Question 1

Which of the following medications is the only drug that inhibits 5-lipoxygenase?&#10;A) Montelukast&#10;B) Omalizumab&#10;C) Zafirlukast&#10;D) Zileuton

Accepted Answer

Zafirlukast and montelukast act by selectively antagonizing leukotriene binding to its cellular receptor, CysLT1, which prevents a cascade that leads to constriction of bronchial smooth muscle. Zileuton acts as a potent and selective inhibitor of leukotriene formation by inhibiting 5-lipoxygenase, the enzyme responsible for converting arachidonic acid to the cysteinyl leukotrienes.

Question 2

Which of the following effects constitute adverse reactions to dornase alfa (Pulmozyme)?
I) Chest pain
II) Pharyngitis
III) Rash
IV) Hypovolemia

A) I and IV only
B) I, II, and III only
C) I, III, and IV only
D) II, III, and IV only

Accepted Answer

Common adverse events have included voice alteration, pharyngitis, laryngitis, rash, and chest pain. Other less common adverse events include respiratory symptoms, flu syndrome, malaise, hypoxia, and weight loss.

Question 3

Which of the following benefits have been associated with the use of inhaled tobramycin?
I) Improvement of FEV₁
II) Treats Pseudomona aeruginosa infection
III) Treats Burkholderia cepacia infection
IV) Reduction in parenteral use of antibiotics

A) I and IV only
B) I, II, and III only
C) I, III, and IV only
D) I, II, III, and IV

Accepted Answer

Use of nebulized tobramycin can improve FEV₁ by 7.8% to 12% in CF patients and potentially eradicate P. aeruginosa from the respiratory tract in early colonization and young patients. Several clinical studies have also shown a reduction in hospitalizations for acute exacerbations as have demonstrated benefits of parenteral use of antipseudomonal antibiotics in CF patients with varying degrees of disease severity.

Question 4

Which of the following responses are considered adverse effects of inhaled corticosteroids?
I) Oropharyngeal candidiasis
II) Tachycardia
III) Wheezing
IV) Dysphonia

A) I and II only
B) II and III only
C) II and IV only
D) I, III, and IV only

Accepted Answer

A majority of side effects attributed to corticosteroids are primarily seen with systemic therapy and not inhalational therapy. Following corticosteroid inhalation, local adverse events include oropharyngeal candidiasis, dysphonia, cough, wheezing, and dry throat. The dysphonia appears to be a direct effect of the steroid on the musculature that controls the vocal cords.

Question 5

How long should a patient wait to receive the maximal benefit of inhaled corticosteroids?&#10;A) 48 hours&#10;B) 5 days&#10;C) 1 to 2 weeks&#10;D) 1 month

Accepted Answer

Maximal benefit may not be achieved for 1 to 2 weeks or longer after starting treatment.

Question 6

Which of the following adverse effects is likely to be experienced by patients who use nonselective $\beta$2-adrenergic agonists?&#10;A) Tremor&#10;B) Tachypnea&#10;C) Bradycardia&#10;D) Blurred vision&#10;

Accepted Answer

The most common adverse effects observed with the use of selective agents are tremors caused by stimulation of the $\beta$2-receptors in skeletal muscle, which is less likely with inhalational therapy than with parenteral or oral therapy. Tachycardia and vasodilatation are observed when â-receptors are stimulated on the heart and peripheral vasculature. On initiation and with high-dose treatment, a reduction of serum potassium concentrations can also be seen.

Question 7

The physician asks the therapist to recommend a long-acting $\beta$-agonist for a 13-year-old patient. Which of the following medications should the therapist recommend?&#10;A) Levalbuterol&#10;B) Formoterol&#10;C) Albuterol&#10;D) Terbutaline&#10;

Accepted Answer

Formoterol is indicated for long-term, twice daily (morning and evening) administration in the maintenance treatment of asthma and prevention of bronchospasm in adults and children 5 years of age and older. Formoterol is available as a single agent in a hard gelatin capsule containing a dry powder blend of 12 mcg of formoterol and 25 mg of lactose that is intended for oral inhalation only. Should use caution in patients with severe milk protein allergy. Formoterol is also available in a solution for nebulization and in an MDI in combination with budesonide approved for use in patients 12 years of age and older.

Question 8

Which of the following medications works to maintain the integrity of the mast cell?&#10;A) Ipratropium bromide&#10;B) Magnesium sulfate&#10;C) Cromolyn sodium&#10;D) Methylprednisolone

Accepted Answer

Although the complete mechanism of action of cromolyn is unknown, it does inhibit mast cell degranulation after exposure to antigens, therefore blocking the release of histamine and leukotrienes. These actions serve to inhibit the early asthmatic response through stabilization of the mast cell membrane. Cromolyn has no intrinsic bronchodilator, antihistaminic, anticholinergic, or vasoconstrictor activity.

Question 9

Which of the following side effects are consistent with dose-related toxicities of theophylline?
I) Nausea
II) Vomiting
III) Bradycardia
IV) Central nervous system stimulation

A) IV only
B) II and III only
C) I, III, and IV only
D) I, II, and IV only

Accepted Answer

The use of theophylline to treat chronic childhood asthma is problematic due to potentially serious short-term and long-term adverse events. Dose-related acute toxicities include tachycardia, nausea, vomiting, supraventricular tachycardia, central nervous system stimulation, seizures, headache, and electrolyte disturbances. Adverse events seen at therapeutic serum concentrations include insomnia, gastric upset, and hyperactivity.

Question 10

Which of the following medications is an effective adjunctive therapy in relieving bronchospasm in patients with acute bronchospasm when combined with albuterol?&#10;A) Formoterol&#10;B) Salmeterol&#10;C) Metaproterenol&#10;D) Ipratropium bromide&#10;

Accepted Answer

Aerosolized ipratropium is not sufficiently effective to be used as a single agent in the treatment of acute bronchospasms. When administered to children with severe asthma exacerbations, multiple doses of ipratropium and a $\beta$-agonist reduced the number of hospitalizations and improved overall lung function.

Question 11

Which of the following effects is related to the activation of $\beta$-adrenergic receptor sites?&#10;A) Activation of guanyl cyclase&#10;B) Skeletal muscle contraction&#10;C) Bronchial smooth muscle relaxation&#10;D) Release of inflammatory mediators&#10;

Accepted Answer

The answer of Which of the following effects is related...

Question 12

Which of the following medications is a humanized monoclonal antibody with neutralizing activity against the F protein use for the treatment of RSV?&#10;A) Palivizumab&#10;B) Ribavirin&#10;C) Omalizumab&#10;D) Aclidinium bromide

Accepted Answer

The answer of Which of the following medications is a...

Question 13

Which of the following agents should be considered in the rapid-sequence intubation of patients with status asthmaticus?&#10;A) Atropine&#10;B) Magnesium sulfate&#10;C) Albuterol&#10;D) Ketamine

Accepted Answer

The answer of Which of the following agents should be...

Question 14

When should the therapist administer short-acting bronchodilators to improve penetration of inhaled antibiotics?&#10;A) Immediately after the antibiotic&#10;B) No more than 4 hours after administration of the antibiotic&#10;C) 15 minutes and 4 hours before each dose&#10;D) At the same time as the administration of the antibiotic

Accepted Answer

The answer of When should the therapist administer short-acting bronchodilators...

Question 15

Which of the following statements accurately describes levalbuterol?&#10;A) It is composed of the (S)-isomer of albuterol.&#10;B) It is composed of the (R)-isomer of albuterol.&#10;C) A dose of 0.63 mg is equipotent to 0.63 mg of racemic albuterol.&#10;D) The (S)-isomer possesses a longer duration of action.

Accepted Answer

The answer of Which of the following statements accurately describes...

Question 16

A patient with status asthmaticus has been admitted to the emergency department. The physician would like to try a $\beta$ 2-agonist that can be administered parenterally. Which of the following drugs should the therapist suggest?

A) Terbutaline
B) Levalbuterol
C) Epinephrine
D) Salmeterol

Accepted Answer

The answer of A patient with status asthmaticus has been...

Question 17

Nebulized pentamidine should be administered in a negative pressure room and through which of the following nebulizer systems?&#10;A) Pari LC Plus&#10;B) Nebutech&#10;C) Respirgard II&#10;D) SPAG

Accepted Answer

The answer of Nebulized pentamidine should be administered in a...

Question 18

Which of the following medications is a recombinant humanized monoclonal anti-IgE antibody use for the treatment of severe persistent asthma?&#10;A) rhDNase&#10;B) RespiGam&#10;C) Omalizumab&#10;D) Palivizumab&#10;

Accepted Answer

The answer of Which of the following medications is a...

Question 19

While working at the bedside of a small child who has myasthenia gravis, the therapist notices a new medication order prescribing glycopyrrolate for the control of secretions. The ordered dosage route is intramuscular and intravenous dosage is 5 mcg/kg every 3 to 4 hours. What should the therapist do at this time?

A) Inform the nurse that this medication is contraindicated for patients with myasthenia gravis.
B) Inform the nurse that the dose is incorrect.
C) Inform the nurse that this medication is contraindicated in children.
D) Mention nothing because the prescription is correct.

Accepted Answer

The answer of While working at the bedside of a...

Question 20

Which of the following medications is most suited for the treatment of postextubation edema?&#10;A) Racemic epinephrine&#10;B) Ephedrine&#10;C) Norepinephrine&#10;D) Fluticasone

Accepted Answer

The answer of Which of the following medications is most...

Deck 20: Pharmacology