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Cystic fibrosis

CPD

February 2, 2021

CPD credits

Accreditation Number : CAP2102CDMPB

Group 1 : 1.75 CPD credits

Group 2 : 3.5 CPD credits

This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 1 CPD (or 1.50 CPD credits) upon successful completion of relevant assessment activities.

Introduction

Cystic fibrosis (CF) is an autosomal recessive disorder affecting the cystic fibrosis transmembrane conductance regulator (CFTR) gene.¹ Patients with CF have a mutated gene, resulting in defective CFTR proteins causing thick mucus in multiple body systems.² CF mainly affects the lungs and the digestive systems in the body.² At present there is no cure for CF, so the aims of treatment are to delay disease progression with lifelong pharmacological and non-pharmacological interventions.³ CF pharmacists are involved in medicines optimisation, antimicrobial stewardship and medication counselling to improve treatment adherence.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

Define cystic fibrosis
Describe the pathophysiology of cystic fibrosis
Discuss the management of patients with cystic fibrosis
Identify the role of the pharmacist in managing a patient with cystic fibrosis.

Competency standards (2016) addressed: 1.1, 1.3, 1.4, 2.1, 2.3, 2.4, 3.2

Extended learning activity

After additional reading and research from recommended resources, pharmacists should be able to:

Identify drug-drug interactions and modify treatment regimens when managing people with cystic fibrosis
Assess the pharmacokinetic and pharmacodynamic properties of drugs used in cystic fibrosis when formulating treatment options
Discuss the drug treatment used for managing cystic fibrosis, including the management of adverse drug reactions.

Competency standards (2016) addressed: 1.1, 1.3, 1.4, 1.5, 2.2, 2.4, 3.1, 5.3

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Patient circumstance	Appropriate pharmacist action on or after 1 July 2022
Patient reached the old (higher) threshold on or before 30 June 2022 and has already received a Safety Net card	Patient retains eligibility for the PBS Safety Net; dispense any PBS prescriptions with the patient’s CN or SN card Concessional co-payment (if applicable) amount remains the same ($6.80) No refunds to the patient relating to co-payments made prior to 1 July 2022
Patient presents evidence (PRF) of having reached the new (lower) threshold prior to 1 July 2022 and requests a Safety Net card but does not require any prescriptions to be dispensed	Advise the patient that they will become eligible for a Safety Net card when their first ‘qualifying’ medicine is dispensed on or after 1 July 2022 A Safety Net card based on the new threshold cannot be issued without the dispensing of a qualifying PBS medicine
Patient has not reached the new (lower) threshold when they present (on or after 1 July) a prescription for two PBS medicines but reaches that threshold upon the first item being dispensed	The first item is dispensed as a general or concessional item (whichever applies); PBS co-payment amount remains the same The second item is the first ‘qualifying’ medicine dispensed; a CN or SN card (whichever applies) can be issued and the relevant PBS co-payment ($6.80 if CN card) applies

CAUSE	DIFFERENTIATING FEATURE
Hair casts (pseudonits): remnants of inner root sheaths of hair follicles, encircling hair shafts of the scalp.	Casts can be easily dislodged from the hair.
Seborrheic dermatitis: can affect the scalp, eyebrows, nasolabial folds, central chest. It is a chronic relapsing condition. Commonly seen at puberty. Dandruff is the mildest form of this condition.	Scaling, ranging from mild to widespread thick crusts. Easily removed and can be accompanied with burning sensation and erythema.
Scalp folliculitis: an inflammatory disorder of the hair follicles.	Small, itchy pustules that become sore and crusted, and often occur on frontal hair line.
Trichorrhexis nodosa: can affect the scalp, pubic area, beard and moustache. Can be congenital or caused by trauma, either physical (e.g. excessive brushing) or chemical (e.g. hair dyes). Most commonly found in females.	Presence of white flecks in the hair, abnormally fragile hair, areas of alopecia.

PRE-TRAUMATIC	PERI-TRAUMATIC	POST-TRAUMATIC
Childhood trauma, adversity or emotional problems	Severity of trauma, injury, perceived life threat, interpersonal violence	Negative appraisals or inappropriate coping strategies
Lower socioeconomic status and poor education	Being a perpetrator, witnessing atrocities or killing the enemy (military)	Exposure to repeated upsetting reminders
Prior mental disorder or family psychiatric history	Dissociation that occurs during trauma and persists afterwards	Subsequent adverse life events, financial or other trauma-related losses
Genes, female sex/ younger age (at time of trauma)		Lack of social support following trauma

DISORDER	HOW IS IT DISTINGUISHABLE FROM PTSD?
Adjustment disorder	Trauma is of another type rather than that outlined by the DSM-V (e.g. divorce, being fired) OR, Trauma does meet the criteria outlined by DSM-V, but the symptom pattern does not (e.g. only a few symptoms are met)
Acute stress disorder	Symptom pattern is restricted to duration of 3 days to 1 month following trauma
Traumatic brain injury (TBI)	There may be significant symptom overlap. The two main differences: Re-experiencing and avoidance seen in PTSD and not TBI Persistent disorientation and confusion seen in TBI and not PTSD

What accreditation offers

Top tips to accreditation

ConPharm 2022

New Omicron-containing bivalent booster available soon

Other pipeline therapeutic targets

Opportunities for pharmacists

25% fewer prescriptions needed for concession card holders to reach the PBS Safety Net

More than 600,000 additional patients expected to benefit

No refunds if you’ve already passed the new threshold!

What if a patient has already reached the new lower threshold?

Talk to your patients now

Stock up on Safety Net cards

What happens in 2023?

When will the PBS co-payments for general scripts be reduced?

Demand surges in metropolitan Sydney

Free flu vax allows for opportunities in Victoria

Reports of mixed demand in Western Australia

Reducing pressure on the healthcare system

Positive patient outcomes

Collaboration essential in rural and remote communities

Duha Nur Gide

Louise Edwards BPharm(Hons), BA, MPS

Top tips

Smother the flare, but the bacteria is always there

When should flare-ups be treated?

Flare-up first-line: amoxicillin or doxycycline?

Prevention? Go for low-dose macrolides

CAL D? Yes! Five days is (usually) best

Review symptoms for post-dated prescriptions

Pharmacists’ role in opioid management

Promoting the standard in a community setting

Carefully dispensing opioids

Opioid safety is everyone’s responsibility

1. Perfect your co-administration technique

2. Patient care improves when barriers are removed

3. Remind overseas travellers to get vaccinated against flu at least 2 weeks before flying

4. Protecting children under 3 is a priority

5. Queensland-based pharmacists can vaccinate children 5 years and older

Case scenario

Learning objectives

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Introduction

What are the symptoms?

What are the causes and risk factors?

The life cycle of head lice

Identifying head lice infestation

When is referral required?

Management of head lice infestation

Non-pharmacological treatments

Drug interactions

Prevention of infestation

Exclusion periods

Case scenario continued

Key points

Case scenario

Learning objectives

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Introduction

Illicit drug use and adverse events in Australia

What are novel psychoactive substances?

What is MDMA?

Drug checking in Australia

The drug checking process

What is the evidence?

Knowledge to practice

Case scenario continued

Conclusion

Key points

Case scenario

Learning objectives

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Introduction

Aetiology and pathophysiology

Signs and symptoms

Diagnosis

Staging

Screening and prevention

Smoking cessation

Management of lung cancer

Targeted therapy – monoclonal antibodies