Cardiovascular System: What the GPhC Registration Assessment Asks

Scope and time budget

Expect a mix of treatment choice, monitoring, counselling and safety. Heart disease is common in community pharmacy, so scenarios often start at the counter: a patient with a new prescription, a missed dose, a bleeding symptom or an over-the-counter purchase that interacts.

What is tested

• Hypertension. The NICE pathway, thresholds, monitoring and the choice of drug by age and ethnicity.
• Heart failure. Drug therapy, electrolyte and renal monitoring, and sick-day advice.
• Atrial fibrillation. Rate control and anticoagulation, with risk scoring and counselling.
• Anticoagulants. Warfarin, DOACs and LMWH, including interactions, bleeding advice and reversal.
• Antiplatelets. Therapy after acute coronary syndrome and stroke, and gastro-intestinal protection.
• Acute coronary syndrome. Secondary prevention and patient counselling.
• Lipids. Statins, ezetimibe, interactions and counselling.
• Angina. Treatment, nitrate tolerance and the use of sublingual GTN.
• Diuretics, ACE inhibitors and ARBs. Electrolyte monitoring and interactions.
• Antiarrhythmics. Amiodarone and digoxin monitoring and interactions.
• Venous thromboembolism. Treatment and prophylaxis.
• Peripheral arterial disease and Raynaud phenomenon. Drug and lifestyle management.
• Interactions and contraindications. Combinations that raise bleeding, potassium or QT risk.

UK guideline anchors

• NICE hypertension guideline (to confirm). Stage 1 hypertension thresholds are 140/90 in clinic and 135/85 on ambulatory or home monitoring. ACE inhibitor or ARB is first line under 55 and not of Black African or Caribbean origin, and a calcium-channel blocker for those over 55 or of Black African or Caribbean origin. Verify in the current guideline.
• Warfarin (to confirm). Target INR is typically 2.0 to 3.0, with a higher target for some mechanical valves. Interactions with macrolides, azoles, metronidazole and rifampicin are well known.
• BNF. Doses, renal adjustments and cautions for each drug.
• Counselling. Missed doses, bleeding warning signs, potassium-containing products and sick-day rules for ACE inhibitors, ARBs and diuretics.
• Children. Cardiovascular drugs in children follow BNFc doses and are rare, but anticoagulant and diuretic calculations by weight are possible.

Anticoagulants in more detail

Anticoagulants are on the framework's high-risk list, so expect at least one question. Think about them in four layers. First, choice: warfarin, a direct oral anticoagulant or low molecular weight heparin, depending on the indication, renal function and interactions. Second, monitoring: INR for warfarin, and renal function and weight for direct oral anticoagulants. Third, interactions: antibiotics, antifungals, antiplatelets, NSAIDs and herbal products. Fourth, counselling: missed doses, signs of bleeding, procedures, alert cards and what to do after a fall or head injury.

When a question gives you an INR, read the target range, the result and the bleeding status. A high INR with no bleeding and a high INR with bleeding lead to different actions. Check reversal and escalation advice in the BNF or local guidance rather than from memory.

Antihypertensives and monitoring

ACE inhibitors, ARBs and diuretics all change potassium and kidney function. Questions typically give a recent blood result or a new interacting medicine, and ask what to do. Know the sick-day principle: during dehydrating illness such as vomiting or diarrhoea, some patients are advised to pause these medicines temporarily and restart after recovery, and to seek advice if unwell for more than a short time. Confirm the exact advice in current guidance. Also know the cautions in pregnancy, which exclude ACE inhibitors and ARBs.

Cardiovascular drugs in children and pregnancy

About one item in five involves a child. Cardiovascular items for children are less common, but diuretic and anticoagulant dosing by weight is a sensible area to practise. For pregnancy, know which cardiovascular medicines are avoided and which are preferred for hypertension, and use the BNF for specifics.

Lipids, angina and secondary prevention

Statin questions usually test interactions and counselling: the macrolide or azole that raises statin exposure, the muscle symptoms to report, and timing advice for certain statins. Angina questions test the practical use of sublingual GTN, including how to take it, when to repeat it and when to call for help, plus the idea of nitrate-free periods for some long-acting preparations. After a heart attack or stroke, know the standard secondary prevention bundle of antiplatelet therapy, a statin, blood pressure control and lifestyle advice, and the usual reasons a patient might be on dual antiplatelet therapy for a time-limited period. Use the BNF for specific durations.

Three typical traps

1. The NSAID trap. A patient on an anticoagulant, an ACE inhibitor or a diuretic asks for an NSAID. The answer is rarely to supply it.
2. The monitoring-date trap. Questions give a result, such as potassium or INR, and ask for the action. Know the thresholds and the interacting drug.
3. The wrong-class trap. Choosing the first-line class without checking age, ethnicity, pregnancy or renal function in the stem.

How to revise it

1. Learn pathways as flowcharts. Hypertension, heart failure and AF, one page each.
2. Pair every drug with one interaction. For example, anticoagulant and antibiotic, ACE inhibitor and potassium.
3. Practise counselling statements. Write the two points a patient must hear for each drug.
4. Do mixed sets. Thirty questions with anticoagulants, antihypertensives and diuretics together.
5. Revisit through calculations. Practise renal function estimates and unit doses.

Continue with nervous system and endocrine, the other high-weighted areas. See high-yield topics for the full ranking, or return to the hub.