Pharmaceutical care of people with chronic obstructive pulmonary disease. Course activities

Transcription

1 Pharmaeutial are of people with hroni ostrutive pulmonary isease Course ativities

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3 Pharmaeutial are of people with hroni ostrutive pulmonary isease Course ativities page 2 Case Stuy 1 4 Case Stuy 2 7 Case Stuy 3 9 Case Stuy 4 11 Multiple Choie Questionnaire

4 Case Stuy 1 Mr Jones, a 64-year-ol patient of the loal surgery who is well known to you has reently een to hospital for spirometry following testing at the loal surgery whih showe an FEV1* of 60% one week after a respiratory trat infetion. Over the last two years he has reeive six ourses of antiiotis for hest infetions an frequently omplains to you of reathlessness. His spirometry results show that he has an FEV1 of 65% of that preite for his age. As the pratie pharmaist you have a isussion aout the treatment that shoul e ommene for this patient. Dotor: Mr Jones s spirometry results have een reporte y the hospital. His FEV1 is 65% on hospital reporting. How oes that ompare with the results from the review at the surgery? Pharmaist: Last month when he was referre to the hospital his FEV1 was 60% using the surgery instrument. Has he stoppe smoking or is he still smoking aout 15 igarettes aily? Dotor: Pharmaist: Dotor: I elieve that he has stoppe smoking ut it is iffiult as he has smoke sine he was 15 ut he was given ounselling an a presription for pathes at his last appointment. That wouln t aount for the improvement in FEV1 however. No, ut stopping smoking will help prevent isease progression. Are there any other fators impliate in the evelopment of COPD, has he worke in the mines or shipuiling? Has he ha reurrent respiratory trat infetions in the last ouple of years? Aoring to his reors he has reeive three ourses of amoxiillin last winter for respiratory trat infetions an his oupation history is rief as he appears to have ha a few ifferent jos an many perios of unemployment. He oesn t appear to have any other moriity an is on no other presrie meiation. What o you suggest that we start as inhale therapy? * FEV1: Fore Expiratory Volume in first seon (FEV1) is the volume of air expelle in the first seon of a fore expiration starting from full inspiration. FEV1%: This is the FEV1 expresse as a perentage of the total volume. It is sometimes alle the FEV1 Ratio or the FEV1/ VC% when it is shown as a perentage of the VC volume, or the FEV1/ FVC% when shown as a perentage of the FVC. This parameter has nothing to o with preite values. (In normal lung funtion this shoul generally e over 75%; i.e. the sujet shoul get at least three quarters of their total air out in the first seon). Priory Loge Euation Limite, 1997 pharmaeutial are of people with hroni ostrutive pulmonary isease

5 Disussion points Case Stuy 1 Do you have enough information to make an informe eision aout presriing? If not what aitional information woul you like? Base on this isussion what woul you suggest is ommene for this patient? What measures woul you use to monitor the effetiveness of the presrie therapy an what woul e the next step if this therapy is not effetive? ourse ativities

6 Case Stuy 2 Mrs Walker, a 56-year-ol patient with known COPD has een presrie a ourse of oral amoxiillin 500mg three times a ay for an exaeration of her COPD. She is urrently maintaine on tiotropium 18mirograms at night, Seretie Auhaler 1 ose twie a ay an a salutamol inhaler 2 puffs as require. This is the seon exaeration that Mrs Walker has experiene this winter an on the last oasion she was amitte to hospital for 6 ays an isharge with support. She oes not have home oxygen. Mrs Walker s husan has ome into the pharmay to ollet her presription for antiiotis. Mr Walker: Pharmaist: Mr Walker: Pharmaist: Mr Walker: Pharmaist: What meiines is she eing given this time? I on t know that the last lot worke as this is the seon infetion that she has ha this winter an it s only the start of Deemer. Mrs Walker has een given the same antiioti as the last time as it is likely that the same organism ause the infetion. The otor has given her a goo ose that she nees to take three times a ay for 7 ays. That s what she ha the last time ut it s only 6 weeks sine she last ha antiiotis an the last time she was in hospital for 7 ays. This time the GP seems to think that it is etter that she stays at home rather than go into hospital. He has ontate the hospital an they are sening some nurses out to have a look at her at home. That will e the speialist respiratory nurses who work with oth the hospital otors an the GP to try to keep people at home rather than sening them into hospital. Di Mrs Walker not get some visits from them the last time she was in hospital an get the neuliser for a few ays as well? Yes, they i ome to visit her a ouple of times an then they took the neuliser away. She also ha those yliners. Will she get them again? She may get these things again ut that will epen on what the nurses think when they ome to see her an what happens in the isussion at the hospital an with the GP. If she oes nee the yliners I an eliver them later toay. pharmaeutial are of people with hroni ostrutive pulmonary isease

7 Disussion points Case Stuy 2 What are the NICE/BTS riteria for patients eing amitte to hospital? What aitional information might you like to know aout Mrs Walker an the eision to presrie amoxiillin for a seon exaeration of COPD? Are there any aitional therapies that shoul e onsiere for this patient? ourse ativities

8 Are neulisers an effetive way of managing an exaeration of COPD or shoul the patient e ontinue on inhale therapy? If neulise therapy is to e ommene on this patient is there any therapy that shoul e isontinue while she is reeiving neulise therapy? pharmaeutial are of people with hroni ostrutive pulmonary isease

9 Case Stuy 3 Mr Jamieson is a 70-year-ol patient who has een amitte to hospital with an exaeration of COPD. He has een presrie oral sterois, neulisers an ontrolle oxygen therapy at 24% via a Venturi mask uring his amission. During this amission he is shown to have type two respiratory failure. The possiility of home oxygen therapy is isusse with the patient. During a onversation with Mr Jamieson you isover that his wife smokes 5 igarettes aily ut he stoppe smoking 5 years ago. On isharge Mr Jamieson is reommene on his tiotropium an Seretie inhalers an salutamol via a neuliser. His prenisolone is to e stoppe after a further 3 ays ompleting a 10-ay ourse. Mr Jamieson is given an appointment to atten the respiratory outpatient lini in 4 weeks time when his arterial loo gases will e measure. His GP has een aske to presrie an oxygen yliner for as require use. ourse ativities

10 Disussion points Case Stuy 3 Oxygen therapy has een shown to e effetive in severe COPD when use for more than 15 hours a ay. What aitional information shoul e otaine from this patient an his family efore long-term oxygen therapy (LTOT) is presrie? What are the health an safety impliations for patient presrie LTOT? What are the ifferent ways of supplying LTOT an how is this presrie an supplie in Sotlan an a GP orer a onentrator? pharmaeutial are of people with hroni ostrutive pulmonary isease

11 Case Stuy 4 Mrs Brown an her aughter onsult you in your pharmay aout smoking essation. Mrs Brown has moerate COPD an smokes 10 igarettes aily. Her aughter, who is 30, smokes 20 igarettes aily. Mrs Brown: I think that it s time that she gave up smoking. Miss Brown: I ll only o it if you agree to give them up too. It s not oing your hest any goo; you know that you ve een in hospital for three times in the last year an the otors have tol you that the fags aren t oing you any goo. Don t use me as your exuse. Mrs Brown: Pharmaist: Both: Pharmaist: Mrs Brown: I know that I have to o it ut you giving up too will help me too. Laies, there are lots of avantages in giving up smoking ut you nee to want to give up yourself an not e persuae y eah other into giving up. We know that an we o want to give up ut think that the support from eah other will help. I nee to get some more information from you so that I an see if there is any help that I an give you. First please an you tell me a it aout your smoking history: how many o you smoke eah ay an for how long have you smoke? I now smoke aout 10 igarettes a ay an have one that for the last year ut efore that I smoke aout a pak an a half a ay sine I was aout 20. Miss Brown: I smoke aout 20 a ay an that s uilt up graually over the last 15 years. I stoppe when I was pregnant ut went straight ak on them after that. Pharmaist: Mrs Brown: An o you rave a igarette when you wake up in the morning, or are there other times of the ay that are a for you? I reah for the igarettes as soon as I wake up Miss Brown: I on t nee them first thing in the morning ut enjoy one after a offee or when I m out for a rink. ourse ativities

12 Disussion points Case Stuy 4 Is there any other information that you woul fin helpful in eiing whih prouts to suggest for these patients? Whih prouts woul e suitale for eah of these patients? Does the same NRT prout suit oth? Are there any other servies in your area that you might like to refer the patients to for support or follow up? Does smoking essation have any impat on other therapies that these patients may e taking for COPD? pharmaeutial are of people with hroni ostrutive pulmonary isease 10

13 Multiple hoie questionnaire. This multiple hoie questionnaire (MCQ) allows you to test your unerstaning. Please tik either TRUE or FALSE for eah part (a to ) for eah of the twenty questions on the next six pages (page 12-16). Tear off the answer sheet on page 17 an opy your tiks onto this sheet, whih you an then return to NES Pharmay at the aress elow NHS Euation for Sotlan (Pharmay) 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW Completion of this MCQ is optional to partiipants an you will not reeive an iniviual sore. However, suessful ompletion of the MCQ will arue an aitional 2.5 NES CE hours. Moel answers will e sent, at the en of the urrent euation an training year, to partiipants who have sumitte this MCQ. ourse ativities 11

14 Pharmaeutial are of people with hroni ostrutive pulmonary isease 1. COPD is a isease a haraterise y reversile airways ostrution True False whih rarely ours in patients uner the age of 35 True False in whih symptoms rarely vary etween ays True False whih is linke to a hroni proutive ough True False 2. Severe COPD is efine as a an FEV1 of less than 50% of preite y NICE / BTS True False an FEV1 of less than 50% of preite y ATS / ERS True False an FEV1 of less than 50% of preite y GOLD True False an FEV1 of less than 30% of preite y NICE / BTS True False 3. When the iagnosis of COPD is onsiere the patient shoul also e questione aout a oupational history True False yspnoea aoring to the MRC yspnoea sale True False pets True False ankle swelling True False 4. Possile ifferential iagnosis onsiere when iagnosing COPD are a lung aner True False pneumothorax True False heart failure True False ysti firosis True False 5. Patients with severe COPD a may have type II respiratory failure True False shoul e manage with a omination of inhale ortiosteroi an long ating eta agonist True False will rarely e manage in hospital True False are maintaine on long term oxygen therapy for more than 20 hours a ay True False pharmaeutial are of people with hroni ostrutive pulmonary isease 12

15 6. A patient who has smoke a 15 igarettes a ay for 42 years has a smoking history of greater than 30 pak years True False 10 igarettes a ay for 30 years has a smoking history of 10 pak years True False 20 igarettes a ay for 10 years has a smoking history of 10 pak years True False 40 igarettes a ay for 30 years has a smoking history of greater than 30 pak years True False 7. Smoking essation a in patients with COPD will return the patients FEV1 to normal for their age True False in patients with COPD will return the rate of eline in FEV1 to normal True False in patients with COPD will have no effet on lung funtion True False is the most enefiial intervention for all patients with COPD True False 8. The National institute for Health an Clinial Exellene (NICE) / British Thorai Soiety (BTS) guieline for the management of COPD iniate that all patients a with an exaeration of COPD shoul e presrie high ose inhale ortiosterois True False amitte to hospital with an exaeration of COPD shoul e presrie oral ortiosterois True False shoul have therapy isontinue if it is shown to ineffetive after two weeks True False shoul e referre pulmonary rehailitation if they think that they are funtionally isale y the isease True False 9. The NICE / BTS guielines for the management of COPD reommen a the use of as require short ating inhale eta agonists True False the use of antiholinergis True False the use of ipratropium an tiotropium together True False the use of omination inhalers in moerate to severe isease True False ourse ativities 13

16 10. Patients with COPD shoul only e presrie a inhale ortiosterois if they have emonstrale reversiility True False ortiosterois in an exaeration if they have ha a steroi trial True False ipratropium if a short ating eta agonist has shown no enefit True False a long ating eta agonist if they are also reeiving an inhale ortiosteroi True False 11. Patients with COPD emonstrate no inrease in quality of life a when presrie inhale ortiosterois unless they emonstrate reversiility True False when presrie tiotropium rather than ipratropium True False unless their FEV1 is also inrease True False when presrie a omination of inhale ortiosterois an long ating eta agonists True False 12. Patients with COPD who are presrie long term oxygen therapy (LTOT) at home shoul a e enourage to stop smoking True False use yliners as the preferre metho of elivery True False shoul have a onentrator orere y their GP True False shoul use a ompressor an air to rive any neulise meiines True False 13. Patients with COPD a shoul have their neulise rugs elivere y a neuliser riven y oxygen True False shoul have their neulise rugs elivere y a neuliser riven y air True False whih is severe shoul e presrie a omination of an inhale ortiosteroi an long ating eta agonist True False whih is moerate to severe shoul e presrie tiotropium True False pharmaeutial are of people with hroni ostrutive pulmonary isease 14

17 14. Other therapies whih have shown usefulness in the management of COPD inlue a muolytis True False iuretis True False theophylline True False prophylati antiaterial therapy True False 15. One of the assessment riteria whih favour home management of exaerations of COPD is that the patient a oes not urrently reeive home oxygen therapy True False lives alone True False has an oxygen saturation aove 80% True False mil reathlessness True False 16. Arupt withrawal of prenisolone following management of an exaeration of COPD a may preipitate a further exaeration of COPD True False is aeptale if the patient has een on a high ose for less than 21 ays True False an e unertaken if the patient is not on a maintenane ose of oral ortiosterois True False annot e unertaken if the patient is on high ose inhale ortiosterois True False 17. An infetive exaeration is haraterise y a an inrease volume of sputum an a ough True False an inrease volume of sputum an inrease purulene of sputum True False an inrease volume of sputum an inrease reathlessness True False an inrease volume of sputum an inrease FEV1 True False ourse ativities 15

18 18. The most ommon ausative organisms of infetive exaerations of COPD are a Staphyloous aureus True False Streptoous pneumonia True False Haemophilus influenzae True False Streptoous faealis True False 19. An appropriate antiaterial for the management of an exaeration of COPD is a. amoxiillin 500mg three times a ay for a non-peniillin allergi patient True False. amoxiillin 3g twie a ay for non-peniillin allergi patients True False. larithromyin 500mg twie a ay for a peniillin allergi patient True False. peniillin V 500mg four times a ay for a non-peniillin allergi patient True False 20. The multiisiplinary team involve in the are of patients with COPD shoul inlue a. Pharmaists True False. Dietiians True False. Physiotherapists True False. Oupational therapists True False pharmaeutial are of people with hroni ostrutive pulmonary isease 16

19 Chroni Ostrutive Pulmonary Disease: MCQ answer sheet Name Aress RPSGB Reg. No. 1. a T F 6. a T F 11. a T F 16. a T F 2. a 7. a 12. a 17. a 3. a 8. a 13. a 18. a 4. a 9. a 14. a 19. a 5. a 10. a 15. a 20. a T = True F = False ourse ativities 17

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22 Please return to: NHS Euation for Sotlan (Pharmay) 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW pharmaeutial are of people with hroni ostrutive pulmonary isease 20

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24 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW Tel: Fax: