ch 32.

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  1. 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
    • b. 1, 3, and 4
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • ANS: B
  2. Which of the following devices are most commonly used to deliver aerosols by the inhalation route?
    • 1. dry powder inhaler
    • 2. metered dose inhaler
    • 3. small-volume nebulizer
    • 4. slip-stream nebulizer
    • a. 1 and 3
    • b. 2 and 4
    • c. 1, 2, and 3
    • d. 1, 2, 3, and 4
    • ANS:C
  3. 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
    • ANS:  D
  4. 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.
    • ANS: C
  5. 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
    • ANS: C
  6. 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
    • ANS:  A
  7. Which of the following anticholinergics is poorly ionized?
    • a. atropine
    • b. ipratropium bromide
    • c. tiotropium bromide
    • d. oxitropium bromide
    • ANS:  A
  8. 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
    • ANS:  D
  9. 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
    • ANS:  D
  10. 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
    • ANS:  D
  11. Which of the following is the usual neurotransmitter in the sympathetic system?a.atropine
    • b.acetylcholine
    • c.norepinephrine
    • d.dopamine
    • ANS: C
  12. When stimulated, which of the following receptors cause bronchoconstriction?
    • a.M3
    • b.M2
    • c.a1
    • d.b2
    • ANS: A
  13. 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
    • ANS: D
  14. 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
    • ANS: B
  15. Proventil and Ventolin are brand names for which of the following -adrenergic bronchodilators?
    • a. albuterol
    • b. isoetharine
    • c. terbutaline
    • d. metaproterenol
    • ANS: A
  16. Foradil is a brand name for which of the following b-adrenergic bronchodilators?
    • a.albuterol
    • b.isoetharine
    • c.terbutaline
    • d.formoterol
    • ANS: D
  17. 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
    • ANS: D
  18. 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
    • ANS: D
  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
    • ANS:  C
  20. Adrenergic bronchodilators improve flow rates for all the following diseases except:
    • a. asthma
    • b. acute bronchitis
    • c. chronic bronchitis
    • d. pulmonary fibrosis
    • ANS: D
  21. 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
    • ANS: B
  22. 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
    • ANS: A
  23. Which of the following short-acting catecholamines are used for their strong 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
    • ANS: D
  24. 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
    • ANS: C
  25. Which of the following is NOT a short-acting noncatecholamine bronchodilator?
    • a. pirbuterol
    • b. terbutaline
    • c. albuterol
    • d. salmeterol
    • ANS: D
  26. 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
    • ANS: B
  27. What is the brand name of the (R)-isomer of formoterol?a.Foradil
    • b.Survanta
    • c.Brovana
    • d.Tornalate
    • ANS:C
  28. Which of the following is NOT a side effect of newer, more b2-selective bronchodilators?a.tremor
    • b.insomnia
    • c.nervousness
    • d.bradycardia
    • ANS:D
  29. Which of the following is NOT a side effect of newer, more 2-selective bronchodilators?
    • a. tremor
    • b. insomnia
    • c. nervousness
    • d. bradycardia
    • ANS:C
  30. Which of the following are assessment features for evaluating patient response to bronchodilator therapy?
    • 1. reversibility of airflow obstruction
    • 2. changes in flow rates using a peak flowmeter or portable spirometry
    • 3. changes in vital signs
    • 4. changes in ventilation and oxygenation
    • 5. the patient’s subjective reaction to treatment
    • a. 2, 3, and 4
    • b. 2, 3, and 5
    • c. 1, 2, 3, and 5
    • d. 1, 2, 3, 4, and 5
    • ANS:D
  31. What amount of ipratropium bromide (Atrovent) is delivered by metered-dose inhaler?
    • a. 10 g/puff
    • b. 15 g/puff
    • c. 17 g/puff
    • d. 90 g/puff
    • ANS: C
  32. 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
    • ANS:A
  33. 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
    • ANS:A
  34. 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
    • ANS:A
  35. 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)
    • ANS:C
  36. What are some common side effects seen with ipratropium bromide (Atrovent)?a.tachycardia
    • b.blood pressure increase
    • c.cough and dry mouth
    • d.tolerance
    • C
  37. 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
    • C
  38. 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
    • A
  39. Acetylcysteine (Mucomyst) is indicated in all of the following diseases except:
    • a.acute tracheobronchitis
    • b.bronchiectasis
    • c.chronic obstructive pulmonary disease (COPD)
    • d.asthma
    • D
  40. 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
    • b. 2 and 4
    • c. 1, 2, and 3
    • d. 1, 2, 3, and 4
    • A
  41. 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
    • D
  42. 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
    • D
  43. 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. nausea
    • 3. bronchospasm
    • 4. airway obstruction due to rapid liquefaction of mucus
    • a. 2 and 3
    • b. 1, 2, and 3
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • D
  44. Which of the following are indications for aerosolized administration of dornase alfa?1. presence of nonpurulent mucoid secretions
    • 2. management of cystic fibrosis
    • 3. reduction of the frequency of exacerbations due to respiratory infection
    • 4. management of bronchospasm
    • a. 2 and 3 only
    • b. 1, 2, and 3
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • A
  45. 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
    • b. 1, 3, and 4
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • ANS:C
  46. Bland aerosols are better classified as:
    • a.mucolytics
    • b.secretagogues
    • c.expectorants
    • d.mucoactive therapy
    • ANS: C
  47. Which of the following should be assessed during the administration of mucolytic agents?1. breathing pattern and rate2. monitoring peak flow changes3. patient’s reaction to treatment4. monitoring for presence of hydrogen sulfide (a rotten egg odor), which means that the acetylcysteine (Mucomyst) is no longer active
    • a. 1 and 3
    • b. 1, 2, and 3
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • ANS: B
  48. 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%
    • D
  49. 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
    • D
  50. Which of the following is NOT an available formulation strength for fluticasone propionate (Flovent) by metered-dose inhaler?
    • a.44 mg/puff
    • b.110 mg/puff
    • c.220 mg/puff
    • d.250 mg/puff
    • D
  51. 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
    • b. 1, 3, and 4
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • A
  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 mg
    • b.1000 mg
    • c.1200 mg
    • d.1400 mg
    • A
  53. Which of the following inhaled corticosteroids is a prodrug?
    • a.ciclesonide
    • b.flunisolide
    • c.budesonide
    • d.triamcinolone
    • A
  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
    • D
  55. 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
    • b. 1, 2, and 3
    • c. 2, 3, and 4
    • d. 1, 2, 3, and 4
    • B
  56. Which of the following are considered to be “quick relief” agents in treating asthma?
    • 1. methylxanthines
    • 2. ipratropium
    • 3. systemic corticosteroids (oral or intravenous)
    • 4. short-acting inhaled 2-agonists
    • 5. long-acting inhaled 2-agonists
    • 6. leukotriene antagonists
    • a. 2, 3, and 4
    • b. 2, 5 and 6
    • c. 1, 3, 5, and 6
    • d. 1, 2, 3, and 4
    • D
  57. 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
    • B
  58. Which of the following are mechanisms of action for nedocromil sodium?
    • 1. mast cell activity inhibition
    • 2. C-fiber sensory nerve inhibition
    • 3. eosinophil activation
    • 4. airway epithelial cell activation
    • a. 1 and 2
    • b. 1, 2, and 3
    • c. 1, 24, and IV
    • d. 1, 2, 3, and 4
    • D
  59. Zileuton belongs to which of the following categories?
    • a. cromolyn-like agents
    • b. leukotriene modifiers
    • c. anti-IgE agents
    • d. anti-IgA agents
    • B
  60. Which of the following is NOT considered an aerosolized antiinfective agent?
    • a. pentamidine
    • b. ribavirin
    • c. tobramycin
    • d. amikacin
    • D
  61. Pentamidine is indicated for the treatment of which of the following diseases?a.Pneumocystis jiroveci
    • b.tuberculosis
    • c.HIV infection
    • d.pneumococcal pneumonia
    • A
  62. When administering aerosolized pentamidine, what should the respiratory care practitioner do?
    • 1. Use a nebulizer that produces particles in the 1- to 2-m 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
    • b. 2 and 4
    • c. 1, 2, and 3
    • d. 1, 2, 3, and 4
    • C
  63. When administering aerosolized pentamidine, what should the respiratory care practitioner do?
    • 1. Use a nebulizer that produces particles in the 1- to 2-m 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
    • b. 2 and 4
    • c. 1, 2, and 3
    • d. 1, 2, 3, and 4
    • C
  64. 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 is 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
    • b. 3 and 5
    • c. 1, 2, 3, and 5
    • d. 1, 2, 4, and 5
    • C
  65. Side effects associated with parenteral administration of aminoglycosides include all of the following, except:
    • a. ototoxicity
    • b. voice alteration
    • c. nephrotoxicity
    • d. deafness
    • B
  66. Inhaled zanamivir is indicated for which of the following treatment of uncomplicated respiratory illness?
    • a. pharyngitis
    • b. croup
    • c. epiglottitis
    • d. influenza
    • D
  67. What is the mechanism behind nitric oxide (INOmax)?
    • 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.
    • D
  68. Which of the following inhalational agents have been approved by the Food and Drug Administration for the treatment of pulmonary hypertension?
    • 1. Epoprostenol
    • 2. nitric oxide
    • 3. Iloprost
    • 4. alprostadil
    • a. 2
    • b. 2 and 3
    • c. 1, 2, 3, and 4
    • d. 2 and 4
    • B
  69. 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
    • C
  70. Which of the following nebulizers is used to nebulize iloprost?


    A.Hudson
    B.I-neb
    C.Respirgard
    D.Pari
    B.I-neb
    (this multiple choice question has been scrambled)
  71. 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 (18µg) 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.
    • C

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Author:
missymar
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328153
Filename:
ch 32.
Updated:
2017-02-06 04:02:48
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