Question 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

Accepted Answer

Tiotropium exhibits receptor subtype selectivity for M₁ and M₃ receptors.The drug binds to all three muscarinic receptors (M₁,M₂,and M₃)but dissociates much more slowly than ipratropium from the M₁ and M₃ receptors;this results in a selectivity of action on M₁ and M₃ receptors.

Question 2

Quaternary ammonium compounds cause bronchodilation by&#10;A)blocking cholinergic sites.&#10;B)stimulating cholinergic sites.&#10;C)blocking adrenergic sites.&#10;D)stimulating adrenergic sites.

Accepted Answer

Quaternary ammonium compounds cause bronchodilation by blocking cholinergic contractile action.In the nasal passages,ipratropium reduces hypersecretion,the basis for its use in rhinitis.As an anticholinergic,the compound would not stimulate cholinergic sites.Quaternary ammonium compounds do not act on adrenergic sites.

Question 3

Quaternary ammonium compounds such as ipratropium bromide&#10;A)are ineffective as inhaled agents.&#10;B)do not cross lipid membranes easily.&#10;C)are distributed quickly throughout the body when inhaled.&#10;D)have no role in respiratory care.

Accepted Answer

Quaternary ammonium compounds are effective when inhaled (e.g. ,Atrovent).Generally,quaternary ammonium compounds do not cross lipid membranes easily and do not distribute throughout the body when inhaled.Atrovent is used frequently in respiratory care.

Question 4

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

Accepted Answer

Ventolin MDI,Serevent Diskus,and Foradil are sympathomimetic agents only.Combivent Respimat is a combination sympathomimetic (albuterol)and parasympatholytic (ipratropium bromide).

Question 5

Cardiac effects of aerosolized ipratropium bromide include which of the following?&#10;A)Increased heart rate&#10;B)Increased blood pressure&#10;C)Increased heart muscle contractility&#10;D)Little or no effect

Accepted Answer

Ipratropium bromide has minimal effects on heart rate or blood pressure when given by inhaled aerosol.However,several more recent meta-analyses have suggested that ipratropium and tiotropium may cause an increase in cardiovascular events.When other meta-analyses were conducted and reexamined,no incidence of cardiovascular involvement from inhaled anticholinergics was found.Currently,no information has been conclusive in showing that these agents have any adverse effects on the cardiovascular system.

Question 6

Which of the following is a once-a-day anticholinergic?&#10;A)Atropine&#10;B)Ipratropium bromide&#10;C)Glycopyrrolate&#10;D)Umeclidinium bromide

Accepted Answer

If used as an inhaled drug,atropine sulfate must be administered several times daily.Ipratropium bromide has a duration of only 4 to 6 hours.Glycopyrrolate is a quaternary ammonium derivative of atropine that,similar to ipratropium,does not distribute well across lipid membranes in the body.It is usually administered parenterally as an antimuscarinic agent during reversal of neuromuscular blockade,as an alternative to atropine,with fewer ocular or central nervous system side effects.It has a duration of approximately 6 hours.Umeclidinium bromide (Incruse Ellipta)has a duration of up to 24 hours and needs to be administered only once daily.

Question 7

Activating an Atrovent inhaler in the eye may cause&#10;A)blindness.&#10;B)pupil dilation.&#10;C)pupil constriction.&#10;D)scarring of the cornea.

Accepted Answer

Pupillary dilation and lens paralysis may result,not total blindness.Corneal scarring is not a known risk factor.

Question 8

Mucociliary slowing,bronchodilation,and increased heart rate all are a result of&#10;A)cholinergic agents.&#10;B)adrenergic agents.&#10;C)anticholinergic agents.&#10;D)parasympathetic agents.

Accepted Answer

Cholinergic agents decrease the heart rate,cause bronchoconstriction,and induce mucus secretion.Adrenergic agents do not cause mucociliary slowing.Anticholinergic agents block parasympathetic tone and may cause mucociliary slowing,bronchodilation,and increased heart rate.Parasympathetic agents decrease heart rate and cause bronchoconstriction.

Question 9

Drugs that competitively block the action of acetylcholine at parasympathetic postganglionic effector cell receptors are called&#10;A)muscarinic agents.&#10;B)adrenergic agents.&#10;C)antimuscarinic agents.&#10;D)cholinergic agents.

Accepted Answer

Anticholinergic bronchodilators are specifically parasympatholytic,that is,antimuscarinic,agents,blocking the effect of acetylcholine at the cholinergic (muscarinic)receptors on bronchial smooth muscle.Adrenergic agents initiate a sympathomimetic action.Cholinergic agents would initiate an action at the effector cell receptor.

Question 10

Which of the following patient populations may benefit from anticholinergic agents?&#10;A)Patients experiencing acute,severe episodes of asthma not responding well to $\beta$ agonists&#10;B)Patients with psychogenic asthma&#10;C)Patients with nocturnal asthma&#10;D)All of the above

Accepted Answer

Anticholinergic (antimuscarinic)agents such as ipratropium do not have a labeled indication for asthma in the United States.Current asthma guidelines state that ipratropium may have some additive benefit when given with inhaled $\beta$ agonists.Antimuscarinic bronchodilators are not clearly superior to$\beta$ -adrenergic agents in treating asthma.Antimuscarinic and $\beta$-adrenergic agents have an approximately equal effect on flow rates in many patients.These agents may be especially useful in the following asthmatic patients: patients with nocturnal asthma,in which the slightly longer duration of action may protect against nocturnal deterioration of flow rates;patients with psychogenic asthma,which may be mediated through vagal parasympathetic fibers;asthmatic patients with glaucoma,angina,or hypertension who require treatment with $\beta$-blocking agents;patients with notable side effects from theophylline as an alternative to theophylline;and patients with acute,severe episodes of asthma not responding well to F1F1F1S1?F1F1F10 agonists.

Question 11

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

A)4 only
B)1,3,and 5 only
C)2,3,and 4 only
D)1,2,3,4,and 5

Accepted Answer

The answer of Cholinergic stimulation produces which of the following...

Question 12

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

Accepted Answer

The answer of Possible side effects of aerosolized Atrovent include...

Question 13

Incruse Ellipta is approved for&#10;A)exacerbation of chronic obstructive pulmonary disease (COPD).&#10;B)thinning of dried secretions.&#10;C)acute bronchoconstriction.&#10;D)maintenance treatment of airflow obstruction in COPD.

Accepted Answer

The answer of Incruse Ellipta is approved for&#10;A)exacerbation of chronic...

Question 14

Combivent is a combination drug including which two medications?&#10;A)Albuterol and salmeterol&#10;B)Salmeterol and ipratropium bromide&#10;C)Albuterol and ipratropium bromide&#10;D)Pirbuterol and ipratropium bromide

Accepted Answer

The answer of Combivent is a combination drug including which...

Question 15

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

Accepted Answer

The answer of Which of the following statements regarding ipratropium...

Question 16

An anticholinergic that can be administered via aerosolization is&#10;A)ipratropium bromide.&#10;B)albuterol sulfate.&#10;C)glycopyrrolate.&#10;D)atropine.

Accepted Answer

The answer of An anticholinergic that can be administered via...

Question 17

Ipratropium bromide is indicated to treat which of the following?&#10;A)Allergic rhinitis&#10;B)Maintenance therapy in patients with COPD&#10;C)Nonallergic rhinitis&#10;D)All of the above

Accepted Answer

The answer of Ipratropium bromide is indicated to treat which...

Question 18

The most common side effect of anticholinergic bronchodilators is&#10;A)dry mouth.&#10;B)increased heart rate.&#10;C)wheezing.&#10;D)delirium.

Accepted Answer

The answer of The most common side effect of anticholinergic...

Question 19

Patients using ipratropium aerosols should be instructed to avoid allowing the aerosol to come in contact with their&#10;A)hair.&#10;B)nose.&#10;C)eyes.&#10;D)ears.

Accepted Answer

The answer of Patients using ipratropium aerosols should be instructed...

Question 20

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

A)2 only
B)1,3,and 4 only
C)1,2,and 4 only
D)2,4,and 5 only

Accepted Answer

The answer of The combination of albuterol and ipratropium bromide...

Question 21

Which of the following is a term used to describe an agent that produces the effect of acetylcholine or an agent that mimics acetylcholine?&#10;A)Parasympatholytic&#10;B)Parasympathomimetic&#10;C)Muscarinic&#10;D)Antimuscarinic bronchodilator

Accepted Answer

The answer of Which of the following is a term...

Question 22

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.

Accepted Answer

The answer of Acetylcholine stimulates M₃ receptors on airway smooth...

Question 23

Which of the following is the generic name for Tudorza Pressair?&#10;A)Aclidinium bromide&#10;B)Tiotropium bromide&#10;C)Ipratropium bromide&#10;D)Umeclidinium bromide

Accepted Answer

The answer of Which of the following is the generic...

Question 24

Which of the following is the generic name for Spiriva?&#10;A)Aclidinium bromide&#10;B)Tiotropium bromide&#10;C)Ipratropium bromide&#10;D)Umeclidinium bromide

Accepted Answer

The answer of Which of the following is the generic...

Question 25

Which of the following is the generic name for Incruse Ellipta?&#10;A)Aclidinium bromide&#10;B)Tiotropium bromide&#10;C)Ipratropium bromide&#10;D)Umeclidinium bromide

Accepted Answer

The answer of Which of the following is the generic...

Question 26

Which of the following is the generic name for Atrovent?&#10;A)Aclidinium bromide&#10;B)Tiotropium bromide&#10;C)Ipratropium bromide&#10;D)Umeclidinium bromide

Accepted Answer

The answer of Which of the following is the generic...

Deck 7: Anticholinergic Parasympatholyticbronchodilators