1. Adrenergic bronchodilators mimic the actions of:
      A. Acetylcholine
      B. Penicillin
      C. Epinephrine
      D. norepinephrine
       
    2. Relaxation of smooth airway muscle in the presence of reversible airflow obstruction is a general indication for the use of:
      A. adrenergic bronchodilators
      B. antiinfective agents
      C. steroids
      D. mucolytics
       
    3. Disease states that could benefit from the use of adrenergic bronchodilators include which of the following?
      I. asthma
      II. bronchitis
      III. emphysema
      IV. bronchiectasis
      V. pleural effusion

      A. II, IV, and V only
      B. I, II, II, and IV only
      C. I, II, III, IV, and V
      D. I and III only
       
    4. Short-acting B2 agonists are indicated for:
      A. relief of acute reversible airflow obstruction
      B. maintenance of bronchodilation
      C. thinning of secretions
      D. reduction of airway edema
       
    5. Your patient is diagnosed with persistent asthma. Which type of drug would you recommend for maintenance bronchodilation and control of bronchospasm?
      A. long-acting adrenergic agent
      B. alpha-adrenergic agent
      C. mucolytic agent
      D. short-acting adrenergic agent
       
    6. Your patient presents with postextubation stridor. You recommend racemic epinephrine for its:
      A. short-acting B2-adrenergic effect
      B. long-acting B2-adrenergic effect
      C. B1-adrenergic effect
      D. alpha-adrenergic vasoconstricting effect
       
    7. You enter the room of a 2-year-old patient who presents with the characteristic “barking cough” found with croup. Once the diagnosis is confirmed, you may recommend which of the following medications to help provide relief from subglottic swelling?
      A. terbutaline
      B. racemic epinephrine
      C. salmeterol
      D. albuterol
       
    8. In a patient who is receiving large doses of catecholamines, you may expect to see all of the following side effects except:
      A. relaxation of brochial smooth muscle
      B. diuresis
      C. tachycardia
      D. incr blood pressure
       

  1. Levalbuterol is:
    A. the single (R)-isomer of albuterol
    B. an equal mixture of (R)- and (S)-isomers
    C. the same as racemic epinephrine
    D. the same as albuterol.
     
  2. Ephinephrine stimulates which sites?
    I. Alpha
    II. B1
    III. B2
    IV. Cholinergic

    A. IV only
    B. I, II, and III only
    C. II, III, and IV only
    D. II only
     
  3. Epinephrine would be indicated for all of the following except:
    A. systemic hypersensitivity reactions
    B. acute asthma episodes
    C. cardiac stimulation
    D. treatment of infections
     
  4. Racemic epinephrine comes in what percent solution?
    A. 1.25%
    B. 2.25%
    C. 5.0%
    D. 0.05%
     
  5. The keyhole theory indicates that the larger the side-chain attachment to a catechol base, the:
    A. more easily it is metabolized
    B. more easily it is broken down by COMT
    C. greater B2 specificity
    D. shorter the duration of action
     
  6. Catecholamines are inactivated by:
    A. COMT
    B. ephinephrine
    C. ATP
    D. ACTH
     
  7. Catecholamines should not be given by which of the following routes:
    A. subcutaneous
    B. oral
    C. injection
    D. inhalation
     
  8. Albuterol is available in which of the following forms?
    I. syrup
    II. nebulizer solution
    III. MDI
    IV. oral tablets
    V. DPI

    A. I, II, and V only
    B. III, IV, and V only
    C. I, II, III, IV and V
    D. II and III only
     
  9. Salmeterol is:
    A. another name for albuterol
    B. available in nebulizer solution only
    C. a long-acting B-adrenergic
    c. indicated for acute asthma attacks
     
  10. Long-acting B2 agonists are indicated for:
    A. mucus reduction
    B. treating infections
    C. maintenance therapy for asthmatics
    D. acute asthma attacks
     
  11. The bronchodilating action of adrenergic drugs is due to stimulation of:
    A. cholinergic receptors
    B. B1 receptors
    C. B2 receptors
    D. alpha receptors
     
  12. B1 receptor stimulation will:
    A. provide upper airway decongestion
    B. incr heart rate and contractile force
    C. relax bronchiole smooth muscles
    D. cause vasoconstriction
     
  13. Smooth muscle relaxation most likely occurs as a result of:
    A. an incr in intracellular cAMP
    B. an incr in ATP
    C. a decr in ATP
    D. a decr in intracellular cAMP
     
  14. Inhalation is the preferred route of administering catecholamines for which of the following reasons?
    I. rapid onset of action
    II. smaller dosage used
    III. reduced side effects
    IV. drug is delivered to target organ
    V. safe and painless route

    A. III and IV only
    B. I, III, and V only
    C. I, II, III, IV, and V
    D. I and II only
     
  15. Continuous nebulization of inhaled B agonists has been used for:
    A. pneumonia
    B. cystic fibrosis
    C. emphysema
    D. severe asthma
     
  16. The dosage recommended by NAEPP EPR 2 for continuous nebulization of adrenergic agents is:
    A. 8 to 12 mg/hr
    B. 10-15 mg/hr
    C. 20-30 mg/hr
    D. 5 to 8 mg/hr
     
  17. Your patient is receiving her third continuous nebulizer of albuterol (15 mg/hr). Which potential complications should you be on the look out for?
    I. hypokalemia
    II. cardiac arrhythmias
    III. hyperglycemia
    IV. PVCs
    V. tremor

    A. I, II, and V only
    B. I, II, IV, and V only
    C. I, II, III, IV, and IV
    D. II and IV only
     
  18. All of the following are side effects that should be monitored in you patient when using sympathomimetic aerosol except:
    A. muscle tremor
    B. bracycardia
    C. tachycardia
    D. insomnia


     
  19. You are ordered to extubate a mechanically ventilated patient who has recently undergone open heart surgery. On postextubation assessment you note that the patient has stridor with mild retractions. Pharmacologically, you would recommend:
    A. alpha adrenergic
    B. anticholinergic
    C. sympatholytic
    D. B2 adrenergic
     
  20. Which is the only B-agonist formulation that is a single isomer and is approved by the FDA for aerosol deliver?
    A. albuterol
    B. levalbuterol
    C. tiotropium
    D. epinephrine
     
  21. What is the rationale for using the single-isomer agent levalbuterol instead of racemic albuterol?
    A. the (S)-isomer is a weak bronchodilator
    B. The (R)-isomer is thought to cause tachycardia
    C. The (R)-isomer is thought to cause tremors
    D. the (S)-isomer is thought to promote bronchoconstriction
     
  22. What is the main difference between salmeterol and formoterol?
    A. formoterol has slower onset and peak effect compared with salmeterol
    B. formoterol is more B2 specific than salmeterol
    C. formoterol has a quicker onset and peak effect than salmeterol
    D. formoterol is a short-acting; salmeterol is long-acting
     
  23. What is the indication for use of a short-acing B agonist in asthma?
    A. rçcue therapy in reversible airflow obstruction
    B. intiinflammatory agent in reversible airlow obstruction
    C. intiinfective agent in respiratory infections
    D. maintenance therapy in reversible airflow obstruction
     
  24. Is it appropriate to use formoterol as a rescue B-agonist bronchodilator?
    a. yes
    b. no
    • b. no
    • (because its a controller – up to 12 hours)
  25. Which procedure would tell you that a patient has reversible airway obstruction?
    ç. pre- and postpulmonary function tests
    B. pulse oximetry
    C. wheezing on auscultation
    D. inspection: patient SOB when walking < 25 ft
     
  26. You receive an order to administer 5 ml of albuterol by SVN. You would:
    A. have your supervisor administer the treatment
    B. call the physician to confirm the medication dose
    C. give 0.5 ml of medication because that is probably what the doctor meant to write
    D. confirm the order on the char and administer as directed
     
  27. You are administering an aerosolized bronchodilator to your patient. Her pretreatment pulse was 85 bpm. You would stop the treatment if her pulse reached:
    A. 100
    B. 110
    C. 120
    D. 90
     
  28. A 7-yr-old boy has been given multiple aerosolized albuterol treatments over the last several days. You enter the room and his father tells you that every time a therapist administers a treatment, a few minutes later the saturation falls. You explain to the father:
    A. that this is abnormal and you will try to changle the med to levalbuterol
    B. that this is normal because of incr perfusion to poorly ventilated areas
    C. that this is abnormal and call the physician
    c. that this is normal because you are giving the treatment with air
     
  29. A patient with glottic edema is in mild distress. Which of the following medications would be of benefit in this situation?
    A. ipratropium bromide
    B. racemic epinephrine
    C. theophylline
    D. albuterol
     
  30. The only anticholinergic that is approved by the FDA for aerosolization is:
    A. albuterol sulfate
    B. glycopyrrolate
    C. atropine
    D. ipratropium bromide
     
  31. Ipratropium bromide can be delivered by which of the following methods?
    I. tablet
    II. nebulizer
    III. injection
    IV. MDI
    V. nasal spray

    A. I, III, and IV only
    B. I, II, and IV only
    C. II, IV, and V only
    D. II only
     
  32. Atrovent is approved for:
    A. thinning of dried secretions
    B. acute bronchoconstriction
    C. maintenance treatment of airflow obstruction in COPD
    D. exacerbation of COPD
     
  33. Combivent is a combination drug including which agents?
    A. serevent and atrovent
    B. albuterol and atrovent
    C. maxair and atrovent
    D. albuterol and serevent
     
  34. Cholinergic stimulation will produce which of the following effects?
    I. bronchoconstrictionn
    II. incr mucus secretion
    III. miosis
    IV. decr heart rate
    V. salivation

    A. I, III, and V only
    B. II, III, and IV only
    C. I, II, III, IV, and V
    D. IV only
     
  35. Mucociliary slowing, bronchodilation, and increased heart rate are all a result of:
    A. adrenergic agents
    B. anticholinergic agents
    C. parasympathetic agents
    D. cholinergic agents
     
  36. Quaternary ammonium compounds such as ipratropium:
    A. do not cross lipid membranes easily
    B. are distributed quickly throught the body when inhaled
    C. have no role in respiratory care
    D. are not effective as inhaled agents
     
  37. Ipratropium agents may be indicated to treat:
    a. allergic rhinitis
    b. common cold
    c. nonallergic rhinitis
    d. all of the above
     
  38. Quaternary ammonium compounds cause bronchodilation by:
    A. stimulating cholinergic sites
    B. blocking adrenergic sites
    C. stimulating adrenergic sites
    D. blocking cholinergic sites
     
  39. Patients using ipratropium aerosols should be instructed to avoid allowing the aerosol in contact with their:
    A. nose
    B. eye
    C. ear
    D. hair
     
  40. Activating an atroven inhaler in the eye may cause:
    A. pupil dilation
    B. pupil constriction
    C. scarring of the cornea
    D. blindness
     
  41. Cardiac effects of aerosolized apratropium bromide include:
    A. incr blood pressure
    B. incr heart muscle contractility
    C. little or no effect
    D. incr heart rate
     
  42. Drugs that competitively block the action of acetylcholine at parasympathetic postganglionic effector cell receptors are called:
    A. adrenergic agents
    B. antimuscarinic agents
    C. cholinergic agents
    D. musarinic agents
     
  43. The most common side effect of anticholinergic bronchodilators is:
    A. incr heart rate
    B. wheezing
    C. delirium
    D. dry mouth
     
  44. Possible side effects of aerosolized atrovent include which of the following?
    I. flulike symptoms
    II. pharyngitits
    III. cardiac arrest
    IV. dry mouth
    V. dyspnea

    A. I, II, and IV only
    B. I, II, IV, and V only
    C. I, II, III, IV, and V
    D. I, II, and III only
     
  45. Results of your patient’s PFT show that the peak flow rate increased the most when she inhaled an aerosolized sympathomimetic agent and an aerosolized parasympatholytic agent. You would recommend that she be given:
    A. serevent DPI
    B. combivent MDI
    C. foradil DPI
    D. ventolin MDI
     
  46. What is the only once-a-day anticholinergic on the market?
    A. ipratropium bromide
    B. glycopyrrolate
    C. tiotropium bromide
    D. atropine
     
  47.  All of the following are true about piratropium, except:
    A. It can be combined with a B-agonist for maintenance bronchodilation in COPD.
    B. It is added to B-agonist in severe asthma episodes that do not respond to B-agonists alone.
    C. It is a leukotriene modifier used to treat step 3 asthma.
    D. It is a first-line choice of bronchodilator for COPD.
    C. It is a leukotriene modifier used to treat step 3 asthma.

    Question Answer
    what is the brand name for epinephrine? adrenalin
    what is the receptor preference for epinephrine? alpha, beta (primarily beta 1)
    what is the adult dosage for SVN for epineprhine? 1% solution (1:100), .25-.5 ml(2.5-5.0 mg) qid
    what is the adult dosage for MDI for epineprhine? .22 mg/puff
    what is the duration of epineprhine? 1-3 hours
    what is the brand name for racemic epineprhine? microNephrin, neprhon, vaponephron
    what is the receptor preference for racemic epineprhine? alpha and beta (primarily beta 2)
    what is the small volume nebulizer adult dose for racemic epineprhine? 2.25% solution, .25-.5 ml (5.63-11.25 mg) qid
    what is the duration of racemic epineprhine? .5-2 hours
    what is the brand name of isoetharine? isoetharine hci, bronchosol
    what is the receptor preference of isoetharine? beta 2
    what is the adult dosage for svn for isoetharine? 1% solution, .5 ml (5.0 mg) q4h
    what is the duration of isoetharine? 1-3 hr
    what is the brand name of metaproterenol? alupent
    what is the receptor preference for metaproterenol? beta 2
    what is the adult dose for svn for metaproterenol? .4%, .6%, 5% solution, .3 ml (15 mg) tid, qid
    what is the mdi adult dose for metaproterenol? 650 micrograms/puff, 2-3 puffs tid, qid
    what is the duration for metaproterenol? 2-6 hr
    what is the brand name for albuterol? proventil, ventolin, proair, accuneb
    what is the receptor preference for albuterol? beta 2
    what is the svn adult dose for albuterol? .5% solution, .5 ml (2.5 mg) unit dose, tid, qid
    what is the mdi adult dose for albuterol? 90 micrograms/puff,2 puffs tid, qid
    what is the duration of albuterol? 5-8 hr
    what is the brand name of pirbuterol? maxair
    what is the receptor preference for pirbuterol? beta 2
    what is the adult mdi dose for pirbuterol? 200 micrograms/puff, 2 puffs q4-6h
    what is the duration of pirbuterol? 5 hours
    what is the brand name of levalbuterol? xopenex
    what is the receptor preference for levalbuterol? beta 2
    what is the adult dose svn for levalbuterol? .31 mg/2 ml tid, .63 mg/3 ml tid, or 1.25 mg/3 ml tid;also comes in concentrate of 1.25 mg/.5 ml,tid
    what is the adult dose mdi for levalbuterol? 45 microgram/puff, 2 puffs q4-6h
    what is the duration of levalbuterol? 5-8 hr
    what is the brand name for salmeterol? serevent
    what is the receptor preference for salmeterol? beta 2
    what is the adult dose dpi for salmeterol? 50 micrograms/blister bid
    what is the duration of salmeterol? 12 hours
    what is the brand name of formoterol? foradil
    what is the receptor preference of formoterol? beta 2
    what is the adult dose dpi for formoterol? 12 micrograms/inhalation bid
    what is the duration of formoterol? 12 hours
    what is the brand name for arformoterol? brovana
    what is the receptor preference for arformoterol? beta 2
    what is the adult dose svn for arformoterol? 15 micrograms/2 ml unit dose, bid
    what is the duration of arformoterol? 12 hour
    what is the brand name for ipratropium bromide? atrovent
    what is the adult dose mdi for ipratropium bromide? 18 microgram/puff, 2 puffs qid
    what is the adult dose hfa mdi for ipratropium bromide? 17 microgram/puff, 2 puffs qid
    what is the adult dose svn for ipratropium bromide? .02% solution (2 mg/ml) 500 micrograms tid, qid
    what is the duration of ipratropium bromide? 4-6 hour
    what is the brand name of ipratropium bromide and albuterol? combivent and duoneb
    what is the adult dose mdi for combivent? ipratropium 18 microgram/puff and albuterol 90 microgram/puff, 2 puffs qid
    what is the duration of ipratropium bromide and albuterol? 4-6 hours
    what is adult dose svn for duoneb? ipratropium .5 mg and albuterol 2.5 mg
    what is the brand name for tiotropium bromide? spiriva
    what is the adult dose dpi for tiotropium bromide? 18 microgram/inhalation, 1 inhalation daily
    what is the duration of tiotropium bromide? 24 hours
    What is the dose for atropine sulfate? .25 mg/kg three or four times daily
    what is the recommended dose for theophylline for asthma management? 5-15 mg/mL




    1.  a-Receptor stimulation: Causes vasoconstriction and a vasopressor effect; in the upper airway (nasal passages) this can provide decongestion
    2.  Adrenergic bronchodilator: An agent that stimulates sympathetic nervous fibers, which allow relaxation of smooth muscle in the airway. Also known as a sympathomimetic bronchodilator, or b2-agonist
    3.  Asthma paradox: Refers to the increasing incidence of asthma morbidity, and especially asthma mortality, despite advances in the understanding of asthma and availability of improved drugs to treat asthma
    4.  b1-Receptor stimulation: Causes increased myocardial conductivity and increased heart rate, as well as increased contractile force
    5.  b2-Receptor stimulation: Causes relaxation of bronchial smooth muscle, with some inhibition of inflammatory mediator release and stimulation of mucociliary clearance
    6.  Bronchospasm: Narrowing of the bronchial airways, caused by contraction of smooth muscle
    7.  Catecholamines: A group of similar compounds having sympathomimetic action; they mimic the actions of epinephrine
    8.  Cyclic AMP (cAMP): Nucleotide produced by b2-receptor stimulation; it affects many cells, but causes relaxation of bronchial smooth muscle
    9.  Cyclic GMP (cGMP): Nucleotide producing the opposite reaction of cAMP, that is, it causes bronchoconstriction
    10.  Downregulation: Long-term desensitization of b receptors to b2 agonists, caused by a reduction in the number of b receptors
    11.  Prodrug: A drug that exhibits its pharmacological activity once it is converted, inside the body, to its active form
    12.  Sympathomimetic: Producing effects similar to those of the sympathetic nervous system