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MRCPI Part 2 → Clinical pharmacology and therapeutics

Clinical pharmacology and therapeutics for MRCPI Part 2

Clinical pharmacology and therapeutics accounts for roughly 8% of the MRCPI Part 2 blueprint. This bank has 1 item tagged to it.

How much of MRCPI Part 2 is clinical pharmacology and therapeutics?

Around 8% of the paper, per RCPI examination regulations and training curricula. That weighting is why the DocPasser mock builder samples sections in proportion rather than shuffling everything into one pile — practising a flat distribution trains you for a paper that does not exist.

Verification status. All 3 published figures on this page have been read in the source document and dated above. Source of truth: RCPI examination regulations and training curricula, Royal College of Physicians of Ireland. How we verify.

Sample clinical pharmacology and therapeutics questions

A 78-year-old man on apixaban 5 mg twice daily for atrial fibrillation presents after a fall with a large intracerebral haemorrhage. His last dose was 4 hours ago. Creatinine clearance is 48 mL/min. What is the most appropriate reversal strategy?

  1. Protamine sulfate Wrong. Protamine reverses unfractionated heparin and partially reverses low molecular weight heparin. It has no role with a direct oral anticoagulant.
  2. Idarucizumab Wrong drug target. Idarucizumab specifically reverses DABIGATRAN, a direct thrombin inhibitor. It has no effect on factor Xa inhibitors.
  3. Andexanet alfa where available, otherwise prothrombin complex concentrate correct Correct. Apixaban is a factor Xa inhibitor, and andexanet alfa is the specific reversal agent. Where it is unavailable or not funded, four-factor prothrombin complex concentrate is the accepted alternative, given alongside urgent neurosurgical and blood pressure management.
  4. Intravenous vitamin K and fresh frozen plasma Wrong. That reverses warfarin by replacing vitamin K-dependent factors. Apixaban does not deplete those factors, so neither agent addresses the anticoagulant effect.
  5. Tranexamic acid alone Insufficient as the reversal strategy. It may be used as an adjunct, but it does not neutralise the anticoagulant.

The point: Match the reversal to the mechanism: dabigatran and idarucizumab; apixaban, rivaroxaban and edoxaban with andexanet alfa or PCC; warfarin with vitamin K plus PCC; heparin with protamine. Activated charcoal is worth considering if the last dose was within about two hours.

Source: BSH guideline on the management of bleeding in patients on antithrombotic agents British Society for Haematology · tier 2, specialty society or college

The other sections of MRCPI Part 2

Cardiology · Respiratory medicine · Gastroenterology and hepatology · Neurology · Endocrinology and metabolic medicine · Nephrology · Rheumatology · Haematology · Infectious diseases and tropical medicine · Oncology and palliative care · Dermatology · Clinical sciences and statistics · Acute and critical care medicine

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