Primary FRCA Pharmacology: What to Study and How
Pharmacology is exactly one third of the Primary FRCA MCQ — 30 of the 90 questions. The questions reward precise mechanisms and numbers, not vague familiarity, which makes pharmacology one of the most revisable subjects on the paper if you study it systematically.
Key points
- 30 of 90 MCQ questions — equal weight with physiology and physics
- Pharmacokinetics and pharmacodynamics are examined every diet
- Mechanism, dose, and side-effect profiles of core anaesthetic drugs
- Numbers matter: half-lives, volumes of distribution, MAC values
What the syllabus covers
The pharmacology third of the paper spans general pharmacological principles and the specific drugs used in anaesthetic practice. The RCoA syllabus expects both: you will be asked about first-order kinetics in one question and the mechanism of rocuronium in the next.
- Pharmacokinetics: absorption, distribution, metabolism, elimination; first- and zero-order kinetics; half-life and context-sensitive half-time
- Pharmacodynamics: receptor theory, agonists and antagonists, dose-response curves, therapeutic index
- Intravenous and inhalational anaesthetic agents, including MAC and factors affecting it
- Neuromuscular blocking drugs and reversal agents
- Opioids and other analgesics, local anaesthetics and their toxicity
- Cardiovascular drugs: inotropes, vasopressors, antihypertensives, antiarrhythmics
- Drugs acting on the CNS, autonomic nervous system, respiratory and gastrointestinal systems
How the questions are pitched
Primary FRCA pharmacology questions are precise. You are more likely to be asked which statement about a drug's mechanism is correct than to be asked to recognise the drug from a vignette. Curve sketches, receptor subtypes, and comparative properties between drugs in the same class are recurring themes.
Comparisons are a favourite format: rocuronium versus suxamethonium onset, sevoflurane versus desflurane blood:gas solubility, morphine versus fentanyl pharmacokinetics. Revise drugs in tables against each other, not in isolation.
How to revise pharmacology
Start with general principles — kinetics and dynamics appear in every diet and unlock the logic behind the drug-specific questions. Then work drug class by drug class: read a structured tutorial, test it immediately with questions, and review every incorrect answer before moving on.
For every core drug, fix five things in memory: mechanism, onset and duration, route of elimination, significant side effects, and one number (half-life, MAC, toxic dose) that distinguishes it from its neighbours.
Free tutorials on this topic
- Minimum alveolar concentration (MAC) — potency, MAC-awake, MAC-BAR and the factors that shift it.
- Suxamethonium — mechanism, side effects and the classic exam traps.
- Neostigmine and sugammadex — reversal of neuromuscular blockade compared.
- Local anaesthetic systemic toxicity — recognition and lipid emulsion treatment.
- Nitrates and hydralazine — vasodilator pharmacology in the perioperative setting.
More Primary FRCA guides
- Primary FRCA Pass Mark: How It Is Set and What to Aim For
- Primary FRCA Physiology: What to Study and How
- Primary FRCA Physics and Clinical Measurement: What to Study and How
- Primary FRCA preparation guide — exam structure, timelines and a full revision strategy.
- See the Primary FRCA pass rate — published RCoA figures, first attempt versus all attempts, and trends between sittings.
- Primary FRCA FAQ — format, study time, marking and results.
- Primary FRCA question bank — what's inside and syllabus coverage.
- Free Primary FRCA revision notes — full tutorials, free to read.
Test your knowledge
Reading about the Primary FRCA only gets you so far. Put it into practice with exam-style questions across pharmacology, physiology and physics — three days of full access, no card required.
Last checked against RCoA guidance: 26 August 2026. Pass marks, pass rates and exam regulations for each diet are published by the Royal College of Anaesthetists — always confirm the current position on the official RCoA examinations pages.