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Doxycycline counselling — GPhC CRA MCQ

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HardInfection ManagementDoxycycline counsellingGPhC CRA

A 78-year-old with COPD is prescribed tiotropium 18 micrograms by HandiHaler once daily. Cockcroft–Gault creatinine clearance is 42 mL/min. They have no glaucoma or urinary retention and have not used another long-acting muscarinic antagonist. Which recommendation best reflects the SmPC?

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Correct answer: B — Use the usual dose only if benefit outweighs risk and monitor closely for anticholinergic effects

Tiotropium is predominantly renally eliminated, and systemic exposure rises in moderate-to-severe renal impairment. The SmPC permits the standard once-daily inhaled dose but advises that at creatinine clearance 50 mL/min or lower it should be used only when expected benefit outweighs risk, with close monitoring for anticholinergic adverse effects. There is no authorised alternate-day or doubled regimen, and this renal value is not an absolute contraindication. HandiHaler capsules are for inhalation and must never be swallowed.

Reference: Spiriva 18 microgram inhalation powder hard capsule SmPC. https://www.medicines.org.uk/emc/product/1693/smpc