Deck 32: Airway Pharmacology

Question 1

Which of the following anticholinergics is poorly ionized?

A)atropine
B)ipratropium bromide
C)tiotropium bromide
D)oxitropium bromide

Answer 1

A

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

Question 3

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 3

D

Question 4

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

A)atropine
B)acetylcholine
C)norepinephrine
D)dopamine

Question 5

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

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

Question 6

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

A)albuterol
B)isoetharine
C)terbutaline
D)formoterol

Question 7

Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
I)dry powder inhaler
II)metered dose inhaler
III)small-volume nebulizer
IV)slip-stream nebulizer

A)I and III
B)II and IV
C)I, II, and III
D)I, II, III, and IV

Question 8

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

A)albuterol
B)isoetharine
C)terbutaline
D)metaproterenol

Question 9

Which of the following is NOT an advantage for the treatment of the respiratory tract with inhaled aerosols?

A)Doses are usually smaller.
B)Onset of drug action is rapid.
C)Delivered dose is consistent with each administration.
D)Systemic side effects are often fewer and less severe.

Question 10

Adrenergic bronchodilators improve flow rates for all the following diseases except:

A)asthma
B)acute bronchitis
C)chronic bronchitis
D)pulmonary fibrosis

Question 11

What is the dosage for salmeterol MDI?

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

Question 12

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 13

When stimulated, which of the following receptors cause bronchoconstriction?

A)M₃
B)M₂
C) $\alpha$ ₁
D) $\beta$ ₂

Question 14

Which of the following phases constitute the course of drug action from dose to effect?
I)drug administration
II)pharmacognosy
III)pharmacokinetic
IV)pharmacodynamic

A)I, II, and III
B)I, III, and IV
C)II, III, and IV
D)I, II, III, and IV

Question 15

Which one or more of the following devices is NOT used in combination with metered dose inhaler (MDI) therapy to reduce the need for hand-breathing coordination and oropharyngeal impaction of aerosolized drugs?

A)nonvalved spacer devices
B)one-way spacer
C)holding chambers
D)drying chambers

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 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 18

Pharmacologic control of the airway is mediated by receptors found on all of the following structures, except:

A)smooth muscle
B)secretory cells
C)blood vessels
D)alveolar epithelium

Question 19

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

Question 20

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 21

Which of the following is NOT a short-acting noncatecholamine bronchodilator?

A)pirbuterol
B)terbutaline
C)albuterol
D)salmeterol

Question 22

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

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

Question 23

Long-acting adrenergic bronchodilators such as salmeterol (Serevent) are not well suited for relief of acute airflow obstruction because it takes about how long for their peak effect to occur.

A)1 to 3 hours
B)3 to 5 hours
C)5 to 7 hours
D)longer than 12 hours

Question 24

What are some potential adverse effects with use of adrenergic bronchodilators?
I.hypokalemia
II.dizziness
III.worsening ventilation/perfusion ratio ( $\dot { V } / \dot { Q }$ )IV.bradycardia

A)I and IV only
B)II and III only
C)I, II, and III
D)I, II, III, and IV

Question 25

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 hours

Question 26

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

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

Question 27

Which of the following is NOT a side effect of newer, more $\beta$ ₂-selective bronchodilators?

A)tremor
B)insomnia
C)nervousness
D)bradycardia

Question 28

Which of the following are assessment features for evaluating patient response to bronchodilator therapy?
I)reversibility of airflow obstruction
II)changes in flow rates using a peak flowmeter or portable spirometry
III)changes in vital signs
IV)changes in ventilation and oxygenation
V)the patient's subjective reaction to treatment

A)II, III, and IV
B)II, III, and V
C)I, II, III, and V
D)I, II, III, IV, and V

Question 29

Which of the following short-acting noncathecholamine agents is a prodrug?

A)albuterol
B)levalbuterol
C)terbutaline
D)bitolterol

Question 30

Ipratropium bromide (Atrovent) is indicated for maintenance treatment of the following diseases, except:

A)chronic bronchitis
B)emphysema
C)asthma
D)chronic obstructive pulmonary disease (COPD)

Question 31

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 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

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

A)10 $\mu$ g/puff
B)15 $\mu$ g/puff
C)18 $\mu$ g/puff
D)90 $\mu$ g/puff

Question 34

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

A)isoproterenol
B)isoetharine
C)dobutamine
D)racemic epinephrine

Question 35

Which of the following mucus-controlling agents is NOT currently approved for inhalation in the United States?

A)tryptase
B)dornase alfa
C)acetylcysteine
D)Mucomyst

Question 36

What is the duration of action for ipratropium bromide?

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

Question 37

Which of the following is an ultra-short-acting catecholamine bronchodilator?

A)ipratropium
B)terbutaline
C)isoetharine
D)metaproterenol

Question 38

Ipratropium bromide should be used with precaution in all of the following diseases/conditions except:

A)prostatic hypertrophy
B)urinary retention
C)kidney stones
D)glaucoma

Question 39

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

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

Question 40

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 41

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

A)44 $\mu$ g/puff
B)110 $\mu$ g/puff
C)220 $\mu$ g/puff
D)250 $\mu$ g/puff

Question 42

Bland aerosols are better classified as:

A)mucolytics
B)secretagogues
C)expectorants
D)mucoactive therapy

Question 43

What is the available formulation strength for flunisolide (AeroBid) by metered-dose inhaler?

A)42 $\mu$ g/puff
B)84 $\mu$ g/puff
C)100 $\mu$ g/puff
D)250 $\mu$ g/puff

Question 44

Which of the following are side effects of dornase alfa administration?
I)allergic reactions due to antibody production in the patient against dornase alfa
II)chest pain
III)rash
IV)laryngitis

A)I, II, and III
B)I, III, and IV
C)II, III, and IV
D)I, II, III, and IV

Question 45

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 $\mu$ g
B)1000 $\mu$ g
C)1200 $\mu$ g
D)1400 $\mu$ g

Question 46

Which of the following are TRUE regarding glucocorticoids?
I.They work through activation of intracellular receptors.
II.Relief is immediate.
III.Daily compliance is essential to controlling inflammation in asthma.
IV.They work in a similar fashion to adrenergic bronchodilators.

A)I and III
B)I, III, and IV
C)II, III, and IV
D)I, II, III, and IV

Question 47

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 48

Use of a reservoir device with aerosolized metered-dose inhaler corticosteroid can reduce which of the following, except:

A)amount swallowed and absorbed systemically
B)oral candidiasis
C)incidence of dysphonia
D)Cushing's syndrome

Question 49

Which of the following inhaled corticosteroids is a prodrug?

A)ciclesonide
B)flunisolide
C)budesonide
D)triamcinolone

Question 50

Which of the following are indications for the use of acetylcysteine (Mucomyst)?
I)treatment of acetaminophen overdose
II)treatment of excessive, viscous mucus secretions
III)treatment of aspirin overdose
IV)treatment of purulent mucus secretions by breaking up DNA

A)I and II only
B)II and IV only
C)I, II, and III
D)I, II, III, and IV

Question 51

Which of the following are considered nonsteroidal antiasthma drugs?
I)cromolyn-like agents
II)leukotriene modifiers
III)anti-IgE agents
IV)anti-IgA agents

A)I and III
B)I, II, and III
C)II, III, and IV
D)I, II, III, and IV

Question 52

Acetylcysteine (Mucomyst) lowers the viscosity of mucus by means of which of the following?

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 53

What is the available formulation strength for triamcinolone acetonide (Azmacort) by metered-dose inhaler?

A)42 $\mu$ g/puff
B)84 $\mu$ g/puff
C)100 $\mu$ g/puff
D)250 $\mu$ g/puff

Question 54

Which of the following are indications for aerosolized administration of dornase alfa?
I)presence of nonpurulent mucoid secretions
II)management of cystic fibrosis
III)reduction of the frequency of exacerbations due to respiratory infection
IV)management of bronchospasm

A)II and III only
B)I, II, and III
C)II, III, and IV
D)I, II, III, and IV

Question 55

Which of the following are side effects of acetylcysteine (Mucomyst)?
I)incompatibility with certain antibiotics when administered together
II)nausea
III)bronchospasm
IV)airway obstruction due to rapid liquefaction of mucus

A)II and III only
B)I, II, and III
C)II, III, and IV
D)I, II, III, and IV

Question 56

Acetylcysteine (Mucomyst) is indicated in all of the following diseases except:

A)acute tracheobronchitis
B)bronchiectasis
C)chronic obstructive pulmonary disease (COPD)
D)asthma

Question 57

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 58

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 59

Which of the following should be assessed during the administration of mucolytic agents?
I)breathing pattern and rate
II)monitoring peak flow changes
III)patient's reaction to treatment
IV)monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active

A)I and III only
B)I, II, and III
C)II, III, and IV
D)I, II, III, and IV

Question 60

The National Asthma Education and Prevention Program guidelines advocate the use of oral administration of 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

Which of the following is TRUE about the use of ribavirin?
I.It is used as an antiviral agent against respiratory syncytial virus.
II.It is delivered via a Respirgard unit.
III.Adverse effects include skin rash, conjunctivitis, and eyelid erythema
IV.It can occlude endotracheal tube and ventilator exhalation valves.

A)I and II only
B)III and IV only
C)I, III, and IV
D)I, II, III, and IV

Question 62

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 63

Which of the following nebulizers is used to nebulize iloprost?

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

Question 64

Which of the following are considered to be "quick relief" agents in treating asthma?
I.methylxanthines
II.ipratropium
III.systemic corticosteroids (oral or intravenous)IV.short-acting inhaled $\beta$ ₂-agonists
V.long-acting inhaled $\beta$ ₂-agonists
VI.leukotriene antagonists

A)II, III, and IV
B)II, V, and VI
C)I, III, V, and VI
D)I, II, III, and IV

Question 65

Which of the following antifungal dugs has been approved for inhalation?

A)amphotericin B
B)nystatin
C)isoconazole
D)no antifungal has yet been approved

Question 66

Zileuton belongs to which of the following categories?

A)cromolyn-like agents
B)leukotriene modifiers
C)anti-IgE agents
D)anti-IgA agents

Question 67

Which of the following are mechanisms of action for nedocromil sodium?
I)mast cell activity inhibition
II)C-fiber sensory nerve inhibition
III)eosinophil activation
IV)airway epithelial cell activation

A)I and II only
B)I, II, and III
C)I, II, and IV
D)I, II, III, and IV

Question 68

Which of the following is NOT considered an aerosolized antiinfective agent?

A)pentamidine
B)ribavirin
C)tobramycin
D)amikacin

Question 69

Which of the following is the only inhaled human insulin available at this time?

A)Humulin
B)Exubera
C)Glucomax
D)No inhaled insulin has yet been approved.

Question 70

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

A)Pneumocystis carinii
B)tuberculosis
C)HIV infection
D)pneumococcal pneumonia

Question 71

Side effects associated with parenteral administration of aminoglycosides include all of the following, except:

A)ototoxicity
B)voice alteration
C)nephrotoxicity
D)deafness

Question 72

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

A)pharyngitis
B)croup
C)epiglottitis
D)influenza

Question 73

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

A)I and II only
B)II and IV only
C)I, II, and III
D)I, II, III, and IV

Question 74

Which of the following inhalational agents have been approved by the Food and Drug Administration for the treatment of pulmonary hypertension?
I)epoprostenol
II)nitric oxide
III)iloprost
IV)alprostadil

A)II only
B)II and III
C)I, II, III, and IV
D)II and IV

Question 75

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 76

Which of the following is true about the use of tobramycin?
I.It is primarily used by patients with cystic fibrosis.
II.It is intended to manage chronic infections with Pseudomonas aeruginosa
III.It is prevents deterioration of lung function due to recurrent infections.
IV.It has very good lung bioavailability.
V.It is associated with a high rate of bacterial resistance.

A)I and II only
B)III and V only
C)I, II, III, and IV
D)I, II, IV, and V