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?
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?
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
-fluid retention and changes in the intergrity of the skin
systemic administration side effects of corticosteroids include?
in what dosage form is/are corticosteroids available for use in the united states?
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.
-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?
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?
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?
t or f
an allergic asthmatic normally has a higher eosiniphils count. after treatment with glucocorticoids the asthmatic will show a lower eosiniphil count.
t or f
natural corticosteroids enhance beta 2 receptor response and may provide pretection from beta 2 receptor tolerance to bronchodilator drugs.
-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?
which of the following are examples of steroids available for inhalation?
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?
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?
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?
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.
t or f
pyridostigmine is the longest acting agent that can reverse neuromuscular blockers. it is orally given for myasthenia gravis.
t or f
a dangerous side effect of succinylcholine is that it causes hyperkalemia and consequent cardiac arrythmias, even cardiac arrest.
which of the following is considered the antidote for opiate based analgesics such as morphine?
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?
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?
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.
pain control by blocking transmission of the pain impulse from the damaged area is achieved through the use of?
t or f
succinylcholine is contraindicated in patients with head trauma because it can elevate ICP.
which of the following would be used to treat a patient having a stroke or coronary artery occulsion to break up the clot?
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.
t or f
reversing non depolarizing vagolytic agents causes other, muscarinic sites to be stimulated, causing bradycardia, peristalsis and salivation.
a patient has increased systemic vascular resistance resulting n hypertension. which of the following drugs would be used to treat this condition?
t or f
sedative drugs can also be used as hypnotics depending on the dose and strength of the drugs.
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?
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?
t or f
non depolarizing neuromuscular agents like pancuronium may cause a vagolytic effect producing tachycardia and increase MAP by unopposed sympathetic activity.
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?
timely/efficient CPR and defibrillation
the most important factor in the management of sudden cardiac death is?
-abnormal heart rhythms
-location of damaged heat muscle
which of the following conditions are detected by the ECG?
during a bronchoscopy with biopsy the patient starts to bleed. which of the following would be injected down the bronchoscope to stop the bleeding?
when stimulated. the sympthetic fibers cause an increase in the?
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?
pentamidine can be admisistered by which of the following routes?
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.
shortness of breath
local airway side effects of aerosolized pentamidine inculde which of the following?
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?
it has been suggested that intal and tilade are effective as antiinflammatory agents by blockiing transport of what ion into inflammatory cells?
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?
-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?
300 mg, once every 4 weeks
the approved dose of pentamidine by aerosol for prevention of pneumocystis carinii pneumonia (PCP) is?
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?
t or f
antileukotrienes are more effective and broader antiinflammatory drugs for use in asthma than corticosteroids.
a drug that is used to prevent serious lower respiratory tract infections with RSV in children under 24 months of age is?
what antimicrobial agent has been given orally in the treatment of pneumocystis jirovecii?
-increased mucus serection
-inhibition of normal ciliary action
-increased airway edema
-recruitment of other inflammatory cells into airways
leukotrienes exhibit which of the following effects?
which of the following pulmonary infections occuring in cystic fibrosis patients is often treated with aerosolized antibiotics?
-airway epithelial cells
tilade is effective as an antiinflammatory by inhibiting activation and activity of 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?
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?
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?