Respiratory Pharmacology Chapter 7 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. 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

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. 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

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. ephinephrine
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
c. 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 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

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. intiinflammatory agent in reversible airlow obstruction
C. intiinfective 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. 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



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 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

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 severent

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 atroven 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. incr blood pressure
B. incr heart muscle contractility
C. little or no effect
D. incr 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. Anticholinergic bronchodilator: An agent that BLOCKS parasympathetic nervous fibers, which allow RELAXATION of AIRWAY SMOOTH MUSCLE.

57. Anticholinergic Effects: Increased Heart Rate, Mydriasis (pupil dilation), Cycloplegia (lens flattening), Drying of upper airways, Inhibition of tear formation, Urinary retention, Antidiarrheal or constipation, Mucociliary slowing, Inhibition of constriction

58. Antimuscarinic bronchodilator: SAME as anticholinergic bronchodilator: an agent that BLOCKS the effect of acetylcholine at the cholinergic site

59. Cholinergic: An agent that produces the effect of acetylcholine.

60. Cholinergic Effects: Decreased Heart Rate, Miosis (contraction of the iris), Contraction (thickening) of the lens, Salivation, Lacrimation, Urination, Defecation, Secretion of mucus, Bronchoconstriction

61. Methacholine – What is the PRIMARY use of this cholinergic agent?: The PRIMARY clinical use of methacholine is to diagnose bronchial hyperreactivity (Methacholine challenge) which is the hallmark of asthma and also occurs in chronic obstructive pulmonary disease.

62. Muscarinic: Same as cholinergic: an agent that produces the effect of acetylcholine or an agent that mimics acetylcholine

63. Parasympatholytic: Blocking parasympathetic nervous fibers

64. Parasympathomimetic: Producing effects SIMILAR to those of the parasympathetic nervous system

65. Quarternary Compounds: Atropine Methylnitrate, Ipratropium Bromide, Tiotropium Bromide

66. T/F – ANTICHOLINERGIC aerosols are found to be MORE potent bronchodilators that Beta adrenergic bronchodilators in BRONCHITIS and EMPHYSEMA (COPD).:

TRUE – ANTICHOLINERGIC aerosols are found to be MORE potent bronchodilators that Beta adrenergic bronchodilators in BRONCHITIS and EMPHYSEMA (COPD).

67. T/F – COMBIVENT is the brand name for a COMBINATION of Ipratropium bromide AND Albuterol. In MDI form.:

TRUE – COMBIVENT IS a combination of Iprtroprium bromide and Albuterol in MDI form with an onset of 15 mins, peaks at 1-2 hours and lasts 4 – 6 hours. Known as DUONEB in SVN/HHN form.

68. T/F – Ipratroprium (Atrovent) and Tiotropium (Spiriva) ARE indicated as anticholinergic bronchodilators for patients receiving REGULAR treatment (Tx) COPD..:

TRUE, both Ipratropium (Atrovent) and Tiotropium (Spiriva) are anticholinergic bronchodilators that are indicated for Pts receiving REGULAR treatment (Tx) for COPD.

69. T/F – Quaternary compounds like IPRATROPRIUM have side effects that are more LOCALIZED than TERTIARY compounds.:

TRUE – Quaternary compounds like IPRATROPRIUM have side effects that are more LOCALIZED than TERTIARY compounds.

70. T/F – Tioptrprium bromide is also known as SPIRIVA and has a duration of 12 hours.:

FALSE – Tiotroprium bromide IS known as SPIRIVA BUT has a duration of 24 hours. It’s ONSET is 30 minutes and peaks in 1 – 3 hours.

71. T/F Anticholinergic bronchodilators are STRICTLY parasympatholytic, BLOCKING the effect of ACETYLCHOLINE at the CHOLINERGIC RECEPTORS on BRONCHIAL SMOOTH MUSCLE.: 

TRUE – Anticholinergic bronchodilators are STRICTLY parasympolytic, BLOCKING the effect of ACETYLCHOLINE at the CHOLINERGIC RECEPTORS on BRONCHIAL SMOOTH MUSCLE.

72. Tertiary Compounds: Atropine; Scopalamine