,
,
,
,10. Place the following intracellular events of the Beta 2 receptor stimulation in order.
I. Phosphodiesterase breaks down cyclic 3’, 5’-AMP into 5’-AMP
II. Adenylate cyclase combines with magnesium and ATP to form cyclic 3’,5’-AMP
III. Cyclic 3’,5’-AMP results in bronchial smooth muscle relaxation
IV. Beta-2 stimulation causes the formation of adenylate cyclase
a. I, II, III, IV c. IV, II, III, I
b. III, IV, I, II d. IV, III, II, I
ANS: C
The following order is correct: IV) Beta-2 stimulation causes the formation of adenylate cyclase. II)
Adenylate cyclase combines with magnesium and ATP (adenosine triphosphate) to form cyclic 3’,5’-
AMP (adenosine monophosphate). III) Cyclic 3’,5’-AMP results in bronchial smooth muscle
relaxation and hence bronchodilation. Cyclic 3’,5’-AMP is not a long-lived agent. It is readily broken
down by another enzyme present in the lungs called phosphodiesterase. I) Phosphodiesterase breaks
3’,5’-AMP down into 5’-AMP, which no longer causes bronchodilation.
PTS: 1
11. Release of acetylcholine will cause
a. bronchodilation. c. stimulation of cyclic 3’5’ AMP.
b. Mast cell stabilization. d. bronchospasm.
ANS: D
Cholinergic receptors are cells that respond when stimulated by acetylcholine. Cholinergic receptors
cause profound bronchospasm in the lungs when stimulated. Cholinergic receptors are found in the
parasympathetic nervous system.
PTS: 1
12. Which of the following is NOT an example of a sympathomimetic drug?
a. Salmeterol Xinafoate c. Pirbuterol Acetate
b. Formoterol fumarate d. Atropine Sulfate
ANS: D
Atropine sulfate is a anti-cholinergic bronchodilator. Salmeterol, formoterol, and pirbuterol are all
sympathomimetic bronchodilators.
PTS: 1
13. Which of the following sympathomimetic drugs are intended for maintenance therapy only?
I. Levalbuterol
II. Salmeterol
III. Formoterol
IV. Pirbuterol
a. II, III, and IV c. II and III
b. I and IV d. I, II, III, and IV
ANS: C
II) Salmeterol and III) Formoterol are intended for maintenance therapy only.
PTS: 1
14. A pediatric patient is admitted to the emergency department from a physician’s office with the
suspected diagnosis of croup. An inspiratory stridor is heard. Which aerosolized sympathomimetic
would you recommend to decrease the stridor?
, a. Racemic epinephrine c. Levalbuterol
b. Albuterol d. Isoproterenol
ANS: A
Racemic epinephrine (Vaponephrine) is a sympathomimetic drug. However, its alpha effects are
strong and it is commonly used to relieve croup and epiglottitis symptoms in children.
PTS: 1
15. Aminophylline causes bronchodilation by
a. stimulating the production of cyclic 3’5’ AMP.
b. blocking the parasympathetic nervous system.
c. inhibiting the enzyme phosphodiesterase.
d. causing Mast cell degranulation.
ANS: C
Aminophylline is a phosphodiesterase inhibitor. It is an example of drugs in the xanthine group.
Common phosphodiesterase drugs are found in the methylxanthine group. Cyclic 3’,5’-AMP is broken
down into 5’-AMP by the enzyme phosphodiesterase. If the action of phosphodiesterase can be
blocked or inhibited, more 3’,5’-AMP will remain in the lungs, resulting in better bronchodilation.
Phosphodiesterase inhibitors act in this way.
PTS: 1
16. Inhibition of the sympathetic nervous system would cause
a. bronchoconstriction.
b. stridor.
c. bronchodilation.
d. relaxation of the bronchial smooth muscle.
ANS: A
If the sympathetic nervous system is inhibited, it would cause bronchoconstriction.
PTS: 1
17. Which of the following drugs cause bronchodilation by inhibiting the effects of the parasympathetic
nervous system?
I. Atropine sulfate
II. Ipratropium bromide
III. Tiotropium bromide
IV. Terbutaline sulfate
a. I and IV c. I, II, III
b. II and III d. IV only
ANS: C
I) Atropine, II) ipratropium, and III) tiotropium are all examples of antocholinergic
bronchodilators (bronchodilators that work by blocking the parasympathetic nervous system).
Anticholinergic drugs block the cholinergic receptor sites, preventing that route of bronchospasm.
PTS: 1
18. Corticosteroids:
a. cause brondilation directly.
b. reduce inflammation.
c. stabilize Mast cells.
, d. should always be administered with a bronchodilator.
ANS: B
Corticosteroids are widely used in the management of the inflammatory process associated with
asthma, reactive airways disease, and other pulmonary disorders.
PTS: 1
19. A patient is ready to be discharged to her home. At home the patient has a compressor and a small
volume nebulizer. Which of the following corticosteroids is in solution and is intended to be
administered via a small volume nebulizer?
a. Prednisone c. Budesonide
b. Dexamethasone d. Triamcinolone
ANS: C
Budesonide (Pulmocort) is available as both an inhalant solution (0.25 mg/ mL once daily) and a dry
powder formulation (200 mcg/dose twice daily). In aerosol form, this anti-inflammatory medication
targets the lungs specifically with fewer side effects.
PTS: 1
20. Salmeterol and Fluticasone are combined into a DPI preparation. What is the purpose of these two
drugs combined?
a. Maintenance bronchodilation and Mast cell stabilization
b. Mucolysis and anti-inflammation
c. Bronchodilation by stimulating the sympathetic nervous system and inhibiting the
parasympathetic nervous system
d. Maintenance bronchodilation and anti-inflammation
ANS: D
Fluticasone propionate (Flovent) and salmeterol (Serevent) have been combined into a DPI preparation
containing 100 mcg of fluticasone propionate and 50 mcg of salmeterol. By taking both drugs together,
the long-term effects of both d) maintenance bronchodilation and anti-inflamation can be achieved.
PTS: 1
21. Which of the following drugs stabilize mast cells?
a. Ipratropium c. Albuterol
b. Cromolyn sodium d. Fluticasone
ANS: B
Cromolyn sodium is a prophylactic agent; it prevents mast cell degranulation. A patient must use the
drug on a regular basis to prevent acute bronchospastic episodes.
PTS: 1
22. Montelukast, Zarfirlukast, and Zileuton are all used as maintenance therapy for asthma. How
do they work?
a. They stabilize the Mast cells.
b. The cause bronchodilation.
c. They are mucolytics.
d. They are leukotriene inhibitors.
, 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?
, 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
, Chapter 01: Introduction to Respiratory Care Pharmacology
Gardenhire: Rau’s Respiratory Care Pharmacology, 11th 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
,
,
,10. Place the following intracellular events of the Beta 2 receptor stimulation in order.
I. Phosphodiesterase breaks down cyclic 3’, 5’-AMP into 5’-AMP
II. Adenylate cyclase combines with magnesium and ATP to form cyclic 3’,5’-AMP
III. Cyclic 3’,5’-AMP results in bronchial smooth muscle relaxation
IV. Beta-2 stimulation causes the formation of adenylate cyclase
a. I, II, III, IV c. IV, II, III, I
b. III, IV, I, II d. IV, III, II, I
ANS: C
The following order is correct: IV) Beta-2 stimulation causes the formation of adenylate cyclase. II)
Adenylate cyclase combines with magnesium and ATP (adenosine triphosphate) to form cyclic 3’,5’-
AMP (adenosine monophosphate). III) Cyclic 3’,5’-AMP results in bronchial smooth muscle
relaxation and hence bronchodilation. Cyclic 3’,5’-AMP is not a long-lived agent. It is readily broken
down by another enzyme present in the lungs called phosphodiesterase. I) Phosphodiesterase breaks
3’,5’-AMP down into 5’-AMP, which no longer causes bronchodilation.
PTS: 1
11. Release of acetylcholine will cause
a. bronchodilation. c. stimulation of cyclic 3’5’ AMP.
b. Mast cell stabilization. d. bronchospasm.
ANS: D
Cholinergic receptors are cells that respond when stimulated by acetylcholine. Cholinergic receptors
cause profound bronchospasm in the lungs when stimulated. Cholinergic receptors are found in the
parasympathetic nervous system.
PTS: 1
12. Which of the following is NOT an example of a sympathomimetic drug?
a. Salmeterol Xinafoate c. Pirbuterol Acetate
b. Formoterol fumarate d. Atropine Sulfate
ANS: D
Atropine sulfate is a anti-cholinergic bronchodilator. Salmeterol, formoterol, and pirbuterol are all
sympathomimetic bronchodilators.
PTS: 1
13. Which of the following sympathomimetic drugs are intended for maintenance therapy only?
I. Levalbuterol
II. Salmeterol
III. Formoterol
IV. Pirbuterol
a. II, III, and IV c. II and III
b. I and IV d. I, II, III, and IV
ANS: C
II) Salmeterol and III) Formoterol are intended for maintenance therapy only.
PTS: 1
14. A pediatric patient is admitted to the emergency department from a physician’s office with the
suspected diagnosis of croup. An inspiratory stridor is heard. Which aerosolized sympathomimetic
would you recommend to decrease the stridor?
, a. Racemic epinephrine c. Levalbuterol
b. Albuterol d. Isoproterenol
ANS: A
Racemic epinephrine (Vaponephrine) is a sympathomimetic drug. However, its alpha effects are
strong and it is commonly used to relieve croup and epiglottitis symptoms in children.
PTS: 1
15. Aminophylline causes bronchodilation by
a. stimulating the production of cyclic 3’5’ AMP.
b. blocking the parasympathetic nervous system.
c. inhibiting the enzyme phosphodiesterase.
d. causing Mast cell degranulation.
ANS: C
Aminophylline is a phosphodiesterase inhibitor. It is an example of drugs in the xanthine group.
Common phosphodiesterase drugs are found in the methylxanthine group. Cyclic 3’,5’-AMP is broken
down into 5’-AMP by the enzyme phosphodiesterase. If the action of phosphodiesterase can be
blocked or inhibited, more 3’,5’-AMP will remain in the lungs, resulting in better bronchodilation.
Phosphodiesterase inhibitors act in this way.
PTS: 1
16. Inhibition of the sympathetic nervous system would cause
a. bronchoconstriction.
b. stridor.
c. bronchodilation.
d. relaxation of the bronchial smooth muscle.
ANS: A
If the sympathetic nervous system is inhibited, it would cause bronchoconstriction.
PTS: 1
17. Which of the following drugs cause bronchodilation by inhibiting the effects of the parasympathetic
nervous system?
I. Atropine sulfate
II. Ipratropium bromide
III. Tiotropium bromide
IV. Terbutaline sulfate
a. I and IV c. I, II, III
b. II and III d. IV only
ANS: C
I) Atropine, II) ipratropium, and III) tiotropium are all examples of antocholinergic
bronchodilators (bronchodilators that work by blocking the parasympathetic nervous system).
Anticholinergic drugs block the cholinergic receptor sites, preventing that route of bronchospasm.
PTS: 1
18. Corticosteroids:
a. cause brondilation directly.
b. reduce inflammation.
c. stabilize Mast cells.
, d. should always be administered with a bronchodilator.
ANS: B
Corticosteroids are widely used in the management of the inflammatory process associated with
asthma, reactive airways disease, and other pulmonary disorders.
PTS: 1
19. A patient is ready to be discharged to her home. At home the patient has a compressor and a small
volume nebulizer. Which of the following corticosteroids is in solution and is intended to be
administered via a small volume nebulizer?
a. Prednisone c. Budesonide
b. Dexamethasone d. Triamcinolone
ANS: C
Budesonide (Pulmocort) is available as both an inhalant solution (0.25 mg/ mL once daily) and a dry
powder formulation (200 mcg/dose twice daily). In aerosol form, this anti-inflammatory medication
targets the lungs specifically with fewer side effects.
PTS: 1
20. Salmeterol and Fluticasone are combined into a DPI preparation. What is the purpose of these two
drugs combined?
a. Maintenance bronchodilation and Mast cell stabilization
b. Mucolysis and anti-inflammation
c. Bronchodilation by stimulating the sympathetic nervous system and inhibiting the
parasympathetic nervous system
d. Maintenance bronchodilation and anti-inflammation
ANS: D
Fluticasone propionate (Flovent) and salmeterol (Serevent) have been combined into a DPI preparation
containing 100 mcg of fluticasone propionate and 50 mcg of salmeterol. By taking both drugs together,
the long-term effects of both d) maintenance bronchodilation and anti-inflamation can be achieved.
PTS: 1
21. Which of the following drugs stabilize mast cells?
a. Ipratropium c. Albuterol
b. Cromolyn sodium d. Fluticasone
ANS: B
Cromolyn sodium is a prophylactic agent; it prevents mast cell degranulation. A patient must use the
drug on a regular basis to prevent acute bronchospastic episodes.
PTS: 1
22. Montelukast, Zarfirlukast, and Zileuton are all used as maintenance therapy for asthma. How
do they work?
a. They stabilize the Mast cells.
b. The cause bronchodilation.
c. They are mucolytics.
d. They are leukotriene inhibitors.
, 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?
, 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
, Chapter 01: Introduction to Respiratory Care Pharmacology
Gardenhire: Rau’s Respiratory Care Pharmacology, 11th 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
