Respiratory II

Question 1

A 3 year old boy has presented in the pharmacy with his father having been diagnosed with asthma for the first time. Which of the following has the child most likely been prescribed?

A. Salbutamol breath-actuated inhaler
B. Salbutamol pMDI with a child aerochamber plus spacer
C. Terbutaline with a child aerochamber plus spacer
D. Ipratropium
E. Salbutamol (Ventolin) accuhaler

Answer 1

B. Salbutamol pMDI with a child aerochamber plus spacer

A. Child cannot use breath-actuated inhalers
C. Terbutaline is a Terbohaler - cannot use a spacer device with it
D. Ipratropium is a LAMA not the first line in asthma treatment
E. A child <5y needs a spacer, they cannot have an inhaler on its own.

***

The spacer will be yellow for a child (1-5y). The blue spacers are for 5y+. The orange spacers are for infants (birth to 1y).

Question 2

An elderly patient seeks your advice, she has recently started a new inhaler and is having issues. Upon gathering the necessary information, you find the patient has developed oral thrush in her mouth. They use several inhalers. Which of the following is most likely to have caused the oral thrush?

A. Salbutamol
B. Beclomethasone
C. Salmeterol
D. Tiotropium
E. Terbutaline

Answer 2

B. Beclomethasone

Steriods cause oral thrush (anti-inflammatories - dampen immune system)

Question 3

A patient has recently been prescribed a salbutamol inhaler for suspected asthma. They have been experiencing a change in their symptoms and have used a full salbutamol inhaler within 3 weeks. He is using the inhaler 5x a week. Using NICE guidance, which of the following do you recommend?

A. No change in treatment
B. Salbutamol + ICS
C. Salbutamol + LABA
D. Salbutamol + Theophylline
E. Salbutamol + ICS + LABA

Answer 3

B. Salbutamol + ICS

Question 4

The year is 2026 and you are four years into your pharmacy career. Your new trainee pharmacist asks the following, which guidelines for asthma treatments are in the BNF?

A. BTS
B. SIGN
C. NICE
D. Marvin’s dodgy restaurant menu
E. The green book

Answer 4

C. NICE

Question 5

A patient is using the following inhalers Bricanyl Terbohaler (Terbutaline), Qvar Easi-breathe (Beclomethasone) and Severent Accuhaler (salmeterol). She is finding is hard to use three different types of inhaler and wondered if you could show her inhalers that she could potentially change to. She would prefer one type of inhaler. Which of the following would you recomment?

A. Ventolin Evohaler (Salbutamol), Clenil (Beclomethasone), Severent Evohaler (salmeterol)

B. Ventolin Accuhaler (Salbutamol), Clenil (Beclomethasone), Severent Accuhaler (salmeterol)

C. Ventolin Accuhaler (Salbutamol), Clenil (Beclomethasone), Severent Evohaler (salmeterol)

D. Bricanyl Turbohaler (Terbutaline), Pulmicort Turbohaler (Budesonide), Severent Evohaler (salmeterol)

E. Ventolin Accuhaler (Salbutamol), Pulmicort Turbohaler (Budesonide), Severent Evohaler (salmeterol)

Answer 5

A. Ventolin Evohaler (Salbutamol), Clenil (Beclomethasone), Severent Evohaler (salmeterol)

because A is Serevent Evohaler –> here you have two evohalers (two pMDIs) and clenil which is a pMDI = 3 pMDIs all the same inhaler

Question 6

When stepping down asthma treatment patients should be reviewed every (…) months. The ICS dose should be reduced by (…)% each time to the (…)-effective dose that controls their asthma symptoms.

Answer 6

When stepping down asthma treatment patients should be reviewed every (3) months. The ICS dose should be reduced by (25-50)% each time to the (lowest)-effective dose that controls their asthma symptoms.

Question 7

In exercise-induced asthma, the patient’s asthma symptoms are brought on by exercise which suggests that their asthma is poorly controlled. They should be advised to use a (…) inhaler immediately before exercising.

Answer 7

In exercise-induced asthma, the patient’s asthma symptoms are brought on by exercise which suggests that their asthma is poorly controlled. They should be advised to use a (SABA) inhaler immediately before exercising.

If that still doesn’t help the patient should visit their asthma clinic for a treatment review. They may be prescribed sodium cromoglycate or nedocromil or LABA or LTRA or Theophylline

Question 8

Women with asthma should be closely (…) when being treated. This is to ensure that no harm comes to the fetus (due to less oxygen taken in during an asthma attack). Counsel women to stop (…lifestyle habit…) because it is also harmful to mother and baby.

Answer 8

Women with asthma should be closely (monitored) when being treated. This is to ensure that no harm comes to the fetus (due to less oxygen taken in during an asthma attack). Counsel women to stop (smoking) because it is also harmful to mother and baby.

Pregnancy = Small LIONS (SABA, LABA, ICS, Oral steorids, Nedocromil, Sodium cromoglycate)

Question 9

Pregnant women can only have the following asthma symptoms treatment:

Small LIONS

SABA
L…
I…
O…
Nedocromil
Sodium cromoglycate

Answer 9

Small LIONS

SABA
​LABA
ICS
Oral steroids
Nedocromil
Sodium cromoglycate

Question 10

Moderate asthma

Peak Expiratory Flow (PEF) of … to ….%

Normal speech

Treat with (…)-dose SABA

Answer 10

Moderate asthma

Peak Expiratory Flow (PEF) of 50 to 75%

Normal speech

Treat with (high)-dose SABA and a spacer

This is typical in a community setting: ((4 puffs SABA →2 puffs every 2 mins up to 10 puffs → repeat every 10-20mins))

Question 11

Severe asthma

Peak Expiratory Flow (PEF) of < (…)%

Not able to complete a sentence in one breath.

Treat with (…O SHIT…)

Answer 11

Severe asthma

Peak Expiratory Flow (PEF) of < 50%

Not able to complete a sentence in one breath.

Treat with (O SHIT = O2 (target 94-98%), SABA (spacer or neb), Hydrocortisone IV/Prednisolone oral, Ipratropium neb, Theophylline)

999 - treated at the hospital. Adults may be prescribed prednisolone single morning dose afterwards for 5 days (3 days for children)