Blood, Nutrition, Immune System and Malignant Disease: GPhC Content Guide

Scope and time budget

Questions focus on safety: dosing intervals, monitoring, handling, emergencies and counselling.

What is tested

• Anaemias. Iron, vitamin B12 and folate treatment.
• Haematological malignancy. Chemotherapy safety.
• Cytotoxics. Methotrexate weekly dosing and safety.
• Oral anticancer drugs. Handling and counselling.
• Immunosuppressants. Transplant medicines.
• Biologics. Monoclonal antibodies.
• Vitamins and minerals. Supplements and deficiency.
• Nutrition. Enteral and parenteral nutrition.
• Allergy and anaphylaxis. Adrenaline auto-injectors.
• Supportive care in cancer. Antiemetics.
• Palliative care. Syringe drivers and end-of-life medicines.
• Neutropenic sepsis. Recognition and urgent action.

UK guideline anchors

• Methotrexate (to confirm). Once-weekly dosing for inflammatory conditions, with safety alerts about daily prescribing errors. Check the BNF and current alerts.
• MHRA. Drug Safety Updates and the Yellow Card scheme for adverse reactions.
• BNF and BNFc. Doses, handling and monitoring.
• Anaphylaxis. Intramuscular adrenaline is first line, and patients should carry two auto-injectors.
• Pregnancy. Many cytotoxics and immunosuppressants need effective contraception and specific advice.

Methotrexate and cytotoxic safety

Methotrexate is on the framework's list of high-risk drugs. For inflammatory conditions it is taken once a week, so a daily prescription is a serious error that has caused deaths. Learn the monitoring (blood counts and liver and kidney function), the symptoms patients must report (sore throat, fever, mouth ulcers, breathlessness, unusual bruising), the usual folic acid arrangement, and the interactions, particularly trimethoprim and co-trimoxazole. Confirm details in the BNF and in current safety alerts. Oral anticancer drugs need safe handling by pharmacy staff and clear patient counselling on schedules, which are often cyclical.

Anaemia, vitamins and nutrition

Know how to treat and counsel on iron, vitamin B12 and folate deficiency. Oral iron causes constipation and dark stools, is best absorbed away from certain foods and drinks, and should be kept away from children because of overdose danger. Vitamin B12 deficiency may need injections or high-dose oral therapy depending on the cause. Folic acid in pregnancy follows its own advice. Enteral and parenteral nutrition appear as calculations and as compatibility and safety questions.

Allergy, anaphylaxis and palliative care

Anaphylaxis is a medical emergency. Know that intramuscular adrenaline is the first-line treatment, the role of auto-injectors, the need to carry two, how to use the device and the importance of calling for help. In palliative care, questions concern syringe drivers, anticipatory medicines, opioid conversion, and the priority of comfort. Neutropenic sepsis is a time-critical emergency in anyone receiving chemotherapy with a fever, and the right pharmacist response is urgent referral.

Counselling points that earn marks

• Methotrexate. Take on the same day each week, report infection symptoms promptly, avoid live vaccines, and do not take trimethoprim or co-trimoxazole without advice.
• Iron. Expect dark stools and constipation, keep out of the reach of children, and separate from certain medicines.
• Adrenaline auto-injectors. Carry two, know how to use them, check the expiry date, call for help after use and go to hospital.
• Immunosuppressants. Avoid certain vaccines and live products, report infections early, and do not change brands or doses without advice for narrow therapeutic index drugs such as ciclosporin.
• Chemotherapy. Follow the cycle schedule, record temperature, and know the number to ring.

Parenteral drugs and nutrition

Parenteral drugs are on the framework's list of high-risk groups. Questions focus on route, dilution, compatibility, rate and labelling, and they overlap with the infusion calculations in the calculations domain. For parenteral nutrition, know that the formulation is complex, that electrolytes, trace elements and vitamins are involved, and that aseptic preparation and stability limit what can be added.

Children

Paediatric oncology and allergy content is specialist, but the principles are general: doses by body surface area or weight, strict dosing intervals, safe handling, and clear instructions for parents. Vitamin D, iron and other supplements have age-specific advice, and an overdose of iron in a child is an emergency.

If you have only an hour

Spend 25 minutes on methotrexate and the safety rules for cytotoxic and oral anticancer drugs. Spend 15 minutes on anaphylaxis, neutropenic sepsis and palliative care emergencies. Spend 10 minutes on iron, vitamin B12 and folate. Spend 10 minutes on parenteral nutrition and infusion safety. Then answer a short mixed set. Because the area carries high-risk drugs, a small amount of exact knowledge here earns more than its weighting suggests.

Also check the immunisation rules for people on immunosuppressants: live vaccines are generally avoided, while inactivated vaccines are encouraged. Confirm the details in the UKHSA Green Book.

Three typical traps

1. The weekly-dose trap. A once-weekly medicine written as daily is an error. Check the frequency before anything else.
2. The fever trap. A fever in a person on chemotherapy is an emergency, not a minor ailment.
3. The handling trap. Cytotoxics need safe handling by staff and carers, and patients need clear storage and disposal advice.

How to revise it

1. Make a methotrexate sheet. Dose frequency, monitoring, symptoms to report and interactions.
2. Learn the emergencies. Anaphylaxis and neutropenic sepsis, one page each.
3. Revise nutrition calculations. Fluid, electrolytes and parenteral nutrition.
4. Revisit counselling. Iron, B12 and adrenaline devices.
5. Use mixed sets. Combine cancer, immune and blood items.

Continue with musculoskeletal, skin, eye, ear, nose, oropharynx and anaesthesia. See high-yield topics and the hub.