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GPhC Exam: The Cardiovascular System

GPhC Pre-Reg Exam Preparation Specialists

What are the key topics in the cardiovascular system?

The cardiovascular system is one of the high-weighted therapeutic areas and is something you will come across quite frequently in real-life scenarios.  It is a large section that has various branches such as: hypertension, heart failure, angina, atrial fibrillation, hypercholesterolemia, pulmonary embolism, and deep vein thrombosis.

Some of the key drug classes which you may come across (if not in the exam, then highly likely in practice) include diuretics, anti-arrhythmic drugs, Beta-blockers, Angiotensin-Converting Enzyme (ACE) Inhibitors, Angiotensin II Receptor Antagonists (ARB), calcium channel blockers, anticoagulants, and antiplatelets.

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Top tips on the cardiovascular system GPhC exam questions

  • You may find that questions are based on patients with co-morbidities as it is very common to have such patients in practice i.e. patient Y has a history of myocardial infarction, currently suffers from type 2 diabetes, high cholesterol, and ulcerative colitis. Therefore, it is ideal to focus on the cautions and contraindications of some of the common drugs that are taken by patients for their cardiovascular health.
  • Individuals with co-morbidities, specific health status and even people of different ethnic backgrounds will often be prescribed drugs differently in comparison to others, and it is essential that you are aware of some of these i.e. it is recommended for adults of Black African/African-Caribbean heritage to be prescribed an ARB instead of an ACE Inhibitor; hypertension in pregnancy is treated differently to non-pregnant cases.
  • Creating care pathway flow charts (or some form of flow diagram) for specific conditions may be of benefit. You will have a visual aid to learn from and will have essentially have questions and answers broken down into a diagram. If you do not wish to devise your own, you can search for similar flow charts online; the National Institute for Health and Care Excellence (NICE) website contains interactive flow charts which are simple and easy to follow.
  • As this section is quite large, it would be ideal to understand the first/second/third line choice of treatment for a given condition. You need to know why a certain drug is preferred over another.
  • Although it is crucial to know details about specific drugs, you do not necessarily need to memorise individual drug monographs in the BNF. It may be worthwhile to learn and make notes on the beginning section of chapter 2 (or the initial sections of each drug class) in the BNF, as these contain a comprehensive overview of the drugs – such information can often be overlooked.
  • Many drugs will require dose adjustments – for example, this could be due to a patient suffering from a certain condition, or due to an interaction i.e. a maximum of 20mg of Simvastatin to be prescribed when a patient is also taking Amlodipine.
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Narrow therapeutic index/high risk drugs in this section

CARDIAC GLCYOSIDE: DIGOXIN

Drug action

What is it used for?

Cautions

(Very) common side effects

      Intracellular sodium

 

      Calcium in the heart

 

      Myocardial contraction

 

      Conductivity in   

      atrioventricular node

·        Atrial fibrillation or flutter

·        Heart failure (sinus rhythm)

·        Emergency loading dose (atrial fibrillation or flutter)

     Calcium

 

     Magnesium

 

     Potassium

 

     Oxygen

·        Arrhythmias

·        Cardiac conduction disorder

·        Nausea, vomiting, diarrhoea

·        Dizziness

·        Eosinophilia

·        Skin reactions

·        Vision disorders

ANTICOAGULANT: WARFARIN

Drug action

What is it used for?

Cautions

(Very) common side effects

·        Warfarin inhibits vitamin K epoxide reductase

 

Vitamin K production

Synthesis of active clotting factors

·        Prophylaxis of embolisation in rheumatic heart disease & atrial fibrillation

·        Prophylaxis after prosthetic heart valve has been inserted

·        Prophylaxis & treatment of venous thrombosis and pulmonary embolism

·        Transient ischaemic attacks

·        Hypo/hyperthyroidism

·        Bacterial endocarditis

·        Conditions that increase the risk of bleeding

·        Peptic ulcer

·        Recent surgery

·        Bleeding/bruising

·        Haemorrhage to any site of the body

Example questions

  1. Mr J takes 8mg of Warfarin daily and he tells his GP that he will need both the “brown tablets” and the “pink tablets” however, he already has one pack of 28 “brown tablets”. Mr J is going away abroad thus, he needs enough tablets to cover the whole time that he is away. Mr J takes one pink tablet daily. Calculate the number of “brown tablets” that needs to be prescribed.
  1. Mrs N has recently been prescribed Valsartan 80mg OD. As the Responsible Pharmacist on duty, you discuss some of the side effects that she may experience. From the following options, which is the least likely side effect that she could experience?
  • Abdominal pain
  • Cough
  • Postural hypotension
  • Renal impairment
  • Skin reactions

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