GPhC Exam: The Genitourinary System

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What are the key topics in the genitourinary system?

This section will comprise of questions that are categorised as medium-weighted therapeutic areas. The genitourinary system refers to the organs that are related to the genital and urinary areas. The key sub-sections focus on drugs used in obstetrics, the treatment of vaginal and vulval conditions (i.e. vaginal candidiasis), contraceptives, and drugs used in genitourinary conditions (i.e. urinary retention, erectile dysfunction).

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Top tips on the genitourinary system GPhC exam questions

  1. Drugs used in obstetrics
  • This is generally a small sub-section and you may come across some overlaps i.e. you may be familiar with Misoprostol (a prostaglandin analogue) being a treatment option for peptic ulcers however, it is also used in the termination of pregnancies. Another example would be that Terbutaline Sulfate is commonly used in asthma, but it can be administered via intravenous infusion in uncomplicated premature labour.
  • Therefore, ensure you understand the mechanism of drugs to further comprehend why they are of use in obstetrics (as opposed to simply knowing the more common uses/related conditions).
  1. Treatment of vaginal and vulval conditions
  • This area tends to cover changes or infections related to the vagina/vulva (which can at times affect the lower urinary tract) i.e. menopausal atrophic vaginitis, prolapse, fungal/bacterial/viral infections, PH disturbances, trichomoniasis.
  • Although this topic is predominantly referring to females, sometimes it is not just a female that needs treatment for a given condition, but her sexual partner could also require it i.e. thrush can be passed on from one partner to the other therefore, a male can apply Clotrimazole 2% external cream on the penis.
  • Like various conditions, the duration of treatment can vary between individuals based on their health status i.e. pregnant women require a longer duration of treatment for a candidiasis infection.
  1. Contraceptives
  • The GPhC exam may consist of law and ethics-based questions on this topic i.e. eligibility of the over-the-counter supply of emergency hormonal contraception. For this, you may find it useful to refer to The Faculty of Sexual & Reproductive Healthcare to aid your revision.
  • Hormonal contraceptives have both health risks and benefits, so you could write up a brief table for these. Also, certain strengths of hormones may be safer first-line option than a higher strength i.e. combined oral contraceptives containing more than 30mcg of Ethinylestradiol are linked to a higher cardiovascular risk.
  • Ensure you know the differences between a combined hormonal contraceptive (containing an oestrogen and a progestogen) and progestogen-only contraceptives.
  1. Genitourinary conditions
  • The key topics covered in this part of the exam can include questions based on the following: urinary retention (inability to completely empty the bladder), urinary incontinence (unintentional leakage of urine), urological pain (i.e. cystitis), and erectile dysfunction.
  • Although certain older age groups are perhaps deemed to be more likely to suffer from conditions in this section, young children can be prone to issues such as urinary incontinence and nocturnal enuresis (i.e. night-time bedwetting). Thus, it would be ideal to learn some of the dosage regimens for different age groups (and even genders) for some drugs.
  • One of the main drug classes to study in this section would be Antimuscarinics i.e. Tolterodine, Oxybutynin, therefore ensure you are aware of the (very) common side effects related to this class of drugs.
  • With regards to over-the-counter (OTC) treatment options, it is vital you know when to refer patients to a doctor and the pharmacy/sales restrictions of some items. For example ask yourself the following questions:
  • If a woman has symptoms of cystitis, when would she need to be referred to a doctor?
  • Can you sell sodium citrate sachets to men?
  • What strength of Sildenafil is a pharmacist able to supply OTC?
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Example questions

  1. Mrs L is going on holiday for 18 days. She would like to postpone her menses for the duration of her holiday, plus an extra three days after her holiday. The GP will prescribe her Norethisterone 5mg tablets at a dose of “5mg 3 times a day, to be started 3 days before expected onset (menstruation expected to occur 2–3 days after stopping tablets)”. Calculate the total number of tablets that need to be prescribed.
  1. An 8-year-old child has been diagnosed with nocturnal enuresis. Initially the parents used an alarm technique however, this alone has not been very effective, and the GP has decided to introduce an oral medication. Which of the following would be the best treatment option at this stage?
  • Combination of the alarm and Desmotabs® 200mcg once daily
  • Desmotabs® 200mcg once daily
  • DesmoMelt® 120mcg once daily
  • Desmotabs® 400mcg once daily
  • Combination of the alarm and DesmoMelt® 240mcg once daily

Written by Fatima Sazzad, GPhC Reg No. 2212805

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