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Rau’s Respiratory Care Pharmacology 9th Edition By Gardenhire – Test Bank 

 

 

Chapter 01: Introduction to Respiratory Care Pharmacology

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The listing of a drug and the amount of drug are found in which part of a prescription?
a. Superscription
b. Inscription
c. Subscription
d. Transcription (signature)

 

 

 

  1. If generic substitution is permitted on a prescription:
a. drug from only one manufacturer must be given.
b. drug formulation may be changed by the pharmacist.
c. any manufactured brand of the drug listed may be given.
d. drug strength may be changed by the pharmacist.

 

 

 

  1. The study of drugs, including their origin, properties, and interactions with living organisms, is known as
a. pharmacogenetics.
b. pharmacology.
c. therapeutics.
d. toxicology.

 

 

REF:   p. 3

 

  1. The brand name given to a drug by a particular manufacturer is known as the drug’s
a. chemical name.
b. generic name.
c. official name.
d. trade name.

 

 

 

  1. To find official information about drugs (according to the FDA), you need to go to the
a. Physician’s Desk Reference (PDR).
b. Basic & Clinical Pharmacology.
c. United States Pharmacopeia–National Formulary (USP-NF).
d. Goodman & Gilman’s The Pharmacological Basis of Therapeutics.

 

 

 

  1. Drugs may be obtained from which of the following sources?
a. Plants
b. Animals
c. Minerals
d. Plants, animals, and minerals

 

 

  1. The branch of the U.S. government responsible for the process of approving drugs for clinical use is the
a. USAN Council.
b. FDA.
c. USP-NF.
d. PDR.

 

 

 

  1. An orphan drug is a drug that is
a. used for rare disease.
b. used for common disease.
c. inexpensive to produce.
d. not claimed by a drug manufacturer.

 

 

 

  1. Which of the following health care practitioners are authorized to write a prescription in the United States?
  2. Physicians
  3. Chiropractors
  4. Dentists
  5. Osteopaths
  6. Veterinarians

 

a. 1 only
b. 1, 2, and 3 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Drugs that are available to the general public without a prescription are known as
a. illegal drugs.
b. generic drugs.
c. investigational drugs.
d. over-the-counter drugs.

 

 

 

  1. Drugs delivered by oral or nasal inhalation are intended to
a. increase heart function.
b. provide a local topical treatment in the respiratory tract.
c. relax patients and relieve anxiety.
d. improve blood flow throughout the body.

 

 

 

  1. The advantages of delivering drugs by oral or nasal inhalation include which of the following?
  2. Aerosol doses are smaller than doses administered systemically.
  3. Side effects are usually fewer and less severe.
  4. The onset of action is rapid.
  5. The delivery process is painless, relatively safe, and usually more convenient.

 

a. 1 and 3 only
b. 1 and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the following classes of drugs can be aerosolized?
  2. Antiasthmatic agents
  3. Adrenergic agents
  4. Antiinfective agents
  5. Mucoactive agents
  6. Corticosteroids

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 2, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Which of the following drug groups are important to respiratory and critical care, although they may or may not be available in an aerosol form?
  2. Diuretics
  3. Antiarrhythmic agents
  4. Neuromuscular blocking agents
  5. Anticoagulant and thrombolytic agents

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Place the following phases of Investigational New Drug (IND) approval in the correct order:
  2. The drug is investigated as a treatment for a small number of individuals with the disease the drug is intended to treat.
  3. The drug is investigated in large, multicenter studies to establish efficacy and safety.
  4. The drug is investigated in small groups of healthy volunteers to establish its activity.

 

a. 1, 2, 3
b. 2, 3, 1
c. 1, 3, 2
d. 3, 1, 2

 

 

 

  1. In today’s market, companies spend approximately how much money per new drug on research, development, and preclinical and postclinical trials?
a. $2 million
b. $10 million
c. $800 million
d. $1 billion

 

 

 

  1. Toxicology studies and studies on the effects of a new drug on such organs as the liver and kidneys occur during which step of the drug approval process in the United States?
a. Animal studies
b. Investigational New Drug approval
c. Chemical identification
d. New Drug Application

 

 

 

  1. Regarding the therapeutic potential of a drug, the code AA symbolizes
a. an important therapeutic gain over other drugs.
b. an important therapeutic gain, indicated for AIDS patients; “fast-track” drug.
c. modest therapeutic gain.
d. little or no therapeutic gain.

 

 

 

  1. Which of the following may be used when writing or preparing drug orders?
  2. Latin
  3. English
  4. Metric measures
  5. Apothecary measures

 

a. 1 only
b. 1 and 2 only
c. 1 and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. If a drug is ordered with the Latin abbreviation qid, it should be administered
a. every hour.
b. four times daily.
c. every other day.
d. every 4 hours.

 

 

 

  1. If a drug is ordered with the Latin abbreviation ac, it should be administered
a. before a meal.
b. every other hour.
c. twice daily.
d. at bedtime.

 

 

 

  1. If a physician desires a drug to be administered as needed, he or she should use which of the following abbreviations?
a. pr
b. prn
c. npo
d. po

 

 

 

  1. Which of the following is a major step in the process of marketing a drug in the United States?
  2. Isolation of the chemical
  3. Identification of the chemical
  4. Investigational new drug approval
  5. New drug application

 

a. 1 only
b. 1 and 2 only
c. 1 and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Your patient has an order for 2 puffs of albuterol MDI q3h, and it was last given at 0700. When should it be administered next?
a. 0900
b. 1000
c. 1100
d. 1200

 

 

 

  1. If drug A is ordered with the Latin abbreviation q4h and drug B is ordered with the Latin abbreviation qid, which drug would be given more frequently in a 24-hour period?
a. Drug A
b. Drug B
c. Both would be given the same amount.
d. More information is needed to answer the question.

 

 

 

  1. The study of toxic substances and their pharmacologic actions, including antidotes and poison control is known as
a. toxicology.
b. therapeutics.
c. pharmacognosy.
d. pharmacology.

 

 

REF:   p. 3

 

  1. The study of the interrelationship of genetic differences and drug effects is known as
a. toxicity.
b. pharmacy.
c. pharmacognosy.
d. pharmacogenetics.

 

 

 

  1. The preparation and dispensing of drugs is known as
a. toxicity.
b. pharmacy.
c. pharmacognosy.
d. pharmacogenetics.

 

 

 

  1. The identification of sources of drugs from plants and animals
a. Toxicity
b. Therapeutics
c. Pharmacognosy
d. Pharmacology

 

 

 

  1. The art of treating disease with drugs is referred to as
a. toxicity.
b. therapeutics.
c. pharmacognosy.
d. pharmacology.

 

 

 

  1. What must physicians include on prescriptions when prescribing narcotics or controlled substances?
a. DEA registration number
b. Generic and trade name of the medication
c. Patient’s social security number
d. All of the above

 

 

 

  1. Once a drug is released for general clinical use, how long must a detailed reporting system remain in place to track any problems that arise with the drug’s use?
a. For 6 months
b. For 1 year
c. For 5 years
d. For 10 years

 

 

 

Chapter 02: Principles of Drug Action

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. During which phase of drug action is a drug made available to the body?
a. Administration
b. Pharmacokinetic
c. Pharmacodynamic
d. Pharmacogenetic

 

 

 

  1. A drug’s portal of entry into the body is known as the
a. formulation.
b. dosage.
c. route of administration.
d. additive.

 

 

 

  1. Which of the following are routes of drug administration?
  2. Enteral
  3. Parenteral
  4. Ointment
  5. Inhalation

 

a. 1 and 4 only
b. 1, 2, and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the following methods of drug delivery are commonly considered parenteral?
  2. Intravenous
  3. Intramuscular
  4. Paste
  5. Aerosol

 

a. 1 and 4 only
b. 1 and 2 only
c. 3 and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the following methods of drug administration requires a needle?
  2. Transdermal
  3. Inhalation
  4. Subcutaneous
  5. Intravenous

 

a. 1 and 3 only
b. 2 and 4 only
c. 1 and 2 only
d. 3 and 4 only

 

 

 

  1. Which of the following is not a part of the pharmacokinetic phase of a drug?
a. Absorption
b. Receptor site
c. Metabolism
d. Elimination

 

 

 

  1. The process of incorporating a substance into a cell by engulfment and transport to the cell interior in vesicles is termed
a. aqueous diffusion.
b. lipid diffusion.
c. bioavailability.
d. pinocytosis.

 

 

 

  1. Which of the following factors may have an effect on drug absorption?
  2. Route of administration
  3. Metabolic degradation
  4. Inactivation by stomach acids
  5. Blood flow to absorption site
a. 1 only
b. 1 and 2 only
c. 1 and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the four major body compartments contains the smallest average volume in liters?
a. Intracellular fluid
b. Vascular space
c. Interstitial fluid
d. Fat

 

 

 

  1. The principal organ for drug metabolism is the
a. brain.
b. liver.
c. stomach.
d. lung.

 

 

 

  1. Which of the following routes of drug administration help to reduce the first-pass effect?
  2. Oral administration
  3. Injection
  4. Sublingual tablets
  5. Rectal administration

 

a. 1 and 3 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, and 4 only

 

 

 

  1. Which of the following organs is considered the primary site of drug excretion?
a. Kidney
b. Liver
c. Small intestine
d. Stomach

 

 

 

  1. Inhaled aerosols may have which types of intended effects on the body?
  2. Enteral
  3. Local
  4. Systemic
  5. Oral

 

a. 1 and 3 only
b. 2 and 4 only
c. 2 and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Approximately what percentage of an inhaled aerosol reaches the lower respiratory tract with current delivery devices?
a. 0% to 10%
b. 10% to 30%
c. 50% to 60%
d. 90% to 100%

 

 

 

  1. Out of the total systemically available drug, the proportion of drug available from the lung is known as the
a. TI
b. VD
c. L/T ratio
d. T1/2

 

 

 

  1. The mechanism of drug action by which a drug molecule causes its effect in the body is known as the
a. pharmacodynamic phase.
b. elimination phase.
c. pharmacokinetic phase.
d. administration phase.

 

 

 

  1. The relationship between a drug’s chemical structure and its clinical activity is known as
a. bioavailability.
b. biotransformation.
c. pharmacokinetics.
d. structure-activity relationship.

 

 

 

  1. Given the following information, which drug is most potent?
Drug ED50
A 10 mg
B 5 mg
C 1 mg
D 15 mg

 

a. Drug A
b. Drug B
c. Drug C
d. Drug D

 

 

  1. Which of the following drugs has the greatest potential of crossing over from a therapeutic effect to a toxic effect?
Drug TI
A 2
B 20
C 5
D 15

 

a. Drug A
b. Drug B
c. Drug C
d. Drug D

 

 

  1. The drug albuterol binds to its corresponding receptor to initiate its intended response of bronchodilation. By definition, albuterol is known as a(n)
a. agonist.
b. antagonist.
c. both A and B.
d. neither A nor B.

 

 

 

  1. Two different drugs (each with its own mechanism of action) are administered to a patient in an attempt to relieve bronchoconstriction. The ordering physician hopes that the effect of the drug pair will be greater than the sum of the separate effects of each individual drug. If successful, this would be an example of
a. potentiation.
b. synergism.
c. additivity.
d. tolerance.

 

 

 

  1. Mrs. Johnson is a 37-year-old woman who has been taking medication for lower back pain for the last 18 months. She reports to her physician that although the medication initially rendered her pain-free, she now receives very little relief from her daily dose. This situation is described by which of the following terms used to refer to drug responsiveness (assuming that her condition has not actually worsened)?
a. Hypersensitivity
b. Idiosyncratic effect
c. Tolerance
d. Tachyphylaxis

 

 

 

  1. A perfectly efficient aerosol delivery device would theoretically have an L/T ratio of which of the following?
a. 0
b. 0.5
c. 0.75
d. 1.0

 

 

 

  1. Which of the following factors can increase the lung availability/total systemic availability ratio of inhaled drugs?
  2. Efficient delivery devices
  3. Inhaled drugs with a high first-pass metabolism rate
  4. Mouth washing
  5. Use of a reservoir device

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. The drug methacholine can stimulate parasympathetic receptors in the airways, causing bronchoconstriction. Epinephrine can stimulate b2 receptors in the airways, causing bronchodilation. These two opposing effects that cancel each other out are an example of
a. chemical antagonism.
b. functional antagonism.
c. competitive antagonism.
d. synergism.

 

 

 

  1. The lining of the lower respiratory tract presents barriers to drug absorption and includes which of the following elements?
  2. Airway surface liquid
  3. Capillary vascular network
  4. Epithelial cells
  5. Interstitium

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. The study of genetic factors and their influence on drug response is termed
a. pharmacogenetics.
b. functional antagonism.
c. competitive antagonism.
d. pharmacokinetics.

 

 

 

  1. The difference between the minimal therapeutic and toxic concentrations of a drug is known as the
a. TI.
b. VD.
c. L/T ratio.
d. T1/2.

 

 

 

  1. A measure of how quickly a drug is eliminated from the body is known as the
a. TI.
b. VD.
c. L/T ratio.
d. T1/2.

 

 

 

  1. Mr. Ashoor is a 29-year-old asthmatic patient who takes MDI albuterol for wheezing and typically gets quick relief following two puffs. After he mowed the lawn today, he realized he was having a rapid decrease in responsiveness to his albuterol. He tried taking it again but still had no relief. This situation is described by which of the following terms used to refer to drug responsiveness?
a. Hypersensitivity
b. Idiosyncratic effect
c. Tolerance
d. Tachyphylaxis

 

 

 

  1. Which is the term that refers to the concentration (EC50) or dose (ED50) of a drug producing 50% of the maximal response of the drug?
a. Potency
b. Hypersensitivity
c. Potentiation
d. Additivity

 

 

 

  1. An allergic or immune-mediated reaction to a drug, which can be serious, requiring airway maintenance or ventilatory assistance is called
a. potency.
b. hypersensitivity.
c. potentiation.
d. additivity.

 

 

 

  1. A special case of synergism in which one drug has no effect but can increase the activity of another drug is known as
a. potency.
b. hypersensitivity.
c. potentiation.
d. additivity.

 

 

 

  1. This term is used to describe when two drugs act on the same receptors and the combined effect is the simple linear sum of the effects of the two drugs, up to a maximal effect.
a. Potency
b. Hypersensitivity
c. Potentiation
d. Additivity

 

 

 

  1. Why is lipid diffusion an important mechanism for drug absorption?
a. Many epithelial membranes must be crossed if a drug is to distribute in the body and reach its target organ.
b. Epithelial cells do not have lipid membranes, so a drug must be water-soluble to diffuse across such a membrane.
c. It is directly related to the proportion of a drug that reaches the systemic circulation.
d. Lipid diffusion has no importance in drug absorption because the body has very few epithelial membranes drugs must cross.

 

 

 

  1. The term used to indicate the proportion of a drug that reaches the systemic circulation is
a. bioavailability.
b. biotransformation.
c. pharmacokinetics.
d. structure-activity relationship.

 

 

 

  1. The process by which a drug is transported to its sites of action, eliminated, or stored is referred to as
a. bioavailability.
b. biotransformation.
c. drug distribution.
d. plasma half-life.

 

 

 

  1. The time required for the plasma concentration of a drug to decrease by one-half is referred to as
a. bioavailability.
b. biotransformation.
c. drug distribution.
d. plasma half-life.

 

 

 

  1. After inhalation of an aerosol by a spontaneously breathing patient with no artificial airway, a proportion of the aerosol does which of the following?
  2. Impacts in the oropharynx
  3. Is swallowed
  4. Is absorbed by the lungs
  5. Is exhaled

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

=

 

 

Chapter 03: Administration of Aerosolized Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. A 2-year-old child is seen in the emergency department of a local hospital, and croup is diagnosed. The physician orders a dose of racemic epinephrine via a small volume nebulizer to help reduce the subglottic swelling. What size aerosol particle is most likely to deposit in this region, providing the greatest therapeutic benefit to the patient?
a. Particles less than 10 µm
b. Particles 5 to 10 µm
c. Particles 2 to 5 µm
d. Particles 0.8 to 3.0 µm

 

 

 

  1. The main uses of aerosol therapy in respiratory care include the following:
  2. Humidification of dry gases
  3. Improved mobilization and clearance of secretions
  4. Delivery of aerosol drugs to the respiratory tract
  5. Delivery of nutrients for patients unable to chew food

 

a. 1 and 2 only
b. 1, 2, and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. What is the particle size range for pulmonary diagnostic and therapeutic applications?
a. 0.5 to 1 µm
b. 1 to 10 µm
c. 10 to 15 µm
d. 15 to 25 µm

 

 

 

  1. Two hypothetical small volume nebulizers, A and B, have the following specifications from the manufacturer:

 

A B
Count median diameter (CMD) 1.7 µm 1.5 µm
Mass median aerodynamic diameter (MMAD) 3.2 µm 7.7 µm
Geometric standard deviation (GSD) 1.1 µm 1.5 µm

 

Which nebulizer would be best to use to treat the lower respiratory tract?

a. Nebulizer A
b. Nebulizer B

 

 

 

  1. You are a respiratory therapist working in the emergency department; a 67-year-old man with chronic bronchitis presents in acute distress. His vital signs include heart rate (HR) 123 beats/min and respiratory rate (RR) 28 breaths/min. On auscultation, you note faint expiratory wheezing. Which of the following devices would be the least appropriate by which to deliver an aerosolized drug to this patient?
a. Jet nebulizer
b. Metered dose inhaler (MDI)
c. MDI with spacer
d. Dry powder inhaler (DPI)

 

 

 

  1. An aerosol is best defined as
a. a drug in liquid form.
b. vapor suspended in a carrier gas.
c. a suspension of solid or liquid particles in a carrier gas.
d. an invisible drug particle.

 

 

 

  1. Traditionally, what percentage of a given dose of aerosolized medication reaches the lower respiratory tract, regardless of the type of delivery device being used?
a. 5% to 10%
b. 10% to 15%
c. 20% to 30%
d. 40% to 50%

 

 

 

  1. What is the purpose of the end-inspiratory breath hold used in conjunction with aerosol delivery?
a. Prevents the patient from hyperventilating
b. Gives the aerosol more time to reach BTPS conditions
c. Allows better deposition through gravitational settling
d. Reduces inertial impaction

 

 

 

  1. You are treating a patient who has a confirmed diagnosis of Pneumocystis pneumonia. Which type of delivery device should you choose to administer the dose of pentamidine ordered by the attending physician?
a. Respirgard II®
b. MDI
c. Pari LC®
d. DPI

 

 

 

  1. A 7-month-old infant presents with a diagnosis of respiratory syncytial virus. The attending physician agrees with your recommendation of ribavirin to treat the disease. Because ribavirin is delivered as an aerosol, you must decide which method of delivery to use. Which of the following aerosol administration devices would you choose?
a. Small volume nebulizer
b. Large volume nebulizer
c. Dry powder inhaler (DPI)
d. Small particle aerosol generator (SPAG)

 

 

 

  1. After delivering an aerosol treatment, you notice that approximately 0.5 mL of medication remains in the small volume nebulizer. Which of the following actions do you take?
a. Replace the nebulizer before administering the next treatment
b. Recommend that subsequent doses be delivered via metered dose inhaler (MDI)
c. Take no action and deliver the following dose with the same small volume nebulizer
d. Double the amount of medication administered during the next treatment

 

 

 

  1. Which of the following statements is true concerning the recommended volume of solution when delivering an aerosol treatment via a small volume nebulizer?
  2. A volume between 3 mL and 5 mL of solution is recommended.
  3. Increasing the volume results in a decrease in the concentration of drug remaining in the dead volume when nebulization ceases.
  4. Patient compliance of therapy is directly proportional to its convenience.
  5. Increasing the volume of solution results in a net increase in the amount of active drug in the nebulizer.

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. You are administering an aerosol treatment to a patient via a small volume nebulizer when you realize that the output appears to be much less than normal. On checking the flow meter, you see that it is set to 4 L/min. Your next action is to:
a. Decrease the flow to 2 L/min
b. Increase the flow to 20 L/min
c. Leave the flow rate unchanged and search for other sources of decreased output
d. Increase the flow rate to 8 L/min

 

 

 

  1. The physician has ordered your patient to receive continuous administration of heliox with racemic epinephrine secondary to postextubation stridor. As you approach the bedside to deliver the ordered dose of racemic epinephrine via small volume nebulizer, what outcome should you expect with a gas flow of 10 L/min of heliox?
a. The nebulization time will be less than when using oxygen as a power gas.
b. The mass median aerodynamic diameter (MMAD) of the aerosolized medication will be greater than when using oxygen as a power gas.
c. There will be a twofold increase in nebulization time (compared with oxygen as a power gas).
d. The MMAD and nebulization time will remain unchanged.

 

 

 

  1. Your patient is receiving gentamicin (a high-viscosity antibiotic solution) via gas-powered small volume nebulizer. To compensate for the increased viscosity of the aerosol solution, you should
a. set the gas flow to 6 L/min.
b. set the gas flow to 12 L/min.
c. recommend a different method of drug delivery.
d. both A and C.

 

 

 

  1. You are instructing the parents of a 4-year-old child with asthma on how to deliver aerosolized medication at home via a traditional small volume jet nebulizer. When the parents ask how much of the medication actually reaches the child’s lungs, you answer:
a. 5% to 10% of the total drug dose.
b. 10% to 15% of the total drug dose.
c. 50% to 60% of the total drug dose.
d. Nearly 100% of the total drug dose.

 

 

 

  1. All metered dose inhalers (MDIs) are powered by which propellant?
a. Chlorofluorocarbons (CFCs)
b. Soy lecithin
c. Hydrofluoroalkanes (HFAs)
d. Oleic acid

 

 

 

  1. Which of the following are problems associated with patient use of an MDI?
  2. Failure to coordinate inhalation and actuation of the inhaler
  3. A too-rapid inspiratory flow rate
  4. Failure to shake and mix canister contents
  5. Cessation of inspiration as the aerosol strikes the throat

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Your patient carries an albuterol MDI, which she claims to use every few weeks. She complains that the first dose actuated from the device seems to have no effect on her bronchospasm. What suggestion would you make to correct the problem?
a. Discharge a waste dose before using the MDI
b. Replace the device
c. Administer three actuations instead of the two that her physician prescribed
d. Recommend use of a small volume nebulizer

 

 

 

  1. Advantages of using portable ultrasonic drug nebulizers include that they
a. require an electrical source.
b. are inexpensive.
c. are very durable.
d. are small in size.

 

 

 

  1. Your patient asks how long to wait between the first and second doses from her albuterol MDI. You suggest that she
a. pause 15 minutes between actuations.
b. not pause at all, but deliver both actuations as quickly as possible, preferably over a time period of 1 second.
c. pause 1 to 5 minutes between actuations.
d. pause 30 minutes between actuations.

 

 

 

  1. Barring any issues regarding patient coordination or ability to use the device correctly, how should you suggest that a patient administer a drug with an MDI if no spacer is available?
a. Insert the MDI into the mouth and make a tight seal with the lips.
b. Hold the MDI several centimeters in front of the open mouth.
c. Never use the device without a spacer.
d. Insert the MDI into the mouth and make a loose seal with the lips.

 

 

 

  1. Your patient informs you that she keeps her albuterol MDI stored in her refrigerator because she feels that this keeps the medication “fresher” for a longer time. What is your best response?
a. Tell her that is a fine idea and that you may make the same recommendation to other patients.
b. Suggest that she put it in the freezer instead because the colder temperature may keep the drug “fresher” for a longer time.
c. Request that she no longer refrigerate the canister but instead store it at room temperature.
d. Tell her to place the MDI in the bottom drawer of the refrigerator because this will keep it the “freshest.”

 

 

  1. You are teaching proper use of a metered dose inhaler (MDI) to an elderly man who is having trouble coordinating actuation of the device with an inspiratory effort. What suggestion(s) would you make to help him with his problem?
a. Suggest adding a reservoir device
b. Suggest that if he cannot effectively use the MDI, he may need to switch to an SVN
c. Both A and B
d. Neither A nor B

 

 

 

  1. The physician has requested that you provide a patient with a reservoir device to use in conjunction with a metered dose inhaler (MDI). Given a choice, which type of device would you give the patient?
a. Spacer
b. Traditional holding chamber
c. Antistatic valved holding chamber
d. Non-antistatic valved holding chamber

 

 

 

  1. The greatest limitation to patient use of a dry powder inhaler (DPI) is
a. patient preference.
b. patient coordination.
c. patient ability to provide an inspiratory flow rate of 30 to 90 L/min.
d. cost.

 

 

 

  1. The physician has granted your request to change a patient from a small volume nebulizer (SVN) to a metered dose inhaler (MDI) for administration of albuterol. The dose via SVN was 2.5 mg of drug. What is the equivalent dose via MDI to administer to your patient?
a. 1 puff
b. 2 puffs
c. 3 puffs
d. 4 puffs

 

 

 

  1. You have been asked to administer albuterol to a neonate who is currently not intubated. Which of the following aerosol devices would be age appropriate?
a. Dry powder inhaler (DPI)
b. Metered dose inhaler (MDI) with reservoir/mask
c. Small volume nebulizer (SVN)
d. Both B and C

 

 

 

  1. The physical method used to measure aerosol particle size distribution that uses multiple steps in determining sizes of aerosol particles is referred to as
a. the laser scattering method.
b. the Mie-scattering theory.
c. a cascade impactor.
d. none of the above.

 

 

 

  1. The physical mechanisms usually considered for aerosol particle deposition in the human lung include which of the following?
  2. Inertial impaction
  3. Gravitational settling
  4. Diffusion

 

a. 1 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1 and 3 only

 

 

 

  1. Your patient is receiving a Duoneb via a small volume nebulizer (SVN) powered by compressed oxygen as part of her maintenance therapy drug regimen. The cylinder runs out before the treatment can be completed. What action would you suggest?
a. Switch remaining treatment to a metered dose inhaler (MDI)
b. Switch remaining treatment to a dry powder inhaler (DPI)
c. Used compressed air to complete the treatment
d. Chart that the treatment was not completed and move to your next patient

 

 

 

  1. Advantages of small volume nebulizers (SVNs) include which of the following?
  2. Ability to aerosolize many drug solutions
  3. Minimal cooperation or coordination required for inhalation
  4. Drug concentration and dose can be modified
  5. Normal breathing pattern can be used

 

a. 1 only
b. 2 and 3 only
c. 1 and 3 only
d. 1, 2, 3, and 4 only

 

 

 

  1. The most common error in use of pressurized metered dose inhalers (pMDIs) is
a. actuation of the pMDI at total lung capacity.
b. inadequate shaking and mixing of pMDI contents before use.
c. failure to coordinate actuation of pMDI with inhalation.
d. exhaling during pMDI actuation.

 

 

 

  1. Asthma was recently diagnosed in your patient, and she was prescribed albuterol PRN. She asks you to suggest a delivery device for her albuterol. She is a college student with a busy schedule and spends little time at home. What suggestion would you make?
a. pMDI
b. Ultrasonic nebulizer
c. Small volume nebulizer
d. Breath-actuated nebulizer

 

 

 

  1. A medical student asks about the different ways albuterol and ipratropium bromide can be delivered. What would you tell the student?
  2. pMDI
  3. DPI
  4. Respimat soft-mist inhaler
  5. Solution for nebulization

 

a. 1 and 4 only
b. 2, 3, and 4 only
c. 1, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. This device releases aerosol only during inspiration, allowing all released aerosol to be available for patient inhalation (examples: AeroEclipse®, Circulaire®).
a. Breath-enhanced nebulizer
b. Breath-actuated jet nebulizer
c. Ultrasonic nebulizer
d. Soft-mist inhaler

 

 

 

  1. This device allows greater aerosol release during inspiration, while decreasing output during exhalation or breath hold (example: Pari LC®).
a. Breath-enhanced nebulizer
b. Breath-actuated jet nebulizer
c. Ultrasonic nebulizer
d. Soft-mist inhaler

 

 

 

  1. This device is electrically powered and operates on the piezoelectric principle and is capable of high output.
a. Breath-enhanced nebulizer
b. Breath-actuated jet nebulizer
c. Ultrasonic nebulizer
d. Soft-mist inhaler

 

 

 

  1. This device is propellant-free and utilizes mechanical energy in the form of a tension spring to deliver medication.
a. Breath-enhanced nebulizer
b. Breath-actuated jet nebulizer
c. Ultrasonic nebulizer
d. Soft-mist inhaler

 

 

 

  1. A measure of the dispersion of a distribution, calculated as the ratio of particle size below which 84% of the particles occur to the particle size below which 50% occur, in a log-normal distribution is termed
a. count mode.
b. count median diameter (CMD).
c. mass median diameter (MMD).
d. geometric standard deviation (GSD).

 

 

 

  1. ________________ is the particle size above and below which 50% of the mass of the particles are found.
a. Count mode
b. Count median diameter (CMD)
c. Mass median diameter (MMD)
d. Geometric standard deviation (GSD)

 

 

 

  1. The most frequently occurring particle size in the distribution is called
a. count mode.
b. count median diameter (CMD).
c. mass median diameter (MMD).
d. geometric standard deviation (GSD).

 

 

 

  1. The particle size above and below which 50% of the particles are found is termed
a. count mode.
b. count median diameter (CMD).
c. mass median diameter (MMD).
d. geometric standard deviation (GSD).

 

 

 

  1. A device that disperses individual doses that are premetered into a blister, which is mechanically punctured when the cover is lifted (example: Diskhaler®), is called a
a. unit dose DPI.
b. multiple unit dose DPI.
c. multiple-dose DPI.

 

 

  1. A device that measures the dose either from a powder reservoir or blister strips prepared by the manufacturer (examples: Twisthaler®, Flexhaler®, and Diskus®) is called a
a. unit dose DPI.
b. multiple unit dose DPI.
c. multiple-dose DPI.

 

 

 

  1. These devices have individually wrapped capsules that contain a single dose of medication and deliver powder medication from a punctured capsule (examples: Aerolizer® and HandiHaler®).
a. Unit dose DPI
b. Multiple unit dose DPI
c. Multiple-dose DPI

 

 

=

 

 

Chapter 04: Calculating Drug Doses

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. One milliliter (mL) is equivalent to how many drops (gtts) of liquid?
a. 4
b. 8
c. 16
d. 20

 

 

  1. One cubic centimeter is equivalent to how many milliliters?
a. 0.1
b. 1
c. 10
d. 100

 

 

  1. One standard teaspoon is the equivalent to how many milliliters?
a. 1
b. 5
c. 10
d. 15

 

 

 

  1. You have atropine 0.4 mg/mL in a vial of liquid. How many milliliters would be needed for a 1.0-mg dose?
a. 0.25
b. 2.5
c. 5
d. 10

 

 

 

  1. How many cubic centimeters do you need for a 2.5-mg dose of Drug A, using a 0.1% solution?
a. 2.5
b. 25
c. 0.25
d. 0.025

 

 

 

  1. You administer 0.5 mL of a 1:200 strength drug; how many milligrams of active ingredient are you giving?
a. 0.25 mg
b. 2.5 mg
c. 25 mg
d. 12.5 mg

 

 

 

  1. You have 3 mg/mL of active ingredient; what is the percent solution of this medication?
a. 3%
b. 0.3%
c. 30%
d. 13%

 

 

 

  1. How much 20% acetylcysteine solution would you need to prepare 5 mL of a 6% solution?
a. 0.15 mL
b. 1.5 mL
c. 15 mL
d. 5 mL

 

 

 

  1. A dosage schedule for pediatric use of albuterol (0.5%) is 0.03 mL/kg. You have a 22-lb, 12-month-old patient in the emergency department. How many milliliters of solution will you need?
a. 0.3 mL
b. 3 mL
c. 30 mL
d. 0.03 mL

 

 

  1. A physician orders 3 mL of an 8% drug solution. You have only a 10% solution available. How many milliliters of 10% solution do you need to make the new 8% solution?
a. 0.24 mL
b. 2.6 mL
c. 24 mL
d. 12.4 mL

 

 

 

  1. A physician orders 12 mg of medication to be delivered to your patient. If 30 mL of the solution contains 20 mg of active drug, how many milliliters will you need to administer?
a. 1.8
b. 18
c. 0.18
d. 0.018

 

 

 

  1. A physician orders 5 mL of a medication to be administered to your patient. If the drug is supplied as 10 mg in 20 mL of solution, how many milligrams of active drug will you be giving?
a. 2.5
b. 5
c. 7.5
d. 10

 

 

  1. A physician orders 3 mL of 0.83% albuterol. How many milligrams of medication would you administer?
a. 25 mg
b. 0.25 mg
c. 2.5 mg
d. 5 mg

 

 

 

  1. Penicillin is supplied as 600,000 U/mL. A physician orders 1,800,000 U to be injected. How many milliliters does the patient need to receive?
a. 1
b. 3
c. 5
d. 10

 

 

 

  1. Exosurf®, a surfactant agent, is administered on a dosage schedule of 5 mL/kg body weight. If a premature infant weighs 1400 g, how many milliliters should be administered?
a. 5
b. 7
c. 9
d. 11

 

 

 

  1. Atrovent® is supplied as a 0.02% solution. If you administer 2.5 mL to a patient, how many milligrams are you giving?
a. 0.02
b. 0.5
c. 1
d. 2

 

 

  1. You have 80 mg of phenobarbital in 20 mL of phenobarbital elixir. How many milliliters of elixir would you use to give a 20-mg dose?
a. 0.5
b. 5
c. 15
d. 10

 

 

 

  1. Which of the following Latin prefixes means 1/10?
a. Micro
b. Milli
c. Centi
d. Deci

 

 

 

  1. Which of the following Latin prefixes means 1/1000?
a. Micro
b. Milli
c. Centi
d. Deci

 

 

 

  1. Which of the following Latin prefixes means 1/100?
a. Micro
b. Milli
c. Centi
d. Deci

 

 

 

  1. Which of the following Latin prefixes means 1/1,000,000?
a. Micro
b. Milli
c. Centi
d. Deci

 

 

 

  1. Which of the following Greek terms means 100?
a. Deca
b. Hecto
c. Kilo

 

 

 

  1. Which of the following Greek terms means 1000?
a. Deca
b. Hecto
c. Kilo

 

 

 

  1. Which of the following Greek terms means 10?
a. Deca
b. Hecto
c. Kilo

 

 

 

  1. Which of the following metric system terms is associated with length?
a. Meter
b. Liter
c. Gram

 

 

 

 

  1. Which of the following metric system terms is associated with mass?
a. Meter
b. Liter
c. Gram

 

 

 

  1. Which of the following metric system terms is associated with volume?
a. Meter
b. Liter
c. Gram

 

 

 

Chapter 05: Central and Peripheral Nervous Systems

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The somatic portion of the nervous system controls which of the following?
a. Heart muscle
b. Glandular secretion
c. Skeletal muscle
d. Smooth airway muscle

 

 

 

  1. How is the neurotransmitter acetylcholine inactivated at the parasympathetic terminal receptor site?
a. By the enzyme catechol O-methyltransferase (COMT)
b. By the reuptake process
c. By the enzyme cholinesterase
d. By the enzyme monoamine oxidase (MAO)

 

 

 

  1. You administer an inhaled bronchodilator that is known to have adrenergic side effects. What cardiovascular clinical effect should you watch for in your patient?
a. Bradycardia
b. Tachycardia
c. Bradypnea
d. Tachypnea

 

 

 

  1. Following administration of a dose of atropine to your patient, which of the following effects are not likely to occur?
a. Dry mouth
b. Decreased mucus production
c. Bronchial constriction
d. Increased heart rate

 

 

 

  1. As a practitioner, you would expect which parts of the physical examination to be affected by a dose of atropine or other parasympatholytic agent?
a. Gastrointestinal examination
b. Neurologic examination
c. Cardiac examination
d. All of the above

 

 

 

  1. What is the adrenergic effect on bronchial smooth muscle?
a. Constriction
b. Dilation (relaxation)
c. Both
d. Neither

 

 

 

  1. Your patient is accidentally given a large dose of a parasympathomimetic drug. What side effects of parasympathetic overstimulation do you expect to see?
  2. Salivation
  3. Lacrimation
  4. Urination
  5. Defecation

 

a. 1 only
b. 1 and 2 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. After administering a sympathomimetic drug to your patient, in what areas would you expect to see an upward trend?
  2. Heart rate
  3. Blood pressure
  4. Blood glucose

 

a. 1 only
b. 1 and 2 only
c. 1 and 3 only
d. 1, 2, and 3

 

 

 

  1. Your patient has bradycardia. Which type of drug do you recommend?
a. Sympatholytic
b. Sympathomimetic
c. Parasympathomimetic
d. Both A and C

 

 

 

  1. A direct-acting cholinergic agent often used in bronchial challenge tests to assess the degree of airway activity is
a. edrophonium.
b. methacholine.
c. neostigmine.
d. phospholine.

 

 

 

  1. Which type of impulse travels from the brain to the neuroeffector sites?
a. Afferent
b. Reflex
c. Ganglionic
d. Efferent

 

 

 

  1. Epinephrine stimulates which of the following receptor sites?
a. a
b. b1
c. b2
d. All of the above

 

 

 

  1. The stimulation of which receptor sites produces bronchial smooth muscle relaxation?
a. b1
b. b2
c. a
d. b1 and b2

 

 

 

  1. Which of the following drugs are sympathomimetic agents?
  2. Salmeterol
  3. Dopamine
  4. Labetalol
  5. Propranolol

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. You are treating a patient for bronchospasm. Albuterol (an adrenergic bronchodilator) is the only aerosolized agent being administered at this time. What other type of aerosolized drug might you recommend?
a. Anticholinergic bronchodilator
b. Sympatholytic
c. Both A and B
d. Neither A nor B

 

 

 

  1. You are treating an asthmatic who also happens to be taking propranolol (a b blocker) for a history of cardiac arrhythmias. What type of effect would you expect albuterol to have on this patient?
a. Antagonistic effect
b. Synergistic effect
c. Little or no effect
d. Additive effect

 

 

 

  1. In the parasympathetic branch of the nervous system, what name is given to the neurotransmitter that conducts nerve transmission at the ganglionic site?
a. Cholinesterase
b. Acetylcholine
c. Epinephrine
d. Norepinephrine

 

 

 

  1. A parasympathetic effect is generally the same as which of the following?
a. Antimuscarinic effect
b. Muscarinic effect
c. Parasympatholytic effect
d. Anticholinergic effect

 

 

 

  1. The peripheral nervous system consists of which of the following?
  2. Spinal cord
  3. Autonomic nervous system
  4. Brain
  5. Somatic portion

 

a. 1 only
b. 2 and 4 only
c. 1 and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. A patient is experiencing changes in heart rate and pupillary response to light. What division of the nervous system is responsible for these changes?
a. Central nervous system
b. Somatic neurons
c. Sensory neurons
d. Autonomic nervous system

 

 

 

  1. Means by which nerve impulses are conducted include which of the following?
a. Electrical
b. Chemical
c. Both A and B
d. Neither A nor B

 

 

 

  1. An indirect-acting cholinergic agent used in the Tensilon® test is
a. edrophonium.
b. methacholine.
c. neostigmine.
d. phospholine.

 

 

 

  1. You are treating a patient for motion sickness with the drug dimenhydrinate (Dramamine®). What possible side effect may the patient experience when taking this drug?
a. Tachycardia
b. Insomnia
c. Dry mouth
d. None of the above

 

 

 

  1. Which portion of the nervous system is manipulated by neuromuscular blocking agents, to induce paralysis in surgical procedures or during mechanical ventilation?
a. The parasympathetic branch of the autonomic nervous branch
b. The somatic portions of the motor branch
c. The sensory branch of the peripheral nervous system
d. The spinal cord

 

 

 

  1. Agents causing stimulation of the parasympathetic nervous system are
a. cholinergic.
b. anticholinergic.
c. adrenergic.
d. parasympathomimetic.

 

 

 

  1. Agents blocking or inhibiting the effects of the parasympathetic nervous system are
a. cholinergic.
b. parasympatholytic.
c. adrenergic.
d. parasympathomimetic.

 

 

 

  1. Agents causing stimulation of the sympathetic nervous system are
a. adrenergic.
b. parasympathomimetic.
c. parasympatholytic.
d. sympathomimetic.

 

 

 

  1. Agents blocking or inhibiting the effect of the sympathetic nervous system are
a. anticholinergic.
b. adrenergic.
c. parasympatholytic.
d. sympatholytic.

 

 

 

  1. A drug causing stimulation of a receptor for acetylcholine is
a. cholinergic.
b. anticholinergic.
c. adrenergic.
d. parasympathomimetic.

 

 

 

  1. Drugs that block a receptor for acetylcholine are
a. cholinergic.
b. anticholinergic.
c. adrenergic.
d. parasympathomimetic.

 

 

 

  1. Drugs that stimulate a receptor for norepinephrine or epinephrine are
a. adrenergic.
b. parasympathomimetic.
c. parasympatholytic.
d. sympathomimetic.

 

 

 

  1. M1 receptors are present on which of the following?
a. Heart, postganglionic parasympathetic nerves
b. Parasympathetic ganglia, nasal submucosal glands
c. Airway smooth muscle, submucosal glands
d. Postganglionic cholinergic nerves, possible effect on CNS

 

 

 

  1. M2 receptors are present on which of the following?
a. Heart, postganglionic parasympathetic nerves
b. Parasympathetic ganglia, nasal submucosal glands
c. Airway smooth muscle, submucosal glands
d. Postganglionic cholinergic nerves, possible effect on CNS

 

 

 

  1. M3 receptors are present on which of the following?
a. Heart, postganglionic parasympathetic nerves
b. Parasympathetic ganglia, nasal submucosal glands
c. Airway smooth muscle, submucosal glands
d. Postganglionic cholinergic nerves, possible effect on CNS

 

 

 

  1. The neurotransmitter norepinephrine is terminated by the enzymes __________ and __________.
a. catechol O-methyltransferase (COMT) and monoamine oxidase (MAO)
b. catechol O-methyltransferase (COMT) and cholinesterase
c. cholinesterase and monoamine oxidase (MAO)
d. monoamine oxidase (MAO) and pseudocholinesterase

 

 

 

  1. Branches of the nervous system, which can cause relaxation of airway smooth muscle, include which of the following?
  2. Sympathetic nerves
  3. Parasympathetic nerves
  4. Nonadrenergic, noncholinergic (NANC) inhibitory nerves

 

a. 1 only
b. 2 only
c. 1 and 2 only
d. 1, 2, and 3

 

 

 

  1. Muscarinic receptors are found in which of the following?
  2. Exocrine glands
  3. Cardiac muscle
  4. Smooth muscle
  5. The gastrointestinal tract

 

a. 1 and 2 only
b. 2 and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Nicotine is capable of stimulating
a. sympathetic receptors only.
b. parasympathetic autonomic cholinergic receptors only.
c. both sympathetic and parasympathetic autonomic cholinergic receptors.
d. neither sympathetic nor parasympathetic autonomic cholinergic receptors.

 

 

 

  1. The two major control systems in the body are
a. the brain and spinal cord.
b. the brain and nervous system.
c. the nervous system and the endocrine system.
d. the brain and the endocrine system.

 

 

 

Chapter 06: Adrenergic (Sympathomimetic) Bronchodilators

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Adrenergic bronchodilators mimic the actions of
a. cAMP.
b. acetylcholine.
c. penicillin.
d. epinephrine.

 

 

 

  1. Relaxation of smooth airway muscle in the presence of reversible airflow obstruction is a general indication for the use of
a. mucolytics.
b. adrenergic bronchodilators.
c. antiinfective agents.
d. steroids.

 

 

 

  1. Disease states that could benefit from the use of adrenergic bronchodilators include which of the following?
  2. Asthma
  3. Bronchitis
  4. Emphysema
  5. Bronchiectasis
  6. Pleural effusion

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Short-acting b2 agonists are indicated for
a. reduction of airway edema.
b. relief of acute reversible airflow obstruction.
c. maintenance of bronchodilation.
d. thinning of secretions.

 

 

 

  1. Your patient is diagnosed with persistent asthma. Which type of drug would you recommend for maintenance bronchodilation and control of bronchospasm?
a. Short-acting adrenergic agent
b. Long-acting adrenergic agent
c. a-adrenergic agent
d. Mucolytic agent

 

 

 

  1. Your patient presents with postextubation stridor. You recommend racemic epinephrine for its
a. a-adrenergic vasoconstricting effect.
b. short-acting b2-adrenergic effect.
c. long-acting b2-adrenergic effect.
d. b1-adrenergic effect.

 

 

 

  1. You enter the room of a 2-year-old patient who presents with a “barking cough” typically associated with croup. Once the diagnosis is confirmed, which of the following medications could you recommend to help provide relief from subglottic swelling?
a. Albuterol
b. Levalbuterol
c. Racemic epinephrine
d. Salmeterol

 

 

 

  1. In a patient who is receiving large doses of catecholamines, which side effect would you expect to see?
a. Decrease in blood pressure
b. Constriction of bronchial smooth muscle
c. Diuresis
d. Bradycardia

 

 

 

 

  1. Levalbuterol is
a. the same as albuterol.
b. the single (R)-isomer of albuterol.
c. an equal mixture of (R)-isomers and (S)-isomers.
d. the same as racemic epinephrine.

 

 

 

  1. Epinephrine stimulates which sites?
  2. a
  3. b1
  4. b2
  5. M3

 

a. 2 only
b. 4 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only

 

 

 

  1. Epinephrine is indicated for which of the following?
  2. Treatment of infections
  3. Severe allergic reactions
  4. Acute asthma episodes
  5. Cardiac stimulation

 

a. 1 and 4 only
b. 2 and 3 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Racemic epinephrine comes in what percent solution?
a. 0.05%
b. 1.25%
c. 2.25%
d. 5.0%

 

 

 

  1. The keyhole theory indicates that the larger the side-chain attachment to a catechol base, the
a. shorter the duration of action.
b. more easily it is metabolized.
c. more easily it is broken down by catechol O-methyltransferase (COMT).
d. greater the b2 specificity.

 

 

 

  1. Catecholamines are inactivated by
a. AchE.
b. COMT.
c. cGMP.
d. ATP.

 

 

 

  1. Catecholamines may be given by which of the following routes?
  2. Inhalation
  3. Subcutaneous
  4. Oral
  5. Injection

 

a. 4 only
b. 2 and 4 only
c. 1, 2, and 4 only
d. 2, 3, and 4 only

 

 

 

  1. Albuterol is available in which of the following forms?
  2. Syrup
  3. Nebulizer solution
  4. Metered dose inhaler (MDI)
  5. Oral tablets
  6. Dry powder inhaler (DPI)

 

a. 2 and 3 only
b. 1, 2, and 5 only
c. 3, 4, and 5 only
d. 1, 2, 3, and 4 only

 

 

 

  1. Salmeterol is
a. a long-acting b-adrenergic agent.
b. another name for albuterol.
c. available in nebulizer solution only.
d. indicated for acute asthma attacks.

 

 

 

  1. Long-acting b2 agonists are indicated for
a. acute asthma attacks.
b. mucus reduction.
c. treating infections.
d. maintenance therapy for asthmatics.

 

 

 

  1. The bronchodilating action of adrenergic drugs is due to stimulation of
a. a receptors.
b. cholinergic receptors.
c. b1 receptors.
d. b2 receptors.

 

 

 

 

  1. b1-receptor stimulation
a. causes vasoconstriction.
b. provides upper airway decongestion.
c. increases heart rate and contractile force.
d. relaxes bronchiole smooth muscle.

 

 

 

  1. Smooth muscle relaxation most likely occurs as a result of
a. a decrease in intracellular cAMP.
b. an increase in intracellular cAMP.
c. an increase in ATP.
d. a decrease in ATP.

 

 

 

  1. Inhalation is the preferred route of administering adrenergic bronchodilators for which of the following reasons?
  2. Rapid onset of action
  3. Smaller dosage used
  4. Reduced side effects
  5. Drug delivered to target organ
  6. Safe and painless route

 

a. 1 and 2 only
b. 3 and 4 only
c. 1, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. Continuous nebulization of inhaled b agonists has been used for
a. severe asthma.
b. pneumonia.
c. cystic fibrosis.
d. emphysema.

 

 

 

  1. The dosage recommended by NAEPP EPR 2 for continuous nebulization of adrenergic agents is
a. 5 to 8 mg/hr.
b. 8 to 12 mg/hr.
c. 10 to 15 mg/hr.
d. 20 to 30 mg/hr.

 

 

 

  1. Your patient is receiving her third continuous nebulizer of albuterol (15 mg/hr). Which potential complications should you be on the lookout for?
  2. Hypokalemia
  3. Cardiac arrhythmias
  4. Hyperglycemia
  5. Premature ventricular contractions
  6. Tremor

 

a. 2 and 4 only
b. 1, 2, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. When monitoring a patient using Ventolin, which side effect would you expect to see?
a. Sleepiness
b. Muscle tremor
c. Bradycardia
d. Hypotension

 

 

 

  1. You are ordered to extubate a mechanically ventilated patient who has recently undergone open heart surgery. On postextubation assessment you note that the patient has stridor with mild retractions. What type of pharmacologic agent would you recommend?
a. b2 adrenergic
b. a adrenergic
c. Anticholinergic
d. Sympatholytic

 

 

 

  1. Which of the following is a b-agonist formulation that is a single isomer approved by the U.S. Food and Drug Administration (FDA) for aerosol delivery?
a. Epinephrine
b. Albuterol
c. Levalbuterol
d. Tiotropium

 

 

 

  1. What is the rationale for using the single-isomer agent levalbuterol instead of racemic albuterol?
a. The (S)-isomer is thought to promote bronchoconstriction.
b. The (S)-isomer is a weak bronchodilator.
c. The (R)-isomer is thought to cause tachycardia.
d. The (R)-isomer is thought to cause tremors.

 

 

 

 

  1. What is the main difference between salmeterol and formoterol?
a. Formoterol is short-acting, and salmeterol is long-acting.
b. Formoterol has a slower onset and peak effect compared with salmeterol.
c. Formoterol is more b2-specific than salmeterol.
d. Formoterol has a quicker onset and peak effect than salmeterol.

 

 

 

  1. What is the indication for use of a short-acting b agonist in asthma?
a. As maintenance therapy in reversible airflow obstruction
b. As rescue therapy in reversible airflow obstruction
c. As an antiinflammatory agent in reversible airflow obstruction
d. As an antiinfective agent in respiratory infections

 

 

 

  1. Is it appropriate to use Arcapta Neohaler as a rescue bronchodilator?
a. Yes
b. No

 

 

 

 

  1. Which procedure would tell you that a patient has reversible airway obstruction?
a. Inspection—patient is short of breath when walking less than 25 ft
b. Pulmonary function tests before and after bronchodilator therapy
c. Pulse oximetry
d. Wheezing on auscultation

 

 

 

  1. You receive an order to administer 5 mL of albuterol by small volume nebulizer (SVN). Which of the following should you do?
a. Confirm the order on the chart and administer as directed
b. Have your supervisor administer the treatment
c. Call the physician to confirm the medication dose
d. Give 0.5 mL of medication because that is probably what the physician meant to write

 

 

 

  1. You are administering an aerosolized bronchodilator to your patient. Her pretreatment pulse was 86 beats/min. You would stop the treatment if her pulse reached
a. 90 beats/min.
b. 100 beats/min.
c. 110 beats/min.
d. 120 beats/min.

 

 

 

 

  1. A 7-year-old boy has been given multiple aerosolized albuterol treatments over the last several days. His father tells you that every time a respiratory therapist administers a treatment, a few minutes later the saturation falls. You explain to the father that this is
a. abnormal and call the physician.
b. abnormal and you will try to change the medication to levalbuterol.
c. normal because of increased perfusion to poorly ventilated areas.
d. normal because you are giving the treatment with air.

 

 

 

  1. What is the generic name of Arcapta Neohaler?
a. Proventil HFA
b. ProAir HFA
c. Indacaterol
d. Arformoterol

 

 

 

 

  1. Metaproterenol can be taken orally because:
a. It has a fast peak time, about 3 to 5 minutes.
b. It does not contain chlorofluorocarbons (CFCs).
c. It is an antibiotic.
d. It resists inactivation by catechol O-methyltransferase (COMT).

 

 

 

  1. A drug that exhibits its pharmacologic activity once it is converted inside the body to its active form is called
a. the asthma paradox.
b. a prodrug.
c. downregulation.
d. a sympathomimetic.

 

 

 

  1. Your patient requires a once daily long-acting b2 agonist. The physician asks for your suggestion regarding medication choice. What medication would you suggest?
a. Brovana
b. Arcapta Neohaler
c. Performist
d. Serevent Diskus

 

 

 

 

  1. The dosage and route for arformoterol is
a. 5 to 8 mg PO.
b. 2.5 mg tid via nebulization.
c. 15 mg bid via nebulization.
d. 90 mg tid via MDI.

 

 

 

  1. Which of the following medications is an ultra-long-acting b-agonist approved for the treatment of COPD?
a. Striverdi Respimat
b. Xopenex
c. VoSpire ER
d. AccuNeb

 

 

 

 

  1. Your patient is receiving continuous albuterol treatment for an acute exacerbation of her asthma. What would you monitor during her treatment?
  2. The patient’s subjective reaction to treatment
  3. The patient’s heart rate
  4. The patient’s pulse oximeter saturation
  5. Laboratory values (CBC)

 

a. 1 and 2 only
b. 2 and 3 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4

 

 

REF:   p. 112

 

  1. Which of the following is the generic name for Brovana?
a. Formoterol
b. Salmeterol
c. Olodaterol
d. Arformoterol

 

 

 

  1. Which of the following is the generic name for Arcapta Neohaler?
a. Indacterol
b. Salmeterol
c. Olodaterol
d. Arformoterol

 

 

 

  1. Which of the following is the generic name for Performist?
a. Indacterol
b. Salmeterol
c. Formoterol
d. Arformoterol

 

 

 

  1. Which of the following is the generic name for Striverdi Respimat?
a. Indacterol
b. Salmeterol
c. Olodaterol
d. Arformoterol

 

 

 

  1. Which of the following medications are classified as ultrashort-acting adrenergic bronchodilators based on their duration of action?
  2. Racemic epinephrine
  3. Formoterol
  4. Albuterol
  5. Indacaterol
  6. Arformoterol
  7. Olodaterol

 

a. 1, 2, and 4 only
b. 1 only
c. 4 and 7 only
d. 1, 4, 7, and 8 only

 

 

 

  1. Which of the following medications are classified as short-acting adrenergic bronchodilators based on their duration of action?
  2. Racemic epinephrine
  3. Formoterol
  4. Albuterol
  5. Levalbuterol
  6. Arformoterol
  7. Olodaterol

 

a. 2 only
b. 3 and 4 only
c. 2, 3, and 6 only
d. 4, 5, and 6 only

 

 

 

  1. Which of the following medications are classified as long or ultra long-acting adrenergic bronchodilators based on their duration of action?
  2. Indacterol
  3. Formoterol
  4. Albuterol
  5. Indacaterol
  6. Arformoterol
  7. Olodaterol

 

a. 1 only
b. 4 only
c. 4 and 6 only
d. 5 and 6 only

 

 

 

  1. Which of the following medications are given only once daily?
  2. Formoterol
  3. Albuterol
  4. Indacaterol
  5. Arformoterol
  6. Levalbuterol
  7. Olodaterol

 

a. 1 and 4 only
b. 4, 5 and 6 only
c. 3 and 6 only
d. 1, 4, 5, and 6 only

 

 

 

Chapter 07: Anticholinergic (Parasympatholytic) Bronchodilators

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. An anticholinergic that can be administered via aerosolization is
a. ipratropium bromide.
b. albuterol sulfate.
c. glycopyrrolate.
d. atropine.

 

 

 

  1. The combination of albuterol and ipratropium bromide can be delivered by which of the following methods?
  2. Tablet
  3. Nebulizer
  4. Injection
  5. MDI
  6. Soft-mist inhaler

 

a. 2 only
b. 1, 3, and 4 only
c. 1, 2, and 4 only
d. 2, 4, and 5 only

 

 

REF:   p. 123

 

  1. Incruse Ellipta® is approved for
a. exacerbation of chronic obstructive pulmonary disease (COPD).
b. thinning of dried secretions.
c. acute bronchoconstriction.
d. maintenance treatment of airflow obstruction in COPD.

 

 

 

 

  1. Combivent® is a combination drug including which two medications?
a. Albuterol and salmeterol
b. Salmeterol and ipratropium bromide
c. Albuterol and ipratropium bromide
d. Pirbuterol and ipratropium bromide

 

 

 

  1. Cholinergic stimulation produces which of the following effects?
  2. Bronchoconstriction
  3. Increased mucus secretion
  4. Miosis
  5. Decreased heart rate
  6. Salivation

 

a. 4 only
b. 1, 3, and 5 only
c. 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Mucociliary slowing, bronchodilation, and increased heart rate all are a result of
a. cholinergic agents.
b. adrenergic agents.
c. anticholinergic agents.
d. parasympathetic agents.

 

 

 

  1. Quaternary ammonium compounds such as ipratropium bromide
a. are ineffective as inhaled agents.
b. do not cross lipid membranes easily.
c. are distributed quickly throughout the body when inhaled.
d. have no role in respiratory care.

 

 

 

  1. Ipratropium bromide is indicated to treat which of the following?
a. Allergic rhinitis
b. Maintenance therapy in patients with COPD
c. Nonallergic rhinitis
d. All of the above

 

 

 

  1. Quaternary ammonium compounds cause bronchodilation by
a. blocking cholinergic sites.
b. stimulating cholinergic sites.
c. blocking adrenergic sites.
d. stimulating adrenergic sites.

 

 

 

 

  1. Patients using ipratropium aerosols should be instructed to avoid allowing the aerosol to come in contact with their
a. hair.
b. nose.
c. eyes.
d. ears.

 

 

 

  1. Activating an Atrovent® inhaler in the eye may cause
a. blindness.
b. pupil dilation.
c. pupil constriction.
d. scarring of the cornea.

 

 

2

 

  1. Cardiac effects of aerosolized ipratropium bromide include which of the following?
a. Increased heart rate
b. Increased blood pressure
c. Increased heart muscle contractility
d. Little or no effect

 

 

 

  1. Drugs that competitively block the action of acetylcholine at parasympathetic postganglionic effector cell receptors are called
a. muscarinic agents.
b. adrenergic agents.
c. antimuscarinic agents.
d. cholinergic agents.

 

 

REF:   p. 126 | p. 127

 

  1. The most common side effect of anticholinergic bronchodilators is
a. dry mouth.
b. increased heart rate.
c. wheezing.
d. delirium.

 

 

 

  1. Possible side effects of aerosolized Atrovent® include which of the following?
  2. Flulike symptoms
  3. Pharyngitis
  4. Bradycardia
  5. Dry mouth
  6. Dyspnea

 

a. 1, 2, and 3 only
b. 1, 2, and 4 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Results of a patient’s pulmonary function test (PFT) show that the peak flow rate increased the most when she inhaled an aerosolized sympathomimetic agent and an aerosolized parasympatholytic agent. You would recommend that she be given which of the following?
a. Ventolin® MDI
b. Serevent Diskus® DPI
c. Combivent Respimat®
d. Foradil® DPI

 

 

 

 

  1. Which of the following is a once-a-day anticholinergic?
a. Atropine
b. Ipratropium bromide
c. Glycopyrrolate
d. Umeclidinium bromide

 

 

 

  1. Which of the following statements regarding ipratropium bromide are true?
  2. It is a first-line choice of bronchodilator for chronic obstructive pulmonary disease (COPD).
  3. It can be combined with a b agonist for maintenance bronchodilation in COPD.
  4. It is added to a b agonist in severe asthma episodes that do not respond to a b agonist alone.
  5. It is a leukotriene modifier used to treat step 3 asthma.

 

a. 1 and 4 only
b. 2 and 4 only
c. 1, 2, and 4 only
d. 1, 2, and 3 only

 

 

 

 

  1. Tiotropium bromide exhibits receptor subtype selectivity for which of the following receptor types?
a. M1 only
b. M2 only
c. M1, M2, and M3
d. M1 and M3

 

 

  1. Which of the following patient populations may benefit from anticholinergic agents?
a. Patients experiencing acute, severe episodes of asthma not responding well to b agonists
b. Patients with psychogenic asthma
c. Patients with nocturnal asthma
d. All of the above

 

 

REF:   p. 132 | p. 133

 

  1. Which of the following is a term used to describe an agent that produces the effect of acetylcholine or an agent that mimics acetylcholine?
a. Parasympatholytic
b. Parasympathomimetic
c. Muscarinic
d. Antimuscarinic bronchodilator

 

 

 

  1. Acetylcholine stimulates M3 receptors on airway smooth muscle, causing which of the following?
a. Bronchodilation
b. Bronchoconstriction
c. Decrease in mucous gland secretion
d. There are no M3 receptors in the airway.

 

 

 

 

  1. Which of the following is the generic name for Atrovent?
a. Aclidinium bromide
b. Tiotropium bromide
c. Ipratropium bromide
d. Umeclidinium bromide

 

 

 

  1. Which of the following is the generic name for Incruse Ellipta?
a. Aclidinium bromide
b. Tiotropium bromide
c. Ipratropium bromide
d. Umeclidinium bromide

 

 

 

  1. Which of the following is the generic name for Spiriva?
a. Aclidinium bromide
b. Tiotropium bromide
c. Ipratropium bromide
d. Umeclidinium bromide

 

 

 

  1. Which of the following is the generic name for Tudorza Pressair?
a. Aclidinium bromide
b. Tiotropium bromide
c. Ipratropium bromide
d. Umeclidinium bromide

 

 

 

Chapter 08: Xanthines

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The mechanism of action of xanthines is
a. well defined.
b. understood by a few physicians but not public knowledge.
c. not published.
d. unclear.

 

 

 

  1. Theophylline should be used to treat
a. acute respiratory distress syndrome (ARDS).
b. pneumonia.
c. apnea of prematurity.
d. cystic fibrosis (CF).

 

 

 

 

  1. The xanthine of choice to treat apnea of prematurity is
a. theophylline.
b. dyphylline.
c. caffeine citrate.
d. aminophylline.

 

 

 

 

  1. Theophylline and caffeine are examples of
a. b agonists.
b. methylxanthines.
c. corticosteroids.
d. anticholinergics.

 

 

 

  1. Theophylline is classified as a bronchodilator because it
a. stimulates b2-adrenergic sites.
b. stimulates a-adrenergic sites.
c. blocks cholinergic sites.
d. has a relaxing effect on bronchial smooth muscle.

 

 

 

  1. Which of the following physiologic effects is not produced by xanthines?
a. Cerebral vasodilation
b. Cardiac muscle stimulation
c. Bronchial smooth muscle relaxation
d. Central nervous system (CNS) stimulation

 

 

 

  1. Which drug stimulates skeletal muscle and the central nervous system (CNS) the strongest?
a. Theophylline
b. Aminophylline
c. Caffeine
d. Ipratropium

 

 

  1. An increase in intracellular cyclic adenosine 3′,5′-monophosphate (cAMP) causes which of the following?
a. Bronchial smooth muscle contraction
b. Bronchial smooth muscle relaxation
c. Skeletal muscle contraction
d. Cardiac muscle relaxation

 

 

 

  1. It is difficult to determine therapeutic doses of theophylline because
a. individuals metabolize theophylline at different rates.
b. individuals may be allergic to theophylline.
c. all doses of theophylline and its derivatives are equivalent.
d. xanthines do not interact with other medications.

 

 

 

  1. The currently recommended blood serum theophylline level for the management of asthma is
a. <5 µg/mL.
b. 5 to 15 µg/mL.
c. 10 to 20 µg/mL.
d. 20 to 25 µg/mL.

 

 

 

  1. The recommended therapeutic blood serum range of theophylline for use in the treatment of chronic obstructive pulmonary disease (COPD) is
a. 5 to 10 µg/mL.
b. 10 to 12 µg/mL.
c. 12 to 20 µg/mL.
d. >20 µg/mL.

 

 

 

  1. Dosage of theophylline is best monitored by
a. clinical reaction of the patient.
b. measuring urine drug levels.
c. monitoring for adverse drug effects.
d. measurement of serum drug levels.

 

 

 

  1. Which of the following will increase theophylline blood levels?
  2. Pneumonia
  3. b agonists
  4. Corticosteroids
  5. b blockers

 

a. 2 only
b. 1, 3, and 4 only
c. 1 and 3 only
d. 1 only

 

 

 

  1. Common, less toxic side effects of theophylline therapy include which of the following?
  2. Headache
  3. Gastric upset
  4. Anxiety
  5. Nervousness
  6. Diuresis

 

a. 1 and 2 only
b. 2, 4, and 5 only
c. 1, 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. An increase in blood theophylline levels can be caused by
a. renal failure.
b. intravenous isoproterenol.
c. b agonists.
d. cigarette smoking.

 

 

 

  1. Disadvantages of theophylline therapy include which of the following?
  2. Narrow therapeutic margin
  3. Toxic effects
  4. Unpredictable blood levels
  5. Need for individual dosing
  6. Numerous drug-drug and drug-condition interactions

 

a. 4 only
b. 1, 3, and 5 only
c. 1, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Theophylline produces which of the following?
a. Increased b2 stimulation causing bronchodilation
b. Increased respiratory muscle strength and endurance
c. Decreased pulmonary vascular resistance
d. Decreased ventilatory drive

 

 

 

  1. You are working the night shift when a 68-year-old man with chronic obstructive pulmonary disease (COPD) is admitted through the emergency department. He has been given Combivent® and inhaled corticosteroids. The intern on call asks for your recommendation for additional medication to give the patient. Which of the following would you recommend?
a. Formoterol
b. Levalbuterol
c. Albuterol
d. Theophylline

 

 

 

 

  1. A significant side effect of theophylline often seen in patients is
a. drowsiness.
b. bradycardia.
c. hypertension.
d. nausea.

 

 

 

  1. Which of the following are possible theories explaining how theophylline works?
  2. Inhibits phosphodiesterase
  3. Blocks acetylcholine
  4. Blocks adenosine
  5. Produces catecholamines
  6. None of the above

 

a. 1, 2, and 3 only
b. 1, 3, and 4 only
c. 1, 2, 3, and 4 only
d. 5 only

 

 

 

  1. You are working in the emergency department when a 77-year-old man with viral hepatitis comes in complaining of nausea. His medications include Combivent®, Advair®, and theophylline. Which drug is likely the cause of his nausea?
a. Combivent®
b. Theophylline
c. Advair®
d. None of the above

 

 

 

 

  1. While working a shift in the neonatal intensive care unit (NICU), you observe a patient receiving caffeine citrate. What is the patient’s likely diagnosis?
a. Supraventricular tachycardia
b. Hypotension
c. Apnea of prematurity
d. Infection

 

 

 

  1. The antiinflammatory effects of theophylline include which of the following?

 

  1. Decreased migration of activated eosinophils into bronchial mucosa
  2. Increased T-cell proliferation and accumulation in atopic asthma
  3. Inhibition of proinflammatory cytokines
  4. Reduced airway responsiveness to stimuli such as histamine and methacholine

 

a. 1 and 2 only
b. 2 and 4 only
c. 1, 2, and 3 only
d. 1, 3, and 4 only

 

 

 

  1. Which of the following factors will increase theophylline levels?
  2. Alcohol
  3. b-blocking agents
  4. Zileuton
  5. Isoniazid
  6. Loop diuretics
  7. Rifampin
  8. Calcium channel blockers
  9. Influenza virus vaccine

 

a. 1, 2, 7, and 8 only
b. 1, 2, 3, 7, and 8 only
c. 2, 3, 6, 7, and 8 only
d. 1, 2, 3, and 4 only

 

 

 

  1. Which of the following factors will decrease theophylline levels?
  2. Alcohol
  3. b-blocking agents
  4. Zileuton
  5. Isoniazid
  6. Loop diuretics
  7. Rifampin
  8. Calcium channel blockers
  9. Influenza virus vaccine

 

a. 4, 5, and 6 only
b. 5, 6, 7, and 8 only
c. 3, 4, and 6 only
d. 5, 6, and 7 only

 

 

 

Chapter 09: Mucus-Controlling Drug Therapy

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following are functions of mucus in the body?
  2. Lubrication
  3. Improvement of gas exchange
  4. Waterproofing
  5. Protection from inflammation

 

a. 1 and 3 only
b. 1 and 4 only
c. 1, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Diseases with hypersecretion or poor clearance of secretions include which of the following?
  2. Cystic fibrosis
  3. Pneumonia
  4. Congestive heart failure
  5. Primary ciliary dyskinesia

 

a. 1 only
b. 1 and 2 only
c. 2 and 3 only
d. 1, 2, and 4 only

 

 

 

 

  1. Medications that increase mucociliary or cough efficiency are
a. mucokinetics.
b. mucolytics.
c. mucoregulatory agents.
d. expectorants.

 

 

 

  1. The number of goblet cells per square millimeter of normal airway mucosa is
a. 60.
b. 600.
c. 6000.
d. 60,000.

 

 

 

  1. Which structures are responsible for providing most mucus secretions?
a. Surface epithelial cells
b. Goblet cells
c. Cilia
d. Submucosal glands

 

 

 

  1. The rate of mucociliary transport in the normal peripheral airway is approximately
a. 0.5 mm/min.
b. 1.5 mm/min.
c. 5.0 mm/min.
d. 21.5 mm/min.

 

 

 

  1. The cholinergic response in terms of mucociliary clearance is
  2. increased ciliary beat.
  3. decreased ciliary beat.
  4. increased mucus production.
  5. decreased mucus production.
a. 1 only
b. 2 only
c. 1 and 3 only
d. 2 and 4 only

 

 

 

  1. Which of the following provide antibacterial defense in the airway?
  2. IgA
  3. IgG
  4. Phospholipids
  5. Serine proteases

 

a. 1 and 2 only
b. 3 and 4 only
c. 1, 2, and 3 only
d. 1, 2, and 4 only

 

 

 

  1. What mucus color typically indicates retained secretions and neutrophil activation?
a. White
b. Yellow
c. Brown
d. Green

 

 

 

  1. The physical properties of mucus include which of the following?
  2. Adhesion
  3. Cohesion
  4. Elasticity
  5. Viscosity

 

a. 1 only
b. 1 and 2 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

 

  1. Which of the following agents are currently approved for administration as aerosolized mucoactive agents?
  2. Dry powder mannitol
  3. N-acetylcysteine (NAC)
  4. Dornase alfa
  5. Ipratropium bromide
  6. 7% hyperosmolar saline

 

a. 1 and 2 only
b. 2, 3, and 5 only
c. 2 and 3 only
d. 5 only

 

 

 

  1. _________ is the most serious potential hazard associated with the use of acetylcysteine.
a. Nausea
b. Rhinorrhea
c. Tachycardia
d. Bronchospasm

 

 

 

 

  1. Pulmozyme® is the trade name for which mucoactive agent?
a. Dornase alfa
b. Acetylcysteine
c. Mucosil-20
d. Iodopropylidene glycerol

 

 

 

  1. The standard dose of dornase alfa for aerosolization is
a. 1.0 mg in 2.5 mL of diluent.
b. 2.5 mg in 2.5 mL of diluent.
c. 5.0 mg in 2.5 mL of diluent.
d. 10.0 mg in 2.5 mL of diluent.

 

 

 

 

  1. Agents that increase volume or hydration of airway secretions are called
a. mucoregulatory.
b. mucolytics.
c. bronchodilators.
d. expectorants.

 

 

 

  1. An expectorant whose action is thought to be mediated by stimulation of the gastrointestinal tract is
a. guaifenesin.
b. sodium bicarbonate.
c. SSKI.
d. mannitol.

 

 

 

 

  1. You have a patient with cystic fibrosis (CF) who needs an aerosol medication to reduce the viscosity and adhesivity of infected respiratory secretions. What agent would you recommend?
a. Atropine
b. Dornase alfa
c. Cromolyn sodium
d. Albuterol

 

 

 

  1. A resident orders 4 mL of 20% Mucomyst® aerosolized for an asthma patient. You are called by the unit secretary about the order. Which of the following should you do?
a. Verify the order in the chart and administer as written
b. Find a student and have him or her give the treatment
c. Not administer the treatment at all
d. Call the resident, suggest 10% Mucomyst®, and obtain a verbal order to give a b2 agonist with the Mucomyst®

 

 

 

 

  1. _____________ has not been tested and approved for use with dornase alfa.
a. PARI LC PLUS®
b. Misty-Neb®
c. Hudson RCI UP-DRAFT II OPTI-NEB®
d. Acorn II®

 

 

 

 

  1. Acetylcysteine is incompatible in solution with which of the following?
a. Certain antibiotics
b. Sympathomimetic bronchodilators
c. Anticholinergic bronchodilators
d. Saline

 

 

 

 

  1. How does dornase alfa work?
a. Adds water to secretions
b. Substitutes sulfhydryl radicals for disulfide bonds in mucus
c. Breaks down DNA content in sputum
d. Increases mucociliary beat frequency

 

 

 

  1. How does N-acetyl cysteine (NAC) work?
a. Adds water content to respiratory secretions
b. Substitutes sulfhydryl radicals for disulfide bonds in mucus
c. Breaks down DNA content in sputum
d. Increases mucociliary beat frequency

 

 

 

  1. Which of the following are essential secretory structures of the mucociliary system?
  2. Surface epithelial cells
  3. Pseudostratified, columnar, ciliated epithelial cells
  4. Surface goblet cells
  5. Clara cells in the distal airway
  6. Submucosal glands
a. 1 , 2, and 5 only
b. 2, 3, and 5 only
c. 1, 2, and 3 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Which of the following conditions or substances slow down the mucociliary transport and are associated with airway damage?
  2. Chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF)
  3. Mechanical ventilation
  4. Narcotics
  5. Cigarette smoke
  6. Hyperoxia

 

a. 1, 2, and 5 only
b. 2, 3, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. __________ is the most common hazard associated with the use of dornase alfa.
a. Voice alteration
b. Rash
c. Tachycardia
d. Chest pain

 

 

 

 

  1. The mucoactive agent used as an irritant to induce a cough and hydrate airway surface fluid is
a. guaifenesin.
b. sodium bicarbonate.
c. albuterol.
d. hypertonic saline (7%).

 

 

 

  1. While working in the surgical intensive care unit (ICU), you read in your patient’s chart that the patient had received atropine before endotracheal intubation. A respiratory therapy student asks you why. You explain it was given for the following reason:
a. It can add water content to respiratory secretions.
b. It prevents laryngospasm and decreases mucus secretions.
c. It breaks down DNA content in sputum.
d. It increases mucociliary beat frequency.

 

 

 

  1. A physician asks you to suggest an airway clearance technique or device to use for a patient with neuromuscular weakness who is unable to cough effectively. Which of the following should you suggest?
a. Postural drainage
b. Chest physical therapy (CPT)
c. An insufflation-exsufflation device
d. Active cycle of breathing (ACB)

 

 

 

 

  1. General contraindications for mucoactive therapy include which of the following?
  2. Forced expiratory volume in 1 second (FEV1) greater than 25% of predicted
  3. Gastroesophageal reflux
  4. End-stage pulmonary disease
  5. Acute exacerbation of chronic obstructive pulmonary disease (COPD)

 

a. 1, 2, and 4 only
b. 2, 3, and 4 only
c. 1, 2, and 3 only
d. 1 only

 

 

 

  1. Medications that degrade polymers in secretions are
a. mucokinetics.
b. mucolytics.
c. mucoregulatory agents.
d. expectorants.

 

 

REF:   p. 149

 

  1. When should mucoactive therapy be considered?
a. Before inhaled corticosteroids are administered
b. When an active upper respiratory infection is causing bronchospasm
c. After therapy to decrease infection and inflammation
d. Only during mechanical ventilation of a patient with COPD

 

 

 

  1. Purulent material in the airways is called
a. gel.
b. mucus.
c. phlegm.
d. sol.
e. sputum.

 

 

 

  1. The weak gel containing attached mucins that bathes the beating cilia and usually separates that mucus layer from the epithelial surface is called
a. gel.
b. mucus.
c. phlegm.
d. sol.
e. sputum.

 

 

 

  1. The term ________________ is used to describe the macromolecular pseudoplastic material that has both viscosity and elasticity.
a. gel
b. mucus
c. phlegm
d. sol
e. sputum

 

 

 

  1. Expectorated phlegm that contains respiratory tract, oropharyngeal, and nasopharyngeal secretions and bacteria and products of inflammation including polymeric DNA and actin is called
a. gel.
b. mucus.
c. phlegm.
d. sol.
e. sputum.

 

 

 

  1. Secretion from surface goblet cells and submucosal glands composed of water, proteins, and glycosylated mucins.
a. Gel
b. Mucus
c. Phlegm
d. Sol
e. Sputum

 

 

 

  1. ____________ is the term used for any medication or drug that has an effect on mucus secretion.
a. Mucoregulatory agent
b. Mucospissic agent
c. Mucoactive agent
d. Mucokinetic agent
e. Mucolytic agent

 

 

 

  1. A drug that reduces the volume of airway mucus secretions and seems to be especially effective in hypersecretory states is called a
a. mucoregulatory agent.
b. mucospissic agent.
c. mucoactive agent.
d. mucokinetic agent.
e. mucolytic agent.

 

 

 

  1. A medication that increases ciliary clearance of respiratory mucus secretions is called a
a. mucoregulatory agent.
b. mucospissic agent.
c. mucoactive agent.
d. mucokinetic agent.
e. mucolytic agent.

 

 

 

  1. Medication that increases the viscosity of secretions and may be effective in the therapy of bronchorrhea.
a. Mucoregulatory agent
b. Mucospissic agent
c. Mucoactive agent
d. Mucokinetic agent
e. Mucolytic agent

 

 

 

  1. Medication that degrades polymers in secretions.
a. Mucoregulatory agent
b. Mucospissic agent
c. Mucoactive agent
d. Mucokinetic agent
e. Mucolytic agent

 

 

 

  1. How much mucus does a healthy person produce per 24 hours?
a. 25 mL
b. 50 mL
c. 75 mL
d. 100 mL

 

 

 

Chapter 10: Surfactant Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Another name for surface-active agents is
a. mucolytic.
b. detergent.
c. bronchodilator.
d. antibiotic.

 

 

 

  1. As it relates to an alveolus, LaPlace’s law is written as
a. pressure = (4 ´ surface tension)/radius
b. dyn/cm
c. pressure = surface tension/radius
d. pressure = (2 ´ surface tension)/radius

 

 

 

  1. Lack of pulmonary surfactant in respiratory distress syndrome (RDS) of the newborn typically results in
a. high surface tension.
b. low surface tension.
c. no effect on surface tension.
d. increased compliance.

 

 

 

 

  1. The term used to describe surfactant produced outside of the patient’s body is
a. endogenous.
b. exogenous.
c. natural.
d. bovine.

 

 

 

  1. Endogenous surfactant is produced by
a. alveolar type II cells.
b. goblet cells.
c. alveolar type I cells.
d. macrophages.

 

 

 

  1. Surfactant is primarily composed of
a. proteins.
b. phospholipids.
c. neutral lipids.
d. water.

 

 

 

  1. Surfactant is stored in
a. alveoli.
b. type II alveolar cells.
c. lamellar bodies.
d. lipids.

 

 

 

  1. The major stimulus for secretion of surfactant into the alveolus is
a. lung inflation.
b. lung deflation.
c. cough.
d. infection.

 

 

 

  1. Which of the following are natural surfactant preparations?

 

  1. Surfaxin®
  2. Curosurf®
  3. Survanta®
  4. Infasurf®

 

a. 1 and 2 only
b. 2 and 3 only
c. 3 and 4 only
d. 2, 3, and 4

 

 

 

  1. ____________ is not a method to obtain natural surfactant.
a. Amniotic fluid extraction
b. In vitro preparation
c. Human alveolar wash
d. Animal alveolar wash

 

 

 

 

  1. Which of the following are approved indications for surfactant therapy?
  2. Prophylaxis of respiratory distress syndrome (RDS) in infants with very low birth weight (<1250 g)
  3. Prophylaxis of RDS in infants with higher birth weight (>1250 g) but with immature lungs
  4. Rescue treatment in infants with RDS
  5. Acute respiratory distress syndrome (ARDS) in adults

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the following are currently used methods for delivering surfactant into infants?
  2. Instillation through side-port adapter
  3. Instillation through catheter
  4. Nebulization
  5. Extracorporeal membrane oxygenation (ECMO)

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. You are assessing a 36-week gestational age newborn immediately after birth. The newborn weighs 2200 g. On assessment, you find the newborn has good color, no retractions, no nasal flaring, respiratory rate of 25 breaths/min, heart rate of 110 beats/min, and pulse oximetry of 96% on room air. Which of the following would you choose?
a. Calfactant
b. Albuterol
c. Beractant
d. No indication for drug therapy at this time

 

 

 

  1. A newborn weighing 1000 g exhibits symptoms of respiratory distress syndrome (RDS), including poor color, suprasternal retractions, nasal flaring, and desaturation. The respiratory therapist should recommend
a. Ipratropium bromide.
b. Poractant alfa.
c. Salmeterol.
d. Dornase alfa.

 

 

 

 

  1. __________ is a synthetic surfactant recently approved by the FDA for use in infants at risk for RDS.
a. Beractant
b. Calfactant
c. Lucinactant
d. Poractant alfa

 

 

 

  1. What is the typical method of administering exogenous surfactant to infants?
a. Direct instillation to the airway
b. Nebulization
c. Intravenously
d. Rectal suppository

 

 

 

  1. Which of the following is considered the mode of action for surfactant?
a. To replace missing surfactant
b. To accelerate lung maturity
c. To emulsify lung secretions
d. To relax bronchial smooth muscle

 

 

 

  1. ____________ is not a hazard or complication of exogenous surfactant.
a. Airway occlusion
b. Overoxygenation
c. Tachycardia
d. Pulmonary insult via barotrauma

 

 

REF:   p. 180

 

  1. You are assessing a 26-week gestational age newborn immediately after birth. The newborn weighs 1200 g. On assessment, you find the newborn has poor color, substernal retractions, nasal flaring, respiratory rate of 45 breaths/min, and heart rate of 140 beats/min. You note that it is difficult to ventilate the newborn with the bag mask. Which of the following agents would you recommend?
a. Cromolyn sodium
b. Albuterol
c. Beractant
d. Solu-Medrol®

 

 

 

  1. A key feature of surfactant production is
a. the recycling activity.
b. to mature lungs immediately.
c. to break up lung secretions.
d. to relax bronchial smooth muscle.

 

 

 

  1. You are called to the room of a 28-week gestational age newborn boy who was placed on pressure-limited mechanical ventilation and given surfactant therapy 2 hours ago. He is hypocapnic, and his tidal volumes are higher than were previously documented. What may be the cause of this finding?
a. Airway occlusion
b. Overoxygenation
c. Lung compliance has improved
d. He needs another dose of surfactant

 

 

 

  1. Which of the following is the trade name for the generic exogenous surfactant preparation lucinactant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta

 

 

 

  1. Which of the following is the trade name for the generic exogenous surfactant preparation calfactant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta

 

 

 

  1. Which of the following is the trade name for the generic exogenous surfactant preparation beractant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta

 

 

 

  1. Which of the following is the trade name for the generic exogenous surfactant preparation poractant alfa?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta

 

 

 

Chapter 11: Corticosteroids in Respiratory Care

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. A significant side effect of corticosteroid use is inhibition of
a. IgE.
b. PDE.
c. HPA axis.
d. SRS-A.

 

 

 

  1. Which of the following is produced in the hypothalamus?
a. Glucocorticoids
b. Corticotropin-releasing factor
c. Mineralocorticoids
d. Sex hormones

 

 

 

  1. Corticosteroids normally produced by the body are known as
a. endogenous.
b. exogenous.
c. extrinsic.
d. intrinsic.

 

 

 

  1. Which of the following are examples of steroids or steroid combinations available for inhalation?
  2. AeroSpan
  3. Flovent
  4. Qvar
  5. Advair

 

a. 1, 2, and 3 only
b. 1 and 2 only
c. 2 and 3 only
d. 1, 2, 3, and 4

 

 

  1. The rise and fall of levels of glucocorticoids in the body follow what kind of rhythm?
a. Weekly
b. Monthly
c. Circadian
d. No set rhythm

 

 

 

  1. The inflammatory process includes which of the following activities?
  2. Mediator cascade
  3. Increased vascular permeability
  4. Leukocytic infiltration
  5. Phagocytosis

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. The major cells responsible for an inflammatory response in asthma are
a. macrophages and mast cells.
b. mast cells and eosinophils.
c. T lymphocytes and macrophages.
d. basophils and SRS-A.

 

 

 

  1. The early phase of an asthmatic reaction occurs during what time frame?
a. 15 minutes to 1 hour
b. 2–4 hours
c. 6–8 hours
d. 24 hours

 

 

 

  1. The product combining an inhaled steroid and a bronchodilator is
a. dulera.
b. flovent.
c. fluticasone.
d. qvar.

 

 

 

  1. Side effects of systemic steroid treatment include which of the following?
  2. HPA suppression
  3. Cough
  4. Dysphonia
  5. Psychiatric reactions

 

a. 1 and 4 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. Which of the following are side effects of aerosolized steroid use?
  2. Cough
  3. Osteoporosis
  4. Dysphonia
  5. Oral thrush

 

a. 1 and 2
b. 1, 3, and 4
c. 2, 3, and 4
d. all of the above

 

 

  1. In chronic obstructive pulmonary disease (COPD), the primary inflammatory cells are
a. eosinophils.
b. T lymphocytes.
c. macrophages.
d. neutrophils.

 

 

 

 

  1. The steroids responsible for secondary male sex characteristics are known as
a. glucocorticoids.
b. mineralocorticoids.
c. androgenic.
d. exogenous.

 

 

 

  1. Corticosteroids are used with asthmatics and patients with chronic obstructive pulmonary disease (COPD) to achieve which effect?
a. Antiinflammatory
b. Breakdown of secretions
c. Reduced surface tension
d. Immunosuppression

 

 

 

 

  1. Use of oral steroids for long periods can cause
a. HPA suppression.
b. increased adrenal cortex activity.
c. bronchospasm.
d. increased ACTH levels.

 

 

 

  1. Corticosteroids are available for use in the United States in which of the following dosage forms?
a. DPI
b. MDI
c. Nebulizer solution
d. All of the above

 

 

 

 

  1. Which of the following is a common side effect of inhaled corticosteroids?
a. Tachycardia
b. Bradycardia
c. Oral candidiasis
d. Immunosuppression

 

 

  1. A patient has been taking oral prednisone for 1 week following a severe episode of asthma. The physician decides to switch the patient to aerosolized beclomethasone (Qvar). What is the best way to accomplish this?
a. Stop the oral drug and begin the aerosol
b. Begin the aerosol and gradually taper off of the oral dose
c. Keep the patient on the full-strength oral dose, and add the aerosol as well for stronger results
d. You cannot stop oral steroids once they are begun

 

 

 

  1. A patient complains of oral thrush and hoarseness since she has been using fluticasone by MDI. The physician asks you to make a suggestion to help her without discontinuing the drug. You suggest
a. inhale with a higher inspiratory flow rate.
b. switch to a DPI.
c. add a spacer and rinse the mouth after use.
d. pause 5 minutes between puffs.

 

 

 

 

  1. Use of systemic corticosteroids may cause which of the following side effects?
  2. Fluid retention
  3. Increased white blood cell count
  4. HPA suppression
  5. Increased endogenous steroid production

 

a. 1 and 4 only
b. 1, 2, and 4 only
c. 2 and 4 only
d. 1, 2, and 3 only

 

 

 

 

  1. Your patient tells you that she is having chest tightness and wheezing four to six times per week, plus she wakes up with chest tightness and wheezing about once per week. She uses albuterol each time, with relief. She is taking no other medication except her albuterol MDI. What other medication would you suggest be prescribed to her?
a. Levalbuterol MDI
b. Salmeterol MDI
c. Beclomethasone MDI
d. Oral tobramycin

 

 

 

  1. Causes of airway inflammation include which of the following?
  2. HPA suppression
  3. Trauma
  4. Chronic bronchitis
  5. Asthma

 

a. 1 and 4 only
b. 3 and 4 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Your patient has an elevated white blood cell (WBC) count but no signs or symptoms of infection. She uses albuterol and salmeterol and is currently taking a glucocorticoid. What is the most likely cause of her elevated WBC count?
a. Albuterol
b. Salmeterol metered dose inhaler
c. Glucocorticoid
d. None of the above

 

 

 

  1. Beneficial effects of glucocorticoids on b-adrenergic receptors include
a. restoration of responsiveness.
b. increase in the number of b receptors on the cell surface.
c. increasing affinity of the receptor for b agonists.
d. all of the above.

 

 

REF:   p. 194

 

  1. What is the generic name of Pulmicort?
a. Fluticasone propionate
b. Mometasone furoate
c. Flunisolide hemihydrate HFA
d. Budesonide

 

 

 

  1. What is the generic name of Asmanex HFA?
a. Fluticasone propionate
b. Mometasone furoate
c. Flunisolide hemihydrate HFA
d. Budesonide

 

 

 

  1. What is the generic name of Flovent HFA?
a. Beclomethasone dipropionate HFA
b. Fluticasone propionate
c. Mometasone furoate
d. Flunisolide hemihydrate HFA

 

 

 

  1. What is the generic name of AeroSpan?
a. Beclomethasone dipropionate HFA
b. Fluticasone propionate
c. Mometasone furoate
d. Flunisolide hemihydrate HFA

 

 

 

  1. What is the generic name of QVAR?
a. Beclomethasone dipropionate HFA
b. Fluticasone propionate
c. Mometasone furoate
d. Flunisolide hemihydrate HFA

 

 

 

  1. What is the generic name of Dulera?
a. Budesonide/formoterol fumarate HFA
b. Fluticasone propionate/salmeterol
c. Mometasone furoate/formoterol fumarate HFA
d. Beclomethasone/formoterol fumarate HFA

 

 

 

  1. What is the generic name of Symbicort?
a. Budesonide/formoterol fumarate HFA
b. Fluticasone propionate/salmeterol
c. Mometasone furoate/formoterol fumarate HFA
d. Beclomethasone/formoterol fumarate HFA

 

 

 

  1. What is the generic name of Advair HFA?
a. Budesonide/formoterol fumarate HFA
b. Fluticasone propionate/salmeterol
c. Mometasone furoate/formoterol fumarate HFA
d. Beclomethasone/formoterol fumarate HFA

 

 

Chapter 12: Nonsteroidal Antiasthma Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The general indication for clinical use of nonsteroidal antiasthma agents is
a. short-term control of bronchospasm.
b. prophylactic management of mild persistent asthma.
c. long-term control of bronchospasm.
d. control of severe asthma attack.

 

 

 

  1. Nonsteroidal antiasthma drugs are
a. relievers.
b. â2 antagonists.
c. antiinfectives.
d. controllers.

 

 

  1. Accolate is the brand name for which medication?
a. Zafirlukast
b. Montelukast
c. Zileuton
d. Omalizumab

 

 

 

  1. Cromolyn sodium is available in what form?
a. Nebulizer solution
b. Tablet
c. MDI
d. Nasal spray

 

 

 

  1. Which type of asthma is associated with allergic reactions?
a. Chronic
b. Intrinsic
c. Acute
d. Extrinsic

 

 

 

  1. Which of the following are antileukotriene agents?
  2. Zafirlukast
  3. Zileuton
  4. Cromolyn sodium
  5. Montelukast

 

a. 1, 2, and 4 only
b. 3 and 4 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only

 

 

 

  1. Cromolyn sodium is effective in preventing bronchospasm by
a. inhibiting mast cell degranulation.
b. blocking cholinergic receptor sites.
c. enhancing mast cell degranulation.
d. stimulating â2-adrenergic sites.

 

 

 

  1. The most commonly reported side effect of cromolyn sodium is
a. diarrhea.
b. pneumonia.
c. nasal congestion.
d. headache.

 

 

 

  1. After a patient begins using cromolyn sodium, how long may it take before clinical improvement in the patient’s symptoms is seen?
a. 24 hours
b. 4 to 6 days
c. 2 to 4 weeks
d. 1 to 3 months

 

 

 

  1. The usual dose of nebulized cromolyn sodium is
a. 10 mg four times per day.
b. 20 mg four times per day.
c. 30 mg three times per day.
d. 80 mg three times per day.

 

 

 

  1. Zileuton is administered by
a. DPI.
b. tablet.
c. MDI.
d. nebulizer.

 

 

  1. Singulair can be administered to which of the following patient populations?
  2. Adults and adolescents 15 years or older
  3. Pediatric patients 6 to 14 years
  4. Pediatric patients 2 to 5 years
  5. Pediatric patients 12 to 23 months
  6. Pediatric patients 6 to 23 months

 

a. 1 and 2 only
b. 1 only
c. 1, 2, and 3 only
d. 1, 2, 3, 4, and 5

 

 

REF:   p. 213

 

  1. Mast cells are
a. chemical mediators that cause inflammation.
b. agents that block the inflammatory response in asthma.
c. agents used prophylactically to treat the inflammatory response in asthma.
d. connective tissue cells that contain heparin and histamine.

 

 

 

  1. Leukotrienes exhibit which of the following effects?
  2. Increased mucus secretion
  3. Inhibition of normal ciliary action
  4. Increased airway edema
  5. Bronchoconstriction
  6. Recruitment of other inflammatory cells into airways

 

a. 4 only
b. 1, 2, and 4 only
c. 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. Zileuton interacts with which of the following respiratory care drugs?
  2. Theophylline
  3. Albuterol
  4. Warfarin
  5. Ipratropium bromide
  6. Beclomethasone

 

a. 1 and 3 only
b. 2 and 4 only
c. 3 and 5 only
d. 1 and 5 only

 

 

 

  1. Zafirlukast is a
a. leukotriene receptor stimulator.
b. leukotriene receptor antagonist.
c. b adrenergic.
d. corticosteroid.

 

 

 

  1. The only antileukotriene agent currently approved for use in patients younger than 5 years of age is
a. zafirlukast.
b. Singulair.
c. Accolate.
d. Xolair.

 

 

  1. What is the clinical indication for use of antileukotriene drug therapy, such as montelukast, in asthma?
a. As a rescue bronchodilator in step 1 asthma
b. As a long-acting bronchodilator in step 3 asthma
c. As an alternative to inhaled steroids
d. As a mast cell stabilizer

 

 

 

  1. Which of the following agents is considered a mast cell stabilizer?
a. Montelukast
b. Zafirlukast
c. Cromolyn sodium
d. Zileuton

 

 

 

  1. Which of the following nonsteroidal antiasthma agents is formulated as a subcutaneous injection?
a. Zileuton
b. Xolair
c. Montelukast
d. Zafirlukast

 

 

 

  1. Which of the following is a monoclonal antibody used to treat asthma?
a. Omalizumab
b. Zileuton
c. Zafirlukast
d. Montelukast

 

 

 

  1. Which of the following is an advantage to the use of antileukotriene agents?
a. Multiple ways of administration
b. No interaction with inhaled steroids
c. Effective in more than 90% of patients
d. All formulations are available for pediatric use

 

 

 

  1. Allergic inflammation of the airway is the product of an immune response, and the ________________ plays a central role in attracting mast cells and eosinophils.
a. T lymphocyte
b. B lymphocyte
c. A and B
d. Neither A nor B

 

 

 

  1. A 22-year-old patient is experiencing an acute exacerbation of her asthma and is complaining of wheezing and shortness of breath. Which is the most appropriate medication to help relieve her symptoms?
a. Omalizumab
b. Zileuton
c. Cromolyn sodium
d. Albuterol

 

 

 

  1. What is the mechanism of action for Singulair?
a. 5-LO inhibitor
b. Leukotriene receptor antagonist
c. Leukotriene receptor agonist
d. Monoclonal antibodies

 

 

 

  1. Zach is a 14 year old with complaints of shortness of breath and wheezing when working out. He currently takes albuterol and theophylline. What medication may help with his symptoms?
a. Xolair
b. Cromolyn
c. Singulair
d. Accolate

 

 

 

  1. Bobby is in a sickle cell crisis. Along with his pain medications, he received a medication via inhalation. His mother asks you if you know what the medication was. What is one possibility?
a. Albuterol
b. Cromolyn
c. Combivent
d. Relenza

 

 

 

Chapter 13: Aerosolized Antiinfective Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Pentamidine is
a. a bactericidal agent.
b. an antiprotozoal agent.
c. an antiviral agent.
d. an antibiotic.

 

 

 

  1. Inhaled pentamidine is indicated for
a. treatment of bronchospasm.
b. bacterial pneumonia in cystic fibrosis patients.
c. prevention of Pneumocystis pneumonia (PCP).
d. treatment of respiratory syncytial virus (RSV).

 

 

 

  1. The trade name for aerosolized pentamidine is
a. Virazole.
b. Atrovent.
c. Flovent.
d. NebuPent.

 

 

 

  1. Pentamidine is administered by which of the following routes?
  2. Inhaled aerosol
  3. Intramuscular injection
  4. Syrup
  5. Tablet
  6. Intravenous injection

 

a. 1 and 4 only
b. 1, 2, and 5 only
c. 2, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. The approved dose of pentamidine by aerosol for prevention of Pneumocystis carinii pneumonia (PCP) is
a. 300 mg once per week.
b. 300 mg once every 4 weeks.
c. 600 mg once every other month.
d. 600 mg once every 4 weeks.

 

 

 

  1. Which nebulizer is used to administer aerosolized pentamidine?
a. Small volume nebulizer
b. Ultrasonic
c. Babington nebulizer
d. Respirgard II

 

 

 

  1. The mechanism of action of pentamidine is
a. unknown.
b. reversal of human immunodeficiency virus (HIV) infection.
c. buildup of immunity to Pneumocystis carinii.
d. destruction of P. carinii organisms.

 

 

 

  1. Local airway side effects of aerosolized pentamidine include which of the following?
  2. Wheezing
  3. Coughing
  4. Shortness of breath
  5. Bad taste
  6. Spontaneous pneumothoraces

 

a. 2 and 3 only
b. 1, 2, and 4 only
c. 1, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Systemic side effects of aerosolized pentamidine can include which of the following?
  2. Pancreatitis
  3. Conjunctivitis
  4. Neutropenia
  5. Renal insufficiency
  6. Rash

 

a. 1 and 2 only
b. 3, 4, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Ribavirin is classified as
a. an antibiotic.
b. bacteriostatic.
c. virostatic.
d. virucidal.

 

 

 

  1. The trade name for ribavirin is
a. NebuPent.
b. Virazole.
c. penicillin.
d. Relenza.

 

 

 

  1. Ribavirin is active against which of the following?
  2. Tuberculosis organisms
  3. Influenza virus
  4. Respiratory syncytial virus (RSV)
  5. Pneumocystis carinii organisms
  6. Herpes simplex virus

 

a. 1 and 3 only
b. 2, 3, and 5 only
c. 1, 2, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. The normal dosage schedule of ribavirin is
a. 20 mg/ml nebulized for 12 to 18 hours per day for 3 to 7 days.
b. 20 mg/ml nebulized for 24 hours per day for 5 days.
c. 40 mg/ml nebulized for 3 to 6 hours per day for 3 to 7 days.
d. 30 mg/ml nebulized for 12 to 18 hours per day for 14 days.

 

 

  1. On what principle does the small particle aerosol generator (SPAG) unit operate?
a. Venturi
b. Hydrodynamic
c. Jet shearing
d. Ultrasonic

 

 

 

  1. The nebulizer used to aerosolize ribavirin is the
a. Respirgard II.
b. SPAG
c. handheld.
d. ultrasonic.

 

 

 

  1. Respiratory syncytial virus (RSV) can cause which of the following?
  2. Asthma
  3. Bronchiolitis
  4. Pneumothorax
  5. Pneumonia
  6. Cystic fibrosis

 

a. 5 only
b. 1 and 3 only
c. 2 and 4 only
d. 1, 2, 4, and 5 only

 

 

 

  1. A physician asked you to suggest an aerosolized antiinfective for a cystic fibrosis patient with chronic Pseudomonas aeruginosa infection. Which is the most appropriate medication?
a. Levalbuterol
b. Pentamidine
c. Ribavirin
d. Tobramycin

 

 

 

  1. An 8-year-old patient is brought to the pediatrician’s office with the complaint of uncomplicated flulike symptoms for 1 day. The pediatrician asks you to suggest an inhaled antiinfective. Which medication is the most appropriate at this time?
a. Aztreonam
b. Zanamivir
c. Ribavirin
d. Tobramycin

 

 

 

  1. Aerosolized antibiotics have been most consistently used for which disease?
a. Cystic fibrosis (CF)
b. Croup
c. Pneumocystis pneumonia (PCP)
d. Asthma

 

 

 

  1. Aminoglycoside antibiotics are effective in treating
a. gram-negative infections.
b. gram-positive infections.
c. viral infections.
d. mycoplasma infections.

 

 

 

  1. Relenza is
a. a bronchodilator.
b. an antiviral agent.
c. a corticosteroid.
d. a prophylactic agent.

 

 

 

  1. Zanamivir would be indicated for
a. cystic fibrosis.
b. exacerbation of COPD.
c. RSV infections.
d. uncomplicated influenza.

 

 

 

  1. A patient with Pneumocystis pneumonia (PCP) has received systemic treatment for the infection, without success. You recommend aerosolizing
a. ribavirin.
b. pentamidine.
c. tobramycin.
d. colistin.

 

 

 

  1. Which of the following drugs is available in a dry powder inhaler (DPI)?
a. Colistin
b. Albuterol
c. Zanamivir
d. Beclomethasone

 

 

 

  1. Tobramycin is a member of which antibiotic group?
a. Aminoglycosides
b. Antifungals
c. Fluoroquinolones
d. First-generation cephalosporins

 

 

 

  1. Pentamidine is thought to work by
a. interfering with nuclear metabolism and inhibiting DNA, RNA, phospholipids, and protein synthesis.
b. acting as a nucleoside analogue to terminate viral DNA replication.
c. binding to penicillin-binding proteins of pathogens inhibiting bacterial cell wall synthesis.
d. providing neutralizing and fusion-inhibiting activity, preventing viral replication.

 

 

 

  1. After reviewing your patient’s chart, you notice he experiences wheezing during his NebuPent treatments. What should you suggest to his physician?
a. Stop this medication immediately because it is causing respiratory side effects.
b. Keep giving the medication as prescribed; wheezing does not cause any problems.
c. Have the patient use a b-adrenergic bronchodilator before inhaling aerosolized NebuPent.
d. Explain to the other therapists they should not chart adverse side effects.

 

 

  1. Precautionary measures that are suggested when administering pentamidine to reduce the risk of both drug exposure and tuberculosis (TB) infection include
  2. use a nebulizer system with one-way valves and expiratory filter.
  3. administer aerosol in a negative-pressure room.
  4. do not expose pregnant women and nursing mothers to the drug.
  5. use barrier protection.
  6. stop nebulization if the patient takes the mouthpiece out of the mouth.

 

a. 3 only
b. 1 and 3 only
c. 2 and 4 only
d. 1, 2, 3, 4, and 5 only

 

 

 

  1. What medication should be given for the treatment and prevention of respiratory syncytial virus (RSV) in premature infants and infants with bronchopulmonary dysplasia (BPD)?
a. Palivizumab
b. Pentamidine
c. Ribavirin
d. Tobramycin

 

 

 

 

  1. A patient newly diagnosed with cystic fibrosis is brought to the emergency department with complaints of voice alterations. Her medication list includes TOBI, albuterol, and hypertonic saline. Which medication is most likely causing this complaint?
a. TOBI
b. Albuterol
c. Hypertonic saline
d. None of the medications cause this complaint

 

 

 

  1. Aerosolized aztreonam would be indicated for
a. cystic fibrosis.
b. exacerbation of chronic obstructive pulmonary disease (COPD).
c. respiratory syncytial virus (RSV) infections.
d. uncomplicated influenza.

 

 

 

 

  1. The monoclonal antibodies clinically used to treat RSV in premature infants and infants with bronchopulmonary dysplasia is
a. Synagis.
b. Virazole.
c. Cayston.
d. NebuPent.

 

 

 

 

Chapter 14: Antimicrobial Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The simplest and most common method of preparing bacteria for examination and identification is
a. acid-fast stain.
b. latex agglutination.
c. microscopic examination of specimen.
d. gram stain.

 

 

 

  1. The most common pathogens responsible for community-acquired pneumonia include which of the following?
  2. Haemophilus influenzae
  3. Chlamydia pneumoniae
  4. 3. Streptococcus pneumoniae
  5. Legionella pneumophila
  6. Mycoplasma pneumoniae

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. A drug that inhibits the growth of bacteria is called
a. bacteriostatic.
b. bactericidal.
c. virucidal.
d. fungicidal.

 

 

 

  1. A bactericidal agent
a. slows the growth of bacteria.
b. kills bacteria, viruses, and fungi.
c. kills bacteria.
d. slows the growth of bacteria, viruses, and fungi.

 

 

 

  1. MRSA and VRE are examples of
a. resistant bacterial pathogens.
b. common bacterial pathogens.
c. susceptibility testing methods.
d. new penicillin drugs.

 

 

 

  1. Penicillins exert their pharmacologic activity by
a. inhibiting translation of RNA into proteins.
b. inhibiting cell wall synthesis.
c. inhibiting protein synthesis.
d. inhibiting DNA synthesis.

 

 

 

  1. Penicillins are
a. bactericidal.
b. bacteriostatic.
c. virucidal.
d. fungicidal.

 

 

 

  1. The natural penicillins are primarily effective against
  2. gram-negative bacteria.
  3. gram-positive bacteria.
  4. viruses.
  5. anaerobes.
  6. mycoplasmas.

 

a. 1 and 5 only
b. 2 and 4 only
c. 3 and 5 only
d. 1, 2, 3, and 4 only

 

 

 

  1. The most common adverse reaction to penicillin is
a. headache.
b. nausea.
c. allergic reaction.
d. seizures.

 

 

 

 

  1. Aminoglycosides are used primarily for
a. gram-positive infections.
b. gram-negative infections.
c. viral infections.
d. mycoplasma infections.

 

 

 

  1. Ventilator-associated pneumonia (VAP) has been successfully treated with
  2. cephalosporins.
  3. gentamicin.
  4. tobramycin.
  5. quinolones.
  6. penicillin.

 

a. 1 and 4 only
b. 1 and 5 only
c. 2 and 3 only
d. 2, 3, and 5 only

 

 

 

  1. Aminoglycosides, such as tobramycin, have been aerosolized specifically for the treatment of
a. acute bronchitis.
b. asthma.
c. emphysema.
d. cystic fibrosis.

 

 

 

  1. Tetracyclines are effective against which of the following?
  2. Protozoa
  3. Mycoplasmas
  4. Rickettsiae
  5. Gram-positive microorganisms
  6. Gram-negative microorganisms

 

a. 4 and 5 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. What antibiotic is used to treat Pneumocystis carinii (jiroveci) infections?
a. TMP-SMX
b. Erythromycin
c. Streptomycin
d. Clindamycin

 

 

 

  1. Nosocomial transmission of tuberculosis (TB) can be prevented by
a. using antimycobacterial agents.
b. placing patients in respiratory isolation.
c. treating patients with penicillin.
d. having patients wear masks.

 

 

 

  1. Isoniazid is indicated to treat
a. pneumonia.
b. cystic fibrosis.
c. tuberculosis (TB).
d. asthma.

 

 

 

  1. The major adverse reaction to antimycobacterial agents such as isoniazid and rifampin is
a. hepatotoxicity.
b. flulike symptoms.
c. ototoxicity.
d. optic neuritis.

 

 

 

  1. The treatment of choice for pulmonary infections such as aspergillosis, histoplasmosis, and coccidioidomycosis is
a. rifampin.
b. ciprofloxacin.
c. ampicillin.
d. amphotericin B.

 

 

 

  1. A major toxic effect of amphotericin B administration is
a. renal impairment.
b. bone marrow suppression.
c. cardiac arrhythmias.
d. liver damage.

 

 

 

 

  1. Which group of antibiotics is effective against Pseudomonas aeruginosa lung infections in cystic fibrosis patients when taken orally?
a. Aminoglycosides
b. Antifungals
c. Fluoroquinolones
d. First-generation cephalosporins

 

 

 

  1. A patient with human immunodeficiency virus (HIV) has been diagnosed with Pneumocystis carinii (jiroveci). You are asked to recommend an antibiotic that is active against Pneumocystis carinii (jiroveci). Your recommendation would be
a. pentamidine.
b. TMP-SMX.
c. levofloxacin.
d. tetracycline.

 

 

 

  1. _____________ is not one of the antimycobacterials used to treat tuberculosis (TB).
a. Isoniazid
b. Rifampin
c. Gentamicin
d. Pyrazinamide

 

 

 

  1. The outcome of antimicrobial therapy depends on which of the following factors?
a. Host factors
b. Susceptibility or resistance to the antimicrobial
c. Pharmacodynamics
d. All of the above

 

 

  1. The term that refers to the science of understanding the optimal effect of a drug as a function of its concentration and in vitro activity (minimal inhibitory concentration [MIC]) against an organism is
a. antagonism.
b. pharmacodynamics.
c. synergy.
d. postantibiotic effect.

 

 

 

  1. The term that refers to the sustained suppression of bacterial growth even after the concentration of the antibiotic is no longer detectable is
a. concentration independent.
b. time dependent.
c. concentration-dependent effect.
d. postantibiotic effect.

 

 

 

  1. Cephalosporins exert their pharmacologic activity by
a. inhibiting translation of RNA into proteins.
b. inhibiting cell wall synthesis.
c. inhibiting protein synthesis.
d. inhibiting DNA synthesis.

 

 

 

  1. A 21-year-old woman presents to the emergency department after a night of alcohol consumption. Her medical complaints include flushing, thirst, palpitations, and vertigo. Her daily medication list includes albuterol, Atrovent, and Advair. She was treated in her physician’s office yesterday with cefoperazone for a urinary tract infection. The medication most likely causing her current medical complaint is
a. albuterol.
b. Atrovent.
c. Advair.
d. cefoperazone.

 

 

 

  1. Macrolides exhibit activity against
  2. MSSA.
  3. MRSA.
  4. mycoplasmas.
  5. Chlamydia.
  6. Legionella.

 

a. 1 and 4 only
b. 1 and 5 only
c. 2 and 3 only
d. 1, 3, 4, and 5 only

 

 

 

  1. Macrolides exert their pharmacologic activity by
a. inhibiting translation of RNA into proteins.
b. inhibiting cell wall synthesis.
c. inhibiting protein synthesis.
d. inhibiting DNA synthesis.

 

 

  1. Quinolones exert their pharmacologic activity by
a. inhibiting translation of RNA into proteins.
b. inhibiting cell wall synthesis.
c. inhibiting protein synthesis.
d. inhibiting DNA synthesis.

 

 

  1. Your patient’s sputum culture indicated the presence of methicillin-resistant S. aureus (MRSA). Which medication is appropriate to treat this infection?
a. Vancomycin
b. Isoniazid
c. Pyrazinamide
d. Rifampin

 

 

 

 

  1. Caspofungin is indicated for the treatment of
a. aspergillosis.
b. candidemia.
c. Both A and B.
d. Neither A nor B.

 

 

 

  1. Antivirals exert their pharmacologic activity by
a. inhibiting translation of RNA into proteins.
b. inhibiting cell wall synthesis.
c. inhibiting protein synthesis.
d. inhibiting DNA synthesis.

 

 

 

  1. A patient is receiving the medication valacyclovir. This patient is most likely being treated for
a. tuberculosis.
b. Pneumocystis pneumonia.
c. herpes simplex virus (HSV)-2.
d. cystic fibrosis.

 

 

  1. Which of the following specimens are commonly collected as the first step in identification of a pathogen?
  2. Blood
  3. Urine
  4. Sputum
  5. Pleural fluid
  6. Stool

 

a. 4 and 5 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. While monitoring a patient on the ventilator being treated for pneumonia you notice continued fever spikes, elevated white blood cell count, and repeated positive cultures. What term is used to describe this clinical finding?
a. Toxicity of pneumonia
b. Noncompliance of treatment regimen
c. Treatment resolutions
d. Treatment failure

 

 

 

Chapter 15: Cold and Cough Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The term “common cold” refers to
a. a bacterial infection of the upper respiratory tract.
b. a nonbacterial infection of the upper respiratory tract.
c. a bacterial infection of the lower respiratory tract.
d. an infection with tuberculosis organisms.

 

 

 

  1. In cold remedies, sympathomimetics are used for their
a. bronchodilating effects.
b. cardiac stimulating effects.
c. vasodilating effects.
d. vasoconstricting effects.

 

 

 

  1. Repeated application of adrenergic agents by nasal spray can result in
a. cardiac arrhythmias.
b. vomiting.
c. rebound nasal congestion.
d. nosebleeds.

 

 

 

  1. An important mediator of local inflammatory responses is
a. histamine.
b. epinephrine.
c. acetylcholine.
d. Tylenol.

 

 

 

  1. A wheal and flare reaction is characterized by which of the following?
  2. Headache
  3. Welt formation
  4. Local redness
  5. Fever
  6. Local swelling

 

a. 5 only
b. 1, 2, and 4 only
c. 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. H2 receptors
a. regulate gastric acid secretions.
b. promote diuresis.
c. cause bronchiole smooth muscle constriction.
d. increase heart rate.

 

 

 

  1. Receptors located on nerve endings, smooth muscle, and glandular cells that are involved in inflammation and allergic reactions are
a. adrenergic receptors.
b. cholinergic receptors.
c. H1 receptors.
d. H2 receptors.

 

 

 

  1. What type of antihistamine is typically found in common cold medications?
a. H1-receptor antagonist
b. H2-receptor antagonist
c. H3-receptor antagonist
d. a-Adrenergic antagonist

 

 

 

  1. Tagamet and Zantac are examples of
a. H1-receptor antagonists.
b. H2-receptor antagonists.
c. H3-receptor antagonists.
d. anticholinergics.

 

 

 

  1. First-generation antihistamines can cause which of the following effects?
  2. Drying of upper airway secretions
  3. Sedation
  4. Decreased rhinitis
  5. Decreased sneezing
  6. Drowsiness

 

a. 2 and 5 only
b. 1, 3, and 4 only
c. 2, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Agents that facilitate removal of mucus by lysing action are called
a. stimulant expectorants.
b. mucokinetic expectorants.
c. mucolytic expectorants.
d. mucodynamic expectorants.

 

 

 

  1. Expectorant agents that increase the production and clearance of mucus secretions are termed
a. mucolytic.
b. mucokinetic.
c. stimulant.
d. irritant.

 

 

 

  1. Stimulant expectorants work by which of the following mechanisms?
  2. b-Adrenergic stimulation
  3. Vagal gastric reflux stimulation
  4. Direct stimulation of glands in the respiratory tract
  5. Topical stimulation
  6. Cholinergic stimulation

 

a. 1 and 5 only
b. 1, 3, 4, and 5 only
c. 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Expectorants include which of the following?
  2. Guaifenesin
  3. Robitussin
  4. Iodinated glycerol
  5. Potassium iodide
  6. Benadryl

 

a. 1 only
b. 2, 3, and 4 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. The active ingredient in Robitussin is
a. guaifenesin.
b. terpin hydrate.
c. iodinated glycerol.
d. potassium iodide.

 

 

  1. _____________ is a defense mechanism to protect the upper airway from irritants.
a. Sneezing
b. Coughing
c. Vomiting
d. Bronchospasm

 

 

 

 

  1. Cough suppressants act by
a. numbing the upper airway.
b. depressing the cough center in the medulla.
c. reducing bronchospasm.
d. decreasing mucus production.

 

 

 

  1. Using over-the-counter (OTC) compounds to treat the common cold presents the risk of
a. overuse and abuse.
b. inability to sleep.
c. anxiety attacks.
d. hair loss.

 

 

 

  1. Treatment of the common cold is basically
a. preventive.
b. useless.
c. symptomatic.
d. specific to causative agent.

 

 

 

  1. What type of drug is used to dry up a runny nose in a common cold?
a. Decongestant (a-sympathomimetic).
b. Antihistamine.
c. Antitussive.
d. Expectorant.

 

 

 

 

  1. What receptor site would be targeted for the antihistamine ranitidine (Zantac)?
a. H1
b. H2
c. H3
d. None

 

 

 

  1. What type of drug could be used to help stimulate secretion removal in a common cold?
a. Decongestant (a-sympathomimetic)
b. Antihistamine
c. Antitussive
d. Expectorant

 

 

  1. A fellow student tells you that he has a dry, hacking cough that keeps him up at night. You would recommend that he take
a. a decongestant (a-sympathomimetic).
b. an antihistamine.
c. an antitussive.
d. an expectorant.

 

 

 

  1. Which of the following is a stimulant expectorant?
a. Pseudoephedrine (Sudafed)
b. Diphenhydramine hydrochloride (Benadryl)
c. Guaifenesin (Robitussin)
d. Cetirizine (Zyrtec)

 

 

 

  1. Which of the following may be prescribed as a sleep aid?
a. Pseudoephedrine (Sudafed)
b. Diphenhydramine hydrochloride (Benadryl)
c. Guaifenesin (Robitussin)
d. Cetirizine (Zyrtec)

 

 

 

 

  1. Which of the following agents should not be given to a patient who is coughing up copious amounts of sputum?
a. Decongestant (a-sympathomimetic)
b. Antihistamine
c. Antitussive
d. Expectorant

 

 

 

  1. H1 receptors
a. regulate gastric acid secretions.
b. promote diuresis.
c. cause bronchiole smooth muscle constriction.
d. increase heart rate.

 

 

 

  1. H3 receptors
a. regulate gastric acid secretions.
b. promote diuresis.
c. cause bronchiole smooth muscle constriction.
d. are involved in central nervous system functioning and feedback control of histamine synthesis and release.

 

 

 

  1. The term “flu” refers to
a. a bacterial infection of the upper respiratory tract.
b. a nonbacterial infection of the upper respiratory tract.
c. a bacterial infection of the lower respiratory tract.
d. a viral infection associated with symptoms of fever, headache, muscle ache, and extreme fatigue.

 

 

 

  1. Which of the following has an antihistamine effect that can last 12 hours or more?
a. Pseudoephedrine (Sudafed)
b. Diphenhydramine hydrochloride (Benadryl)
c. Guaifenesin (Robitussin)
d. Cetirizine (Zyrtec)

 

 

 

  1. Which of the following may be prescribed as an antitussive?
a. Pseudoephedrine (Sudafed)
b. Diphenhydramine hydrochloride (Benadryl)
c. Guaifenesin (Robitussin)
d. Benzonatate (Tessalon)

 

 

 

Chapter 16: Selected Agents of Pulmonary Value

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. A drug intended for therapy of congenital a1-antitrypsin deficiency is
a. pulmozyme.
b. pneumovax.
c. prolastin.
d. prednisone.

 

 

 

  1. The physician suspects that your patient may have a1-antitrypsin (a-AT) deficiency. Which disease process would help to confirm this diagnosis?
a. Panacinar emphysema
b. Centrilobular emphysema
c. Bronchiectasis
d. Asthma

 

 

 

  1. Emphysema is a process of
a. excessive mucus secretion.
b. large airway dilation.
c. bronchial smooth muscle constriction.
d. alveolar wall destruction.

 

 

 

  1. The major limitation of Prolastin therapy is
a. lack of availability.
b. cost.
c. no FDA approval.
d. severe adverse effects.

 

 

 

  1. The recommended dosage of Prolastin is
a. 30 mg/kg once daily.
b. 40 mg/kg once weekly.
c. 50 mg/kg once weekly.
d. 60 mg/kg once weekly.

 

 

 

  1. An 80-kg man should receive what dose of Prolastin?
a. 2400 mg weekly
b. 480 mg daily
c. 4800 mg weekly
d. 240 mg daily

 

 

 

  1. Potential adverse effects of Prolastin administration include which of the following?
  2. Hypertension
  3. Fever
  4. Arrhythmias
  5. Exacerbation
  6. Flulike symptoms

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 1, 2, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Physical symptoms of nicotine withdrawal include which of the following?
  2. Irritability
  3. Weight gain
  4. Craving for nicotine
  5. Anxiety
  6. Sleep disturbances

 

a. 3 only
b. 1, 2, and 4 only
c. 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. Nicotine replacement agents are indicated to
a. simulate the act of smoking.
b. relieve nicotine withdrawal symptoms.
c. punish negative behaviors.
d. produce strong adverse effects of smoking.

 

 

 

  1. Bupropion is an
a. anxiolytic.
b. antidepressant.
c. anticholinergic.
d. antibiotic.

 

 

 

 

  1. Smoking cessation drugs are available in which of the following forms?
  2. Gum
  3. Nasal spray
  4. Transdermal patch
  5. Intravenous infusion
  6. Tablets

 

a. 1 and 3 only
b. 2, 3, and 5 only
c. 1, 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. The nicotine replacement method that provides the most consistent level of nicotine and that is easy and convenient is
a. the transdermal patch.
b. gum.
c. a nasal spray.
d. an inhaler.

 

 

 

  1. Zyban is a(n)
a. nicotine replacement.
b. bronchodilator.
c. antidepressant.
d. steroid.

 

 

 

  1. Nitric oxide (NO) is a
a. cardiac stimulant.
b. pulmonary vasodilator.
c. pulmonary vasoconstrictor.
d. systemic vasodilator.

 

 

 

  1. The recommended dose of nitric oxide (NO) is
a. 20 ppm.
b. 30 ppm.
c. 40 ppm.
d. 60 ppm.

 

 

 

  1. The drug used to treat hypoxic respiratory failure in newborns with pulmonary hypertension is
a. ribavirin.
b. Xopenex.
c. Survanta.
d. nitric oxide.

 

 

 

  1. Which of the following is the enzyme that is responsible for cleaving good lung tissue in a1-antitrypsin deficiency?
a. Prolastin
b. Neutrophil elastase
c. Leukocyte protease inhibitor
d. Zemaira

 

 

 

  1. ___________ is not used pharmacologically to treat smoking addiction.
a. Nicotine replacement patch
b. Varenicline (Chantix)
c. Bupropion (Zyban)
d. Prolastin

 

 

 

 

  1. Nitric oxide (NO) should not be used in neonates with
a. left-to-right shunts.
b. pulmonary hypertension.
c. right-to-left shunts.
d. increased pulmonary artery pressure.

 

 

 

  1. Prolastin is
a. a corticosteroid.
b. an antihistamine.
c. an a1-proteinase inhibitor.
d. a bronchodilator.

 

 

 

  1. Ventavis is indicated for
  2. pulmonary arterial hypertension.
  3. type 1 diabetes mellitus.
  4. type 2 diabetes mellitus.
  5. a1-antitrypsin deficiency.
  6. smoking cessation.

 

a. 1 only
b. 2, 3, and 5 only
c. 2 and 3 only
d. 4 only

 

 

 

  1. Toxic products of nitric oxide (NO) include
  2. nitrogen dioxide.
  3. formation of methemoglobin.
  4. type 2 diabetes mellitus.
  5. a1-antitrypsin deficiency.

 

a. 1 and 2 only
b. 2 and 3 only
c. 2 and 3 only
d. 4 only

 

 

  1. Individuals attempting to quit smoking using Nicotrol should be advised
a. If taken while using tobacco products, potential toxic concentrations of nicotine can occur in the blood.
b. Bupropion has a better quit rate compared with Chantix.
c. The treatment process lasts 3 weeks.
d. Nortriptyline is another smoking cessation option approved by the FDA for individuals who fail to quit smoking with Chantix.

 

 

REF:   p. 279 | p. 280

 

  1. A smoker with very low dependency seeks your advice about smoking cessation. What nicotine replacement agent would you suggest?
a. Nicotine replacement patch (21 mg)
b. Varenicline (Chantix)
c. Nicotine inhaler
d. Bupropion

 

 

 

 

  1. Respiratory care assessment of smoking cessation drug therapy includes
  2. monitoring abstinence rates at intervals such as 3, 6, or 12 months.
  3. monitoring for symptoms of nicotine overdose.
  4. counseling and support throughout treatment for smoking cessation.
  5. assessing patients for weight gain and encouraging an exercise program.

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

 

  1. The two inhaled prostacyclin analogues available in the United States are
a. Iloprost and Tyvaso.
b. Varenicline and bupropion.
c. Albuterol and Atrovent.
d. Xopenex and Survanta.

 

 

 

  1. Signs of strong physical addiction to nicotine include
  2. inhaling smoke frequently and deeply.
  3. smokes even when ill enough to be bed-ridden.
  4. can smoke less than 10 cigarettes a day if in a smoke-free environment.
  5. smokes within 30 minutes of waking up.

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

Chapter 17: Neonatal and Pediatric Aerosolized Drug Therapy

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The use of a drug in an age group for which there is a lack of FDA-approved dosing information is termed
a. against the law.
b. off-label.
c. unapproved.
d. orphan drug.

 

 

 

  1. Generally, neonatal and pediatric drug dosing with inhaled aerosols is based on
a. body size.
b. a target effect strategy.
c. when side effects occur.
d. achievement of a certain blood level.

 

 

  1. Which of the following affect penetration and deposition of an aerosol in neonatal and pediatric patients?
  2. Inertial impaction
  3. Particle size
  4. Velocity
  5. Sedimentation

 

a. 1, 2, 3, and 4
b. 1 and 2 only
c. 1, 2, and 3 only
d. 1 only

 

 

 

  1. Which of the following does affect aerosol drug delivery in infants and children?
  2. Airway diameter
  3. Gender
  4. Tidal volume and flow rate
  5. Respiratory rate

 

a. 1 and 3 only
b. 2, 3, and 4 only
c. 1, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. A dry powder inhaler (DPI) is not recommended for children younger than age
a. 5 years
b. 7 years
c. 8 years
d. 12 years

 

 

 

  1. An infant is given albuterol via a small volume nebulizer (SVN); what will happen to the L/T ratio of the infant compared with an adult?
a. It will be much higher
b. It will be the same
c. It will be lower
d. It will be slightly higher

 

 

 

  1. You enter the room of a 15-month-old patient with respiratory syncytial virus (RSV) infection to deliver racemic epinephrine via small volume nebulizer (SVN). His mother asks you if it is okay for her to give her child the breathing treatment. Because your hospital policy allows this, you agree. During the treatment you notice that the patient’s mother is holding the aerosol mask about 4 cm off of his face. You tell her
a. “Good idea … he seems much calmer this way.”
b. “Maybe we should try blow-by instead.”
c. “I’ll be back later … it’s my lunchtime.”
d. “We need to hold the mask as close to his face as we possibly can to make sure he gets his medicine.”

 

 

 

 

  1. A respiratory therapist is administering a nebulizer treatment to an intubated pediatric patient and notices an increase in the patient’s airway pressure. What could be the cause?
a. The nebulizer
b. The medication is working
c. PEEP has decreased
d. Decrease in volume delivered by the ventilator

 

 

 

  1. What is the average minute ventilation for a neonate?
a. 200–300 mL/kg/min
b. 2 L/min
c. 4 L/min
d. 6 L/min

 

 

 

  1. A patient is considered a child if he or she is
a. less than 37 weeks of gestational age.
b. in the first month of postnatal life.
c. 12 to 18 years.
d. 1 to 12 months.
e. 1 to 12 years.

 

 

 

  1. A patient is considered a neonate if he or she is
a. less than 37 weeks of gestational age.
b. in the first month of postnatal life.
c. 12 to 18 years.
d. 1 to 12 months.
e. 1 to 12 years.

 

 

 

  1. A patient is considered an adolescent if he or she is
a. less than 37 weeks of gestational age.
b. in the first month of postnatal life.
c. 12 to 18 years.
d. 1 to 12 months.
e. 1 to 12 years.

 

 

 

  1. A patient is considered an infant if he or she is
a. less than 37 weeks of gestational age.
b. in the first month of postnatal life.
c. 12 to 18 years.
d. 1 to 12 months.
e. 1 to 12 years.

 

 

  1. A patient is considered a premature neonate if he or she is
a. less than 37 weeks of gestational age.
b. in the first month of postnatal life.
c. 12 to 18 years.
d. 1 to 12 months.
e. 1 to 12 years.

 

 

 

Chapter 18: Skeletal Muscle Relaxants (Neuromuscular Blocking Agents)

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Primary clinical uses of neuromuscular blocking agents include which of the following?
  2. Facilitate endotracheal intubation
  3. Relieve anxiety
  4. enhance patient-ventilator synchrony
  5. Relax muscle during surgery
  6. Reduce intracranial pressure in intubated patients

 

a. 1 and 2 only
b. 1, 2, and 3 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

  1. The neurotransmitter released by all somatic motor nerves is
a. epinephrine.
b. acetylcholine.
c. norepinephrine.
d. acetylcholinesterase.

 

 

 

  1. The termination of the nerve axon on the skeletal muscle fiber is called the
a. neuromuscular junction.
b. adrenergic receptor.
c. skeletal-muscular junction.
d. cholinergic receptor.

 

 

  1. Immediately after acetylcholine is released at the neuromuscular junction, it is inactivated by
a. pseudocholinesterase.
b. acetaminophen.
c. adenyl cyclase.
d. acetylcholinesterase.

 

 

 

 

  1. Of the following, the only depolarizing agent is
a. cisatracurium.
b. pancuronium.
c. succinylcholine.
d. vecuronium.

 

 

 

  1. Skeletal muscle contraction occurs during
a. repolarization.
b. depolarization.
c. nonpolarization.
d. electrolyte depletion.

 

 

 

  1. Examples of skeletal muscle include which of the following?
  2. Quadriceps
  3. Bronchial wall
  4. Biceps
  5. Diaphragm
  6. Cardiac fibers

 

a. 5 only
b. 1, 3, and 4 only
c. 2 and 4 only
d. 1, 2, 3, and 5 only

 

 

 

  1. Agents that paralyze skeletal muscle by simple competitive inhibition of acetylcholine at muscle receptor sites are called
a. nondepolarizing.
b. depolarizing.
c. antagonizing.
d. repolarizing.

 

 

 

  1. Nondepolarizing agents are administered
a. by inhalation.
b. orally.
c. topically.
d. parenterally.

 

 

 

  1. Which of the following is an exhibited characteristic of nondepolarizing neuromuscular blocking agents?
a. They are tertiary ammonium drugs
b. They quickly diffuse across the blood–brain barrier
c. They reach peak effect slowly when given intravenously
d. They are poorly absorbed from the gastrointestinal tract

 

 

 

  1. Maximal paralyzing effect of succinylcholine is reached in
a. 60 to 90 seconds.
b. 2 to 5 minutes.
c. 5 to 10 minutes.
d. 10 to 20 minutes.

 

 

 

  1. Adverse effects of nondepolarizing neuromuscular blocking agents include which of the following?
  2. Bronchospasm
  3. Tachycardia
  4. Apnea
  5. Increased airway resistance
  6. Increased blood pressure

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Succinylcholine would be given to
a. assist with mechanical ventilation.
b. intubate patients.
c. reduce blood pressure.
d. reduce intracranial pressure.

 

 

 

  1. Characteristics of depolarizing neuromuscular blocking agents include which of the following?
  2. Cannot be reversed
  3. Effects last 60 to 90 seconds
  4. Shorter acting than nondepolarizing agents
  5. Cause fasciculation
  6. Cause total paralysis in 60 to 90 seconds

 

a. 1, 3, and 5 only
b. 2, 3, and 4 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

REF:   p. 310 | p. 311

 

  1. Benefits of neuromuscular paralysis in ventilator management include which of the following?
  2. Improved ventilation
  3. Better synchrony with the ventilator
  4. Reduced ventilator pressures
  5. Improved oxygenation
  6. Decreased intrathoracic pressure

 

a. 1 and 4 only
b. 3 and 5 only
c. 1, 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Neuromuscular blocking agents do which of the following?
  2. Decrease consciousness
  3. Paralyze skeletal muscle
  4. Relieve bronchospasm
  5. Increase force of myocardial contraction
  6. Alter pain perception

 

a. 2 only
b. 3 and 4 only
c. 1, 2, and 5 only
d. 2, 3, and 4 only

 

 

 

  1. Which of the following are examples of nondepolarizing neuromuscular blocking agents?
  2. Succinylcholine (Anectine)
  3. Pancuronium (Pavulon)
  4. Rocuronium (Zemuron)
  5. Vecuronium (Norcuron)

 

a. 1 and 2 only
b. 2 and 3 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. Nondepolarizing neuromuscular blocking agents can be reversed by administering
a. cholinesterase inhibitors.
b. parasympatholytics.
c. sympathomimetics.
d. acetylcholine inhibitors.

 

 

  1. Your patient has been give succinylcholine in an effort to facilitate endotracheal intubation. However, you are unable to place an endotracheal tube. You should
a. administer neostigmine to reverse the paralysis and allow the patient to breathe spontaneously.
b. manually ventilate the patient until succinylcholine wears off.
c. administer a cholinesterase inhibitor other than neostigmine.
d. immediately place the patient on continuous positive airway pressure (CPAP).

 

 

  1. Atracurium and cisatracurium are eliminated by
a. the kidneys in urine.
b. hepatic metabolism.
c. excretion in bile.
d. Hofmann degradation.

 

 

 

  1. You are taking care of an intubated trauma patient who must remain immobile. The patient has a medical history of end-stage renal failure and atrial fibrillation. What is the most appropriate neuromuscular blocking agent?
a. Succinylcholine (Anectine)
b. Pancuronium (Pavulon)
c. Rocuronium (Zemuron)
d. Cisatracurium (Nimbex)

 

 

 

  1. Your patient has been given neostigmine for reversal of the nondepolarizing blockade agent he received during surgery. On examination, you observe severe bradycardia and increased salivation. What is a possible explanation?
a. These are both responses following most kinds of surgery
b. Bradycardia and salivation are not concerns of the respiratory therapist
c. These are side effects of cholinesterase inhibitors
d. The patient should immediately be placed on continuous positive airway pressure (CPAP). The cardiologist can address these clinical manifestations

 

 

 

  1. Succinylcholine is metabolized to
a. cholinesterase inhibitors.
b. succinylmonocholine.
c. laudanosine.
d. pseudocholinesterase.

 

 

 

  1. Succinylcholine is metabolized by
a. cholinesterase inhibitors.
b. succinylmonocholine.
c. laudanosine.
d. pseudocholinesterase.

 

 

 

  1. Clinical factors that potentiate neuromuscular blockade include
  2. acidosis.
  3. hyponatremia.
  4. hypocalcemia.
  5. hypokalemia.
  6. hypothermia.

 

a. 2 and 3 only
b. 2, 3, and 4 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Factors that should be considered when choosing a neuromuscular blocking agent include
  2. duration of procedure.
  3. onset of action.
  4. hemodynamic stability.
  5. histamine release.
  6. cost.

 

a. 1 and 2 only
b. 1, 3, and 4 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. A technique used for monitoring blockade that evaluates the conduction of an impulse across the neuromuscular junction using supramaximal stimulus at a frequency of 2 Hz over 2 seconds is referred to as
a. TOF.
b. 2 by 2 measuring.
c. negative inspiratory force.
d. hand-grip strength.

 

 

 

 

  1. Clinical factors that inhibit neuromuscular blockade include
  2. alkalosis.
  3. hypernatremia.
  4. hypercalcemia.
  5. thrombocytopenia.
  6. hypothermia.

 

a. 1 and 3 only
b. 2, 3, and 4 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Nondepolarizing agents
a. cause muscles to fasciculate and remain in a refractory state.
b. bind to acetylcholine receptors and cause a sustained postsynaptic membrane depolarization.
c. produce paralysis and muscle weakness by competing with acetylcholine for binding at the acetylcholine receptors.
d. all of the above are correct.

 

 

 

  1. A nondepolarizing agent has a(n) _____________duration of action to a depolarizing agent.
a. longer
b. shorter
c. equal

 

 

 

Chapter 19: Diuretic Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Which group of diuretic agents is the most potent?
a. Potassium-sparing
b. Osmotic
c. Loop
d. Thiazide

 

 

 

  1. ________ is a common complication in the use of loop diuretics.
a. Hypokalemia
b. Volume overload
c. Hyperlipidemia
d. Hypoglycemia

 

 

 

  1. Any substance that increases urine flow is termed
a. a corticosteroid.
b. a diuretic.
c. a vasopressor.
d. an antihypertensive.

 

 

 

  1. The functional unit of the kidney is the
a. loop of Henle.
b. proximal tubule.
c. glomerulus.
d. nephron.

 

 

 

  1. Approximately what percentage of cardiac output flows through the renal system per minute?
a. 10
b. 20
c. 30
d. 40

 

 

 

  1. Which ions are filtered and exchanged in the kidney tubules?
  2. Na+
  3. H2O
  4. K+
  5. Cl
  6. HCO3
a. 1 and 4 only
b. 2, 3, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Aldosterone
a. increases sodium and water reabsorption.
b. decreases sodium and water reabsorption.
c. increases glomerular blood flow.
d. increases urine output.

 

 

 

  1. Osmotic diuretics function by
a. blocking reabsorption of sodium and chloride in the distal tubule.
b. blocking reabsorption in the ascending limb of the loop of Henle.
c. blocking reabsorption of NaCl in the proximal tubule and descending limb of the loop of Henle.
d. blocking reabsorption of sodium and bicarbonate from the proximal tubule.

 

 

 

  1. Which of the following is the most selected osmotic diuretic agent?
a. Urea
b. Furosemide
c. Chlorothiazide
d. Mannitol

 

 

 

  1. The use of carbonic anhydrase inhibitors (CAIs) typically results in
a. metabolic alkalosis.
b. metabolic acidosis.
c. respiratory alkalosis.
d. respiratory acidosis.

 

 

 

  1. Diuretics that produce their effect by inhibiting the reabsorption of chloride and sodium in the ascending limb of the loop of Henle are known as
a. potassium-sparing.
b. osmotic.
c. loop.
d. thiazide.

 

 

 

 

  1. Thiazide diuretics work by
a. blocking reabsorption of sodium and bicarbonate from the proximal tubule.
b. blocking reabsorption of sodium and chloride in the ascending limb of the loop of Henle.
c. blocking reabsorption of NaCl in the proximal tubule and loop of Henle.
d. blocking sodium and chloride reabsorption in the distal tubule.

 

 

 

  1. Agents that block reabsorption of sodium in the distal tubule are
a. osmotic diuretics.
b. thiazide diuretics.
c. potassium-sparing diuretics.
d. loop diuretics.

 

 

 

  1. The most common adverse reactions associated with diuretics include
  2. ototoxicity.
  3. volume depletion.
  4. diarrhea.
  5. allergic reactions.
  6. electrolyte abnormalities.

 

a. 1 only
b. 2 and 5 only
c. 2, 3, and 4 only
d. 2, 3, 4, and 5 only

 

 

 

  1. Your patient has cerebral edema. Which group of diuretic agents would you expect to be administered?
a. Loop
b. Osmotic
c. Carbonic anhydrase inhibitors
d. Thiazide

 

 

 

  1. Your patient is receiving intravenous furosemide and complains of a ringing in her ears. What steps could you take to help alleviate this side effect without changing the medication itself?
a. Speed up the rate of infusion
b. Slow the rate of infusion
c. Deliver the medication as an intravenous bolus
d. Both A and C

 

 

 

 

  1. Which of the following electrolyte imbalances would force Na+ to exchange for H+, producing metabolic alkalosis?
  2. Hypochloremia
  3. Hyperchloremia
  4. Hypokalemia
  5. Hyperkalemia
  6. HCO3

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Loop diuretics can cause which of the following?
a. Increased pulmonary capillary wedge pressure and increased blood pressure
b. Decreased pulmonary capillary wedge pressure and increased blood pressure
c. Increased pulmonary capillary wedge pressure and decreased blood pressure
d. Decreased pulmonary capillary wedge pressure and decreased blood pressure

 

 

 

 

  1. Your patient has mild hypertension. Which group of diuretic agents would you expect the physician to prescribe?
a. Loop
b. Osmotic
c. Carbonic anhydrase inhibitors
d. Thiazide

 

 

 

  1. Which diuretics have been associated with hyperglycemia?
a. Loop and osmotic
b. Osmotic and thiazide
c. Thiazide and loop
d. Carbonic anhydrase inhibitors and loop

 

 

 

  1. Your pregnant patient has mild hypertension and has been taking diuretics. Which group of diuretic agents would you expect the physician to prescribe while she is pregnant?
a. Loop
b. Thiazide
c. Carbonic anhydrase inhibitors
d. None are recommended for pregnant women

 

 

 

 

  1. Diuretic combinations may be used in an attempt to obtain a(n)_______________effect in patients not responding to one agent.
a. synergistic
b. complementary
c. potency
d. ototoxic

 

 

 

Chapter 20: Drugs Affecting the Central Nervous System

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. This group of agents can depress the respiratory system, causing the patient to stop breathing.
a. Opiates
b. Benzodiazepines
c. Barbiturates
d. Antidepressants

 

 

 

 

  1. In the brain, the control area for autonomic functions such as breathing is located in the
a. cortex.
b. midbrain.
c. medulla.
d. reticular activating system.

 

 

 

  1. The hypothalamus is located in the
a. cortex.
b. midbrain.
c. brainstem.
d. spinal cord.

 

 

 

  1. One of the most common psychiatric disorders and a major cause of disability worldwide is
a. psychosis.
b. depression.
c. suicidal tendencies.
d. attention-deficit/hyperactivity disorder (ADHD).

 

 

 

  1. Most cases of depression are believed to be caused by
a. increased activity of norepinephrine neurons.
b. genetic factors.
c. family or social environment.
d. reduced activity of norepinephrine neurons.

 

 

 

  1. Prozac and Zoloft are examples of
a. antidepressants.
b. mild tranquilizers.
c. barbiturates.
d. opioids.

 

 

 

  1. Benzodiazepines are used to
a. relieve anxiety.
b. produce analgesia.
c. control psychotic illnesses.
d. treat diarrhea.

 

 

 

  1. Xanax, Valium, Versed, and Ativan are examples of
a. barbiturates.
b. opioids.
c. benzodiazepines.
d. antidepressants.

 

 

 

  1. Barbiturates are often avoided because of which of the following effects?

 

  1. High risk of abuse
  2. Rapid development of tolerance
  3. Increased seizure activity
  4. High risk of addiction
  5. Toxic potential

 

a. 1 and 4 only
b. 1, 3, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. Barbiturates are indicated for
a. reducing anxiety.
b. seizure control.
c. inducing sleep in infants.
d. reversal of anesthesia.

 

 

 

 

  1. Abrupt withdrawal after prolonged use of alcohol may result in
a. liver failure.
b. respiratory failure.
c. coma.
d. delirium tremens.

 

 

 

  1. Alcohol affects the central nervous system as a(n)
a. stimulant.
b. depressant.
c. antidepressant.
d. no effect.

 

 

 

  1. Pain is
a. easy to measure.
b. experienced at the same threshold by all patients.
c. subjective and unpleasant.
d. always well controlled.

 

 

 

  1. The most commonly used method to assess pain is to
a. watch the patient’s reactions.
b. ask the patient’s spouse.
c. measure patient vital signs.
d. use a analog pain scale.

 

 

 

  1. Nonsteroidal antiinflammatory drugs (NSAIDs) are used to
a. relieve depression.
b. treat moderate pain.
c. reduce seizure activity.
d. induce sleep.

 

 

 

  1. Major problems with the administration of NSAIDs are
a. gastric irritation and ulceration.
b. headache and coma.
c. pancreatitis and cholecystitis.
d. addiction and abuse.

 

 

 

  1. Your patient is a 6-year-old boy with a common childhood febrile illness (e.g., the flu). Which NSAID should be avoided because of its risk of Reye syndrome?
a. Tylenol
b. Naprosyn
c. Aspirin
d. Advil

 

 

 

 

  1. Opioids are characterized by which of the following?
  2. Highly addictive
  3. Known as narcotic agents
  4. Used to treat moderate to severe pain
  5. Produce euphoria
  6. Derived from dandelion flowers

 

a. 1 and 2 only
b. 3, 4, and 5 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Patient-controlled analgesia (PCA) means
a. patients can have as much opioid as they want.
b. patients inform the nurse when they need pain control.
c. patients self-administer a predetermined dose of opioid at set intervals.
d. patients are taught to meditate to reduce pain.

 

 

 

  1. Morphine, codeine, Dilaudid, Demerol, and Darvon all are examples of
a. opioids.
b. barbiturates.
c. antidepressants.
d. NSAIDs.

 

 

 

  1. Pain control by blocking transmission of the pain impulse from the damaged area is achieved through the use of
a. narcotics.
b. local anesthetics.
c. general analgesics.
d. spinal blocks.

 

 

 

  1. ________ refers to the pharmacologic modification of painful and frightening experiences during medical procedures.
a. General anesthesia
b. Conscious sedation
c. Deep sedation
d. Local anesthesia

 

 

 

  1. Analeptic drugs would be used for treatment of which of the following?
  2. Respiratory failure
  3. Narcolepsy
  4. Barbiturate overdose
  5. Obesity
  6. Attention-deficit/hyperactivity disorder (ADHD)

 

a. 2 and 3 only
b. 1, 3, and 4 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Your 20-year-old patient has just been admitted through the emergency department with a blood alcohol level of 520 mg/dl. What potential side effect of alcohol overconsumption should you be most concerned about?
a. Disinhibition
b. Nausea and vomiting
c. Abusive behavior
d. Respiratory arrest

 

 

 

  1. Your 68-year-old patient with coronary arteriosclerotic heart disease (status post–coronary artery bypass graft surgery) has a history of gastric ulcers. Which nonsteroidal antiinflammatory drug (NSAID) could you safely recommend he use at home?
a. Aspirin
b. Ibuprofen
c. Acetaminophen
d. A and B

 

 

 

 

  1. Your 75-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and bipolar disorder is experiencing tremors, cognitive slowing, and polyuria. His medications include Combivent, Advair, and lithium. Which drug is most likely to be causing his symptoms?
a. Combivent
b. Advair
c. Lithium
d. None of these medications

 

 

 

  1. Your 24-year-old patient has just been admitted through the emergency department with a drug overdose. You observe the physician administering flumazenil. What possible drug did your patient overdose on?
a. Xanax
b. Lithium
c. Depakote
d. Tylenol

 

 

 

  1. Your 82-year-old patient has just been discharged from the hospital with a prescription for oxycodone. About what potential side effects of opioids should you advise her?
  2. Respiratory depression
  3. Nausea and vomiting
  4. Constipation
  5. Uncontrollable coughing

 

a. 2 and 3 only
b. 1, 2, and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. ________ refers to the use of a mixture of agents to achieve the anesthetic state.
a. General anesthesia
b. Conscious sedation
c. Balanced anesthesia
d. Local anesthesia

 

 

 

 

  1. Guidelines for conscious sedation suggest which of the following?
  2. At least three qualified people must be continually present during the sedation period.
  3. One person must have sole responsibility of monitoring of the patient and recording vital signs.
  4. Resuscitation equipment must be immediately available.
  5. Assessment of oxygenation, ventilation, and temperature maintenance is necessary.

 

a. 2 and 3 only
b. 1, 2, and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

 

  1. You are working in the ED when EMS brings an 83-year-old female who was found unresponsive by her husband. She recently broke her ankle and was prescribed Dilaudid. Her husband states she also takes Vicodin for arthritis pain. What medication should you administer?
a. Ultram
b. Demerol
c. Epinephrine
d. Naloxone

 

 

 

Chapter 21: Vasopressors, Inotropes, and Antiarrhythmic Agents

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Cardiac output depends on which of the following factors?
  2. Venous return
  3. Heart rate
  4. Systemic vascular resistance
  5. Pulmonary vascular resistance
  6. Stroke volume

 

a. 2 and 5 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 5 only

 

 

 

  1. Complications of pulmonary artery catheterization include which of the following?
  2. Pneumothorax
  3. Fluid overload
  4. Dehydration
  5. Infection
  6. Thrombus formation

 

a. 3 only
b. 2, 3, and 5 only
c. 1, 4, and 5 only
d. 1, 2, and 4 only

 

 

 

  1. Your patient is experiencing heart failure and is in need of an inotropic agent. Which of the following would you recommend, barring any other cardiac issues?
  2. Lidocaine
  3. Digoxin
  4. Milrinone
  5. Dobutamine

 

a. 2, 3, and 4
b. 1, 2, and 3
c. 1 and 2
d. 2 and 4

 

 

  1. You are treating a patient who has severe asthma. Which classification of drugs may pose some risk of bronchoconstriction and should be used carefully in patients with asthma and chronic obstructive pulmonary disease?
a. b-adrenergic cardiac stimulants
b. Cardiac glycosides
c. b blockers
d. Antiarrhythmics

 

 

 

  1. Which of the following agents is a parasympatholytic used in cardiac resuscitation for asystole?
a. Epinephrine
b. Magnesium
c. Atropine
d. Vasopressin

 

 

 

  1. Cardiac glycosides
a. reduce ventricular arrhythmias.
b. decrease blood pressure.
c. increase heart rate.
d. increase myocardial contractility.

 

 

 

  1. Class IA anti-arrhythmic agents are effective in treating
a. bradycardia.
b. atrioventricular node delays.
c. ectopic beats.
d. atrial and ventricular arrhythmias.

 

 

 

  1. Class IB antiarrhythmics are limited to treating
a. atrial arrhythmias.
b. ventricular arrhythmias.
c. tachycardia.
d. congestive heart failure.

 

 

 

  1. Lidocaine is used to treat
a. ventricular arrhythmias.
b. atrial arrhythmias.
c. atrioventricular node delays.
d. supraventricular tachycardia.

 

 

 

 

  1. Atropine is given to
a. increase blood pressure.
b. increase heart rate.
c. treat ventricular arrhythmias.
d. improve cardiac contractility.

 

 

  1. Which of the following is considered the mainstay for improving hypotensive episodes?
a. Vasopressors
b. Inotropes
c. Fluids
d. Catecholamines

 

 

 

  1. Which of the following are considered inotropic agents?
  2. Dobutamine
  3. Milrinone
  4. Digoxin
  5. Lidocaine

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

 

  1. Your patient is experiencing heart failure secondary to decreased contractility and has a confirmed severe allergy to sulfites. Which of the following inotropic medications would you not recommend?
a. Dobutamine
b. Milrinone
c. Digoxin
d. Inamrinone

 

 

 

  1. The innate pacemaker of the heart is known as the
a. atrioventricular (AV) node.
b. bundle of His.
c. sinoatrial (SA) node.
d. purkinje fibers.

 

 

 

  1. According to the Vaughan Williams classification system, which class of agents blocks fast sodium channels in the myocardium, specifically in the atrium?
a. Class I
b. Class II
c. Class III
d. Class IV

 

 

 

  1. According to the Vaughan Williams classification system, which class of antiarrhythmic agents consists mainly of b blockers?
a. Class I
b. Class II
c. Class III
d. Class IV

 

 

 

  1. According to the Vaughan Williams classification system, which class of antiarrhythmic agents consists of the only two calcium channel blockers (CCBs) used in the management of supraventricular arrhythmias and ventricular rate control for atrial fibrillation?
a. Class I
b. Class II
c. Class III
d. Class IV

 

 

 

  1. Your patient requires a dose of adenosine for confirmed supraventricular tachycardia (SVT). His only line is a peripheral intravenous line in the right arm. How should you proceed?
a. Slowly administer the dose over 30 seconds.
b. Administer the dose quickly and immediately follow with a saline flush.
c. Hold the patient’s right arm in an upright position while administering the dose.
d. Both B and C.

 

 

 

  1. The most important factor in the management of sudden cardiac death is
a. the age of the patient.
b. the underlying disease process.
c. timely and efficient cardiopulmonary resuscitation (CPR) and defibrillation.
d. fluid status.

 

 

 

  1. Your patient is a 67-year-old homeless man with malnutrition. Laboratory test results show that he has hypomagnesemia. What arrhythmia should you monitor for until a dose of magnesium sulfate can be administered?
a. Ventricular fibrillation
b. Atrial fibrillation
c. Torsades de pointes
d. Asystole

 

 

 

  1. Which cardiac agent may be administered endotracheally?
a. Lidocaine
b. Epinephrine
c. Atropine
d. All of the above

 

 

 

  1. How does digoxin exert an inotropic effect on the myocardium?
a. By reversibly inhibiting the Na+/K+-ATPase pump
b. By stimulating the vagus nerve
c. By increasing extracellular sodium concentrations
d. By pumping calcium out of the cell

 

 

 

  1. Digoxin toxicity may include which of the following manifestations?
  2. Hyperkalemia
  3. Premature ventricular contractions
  4. Bigeminal rhythm
  5. Nausea
  6. Abdominal pain

 

a. 2 and 5 only
b. 1, 2, and 3 only
c. 1, 2, 3, 4, and 5
d. 1, 2, 3, and 5 only

 

 

 

 

  1. Place the five phases of a myocardial action potential in correct order.
  2. Fast sodium channels are inactivated
  3. Cell returns to its “resting” state
  4. “Plateau” phase
  5. Initial rapid depolarization of myocardial tissues
  6. Calcium channels close

 

a. 1, 3, 2, 5, 4
b. 4, 1, 3, 5, 2
c. 1, 2, 3, 4, 5
d. 4, 1, 2, 5, 3

 

 

 

  1. When should intravenous access and medication be considered during pulseless ventricular tachycardia?
a. After beginning cardiopulmonary resuscitation (CPR) and attempting defibrillation
b. Before beginning CPR and attempting defibrillation
c. When the patient has an established advanced airway
d. Intravenous access and medication are not a part of the treatment algorithm for pulseless ventricular tachycardia

 

 

 

  1. Ablation with radiofrequency current is effective in the treatment of
a. atrial fibrillation (AF) caused by multiple circuits.
b. asystole.
c. sinus rhythm.
d. AF caused by single primary circuit.

 

 

 

  1. Implantable cardioverter-defibrillators (ICDs) are indicated for the following conditions:
  2. Cardiac arrest caused by pulseless ventricular tachycardia (VT)
  3. Spontaneous sustained VT
  4. Asystole
  5. Pulseless electrical activity
  6. Electrophysiologically inducible VT or ventricular fibrillation (VF) not suppressed by class I antiarrhythmics

 

a. 1 only
b. 1, 2, and 5 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, 5

 

 

 

  1. Your patient is experiencing bronchospasm secondary to asthma and is unresponsive to bronchodilator therapy. Her current medications include propafenone, lidocaine, and albuterol. Which of these medications could be contributing to her unresponsiveness to therapy?
a. Propafenone
b. Lidocaine
c. Albuterol
d. None could cause this unresponsiveness

 

 

 

 

  1. Magnesium toxicity may include which of the following manifestations?
  2. Hyperkalemia
  3. Sweating
  4. Hypothermia
  5. Depression of reflexes
  6. Abdominal pain

 

a. 2 and 5 only
b. 1, 2, and 3 only
c. 1, 2, 3, 4, and 5
d. 2, 3, and 4 only

 

 

 

  1. Your patient is experiencing torsades de pointes. What is the proper medication, dose, and route to treat her arrhythmias?
a. Propafenone, 1 g, IV
b. Lidocaine, 1 g, PO
c. Sodium bicarbonate, 1 mEq/kg, IV
d. Magnesium sulfate, 1 to 2 g, IV

 

 

 

  1. Signs and symptoms of vasopressor-induced extravasation include which of the following?
  2. Hyperkalemia
  3. Pain
  4. Swelling
  5. Depression of reflexes
  6. Erythema

 

a. 2 and 5 only
b. 2, 3, and 5 only
c. 1, 2, 3, 4, and 5
d. 2, 3, and 4 only

 

 

 

  1. Your patient has a decrease in his CVP, PCWP, and CO, with an increased HR following a laceration to his liver in a motor vehicle crash. Which shock state is he experiencing?
a. Septic shock
b. Hypovolemic shock
c. Neurogenic shock
d. Cardiogenic shock

 

 

 

Chapter 22: Drugs Affecting Circulation: Antihypertensives, Antianginals, Antithrombotics

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Damage to vital body organs resulting from hypertension is called
a. congestive heart failure.
b. multiple organ/system failure.
c. cardiovascular disease.
d. chronic obstructive pulmonary disease.

 

 

  1. Uncontrolled hypertension increases the risk of which of the following?
  2. Myocardial infarction
  3. Peripheral arterial disease
  4. Angina
  5. Stroke
  6. Renal failure

 

a. 1 and 3 only
b. 2 and 4 only
c. 1, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. What agents act to lower blood pressure by stopping the conversion of angiotensin I to angiotensin II?
a. Angiotensin-converting enzyme inhibitors (ACEIs)
b. Angiotensin II receptor blockers
c. Diuretics
d. b blockers

 

 

 

  1. The product of cardiac output and total peripheral resistance defines
a. arterial blood pressure.
b. central venous pressure.
c. afterload.
d. preload.

 

 

 

  1. Hypertension in adults is defined as a blood pressure greater than
a. 120/80 mm Hg.
b. 130/85 mm Hg.
c. 140/90 mm Hg.
d. 160/100 mm Hg.

 

 

 

  1. First-line agents for treatment of uncomplicated hypertension include
a. diuretics only.
b. thiazide diuretics, ACEIs, ARBs, and CCBs.
c. ACEIs and a-blocking agents.
d. ACEIs, b blockers, and ARBs.

 

 

 

  1. Angiotensin-converting enzyme inhibitors (ACEIs) produce which of the following effects?
  2. Decrease in renal blood flow
  3. Reduction of peripheral arterial pressure
  4. Increase in renal blood flow
  5. Significant increase in heart rate
  6. Increase in cardiac output

 

a. 2, 4, and 5 only
b. 1, 2, and 4 only
c. 2, 3, and 5 only
d. 1, 2, 3, 4, and 5

 

 

  1. Angiotensin-converting enzyme inhibitors (ACEIs) are indicated for which of the following?
  2. Heart failure
  3. Systolic dysfunction
  4. Post–myocardial infarction
  5. Hypertension
  6. Proteinuric kidney disease

 

a. 4 only
b. 1, 2, and 4 only
c. 1, 2, 3, and 4 only
d. 1, 2, 3, 4, and 5

 

 

 

 

  1. The most common side effect of angiotensin-converting enzyme inhibitors (ACEIs) is
a. persistent dry cough.
b. loss of taste.
c. rash.
d. orthostatic hypotension.

 

 

 

 

  1. A significant drug interaction occurs between angiotensin-converting enzyme inhibitors (ACEIs) and
a. corticosteroids.
b. loop diuretics.
c. NSAIDs.
d. antibiotics.

 

 

 

 

  1. The classes of diuretics include which of the following?
  2. Loops
  3. Potassium-sparing
  4. Osmotics
  5. Thiazides
  6. Carbonic anhydrase inhibitors

 

a. 1 and 4 only
b. 2, 3, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Thiazide diuretics increase excretion of
  2. sodium.
  3. chloride.
  4. calcium.
  5. potassium.
  6. magnesium.

 

a. 1 and 2 only
b. 3, 4, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Lasix and Bumex are
a. thiazide diuretics.
b. loop diuretics.
c. osmotic diuretics.
d. potassium-sparing diuretics.

 

 

 

  1. Which of the following agents reduce total peripheral resistance by a direct action on vascular smooth muscle?
a. Angiotensin blockers
b. Vasodilators
c. Angiotensin-converting enzyme inhibitors
d. Calcium channel blockers

 

 

 

  1. ________ is a symptom of myocardial ischemia.
a. Peripheral swelling
b. Angina
c. Low oxygen saturation
d. Headache

 

 

 

  1. Nitroglycerin relieves chest pain by
a. decreasing heart rate.
b. increasing force of heart contractions.
c. dilating coronary arteries.
d. constricting coronary arteries.

 

 

 

  1. Nitrates can be administered by which of the following routes?
  2. Transdermal
  3. Inhalation
  4. Oral
  5. Intravenous
  6. Sublingual

 

a. 1 and 5 only
b. 2 and 3 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, and 5 only

 

 

 

  1. All patients with angina should receive what drug for prophylaxis of a myocardial infarction?
a. Heparin
b. Dopamine
c. Lidocaine
d. Aspirin

 

 

 

  1. Anticoagulants work by
a. preventing the formation of the fibrin clot.
b. lysing thrombi by degrading fibrin.
c. dilating vessels so that clots are less likely to form.
d. inhibiting the action of platelets.

 

 

  1. The most commonly used anticoagulant is
a. warfarin.
b. aspirin.
c. heparin.
d. protamine sulfate.

 

 

 

  1. Aspirin is
a. an anticoagulant.
b. an antiplatelet agent.
c. an analgesic.
d. a thrombolytic.

 

 

 

  1. Thrombolytic agents should be given ________ in relation to the onset of symptoms.
a. within 12 hours
b. within 2 days
c. within minutes
d. within 1 to 2 weeks

 

 

 

  1. Thrombolytics restore coronary blood flow by
a. dilating the artery.
b. preventing fibrin clot formation.
c. preventing platelet aggregation.
d. dissolving the thrombus.

 

 

 

  1. Your 37-year-old patient has an initial blood pressure reading of 160/98 mm Hg. No other readings have been taken since this time. Should he be diagnosed as having hypertension?
a. Yes
b. No

 

 

 

 

  1. Your 74-year-old patient has a recorded blood pressure of 185/125 mm Hg. He is not currently showing any signs or symptoms of acute organ complications. You would label his condition a
a. hypertensive urgency.
b. hypertensive emergency.
c. hypertensive crisis.
d. both A and C.

 

 

 

  1. Antihypertensive effects of b blockers include
  2. blockade of b receptors on the renal juxtaglomerular cells.
  3. blockade of b receptors in the lungs.
  4. blockade of myocardial b receptors.
  5. blockade of Na+ channels in the luminal membrane of the cells in the distal tubules.
  6. blockade of central nervous system b receptors.

 

a. 1 and 2 only
b. 1, 3, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Centrally acting adrenergic agents lower blood pressure by
a. affecting cardiac output.
b. affecting peripheral resistance.
c. neither A nor B.
d. both A and B.

 

 

 

 

  1. Side effects of centrally acting adrenergic agents include
  2. dry mouth.
  3. constipation.
  4. urinary retention.
  5. blurred vision.
  6. central nervous system side effects.

 

a. 5 only
b. 1, 3, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. The unmonitored dosing for unfractionated heparin for deep vein thrombosis and pulmonary embolism is
a. bolus of 60 U/kg (maximum 400 U) and then 12 U/kg/hr.
b. 175 U/kg every 24 hours.
c. initial 333 U/kg and then 250 U/kg every 12 hours.
d. 1 mg/kg subcutaneously every 12 hours.

 

 

 

 

  1. The dose of aspirin for prevention of myocardial infarction is
a. 325 to 650 mg every 4 hours.
b. 50 to 325 mg daily.
c. 81 to 325 mg daily.
d. 500 to 1.5 g daily.

 

 

  1. Delayed-onset heparin-induced thrombocytopenia type 2 (HIT-2) is due to
a. congestive heart failure.
b. multiple organ/system failure.
c. cardiovascular disease.
d. formation of antiplatelet antibodies.

 

 

 

  1. The standard for monitoring warfarin therapy is
a. international normalized ratio (INR).
b. complete blood count.
c. prothrombin time (PT).
d. pulmonary function testing.

 

 

 

  1. Glycoprotein (GP) inhibitors are indicated for the treatment of
  2. acute coronary syndromes.
  3. unstable angina.
  4. deep vein thrombosis.
  5. hypertension.
  6. patients undergoing percutaneous coronary intervention (PCI).

 

a. 5 only
b. 1, 2, and 5 only
c. 1, 2, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. The most common adverse effect associated with thrombolytic agents is
a. dry mouth.
b. heparin-induced thrombocytopenia type 2.
c. cardiovascular disease.
d. bleeding.

 

 

 

  1. Novo Seven initiates thrombin generation by activating factor
a. V.
b. VII.
c. VIII.
d. X.

 

 

 

  1. What is Kcentra indicated for?
a. Diuresis
b. Urgent reversal of warfarin
c. Hypertensive crisis
d. Angina

 

 

 

  1. Disease conditions and medications that cause hypertension include which of the following?
  2. Cushing’s syndrome
  3. Hypothyroidism
  4. Pheochromocytoma
  5. Amphetamines
  6. Pseudoephedrine

 

a. 1, 2, and 5 only
b. 1, 4, and 5 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

 

  1. Vascular smooth muscle and cardiac cell contraction is dependent on
a. the free extracellular calcium ion concentration.
b. the free intracellular calcium ion concentration.
c. the free extracellular potassium ion concentration.
d. the free intracellular potassium ion concentration.

 

 

 

Chapter 23: Sleep and Sleep Pharmacology

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. Which of the following are classified as sleep disorders?
  2. Insomnia
  3. Narcolepsy
  4. Restless legs syndrome
  5. Asthma
  6. Parasomnias

 

a. 2 and 5 only
b. 1 and 2 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 5 only

 

 

 

  1. The onset and duration of sleep is orchestrated through
  2. hypothalamic-pituitary-adrenal (HPA) axis.
  3. multiple brain structures.
  4. neurotransmitter substrates.
  5. mast cells.

 

a. 2 and 3 only
b. 1 and 3 only
c. 1 and 4 only
d. 1, 2, and 4 only

 

 

 

  1. The suprachiasmatic nucleus (SCN) is localized to the
a. anterior hypothalamus.
b. posterior hypothalamus.
c. laterodorsal pontine tegmentum.
d. pedunculopontine tegmentum.

 

 

 

  1. What are the two phases of REM sleep?
a. Tonic and periodic
b. Phasic and cyclic
c. Tonic and phasic
d. Tonic and cyclic

 

 

 

  1. Most ascending activating system (AAS) projections that mediate electroencephalographic (EEG) arousal and wakefulness synapse in which brain region?
a. Laterodorsal pontine tegmentum
b. Thalamus
c. Pedunculopontine tegmentum
d. Hippocampus

 

 

 

  1. Under normal circumstances, circadian rhythms become synchronized to the
a. person’s work schedule.
b. chronopharmacology.
c. chronobiology.
d. environmental light/dark cycle.

 

 

 

  1. Drugs that directly influence circadian mechanisms are often referred to as
a. chronobiology.
b. chronopharmacology.
c. chronotoxicity.
d. chronobiotics.

 

 

 

  1. The prototypic chronobiotic is
a. valium.
b. melatonin.
c. phenobarbital.
d. klonopin.

 

 

 

  1. Melatonin is secreted
a. exclusively during the subjective night.
b. exclusively during the subjective day.
c. during day and night.
d. continuously.

 

 

 

  1. The sleep disorder characterized by difficulty falling asleep, insufficient sleep, or nonrestorative sleep is
a. restless legs syndrome (RLS).
b. insomnia.
c. narcolepsy.
d. parasomnias.

 

 

 

  1. Pharmacologic treatment of insomnia includes
  2. estazolam.
  3. eszopiclone.
  4. zolpidem.
  5. ramelteon.

 

a. 2 and 3 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

 

  1. A chronic and progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake is referred to as
a. RLS.
b. insomnia.
c. narcolepsy.
d. parasomnias.

 

 

 

 

  1. Your patient is experiencing worsening of symptoms associated with restless legs syndrome (RLS). Which medications could be causing this?
a. Albuterol
b. Valium
c. Ranitidine
d. Zolpidem

 

 

 

  1. Reduced extracellular levels of which neurotransmitter can contribute to the symptoms of restless legs syndrome (RLS)?
a. Dopamine
b. Histamine
c. Norepinephrine
d. Glutamate

 

 

 

  1. The sleep disorder characterized by persistent excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis is
a. restless legs syndrome (RLS).
b. insomnia.
c. narcolepsy.
d. parasomnias.

 

 

 

  1. Pharmacologic treatment for narcolepsy includes
a. valium.
b. xyrem.
c. phenobarbital.
d. zolpidem.

 

 

 

 

  1. The sleep disorder characterized by undesirable motor, sensory, or behavioral phenomena is referred to as
a. insomnia.
b. narcolepsy.
c. parasomnias.
d. restless legs syndrome (RLS).

 

 

 

  1. Treatment for NREM and REM sleep parasomnias frequently includes
a. phenobarbital.
b. avoidance of potential triggers.
c. longer acting benzodiazepines.
d. both B and C.

 

 

 

  1. Lunesta is the trade name for
a. estazolam.
b. temazepam.
c. triazolam.
d. eszopiclone.

 

 

 

  1. Restoril is the trade name for
a. estazolam.
b. temazepam.
c. triazolam.
d. eszopiclone.

 

 

 

  1. Halcion is the trade name for
a. estazolam.
b. temazepam.
c. triazolam.
d. eszopiclone.

 

 

 

  1. The trade name for Zolpidem is
a. Ambien.
b. ProSom.
c. Sonata.
d. Rozerem.

 

 

  1. The trade name for Zaleplon is
a. Ambien
b. ProSom
c. Sonata
d. Rozerem

 

 

 

  1. The trade name for Ramelteon is
a. Ambien
b. ProSom
c. Sonata
d. Rozerem

 

 

 

  1. Side effects of phenobarbital include
  2. potential risk for addiction.
  3. respiratory suppression when taken with alcohol.
  4. insomnia.

 

a. 1 and 3 only
b. 2 and 3 only
c. 1 and 2 only
d. 1, 2, and 3

 

 

  1. ______________________ is the study of time-dependent variations in pharmacology.
a. Chronopharmacology
b. Chronobiology
c. Circopharmacology
d. Chromopharmacology