The TMC Exam is a comprehensive test that covers a wide range of topics, including pharmacology. Pharmacology is the scientific study of drugs and their interactions with living organisms.
It’s an essential aspect of respiratory care, and mastering this topic is required to earn a passing score.
In this article, you will learn some essential tips and tricks to ace the pharmacology section of the TMC Exam and take a step closer to your dream of becoming a licensed respiratory therapist.
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Pharmacology Tips for the TMC Exam
1. Know the Basics
There will be several questions on the exam that feature or mention respiratory drugs in some way. That’s why it is important to spend some additional time developing your knowledge of pharmacology.
Here are some helpful tidbits about the basics that you should remember:
- Beta-2 adrenergic bronchodilators help treat bronchoconstriction by promoting the relaxation of smooth muscle tissue in the airways of the lungs. This includes short-acting or rescue drugs (e.g., albuterol) and long-acting or maintenance drugs (e.g., Brovana).
- Anticholinergic bronchodilators treat bronchoconstriction by blocking the acetylcholine neurotransmitter. Some examples include ipratropium bromide (Atrovent) and tiotropium bromide (Spiriva).
- Methylxanthines (phosphodiesterase inhibitors) work by increasing the amount of cAMP in smooth muscle tissue, which results in bronchodilation. For example, Theophylline (aminophylline) is one that you should remember.
- Corticosteroids are anti-inflammatory drugs that promote bronchodilation, often administered to patients with asthma and COPD. Some examples include budesonide (Pulmicort), fluticasone (Flovent), and triamcinolone (Azmacort).
- Mucolytic agents are administered to help break up mucus. Some examples include acetylcysteine (Mucomyst) and Pulmozyme, which is used to treat patients with cystic fibrosis.
- Other drug types that you may see on the exam include pulmonary vasodilators, saline solutions, leukotriene modifiers, mast cell stabilizers, and cardiovascular drugs, such as inotropic agents, anti-arrhythmic agents, vasodilators, antianginal drugs, and vasopressors,
2. Don’t Worry About Drug Dosages
In general, you shouldn’t worry about memorizing all the specific drug doses for the exam. That is because the NBRC typically doesn’t ask about the specific drug dose within the exam questions.
However, there is one exception:
It’s probably a good idea to remember that a standard SVN dose for albuterol. This is one that you could potentially see on the exam.
Albuterol SVN: 0.5 mL (2.5 mg) given 3–4 times per day
Otherwise, there’s no need to stress about memorizing all of the other specific drug doses because you’re likely not going to see them on the exam.
3. Recommend the Correct Aerosol Delivery Device
For the TMC Exam, you must know how to choose the most appropriate aerosol delivery device for patients under different circumstances. The different types include:
- Small-volume nebulizer (SVN)
- Metered-dose inhaler (MDI)
- Dry powder inhaler (DPI)
Rule of thumb: You should recommend an MDI or DPI over an SVN whenever possible.
However, some patients are not capable of using an inhaler with the proper technique. In these cases, a small-volume nebulizer would be the preferred aerosol delivery device.
Using an MDI requires the patient to have hand-breath coordination to successfully activate the inhaler as they take a breath in. This is essential for the medication to reach the lungs. If the patient lacks this ability, a DPI or SVN would be recommended instead.
Hand-breath coordination is not required for using a DPI. Instead, the patient must be able to perform a deep, fast inspiration for the medication to reach the lungs.
In other words, the patient must generate an inspiratory flow of at least 40–60 L/min to successfully use a DPI. If they lack this ability, then you should recommend an MDI or SVN instead.
4. Know the Different Types of Anti-Infective Agents
Anti-infective agents are a class of drugs that eliminate potentially harmful organisms in the body. They are used to treat infections caused by bacteria, fungi, and viruses.
For the TMC Exam, it’s important to learn the different types, including the following:
- Tobramycin (TOBI): Used to treat patients with cystic fibrosis.
- Penicillin: An antibiotic used to treat gram-positive bacteria (e.g., streptococcus and staphylococcus).
- Gentamicin: An antibiotic used to treat gram-negative bacteria (e.g., E. coli and Pseudomonas)
- Ribavirin (Virazole): An antiviral agent used to treat RSV in children. It must be administered with a SPAG nebulizer.
- Pentamidine: Used for the treatment of HIV/AIDS.
- Zanamivir (Relenza): An antiviral agent used to treat influenza (i.e., the flu).
5. Recognize the Need for Diuretics
Diuretic agents are a class of drugs that stimulates urine production, which promotes the excretion of excess water and sodium from the body.
You will see this topic on the exam!
Remember: When a patient is fluid-overloaded, a diuretic agent (e.g., Lasix) is indicated.
Some signs of hypervolemia to look for include:
- Peripheral edema
- Jugular venous distention (JVD)
- Crackles on auscultation
- Shortness of breath
Furthermore, if a patient is wheezing due to fluid overload, a bronchodilator is not going to help. Instead, this patient would benefit from a diuretic medication.
6. Remember the Drugs for Endotracheal Instillation
Endotracheal instillation is the process of administering drugs directly through the endotracheal tube into the patient’s trachea. Only certain drugs can be administered using this method.
This is where the NAVEL mnemonic comes in handy, as it’s an easy way to memorize which medications can be instilled directly into the endotracheal tube.
Please remember the following:
- N – Naloxone (Narcan)
- A – Atropine
- V – Vasopressin
- E – Epinephrine
- L – Lidocaine
Exogenous surfactant is another substance that can be administered via direct instillation in premature infants. It’s helpful in treating infants with respiratory distress syndrome.
Reminder: You must administer 2 to 2.5 times the normal dose for endotracheal instillation to be effective. You must also dilute the drug with 10 mL of saline or sterile water.
7. Know How to Treat a Drug Overdose
A drug overdose occurs when a patient takes more of a medication than their body can safely process. This can be accidental or intentional and can have life-threatening consequences.
You must be able to recognize when a patient has overdosed and recommend the most appropriate treatment method. For example, this includes knowing how to reverse narcotic drugs.
Narcotic opioids are responsible for the highest percentage of overdose deaths. Some examples include:
- Prescription painkillers
A patient who has overdosed on one of these drugs may arrive at the ER with signs of apnea and respiratory depression. This is a serious situation that may require intubation and mechanical ventilation.
Remember: You can treat a narcotic overdose with the drug Narcan (naloxone), which works by reversing the opioid effects.
Pharmacology is a vital component of respiratory therapy and a challenging topic on the TMC Exam. However, with the right strategies and preparation, you can feel confident and well-prepared for this section of the exam.
If you found this guide helpful, you’ll love the exclusive tips inside our TMC Exam Hacks video course.
It’s packed with premium videos that share insider tips, tricks, and insights that our students are using to pass the exam and earn their RRT credentials.
Check it out if you want to learn more about how you can increase your chances of passing the TMC Exam. Good luck on your journey to becoming a registered respiratory therapist (RRT).
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- “Registered Respiratory Therapist (RRT).” The National Board of Respiratory Care, www.nbrc.org/examinations/rrt. Accessed 8 July 2020.