Question 1

An expectorant whose action is thought to be mediated by stimulation of the gastrointestinal tract is

Accepted Answer

It is thought that the expectorant action of guaifenesin is mediated by stimulation of the gastrointestinal tract and not by systemic exposure to the drug.Sodium bicarbonate increases local bronchial pH,weakening the bonds between the side chains of the mucus molecule,resulting in lowering of the mucus viscosity and elasticity.Supersaturated potassium iodide (SSKI)agents are thought to stimulate the secretion of airway fluid.Mannitol exhibits its expectorant properties by disrupting the weak hydrogen bonds found in the oligosaccharide side chains of the mucin structure.

Question 2

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

Accepted Answer

Mucus lubricates the airways,acts to "waterproof" the airways by forming a gel layer that floats over a water periciliary layer,and provides protection from inflammation by forming a boundary between the airway and potential irritants.Mucus does not act to improve gas exchange;overproduction or difficulty clearing mucus may prove detrimental to gas exchange.

Question 3

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

Accepted Answer

Cystic fibrosis is a disease characterized by thick,tenacious secretions that are difficult to clear.The inflammatory response often seen with pneumonia may lead to hypersecretion.Uncomplicated congestive heart failure alone should have no effect on respiratory secretions.Ciliary dyskinesia is a disease marked by poor clearance of secretions because of an inability of the cilia to clear secretions adequately.

Question 4

_________ is the most serious potential hazard associated with the use of acetylcysteine.

Accepted Answer

The most serious potential complication with N-acetylcysteine (NAC)is bronchospasm.Other complications include stomatitis,nausea,and rhinorrhea.Tachycardia is not a potential hazard.

Question 5

Which structures are responsible for providing most mucus secretions?

Accepted Answer

Surface epithelial cells include primary ciliated cells and goblet cells,but they do not produce most of the mucus in the human body.Cilia line the mucosal tract and work to clear secretions toward the larynx but do not produce mucus.Submucosal glands below the epithelial surface are thought to provide much of the airway surface mucin.

Question 6

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

Accepted Answer

Adhesion refers to attractive forces between unlike molecules,such as mucus and the airway surface in this case.Cohesion refers to forces between like molecules;in this case cohesive forces result from the elongation of the mucus macromolecule.Elasticity refers to the ability of a deformed material,such as mucus,to return to its original shape.Viscosity refers to the resistance of a fluid,such as mucus,to flow.

Question 7

_____________ has not been tested and approved for use with dornase alfa.

Accepted Answer

The administration of dornase alfa is approved using the Hudson RCI UP-DRAFT II OPTI-NEB nebulizer with tee (Teleflex Medical,Research Triangle Park,NC),the Acorn II nebulizer (Vital Signs,Totowa,NJ)with a DeVilbiss Pulmo-Aide compressor (Sunrise Medical,Carlsbad,CA),or the PARI LC PLUS nebulizer (PARI Respiratory Equipment,Midlothian,VA)with PARI Inhaler Boy compressor.

Question 8

The rate of mucociliary transport in the normal peripheral airway is approximately

Accepted Answer

Mucociliary transport velocity varies in the normal lung and has been estimated at about 1.5 mm/min in the peripheral airways and 20 mm/min in the trachea.

Question 9

The standard dose of dornase alfa for aerosolization is

Accepted Answer

Dornase alfa is available as a single ampule,with 2.5 mg of drug in 2.5 mL of clear,colorless solution.

Question 10

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?

Accepted Answer

Bronchospasm is a common side effect of acetylcysteine administration.This side effect is more likely in asthmatic patients and is less common when using the 10%,rather than the 20%,solution.The risk can be ameliorated by pretreatment with a bronchodilator.

Question 11

The number of goblet cells per square millimeter of normal airway mucosa is

Accepted Answer

There are more than 6000 goblet cells per square millimeter of normal airway mucosa.

Question 12

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?

Accepted Answer

Dornase alfa was the first approved mucoactive agent for the treatment of CF.Dornase alfa reduces the viscosity and adhesivity of infected respiratory secretions when given by aerosol.Dopamine,cromolyn sodium,and albuterol are not mucus-controlling agents.

Question 13

Acetylcysteine is incompatible in solution with which of the following?

Accepted Answer

Acetylcysteine is incompatible with sodium ampicillin,amphotericin B,erythromycin lactobionate,tetracyclines,and aminoglycosides.It is often administered with sympathomimetic and anticholinergic bronchodilators,and if it is not,normal saline is frequently used as a diluent.

Question 14

Pulmozyme is the trade name for which mucoactive agent?

Accepted Answer

Pulmozyme is the trade name for the mucoactive agent dornase alfa,which comes in 2.5-mg doses for administration via small volume nebulizer (SVN).Mucomyst and Mucosil-20 are trade names for acetylcysteine.Iodopropylidene glycerol is an expectorant.

Question 15

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

Accepted Answer

At the time of this edition,three drugs have been used for administration as an aerosol to treat abnormal pulmonary secretions: NAC,dornase alfa,and 7% hyperosmolar saline.The first two drugs are considered mucolytic in their action,disrupting disulfide bonds in mucus (NAC)or enzymatically breaking down DNA in airway secretions (dornase alfa).Inhalation of hypertonic saline as an aerosol is now recommended as part of the treatment regimen for CF.

Question 16

The cholinergic response in terms of mucociliary clearance is
1)increased ciliary beat.
2)decreased ciliary beat.
3)increased mucus production.
4)decreased mucus production.

Accepted Answer

The cholinergic response in terms of mucociliary clearance involves an increase in ciliary beat,an increase in mucus production,and an increase in mucus transport.

Question 17

Agents that increase volume or hydration of airway secretions are called

Accepted Answer

A mucoregulatory agent reduces mucus hypersecretion to normal levels.A mucolytic breaks down the structure of mucus,usually reducing viscosity and elasticity.Bronchodilators act to relax bronchial smooth muscle,reversing bronchospasm.Expectorants increase the volume or hydration of airway secretions,improving expectoration of respiratory secretions,usually by stimulation of bronchial gland output.

Question 18

Medications that increase mucociliary or cough efficiency are

Accepted Answer

Mucokinetic describes the effect of improving the mobilization and clearance of secretions.Mucolytic describes a substance capable of breaking down the structure of mucus.Mucoregulatory describes an agent that reduces mucus hypersecretion.Expectorant describes a medication designed to increase the volume or hydration of airway secretions.

Question 19

What mucus color typically indicates retained secretions and neutrophil activation?

Accepted Answer

Purulent,green sputum is caused by the neutrophil-derived enzyme myeloperoxidase,indicating neutrophil activation.

Question 20

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

Accepted Answer

Antibacterial defense in the airway is provided by mucin,secretory IgA,IgG,lysozyme,lactoferrin,defensins,and peroxidase and serine proteases.

Quiz 9: Mucus-Controlling Drug Therapy

An expectorant whose action is thought to be mediated by stimulation of the gastrointestinal tract is

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

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