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 epinephrine? 1% solution (1:100), .25-.5 ml(2.5-5.0 mg) qid
what is the adult dosage for MDI for epinephrine? .22 mg/puff
what is the duration of epinephrine? 1-3 hours
what is the brand name for racemic epinephrine? microNephrin, nephron, vaponephron
what is the receptor preference for racemic epinephrine? alpha and beta (primarily beta 2)
what is the small volume nebulizer adult dose for racemic epinephrine? 2.25% solution, .25-.5 ml (5.63-11.25 mg) qid
what is the duration of racemic epinephrine? .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

Respiratory Pharmacology Chapter 6 Practice Questions:

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. anti-infective 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 bronchial smooth muscle

B. diuresis

C. tachycardia

D. increase blood pressure 

9. 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.

10. Epinephrine 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

11. 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 

12. Racemic epinephrine comes in what percent solution?

A. 1.25%

B. 2.25%

C. 5.0%

D. 0.05% 

13. 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

14. Catecholamines are inactivated by:

A. COMT

B. epinephrine

C. ATP

D. ACTH

15. Catecholamines should not be given by which of the following routes:

A. subcutaneous

B. oral

C. injection

D. inhalation

16. 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

17. Salmeterol is:

A. another name for albuterol

B. available in nebulizer solution only

C. a long-acting B-adrenergic

D. indicated for acute asthma attacks

18. Long-acting B2 agonists are indicated for:

A. mucus reduction

B. treating infections

C. maintenance therapy for asthmatics

D. acute asthma attacks

19. The bronchodilating action of adrenergic drugs is due to stimulation of:

A. cholinergic receptors

B. B1 receptors

C. B2 receptors

D. alpha receptors

20. B1 receptor stimulation will:

A. provide upper airway decongestion

B. increase heart rate and contractile force

C. relax bronchiole smooth muscles

D. cause vasoconstriction

21. Smooth muscle relaxation most likely occurs as a result of:

A. an increase in intracellular cAMP

B. an incr in ATP

C. a decr in ATP

D. a decr in intracellular cAMP

22. 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 

23. Continuous nebulization of inhaled B agonists has been used for:

A. pneumonia

B. cystic fibrosis

C. emphysema

D. severe asthma 

24. 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 

25. 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 

26. All of the following are side effects that should be monitored in you patient when using sympathomimetic aerosol except:

A. muscle tremor

B. bradycardia

C. tachycardia

D. insomnia 

27. You are ordered to extubate a mechanically ventilated patient who has recently undergone open heart surgery. On post-extubation 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 

28. 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

29. 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

30. 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

31. What is the indication for use of a short-acing B agonist in asthma?

A. rescue therapy in reversible airflow obstruction

B. antiinflammatory agent in reversible airflow obstruction

C. antiinfective agent in respiratory infections

D. maintenance therapy in reversible airflow obstruction 

32. Is it appropriate to use formoterol as a rescue B-agonist bronchodilator?

a. yes

b. no 

33. Which procedure would tell you that a patient has reversible airway obstruction?

A. pre- and postpulmonary function tests

B. pulse oximetry

C. wheezing on auscultation

D. inspection: patient SOB when walking < 25 ft 34. You receive an order to administer 5 ml of albuterol by SVN.

34. 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 chart and administer as directed 

35. 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

36. 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 change the med to levalbuterol B. that this is normal because of

B. that this is normal because of increase perfusion to poorly ventilated areas

C. that this is abnormal and call the physician 

37. 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

38. The only anticholinergic that is approved by the FDA for aerosolization is: 

A. albuterol sulfate 

B. glycopyrrolate 

C. atropine 

D. ipratropium bromide

39. 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

40. Atrovent is approved for:

A. thinning of dried secretions

B. acute bronchoconstriction 

C. maintenance treatment of airflow obstruction in COPD 

D. exacerbation of COPD

41. Combivent is a combination drug including which agents? 

A. serevent and atrovent 

B. albuterol and atrovent 

C. maxair and atrovent 

D. albuterol and serevent 

42. 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 

43. Mucociliary slowing, bronchodilation, and increased heart rate are all a result of: 

A. adrenergic agents

B. anticholinergic agents 

C. parasympathetic agents

D. cholinergic agents 

44. 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 

45. Ipratropium agents may be indicated to treat: 

a. allergic rhinitis

b. common cold 

c. nonallergic rhinitis 

d. all of the above

46. Quaternary ammonium compounds cause bronchodilation by: 

A. stimulating cholinergic sites

B. blocking adrenergic sites 

C. stimulating adrenergic sites 

D. blocking cholinergic sites 

47. Patients using ipratropium aerosols should be instructed to avoid allowing the aerosol in contact with their: 

A. nose

B. eye 

C. ear 

D. hair 

48. Activating an Atrovent inhaler in the eye may cause: 

A. pupil dilation

B. pupil constriction 

C. scarring of the cornea 

D. blindness 

49. Cardiac effects of aerosolized apratropium bromide include: 

A. increase blood pressure

B. increase heart muscle contractility 

C. little or no effect 

D. increase heart rate 

50. 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 

51. The most common side effect of anticholinergic bronchodilators is: 

A. incr heart rate 

B. wheezing 

C. delirium 

D. dry mouth 

52. 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

53. 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 

54. What is the only once-a-day anticholinergic on the market? 

A. ipratropium bromide

B. glycopyrrolate 

C. tiotropium bromide 

D. atropine

55. 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. 

56. a-Receptor stimulation: Causes vasoconstriction and a vasopressor effect; in the upper airway (nasal passages) this can provide decongestion

57. 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

58. 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

59. b1-Receptor stimulation: Causes increased myocardial conductivity and increased heart rate, as well as increased contractile force 60. b2-Receptor stimulation: Causes relaxation of

60. b2-Receptor stimulation: Causes relaxation of bronchial smooth muscle, with some inhibition of inflammatory mediator release and stimulation of mucociliary clearance 

61. Bronchospasm: Narrowing of the bronchial airways, caused by contraction of smooth muscle

62. Catecholamines: A group of similar compounds having sympathomimetic action; they mimic the actions of epinephrine

63. Cyclic AMP (cAMP): Nucleotide produced by b2-receptor stimulation; it affects many cells, but causes relaxation of bronchial smooth muscle

64. Cyclic GMP (cGMP): Nucleotide producing the opposite reaction of cAMP, that is, it causes bronchoconstriction

65. Downregulation: Long-term desensitization of b receptors to b2 agonists, caused by a reduction in the number of b receptors

66. Prodrug: A drug that exhibits its pharmacological activity once it is converted, inside the body, to its active form

67. Sympathomimetic: Producing effects similar to those of the sympathetic nervous system