in the design and development of medicines and devices
 What factors affect the stability of medicinal products?
 What are some examples of products that are kept in its original container to protect from degradation?
 How should to cold chain be maintained when receiving stock from suppliers?
 Who do you contact about the suspicion of counterfeit stock?
 What examples do you have of products that have been counterfeit?
 Good manufacturing process - https://www.gov.uk/guidance/good-manufacturing-practice-and-good-distribution-practice
 What products need to be kept sterile and how to we maintain sterility? http://www.mhra.gov.uk/home/groups/comms-
ic/documents/websiteresources/con2031677.pdf

LOW Topics

Apply the principles of clinical governance in practice


 What is clinical governance and what are the pillars of clinical governance?
 Why do we have clinical governance and why is it important in patient safety?
 Components of clinical governance - http://www.uhb.nhs.uk/clinical-governance-components.htm
 Clinical Governance - http://www.uhb.nhs.uk/clinical-governance-components.htm
 How do we achieve the high standards and improvement of care and why is this so important?
 How do we audit our services? NHS Audit/ Practice based audit? How many audits do we need to do a year?
 What part does risk management play in clinical practice? Near miss and route cause analysis teaches us where processes may
have gone wrong and allows us a chance to learn and make changes because of them, for example re-arranging stock to ensure a
reduction in errors.
 What professional development is available? Education/training – why do we do this? To ensure competence.
 What other ways are there to reduce dispensing errors? What systems are in place to minimise medication errors? (Dispensing
Incident Reporting, NHS Safety Updates, MHRA yellow card updates, safety audits)
 GPhC inspections – do you know the five principles for registered pharmacies? What is the guidance around inspection? How often
do inspectors come and what are the different grading systems?
 What is a route cause analysis? What are the key parts to this type of analysis? What are the FIVE WHYS?
http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/identifying_problems_-
_root_cause_analysis_using5_whys.html
 Mini guide to route cause analysis - http://www.root-cause-
analysis.co.uk/images/Green%20RCA%20mini%20guide%20v5%20small.pdf

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10.2 The skills required in practice
10.2.1 Implementing health policy

MEDIUM Topics

Access and critically evaluate evidence to support safe, rational and cost-effective use of medicines
 Evidence based practice – what types of research is credible and at what level is there the most bias? (Meta-analysis, systematic
reviews, randomised controlled trials, cohort studies, case control studies, case series, expert opinions etc.)
 What is the difference between randomised controlled trials, meta-analysis and cohort studies?
 What are the principles of applying evidence into practice? Why is it so important?
 Why are we required to interpret information and apply into practice to improve patient care?
 How does this link to CPD? (Continued Professional Development)

Apply knowledge of current pharmacy-related policy to improve health outcomes


 Principles of promoting healthy lifestyles- what is a healthy lifestyle? What are the key requirements?
 Exercise, diet, blood pressure, cholesterol, sugars etc. what are the ranges for these parameters?
 Improving health and patient care through community pharmacy – a call to action - http://www.england.nhs.uk/wp-
content/uploads/2013/12/community-pharmacy-cta.pdf
 How can people lead healthy lifestyles and what is the importance of pharmacy in helping people to live this way?
 How important is communication when discussing with patients to improve their health outcomes?
 How can we collaborate with other healthcare professionals? Where can we sign post patients to?
 How does medicines management and medicines optimisation link into this? Define medicines management, medicines
optimisation, medicines reconciliation. How do these improve pharmaceutical care?
 What national programmes are there to improve health? Stop smoking day, Stoptober etc.

10.2.2 Validating therapeutic approaches and supplying prescribed and over-the-counter medicines

HIGH topics

Identify and employ the appropriate diagnostic or physiological testing techniques in order to promote health
 What health procedures are there for detecting illness or disease? Blood pressure, blood tests, urine samples, peak flow meters,
scans etc.
 How do we use these devices? What are the units of measurement? What are the normal ranges and what is not normal?
 Take blood pressure for example? What are the ranges for different patients with other conditions, e.g. diabetes?
 What physiological measures are there for detecting any problems with health? Consider those in asthma or COPD?
 What narrow therapeutic index drugs are there? How often do we need to measure their levels? Do you known how to draw the
therapeutic window graph?
 Selecting appropriate diagnostic or physiological testing techniques for use in clinical decision-making and to promote health
 Normal ranges for test results, and actions to take when results are out of the normal range
 What type of test results are there and what are their normal ranges?
Use this table to help you get started:

Blood pressure
Cholesterol
HbA1c%
Haemoglobin
White Blood Cells
Red Blood Cells
Plasma
Neutrophils
Platelet Count
Sodium
Potassium
Calcium
Vitamin D

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Identify inappropriate health behaviours and recommend suitable approaches to interventions
 Concepts of health promotion, health education and health improvement programmes, based on national and local health priorities
and parameters
 What do you do in your practice to promote health? What services do you offer in your pharmacy? What are the service
requirements?
 What national objectives are there? Stop smoking, alcohol awareness day etc.
 What is the role of the pharmacist in promoting health? What are their actions? What skills do you need to be able to communicate
effectively? What are the key responsibilities of the pharmacist when counselling patients?
 Behavioural models – Health Belief Model of Change – use smoking cessation as an example.
 What factors influence poor health (and good health) – balanced diet, hydration, range of fruit and vegetables.
 What other factors influence health? Social, environmental, diet? Place of work? Passive smoking can harm people’s lives- what is
the new law about smoking in a vehicle with children?
 What can the pharmacist and pharmacy support staff do to improve health- consider courses – getting pharmacies accredited to
performing healthy living services, offering blood pressure testing, cholesterol testing, chlamydia testing etc.
 What are the benefits of good health – what are the implications on doctors hospitals etc. (reduced GP visits, less hospital beds
occupied, pharmacies are local they are open all the time and require no appointment – pharmacists are also skilled and have all
the skills to help individuals with minor ailments and able to provide healthy lifestyle advice
 What are the social and environmental implications of bad health – depression, smoking can cause environmental ‘passive smoking’
etc.

Instruct patients in the safe and effective use of their medicines and devices
 The principles of medicines management and speaking to patients about their medicines is very important
 What ways can we do this? MUR’s/NMS?
 What can we be discussing with patients? Inhaler technique? Compliance or adherence?
 Do you know your inhaler technique? Or spacer cleaning methods? Essential counselling to be able to discuss with patients
 Consider an MUR, in an asthma patient asking patients the frequency of the use of their blue inhaler? Or in a cardiovascular MUR,
consider asking the patient about any counter medication they may take? Or asking a patient when they take their medicines and
educating them about when is best to take and why. Simvastatin – explaining why you take this at night.
 What other opportunities are there to speak to patients about their medicines?
 What advice do you need to give to patients on special medicines, such as warfarin, MAOI’s etc.? Interactions with food, or common
over the counter medicines.
 WWHAM Questions? Why are they important? What safety measures are in place for OTC medicines? Which sales need to be
dealt with pharmacists only? What is the legislation around pseudoephedrine/ephedrine sale? Do you know the guidance on
Paracetamol doses, quantity supply, use together with Ibuprofen for children? Or the law around codeine for under 18’s? Or the
ingredients that should be avoided in under 6 with coughs and colds?
 Patients taking thyroxine – avoiding caffeine containing food whilst taking, and taking preferably before breakfast.

Clinically evaluate the appropriateness of prescribed medicines


 Appropriateness of prescribed medicines, for example in the context of presenting conditions, associated diseases, and test results
 Circumstances in which prescribed medicines are contra-indicated
 Interactions that occur between medicines (either prescribed or purchased), and between these medicines and food or other
substances. What examples can you think of where certain foods must be avoided with certain drugs – use MAOI’s as an example.
Or where certain drinks are best avoided in certain therapies – consider Grapefruit Juice or Cranberry Juice.
 Use of licensed, off-label and unlicensed medicines including providing information to patients
 Interactions between non prescribed medicines and prescribed medicines, for example diabetics taking none sugar free
preparations, or patients taking warfarin or lithium and buying NSAID’s. What other examples of OTC interactions can you think of?

Provide, monitor and modify prescribed treatment to maximise health outcomes


 Principles of medicines management, medicines optimisation and pharmaceutical care
 Dosages and dose adjustments, especially for people with particular needs due to, for example, age or health conditions
 Reasons for treatment failures. What are common examples of treatment failures? (Lack of understanding of the medicine,
adherence, lack of knowledge of condition…)
 Recognising and managing adverse effects of medicines – where do you report the adverse events? What are the signs and
symptoms of some overdoses? Or toxicity – e.g. digitalis toxicity?
 Mechanism of action, administration, absorption, distribution, metabolism and excretion of medicines

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MEDIUM topics

Analyse prescriptions for validity and clarity


 Legal and professional requirements for prescriptions, to enable the safe and legal supply of medicines
 What are the legal requirements on a prescription? When does the patient age or date of birth need to be included?
 When does the quantity need to be written in both words and figures?
 How long are prescriptions valid for? What is the validity of controlled drugs? What is the legislation around repeat dispensing –
when does the first prescription need to be dispensed and is there an expiry after that?
 What units are acceptable on a prescription and when should decimal points be used?

Record, maintain and store patient data


 Maintaining confidentiality, and disclosing information both with and without the subject’s consent
 What is consent? What types of consent are there and how can they be obtained? MEP Appendix 5 – Guidance on consent &
GPhC Guide to Consent – MUST read
 Obtaining consent for professional services; what services do we need to obtain consent for? Where is this then stored? How long
do we store this data for? What is the purpose of obtaining the consent? (To share with their GP?) – example of services could be:
repeat dispensing, electronic prescribing, flu vaccination, medicines use review etc.
 Information governance – what is it? How can we ensure data is kept safe in the pharmacy? Filing cabinets that are locked,
password protected PMR’s, delivery drivers – what professional responsibilities do they have to ensure patient confidentiality (not
only when delivering but when collecting and transporting prescriptions), what are the ethical and professional responsibilities for
members of the Pharmacy team to ensure confidentiality? Data Protection Act 1998 – do you know the principle, how long data
should be kept for and who has access to it? Does the act cover both paper based record and electronic based record – yes
 Freedom of Information Act – what is it? How can you request information> https://www.gov.uk/make-a-freedom-of-information-
request/the-freedom-of-information-act
 Requirements for recording, maintaining and storing data
 How long can data be kept for? What records do we keep and how long do we need them for? Where does it need to be stored?

Supply medicines safely and efficiently, consistently within legal requirements and best professional practice. NB This
should be demonstrated in relation to both human and veterinary medicines
 Statutory regulations and professional requirements for the supply of human and veterinary medicines
 Veterinary medicine classes?

10.2.3 Ensuring that safe and effective systems are in place to manage the risk inherent in the practice of
pharmacy and the delivery of pharmaceutical services

MEDIUM Topics

Ensure quality of ingredients to produce medicines and products


 Quality assurance processes for medicines and ingredients
 Storage requirements for medicines and ingredients
 Fridge storage conditions?
 Good manufacturing process – what is this?

Apply pharmaceutical principles to the formulation, preparation and packaging of products


 Formulation, preparation and packaging of products
 What medicines should not be crushed? What type of formulation cannot be crushed?
 Any examples of medicines that can be broken and sprinkled?
 What are some examples of medicines that need to be kept refrigerated?

LOW Topics

Procure and store medicines and other pharmaceutical products working within a quality assurance framework
 Procurement and storage of medicines – from reliable sources. What records do we need to keep?
 Invoices should be kept for how long? Which controlled drug invoices need to be kept?
 Additional precautions necessary for particular formulations
 Manufacturers recall – how do you deal with a drug recall? What types of recall are there? Class 1 – immediate action (serious risk
to health) Class 2- recall within 48 hours (potential harm but not life threatening), Class 3- action within 5 days (unlikely harm) Class
4- caution to be exercised.

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Dispose of medicines safely, legally and effectively
 Statutory regulations covering the safe, legal and effective disposal of medicines
 What type of service is it in the pharmacy to accept medicinal waste from patients?  Essential service. View the specification
here: http://psnc.org.uk/wp-content/uploads/2013/07/Service-Spec-ES3-Waste-Disposal.pdf
 What is a pre-acceptance audit? What is a T28 exemption?
 What records are needed for the destruction of controlled drugs? Which controlled drug schedules need to be denatured?
 What is the difference between destroyed out of date controlled drugs and patient returned controlled drugs?
 COSHH 2002– what are the principles of the assessment? Why is it important? What examples of substances is there that can be
hazardous to health? What training is required for support staff with COSHH and substances that is hazardous? What warnings do
we have in place and what safety measures are there?
 Procedures for the disposal of special and controlled waste from the pharmacy. What can controlled drugs be denatured in? How do
you put controlled drugs into the denature kits? Ampoules must be broken etc.

Identify, report and prevent errors and unsafe practice


 Supervising others involved in service delivery. How do we ensure errors are kept to a minimum? What training do we give to staff
members to bring them to the required competence? E.g. what training does a counter assistant receive? Or a Pharmacy
Technician? What NVQ level?
 Identifying, reporting and preventing errors and unsafe practices. What do we do when an error is made – ensure the patient is not
harmed. Who do we contact if there are concerns?
 What methods are there to prevent errors? Moving stock around, warning labels, near miss logs, reviewing and auditing
 Responding to complaints and concerns

Procure, store and dispense and supply veterinary medicines safely and legally
 Regulations and professional requirements governing the procurement, storage, dispensing and supply of veterinary medicines
 What are the legal classifications of veterinary medicine?
 What records need to be made upon dispensing? What is a legal prescription? See MEP What is essential on the prescription for it
to be legal
 https://www.rcvs.org.uk/advice-and-guidance/code-of-professional-conduct-for-veterinary-surgeons/supporting-guidance/veterinary-
medicines/

10.2.4 Working with patients and the public

HIGH Topics

Identify and employ the appropriate diagnostic or physiological testing techniques to inform clinical decision-making
 Identifying appropriate diagnostic or physiological testing techniques, and interpreting results
 Identifying conditions that need referring to another healthcare professional
 What examples can you think of where you would have had to refer the patient to the GP? (High blood pressure, signs and
symptoms of diabetes, chest pain, migraine attacks in children etc.) What tests would they then do to further confirm diagnosis and
what is the basic treatment regimen for the condition?
 Identifying conditions that may be treated by non-prescription medicines
 What are the common non-prescription medicines you dispense? Make a list and then match them to the indication they are used
for? When are these non-prescription medicines not used, for which types of patients? For example, a patient with a persisting dry
cough and they are on an ACE inhibitor – would you supply Pholcodine? Which cough mixture would you give to a type 2 diabetic
patient?
 Who can perform diagnostic procedures? What healthcare professionals can be involved in diagnosis?

10.2.5 Maintaining and improving professional performance

LOW topics

Demonstrate the characteristics of a prospective professional pharmacist as set out in relevant codes of conduct and
behaviour
 Characteristics of a pharmacist as set out in the relevant standards and guidance – what are the standards for a registered
pharmacist?
 What are the key roles and responsibilities of a pharmacist? Do you know the definitions of ethics, liability, accountability,
professionalism, professional responsibility, protecting patient safety and whistleblowing?
 Appendix 10 – MEP – guidance for responsible pharmacists
 Appendix 8 – MEP – guidance for provision of services affected by religious and moral beliefs
 What skills can you think of that makes a good pharmacist? Teamwork, communication, leadership etc.

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 Principles of the NHS complaints procedures
 NHS Complaint policy? - http://www.nhs.uk/aboutNHSChoices/aboutnhschoices/Aboutus/Documents/120117-nhs-choices-
complaints-policy-v2-D01.pdf
 What is the time frame for complaints? What happens if it is not resolved immediately? Can the patient contact the Ombudsman?
 Complaints against pharmaceutical services - http://psnc.org.uk/contract-it/essential-service-clinical-governance/complaints/
 Who is responsible for complaints? Does the contractor have to nominate an individual in the team to deal with complaints – yes?
Responsible person should act as the Chief Executive Officer of the company and act as the complaints manager to deal with any
incoming concerns. What can make a complaint? Clinical governance means you are required to have a complaints process and a
policy in place for handling them.
 What is the contractor’s duty to handle complaints? http://psnc.org.uk/contract-it/essential-service-clinical-governance/complaints/

Participate in audit and in implementing recommendations


 Purpose of audit and principles of audit procedures
 What is audit? http://www.england.nhs.uk/ourwork/qual-clin-lead/clinaudit/
 Why do we audit? http://www.hqip.org.uk/assets/Guidance/HQIP-Clinical-Audit-Simple-Guide-online1.pdf
 How does audit help our practice? How often do we need to audit? What types of audit are there? Clinical Audit. Practice Based
Audit? What was your pharmacies practice based audit (repeat dispensing, services?)
 Principles of change management
 What is change management and how does it affect pharmacy? Consider the change cycle?

Contribute to the development and support of individuals and teams


 Principles of identifying, and responding to, the learning and development needs of professional team members
 What training is available for pharmacy team members? What members of the pharmacy team are there? (Healthcare assistants,
dispensing assistants, technician, accuracy checking technician)
 What are their professional responsibilities? What qualifications do they need to become these roles? Who is allowed to work in the
dispensary? Which of them needs to complete CPD? http://www.pharmacyregulation.org/education/support-staff
 Principles of CPD and regulatory requirements
 What is CPD? Do you know the CPD cycle? What situations can you do a CPD for – training? Professional meeting? Reading the
Pharmaceutical Journal?
 How many CPD’s throughout the year? What systems are in place for you to record your CPD?
 Why do we do CPD? How often can CPD’s be called in and what are the implications if they are not submitted when requested?

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Therapeutic Areas

Questions in the examination can link to a therapeutic area; any question can also link multiple clinical areas together.
Each area has been given a clinical weighting and these are listed below:

 Cardiovascular System HIGH


 Central Nervous System HIGH
 Endocrine System HIGH
 Infections MEDIUM
 Obstetrics, gynaecology, and urinary-tract system MEDIUM
 Gastro-intestinal system MEDIUM
 Respiratory system MEDIUM
 Malignant disease and immunosuppression MEDIUM
 Nutrition and blood MEDIUM
 Musculoskeletal and joint diseases LOW
 Eye LOW
 Ear, nose, and oropharynx LOW
 Skin LOW
 Immunological products and vaccines LOW
 Anaesthesia LOW

We will now take each therapeutic area and list key topics we believe that are essential that should be covered, it is important that you do not
solely rely on this list, but only use it as a guide or a checklist and make sure you add to the list.

Cardiovascular System

 Principles of Digoxin, its therapy, antidote and digitalis toxicity


 Different types of diuretics and in what situation they are used in (e.g. loop diuretics are used in pulmonary oedema), how they work,
what their indications are and when they should be contraindicated
 What is an arrhythmia? What medicines are used? What is the Vaughan Williams Classification? How do you manage arrhythmias?
 Amiodarone – what is it? What is it used for? Contraindications, side effects, cautions, what monitoring needs to be done.
 Hypertension guidelines. What type of anti-hypertensives is there? Side effects (particularly of ACE inhibitors, beta-blockers, calcium
channel blockers) what is the ideal blood pressure in different types of patients? Which is safe in pregnancy for hypertensive
treatment?
 Beta blockers- which are the ones that precipitate bronchospasm? Which is lipid soluble?
 What is heart failure? What treatments are available for heart failure?
 What the indications are for nitrates, storage and dosage requirements? (E.g. tolerance development) what are the key side effects
of nitrates? Storage of GTN tablets?
 What other anti-angina drugs are there? What are examples of peripheral vasodilators and how do they work?
 How do you treat shock? How do you deal with cardiopulmonary resuscitation?
 Anticoagulants? Do you know all about warfarin, heparin etc. Indications, side effects, cautions, contraindications? Warnings or
cautions issued by the CHM?
 How do you manage stroke/NSTEMI/STEMI?
 Lipid regulating drugs? When does the strength of Simvastatin need to be reduced? What are the monitoring requirements? How do
you diagnose high cholesterol? When is there the highest risk of muscle effects when taking a statin?

Central Nervous System

 What are anxiolytics? What are hypnotics? What is the difference between both of these?
 What are the effects of central nervous agents such as benzodiazepines, anxiolytics when driving? What is the guidance for
withdrawing long term benzodiazepines? Are you aware of the equivalent doses to Diazepam 5mg?
 Z-drugs- indications, when are they used and for what types of patients? How long are these prescriptions valid for does each Z drug
differ or do they all have the same prescription rules?
 Anti-psychotic treatment – indications, side effects? Difference between first generation and second generation? What is the
difference when prescribing for the elderly?
 Clozapine – indications, cautions, contraindications, side effects, monitoring etc.
 Lithium - indications, cautions, contraindications, side effects, monitoring etc.
 Antidepressants - indications, cautions, contraindications, side effects, monitoring etc. also be aware of switching between anti-
depressants and the guidance on withdrawal, failure to respond and general management.

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 MAOI’s indications, cautions, contraindications, side effects, monitoring etc. what foods do you need to avoid? Warning card?
 Prescribing in ADHD? What is ADHD? What common groups of people are affected? What are the treatment types?
 Treatments for obesity, nausea, vertigo, alcohol dependence – be aware of the indications, cautions, contraindications, side effects,
monitoring etc.
 Pain relief – what is the pain ladder? Use the pain ladder to understand the different types of treatments. What are the side effects of
pain killers, which groups of patients should they be avoided in? When can they be used? Legislation of controlled drugs can be
looked into here too.
 How do you treat migraine? What are the OTC therapies and what are the POM therapies? When is prophylaxis of migraine
initiated?
 Indications for neuropathic pain? What is neuropathic pain? (Common in diabetes – why?)
 Anti-epileptic medication. Indications, cautions, contraindications, side effects, monitoring etc. What medications should you not
switch the brands? What are the different categories for this? What types of seizure are there? What is epilepsy? Where can you
refer epileptic patients? What guidance do they need with regards to informing the DVLA? Look into each anti-epileptic medication
and look at cautions and warnings, for example – Vigabatrin – causes visual field defects, sodium valproate can cause liver toxicity.
 What is status epilepticus?
 Parkinson’s disease, what treatments are there? What is Parkinson’s disease and how is it diagnosed? Side effects of treatment?
 What drugs are used in substance dependence? What are the legal requirements for this type of therapy and these prescriptions?
Look into FP10MDA prescriptions? What can be prescribed on these?
 Dementia - what is it? How is it diagnosed? Look into MMSE testing. What treatments are available? What is used in mild, moderate,
severe dementia?

Endocrine System

 What is the endocrine system? What is it made up by?


 Diabetes, what is it? How many types are there and how is each one categorised? What is the difference between Type 1 and Type
2? How are they diagnosed?
 How do you prevent diabetic complications? What are they? Microvascular, Macrovascular? How do we measure HbA1C?
 What is insulin? How many types are there? Make sure you know which the short acting ones are and the longer? How does
combination insulin work? What is the duration of action of different insulins? Where can insulin be injected?
 What are the signs and symptoms of hypoglycaemia and how can we manage them?
 What other type of anti-diabetic medicines are there? Biguanides? Sulphonylureas? How do these work? What is their mechanism of
action?
 What is diabetic nephropathy, neuropathy?
 What different tests are there for the diagnosis of diabetes? How do these work?
 Thyroid hormones? What does it mean to be thyroid deficient? How do the medicines work? Side effects, cautions etc.
 Corticosteroids. Uses? Side effects? Cautions, contraindications and warnings?
 Which steroids cause glucocorticoid activity, which cause mineralocorticoid activity? What is the guidance about issuing a steroid
card? What is the guidance about withdrawal of corticosteroids? Why do we need to gradually withdraw?
 Hormone replacement therapy. What is it, what are the treatments? Who is at the highest risk? What is the risk of stroke,
thromboembolism etc.
 Uses of male sex hormones and dutasteride, finasteride?
 What is desmopressin used for?
 Osteoporosis. What is it? How does it occur, how can we treat it? What are the counselling points for Alendronic Acid?

Infections

 What are antibacterial drugs? How do we ensure we choose the most suitable drug? What policies are in place about choosing the
correct treatment?
 Table that summaries the antibacterial therapy – be aware of this, know how to use it. For example look at the different treatments
available for Typhoid Fever, a first line will be indicated, but if not suitable there may be another alternative. Learn to navigate around
this table and be aware of the different types of infections and treatments available. Ask yourself while dispensing what the indication
for an antibiotic could be.
 Penicillin’s - what are they? Examples and contraindications and side effects.
 Cephalosporins - what are they? Examples and contraindications and side effects
 Tetracyclines – what is the warning that is issued for this? What are the indications and who should avoid them?
 Aminoglycosides. What are the examples of these? Where are these types of drugs absorbed from? What is the pharmacokinetics of
them? When are they used? What plasma levels do we hope to achieve? Monitoring requirements?
 What are macrolides? When are they used?
 Tuberculosis? What is it, treatments? What is peripheral neuropathy and how is it treated?

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 How do water infections occur? (Urinary tract infection) how is it treated? What bacteria cause it?
 What fungal infections can you think of? Which can be treated OTC? What are the treatments needed?
 Antiviral drugs.
 Malaria. What is it? How is it caused? What species? How do we prevent? What medicines are available for prophylaxis? How do we
know which is suitable? What are the side effects? What treatment regimen is available for treatment?

Obstetrics, gynaecology, and urinary-tract system

 Prostaglandis and oxytocics? What are they and what examples can you provide?
 What treatments are used in premature labour?
 What topical treatments are available for vaginal atrophy? What is vaginal atrophy?
 How are fungal infections treated? What medicines available? What common examples of fungal infections are there? Candidiasis
etc.
 What examples of combined hormonal contraceptives are there? What are the advantages of them? How do you choose which one?
What happens if a woman misses a pill? What reasons are there to stop immediately? What are the risk factors for a woman taking
combined hormonal contraceptive and the risk of arterial disease or venous thromboembolism?
 What guidance is there around migraine and headache when taking combined hormonal contraceptives?
 What is a progesterone only contraceptive? What types of patients are these suitable in? How do you switch from a combined
hormonal contraceptive?
 What parenteral progesterone contraceptives are available? What is an intrauterine device?
 What emergency contraception is available? How many days after unprotected sex can each one be used for?
 What drugs are available for urinary retention? Can they be used by male and female or just a single sex? What are the side effects
and cautions for these?
 What drugs are available for urinary incontinence? Can they be used by male and female or just a single sex? What are the side
effects and cautions for these?
 What drugs are available for urological pain/erectile dysfunction?

Gastro-intestinal system

 What is dyspepsia? Who is most affected? What types of medicines can cause this? What signs and symptoms is there that
diagnose dyspepsia? What medical investigation is needed to diagnose? What treatments are available for this?
 What is gastro-oesophageal reflux disease? Does this differ to dyspepsia? What treatment is available for this? What are the signs
and symptoms? What treatments are available OTC for this? Who should be referred when customers enter into the pharmacy with
this presentation?
 What does it mean by ‘Low Na+? What indigestion remedies are there?
 What are the side effects, indications and contraindications for proton pump inhibitors, H2 Receptor antagonists, antimuscarinics and
drugs that alter the gut motility?
 What is a Helicobacter pylori infection? Signs and symptoms? How is this treated? What are NSAID associated ulcers? Treatment?
 What is misoprostol? What are the instructions when prescribing to a woman of child bearing age?
 What is inflammatory bowel disease? (Crohns Disease & Ulcerative Collitis) – What is the difference? What similarities are there?
(You will need to look into the biology of the disease to find the answer to this) what medications are available for this and what is the
guidance? Particularly with adherence to medication?
 What is constipation? How does it occur? What medicines contribute to it? How can it be treated? What are the different types of
laxatives? How do they work and how long do they take?
 What are haemorrhoids? How do we treat them?

Respiratory System

 Management of asthma? How do you use inhalers? What is the guidance for the management of severe asthma?
 COPD – what is it? How do you diagnose it if there is doubt?
 Management of chronic asthma for under 5 year olds and over 5 do you know the flow chart? For both COPD and Asthma? (and
management of acute asthma)
 CHM advice for long acting beta2 agonists? How do you deal with croup? What are the long acting beta2 agonists? Which are the
short acting beta2 agonists?
 Are you aware of the risk of hypokalaemia when taking beta2 agonists?
 Anti-muscarinic bronchodilators – indications, where are they added on the flow chart, side effects, contraindications?
 Theophylline- a narrow therapeutic agent – cover everything regarding this (e.g. plasma levels, interactions etc.)
 How do peak flow meters work, and inhaler devices such as spacers, nebulisers? What are the cleaning procedures for a spacer?

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 Corticosteroids – use, side effects, indications and interactions, oral hygiene procedures (e.g. rinsing after use- why?)
 Montelukast & Zafirlukast
 Importance of antihistamines – indication, side effects and when they should not be used
 Adrenaline – know the doses for different ages, routes of administration and anaphylaxis guidance.
 Oxygen
 Mucolytics
 What cough preparations are there? E.g. codeine phosphate, pholcodine, demulcents etc. use your OTC knowledge here.

Malignant disease and immunosuppression

 What are cytotoxic drugs and what is the guidance for handling them?
 What is cancer? What types of cancer are there? How do we diagnose cancer? What are the side effects to cancer treatment? What
can you expect during treatment in terms of bodily changes? What medicines are safe in cancer to treat the side effects of it? Where
can you refer patients to for support and information?
 Alkylating drugs – what are they and side effects? When are they used?
 What are antimetabolites? What treatments are in this category?
 Methotrexate – uses, indications, side effects, contraindications, warnings, need to know everything about this medicine.
 Antiproliferative immunosuppressant’s is the drug class for which types of drugs? How do they work and what are their side effects,
indications and contraindications?
 What is the use of corticosteroids in the treatment of cancer?
 Oestrogens? Androgens? Tamoxifen?

Nutrition and blood

 Iron deficiency anaemia. What is it? What are the different iron salts and how much ferrous iron is in each one? What are the side
effects of iron? What is an acceptable level or iron in the blood?
 G6PD deficiency, what drugs have a definite risk of haemolysis in G6PD deficient individuals and which have a possible risk?
 What is oral potassium for? Which patient groups need to be careful? How can we manage hyperkalaemia?
 What is the purpose of oral rehydration and rehydration salts?
 Intravenous Nutrition
 What can be used in hypercalcaemia and hypercalciuria?
 Do you know why we use the following, their side effects, where its avoided and cautions about – magnesium, phosphorous, fluoride,
zinc
 Vitamins - do you know them all? Which are fat soluble? What are the different B vitamins – what are they used for and where can
you get them from (what foods?)
 What deficiency does each vitamin lead you to – e.g. lack of vitamin D = Ricketts Disease. What are the appropriate levels of each in
the body?
 What is vitamin K used for? Where is vitamin K found, what types of food?
 Acute porphyria’s

Musculoskeletal and joint diseases

 What drugs are used in rheumatic disorder and gout? What are both of these and what is the physiology?
 What are non-steroidal anti-inflammatory drugs? How do you choose between which is the most effective? Which ones are safer for
cardiovascular patients and which is safest with GI complications? What NSAID is most suitable for dental pain? Which ones need to
be avoided in renal impairment and what is their use in pregnancy? (there is none – avoid unless benefit outweighs risk)
 Leflunomide washout procedure?
 Drugs affecting the immune response? What are they and what are the monitoring parameters?
 Cytokine modulators –what are they? How do they work?
 What is sulfasalazine? How does it work? What is it used for? Do you know about the risk of blood disorders – what do you need to
look out for?
 What is gout? What is its physiology? Why should aspirin be avoided? How do we treat an acute attack? When do we start the
prophylaxis? What are the differences in the treatment? When would we use colchicine?
 Skeletal muscle relaxants
 Topical NSAID’s and Capsaicin

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Eye

 What is the difference between eye drops and eye ointment? Which one causes blurriness initially?
 How do you control microbial contamination? How do we choose which eye drop is essential? What different types of eye drops are
available and what combinations are available?
 When are corticosteroid based eye drops used? After which conditions or operations?
 What anti-inflammatory eye drops are available? What anti-allergy eye drops are available and how do they work?
 How do we treat glaucoma? What treatment is available? How frequently do we apply drops and do we need to monitor?
 Prostaglandin analogues and prostamides are used for what?
 How do we treat tear deficiency? What ocular lubricants are available?
 Contact lens care and treatment

Ear, nose, and oropharynx

 What drugs act on the ear and for what conditions? What is otitis externa? What is otitis media? What is used for the removal of ear
wax? What impact can ear wax have? How does ear wax accumulate?
 What is used for otitis externa/ media?
 What is available to treat ear wax? Can this be bought OTC?
 What drugs can be used in nasal allergy? What topical nasal decongestants are available?
 What drugs are available for oral ulceration and inflammation?
 What treatment is there for dry mouth? How does dry mouth occur? What mouthwashes and gargles are available?

Skin

 What is skin? What is the purpose of the skin? In terms of skin preparation what is a vehicle? What is a suitable quantity to prescribe
for different areas of the body?
 What is an emollient? What different types of preparations are available (shower, lotion etc.)
 What is a barrier preparation and what is the treatment for nappy rash?
 Topical local anaesthics and antipruritic’s
 What topical corticosteroids are available? How much do you need to use on each body part? Do you know about the classification
of mild, moderate, potent, very potent for steroid creams?
 What is eczema and how does it present? How do we manage it?
 What is psoriasis and how does it present? How do we manage it? What topical treatments are available for psoriasis?
 What is acne and how does it present? How do we manage it? What topical preparations are available for it? What oral treatments
are available?
 Warts and calluses
 Sunscreens and shampoos
 Anti-fungal treatment, anti-viral therapy and parasite treatment

Immunological products and vaccines

 What types of vaccines are there? Live, inactivated, detoxified, extracts etc.
 What guidance is there for when more than two vaccines are administered? When are vaccines contraindicated? What about
hypersensitivity to egg? When are live vaccines temporarily contraindicated, in which types of patients?
 What is the normal vaccine schedule for new-born babies?
 How should vaccines be stored and used? Which groups of patients are recommended to have an influenza vaccination?
 Side effects of different vaccines, MMR, etc.
 Immunoglobulin
 International travel – typhoid etc.

Anaesthesia

 What anaesthesia is there for surgery and long term medication?


 What drugs should be stopped before surgery? What is the recommendation for anaesthesia and driving? Why types of anaesthesia
are there? What is commonly used before surgery?

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