Deck 35: Airway Pharmacology

Question 1

Which phase describes the mechanism of drug action by which a drug causes its effects within the body through drug-receptor interactions?

A) Pharmaceutical
B) Pharmacognosy
C) Pharmacokinetic
D) Pharmacodynamic

Answer 1

D
Explanation: The pharmacodynamic phase describes the mechanisms of drug action by which a drug molecule causes its effects in the body.

Question 2

Which of the following terms is used to describe a drug that stimulates a receptor responding to norepinephrine?

A) Sympatholytic
B) Anticholinergic
C) Cholinergic
D) Adrenergic

Answer 2

D
Explanation: Adrenergic (adrenomimetic) refers to a drug that stimulates a receptor responding to norepinephrine or epinephrine.

Question 3

Which phase describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination?

A) Pharmaceutical
B) Pharmacognosy
C) Pharmacokinetic
D) Pharmacodynamic

Answer 3

C
Explanation: The pharmacokinetic phase of drug action describes the time course and disposition of a drug in the body based on its absorption, distribution, metabolism, and elimination.

Question 4

Which of the following are advantages for the treatment of the respiratory tract with inhaled aerosols?
1) Doses are usually smaller.
2) Onset of drug action is rapid.
3) Delivered dose is consistent with each administration.
4) Systemic side effects are often fewer and less severe.

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

Question 5

Proventil and Ventolin are brand names for which of the following beta-adrenergic bronchodilators?

A) Albuterol
B) Levalbuterol
C) Vilanterol
D) Arformoterol

Question 6

Which of the following phases constitute the course of drug action from dose to effect?
1) Drug administration
2) Pharmacognosy
3) Pharmacokinetic
4) Pharmacodynamic

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

Question 7

Which one or more of the following devices are used in combination with metered dose inhaler (MDI) therapy to reduce the need for hand-breathing coordination and oropharyngeal impaction of aerosolized drugs?
1) Reservoir devices
2) One-way spacers
3) Valved holding chambers
4) Drying chambers

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

Question 8

Which of the following methods limits the systemic distribution of an inhaled aerosolized drug?

A) Use of a fully ionized drug
B) Use of a partially ionized drug
C) Use of metabolites
D) Use of the generic form of the drug

Question 9

Adrenergic bronchodilators improve flow rates for which of the following diseases?
1) Asthma
2) Acute bronchitis
3) Chronic bronchitis
4) Pulmonary fibrosis

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

Question 10

What is the dosage for salmeterol MDI?

A) 2 puffs every 4 to 6 hr
B) 1 to 2 puffs four times daily
C) 2 puffs three times daily
D) 2 puffs every 12 hr

Question 11

Which of the following anticholinergics is poorly ionized?

A) Atropine
B) Ipratropium bromide
C) Tiotropium bromide
D) Aclidinium bromide

Question 12

Pharmacologic control of the airway is mediated by receptors found on which of the following structures?
1) Smooth muscle
2) Secretory cells
3) Blood vessels
4) Alveolar epithelium

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

Question 13

A metered dose inhaler of salmeterol delivers which of the following?

A) 131 mcg/puff
B) 90 mcg/puff
C) 65 mcg/puff
D) 25 mcg/puff

Question 14

Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
1) Small particle aerosol generator
2) Metered dose inhaler
3) Small volume nebulizer
4) Soft-mist inhaler

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

Question 15

When stimulated, which of the following receptors causes bronchoconstriction?

A) M₃
B) M₂
C) $\alpha$ ₁
D) $\beta$ ₂

Question 16

Which of the following lung availability/total systemic availability (L/T) ratios is consistent with an efficient aerosol delivery?

A) 0.46
B) 0.23
C) 0.1
D) 0.6

Question 17

Which of the following is the usual neurotransmitter in the sympathetic system?

A) Atropine
B) Acetylcholine
C) Norepinephrine
D) Dopamine

Question 18

Foradil is a brand name for which of the following beta-adrenergic bronchodilators?

A) Albuterol
B) Levalbuterol
C) Arformoterol
D) Formoterol

Question 19

Which of the following is an indication for use of an adrenergic bronchodilator?

A) Treatment of excessive, viscous mucus secretions
B) Antiinflammatory treatment of mild to moderate persistent asthma
C) Treatment of reversible airflow obstruction
D) Prophylactic management of asthma

Question 20

Which of the following comprises the largest single group of drugs among aerosolized agents used for inhalation?

A) Inhaled corticosteroids
B) Adrenergic bronchodilators
C) Mucus-controlling agents
D) Anticholinergic bronchodilators

Question 21

Which of the following are mucoactive agents currently approved for inhalation in the United States?
1) Tryptase alfa
2) Dornase alfa
3) Hyperosmolar saline
4) Mucomyst

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

Question 22

Which of the following nebulizers is used to nebulize iloprost?

A) Hudson
B) Pari
C) I-neb
D) Respirgard

Question 23

What is the average duration of action of the short-acting noncatecholamine agents?

A) 1 to 2 hr
B) 2 to 4 hr
C) 4 to 6 hr
D) 6 to 8 hr

Question 24

What is the duration of action for ipratropium bromide?

A) 4 to 6 hr
B) 6 to 8 hr
C) 8 to 10 hr
D) 12 hr

Question 25

What are some potential adverse effects with use of adrenergic bronchodilators?
1) Hypokalemia
2) Dizziness
3) Worsening ventilation/perfusion ratio ( )
4) Bradycardia

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

Question 26

What is the duration of action for the formulation of ipratropium bromide plus albuterol sulfate (DuoNeb)?

A) 4 to 6 hr
B) 6 to 8 hr
C) 8 to 10 hr
D) 12 hr

Question 27

Which of the following are LABA bronchodilators?
1) Indacaterol
2) Olodaterol
3) Albuterol
4) Salmeterol

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

Question 28

Which of the following short-acting catecholamines is used for their strong alpha-1-vasoconstricting effects to reduce swelling in the nose and larynx and to control bleeding during bronchoscopic biopsy?

A) Levophed
B) Dopamine
C) Dobutamine
D) Racemic epinephrine

Question 29

What is the dosage for ipratropium bromide (Atrovent)?

A) 2 puffs four times daily
B) 2 puffs three times daily
C) 2 puffs twice daily
D) 2 puffs every 12 hr

Question 30

What is the name of the enzyme responsible for the short duration of action of catecholamine bronchodilators?

A) Catechol O-methyltransferase (COMT)
B) Epinephrine dismutase
C) EDTA
D) Hyaluronidase

Question 31

What is the brand name of the (R)-isomer of formoterol?

A) Foradil
B) Survanta
C) Brovana
D) Performist

Question 32

Short-acting adrenergic bronchodilators are considered what type of agent according to the National Asthma Education and Prevention Program?

A) Antiinflammatory
B) Rescue
C) Controller
D) Mucolytic

Question 33

Which of the following are side effects of beta-2-selective bronchodilators?
1) Bradycardia
2) Tremor
3) Insomnia
4) Headache

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

Question 34

Which of the following is the generic name for Arcapta Neohaler?

A) Indacaterol
B) Olodaterol
C) Formoterol
D) Umeclidinium bromide

Question 35

What are some common side effects seen with ipratropium bromide (Atrovent)?

A) Tachycardia
B) Blood pressure increase
C) Cough and dry mouth
D) Tolerance

Question 36

What amount of ipratropium bromide (Atrovent) is delivered by metered dose inhaler?

A) 10 mcg/puff
B) 15 mcg/puff
C) 17 mcg/puff
D) 90 mcg/puff

Question 37

Which of the following are indications for the use of acetylcysteine (Mucomyst)?
1) Treatment of acetaminophen overdose
2) Treatment of excessive, viscous mucus secretions
3) Treatment of aspirin overdose
4) Treatment of purulent mucus secretions by breaking up DNA

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

Question 38

Ipratropium bromide should be used with precaution in which of the following diseases/conditions?
1) Prostatic hypertrophy
2) Urinary retention
3) Kidney stones
4) Glaucoma

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

Question 39

A 45-year-old man has a history of heart failure and is diagnosed with pulmonary arterial hypertension. Initially, he is prescribed treprostinil (Tyvaso) 3 breathes (18 mcg) per treatment session via the Tyvaso Inhalation System. Upon first administration, the patient feels nauseated, throat irritation, muscle pain, and experiences flushing. What is the best next course of action?

A) Continue medication administration with the addition of pain relievers.
B) Stop medication administration and continue to the next treatment session.
C) Reduce dose to 1 to 2 breaths per session and then gradually increase to 3.
D) Change medication administration.

Question 40

Acetylcysteine (Mucomyst) is indicated in which of the following diseases?
1) Acute tracheobronchitis
2) Bronchiectasis
3) Chronic obstructive pulmonary disease (COPD)
4) Asthma

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

Question 41

Which of the following explains how acetylcysteine (Mucomyst) lowers the viscosity of mucus?

A) Breaking down DNA
B) Increasing the osmolarity of the mucus and pulling water into it
C) Changing the pH of the mucus, causing it to break down
D) Substituting its sulfhydryl group for disulfide bonds and breaking a portion of the bond forming the gel structure

Question 42

Which of the following FEV₁ values indicates severe compromise of expiratory airflow that may contraindicate the use of mucoactive therapy?

A) Less than 65%
B) Less than 55%
C) Less than 35%
D) Less than 25%

Question 43

Which of the following should be assessed during the administration of mucolytic agents?
1) Breathing pattern and rate
2) Monitoring peak flow changes
3) Patient's reaction to treatment
4) Monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active

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

Question 44

Which of the following are true regarding glucocorticoids?
1) They work through activation of intracellular receptors.
2) Relief is immediate.
3) Daily compliance is essential to controlling inflammation in asthma.
4) They work in a similar fashion to adrenergic bronchodilators.

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

Question 45

Zileuton belongs to which of the following categories?

A) Cromolyn-like agents
B) Leukotriene modifiers
C) Anti-IgE agents
D) Anti-IgA agents

Question 46

Which of the following inhaled corticosteroids is a prodrug?

A) Ciclesonide
B) Flunisolide
C) Budesonide
D) Triamcinolone

Question 47

Bland aerosols are best classified as:

A) mucolytics.
B) bronchodilators.
C) expectorants.
D) mucoactive therapy.

Question 48

Which of the following prophylactic therapies is recommended to reduce the irritant effect of acetylcysteine?

A) Administration of anticholinergics
B) Administration of dornase alfa
C) Administration of corticosteroids
D) Administration of adrenergic bronchodilator

Question 49

Which of the following are considered nonsteroidal antiasthma drugs?
1) Cromolyn-like agents
2) Leukotriene modifiers
3) Anti-IgE agents
4) Anti-IgA agents

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

Question 50

When administering acetylcysteine (Mucomyst), the respiratory therapist should be particularly focused on which of the following potential adverse effects?
1) Incompatibility with certain antibiotics when administered together
2) Blurred vision
3) Bronchospasm
4) Airway obstruction due to rapid liquefaction of mucus

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

Question 51

Which of the following are side effects of dornase alfa administration?
1) Allergic reactions due to antibody production in the patient against dornase alfa
2) Chest pain
3) Rash
4) Laryngitis

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

Question 52

Aerosolized delivery of corticosteroids usually does not manifest in adrenal suppression compared to systemic use as long as the daily dose in adults is kept below what level?

A) 800 mcg
B) 1000 mcg
C) 1200 mcg
D) 1400 mcg

Question 53

Which of the following is a contraindication for the use of nitric oxide?

A) Neonates older than 34 weeks
B) Hypoxic respiratory failure
C) Right-to-left shunt dependence
D) Pulmonary hypertension

Question 54

Which of the following is NOT considered part of the assessment of severity of symptoms recommended by the NAEPP and GOLD guidelines to modify level or dosage of corticosteroids?

A) Number of exacerbations
B) Missed work or school days
C) Pulmonary function
D) Use of anticholinergics

Question 55

Pentamidine is indicated for the treatment of which of the following diseases?

A) Pneumocystis jiroveci
B) Tuberculosis
C) HIV infection
D) Pneumococcal pneumonia

Question 56

How does cromolyn sodium work?

A) Produces antiinflammatory enzymes within cells.
B) Inhibits degranulation of mast cells.
C) Prevents arachidonic acid formation from activation of mast cell membrane phospholipase A₂.
D) Provides leukotriene inhibition.

Question 57

Which of the following is not an available formulation strength for fluticasone propionate (Flovent) by metered dose inhaler?

A) 44 mcg/puff
B) 110 mcg/puff
C) 220 mcg/puff
D) 250 mcg/puff

Question 58

Which of the following are considered an aerosolized antiinfective agent?
1) Pentamidine
2) Ribavirin
3) Tobramycin
4) Amikacin

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

Question 59

Which of the following are medications contain fluticasone furoate?
1) Arnuity Ellipta
2) Breo Ellipta
3) Combivent Respimat
4) Advair Diskus

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

Question 60

The National Asthma Education and Prevention Program guidelines advocate the use of oral corticosteroids for which of the following?

A) Acute asthma exacerbations
B) Maintenance of severe persistent asthma
C) Maintenance of moderate to severe persistent asthma
D) Maintenance of mild to moderate persistent asthma

Question 61

What is the mechanism behind nitric oxide (INO_max)?

A) It dilates pulmonary arterial vascular beds and affects platelet aggregation.
B) It inhibits the degranulation of mast cells.
C) It inhibits the 5-lipoxygenase enzyme that catalyzes the formation of leukotrienes from arachidonic acid.
D) It relaxes vascular smooth muscle by binding to the heme group of cystolic guanylate, activating guanylate cyclase, increasing cyclic GMP.

Question 62

In addition to nitric oxide, which of the following inhalational agents have been approved by the U.S. Food and Drug Administration for the treatment of pulmonary hypertension?
1) Treprostenil
2) Epoprostenol
3) Iloprost
4) Alprostadil

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

Question 63

When administering aerosolized pentamidine, what should the respiratory care practitioner do?
1) Use a nebulizer that produces particles in the 1- to 2-µm mean mass aerodynamic diameter (MMAD) range.
2) Use a nebulizer system with one-way valves and scavenging expiratory filters.
3) Provide isolation and an environmental containment system.
4) Screen patients for human immunodeficiency virus (HIV).

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

Question 64

Side effects associated with parenteral administration of aminoglycosides include which of the following?
1) Ototoxicity
2) Voice alteration
3) Nephrotoxicity
4) Deafness

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

Question 65

Which of the following is true about the use of ribavirin?
1) It is used as an antiviral agent against respiratory syncytial virus.
2) It is delivered via a Respirgard unit.
3) Adverse effects include skin rash, conjunctivitis, and eyelid erythema.
4) It can occlude endotracheal tube and ventilator exhalation valves.

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

Question 66

Which of the following is true about the use of tobramycin?
1) It is primarily used by patients with cystic fibrosis.
2) It is intended to manage chronic infections with Pseudomonas aeruginosa.
3) It prevents deterioration of lung function due to recurrent infections.
4) It has very good lung bioavailability.
5) It is associated with a high rate of bacterial resistance.

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

Question 67

Inhaled zanamivir is indicated for which of the following treatment of uncomplicated respiratory illness?

A) Pharyngitis
B) Croup
C) Epiglottitis
D) Influenza