Question 1

____________ is not a hazard or complication of exogenous surfactant.

Accepted Answer

In the dosing procedure,relatively large volumes of suspension are instilled in neonatal-size airways;this can block gas exchange,causing desaturation and bradycardia.The effect of the drug in improving pulmonary compliance can lead to overventilation,excessive volume delivery from pressure-limited ventilation,and overoxygenation with dangerously high arterial oxygen pressure (PaO₂)levels.Complications of prematurity generally may affect the response to exogenous surfactant.

Question 2

____________ is not a method to obtain natural surfactant.

Accepted Answer

Natural surfactant is a descriptive term for the category of surfactants obtained from animals or humans by alveolar wash or from amniotic fluid.The term synthetic natural surfactant would be used to describe surfactant that is genetically engineered by in vitro recombinant DNA technology.No products of this type are available for general use at the present time.

Question 3

As it relates to an alveolus,LaPlace's law is written as

Accepted Answer

For an alveolus (one air-liquid interface),LaPlace's law is written as follows: pressure = (2 * surface tension)/radius.
For a bubble (two air-liquid interfaces),LaPlace's law is written as follows: pressure = (4 * surface tension)/radius.
The unit of measure for surface tension is usually dynes per centimeter (dyn/cm).

Question 4

Another name for surface-active agents is

Accepted Answer

Surface-active agents lower alveolar surface tension and allow lower pressures to be used for alveolar inflation.Soap and various forms of detergent have similar surface tension-lowering capabilities,and surface-active agents,or surfactants,have also been termed detergents.

Question 5

__________ is a synthetic surfactant recently approved by the FDA for use in infants at risk for RDS.

Accepted Answer

Lucinactant is a synthetic peptide containing surfactant replacement therapy.
Natural surfactant refers to the category of surfactants obtained from animals or humans by alveolar wash or from amniotic fluid.

Question 6

Which of the following are natural surfactant preparations?
1)Surfaxin
2)Curosurf
3)Survanta
4)Infasurf

Accepted Answer

Curosurf is a modified natural porcine (pig)surfactant.Survanta and Infasurf are modified natural bovine (cow)surfactants.Surfaxin is a synthetic surfactant recently approved by the U.S.Food and Drug Administration (FDA).

Question 7

Surfactant is primarily composed of

Accepted Answer

Proteins comprise only about 10% of whole surfactant by weight.Phospholipids account for 85% to 90% of whole surfactant by weight.Neutral lipids comprise only about 10% of whole surfactant by weight.Water is not a major component of surfactant by weight.

Question 8

Surfactant is stored in

Accepted Answer

Surfactant is produced by type II alveolar cells and stored in vesicles termed lamellar bodies.Surfactant is composed mostly of lipids and is introduced into the alveoli as it is needed.

Question 9

A key feature of surfactant production is

Accepted Answer

A key feature of surfactant production,which is the basis for the success of replacement therapy with exogenous compounds,is the recycling activity in surfactant production.Most surfactant (90% to 95%)is taken back into the alveolar type II cell,reprocessed,and resecreted.For this reason,exogenously administered surfactant is successful in replacing missing surfactant with one or two doses.The exogenous surfactant is taken into the type II cells and becomes the surfactant pool,through the reuptake and recycling mechanism.

Question 10

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

Accepted Answer

Surfactant may be delivered either through a special side-port adapter that is part of some neonatal endotracheal tubes (ETTs)or via a 5-F catheter positioned inside the ETT.The aim is to achieve a high rate of lung deposition and to avoid having the surfactant adhere to the sides of the ETT.Surfactant is not administered by nebulization or by ECMO.

Question 11

You are assessing a 36-week gestational age newborn immediately after birth.The newborn weighs 2200g.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?

Accepted Answer

Exogenous surfactants are clinically indicated for the treatment or prevention of respiratory distress syndrome in the newborn.This newborn is not currently exhibiting any signs of respiratory distress,and drug therapy is not indicated at this time.

Question 12

The term used to describe surfactant produced outside of the patient's body is

Accepted Answer

Endogenous surfactant is produced within a patient's own body.The term exogenous,when used to describe this class of drugs,refers to surfactant preparations made outside the patient's own body.These preparations may be obtained from other humans,from animals,or by laboratory synthesis.Natural surfactant may be either bovine or porcine and still be produced outside the patient's own body.Bovine refers to a substance produced in or gathered from a cow.

Question 13

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

Accepted Answer

Exogenous surfactants are clinically indicated for the treatment or prevention of RDS in the newborn.Ipratropium bromide,salmeterol,and dornase alfa are not surfactants.

Question 14

The major stimulus for secretion of surfactant into the alveolus is

Accepted Answer

The major stimulus for secretion of surfactant-containing lamellar bodies into the alveolar space seems to be inflation of the lung via a chemically coupled stretch response.

Question 15

Which of the following is considered the mode of action for surfactant?

Accepted Answer

Exogenous surfactants replace missing pulmonary surfactant in newborns with RDS.

Question 16

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

Accepted Answer

Clinical indications for use of exogenous surfactants include the following: (1)prevention of RDS in infants with very low birth weight or infants with higher birth weight but with evidence of immature lungs and (2)rescue treatment of infants who have developed RDS.Exogenous surfactants are being investigated for clinical use in disease states such as ARDS,MAS,and pneumonia.

Question 17

You are assessing a 26-week gestational age newborn immediately after birth.The newborn weighs 1200g.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?

Accepted Answer

Exogenous surfactants are clinically indicated for the treatment or prevention of respiratory distress syndrome (RDS)in the newborn.This newborn is showing signs of impending RDS (prematurity,retractions,nasal flaring,poor lung compliance)and needs prophylactic administration of exogenous surfactant.Albuterol (a bronchodilator),and Solu-Medrol (a corticosteroid)are not indicated at this time.

Question 18

Endogenous surfactant is produced by

Accepted Answer

Pulmonary surfactant is a complex mixture of lipids and proteins produced by alveolar type II cells.Goblet cells produce mucus.Alveolar type I cells form the thin blood-gas barrier through which gas exchange occurs.Macrophages are phagocytic cells that defend alveoli against foreign invaders.

Question 19

Lack of pulmonary surfactant in respiratory distress syndrome (RDS)of the newborn typically results in

Accepted Answer

The basic problem in RDS of the newborn is lack of pulmonary surfactant secondary to lung immaturity,which results in high surface tension in the liquid-lined,gas-filled alveoli.

Question 20

What is the typical method of administering exogenous surfactant to infants?

Accepted Answer

The calculated dose is given in quarters from a syringe and instilled into the trachea through a 5-F catheter placed into the endotracheal tube.The catheter is removed,and the infant is manually ventilated for at least 30 seconds,or until stable,between doses.The remaining doses are given in similar fashion.During each quarter dose,the infant is placed in a different position.

Quiz 10: Surfactant Agents