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Tiotropium device issue — GPhC CRA MCQ

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HardRespiratory TherapeuticsTiotropium device issueGPhC CRA

A patient accidentally swallowed their once-daily Spiriva HandiHaler capsule at 09:00. At 15:00 the same day they realise the error; they are clinically stable and the next dose is due tomorrow morning. What should the pharmacist advise?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Inhale one fresh capsule correctly now, then resume the usual once-daily schedule tomorrow

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

A is wrong: swallowing does not deliver the intended inhaled maintenance dose, and NHS advice is to use a forgotten tiotropium dose when remembered on the same day. B repeats the route error. C doubles the next dose, which is specifically discouraged. D is correct: at 15:00 on the same day, inhale one capsule through HandiHaler after technique re-training, then continue at the usual time tomorrow; if it had not been remembered until the next day, the missed dose would be skipped. E bypasses the device and cannot ensure safe lung delivery.

Reference: Spiriva HandiHaler SmPC. https://www.medicines.org.uk/emc/product/1693/smpc NHS: How and when to use tiotropium inhalers. https://www.nhs.uk/medicines/tiotropium-inhalers/how-and-when-to-use-tiotropium-inhalers/