Pharmaceutical Care of Respiratory Patients community 1

Question 1

cough mixtures containing what should not be recommended to patients with Respiratory Diseases?

Answer 1

1) Do not recommend cough mixtures containing respiratory depressants
2) Be more ready to refer if worsening of condition

Question 2

what are the Red Flag Symptoms for a cough in patients suffering with a Respiratory Condition?

Answer 2

1) Chest pain/pain on breathing in
2) Wheezing/SOB
3) Chronic cough (>3 weeks)
4) Recurring cough
5) Haemoptysis (coughing up blood).
6) Weight loss
7) Purulent sputum
8) Fever

Question 3

what are the recommended OTC treatment options for a Cold in Patients with a Respiratory Disease?
- also outline what should be avoided in certain conditions

Answer 3

1) Avoid respiratory depressants: No cough suppressants or antihistamines
2) Asthma: Avoid NSAIDS
3) Recommend
- Paracetamol
- Honey and lemon
- Steam inhalation

Question 4

How would you treat a strains or sprains in Patients with a Respiratory Disease, specifically COPD?

Answer 4

1) Can use NSAIDS if no other cautions/ contra-indications

2) Paracetamol

Question 5

How would you treat a strains or sprains in Patients with a Respiratory Disease, specifically Asthma?

Answer 5

1) Paracetamol

2) Co-codamol if respiratory function OK

Question 6

outline the treatment options suitable for head lice in Patients with Asthma?
- what should be avoided

Answer 6

1) no Alcoholic solutions: Evaporating alcohol can irritate lungs and cause wheezing
2) Aqueous solutions: Don’t irritate skin or lungs e.g. Hedrin

Question 7

outline the suitable treatment options to manage Hayfever in Patients with Respiratory Diseases.
- list two suitable antihistamines

Answer 7

1) Sedating antihistamines: Not recommended in respiratory conditions due to anticholinergic effects
2) Non-sedating: Cetirizine, Loratadine
3) Topical preparations: Nasal corticosteroids, Eye drops

Question 8

if a respiratory patient presents with Tremors/ Palpitations what could this be a side effect of, and how should it be managed?

Answer 8

1) side effect from: Salbutamol, theophylline

2) Review treatment

Question 9

if a respiratory patient presents with Tiredness what could this be a side effect of, and how should it be managed?

Answer 9

1) Deterioration in COPD – lack of oxygen

2) Refer

Question 10

if a respiratory patient presents with Nausea what could this be a side effect of, and how should it be managed?

Answer 10

1) Side effects of drugs e.g. theophylline

2) Check levels

Question 11

if a respiratory patient presents with Heartburn what could this be a side effect of, and how should it be managed?

Answer 11

1) oral prednisolone, theophylline

2) Antacid/ omeprazole

Question 12

if a respiratory patient presents with Insomnia what could this be a side effect of, and how should it be managed?

Answer 12

1) Theophylline

2) Check plasma levels

Question 13

if a respiratory patient presents with Thrush what could this be a side effect of, and how should it be managed?

Answer 13

1) Effects of antibiotics and steroids

2) Miconazole oral gel / fluconazole

Question 14

what OTC medications does Theophylline interact with?

Answer 14

1) Cimetidine, Fluconazole- > Increased levels
of theophylline
2) St John’s Wort -> Decreased levels of theophylline
- AVOID

Question 15

discuss the importance of MURS for asthma patients

Answer 15

1) Inthe UK more than three people die from asthma every day, reflecting both a failure of care and a failure to access medical help promptly enough during severe episodes
2) Various studies have demonstrated value of MURS in asthma control

Question 16

what does the acronym SIMPLE stand for?

Answer 16

1) Stop smoking
2) Inhaler technique
3) Monitoring
4) Pharmacotherapy
5) Lifestyle
6) Education

Question 17

discuss why smoking cessation is vital for patients with respiratory diseases.
- why should you stop smoking?

Answer 17

1) Smokers respond less to asthma treatment
2) Reduces rate of decline of COPD and improves survival rate
3) Support tools available e.g. Smokefree NHS
4) Smokers taking theophylline generally tend to require higher doses than non-smokers as tobacco smoke contains polycyclic hydrocarbons, which induce CYP1A2
5) Smoking cessation will therefore result in an increase in serum theophylline concentrations, and possibly toxicity

Question 18

why should pharmacists check Inhaler technique?

Answer 18

1) Pharmacists can really make a difference in this area by ensuring that any person prescribed an inhaler for the first time knows how to use the device correctly
2) Recognise that people can pick up bad habits and ongoing technique should be confirmed at every opportunity

Question 19

discuss the role of a pharmacist in monitoring patients with respiratory diseases

Answer 19

1) Pharmacists can play an important role in encouraging people with asthma to attend their medical practice for their review.
2) People identified as being at high risk of severe asthma should be closely monitored and pharmacists should be aware of the features that increase the risk of asthma exacerbations and death

Question 20

what should pharmacists ensure is prescribed alongside a LABA for people suffering with asthma?

Answer 20

1) Where LABAs are prescribed for people with asthma, they should be prescribed with concomitant Inhaled corticosteroids (ICSs), ideally in a single inhaler device, and pharmacists can ensure this
2) ICSs should be prescribed for all symptomatic people with asthma
3) ICS should never be used as monotherapy in COPD

Question 21

what lifestyle advice should pharmacists promote for people suffering with asthma?

Answer 21

1) Pharmacists should encourage patients to adopt a healthy lifestyle and support weight reduction
- (National Review of Asthma Deaths) NRAD - Body mass index was over 25 in 50 per cent of those who had died
2) Allergy – an avoidable factor e.g. animals, food, seasonal, drugs
3) Pharmacists can refer asthma patients with allergies to Allergy UK

Question 22

why should pharmacists promote exercise in participants suffering with respiratory diseases?
- what medication should the patient take 15 minutes prior to exercise?

Answer 22

1) Beneficial in both COPD and asthma if kept within aerobic range and environmental conditions correct.
2) Can result in significant improvement in a COPD sufferer’s quality of life
3) Asthmatics may need to inhale 200 micrograms salbutamol 15 minutes prior to exercise
4) Swimming, running or fast walking best

Question 23

why is Weight Control and Avoiding Fast Food important in patients with respiratory diseases?

Answer 23

Link between obesity and respiratory diseases:

1) Thoracic restriction
2) Reduction in cardiovascular space
3) Oxidative stress
4) Obesity-related co-morbidities
5) Obesity and lifestyle associated with it predisposes people to COPD

Question 24

diet plays an important role in the control of asthma. what components of a diet leads to an increased risk of asthma ?

Answer 24

1) Reduced fruits, vegetables and fish
2) Increased saturated fats
3) Fast foods
4) High regular intake of sugary drinks

Question 25

list some foods which increase Bronchoconstriction

Answer 25

1) Eggs
2) Fish
3) Peanuts
4) Soy
5) Yeast
6) Cheese
7) Wheat
8) Rice

Question 26

list some foods which increase broncho-dilation

Answer 26

1) Low dose alcohol
2) Caffeine
3) Magnesium

Question 27

discuss how pharmacists can educate patients with respiratory diseases

Answer 27

1) Pharmacists should ensure that all their patients with asthma have a written personal asthma action plan which they understand and use
2) Pharmacists should encourage COPD patients to recognise when they’re getting worse and see the doctor
3) Doctors may give them a reserve course of antibiotics/steroids for self treating at home

Question 28

what other non-pharmacological advice can pharmacists provide to patients suffering from respiratory diseases?

Answer 28

1) Avoid extremes of temperature
2) Vaccinations
3) Take time to relax

Question 29

what drugs interact with theophylline and subsequently cause an increase its levels?

Answer 29

Drugs that increase levels:

1) Macrolides
2) Quinolones
3) Fluvoxamine
4) Calcium channel blockers

Question 30

what drugs interact with theophylline and subsequently cause a decrease its levels?

Answer 30

Drugs that decrease levels:

1) Rifampicin
2) Phenobarbital
3) Phenytoin

Question 31

list some drugs theophylline interact with, which leads to an increased risk of hypokalaemia?

Answer 31

Drugs lowering potassium

1) Corticosteroids
2) High dose beta-2 agonists
3) Diuretics

Question 32

which drugs could lead to a deterioration in a specific Respiratory Condition?

Answer 32

Things to look out for :

1) NSAIDs
2) Aspirin
3) Beta blockers
4) Remember topical administration too
5) Drug interactions

Question 33

Infection/Surgery/Trauma can lead to Deterioration in a Respiratory Condition. how can this be overcome?

Answer 33

1) May need to increase bronchodilator

2) May need extra steroid e.g. short course of prednisolone