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GPhC Exam: The Respiratory System

GPhC Pre-Reg Exam Preparation Specialists

What are the key topics in the respiratory system?

In simple terms, the respiratory system comprises of organs, blood vessels, muscles and airways which are in control of the movement of oxygen and carbon dioxide. The key conditions that are covered in this area are asthma, chronic obstructive pulmonary disease (COPD), allergies and common issues such as coughs, colds, and respiratory infections.

During your studies you will find a slight overlap between infections and this section, so it is a good way to reinforce some of your learning (if you have previously thoroughly studied the infections section before tackling this part). Some of the respiratory system infections will include: bronchitis, acute exacerbation of COPD, pneumonia, sinusitis, and influenza.

There is a large variety of drug classes to focus on in this section which include some of the following: bronchodilators, corticosteroids, leukotriene receptor antagonists, mucolytics, antihistamines, antifibrotics, nasal decongestants, and antibacterials.

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Top tips on the respiratory system GPhC exam questions

  • Learn the differences between diagnostic parameters (peak flow, heart rate, respiratory rate, etc) for different levels of acute asthma (moderate, severe, life-threatening), as this will help you to understand the rationale behind treatment options for each level.
  • The management of asthma differs between adults and children thus, it is essential you know the variations in the treatment.
  • Asthma and COPD are two different clinical conditions however, there are some similarities in the treatment options. Therefore, it is essential you know how to differentiate between the two conditions based on the clinical presentation. Also, patient with COPD may or may NOT suffer from asthmatic features hence, drug choices will differ for each state.
  • Inhalation is a key drug delivery method to focus on. For instance, understand the differences, pros, cons, and directions of use between the range of inhaler devices available i.e. dry powder, pressurised metered-dose, and breath-actuated inhalers. Also, ask yourself the reason behind a patient needing to use a spacer device or a nebuliser. Are you able to counsel a patient appropriately on the use of such devices?
  • Individuals may need a drug to be delivered via the oral or parenteral routes to treat a respiratory condition – why and when would this be necessary? Can you think of any scenarios when this would be the case?
  • Many antihistamines and nasal decongestants are readily available for the public to purchase as a general sales list (GSL) line or over the counter. You must be aware of the legislation behind supplying these i.e. age restrictions, pack size restrictions, pregnancy/breastfeeding.
  • During your pre-reg year you may attend a first aid training session which covers emergency allergic reactions (anaphylaxis). Some pharmacies may provide vaccination services, so you may come across anaphylaxis and/or the use of adrenaline in your workplace. Ensure you know how to differentiate between syncope and an anaphylaxis reaction. Also, remember that different strengths of adrenaline are administered according to a patient’s age group i.e.
  • 1 month to 5 years – 150mcg
  • 6 to 11 years – 300mcg
  • 12 years plus – 500mcg
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Narrow therapeutic index drug in this section

XANTHINE: THEOPHYLLNE

Drug action

What is it used for?

Cautions

Signs of toxicity

·        Inhibits type III and type IV phosphodiesterase (PDE)

·        Reduces break down of adenosine monophosphate (cAMP) in smooth muscle cells

·        Leads to bronchodilation

·        Reversible airways obstruction

·        Severe acute/chronic asthma

·        Cardiac arrhythmias/conditions

·        Elderly (plasma-theophylline concentration is increased in adults)

·        Epilepsy

·        Fever

·        Hypertension

·        Peptic ulcer

·        Thyroid disorder

·        Vomiting, haematemesis (vomiting blood)

·        Agitation, restlessness

·        Dilated pupils

·        Sinus tachycardia, ventricular arrhythmias

·        Hyperglycaemia

·        Convulsions

Example questions

  1. Miss F is an 18-year-old patient who takes Uniphyllin Continus® (Theophylline). Her dosage regimen has recently been changed to 400mg BD. Use the following information to calculate the Theophylline clearance for this patient. Miss F is a smoker, she is 168cm tall and weighs 69kg. Write your answer in Litres/hour and round to one decimal place.

1 inch = 2.54cm

12 inches = 1 feet

IBW (female) = 45.5kg + 2.3kg for each inch over 5ft

Theophylline clearance = 0.04 L/hour per kg IBW x 1.6

  

  1. Mr T suffers from lung disease due to Cystic Fibrosis. For the maintenance of his condition he must be on a mucolytic treatment. Which of the following would be the most appropriate mucolytic as a first-line option?
  • Dornase alfa
  • Dornase alfa and hypertonic sodium chloride
  • Hypertonic sodium chloride
  • Mannitol
  • Colistimethate sodium

 

Written by Fatima Sazzad, GPhC Reg No. 2212805

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