FCCS Exam Questions and Answers Latest Updated

What is the most important sign in a critically ill pt? Why? - ANSWER-Tachypnea Indicates metabolic acidosis (often w/ respiratory alkalosis compensation) A pt misses dialysis for a few days and comes in with fluid overload. He's tachycardic and tachypneic. On physical exam, you find JVD, pulsus paradoxus (20 mmHg drop during inspiration), and HoTN (80/40) with distant, muffled heart sounds. Lungs are clear to auscultation. What is the dx? - ANSWER-Cardiac tamponade; obstructive shock If a pt has a thyromental distance of 2 cm, what can you expect about their airway? - ANSWER-Difficult airway w/ an anteriorly displaced larynx A COPD pt comes in with difficulty breathing. He then becomes apneic and unresponsive. How would you ventilate this pt? - ANSWER-BVM A pt arrives after falling from a ladder and has a frontal laceration. On examination, you find papilledema and labored breathing w/o being able to clear secretions. What is your biggest concern when intubating this pt? - ANSWER-Cerebral edema/increasing ICP Intubation tends to cause an increase in ICP. Administer lidocaine prior to intubation to inhibit vagal stimulation. An ESRD pt w/ hyperkalemia develops dyspnea and requires intubation. Which paralytic agent/NMB should you avoid and why? - ANSWER-Succinylcholine Worsens hyperkalemia A pt is admitted after an OD. He starts to have apneic episodes and his SpO2 is dropping. You place him on a non-rebreather mask w/ 100% O2, yet his SpO2 remains at 80%. Why is it not being corrected? Then, if you try a BVM and it also fails, and video laryngoscopy is unavailable, what is your next best choice for an airway? - ANSWER-The pt is having apneic episodes, which means that administering high-flow O2 will be ineffective. Choose an LMA if the BVM fails. What intervention improves outcomes with ROSC after cardiac arrest? - ANSWER-Targeted temperature management. 32-36 C A shunt means there is perfusion without ventilation. What disease process is an example of a shunt? - ANSWER-Pneumonia Which type of respiratory failure occurs with CNS depression after an OD? - ANSWER-Acute hypercapnic respiratory failure --> mixed A 50 y/o pt is having a COPD exacerbation. You have tried steroids, bronchodilators, etc. with no improvement. PCO2 is in the 90s, pH is 7.20. You decide to intubate. Vent settings are: VT 375, RR 20, FiO2 .35, PEEP 5. CXR is normal. A few minutes later, his BP drops to 70/40. Lungs are clear/equal. Vent shows peak airway pressure of 55 (high) and plateau pressure of 15. End expiratory hold gives auto-peep of 15. What is the cause of this pt's HoTN and why? - ANSWER-Auto-peep is the cause. COPD pts have difficulty exhaling --> pressure buildup in alveoli. We use PEEP for the pressure and to improve oxygenation. Auto-peep comes from breath-stacking --> intrinsic peep. Alveoli enlarge --> high peak airway pressure. All leads to low venous return --> low CO --> HoTN A COPD pt is admitted to the ICU for exacerbation. Pt is on a vent. Pt is tx w/ bronchodilators, steroids, and Abx. ABG was normal 1 hr ago, but now the peak airway pressure is up to 55 and plateau pressure is also high at 50. Pt becomes hypotensive at 70/40. You observe tracheal deviation to the R. Normal breath sounds on the right, diminished on the left. No wheezing. WBC is normal. What is the dx and treatment? - ANSWER-Tension pneumothorax Needle decompression/chest tube A pt in ARDS s/p pneumonia is on 100% FiO2 with PEEP of 22. PO2 is 88%. Peak airway pressure and plateau are both high. VT is 5 ml/kg. How can you decrease the airway pressures? - ANSWER-Decrease the PEEP, even though it will decrease PaO2. (Note: you can't decrease the VT because it is already on the low end). A young asthmatic pt is on the vent. His lungs are very tight. He is on the AC setting and there is a lot of auto-PEEP. You correct it by reducing the rate, giving him more time to exhale and making sure he has enough flow. FiO2 is at .50. He is sedated and seems comfortable. On ABG the pH is 7.24, CO2 is 65, O2 is 80, and bicarb is 29. What would you do with the vent settings in this case? - ANSWER-Keep the settings where they are. You can't hyperventilate the pt to blow off CO2 b/c the asthma will worsen. As long as the pH is > 7.2, the settings are okay as they are. CO2 will correct over time. Which two conditions are the most indicated for BiPAP? - ANSWER-COPD exacerbation Cardiogenic pulmonary edema A 70 y/o pt with CHF presents with SOB, accessory muscle use, RR 34, SpO2 90% on 8L O2. CXR reveals infiltrates in a bat wing pattern. She also has LE edema. She is dx with a CHF exacerbation w/ respiratory failure. Her ABG shows pH 7.3, PO2 64, CO2 50. What is the best tx for this pt? - ANSWER-Non-invasive BiPAP. A pt comes in w/ a femur fx and a rod is placed. Post-op he develops dyspnea and fever. HR 140, RR 30, SpO2 92% on non-rebreather. He is transferred to the ICU where you intubate, place a central line, and start resuscitating him. Hb 8.2, lactate 3.2, SVO2 is 52%. Why is his SVO2 low? How can we improve it? - ANSWER-Decreased O2 delivery and increased consumption. (normal is 65-70) Administer packed RBCs - 1U of blood will change his Hb from 8.2 to 9.2. O2, fluid, and VT would not work. A young pt after an MVA comes to the ER hypotensive and tachycardic. CXR is clear. He has a contusion on his chest wall and torso. He is unconscious. What will give you the best insight on what is causing his shock? Hb SCV Urine Output FAST exam - ANSWER-FAST exam 41 y/o pt in the SICU following debridement of b/l lower extremities for necrotizing fasciitis is intubated on AC. Temp 102, HR 116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2 38, Na 139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/ anion gap d/t infection. What is the most appropriate intervention? Increase VT Continue resuscitation Decrease RR Administer bicarb - ANSWER-Continue resuscitation. Don't need to increase VT bc the pt doesn't have respiratory acidosis. If you decrease the RR, the pt will go into respiratory acidosis. A pt has obstructive uropathy. A catheter is placed d/t the obstructive kidney injury. After the cath is placed, he has massive diuresis to the point where he is hypotensive, tachy, and lactate is 2x the ULN from decreased perfusion. How would you correct this? - ANSWER-Fluids - LR When treating hyponatremia, what is the first thing to assess? When do you give 3% NaCl? How do you correct it? - ANSWER-1. fluid status 2. seizures or changes in mental status 3. slowly, 8-12 meq over 24 hr What are the classifications of hemorrhagic shock? - ANSWER-I: <15%; HR <100, BP normal, RR normal II: 15-30%; HR >100, BP normal, RR 20-30 III: 30-40%; HR >120, BP low, RR 30-40 IV: >40%; HR >140, BP low, RR >40 An 84 y/o pt fell down the stairs. He is moaning and crying. He has a C-collar in place. His neck is painful and he has bruising on his face. He is tachy but BP is okay. You administer 2L O2 bc SpO2 was 92%. Shortly after he deteriorates, becoming altered and then comatose. His left pupil > the right. He is herniating from cerebral edema. How do you treat him? - ANSWER-Intubate and ventilate, maintaining c-spine precautions. Administer mannitol. A pt comes in with several cardiovascular RFs: elderly, DM, and HTN. He is having chest pain, SOB, and is diaphoretic. What diagnosis do you need to re-perfuse him immediately? - ANSWER-STEMI What is the most appropriate management for both STEMI and non-STEMI? nitro if bp >80 morphine q 30 min bb oxygen if sats are <94% - ANSWER-Oxygen Which NSTEMI needs to be sent to the cath lab immediately? - ANSWER-NSTEMI w/ shock Which medication improves outcomes for pts with STEMI? - ANSWER-ACE-I Give if BP is stable. It decreases LV remodeling and decreases afterload. A 70 y/o pt has been hospitalized for 15 days. He had a cholecystectomy and abscess formation which was tx appropriately. He has a central line in the right IJ. The site looks visibly infected, and he has a fever, is tachy, and hypotensive. WBCs are high. Blood culture and initial gram stain reveals G(+) cocci. What is the dx? What is the MC pathogen? What is the tx? - ANSWER-1. line-related infection 2. coag (-) staph epidermis 3. vanco + zosyn + ceftriaxone if MRSA: vanco + ceftriaxone if MSSA: zosyn + ceftriaxone What is the tx for meningitis? - ANSWER-young pt: ceftriaxone + vanco > 50 pt: add ampicillin A chemotherapy pt becomes septic. You suspect a neutropenic fever. What is the tx? - ANSWER-broad spectrum abx (vanco/zosyn) obtain blood, urine, and sputum culture CXR + CT What is the tx of hyperkalemia? - ANSWER-calcium gluconate + insulin + dextrose bicarb, kayexalate, albuterol definitive tx: dialysis How do you manage DKA? - ANSWER-Check potassium Multiple L bolus via at least 2 peripheral IVs Insulin infusion, 0.1U/kg/hr until sugar reaches 250 mg/dl Switch NS to D5W Once anion gap is closed, administer long-acting insulin 1 hr prior to d/c infusion A 70 y/o pt with COPD comes in with an exacerbation. He is rapidly becoming more hypoxic. To rule out PE, what test should you order? - ANSWER-CT A 22 y/o pt ingested drugs >4 hours ago. She came to the ICU obtunded w/ arousal to tactile stimulation. She is hemodynamically stable. RR 8 with an NG tube in place. What is the next step for tx of the ingestion? - ANSWER-Monitor / watchful waiting. The pt ingested the drugs more than 4 hours ago. Monitor RR and intubate if necessary. A pt presents with HTN, ripping/tearing pain to the back, and unequal pulses. What is the dx? What is the tx goal and what should you use? What medication is contraindicated? - ANSWER-1. aortic dissection 2. lower BP and HR 3. Labetalol, no reflex tachycardia 4. Nitro is contraindicated What decreases during pregnancy by ~25%? - ANSWER-Functional residual capacity A 24 y/o male comes in following a concussion. CT reveals a frontal lobe contusion. He does not require intubation and is kept on 3 L O2 NC. He then suddenly has a generalized seizure. What is the DOC? What do you give after the seizure? What med class is an absolute contraindication for seizures? - ANSWER-1. lorazepam IV 2. dilantin 3. NMB a 55 y/o male comes in with AMS and diffuse abdominal pain. He takes HCTZ and a multivitamin. HR 120 sinus tach. He is moaning in pain and unable to articulate what is happening. CT reveals lytic lesions in the vertebrae. You administer a 3L NS bolus which shows mild improvement. What is the dx and what is causing his symptoms? How do you tx? - ANSWER-Dx: multiple myeloma The hypercalcemia is what is causing the symptoms. Tx: Fluids, then diuretic or bisphosphonate if symptoms persist. How do you treat septic shock (4 things)? - ANSWER-2-3 L bolus NE Vasopressin Steroids what vital sign abn and BMP finding is the most important indicator of critical illness? - ANSWER-tachypnea; metabolic acidosis what is the gas volume in an adult resus bag? - ANSWER-1-1.5 L waht is the mnemonic for airway prep? - ANSWER-SOAP-ME Suction Oxygen Airways (OPA, NPA, Ett) Position: adjust bed Monitoring and Medications: EtCO2, RSI drugs Equipment: DL, VL, bougie what are indicators of a difficult mask? - ANSWER-beard,no teeth, OSA, high BMI, age > 55 how should you evaluate a patient for intubatioN? - ANSWER-*same order you go through to acutally intubate: 1. neck mobility 2. external face: small mandible, surg scarring 3. mouth (<3 finger breaths of opening is worrying) 4. tongue/pharynx 5. jaw: thyromental distance (from anterior prominence of thyroid cartilage to tip of mandible what are the 2 NM blockers to know for intubation? - ANSWER-sux, roc drugs: -lido p 28 - ANSWER-a what periintubation drug has been shown to blunt response of increasing ICP in someone whith a head injury? - ANSWER-lidocaine (1-1.5 mg/kg) what is goal temp ranges for targeted temperature management? what are the 2 potential big SEs? - ANSWER-32 to 36 C for at least 24 hours in comatose (GCS<8) patients following ROSC SEs: coagulopathy, increased risk of infxn what percentage of normal CO does chest compressions produce? - ANSWER-1/3 what is the goal CO2 following arrest? - ANSWER-38-42 (normocapnea) what are teh 3 broad types of respiratory failure? PNA is most often associated with which one? drug OD? CHF? COPD? dead space ventillation? - ANSWER-hypoxemic (PaO2 <60), hypercapneic (PaCO2 >50), mixed hypoxemic (although can be mixed) hypercapneic hypoxemic mixed hypercapneic define shunt physiology? waht is at the other end of the VQ spectrum? - ANSWER-no V, still adequate Q dead space what ratio is most useful in tracking hypoxia over time? - ANSWER-P:F ratio, PaO2 and FiO2 normal is 300-500 define minute ventilation (VA) - ANSWER-VA = RR* (VT - VD) VD = dead space define paradoxical breathing? why does it occur - ANSWER-diaphragm is flaccid b/c of fatigue and moves upward during inspiration what FiO2 is given with 2 L NC? 8 L facemask? - ANSWER-28%, 60% what are BiPAP settings to start a patient on (EPAP, IPAP, Vt, backup rate), at what IPAP do you worry about gastric distention? - ANSWER-5, 10, 6-8 mL/kg, 6 IPAP > 20 what are the 4 indications for invasive ventillation? - ANSWER-failure to oxygenate, failure to ventilate, failure to protect, projected clinical course what are teh ABCD of teh vent cycle? - ANSWER-A: triggering (initiation of inspiration) B: end of inspiratory flow C: cycling (start of expiratory flow) what is assist-control ventilation? - ANSWER-VT is guaranteed at present flow rate with a minimum RR however pt can initiate breaths and trigger teh vent, so Pt can breath at higher RR if he wants can be either volume cycled or time cycled (pressure assist), volume is much more common what is PSV? - ANSWER-SPV provides a preset level of inspiratory pressure with each vent detected pt effort best for spontaneously breathign pt to offer increased comfort what is SIMV? - ANSWER-synchronized intermittent manditory ventilation, breaths may be triggered by the pt or time delapsed, vent will synch to pt breaths, if no breath is detected vent will deliver preset VT at preset time PSV is usually paired with what other vent mode for pt comfort and decrease in pt's WOB? - ANSWER-SIMV volume assist control waveforms? - ANSWER- pressure assist control ventilation waveforms? - ANSWER- review advantages/disadvantages to different vent modes on p 77 - ANSWER-do it after you intubate what is the first mode used? - ANSWER-AC, usally volume controlled what are best initial vent settings? (VT, FiO2, RR)? what is normal minute ventilation? - ANSWER-VT = 4-8 mL/kg; closer to 8 for COPD, closer to 4 for ARDS 7-8 L/min 92-94% what is peak airway pressure? inspiratory plateau pressure? which one corresponds more to barotrauma? how can you decrease Pplat? - ANSWER-Ppeak = a measure of airway resistance; < 40 is ideal Pplateau = measure of compliance and alveolar distension, a static measurement; need an inspiratory hold of 1 sec; normal < 30 cm H2O Pplat decrease PEEP, decrease VT if you can't get FiO2 < 60 what should you do? - ANSWER-increase PEEP waht is auto PEEP? how can tell its happening on tracing? - ANSWER-badness, happens when expiratory time is too short to allow full exhalation. can decrease CO, need to adjust vent. To get rid of increase peak flow and decrease RR can see on tracing by if a breath is initiated below baseline Most important indicator that a patient has a severe illness? - ANSWER-Tachypnea 3 respiratory types, and their criteria - ANSWER-Hypoxemic (PaO2 <50-60) Hypercapnic (PaCO2 >50, pH <7.36) Mixed Delta gap (formula, when and why it's used) - ANSWER-Difference in AG from normal - Difference in HCO3 from normal In AG metabolic acidosis it's used. It tells you if there's underlying metabolic alkalosis or respiratory acidosis with bicarb compensation IN ADDITION to the AG metabolic acidosis. Both of those would result in a high bicarb to begin with, and a smaller change in bicarb from normal. Winter's formula (equation, what it measures) - ANSWER-1.5[HCO3] + 8 +/- 2 If compensation is adequate in acid/base issues How AG changes with albumin changes - ANSWER-Decreases 2.5-3 for every 1 decrease in albumin Hemodynamic changes after intubation - ANSWER-Hypo/hypertension Arrhythmia Tachycardia Pressure support equation for BiPAP - ANSWER-IPAP - EPAP 3 types of vent cycles - ANSWER-Volume (preset tidal volume, relieves WOB the most) Time (constant pressure of time) Flow (constant pressure until inspiratory flow is below 25% of peak) Goal tidal volume - ANSWER-10 cc/kg Goal FiO2 on vent - ANSWER-Start at 1.0, then decrease as SpO2 tolerates (goal of 92-94 saturation) Ppeak - ANSWER-Peak inspiratory pressure Pplat (try to keep it below ?) - ANSWER-Inspiratory plateau pressure (shows alveolar distention) 30 AutoPEEP (what it is, what it causes, how to fix it) - ANSWER-Breath stacking Decreases preload to the heart with positive pressure on the lungs --> hypotension Decrease RR, decrease inspiration time (goal is to have more time for the lungs to exhale) Danger of increased PEEP - ANSWER-Increases autoPEEP, increases Pplat PaO2 we're usually happy with - ANSWER->60 When to consider NPPV vs invasive - ANSWER-When it's a quickly solved problem in 1-2 days (e.g. COPD exacerbation) When the patient can be compliant with working with NPPV When to consider switching from NPPV to invasive ventilation support - ANSWER-If things aren't really improving in a matter of hours If your therapeutic goals haven't been met in 4-6 hours Manual decompression (when you use it) - ANSWER-If patient is air trapping like crazy on the vent, and you disconnect it and push up on the patients diaphragm to get everything out What a high A-a gradient means - ANSWER-V/Q mismatch Volume assist-control breath (Volume cycled) - ANSWER-Vent delivers preset tidal volume Pressure assist-control breath (time cycled) - ANSWER-Vent delivers a constant pressure over a preset time Pressure support breath (flow cycled) - ANSWER-Same as pressure assist-control breaths, but the vent cuts out when the flow rate decreases to 25% of initial peak flow rate Assist-control ventilation - ANSWER-Either volume or time cycled breaths given Usually the go to when you just started someone on the vent Gives the pt a set tidal volume and preset flow rate respiratory rate. Very rigid. However, if the patient wants to take extra breaths if they trigger them. Pressure support ventilation - ANSWER-Waits for patient to start breath, and then helps out with a set amount of pressure Synchronized intermittent mandatory ventilation - ANSWER-SIMV Delivers volume or time cycled breaths at a mandatory rate Patient can breathe spontaneously between mandatory breaths Spontaneous breaths count - this allows the patient to contribute to the mandatory tidal volume the machine requires them to breathe When do you give tPA in ACS? - ANSWER-ONLY for a STEMI, and ONLY when PCI isn't readily available Tx of an inferior MI - ANSWER-NO nitroglycerin Give fluids instead ABG findings in PE - ANSWER-Decreased CO2 (hyperventilating) Decreased O2 (V/Q mismatch) When to give tPA in PE - ANSWER-Only for huge ones and heparin's not working Lovenox class - ANSWER-LMWH Airway in hematemesis pt - ANSWER-Electively intubate it Tx of HTN urgency vs emergency - ANSWER-No drip vs drip Intraabdominal HTN (criteria, effects) - ANSWER->12 mmHg End organ damage and decreased preload to heart causing hypotension CPP goal in TBI (and how to calculate it) - ANSWER-50-70 MAP - ICP SAH tx - ANSWER-nimodipine to stop vasospasm and control BP Sepsis vs severe sepsis vs septic shock - ANSWER-You know vs End organ damage vs Resistant to tx CAP tx - ANSWER-beta-lactam and macrolide OR fluoroquinolone HCAP tx - ANSWER-vanc/zosyn CAP immunocompromised pt (tx) - ANSWER-Bactrim Endocarditis bugs - ANSWER-Strep viridans and other streps, staph SBP abx - ANSWER-ceftriaxone flagyl Pregnancy pyelo tx - ANSWER-ceftriaxone Necrotizing fasciitis tx - ANSWER-vanc/zosyn clindamycin Neutropenic fever abx - ANSWER-Think G-, so cefepime C diff abx - ANSWER-Flagyl When hypothermia helps (disease) - ANSWER-V fib 1st step in respiratory arrest while ON the vent - ANSWER-Disconnect them from the vent SVT tx - ANSWER-Adenosine Wide complex tachycardia tx - ANSWER-Amiodarone GI change in pregnancy - ANSWER-LES tone decreases, increasing the risk of aspiration Preeclampsia - ANSWER-20+weeks, HTN, proteinuria/edema HELLP vs preeclampsia tx - ANSWER-Delivery vs Mg Peripartum cardiomyopathy - ANSWER-late in gestation incurable presents like CHF ACE-I in pregnancy - ANSWER-NO What pulse oximetry value is considered hypoxic? - ANSWER-<88%; 92%+ is ideal Most common cause of hypxemia - ANSWER-V/Q mismatch Shunt = Congested air flow Dead Space = Imparied blood flow A-a Gradient goals - ANSWER-Healthy young adult = <10; PO2 90-100 Healthy older adult = <20; PO2 80-100 Anything more indicates lung disease. Hypercapnic ARF is d/t..... - ANSWER-Decreased minute ventilation Name 1 agent used for analgesia prior to intubation - ANSWER-lidocaine aerosol; do not exceed 4mg/kg of lidocaine (max dose 300mg) b/c it is easily absorbed from the airway mucosa Preferred agents for sedation have what 3 qualities? - ANSWER-rapid-acting, short-lived and potentially reversible Name 4 agents commonly used for sedation/amnesia in intubation - ANSWER-fentanyl, midazolam (Versed), etomidate (Amidate), lidocaine dosing of fentanyl for sedation - ANSWER-0.5-2mcg/kg IV bolus every several minutes titrated to sedative effect benefits of fentanyl for sedation - ANSWER-rapid onset, short-acting, reversible with naloxone cautions with fentanyl for sedation - ANSWER-chest wall rigidity with rapid administration; respiratory depression; does not inhibit patient awareness of procedure dosing of midazolam for sedation - ANSWER-0.1-0.2mg/kg IV bolus every several minutes titrated to sedative effect benefits of midazolam for sedation - ANSWER-provides amnesia; rapid onset; short-acting; reversible with flumazenil (Romazicon) cautions with midazolam for sedation - ANSWER-additive respiratory depression when combined with narcotic; does not provide analgesia dosing of etomidate for sedation - ANSWER-0.3-0.4mg/kg single IV bolus benefits of etomidate for sedation - ANSWER-provides sedative effect; may be preferred in head injury; no adverse cardiovascular effects cautions with etimidate for sedation - ANSWER-may induce myoclonus or mild trismus (lockjaw); consider premedication with 50mcg of fentanyl; transient adrenal suppression; no reversal agent dosing of lidocaine for sedation - ANSWER-1-1.5mg/kg IV bolus 2-3 minutes prior to laryngoscopy benefits of lidocaine for sedation - ANSWER-blunts hemodynamic and tracheal response to intubation; may reduce elevations of intracranial pressure during laryngoscopy Is neuromuscular blockade required prior to endotracheal intubation? - ANSWER-No, often intubation can be performed after topical anesthesia (ie, an awake intubation) or with sedation alone Name 3 agents used for neuromuscular blockade for intubation. - ANSWER-succinylcholine, vecuronium and rocuronium dosing of succinylcholine for neuromuscular blockade - ANSWER-1-1.5mg/kg IV bolus benefits of succinylcholine - ANSWER-rapid onset; shortest duration provides an element of safety cautions with succinylcholine - ANSWER-may cause muscle fasciculations d/t depolarization of skeletal muscle and emesis can occur if abdominal muscle fasciculations are severe; can precipitate malignant hyperthermia Name 3 contraindications with succinylcholine - ANSWER-ocular injury; head injury; hyperkalemia (potassium release of 0.5-1mmol/L will routinely occur, and massive potassium release can occur with burn or crush injuries) dosing of vecuronium - ANSWER-0.1-0.3mg/kg IV bolus dosing of rocuronium - ANSWER-0.6-1mg/kg IV bolus Name 1 benefit and 2 cautions with vecuronium and rocuronium - ANSWER-benefit: no fasciculations because these are nondepolarizing agents cautions: slower onset of muscle paralysis and significantly longer duration than with succinylcholine drugs that can contribute to respiratory failure - ANSWER-opioids, bzds, propofol, barbiturates, general anesthetics (midazolam, etomidate, ketamine), neuromuscular blocking agents (succinylcholine, vecuronium, rocuronium), aminoglycosides (gentamicin, tobramycin) mechanism of beta2 agonists - ANSWER-stimulation of beta2 adrenergic receptors --> bronchial and vascular smooth muscle relaxation Name 2 beta2 agonists used in ARF - ANSWER-albuterol (Proventil,Ventolin), levalbuterol (Xopenex) albuterol dosing - ANSWER-0.5% solution - 2.5-5mg q 2-4 hours per nebulizer