The GPhC Exam: Infection
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What are the key topics in Infection?
Infections are not only caused by bacteria – which is probably the first thing many think of when they hear the word “infection”. In fact, infections can be caused by a range of microorganisms, hence will need to be treated by different types of drugs. The main components of this part of the GPhC exam will include the following drug groups: antibacterial, antifungal, antiviral, antiprotozoal (i.e. used to treat “tropical infections” such as Malaria), and anthelmintics (i.e. to treat Helminth infections that are caused by parasitic worms).
Some of the common infections that may appear in the exam (but of course are not limited to) include: candidiasis, Helicobacter pylori, acne, cellulitis, Herpesvirus, Malaria, urine tract infections, sexually transmitted infections/diseases.
In comparison to the other groups in this section, antibacterial therapy predominates in Chapter 5 of the British National Formulary (BNF) with the largest range of drug classes. Some drug classes i.e. penicillins, macrolides, and cephalosporins, will commonly appear in your everyday work. On the other hand, a drug like Gentamicin which is classed as an aminoglycoside is usually a treatment option for more severe cases.
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- Do not focus all of your energy on just antibacterial therapy. Although it is undoubtedly a very large segment, do not forget that there are other types of infections and drug groups in this section – and it is high likely that these will appear in your day-to-day practice as a pharmacist.
- For each infection treatment subsection, it may be ideal to create comparison tables. For example, the BNF has very useful and detailed information on antibacterial prophylaxis for various infections and indicates first/second line options. For some of us, we may feel a little overloaded when we come across masses of information. Therefore, try to condense the information into (a) table(s), and this should support you in comparing the different infections and treatment options available.
- Create a separate revision source for over-the-counter pharmacy products that are related to this section. Ensure you understand the counselling and legal sales aspects for each drug.
- Throughout your pre-reg placement you may find that you/your colleagues need to complete local/national audits at some points in the year. For instance, you may be required to complete an audit on the public requesting a medication or advice for winter viral infections. Use such opportunities to learn more about the topic of focus, since the audits will usually have pre-set questions/guidelines to follow (and may even require the pharmacy team to do some background reading prior to starting the audit) therefore, you can learn a lot from simply participating in them.
- As with all topics, try to make links and relate different topics to one another.
- Allergies and anaphylaxis fit in well within this area. For example, if a patient has a known drug allergy (mild or severe) what would be an alternative treatment option for this individual? What is a true allergy and what is a simple intolerance, and does this make a difference in a life and death situation when you need to treat a patient with a specific drug? These kinds of questions, or scenarios, can be solved by understanding the rationale behind a prescriber’s choice of drug.
- A second example could be between Candida infections and type 2 diabetes or the use of inhaled corticosteroids in Asthma. As a pharmacist, being able to divulge into a given situation and reveal further facts about it very often makes a huge difference in providing the appropriate care for an individual.
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Drugs that require monitoring in this section
In general, antibiotics are classed as a high-risk topic in the GPhC exam and infection is also categorised as a high-weighted segment. The following example indicates a tetracycline that may require monitoring of certain parameters if a patient is taking the drug for a period of longer than 6 months.
What is it used for?
Cautions & Monitoring
(Very) common side effects
· Binds to 30S ribosomal subunit of susceptible bacteria.
· Inhibits protein synthesis of bacteria thus, usually bacteriostatic.
· Susceptible infections (i.e. chlamydia, gonorrhoea, pelvic inflammatory disease, rickettsia, mycoplasma)
· Myasthenia gravis
· Systemic lupus erythematosus
· Nausea, vomiting, diarrhoea
· Hypersensitivity reaction i.e. rash, exfoliative dermatitis
· Photosensitivity reactions
· Exacerbation of systemic lupus erythematosus
- Mr D will receive Ganciclovir at a dose of 5mg/kg every 12 hours. Mr D weighs 82kg. Calculate the rate of IV infusion in micrograms per minute for the 12-hour period.
- Patient T has been diagnosed with Impetigo for which hydrogen peroxide has been used however, the treatment was ineffective. Which of the following topical treatments would be the most appropriate to use as a next step?
- Fusidic acid
Written by Fatima Sazzad, GPhC Reg No. 2212805
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