OPRA Therapeutics for Body Systems: Heart, Lung, Endocrine, Renal and Gut

Weight and time budget

The APC says therapeutics and patient care is 45% of OPRA, about 54 questions. We divide it into three study blocks of about 18 questions each. That split is ours, not the APC's, so the real proportion in a given exam version may differ. Nine of the APC's 25 sample questions were therapeutics, and several fall in this block, such as warfarin management, gout and an insulin regimen. Give this block about two weeks in a 12-week plan.

What is tested

• Cardiovascular. Hypertension, heart failure and angina therapy. Atrial fibrillation and anticoagulation. Dyslipidaemia and cardiovascular risk reduction. Venous thromboembolism treatment and prophylaxis.
• Respiratory. Asthma therapy and inhaler technique. COPD management.
• Endocrine and metabolic. Type 2 diabetes medicines and insulin regimens. Hypoglycaemia and diabetic emergencies. Thyroid disease therapy. Osteoporosis therapy. Gout and hyperuricaemia.
• Renal. Chronic kidney disease and medicines in renal impairment.
• Gastrointestinal. Gastro-oesophageal reflux, peptic ulcer and Helicobacter pylori eradication. Inflammatory bowel disease and irritable bowel syndrome. Constipation, diarrhoea, and nausea and vomiting.

The APC describes therapeutics as the safe and effective use of medicines, extended to populations that need extra consideration, plus screening, primary health care, harm minimisation, health promotion and confidentiality. The other two therapeutics blocks are infections, CNS, pain, skin and oncology and calculations, screening and safe use.

Local guideline points

• Therapeutic Guidelines and the AMH are the Australian references for treatment choice and drug detail. Where a textbook from another system differs, the Australian source is your anchor.
• Anticoagulation: a typical INR target for most warfarin indications is 2.0 to 3.0. Management of a high INR depends on the INR value and on whether there is bleeding. Confirm the thresholds and reversal in the AMH.
• Inhalers: device technique and choice of reliever and preventer are common themes. Questions test counselling points, such as rinsing the mouth after an inhaled corticosteroid and the use of a spacer.
• Diabetes: hypoglycaemia management and sick-day rules matter in practice and in exam stems. Glucose targets and thresholds are in the Australian guidance, not in this page.
• Subsidy: PBS listing can be mentioned as context. The APC says legislation and practice standards are not tested, so questions should not depend on subsidy rules.
• Units: glucose and creatinine in SI units, drugs by TGA-approved names, and "units" written in full for insulin and heparin.

Three typical traps

1. Choosing the drug you use at home. First-line classes differ between systems. A stem that gives patient characteristics is usually asking for the choice that fits those characteristics under Australian guidance. Read for the clue: comorbidity, pregnancy, renal function, interactions.
2. Forgetting the renal check. Many drugs in this block (metformin, NSAIDs, ACE inhibitors, digoxin, DOACs, antidiabetic agents) need a renal consideration. A stem with a reduced eGFR or creatinine clearance is a signal to adjust, avoid or monitor.
3. Missing the interaction hidden in the stem. A new antibiotic, azole or NSAID in the medication list is often the point of a warfarin or lithium question. Scan the whole medicine list before choosing.

Self-check before you move on

You are ready to leave this block when you can do each of the following without notes. If you cannot, return to that point before taking more mixed blocks.

• Give the first-line drug class for hypertension, heart failure, angina and atrial fibrillation, and the main monitoring point for each.
• Explain the stepwise approach to asthma and the reliever versus preventer roles.
• Name the main options for type 2 diabetes, their main hazards, and what to do for hypoglycaemia.
• State which common drugs need dose adjustment or avoidance in chronic kidney disease.
• Describe the aim and the main regimen features of Helicobacter pylori eradication, and check the exact drugs in the guideline.
• Say how to treat an acute gout flare, and what changes when starting long-term urate-lowering therapy.
• List the counselling points for an inhaler, insulin pen and warfarin.

Add condition cards for any topic that you cannot summarise in four lines.

How to revise this block

1. Make a one-page decision card per condition. Diagnostic hint, first-line class, alternatives, monitoring, drugs to avoid, referral triggers.
2. Work by system, with five questions a day on the system. Review each error and rewrite the card.
3. Use patient cases. Write a short case yourself for each condition with one complication, such as renal impairment, and decide what changes.
4. Practise counselling points. Inhaler use, insulin storage and injection technique, warfarin diet and bleeding advice, and glyceryl trinitrate use and storage.
5. Cross-link to pharmacology. For each drug on a card, check that you can state its mechanism and main hazard from pharmacology and toxicology.

The ranking of conditions by study priority is in high-yield topics, and the timing is in the study plan. The full blueprint is on the OPRA hub.