Common Registration Assessment · Topic deep-dive
GPhC Cardiovascular Questions
Cardiovascular therapeutics is the single largest clinical content area in CRA Part 2 and a recurring Board of Assessors weak area. The questions below cover the patterns the GPhC has explicitly flagged across the 2025 sittings — heart failure up-titration, stable angina management, antiplatelet duration after coronary intervention, lipid targets, and primary/secondary CVD prevention.
What the GPhC actually tests on this topic
- Heart failure: stepwise pharmacological management (ACE inhibitor / ARB / sacubitril–valsartan, beta-blocker, MRA, SGLT2 inhibitor), titration sequence, contraindications
- Stable angina: first-line beta-blocker or calcium-channel blocker, when to add a long-acting nitrate or nicorandil, when to refer for revascularisation
- Antiplatelet therapy: dual antiplatelet duration after ACS/PCI, single vs dual antiplatelet long-term, switching agents around bleeding events
- Lipid-modifying therapy: NICE statin initiation thresholds, intensification, individualised lipid targets, when to add ezetimibe or a PCSK9 inhibitor
- Primary and secondary cardiovascular prevention: QRISK3 use, when blood pressure or lipids should be optimised further
- Anticoagulation: DOAC choice and dosing by indication, vitamin K antagonist monitoring, switching between agents
Common pitfalls — from the Board of Assessors’ feedback
Heart failure up-titration sequence
Many candidates know the four pillars of heart failure but mistime the up-titration. The Board of Assessors flagged heart failure management in June 2025. Know which agent to start, the typical doubling intervals, and which adverse effects (hyperkalaemia, hypotension, renal decline) gate the next titration step.
Antiplatelet duration after PCI
Dual antiplatelet therapy duration after PCI is decided by stent type, ACS vs stable indication, and bleeding risk. The default-12-months answer is often wrong in exam scenarios — check the specifics in the question stem.
Statin intensity and lipid targets
NICE specifies high-intensity statin doses for both primary and secondary prevention but the lipid target is individualised, not a fixed number. Exam questions test whether you optimise treatment when a target is not met — not whether you can recite a single threshold.
Contraindications and concomitant medication
The June 2025 feedback specifically flagged candidate failure to consider comorbidities and concomitant medication when selecting treatment. Always cross-check against contraindications and clinically significant interactions before committing.
Sample practice questions
CRA-style practice questions, not real exam questions. The Board of Assessors does not endorse third-party question banks.
A clinical pharmacist is reviewing Mr O'Brien, a 57-year-old male with co-existing AF on warfarin (target INR 2.0-3.0), frequent INR fluctuations, and CKD stage 3. Current medications include metformin 1 g BD, gliclazide 80 mg BD, ramipril 5 mg OD, and atorvastatin 40 mg ON. HbA1c 72 mmol/mol. Fasting glucose 12.4. eGFR 45. ACR 8 mg/mmol. In the context of this clinical picture, a patient diagnosed with type 2 diabetes is interested in lifestyle interventions to manage their condition. Which of the following recommendations is NOT appropriate?
- A. Engage in 150 minutes of moderate exercise weekly
- B. Follow a low-carbohydrate diet
- C. Limit alcohol intake to one drink per day
- D. Take a daily multivitamin
- E. Monitor blood glucose levels regularly
Show worked answer
Correct answer: D
Which type of dosage form is suitable for a drug with high first-pass metabolism to achieve systemic effects?
- A. Oral tablet
- B. Sublingual tablet
- C. Topical gel
- D. Rectal suppository
- E. Intramuscular injection
Show worked answer
Correct answer: B
Cardiovascular — frequently asked
How many cardiovascular questions are in the GPhC exam?
The GPhC does not publish a fixed split, but cardiovascular therapeutics is the largest single clinical content area in CRA Part 2 — expect 15–25 of the 120 Part 2 questions to draw on cardiovascular knowledge, often in combination with another comorbidity.
Which cardiovascular guidelines does the CRA test against?
NICE clinical guidelines are the primary reference for cardiovascular therapeutics in the CRA: NG106 (heart failure), CG126 (stable angina), NG185 (acute coronary syndromes), NG196 (atrial fibrillation), CG181 (CVD risk assessment and lipid modification). The BNF cardiovascular chapters are the day-to-day reference.
What is the most common cardiovascular weak area?
The Board of Assessors’ June 2025 feedback named heart failure and stable angina management explicitly, with particular emphasis on selecting treatment in the presence of comorbidities and concomitant medication, and on advising primary and secondary CVD prevention including antiplatelet therapy and lipid-modifying therapy.
Does the CRA test ECG interpretation?
Not directly. ECG interpretation is not in the CRA framework. Questions may reference ECG findings (e.g. atrial fibrillation diagnosed on ECG) as part of a scenario, but they will not ask you to interpret a raw trace.
How should I revise cardiovascular for the GPhC exam?
Work in this order: BNF chapter 2 (cardiovascular system) start to finish, then NICE NG106 (heart failure), CG126 (angina), and CG181 (lipid modification). Build a flashcard deck on antiplatelet duration rules, statin intensity tables, and DOAC dosing by indication. Then drill 50–80 mixed cardiovascular practice questions with a mistake log.
Practise cardiovascular questions in context
Across the full bank of GPhC exam questions — every format, with worked answers grounded in the Board of Assessors’ published feedback.