Exam: Pulmonary Pharmacology: Delivery Devices and Medications
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Select the best answer to each of the following items.

1. Epinephrine, isoproterenol, and isoetharine are part of which class of Beta adrenergic medications?
  1. resorcinols
  2. saligenins
  3. catecholamines
  4. none of the above
2. _______ is the only major side-effect of aerosolized steroids.
  1. tachycardia
  2. occasional renal failure in elderly patients
  3. a fungal infection of the oropharynx
  4. transient tachypnea
3. _______ is the actual content of water vapor in a gas measured in milligrams per liter.
  1. absolute humidity
  2. potential humidity
  3. relative humidity
  4. effective humidity
4. Stimulation of _______ results in lipolysis, an increase in heart rate and force of contraction.
  1. Alpha receptors
  2. Beta1 receptors
  3. Beta2 receptors
  4. all Beta receptors
5. The primary use for _______ is for vasoconstriction and upper airway decongestion, with specific indications for use being laryngeal edema, laryngotracheobronchitis, croup, and for post-extubation glottic edema.
  1. ephedrine
  2. theophylline
  3. racemic epinephrine
  4. epinephrine
6. Bronchodilation can be accomplished by _______.
  1. through SNS stimulation and increased production of cAMP
  2. by decreasing the destruction of cAMP through inhibition of phosphodiesterase
  3. by decreasing the bronchoconstricting influence of the PNS
  4. all of the above
7. It is important to remember that _______ deliver considerably less medication than MDIs, with fully two-thirds to three-fourths of the medication being lost on expiration alone.
  1. DPIs
  2. USNs
  3. SPAGs
  4. SVNs
8. If the upper airway were bypassed or dry gases were inhaled, a chain reaction of events would take place causing adverse reactions such as _______.
  1. impairment of ciliary activity
  2. slowing of mucus movement
  3. atelectasis
  4. all of the above
9. Isoproterenol is a very strong Beta1 and Beta2 stimulant and an effective bronchodilator, but _______, it is rarely used for bronchodilation today.
  1. due to its cost
  2. because it can cause kidney failure
  3. because of the probability of tachycardia
  4. because effective use requires such high doses
10. _______ belongs to a group of vegetable organic compounds known as xanthines and is commonly used for the relief and prevention of bronchospasm.
  1. Theophylline
  2. Fenoterol
  3. Pirbuterol
  4. Bitolterol
11.Metaproterenol, terbutaline, and fenoterol are all part of which class of Beta Adrenergic medications?
  1. catecholamines
  2. resorcinols
  3. saligenins
  4. none of the above
12. Which of the following is a side effect of Beta adrenergic agonists?
  1. tachyphylaxis
  2. skeletal muscle tremor
  3. increase in heart rate and force of contraction
  4. all the above
13. Prednisolone is a _______ that is rarely aerosolized, has anti-inflammatory potency 3-4 times that of hydrocortisone but it takes longer to reach its peak effect, so the route of administration is oral or parenteral.
  1. beta adrenergic bronchodilator
  2. xanthine
  3. steroid
  4. synthetic steroid
14. With prolonged use, steroids _______, so patients have to be weaned slowly to begin proper functioning again.
  1. lead to adrenal insufficiency
  2. activate circulating antibodies
  3. cause lowered blood pressure
  4. all the above
15. Cromolyn sodium and nedocromil sodium are prophylactic drugs known as _______.
  1. mediator modifiers
  2. mucolytics
  3. proteolytics
  4. xanthines
16. ______________ cause contraction of the muscle fibers of the arterioles and small arteries, triggering a reduction of blood flow to the affected area and lowering of hydrostatic pressure that permits fluid to move into the tissues.
  1. bronchodilators
  2. decongestants
  3. mucokinetics
  4. none of the above
17. Particles between _______ microns are optimal in size for depositing in the bronchi, trachea and pharynx.
  1. .005 and .5
  2. .5 and 1.5
  3. 2 and 5
  4. 6 and 10
18. _______ is the maximum amount of water vapor that a gas can hold at a given temperature.
  1. absolute humidity
  2. potential humidity
  3. relative humidity
  4. effective humidity
19. Variables necessitating an increase in Theophylline dosage are:
  1. liver congestion or disease
  2. marked obesity
  3. fever
  4. high caffeine intake
20. If an SVN is being used inline with a ventilator circuit, _______.
  1. the patients receive optimum amount of the aerosol
  2. flows should be decreased
  3. the aerosol delivery needs to be increased
  4. the aerosol delivery should be decreased
21. _______ has been used in some patients because it is considered safer than intravenous beta-adrenergic agonists for status asthmaticus.
  1. PEEP
  2. continuous nebulizer therapy (CNT)
  3. Theophylline
  4. DPI
22. _______ inactivates cAMP thereby removing its bronchodilating influence.
  1. aerosolizing
  2. the enzyme adenylate cyclase
  3. the enzyme phosphodiesterase
  4. Theophylline
23. Many hospitals have converted SVN patients to _______ in an effort to decrease costs with no loss in effectiveness.
  1. USN
  2. IPPB
  3. DPI
  4. MDI
24.A _______ is a humidification device that uses a conduction system that allows the gas to be introduced into the water below its surface.
  1. bubble diffusion device
  2. blow–by humidifier
  3. jet humidifier
  4. heated humidifier
25. _______, like leukotrienes, are arachadonic acid derivatives that cause bronchospasm.
  1. Prostaglandins
  2. Xanthines
  3. Thromboxanes
  4. Antimuscarinics
26. _______ is recommended for use with COPD patients having a bronchospastic component to their disease, and should be delivered prior to a Beta agonist for best results.
  1. Albuterol
  2. Pirbuterol
  3. Ipratropium
  4. Budesonide
27. _______, through stimulation of a receptors, cause vasoconstriction and decrease fluid in the airway.
  1. mucolytics
  2. decongestants
  3. expectorants
  4. Xanthines
28. _______ is a physiologically inert substance found in many aerosol preparations, and it is used as a solvent and stabilizing agent.
  1. Propylene glycol
  2. Cytokine
  3. Antioxidant
  4. Nitric oxide
29. _______ is an orally administered expectorant that achieves its action through stimulation of the vagusnerve which, in turn, stimulates the submucosal bronchial glands to produce more serous fluid.
  1. Hydrocodone
  2. Diphenhydramine
  3. Super Saturated Potassium Iodide (SSKI)
  4. Codeine
30. Cloxacillin, dicloxacillin, methicillin, nafcillin, and oxacillin are all _______.
  1. "broad-spectrum" semisynthetic penicillin derivatives that are given for gram negative microorganisms
  2. part of a subgroup of the penicillins that is resistant to penicillinase
  3. substitutes for penicillin G when it has been proven effective
  4. all the above

31. _______ have become increasingly popular because this delivery system is relatively inexpensive, and does not require the hand-breath coordination required of metered dose inhalers.

  1. SPAGs
  2. DPIs
  3. SVNs
  4. USNs
32. Agitation can cause catecholamine release and produces auto-PEEP in ventilator patients, but the problem of imbalance between 02 delivery and 02 consumption can be prevented by administering ____.
  1. Haloperidol (Haldol)
  2. Progesterone
  3. Doxapram
  4. all the above
33.Which of the following statements is NOT true?
  1. regarding aerosol therapy, the patient (in most instances) must be capable of taking a coordinated, deep breath.
  2. aerosol delivery provides topical administration for a rapid therapeutic effect.
  3. actual delivery of the drug is erratic when aerosolized.
  4. with most aerosol delivery systems, a the proportion of the drug actually retained in the lung usually 60-70%.
34. _______ delivery is reserved for the patient who is not capable of taking deep, coordinated breaths.
  1. IPPB
  2. centrifugal room nebulizer
  3. USN
  4. Babbington nebulizer
35. ______ is the amount of water vapor in a gas as compared to the maximum amount possible, expressed as a percentage.
  1. absolute humidity
  2. potential humidity
  3. relative humidity
  4. effective humidity
36. According to _______, the volume of a gas increases as its temperature increases.
  1. the law of gravity
  2. Charles’ law
  3. Moles’ law
  4. all the above
37. _______ significantly decreases pulmonary artery pressure, decreases shunting and improves PaO2, however, it can be lethal being a toxic component of air pollution.
  1. Alveofact
  2. Virazole
  3. Pentamidine
  4. nitric oxide

       

38. ________ is the drug of choice for aspergillosis, candidiasis, coccidioidomycosis, eryptocoecosis, histoplasmosis, mucormycosis, North American blastomycosis, and sporotrichosis.

  1. Gentamicin
  2. Kanamycin
  3. Amphotericin B
  4. Tobramycin
39._______ is a highly specialized jet-type aerosol generator designed to for administering ribavirin (Virazole)
  1. centrifugal room nebulizer
  2. USN
  3. SPAG
  4. the Babbington nebulizer
40. _______ decreases systemic and pulmonary vascular resistance, decreases blood pressure, increases stroke volume, increases cardiac output, and increases heart rate.
  1. Prostaglandin E1
  2. Pentamidine Isoethionate
  3. Amphotericin B
  4. Dextromethorphan
41.A patient has bronchospasm and thick, tenacious secretions. The physician asks the RCP to deliver an aerosolized bronchodilator. Which of the following bronchodilators would NOT BE INDICATED in this situation?
  1. Isoproterenol
  2. Epinephrine
  3. Atropine
  4. Metaproterenol
42. A patient is receiving isoproterenol to treat his bronchospasm. Two hours after his aerosol treatment, the bronchospasm returns. Which bronchodilator should the RCP suggest?
  1. Isoetharine
  2. Racemic epinephrine
  3. Epinephrine
  4. Metaproterenol
43. A patient is receiving ultrasonic therapy. The RCP is asked to recommend the solution for nebulization which will cause the least amount of mucosal irritation. Which fluid should the therapist suggest?
  1. Half-normal saline (0.45%)
  2. Hypertonic saline (10%)
  3. Propylene glycol 10%
  4. Sterile water
44. 40% ethanol would be most appropriate in the treatment of _______.
  1. chronic bronchitis
  2. cor pulmonale
  3. pulmonary edema
  4. status asthmaticus
45. A patient is most likely to receive which of the following drugs to treat the premature ventricular contractions as seen on his ECG?
  1. Dopamine
  2. Lidocaine
  3. Digitalis
  4. Atropine
46. How many grams of active ingredient are in 0.5 ml of 1:100 epinephrine?
  1. 5 grams
  2. .0005 grams
  3. .002 grams
  4. 2 grams
47. What percent solution is given when the physician orders a 1:10,000 epinephrine solution?
  1. .5%
  2. .1%
  3. 10%
  4. .01%
48. How many milliteters of solution must be given if an order is for 4 drops of 2.25 Vaponephrine?
  1. 0.5 ml
  2. 0.2 ml
  3. ml
  4. 0.15 ml
49. Which of the following statements best describes the term aerosol?
  1. particulate matter suspended in a gas >
  2. particulate matter vaporized into a gas
  3. particulate molecules in a gaseous form
  4. molecular particles of hygroscopic substances
50. A piezoelectric transducer _______.
  1. measures % relative humidity
  2. is an efficient heating element for producing a heated aerosol
  3. is part of a Babington nebulizer
  4. transforms electrical impulses to sound waves
51. If aerosol therapy is effective, it will _______.
  1. restore and maintain mucus blanket continuity
  2. promote expectoration
  3. decrease the work of breathing
  4. all the above
52. A mainstream jet instrument with a solution reservoir capacity of greater than 250 ml is called a(an)__________.
  1. small volume jet nebulizer
  2. reservoir nebulizer
  3. hydronamic nebulizer
  4. metered-dose nebulizer
53. Aerosol particles between _____ microns are trapped in the nose and the mouth.
  1. 0.25-0.5
  2. 0.6-1.5
  3. 2-5
  4. 6-100
54. If the water vapor capacity at 22° is 19.42 mm H2O/L and RH = 50%, then absolute humidity is ____.
  1. cannot be calculated
  2. 9.71 mg H2O/L
  3. mg H2O/L
  4. 27.84 mg H2O/L
55. An atomizer is a _______.
  1. type of jet humidifier
  2. type of jet nebulizer
  3. jet instrument without a baffle
  4. sidestream nebulizer
56. Alveolar water vapor pressure is _____ mm Hg at 37° C.
  1. 28
  2. 35
  3. 47
  4. 52
57. The water added to inspired gas from the mucosal lining demonstrates the phenomenon of _____.
  1. saturation
  2. evaporation
  3. oxidation
  4. transforms electrical impulses to sound waves
58. The jet nebulizer utilizes _______.
  1. the Babington principle
  2. Bernoulli's principle
  3. bubble diffusion
  4. centrifugal force
59. As the temperature of a gas sample decreases, the water vapor pressure will _______.
  1. only change with atmospheric pressure changes
  2. stay the same
  3. decrease
  4. increase
60. The most common bacteria found in reservoirs of aerosol generating equipment are _______.
  1. gram + cocci
  2. gram - cocci
  3. gram - bacilli
  4. acid-fast bacilli
61. As the temperature of a gas decreases, the water vapor capacity will _______.
  1. increase
  2. decrease
  3. remain unchanged
  4. only change if pressure changes
62. Aerosolized steroids are prescribed to _______.
  1. enhance expectoration
  2. improve cough effectiveness
  3. provide topical anti-inflammatory action
  4. dilute and rehydrate inspissated secretions
63. Patients who require prednisone may have _______.
  1. asthma
  2. pulmonary edema
  3. atelectesis
  4. empyema
64. Most expectorants work by _______.
  1. medullary stimulation
  2. activation of vagal gastric reflex
  3. inhalation of volatile agents
  4. CNS stimulation
65. The fastest parenteral method of drug administration is _______.
  1. intramuscular
  2. intravenous
  3. topical
  4. subcutaneous
66.Cyclic AMP is metabolized by the enzyme _______.
  1. adenylcyclase
  2. cholinesterase
  3. phosphodiesterase
  4. carbonic anhydrase
67. Which of the following drugs is the best choice for treating a fungal infection?
  1. nystatin
  2. penicillin
  3. tetracycline
  4. polymixin
68. The cheapest and most effective mucokinetic is _____.
  1. H2O
  2. NaCl
  3. mucomyst
  4. alcohol
69. Bronchospasms can be treated pharmacologically by all of the following EXCEPT:
  1. sympathomimetics
  2. anticholinergics
  3. antibiotics
  4. catecholamines
70. Sodium bicarbonate is _______.
  1. a surface-active agent
  2. a thiol
  3. an enzyme
  4. a wetting agent
71. For which of the following conditions would you use respiratory stimulants?
  1. chronic ventilatory failure
  2. acute ventilatory failure
  3. pulmonary edema
  4. chronic bronchitis
72. _______ is an antituberculosis drug.
  1. Polymixin
  2. Cephalosporin
  3. Isoniazid
  4. Penicillin
73. Antitussives are used to treat _______.
  1. cystic fibrosis
  2. dry hacking coughs
  3. wheezing
  4. upper airway narrowing
74. The antibiotic is available in 50,000 unit/ml strength. How many mls of an antibiotic are required for a 100,000 unit dose?
  1. 1.5 ml
  2. ml
  3. 2.0 ml
  4. ml
75. A patient receives isoproterenol during his second day at the hospital but fails to get the same response he got the first time he received the drug. This patient may be experiencing _______.
  1. tachyphylaxis
  2. cumulation
  3. potentiation
  4. synergism

76. _______ facilitate loosening and mobilization of secretions.

  1. Decongestants
  2. Mucokinetics
  3. Bronchodilators
  4. Antivirals
77. The principle site of metabolism of drugs is the _______.
  1. kidney
  2. liver
  3. pancreas
  4. stomach
78. _______ is known as a pro-drug, meaning that the administered form must be converted in the body to become an active drug.
  1. Fenoterol
  2. Pirbuterol (Maxair)
  3. Bitolterol (Tornalate)
  4. Albuterol
79. _______ represents a new generation of long-acting beta2 specific bronchodilators whose pharmakinetics provide for a slower onset and time to peak effect, and a longer duration of action than seen in other adrenergic agents.
  1. Isoproterenol (Isuprel)
  2. Metaproterenol (Metaprel)
  3. Terbutaline (Bricanyl)
  4. Salmeterol Xinafoate (Serevent)
80. Dopamine, epinephrine, isoproterenol, norepinephrine, and isoetharine are all examples of _______.
  1. Resorcinols
  2. Catecholamines
  3. Saligens
  4. Xanthines
81. The term _______ refers to the concentration or dose a drug producing 50% of that drug's maximal response.
  1. TI ratio
  2. half-life
  3. peak effectiveness
  4. potency
82. Besides its use for bronchodilation, _______ has been shown to increase patient's minute volume by improving contractility of a normal or fatigued diaphragm.
  1. theophylline
  2. bitoterol
  3. isoetherine
  4. salmeterol xinafoate
83. One of the major therapeutic effects seen with analogues of natural adrenal cortical hormone hydrocortisone is _______.
  1. a hydrating action
  2. an antiinflammatory action
  3. a decongesting action
  4. all the above
84. Aerosol corticosteroid therapy is currently considered clinically indicated for:
  1. control of asthma
  2. treatment of related steroid-responsive bronchospastic states not controlled by other therapies
  3. control of seasonal allergic or non-allergic rhinitis
  4. all the above
85. _______ is part of androstane analogues which has a very weak HPA inhibitory activity, but high antiinflammatory effect.
  1. Hydrocortisone
  2. Predisone
  3. Fluticasone
  4. Dexamethasone
86. Because _______ becomes active only after being converted in the liver, it is completely ineffective as an aerosol.
  1. budesonide
  2. prednisone
  3. fluticasone
  4. flunisolide
87. The _______ represents the safety margin for a drug.
  1. maximal response
  2. half-life
  3. potency
  4. therapeutic index
88. In treating patients with more severe respiratory ailments, caregivers test several combinations of dosage and frequency to arrive at what seems to be the _______ dosage regimen for each individual.
  1. maximum
  2. potent
  3. optimal
  4. all the above
89. _______ have a wide variety of physiologic effects on humans, ranging from CNS stimulation to bronchial smooth muscle relaxation and cerebral vasoconstriction.
  1. Corticosteroids
  2. Xanthines
  3. Saligenins
  4. Mediator modifiers
90. Indications for _______ include severe inflammation, immunosuppression, nephrosis, or acute exacerbations of multiple sclerosis.
  1. prednisone
  2. hydrocortisone
  3. theophylline
  4. cromolyn sodium
91. _______ is a prophylactic agent that acts on a portion of the inflammatory process as a leukotriene receptor antagonist, preventing the inflammaory response of airway contractility, vascular permeability, and mucus secretion caused by certain leukotrienes.
  1. Methylprednisolone
  2. Atrovent
  3. Guaifenesin
  4. Zafirlukast
92. _______ are the most common devices used for nasal aerosol administration of antiallergics, sympathomimetics, antimuscarinics, and anti-inflammatory drugs.
  1. Spray pumps
  2. MDIs
  3. DPIs
  4. Jet nebulizers
93. _______ is dispensed in a device called the Spinhaler, which pokes holes in capsules containing the powdered drug.
  1. Dexamethasone
  2. Ribavirin
  3. Albuterol
  4. Cromolyn sodium
94.While it is usually classified as a bronchodilator, _______ is relatively ineffective when compared with the beta agonists.
  1. racemic epinephrine
  2. epinephrine
  3. theophylline
  4. beclamethasone
95. _______ is essentially an inflammatory disorder of the airways, in which allergic stimuli often trigger IgE-mediated mast cell release of mediators of inflammation.
  1. Tuberculosis
  2. Asthma
  3. COPD
  4. Bronchiectasis
96. Vasodilators are effective for some patients with primary pulmonary hypertension (PPH). _______ is given to test the patient's response prior to prescribing their long term use.
  1. Azactam
  2. Nystatin
  3. Pancuronium
  4. Epoprostenol
97. Inhaled _______ selectively improves perfusion of ventilated areas, and improves oxygenation in ARDS. However, caution must be used because it is a toxic component of air pollution, and exposure to it can result in pulmonary edema and unacceptable levels of methemoglobin.
  1. S-Carboxymethylcysteine
  2. Azactam
  3. nitric oxide
  4. surfactant replacement
98. In sufficient orally administrated concentrations, _______ has a direct mucolytic effect, and an indirect effect on mucus vicosity by stimulating submucosal glands to produce more serous secretions.
  1. SSKI
  2. Sodium bicarbonate
  3. Pulmozyme
  4. Guaifenesin
99. _______ is a popular nonnarcotic antitussive that is popular because it has no analgesic, respiratory depression, or addictive properties.
  1. Dextromethorphan hydrobromide
  2. Codeine
  3. Hydrocodone
  4. Monobactam
100. _______, which is administered by IV, has been the drug of choice for serious fungal infections since the 1950s, but its toxic effects such as nephrotoxicity, fever, and hypotension have limited its use.
  1. Clindamycin
  2. Nystatin
  3. Amphotericin B
  4. Pyrazinamide
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