Genito-Urinary, Renal and Reproductive Health in the GPhC Assessment

Scope and time budget

Questions here usually concern avoiding harm in a vulnerable population: someone with reduced kidney function, someone who is pregnant or breastfeeding, or someone who needs emergency contraception.

What is tested

• Chronic kidney disease. Nephrotoxic drugs and dose adjustment.
• Acute kidney injury. Sick-day guidance.
• Prostate and erectile dysfunction. Benign prostatic hyperplasia and erectile dysfunction treatments.
• Bladder. Urinary incontinence and overactive bladder with antimuscarinics.
• Pregnancy. Safe and unsafe medicines.
• Breastfeeding. Medicines and infant exposure.
• Fertility and menstrual disorders. Treatment principles.
• Vaginal infections and thrush. OTC supply rules and referral.
• Contraception. Hormonal and non-hormonal counselling.
• Termination of pregnancy. The pharmacist's conscientious objection duties.

UK guideline anchors

• Emergency contraception (checked). Copper IUD within 5 days (120 hours), levonorgestrel within 3 days (72 hours) and ulipristal acetate within 5 days (120 hours), free from most pharmacies including for those under 16.
• Valproate (checked). A pregnancy prevention programme for girls and women who could become pregnant.
• UKMEC. FSRH categories for contraception.
• Pharmacy First (checked). Uncomplicated UTI in women aged 16 to 64.
• BNF. Renal and pregnancy advice for each drug, and breastfeeding information.

Kidney disease and prescribing

Renal questions are about avoiding harm. In chronic kidney disease, know which commonly used medicines are nephrotoxic or need dose reduction: NSAIDs, some antibiotics, metformin at low kidney function, and drugs cleared by the kidney such as digoxin and some anticoagulants. In acute kidney injury, know the sick-day advice that applies to certain medicines during dehydrating illness. Questions often give a creatinine or an estimated clearance and ask you to choose a dose, a different drug or a referral. See the calculations page for the estimate itself.

Pregnancy, breastfeeding and fertility

Pregnancy items ask which medicine is safe and which is not, and what to advise. Valproate is the headline example, but know others with specific risks and the preferred alternatives, from the BNF. For breastfeeding, most medicines are compatible, and the question is usually about the few that are not or that need monitoring of the infant. Use the BNF and specialist resources, not memory, for specifics. Folic acid advice before and during early pregnancy, and the reasons some women need a higher dose, are standard counselling points.

Emergency contraception is checked: copper intrauterine device within 5 days (120 hours), levonorgestrel within 3 days (72 hours) and ulipristal acetate within 5 days (120 hours), supplied free from many pharmacies including to those under 16. A pharmacist with a conscientious objection must signpost promptly to another provider, which is both a legal and a professional duty. Confirm the current GPhC guidance on religion, personal values and beliefs.

Urological and gynaecological conditions

For benign prostatic hyperplasia, know the alpha-blocker and 5-alpha-reductase inhibitor classes and their main effects, including postural hypotension. For overactive bladder, know the anticholinergic burden in older people. For vaginal thrush, know which products are available over the counter and when to refer, for example recurrent infection, pregnancy, or a first episode. Erectile dysfunction questions combine safety (nitrates and phosphodiesterase inhibitors) with supply rules.

Counselling points that earn marks

• Kidney disease. Avoid NSAIDs unless advised, stay hydrated, and follow the sick-day guidance for medicines such as ACE inhibitors, diuretics and metformin.
• Pregnancy. Take folic acid as advised, check every new medicine, including OTC products and herbal remedies, and do not stop a necessary long-term medicine without advice.
• Breastfeeding. Most medicines are compatible, and the question is usually about the few that are not.
• Emergency contraception. Take it as soon as possible, check whether the method fits the time since sex and the patient's other medicines, and advise on follow-up testing and ongoing contraception.

Children and young people

Young people can ask for emergency contraception, and the supply is free, including to those under 16. The pharmacist's role includes confidentiality, an assessment of capacity and maturity, and safeguarding if there are concerns about exploitation or abuse. Paediatric urinary tract infection and bed-wetting medicines can also appear, with doses from the BNFc.

Sexual health in community pharmacy

Pharmacists meet requests about sexually transmitted infections, erectile dysfunction and contraception. The best answers protect confidentiality, avoid assumptions, give clear advice on testing and treatment pathways, and signpost to sexual health services when needed. For erectile dysfunction treatments, check for nitrates, because the combination can cause severe hypotension. For thrush, refer in pregnancy, in young girls, in recurrent cases and in the first episode if the diagnosis is uncertain.

Three typical traps

1. The estimate trap. Weight, age and creatinine change the dose band. Use the estimate in the stem, not a guess.
2. The pregnancy trap. A drug may be fine for the mother's condition and unsafe in pregnancy. Check the trimester and the alternative.
3. The referral trap. Recurrent or atypical symptoms need referral, not repeat OTC treatment.

How to revise it

1. Make a renal list. Drugs to avoid, reduce or monitor in CKD.
2. Make a pregnancy list. Medicines to avoid and their preferred alternatives.
3. Practise estimates. Calculate clearance and apply a dose band.
4. Learn the services. Contraception and emergency contraception supply.
5. Check the professional duty. Conscientious objection and signposting.

Continue with blood, nutrition, immune system and malignant disease. See the clinical evaluation domain for prescription review. Back to the hub.