ANS: D
Montelukast (Singulair), Zarfirlukast (Accolate), and Zileuton (Zyflo) are leukotriene
inhibitors used for maintenance therapy in asthma.
PTS: 1
23. One of the side effects of Acetylcysteine is bronchospasm. How can this side effect be avoided?
a. By giving Acetylcysteine with a bronchodilator.
b. By giving the patient a corticosteroid after the treatment.
c. By administering half of the therapy, allowing the patient to rest, then finishing the therapy.
d. By simultaneous use of sodium bicarbonate.
ANS: A
Usually, acetylcysteine is given with a bronchodilator to prevent the bronchospastic side effect.
PTS: 1
24. Which of the following is a frequently nebulized antibiotic for patients with cystic fibrosis?
a. Pentamidine c. Sodium bicarbonate
b. Ribvirin d. Tobramycin
ANS: D
Tobramycin (TOBI) and gentamicin are sometimes aerosolized for use in patients with cystic fibrosis
and have shown some efficacy in treatment of the recurrent infections these patients experience.
PTS: 1
25. MDI spacer devices are used in conjunction with MDIs to:
a. serve as a baffle, removing smaller particles from suspension.
b. enhance the effectiveness of aerosol deposition and improve medication delivery.
c. act as a reservoir that helps to decrease the evaporation of the MDI propellant.
d. a, b, and c.
ANS: B
MDI spacer devices are used in conjunction with MDIs and enhance the effectiveness of aerosol
deposition and improve medication delivery
PTS: 1
ESSAY
1. An aerosol drug is ordered on a patient in MDI form. The propellant causes a reflex bronchospasm in
the patient. What can be done?
ANS:
The drug could be delivered to the patient in other forms such as DPI form or in solution by a small
volume nebulizer. A spacer could be used to allow for partial evaporation of the propellant from the
MDI. If the drug is available in pill form or oral solution it could be delivered via mouth.
PTS: 1
2. A small volume nebulizer is ordered for a patient on a mechanical ventilator. To prevent condensation
and secretions from draining into the nebulizer and contaminating it, what could be done?
dr.j
, ANS:
A heated wire circuit should decrease the amount of condensation in the ventilator tubing and therefore
the amount of solution that could get into the nebulizer cup. Position the nebulizeer so that the upper
end of the reservoir would be higher than the ventilator tubing. Use barriers (one-way valve) between
the nebulizer cup and the and the ventilator circuit. It could also be suggested to the physician that an
MDI be used instead of the SVN and the device could be removed immediately after the therapy.
PTS: 1
3. After delivery of an adrenergic bronchodilator with a small volume nebulizer, a patient complains of
“shakiness” and feeling “nervous”. He notes palpitations and his heart feels like it is racing. What is
happening and how could these problems be corrected?
ANS:
The patient is having adverse side effects from the bronchodilator. The patient’s bronchodilator could
be given with more diluting solution, the amount of medication could be decreased, or the patient
could be given another bronchodilator with fewer side effects.
PTS: 1
dr.j
,Chapter 01: Introduction to Respiratory Care Pharmacology
Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition
The superscription directs the pharmacist to take the drug listed and prepare the medication;
the inscription lists the name and quantity of the drug being prescribed; the subscription
provides directions to the pharmacist for preparing the medication; and the transcription, or
signature, is the information the pharmacist writes on the label as instructions to the patient.
REF: p. 7
A generic substitution allows any brand of a drug to be given, but the pharmacist may not
change a drug formulation without specific permission from the prescribing physician. A
physician can indicate to the pharmacist that generic substitution is permitted in the filling of
the prescription. In such a case, the pharmacist may provide any manufacturer’s version of the
prescribed drug, rather than a specific brand. However, the pharmacist may not change the
strength of a drug without specific permission from the prescribing physician.
REF: p. 8
Pharmacogenetics is the study of the interrelationship of genetic differences and drug effects.
Pharmacology is the study of drugs (chemicals), including their origin, properties, and
interactions with living organisms. Therapeutics is the art of treating disease with drugs.
Toxicology is the study of toxic substances and their pharmacologic actions, including
antidotes and poison control.
REF: p. 3
The chemical name indicates the drug’s chemical structure. The generic name is assigned by the
United States Adopted Name Council and is usually based loosely on the drug’s chemical
structure. The official name is the name given to the generic name once a drug becomes fully
approved for general use and is admitted to the United States Pharmacopeia–National
Formulary. The trade name is the brand, or proprietary, name given by a particular
manufacturer. For example, the generic drug albuterol is currently marketed by Schering-
Plough as Proventil® and by GlaxoSmithKline as Ventolin®.
REF: p. 5
Because the PDR is prepared by drug manufacturers themselves, it may be lacking in
objectivity. Basic & Clinical Pharmacology covers only general pharmacologic principles and
drug classes. Goodman & Gilman’s The Pharmacological Basis of Therapeutics covers only
general pharmacologic principles and drug classes. The USP-NF is a book of standards
containing information about medications, dietary supplements, and medical devices. The
U.S. Food and Drug Administration (FDA) considers this book the official standard for drugs
marketed in the United States.
REF: p. 5
dr.j
, Drugs may be obtained from plants (e.g., digitalis), animals (e.g., insulin), and minerals (e.g.,
magnesium sulfate).
REF: p. 5
The United States Adopted Name (USAN) Council is responsible for assigning a generic
name to a chemical that appears to have therapeutic use. The U.S. Food and Drug
Administration (FDA) is responsible for the process of approving drugs for clinical use. The
process by which a chemical moves from the status of a promising potential drug to one fully
approved by the FDA for general clinical use is, on average, long, costly, and complex. Cost
estimates vary, but in the 1980s it took an average of 13 to 15 years from chemical synthesis
to marketing approval by the FDA, with a cost of $350 million in the United States. The USP-
NF is a book of standards for medications, dietary supplements, and medical devices. The
PDR is a source of drug information prepared by drug manufacturers.
REF: p. 4
An orphan drug is a drug or biologic product for the diagnosis or treatment of a rare disease.
Rare is defined as a disease that affects less than 200,000 persons in the United States.
Alternatively, a drug may be designated as an orphan if used for a disease that affects more
than 200,000 persons in the United States but for which there is no reasonable expectation of
recovering the cost of drug development. Orphan drugs are often quite expensive to produce
because they have a limited market in which to recoup the initial investment.
REF: p. 6 | p. 7
A prescription may be written by a physician, osteopath, dentist, and veterinarian and some
other practitioners but not by chiropractors.
REF: p. 7
Illegal drugs are not legally available to the general public, and many generic drugs require a
prescription. The use of investigational drugs is very closely monitored, and they are not
available to the general public. Drugs available to the general public without a prescription are
referred to as over-the-counter (OTC) products.
REF: p. 8
Although some inhaled drugs do increase heart rate as a side effect, most drugs intended for
this purpose are given intravenously; orally or nasally inhaled drugs are intended to provide a
local topical treatment in the respiratory tract. Most anxiolytics and drugs used to improve
blood flow are given intravenously.
REF: p.
dr.j
Montelukast (Singulair), Zarfirlukast (Accolate), and Zileuton (Zyflo) are leukotriene
inhibitors used for maintenance therapy in asthma.
PTS: 1
23. One of the side effects of Acetylcysteine is bronchospasm. How can this side effect be avoided?
a. By giving Acetylcysteine with a bronchodilator.
b. By giving the patient a corticosteroid after the treatment.
c. By administering half of the therapy, allowing the patient to rest, then finishing the therapy.
d. By simultaneous use of sodium bicarbonate.
ANS: A
Usually, acetylcysteine is given with a bronchodilator to prevent the bronchospastic side effect.
PTS: 1
24. Which of the following is a frequently nebulized antibiotic for patients with cystic fibrosis?
a. Pentamidine c. Sodium bicarbonate
b. Ribvirin d. Tobramycin
ANS: D
Tobramycin (TOBI) and gentamicin are sometimes aerosolized for use in patients with cystic fibrosis
and have shown some efficacy in treatment of the recurrent infections these patients experience.
PTS: 1
25. MDI spacer devices are used in conjunction with MDIs to:
a. serve as a baffle, removing smaller particles from suspension.
b. enhance the effectiveness of aerosol deposition and improve medication delivery.
c. act as a reservoir that helps to decrease the evaporation of the MDI propellant.
d. a, b, and c.
ANS: B
MDI spacer devices are used in conjunction with MDIs and enhance the effectiveness of aerosol
deposition and improve medication delivery
PTS: 1
ESSAY
1. An aerosol drug is ordered on a patient in MDI form. The propellant causes a reflex bronchospasm in
the patient. What can be done?
ANS:
The drug could be delivered to the patient in other forms such as DPI form or in solution by a small
volume nebulizer. A spacer could be used to allow for partial evaporation of the propellant from the
MDI. If the drug is available in pill form or oral solution it could be delivered via mouth.
PTS: 1
2. A small volume nebulizer is ordered for a patient on a mechanical ventilator. To prevent condensation
and secretions from draining into the nebulizer and contaminating it, what could be done?
dr.j
, ANS:
A heated wire circuit should decrease the amount of condensation in the ventilator tubing and therefore
the amount of solution that could get into the nebulizer cup. Position the nebulizeer so that the upper
end of the reservoir would be higher than the ventilator tubing. Use barriers (one-way valve) between
the nebulizer cup and the and the ventilator circuit. It could also be suggested to the physician that an
MDI be used instead of the SVN and the device could be removed immediately after the therapy.
PTS: 1
3. After delivery of an adrenergic bronchodilator with a small volume nebulizer, a patient complains of
“shakiness” and feeling “nervous”. He notes palpitations and his heart feels like it is racing. What is
happening and how could these problems be corrected?
ANS:
The patient is having adverse side effects from the bronchodilator. The patient’s bronchodilator could
be given with more diluting solution, the amount of medication could be decreased, or the patient
could be given another bronchodilator with fewer side effects.
PTS: 1
dr.j
,Chapter 01: Introduction to Respiratory Care Pharmacology
Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition
The superscription directs the pharmacist to take the drug listed and prepare the medication;
the inscription lists the name and quantity of the drug being prescribed; the subscription
provides directions to the pharmacist for preparing the medication; and the transcription, or
signature, is the information the pharmacist writes on the label as instructions to the patient.
REF: p. 7
A generic substitution allows any brand of a drug to be given, but the pharmacist may not
change a drug formulation without specific permission from the prescribing physician. A
physician can indicate to the pharmacist that generic substitution is permitted in the filling of
the prescription. In such a case, the pharmacist may provide any manufacturer’s version of the
prescribed drug, rather than a specific brand. However, the pharmacist may not change the
strength of a drug without specific permission from the prescribing physician.
REF: p. 8
Pharmacogenetics is the study of the interrelationship of genetic differences and drug effects.
Pharmacology is the study of drugs (chemicals), including their origin, properties, and
interactions with living organisms. Therapeutics is the art of treating disease with drugs.
Toxicology is the study of toxic substances and their pharmacologic actions, including
antidotes and poison control.
REF: p. 3
The chemical name indicates the drug’s chemical structure. The generic name is assigned by the
United States Adopted Name Council and is usually based loosely on the drug’s chemical
structure. The official name is the name given to the generic name once a drug becomes fully
approved for general use and is admitted to the United States Pharmacopeia–National
Formulary. The trade name is the brand, or proprietary, name given by a particular
manufacturer. For example, the generic drug albuterol is currently marketed by Schering-
Plough as Proventil® and by GlaxoSmithKline as Ventolin®.
REF: p. 5
Because the PDR is prepared by drug manufacturers themselves, it may be lacking in
objectivity. Basic & Clinical Pharmacology covers only general pharmacologic principles and
drug classes. Goodman & Gilman’s The Pharmacological Basis of Therapeutics covers only
general pharmacologic principles and drug classes. The USP-NF is a book of standards
containing information about medications, dietary supplements, and medical devices. The
U.S. Food and Drug Administration (FDA) considers this book the official standard for drugs
marketed in the United States.
REF: p. 5
dr.j
, Drugs may be obtained from plants (e.g., digitalis), animals (e.g., insulin), and minerals (e.g.,
magnesium sulfate).
REF: p. 5
The United States Adopted Name (USAN) Council is responsible for assigning a generic
name to a chemical that appears to have therapeutic use. The U.S. Food and Drug
Administration (FDA) is responsible for the process of approving drugs for clinical use. The
process by which a chemical moves from the status of a promising potential drug to one fully
approved by the FDA for general clinical use is, on average, long, costly, and complex. Cost
estimates vary, but in the 1980s it took an average of 13 to 15 years from chemical synthesis
to marketing approval by the FDA, with a cost of $350 million in the United States. The USP-
NF is a book of standards for medications, dietary supplements, and medical devices. The
PDR is a source of drug information prepared by drug manufacturers.
REF: p. 4
An orphan drug is a drug or biologic product for the diagnosis or treatment of a rare disease.
Rare is defined as a disease that affects less than 200,000 persons in the United States.
Alternatively, a drug may be designated as an orphan if used for a disease that affects more
than 200,000 persons in the United States but for which there is no reasonable expectation of
recovering the cost of drug development. Orphan drugs are often quite expensive to produce
because they have a limited market in which to recoup the initial investment.
REF: p. 6 | p. 7
A prescription may be written by a physician, osteopath, dentist, and veterinarian and some
other practitioners but not by chiropractors.
REF: p. 7
Illegal drugs are not legally available to the general public, and many generic drugs require a
prescription. The use of investigational drugs is very closely monitored, and they are not
available to the general public. Drugs available to the general public without a prescription are
referred to as over-the-counter (OTC) products.
REF: p. 8
Although some inhaled drugs do increase heart rate as a side effect, most drugs intended for
this purpose are given intravenously; orally or nasally inhaled drugs are intended to provide a
local topical treatment in the respiratory tract. Most anxiolytics and drugs used to improve
blood flow are given intravenously.
REF: p.
dr.j
