PAC3421 Study Guide - Final Guide: Ipratropium Bromide, Salbutamol, Smoking Cessation
21 Jun 2018
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MCQ (Practice Exam) - COPD
Nadine is a 60-year-old retired executive who was diagnosed with COPD two years ago. She comes into your
pharmacy today for a refill of her salbutamol inhaler.
In the past few months, Nadine has noticed more shortness of breath and cough. There has been no noticeable
change in her sputum quality or colour. Nadine has been feeling more fatigued than usual, and she complains that
she is having a difficult time doing her gardening and getting her household chores accomplished. She has never had
an exacerbation of COPD requiring a visit to the hospital emergency department.
Upon review of Nadine’s profile, you notice that she has prescriptions for:
ipratropium bromide 2 puffs four times daily salbutamol 2 puffs four times daily prn
Nadine used to use her ipratropium bromide regularly, but gave up on using it because she didn’t find it to be very
helpful in relieving her symptoms. Also she was concerned about its side effects. She gets quicker relief from the
salbutamol, so she prefers to use this medication instead. Inhaled corticosteroids have never been prescribed.
You have asked Nadine to demonstrate how she uses her inhaler and have observed that she has very good inhaler
technique.
Nadine has smoked about ½ - 1 pack per day since she was in high school. Nadine would like to know if there is a
treatment that may allow her to take a more active part in her day-to-day activities.
When Nadine comes to the pharmacy to pick up salbutamol, you ask her about ipratropium and whether she has any
concerns about side effects.
1. Which of the following statements about inhaled anticholinergics are correct?
Select one or more:
a. Nadine should avoid spraying it into her eyes
b. Nadine may experience a mild tremor
c. Nadine may experience some urine retention or hesitancy when urinating
d. Nadine may experience a dry mouth
e. Nadine may become constipated
Proposed Answer: A and D
2. What changes to Nadine’s treatment would you recommend?
Select one or more:
a. Nadine should use salbutamol on a regular basis and not to bother with using ipratropium bromide since it does
not appear to have provided much benefit (feedback: salbutamol should not be used on regular basis, should only be
used ‘as needed’)
b. Nadine may benefit from enrolling in specialized exercise programs, a COPD support group and a smoking
cessation program
c. Introduce salmeterol 50mcg twice daily or tiotropium 18mcg once daily; remove ipratropium bromide from the
regimen
d. Nadine may benefit from the addition of inhaled corticosteroids to her regimen (feedback: ICS is only for frequent
exacerbations in COPD)
e. None of the other answers would benefit Nadine
Proposed Answer: B and C
3. Which key message(s) would you like to discuss with Nadine?
Select one or more:
a. By quitting smoking, Nadine may reduce her symptoms
b. It is too late to worry about quitting smoking, since smoking cessation is of no benefit to those who have smoked
heavily for 20 years or more
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Document Summary
Nadine is a 60-year-old retired executive who was diagnosed with copd two years ago. She comes into your pharmacy today for a refill of her salbutamol inhaler. In the past few months, nadine has noticed more shortness of breath and cough. There has been no noticeable change in her sputum quality or colour. Nadine has been feeling more fatigued than usual, and she complains that she is having a difficult time doing her gardening and getting her household chores accomplished. She has never had an exacerbation of copd requiring a visit to the hospital emergency department. Upon review of nadine"s profile, you notice that she has prescriptions for: ipratropium bromide 2 puffs four times daily salbutamol 2 puffs four times daily prn. Nadine used to use her ipratropium bromide regularly, but gave up on using it because she didn"t find it to be very helpful in relieving her symptoms. Also she was concerned about its side effects.
