This paper covers the following areas as listed on the PPBHK website:

General principles of pharmacology

• Drug receptors and pharmacodynamics:
• Pharmacokinetics: Absorption, Distribution, Metabolism and Excretion
• Basic and clinical evaluation of new drugs
• Individual variation and drug interaction (e.g. pregnant women, elderly, adolescent, infant, etc…)

Autonomic nervous system

• Chemical transmission and the autonomic nervous system
• Cholinergic transmission and cholinoceptor-blocking and activating agents
• Adrenergic transmission and adrenoceptor-blocking and activating agents

Cardiovascular system

• Antihypertensive agents
• Vasodilators and the treatment of angina pectoris
• Drugs used in congestive heart failure
• Agents used in cardiac arrhythmias
• Treatment of dyslipidaemias
• Diuretics and drugs affecting renal excretion

Central nervous system

• Sedatives, hypnotics and anxiolytics
• Antiepileptic drugs
• General and local anaesthetics
• Skeletal muscle relaxants
• Pharmacologic management of Parkinsonism and other movement disorders
• Antipsychotic agents
• Antidepressant agents
• Drugs of abuse

Chemotherapeutic agents

• Antibacterial agents
• Antiviral agents
• Antifungal agents
• Antiprotozoal and authelmintic agents
• Disinfectants and antiseptics
• Cancer chemotherapy and immunosuppression

Agents used in the treatment of diseases of the blood

• Agents used in anaemias
• Drugs used in disorders of coagulation

Arthritis and anti-inflammatory agents

• Nonsteroidal anti-inflammatory drugs, non-opioid analgesics, drugs used to treat gout

Endocrine drugs

• Hypothalamic and pituitary hormones, sex hormones, contraception
• Adrenal corticosteroids, antagonists, corticotrophin
• Diabetes mellitus, insulin, oral antidiabetic agents
• Thyroid and antithyroid drugs
• Agents that affect bone mineral homeostasis

Gastro-intestinal system

• Drugs for peptic ulcers
• Antiemetic and prokinetic drugs
• Drugs used in constipation, diarrhoea and abnormal gut motility
• Drug-induced liver injury and changes in drug handling in liver diseases, treatment of liver diseases

Respiratory tract

• Drugs used in the management of asthma
• Cough suppressants, antihistamines, mucolytics and expectorants

Skin

• Transdermal drug absorption and dermal adverse drug reactions
• Antipruritics, adrenocortical steroids
• Sunscreen and sunburn
• Treatment of specific skin disorders

Toxicology

• Management of the poisoned patient
• Chelators and heavy metal intoxication and other antidotes

Miscellaneous

Nutrition

• Vaccine and immunoglobulins

Exam Strategy

The pass rate of this paper has been the lowest out of all three papers (as low as 8% in one recent year). Taking both the pharmacology paper and the pharmacy practice paper will save you time since similar essay questions can be appeared in both papers, e.g. pharmacological treatment regimen on clinical case, responding to symptoms and drug interactions. The syllabus for this paper covers nearly every clinical condition and some candidates found unexpected questions appeared in the exam.

This paper consists of 5 short essay questions, each with a score of 20%. I have tried to summarise the most common knowledge area below as a brief guidance.

I – Clinical Case and Responding to Symptoms:

You need to understand very thoroughly about each health condition and its treatment for answering these questions. There is no shortcut for the revision of this part however you would notice there are some “hot” conditions which were appeared quite a number of times in the past papers. Sometimes questions only focus on specific drugs and their associated side effects / mechanisms, e.g. on NSAID, Corticosteriod, Beta-Blocker etc… Below are the revision areas generally questioned in the case questions:

• Pharmacological treatment regimen (e.g. 1st to 4th line treatment, combination of drug, dose, dosage form)
• Mechanism of action (e.g. the cascade of COX-2 inhibitors)
• Clinical indications (e.g. Beta-blocker’s major clinical indications)
• Role (e.g. to reduce night symptoms in Parkinson’s Disease)
• Side effects and measures to reduce them (e.g. postural hypotension, to be taken when sitting upright at a relax position and no vigorous exercise afterwards)
• Advices and considerations (e.g. lifestyle advices for COPD – vaccination, smoking cessation, use of spacer for inhaler etc…)
• Monitoring (e.g. serotonin syndrome symptoms)
• Interactions (e.g. food-drug, herbal-drug, drug-drug)
• Clinical study data and outcome (I did not manage to revise on this)
• Cost-effectiveness / Efficacy / Risk-benefits / Safety (I did not manage to revise on this)

II – Toxicology: 

This question has been appeared in every year of past papers, which ask about the toxic effect, general and specific management of drug overdosing on 4 drugs / poisons. Some candidate would be struggled about this area since toxicology has not been covered in their pharmacy course.

Here I have drafted a sample answer to question on the drug – Amitriptyline:

Amitriptyline is a Tricyclic Antidepressant with the toxic effects of anti-cholineric effects, respiratory failure, convulsion, arrhythmia and low temperature. When the patient has been overdosed, we should clear the patient’s airway immediately and allow ventilation to correct hypoxia and acidosis. 50g of activated charcoal shall be taken by the patient orally within 1 hour, which could bind to the poisons in GI tract.  On the other hand, to control the symptom of convulsion, intravenous diazepam shall be given. Moreover, intravenous sodium bicarbonate can also be given to control the potential arrested arrhythmia.

III – Pharmacokinetics and Pharmacogenetics:

Questions on the pharmacokinetics change in different populations were asked in the past papers, e.g. on pregnant women, elderly, adolescent and infant. This initial question would lead to subsequent questions on the examples of drug that should be used in cautions in particular population group, and to justify how the interaction between the mechanism of drug and pharmacokinetic  changes leading to the anticipated adverse effect.

Questions on the pharmacogenetics and teratogenicity of drugs are often appeared:

e.g. Brief answer on the genetic marker of the severe side effect complication of Carbamazepine:

The allele of Human Leukocyte Antigen [HLA] – B*1502 increases the risk of getting severe skin allergy from taking Carbamazepine by 72 times. Patients with Chinese origin have the highest chance of carrying this allele

IV – Pharmacodynamics and Drug Interactions:

Questions on herb-drug, food-drug, drug-drug, gene-drug interactions could be appeared.

Below are some very brief examples of interactions:

e.g. Broccoli increases vitamin K in our body and reduces the efficacy of Warfarin

e.g. Grapefruit juice inhibits CYP3A (R)-W

e.g. Cranberry juice inhibits CYP2C9 (S)-W

V – Anti-bacterials and Anti-fungals

Clinical cases on antibiotics have been appeared quite frequently on past papers. Over 15 different classes of antibiotics could be used to treat different infectious condition (e.g. pyelonephritis, tuberculosis, endocarditis) through different combination regimen and mode of actions, it can be sometimes confusing for candidates to memorise and could mix up the antibiotics with one another.

VI – Liver and Kidney

• Cause of acute and chronic toxicity
• Mechanism of acute and chronic toxicity
• pharmacokinetics effect (ADME) due to function impairment

Exam Tips and Study Kit:

A study kit for the pharmacy pharmacology exam paper is available, please message me for more details.