pharm137 FINAL

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beractant

you are in the room of a 26-week gestational baby that has just been born. the newborn weighs 1200 g. on assessment you find the baby has poor color, substernal retractions, nasal flaring, RR of 45 breaths/min, and a HR of 140 beats/min. you note that the baby is difficult to ventilate using an AMBO bag. which of the following agents would you recommend?

phospholipids

sufactant is composed primarly of?

in vitro preparation

natural surfactant is obtained by all of the following methods except?

budesonide and formoterol

symbiocort is a combination of?

gluconeogenesis and increaded plasma glucose levels

steroids diabetes is term that describes?

-curosurf
-survanta
-infasurf

which of the following are natural surfactant preparations?

exogenous

the term used to describe surfactant produced outside of the patients body is?

poractant alfa

a newborn baby weighing 1000g exhibits symptoms of respiratory distress syndrome (RDS), including poor color, suprasternal retractions, nasal flaring, and desaturation. the therapist should recommend?

-instillation through side-port adapter
-instillation through catherter

which of the following are currently used methods for delivering surfactant into infants?

mast cells and eosinophils

the major cells responsible for an inflammatory response in asthma are?

pressure=(2xsurface tension)/radius

for an alveolus, LaPlace's law which states the relationships of the vessel radius, the internal pressure, and the surface tension, is written as?

-decreased activity of the imune system
-osteoporosis
-fluid retention and changes in the intergrity of the skin

systemic administration side effects of corticosteroids include?

tachycardia

all the following are hazards or complications of exogenous surfactants except?

-DPI
-MDI
_nebulizer solution

in what dosage form is/are corticosteroids available for use in the united states?

advair

the product combining an inhaled steroid and a bronchodilator is?

true

t or f
exogenous surfactant agents enters the alveolar pool and replace deficient natural surfactant. this explains why lung mechanics improve aftr only one or two administrations of exogenous surfactant.

true

t or f
natural corticosteroids are produced by the cortex of the adrenal gland.

osteoporosis

side effects of aerosolized steroids use include all of the following except?

-prophylaxis in very low birth weight (<1250g) infants
-prophylaxis in infants of hight birth weigh (>1250g) but with immature lungs
-rescue treatment in infants with respiratory distress syndrome

which of the following are approved indications for surfactant therapy?

glucocorticoids restore beta adrenergic response

the rational for giving an IV bolus of steroids in acute asthma that is not responding to beta adfrenergics is?

corticotropin-releasing factor

all of the following are types of corticosteroids produced in the adrenal cortex except?

oral candidiasis: is an infection of yeast fungi of the genus candida on the mucous membranes of the mouth

which of the following is very common side effect of inhaled corticosteroids?

dornase alfa

all the following are considered natural surfactants except?

beclomethasome MDI

your patient tells you that she is having chest tightness and wheezing for to six times per week, plus she wakes up with chest tightness and wheezing about once per week. she uses albuterol each time, with relief. she is taking no other medications, except her albuterol MDI. what other medications would you suggest be prescribed to her?

no indications for drug therapy at this time

you are in a room of a 36 week gestational baby that has just been born. the newborn weighs 2200g. on assessment you fine the baby has good color , no retractions, no nasal flaring, a respiratory rate (RR) of 25 beats/min, a heart rate (HR) of 110 beats/min, and pulse-ox of 96%on room air. which of the following would you choose?

begin the aerosol and begin to gradually taper off of the oral dose

a patient has been taking oral prednisone for 1 week followin a severe episode of asthma, in other to swtich to an aerosol corticosteroids?

to replace missing surfactant

which of the following is considered the mode of action for surfactant?

add a spacer and rinse the mouth after use

a patient complains of oral thrush and hoarseness since she has been using fluticasone by MDI. the physician asks you to make a suggestion to help her without discontinuing the drug. you suggest?

true

t or f
an allergic asthmatic normally has a higher eosiniphils count. after treatment with glucocorticoids the asthmatic will show a lower eosiniphil count.

true

t or f
natural corticosteroids enhance beta 2 receptor response and may provide pretection from beta 2 receptor tolerance to bronchodilator drugs.

neutrophils

in chronic obstructivepulmonary disease (COPD), the prmary inflammatory cells are?

-mediator cascade:histamine and chemoattractant factors are release at the side of injury, and various inflammatory mediators such as complement and arachidonic acid products are generated
-increased cascular premeability: an exudate 9any fluid that filters from the circulatory system into lesions or areas of inflammation) is formed in a surrrounding tissues
-leukocytic infiltration:white cells emigrate through capillary walls (diapedesis) in response to attractant chemicals (chemotaxis)
-phagocytosis: white cells and macrophages (in the lungs) ingest and process foreign material such as bacteria

the inflammatory process includes which of the following activities?

increased endogenous steroid production

use of systemic corticosteroids can cause all of the following except?

high surface tension of alveorlar liquid

lack of pulmonary surfactant in respiratory distress syndrome of the newborn results in?

lung inflation

a major stimulus for secretion of surfactant into the alveolus is?

-flunisolide
-azmacort
-QVAR

which of the following are examples of steroids available for inhalation?

detergent

another name for surface-active agents?

15 min. to 1 hour

the early phase of an asthmatic reaction occurs during what time frame?

HPA axis

a significant side effect of corticoteroid use is inhibition of?

false

t or f
prednisone is a corticoteroid that can be given as an aerosol:

osmotic diurectics

your patient is suffering from cerebral edema. which group of diurectic agents would you expect to be administered?

non-cardio specific Beta blockers

you are treating a patient who has severe asthma, which classificiation of drugs may pose some risk of bronchoconstriction and should be carefully utilized in patients with asthma and chronic obstructive pulmonary disease?

atropine and glycopyrollate

identify two drugs you could use prior to reversing the effect of a non depolarizing vagolytic drugs like vecuronium, in order to minimize unwanted muscarinic side-effects like bradycardia, peristalsis and salivation?

heparin

which of the following medications would be used to prevent thrombus formation in the legs?

false

t or f
succinylcholine is a long acting non-depolarizing neuromuscular agent.

true

t or f
vecuronium is almost entirely excreted by the kidneys, unlike other non-depolarizing neuromuscular agents that excrete metabolite byproducts through the bile as a route to the feces. accordingly vecuronium should not be given to patients with renal failure.

rate x SV

which of the following formulas is used to calculate the total amount of blood pumped by the heart per minute, or cardiac output?

true

t or f
physostigmine can cross the blood brain barrier

true

t or f
edrophonium is a short lived agent that reverses neuromuscular blockers.

narcan is an opiod receptor antagonist, the others are sympathomimetics

stimulant drugs are used to treat narcolepsy, ADHA,AOP or recreationally as when one drinks too much coffee to stay awake. how are these different from Narcan (naloxone) used to counter drug overdose?

true

t or f
morphine depresses rate and tidal volume, and will cause death by progressively suppressing the hypercapnic and hypoxic respiratory drives, with increasing overdose.

true

t or f
pyridostigmine is the longest acting agent that can reverse neuromuscular blockers. it is orally given for myasthenia gravis.

a life threatening drop in blood pressure

shock is?

true

t or f
a dangerous side effect of succinylcholine is that it causes hyperkalemia and consequent cardiac arrythmias, even cardiac arrest.

-epinephrine
-lidocaine
-atropine

which cardiac agent may be administered endotracheally?

induce sleep

a drug is termed a hypnotic medication when it is used to?

naloxone

which of the following is considered the antidote for opiate based analgesics such as morphine?

reduce anxiety

benzodiazepines are used to?

vecuronium

one major side effect of most non-depolarizing neuromuscular agents is that they cause the release of histamine, a potent bronchodilator. which one has no histamine release and can be safel used as a muscle relaxant for asthmatics?

false

t or f
there are multiple agents that reverse the effect of succinylcholine.

dopamine (intropin)

a patient is in cardiac shock with a blood pressure of 70/30. which of the following drugs would you recomment to help correct the hypotension?

lidocaine

which of the following is a drug of choice to treat frequent PVC's?

true

t or f
acetylcholinesterase is an enzyme that inactivates actylcholine. because acetylcholinesterase is itself blocked by neostigmine, the levels of acetylcholine increase and can compete with neuromuscular blockers. thus neostigmine can reverse neuromuscular blockers.

local anesthetics

pain control by blocking transmission of the pain impulse from the damaged area is achieved through the use of?

true

t or f
succinylcholine is contraindicated in patients with head trauma because it can elevate ICP.

antithrombitic medications

which of the following would be used to treat a patient having a stroke or coronary artery occulsion to break up the clot?

true

t or f
atracurium and cisatracurium should not be used in patients with cranial injury as their metabolite byproducts landanosine can cross the blood brain barrier and cause seizures.

true

t or f
reversing non depolarizing vagolytic agents causes other, muscarinic sites to be stimulated, causing bradycardia, peristalsis and salivation.

nitroprusside (nipride)

a patient has increased systemic vascular resistance resulting n hypertension. which of the following drugs would be used to treat this condition?

increase myocardial contractility

cardiac glycosides would?

diurectic

any substance that increases urine flow is termed a?

true

t or f
sedative drugs can also be used as hypnotics depending on the dose and strength of the drugs.

lidocaine

which of the following is not considered an intropic agent?

analgesics

morphine, codeine, dilaudid, demerol, and darvon are all examples of?

dobutamine

your patient is suffering from heart failure secondary to decreased contractillity and has a confirmed severe allergy to sulfites. which of the following inotropic medications would you NOT recomment?

increased strength of cardiac muscle contraction

which of the following is the desired result from medication that is classified as an inotropic drug?

increase heart rate and contractile force

beta 1 receptor stimulation will?

fluid

which of the following is considered the mainstay for improving hypotensive episodes?

dopamine

which of the following is the drug of choice for hypotension in the ICU setting and can be used to increase renal perfusion, cardiac contractillit and casoconstriction depending on the dose?

-hold the patients right arm in an up right position
-administer the dose quickly and follow with a saline flush

your patient requires a dose of adenosine for confirmed SVT. at present his only line is a peripheral IV in the right arm. how should you proceed?

decreased perfusion to vital organs

all of the following are considered common complications of hypertension except?

true

t or f
non depolarizing neuromuscular agents like pancuronium may cause a vagolytic effect producing tachycardia and increase MAP by unopposed sympathetic activity.

true

t or f
atracurium and cisatracurium self destruct with pH changes. these non depolarizing neuromuscular agents are advised for patients with kidney failure.

deep veins of the legs (DVT)

in a hospitalized patient suffering from a pulomnary embolus, where would the most likely site of the original clot formation occur?

depolarizing neuromuscular relaxant

succinylcholine is a?

atropine sulfate

which of the following drugs is indicated in cases of sinus bradycardia?

but do not block the sensation of pain

neuromuscular blocking agents cuase muscle paralysis?

male children under 12

succinylcholine is contraindicated for?

atropine

which agent is a parasympatholytic used in cardia resuscitation for asystole?

ventricular arrhythmias

lidocaine is used to treat?

timely/efficient CPR and defibrillation

the most important factor in the management of sudden cardiac death is?

-abnormal heart rhythms
-conduction problems
-location of damaged heat muscle

which of the following conditions are detected by the ECG?

cardiotonic in congestive heart failure

what is a primary use for digitalis drugs?

epinephrine

during a bronchoscopy with biopsy the patient starts to bleed. which of the following would be injected down the bronchoscope to stop the bleeding?

increase heart rate

atropine would be given to?

-heart rate
-AV conduction
-cardiac contractillity
-excitability

when stimulated. the sympthetic fibers cause an increase in the?

nicotinic and muscarinic

vagolytic agents competitively block post synaptic__________receptors.

ectopic beat

a heart beat that did not originate from the SA node is called?

-alpha
-beta1
-beta2

epinephrine stimulateds which site?

torsades de pointes

your patient is a 67 yr old homeless male who suffers from malnutrition. his labs show that he suffers from hypomagnesemia. what arrhythmia should you be on the lookout for until a dose of magnesium can be administered?

tablet

cromolyn sodium is avaiable in all of the following except?

antifungal agent

pentamidone is a?

aminoglycosides

tobramycin is a member of which antibiotic group?

-inhaled aerosol
-intramuscular injection
-intravenously

pentamidine can be admisistered by which of the following routes?

false

t or f
TOBI is usually inhaled after other medications like bronchodilators and alpha dornase, but could also be given in the same nebulizer with alph dornase.

uncomplicated influenza

zanamivir would be indicated for?

respirgard II

pentamidine is administered by aerosol with which nebulizer?

controllers

nonsteroidal antiasthma drugs are?

nasal congestion

the most commonly reported side effect of cromolyn sodium is?

-wheezing
-coughing
shortness of breath
-bad taste
-spontaneous pneumothorax

local airway side effects of aerosolized pentamidine inculde which of the following?

singular

the only antileukotriene agent currently approved for use in pedicatric patients is?

-zafirlukast
-zilenton
-montelukast

which of the following are antileukotrienes?

acetylcysteine

aerosolized antibiotics should not be mixed in the same nebulizer preparation with which of the following drugs?

small particle aerosol generator (SPAG)

which type of aerosol device must be used for the delivery of Ribavirin to infants with RSV pneumonia?

intal

the brand name for cromolyn sodium is?

antiviral agent

relenza is a?

chloride

it has been suggested that intal and tilade are effective as antiinflammatory agents by blockiing transport of what ion into inflammatory cells?

gram negative infections

the aminoglycoside antibiotics are effective in treating?

-pancreatis
-conjunctivitis
-neutropenis
-renal insufficiency
-rash

systemic side effects of aerosolized pentamidine can include which of the following?

as an alternative to, or in combinations with, inhaled steroids

what is the clinical indication for use of leukotriene modifiers, such as montelukast, in asthma?

omalizumab

which of the following is a monoclonal antibody used the treat asthma?

-theophylline
-warfarin

zileuton interacts with which of the following respiratory care drugs?

-the RT should be careful not the expose themselves to the medication exhaled
-care should be taken to prevent the aerosolized medciation from entering the machine of a mechanically ventilated patient
-an antibiotic should not be givien in the same nebulizer as mucomyst
-the patient should be monitored carefully for any adverse drug reaction

when delivering aerosolized antibiotic medication to a patient which of the following are precauseions taht should be taken?

zanamivir

which of the following drugs is avaliable in a DPI?

leukotriene receptors antagonist

zafirlukast is a?

300 mg, once every 4 weeks

the approved dose of pentamidine by aerosol for prevention of pneumocystis carinii pneumonia (PCP) is?

prevent RSV infections

RSV-IGIV would be used to?

pretreatment with an aerosolized beta agonist

inhalation of nebulized tobramycin is associated with an increase in airway reactivity (bronchospasm). what would be the recommended method to avoid this problem?

extrinsic

which type of asthma is associated with allergic reactions?

false

t or f
antileukotrienes are more effective and broader antiinflammatory drugs for use in asthma than corticosteroids.

RespiGam

a drug that is used to prevent serious lower respiratory tract infections with RSV in children under 24 months of age is?

trimethoprim-sulfamethoxazole

what antimicrobial agent has been given orally in the treatment of pneumocystis jirovecii?

-increased mucus serection
-inhibition of normal ciliary action
-increased airway edema
-bronchoconstriction
-recruitment of other inflammatory cells into airways

leukotrienes exhibit which of the following effects?

MDI

nedocromil sodium is administered by?

-bronchiolitis
-pneumonia

respiratory syncytial virus (RSV) can cause which of the following?

ribavirin

when treating an infant for RSV pneumonia, which of the following medications are used?

virostatic

ribavirin is classified as a?

cystic fibrosis

the disease that aerosolized antibiotics have been most consistently used for is?

pseudomonas aeruginosa

which of the following pulmonary infections occuring in cystic fibrosis patients is often treated with aerosolized antibiotics?

20 mg four times per day

the usual dose of nebulized cromolyn sodium is?

-sensory neurons
-mast cells
-airway epithelial cells
-eosinophils

tilade is effective as an antiinflammatory by inhibiting activation and activity of which of the following?

-influenza virus
-RSV
-herpes simplex virus

ribavirin is active against which of the following?

20mg/ml nebulized for 12 to 18 hours per day for 3-7 days

the normal dose of ribavirin administration is?

penatmidine

which of the following microbial agents is used for treatment of pneumocystis caranii pneumonia in AIDS patients?

effective in more than 90% of patients

advangates to the use of antileukotrienes include all of the following except?

true

t or f
in mild to moderate asthma, antileukotriends improve lung function, reduce the need for rescue beta agonists and in moderate to severe asthma there is an additive effect that lowers the need for steroids.

prophylactic management of mild presistant asthma

the general indication for clinical use of nonsteroidal antiasthma agents is?

jet shearing

the small particle aerosol generator (SPAG) unit opertates on what principle?

inhibiting mast cell degranulation

cromonly sodium is effective in preventing bronchospasms by?

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