Pharmaceutical Care in Respirtory Disease Flashcards
What is the aim of pharmaceutical care in respiratory disease
Our aim is to help patients with respiratory disease to:
• obtain most effective therapy
• understand their disease
• use their medicines appropriately (medicines optimisation)
• experience improved QoL
We can do this by preventing disease, identifying disease and managing diagnosed conditions.
How do we try to prevent asthma and copd in the first instance
Asthma: Encourage breast feeding - protective effect Allergen detection and avoidance Smoking COPD: Prevent smoking
How do we identify underlying disease
If a patient presents with the following, pharmacists may be in a position to identify respiratory diseases Asthma: Frequent ‘chest infections’ Persistent cough Children: Recurrent ‘wheezy bronchitis’ Chest tightness or shortness of breath COPD: Current or ex-smoker Persistent cough Recurrent ‘bronchitis’ in winter Breathlessness on exertion Wheezing
For both, we must be mindful of regular OTC sales/Rx’s for cough medicines and antibiotics
What links can be made between smoking and respiratory disease
Smoking causes 35% of respiratory related deaths each year
COPD is the fourth most common cause of death worldwide
Second hand smoke is related to asthma in both children and adults
What support must pharmacists offer to people with newly diagnosed respiratory disease
Newly diagnosed patients need support: • Ensure understanding of disease, education • Assess prescriptions: o appropriate doses o interactions o sensitivities o Contraindications • Most important - check patients have been shown how to use inhalers/take medicines
Why do we need to councel patients on the correct way to use inhalers
The device is as important as the drug itself!
Device must be:
• Able to effectively deliver drug to the site of action
• Suitable for individual patients to be able to use
What factors must we consider when deciding on the best device for the patient
There are lots of devices available, but there a few factors to consider when making a choice:
• Aerosol or dry powder
• Breath actuated?
• Manipulation of it – is the patient able to (cognitively or physically) use the device?
• Taste
• Is there a dose counter?
What factors influence the prescribing choice of inhaler
• Cost • Patient preference • Assessment of correct use o Consider: - manual dexterity - age - portability - choice of drug may determine inhaler
There is no evidence for using one type of inhaler over another (when the dose and drug is the same)
What are some common errors patients make when using MDIs
Problems commonly occur with:
• Not shaking inhaler before use (drug isn’t well dispersed)
• Inhaling too sharply or at the wrong time (breath doesnt have to be overstated)
• Not holding breathe for long enough after inhaling
What is the difference in drug delivery in patients with good inhaler technique vs poor inhaler technique
With GOOD technique, the patient will get 20% lung disposition.
With BAD technique it can be as little as 5% disposition of drug at the target site.
90% of patients have the wrong technique.
Health professionals have also been shown to have a poor technique, therefore they train patients incorrectly.
What is important to remember when using MDIs and DPIs
MDI – slow and gentle inhalation (normal breath)
DPI – Fast and quick
Both = deep inhalation
What are spacers and what do they help with?
Spacers can help patients get a better outcome from their MDIs e.g. aerochamber, nebuhaler, volumatic
• Avoid need for coordination with MDI
• Increase lung deposition
• decrease deposition in mouth/throat
• Caution! Dry in air after washing with soap and water – don’t towel dry, wash the spacer monthly (no dishwasher due to static electricity)
• Replace every 6-12 months
What are the cautions around nebulisers
- Caution - over reliance (asthma)
- Mixing drugs, compatibility
- Increased side effects compared with inhalers
- Servicing once per year
How are patients supplied with oxygen therapy are what are the cautions
Oxygen cylinders are supplied by commercial company for different parts of England, e.g. Air Products for NW
• GP/hospital uses Home Oxygen Order Form (HOOF) to order
• Provision of advice for patient &/or carer
• Smoking!
What are the general monitoring requirements for patients with respiratory disease
• Changes in prescriptions (escalating/de-escalating therapy)
• Symptoms, including exercise limitation
• Inhaler technique
• Adherence
• Drug/disease interactions e.g. beta-blockers, NSAIDS (negative impact)
• Adverse effects, e.g.
o Beta agonists – tremor
o ICS - thrush, hoarse voice
