Test Bank for Raus Respiratory Care Pharmacology 9th Edition

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Test Bank for Raus Respiratory Care Pharmacology 9th Edition

Description

WITH ANSWERS

 

Raus Respiratory Care Pharmacology 9th Edition
Test Bank Of

 

SAMPLE QUESTIONS

 

Chapter 01: Introduction to Respiratory Care Pharmacology

Gardenhire: Raus Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. The listing of a drug and the amount of drug are found in which part of a prescription?
a. Superscription
b. Inscription
c. Subscription
d. Transcription (signature)

 

 

ANS:  B

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

 

  1. If generic substitution is permitted on a prescription:
a. drug from only one manufacturer must be given.
b. drug formulation may be changed by the pharmacist.
c. any manufactured brand of the drug listed may be given.
d. drug strength may be changed by the pharmacist.

 

 

ANS:  C

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 manufacturers 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

 

  1. The study of drugs, including their origin, properties, and interactions with living organisms, is known as
a. pharmacogenetics.
b. pharmacology.
c. therapeutics.
d. toxicology.

 

 

ANS:  B

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

 

  1. The brand name given to a drug by a particular manufacturer is known as the drugs
a. chemical name.
b. generic name.
c. official name.
d. trade name.

 

 

ANS:  D

The chemical name indicates the drugs chemical structure. The generic name is assigned by the United States Adopted Name Council and is usually based loosely on the drugs 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 PharmacopeiaNational 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

 

  1. To find official information about drugs (according to the FDA), you need to go to the
a. Physicians Desk Reference (PDR).
b. Basic & Clinical Pharmacology.
c. United States PharmacopeiaNational Formulary (USP-NF).
d. Goodman & Gilmans The Pharmacological Basis of Therapeutics.

 

 

ANS:  C

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 & Gilmans 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

 

  1. Drugs may be obtained from which of the following sources?
a. Plants
b. Animals
c. Minerals
d. Plants, animals, and minerals

 

 

ANS:  D

Drugs may be obtained from plants (e.g., digitalis), animals (e.g., insulin), and minerals (e.g., magnesium sulfate).

 

REF:   p. 5

 

  1. The branch of the U.S. government responsible for the process of approving drugs for clinical use is the
a. USAN Council.
b. FDA.
c. USP-NF.
d. PDR.

 

 

ANS:  B

The United States Adopted Name (USAN) Council is responsible for assigning a generic name to a chemical that appears to have therapeutic use. The U.S. Food and Drug Administration (FDA) is responsible for the process of approving drugs for clinical use. The process by which a chemical moves from the status of a promising potential drug to one fully approved by the FDA for general clinical use is, on average, long, costly, and complex. Cost estimates vary, but in the 1980s it took an average of 13 to 15 years from chemical synthesis to marketing approval by the FDA, with a cost of $350 million in the United States. The USP-NF is a book of standards for medications, dietary supplements, and medical devices. The PDR is a source of drug information prepared by drug manufacturers.

 

REF:   p. 4

 

  1. An orphan drug is a drug that is
a. used for rare disease.
b. used for common disease.
c. inexpensive to produce.
d. not claimed by a drug manufacturer.

 

 

ANS:  A

An orphan drug is a drug or biologic product for the diagnosis or treatment of a rare disease. Rare is defined as a disease that affects less than 200,000 persons in the United States. Alternatively, a drug may be designated as an orphan if used for a disease that affects more than 200,000 persons in the United States but for which there is no reasonable expectation of recovering the cost of drug development. Orphan drugs are often quite expensive to produce because they have a limited market in which to recoup the initial investment.

 

REF:   p. 6 | p. 7

 

  1. Which of the following health care practitioners are authorized to write a prescription in the United States?
  2. Physicians
  3. Chiropractors
  4. Dentists
  5. Osteopaths
  6. Veterinarians

 

a. 1 only
b. 1, 2, and 3 only
c. 1, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

ANS:  C

A prescription may be written by a physician, osteopath, dentist, and veterinarian and some other practitioners but not by chiropractors.

 

REF:   p. 7

 

  1. Drugs that are available to the general public without a prescription are known as
a. illegal drugs.
b. generic drugs.
c. investigational drugs.
d. over-the-counter drugs.

 

 

ANS:  D

Illegal drugs are not legally available to the general public, and many generic drugs require a prescription. The use of investigational drugs is very closely monitored, and they are not available to the general public. Drugs available to the general public without a prescription are referred to as over-the-counter (OTC) products.

 

REF:   p. 8

 

  1. Drugs delivered by oral or nasal inhalation are intended to
a. increase heart function.
b. provide a local topical treatment in the respiratory tract.
c. relax patients and relieve anxiety.
d. improve blood flow throughout the body.

 

 

ANS:  B

Although some inhaled drugs do increase heart rate as a side effect, most drugs intended for this purpose are given intravenously; orally or nasally inhaled drugs are intended to provide a local topical treatment in the respiratory tract. Most anxiolytics and drugs used to improve blood flow are given intravenously.

 

REF:   p. 9

 

  1. The advantages of delivering drugs by oral or nasal inhalation include which of the following?
  2. Aerosol doses are smaller than doses administered systemically.
  3. Side effects are usually fewer and less severe.
  4. The onset of action is rapid.
  5. The delivery process is painless, relatively safe, and usually more convenient.

 

a. 1 and 3 only
b. 1 and 4 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

The following are advantages of this method and route of delivery:

Aerosol doses are smaller than doses used for the same purpose and given systemically.

Side effects are usually fewer and less severe with aerosol delivery than with oral or parenteral delivery.

The onset of action is rapid.

Drug delivery is targeted to the respiratory system, with lower systemic bioavailability.

The inhalation of aerosol drugs is painless, is relatively safe, and may be convenient depending on the specific delivery device used.

 

REF:   p. 9

 

  1. Which of the following classes of drugs can be aerosolized?
  2. Antiasthmatic agents
  3. Adrenergic agents
  4. Antiinfective agents
  5. Mucoactive agents
  6. Corticosteroids

 

a. 1 and 3 only
b. 2, 4, and 5 only
c. 2, 3, 4, and 5 only
d. 1, 2, 3, 4, and 5

 

 

ANS:  D

Antiasthmatic agents (e.g., cromolyn sodium), adrenergic agents (e.g., racemic epinephrine), and mucoactive agents (e.g., Pulmozyme) can be aerosolized. Antiinfective agents (e.g., TOBI) and corticosteroids (e.g., budesonide) may also be aerosolized.

 

REF:   p. 9

 

  1. Which of the following drug groups are important to respiratory and critical care, although they may or may not be available in an aerosol form?
  2. Diuretics
  3. Antiarrhythmic agents
  4. Neuromuscular blocking agents
  5. Anticoagulant and thrombolytic agents

 

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

The following groups of drugs are important in critical care:

Antiinfective agents, such as antibiotics and antituberculous drugs

Neuromuscular blocking agents, such as curariform agents and others

Central nervous system agents, such as analgesics and sedatives/hypnotics

Antiarrhythmic agents, such as cardiac glycosides and lidocaine

Antihypertensive and antianginal agents, such as b-blocking agents and nitroglycerin

Anticoagulant and thrombolytic agents, such as heparin and streptokinase

Diuretics, such as thiazides and furosemide

 

REF:   p. 9

 

  1. Place the following phases of Investigational New Drug (IND) approval in the correct order:
  2. The drug is investigated as a treatment for a small number of individuals with the disease the drug is intended to treat.
  3. The drug is investigated in large, multicenter studies to establish efficacy and safety.
  4. The drug is investigated in small groups of healthy volunteers to establish its activity.

 

a. 1, 2, 3
b. 2, 3, 1
c. 1, 3, 2
d. 3, 1, 2

 

 

ANS:  D

The first step of IND approval is to test the drug on healthy volunteers. Investigation by administration to ill individuals occurs only after the drug is proven safe in healthy volunteers. Multicenter studies are the third and final phase of IND approval.

 

REF:   p. 6

 

  1. In todays market, companies spend approximately how much money per new drug on research, development, and preclinical and postclinical trials?
a. $2 million
b. $10 million
c. $800 million
d. $1 billion

 

 

ANS:  D

In a study done in 2003 by DiMasi and associates, it was calculated that companies spend over $800 million on research and development and on preclinical and postclinical trials of a new drug in the current market. In a recent study by Adams and Brantner that replicated DiMasis calculations, they estimated companies now spend over $1 billion to bring a new drug to market.

 

REF:   p. 6

 

  1. Toxicology studies and studies on the effects of a new drug on such organs as the liver and kidneys occur during which step of the drug approval process in the United States?
a. Animal studies
b. Investigational New Drug approval
c. Chemical identification
d. New Drug Application

 

 

ANS:  A

Chemical identification is the process of recognizing that a chemical may have the potential for useful physiologic effects. No testing has occurred before this step. Once an active chemical is isolated and identified, a series of animal studies examines its general effect on animals and effects on specific organs such as the liver or kidneys. Toxicology studies to examine mutagenicity, teratogenicity, effect on reproductive fertility, and carcinogenicity are also performed. Investigational New Drug (IND) approval is a three-phase process that involves administering the drug to human subjects. It is imperative that safety be established before this step is taken. New Drug Application occurs only after a successful IND process, when the U.S. Food and Drug Administration (FDA) approves the drug for general clinical use.

 

REF:   p. 6

 

  1. Regarding the therapeutic potential of a drug, the code AA symbolizes
a. an important therapeutic gain over other drugs.
b. an important therapeutic gain, indicated for AIDS patients; fast-track drug.
c. modest therapeutic gain.
d. little or no therapeutic gain.

 

 

ANS:  B

The U.S. Food and Drug Administration (FDA) has a classification system to help identify the significance of new products. Codes A, AA, C, and D are used to describe therapeutic potential. Code A is given to a drug that shows significant therapeutic gain over other drugs. Code AA is given to a drug that shows significant therapeutic gain for patients with AIDS; this agent is then fast-tracked. Code B is given to a drug that shows moderate therapeutic gain. Code C is given to a drug that shows little or no therapeutic gain over other drugs, although the drug may have important options.

 

Choice A: This statement describes code A.

Choice B: This statement describes code AA: Important therapeutic gain, indicated for a patient with acquired immunodeficiency syndrome (AIDS); fast-track.

Choice C: This statement describes code B.

Choice D: This statement describes code C.

 

REF:   p. 6

 

  1. Which of the following may be used when writing or preparing drug orders?
  2. Latin
  3. English
  4. Metric measures
  5. Apothecary measures

 

a. 1 only
b. 1 and 2 only
c. 1 and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

Latin, English, and metric and apothecary measures may all be used for drug orders.

 

REF:   p. 7

 

  1. If a drug is ordered with the Latin abbreviation qid, it should be administered
a. every hour.
b. four times daily.
c. every other day.
d. every 4 hours.

 

 

ANS:  B

The abbreviation for every hour is qh, for four times daily is qid, for every other day is qod, and for every 4 hours is q4h.

 

REF:   p. 8

 

  1. If a drug is ordered with the Latin abbreviation ac, it should be administered
a. before a meal.
b. every other hour.
c. twice daily.
d. at bedtime.

 

 

ANS:  A

The abbreviation for ante cenam (before a meal) is ac, for every other hour is alt hor, for twice daily is bid, and for at bedtime is hs.

 

REF:   p. 8

 

  1. If a physician desires a drug to be administered as needed, he or she should use which of the following abbreviations?
a. pr
b. prn
c. npo
d. po

 

 

ANS:  B

The abbreviation pr means rectally, prn means as needed, npo means nothing by mouth, and po means by mouth.

 

REF:   p. 8

 

  1. Which of the following is a major step in the process of marketing a drug in the United States?
  2. Isolation of the chemical
  3. Identification of the chemical
  4. Investigational new drug approval
  5. New drug application

 

a. 1 only
b. 1 and 2 only
c. 1 and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

BOX 1-1 Major Steps in the Process of Marketing a Drug in the United States

Isolation and Identification of the Chemical

Animal studies

General effects

      Special effects on organ systems

      Toxicology studies

Investigational New Drug (IND) Approval

Phase 1 studies: Small number, healthy subjects

Phase 2 studies: Small number, subjects with disease

Phase 3 studies: Large, multicenter studies

New Drug Application (NDA)

Reporting system for first 6 months

 

 

REF:   p. 6

 

  1. Your patient has an order for 2 puffs of albuterol MDI q3h, and it was last given at 0700. When should it be administered next?
a. 0900
b. 1000
c. 1100
d. 1200

 

 

ANS:  B

q3h means every 3 hours. If first given at 0700, 1000 would be 3 hours later.

 

REF:   p. 8

 

  1. If drug A is ordered with the Latin abbreviation q4h and drug B is ordered with the Latin abbreviation qid, which drug would be given more frequently in a 24-hour period?
a. Drug A
b. Drug B
c. Both would be given the same amount.
d. More information is needed to answer the question.

 

 

ANS:  A

The abbreviation q4h means every 4 hours, which would be 6 times in a day. The abbreviation qid means four times a day.

 

REF:   p. 8

 

  1. The study of toxic substances and their pharmacologic actions, including antidotes and poison control is known as
a. toxicology.
b. therapeutics.
c. pharmacognosy.
d. pharmacology.

 

 

ANS:  A

Toxicology is the study of toxic substances and their pharmacologic actions, including antidotes and poison control. Therapeutics is the art of treating disease with drugs. Pharmacognosy is the identification of sources of drugs, from plants and animals. Pharmacology is the study of drugs (chemicals), including their origin, properties, and interactions with living organisms.

 

REF:   p. 3

 

  1. The study of the interrelationship of genetic differences and drug effects is known as
a. toxicity.
b. pharmacy.
c. pharmacognosy.
d. pharmacogenetics.

 

 

ANS:  D

Pharmacogenetics Study of the interrelationship of genetic differences and drug effects. Toxicology is the study of toxic substances and their pharmacologic actions, including antidotes and poison control. Pharmacology is the study of drugs (chemicals), including their origin, properties, and interactions with living organisms.

Pharmacognosy is the identification of sources of drugs, from plants and animals.

 

REF:   p. 3

 

  1. The preparation and dispensing of drugs is known as
a. toxicity.
b. pharmacy.
c. pharmacognosy.
d. pharmacogenetics.

 

 

ANS:  B

Toxicology is the study of toxic substances and their pharmacologic actions, including antidotes and poison control. Therapeutics is the art of treating disease with drugs. Pharmacognosy is the identification of sources of drugs, from plants and animals. Pharmacology is the study of drugs (chemicals), including their origin, properties, and interactions with living organisms.

 

REF:   p. 3

 

  1. The identification of sources of drugs from plants and animals
a. Toxicity
b. Therapeutics
c. Pharmacognosy
d. Pharmacology

 

 

ANS:  C

Toxicology is the study of toxic substances and their pharmacologic actions, including antidotes and poison control. Therapeutics is the art of treating disease with drugs. Pharmacognosy is the identification of sources of drugs, from plants and animals. Pharmacology is the study of drugs (chemicals), including their origin, properties, and interactions with living organisms.

 

REF:   p. 3

 

  1. The art of treating disease with drugs is referred to as
a. toxicity.
b. therapeutics.
c. pharmacognosy.
d. pharmacology.

 

 

ANS:  B

Toxicology is the study of toxic substances and their pharmacologic actions, including antidotes and poison control. Therapeutics is the art of treating disease with drugs. Pharmacognosy is the identification of sources of drugs, from plants and animals. Pharmacology is the study of drugs (chemicals), including their origin, properties, and interactions with living organisms.

 

REF:   p. 3

 

  1. What must physicians include on prescriptions when prescribing narcotics or controlled substances?
a. DEA registration number
b. Generic and trade name of the medication
c. Patients social security number
d. All of the above

 

 

ANS:  A

Since the passage of the Controlled Substances Act in 1971, all physicians are required to include their DEA registration number when prescribing narcotics or controlled substances.

 

REF:   p. 7

 

  1. Once a drug is released for general clinical use, how long must a detailed reporting system remain in place to track any problems that arise with the drugs use?
a. For 6 months
b. For 1 year
c. For 5 years
d. For 10 years

 

 

ANS:  A

The detailed reporting system monitoring a drug released for general clinical use remains in place for only 6 months.

 

REF:   p. 6

 

Chapter 03: Administration of Aerosolized Agents

Gardenhire: Raus Respiratory Care Pharmacology, 9th Edition

 

MULTIPLE CHOICE

 

  1. A 2-year-old child is seen in the emergency department of a local hospital, and croup is diagnosed. The physician orders a dose of racemic epinephrine via a small volume nebulizer to help reduce the subglottic swelling. What size aerosol particle is most likely to deposit in this region, providing the greatest therapeutic benefit to the patient?
a. Particles less than 10 m
b. Particles 5 to 10 m
c. Particles 2 to 5 m
d. Particles 0.8 to 3.0 m

 

 

ANS:  B

The upper airway (nose and mouth) is efficient in filtering particulate matter, so generally there is 100% deposition in the nose and mouth of particles larger than 10 m and 15 m. Particle sizes 5 to 10 m tend to deposit out in the upper airways and the early airway generations, whereas particles 1 to 5 m have a greater probability of reaching the lower respiratory tract from the trachea to the lung periphery. Larger or coarser aerosol particles (>5 m) may be useful for treating the upper airway (nasopharynx and oropharynx).

 

REF:   p. 34

 

  1. The main uses of aerosol therapy in respiratory care include the following:
  2. Humidification of dry gases
  3. Improved mobilization and clearance of secretions
  4. Delivery of aerosol drugs to the respiratory tract
  5. Delivery of nutrients for patients unable to chew food

 

a. 1 and 2 only
b. 1, 2, and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

ANS:  B

At the present time, there are three main uses of aerosol therapy in respiratory care, as follows:

Humidifying dry inspired gases, using bland aerosols

Improving mobilization and clearance of respiratory secretions, including sputum induction, using bland aerosols of water and hypertonic or hypotonic saline

Delivering aerosolized drugs to the respiratory tract

 

REF:   p. 32

 

  1. What is the particle size range for pulmonary diagnostic and therapeutic applications?
a. 0.5 to 1 m
b. 1 to 10 m
c. 10 to 15 m
d. 15 to 25 m

 

 

ANS:  B

For pulmonary diagnostic and therapeutic applications, the particle size range of interest is 1 to 10 m. This size range is small enough to exist as a suspension and enter the lung and large enough to deposit and contain the required amount of an agent. Larger particles deposit mostly in the nasopharynx or oropharynx, and smaller particles may be too fine to leave suspension and could be exhaled.

 

REF:   p. 32

 

  1. Two hypothetical small volume nebulizers, A and B, have the following specifications from the manufacturer:

 

  A B
Count median diameter (CMD) 1.7 m 1.5 m
Mass median aerodynamic diameter (MMAD) 3.2 m 7.7 m
Geometric standard deviation (GSD) 1.1 m 1.5 m

 

Which nebulizer would be best to use to treat the lower respiratory tract?

a. Nebulizer A
b. Nebulizer B

 

 

ANS:  A

Although nebulizer B has a smaller CMD than nebulizer A, nebulizer A produces particles whose mass centers within a lower range and so would be the better nebulizer with which to treat the lower respiratory tract. A major factor in lung penetration by aerosols is particle size, which is best characterized by the mass median aerodynamic diameter (MMAD) for inhaled drugs, because particle mass is a function of the third power of the particle radius. Nebulizer A produces particles whose mass centers within a lower size range (1 to 5 m), and would be the better nebulizer for treatment of the lower respiratory tract.

 

REF:   p. 33

 

  1. You are a respiratory therapist working in the emergency department; a 67-year-old man with chronic bronchitis presents in acute distress. His vital signs include heart rate (HR) 123 beats/min and respiratory rate (RR) 28 breaths/min. On auscultation, you note faint expiratory wheezing. Which of the following devices would be the least appropriate by which to deliver an aerosolized drug to this patient?
a. Jet nebulizer
b. Metered dose inhaler (MDI)
c. MDI with spacer
d. Dry powder inhaler (DPI)

 

 

ANS:  D

A jet nebulizer and an MDI with spacer would be the most appropriate because they would likely provide the best deposition. Although an MDI without spacer would be less desirable, it would not require the relatively high inspiratory flow rate needed to use a DPI.

 

REF:   p. 53

 

  1. An aerosol is best defined as
a. a drug in liquid form.
b. vapor suspended in a carrier gas.
c. a suspension of solid or liquid particles in a carrier gas.
d. an invisible drug particle.

 

 

ANS:  C

Drugs in liquid form may be administered in ways other than aerosol (e.g., intravenous [IV] route). By definition, an aerosol may be either solid or liquid particles suspended in a carrier gas, not just a vapor. It is possible to see aerosols, depending on the size of the particles.

 

REF:   p. 32

 

  1. Traditionally, what percentage of a given dose of aerosolized medication reaches the lower respiratory tract, regardless of the type of delivery device being used?
a. 5% to 10%
b. 10% to 15%
c. 20% to 30%
d. 40% to 50%

 

 

ANS:  B

Although some modern devices allow for up to 50% deposition, traditionally only 10% to 15% of aerosolized medications reach the lower airways.

 

REF:   p. 32

 

  1. What is the purpose of the end-inspiratory breath hold used in conjunction with aerosol delivery?
a. Prevents the patient from hyperventilating
b. Gives the aerosol more time to reach BTPS conditions
c. Allows better deposition through gravitational settling
d. Reduces inertial impaction

 

 

ANS:  C

Although we do not wish a patient to hyperventilate, prevention of hyperventilation is not the purpose of the breath hold. A slow, even respiratory rate is the best way to avoid hyperventilation. The more time an aerosol has to reach BTPS (body temperature, barometric pressure, and saturated with water) under these conditions, the larger its particles become because of their hygroscopic properties and the more likely they are to fall out of suspension before reaching the lower respiratory tract. The encouragement of a breath hold can increase the settling of particles; however, depending on particle size, a particle may not fall out of suspension. Inertial impaction occurs during the initial act of inspiring, before the end-inspiratory breath hold.

 

REF:   p. 35 | p. 36

 

  1. You are treating a patient who has a confirmed diagnosis of Pneumocystis pneumonia. Which type of delivery device should you choose to administer the dose of pentamidine ordered by the attending physician?
a. Respirgard II
b. MDI
c. Pari LC
d. DPI

 

 

ANS:  A

DRUG APPROVED NEBULIZER
Bronchodilator Nebulizer type not specified
Acetylcysteine Nebulizer type not specified
Budesonide (Pulmicort Respules) Should not be used with ultrasonic nebulizer
Tobramycin (TOBI) Pari LC
Dornase alfa (Pulmozyme) Hudson T Up-draft II, Marquest Acorn II, Pari LC, Durable Sidestream, Pari Baby
Pentamidine (NebuPent) Marquest Respirgard II
Ribavirin (Virazole) Small particle aerosol generator (SPAG)

 

An SVN fitted with inspiratory and expiratory one-way valves and with expiratory filter is used during the administration of aerosolized pentamidine. The one-way valves used with the SVN prevent secondhand exposure of pentamidine by eliminating the contamination of the ambient environment with exhaled aerosol.

 

REF:   p. 44

 

  1. A 7-month-old infant presents with a diagnosis of respiratory syncytial virus. The attending physician agrees with your recommendation of ribavirin to treat the disease. Because ribavirin is delivered as an aerosol, you must decide which method of delivery to use. Which of the following aerosol administration devices would you choose?
a. Small volume nebulizer
b. Large volume nebulizer
c. Dry powder inhaler (DPI)
d. Small particle aerosol generator (SPAG)

 

 

ANS:  D

Ribavirin is not produced for administration with a DPI. The manufacturer of ribavirin used a SPAG during clinical trials, and the device is marketed for delivery of the drug. A small volume nebulizer is incapable of holding a large enough volume of ribavirin, which is delivered over a long period of time. Although a large volume nebulizer may hold more medication, it is not the device recommended by the manufacturer of ribavirin.

 

REF:   p. 40

 

  1. After delivering an aerosol treatment, you notice that approximately 0.5 mL of medication remains in the small volume nebulizer. Which of the following actions do you take?
a. Replace the nebulizer before administering the next treatment
b. Recommend that subsequent doses be delivered via metered dose inhaler (MDI)
c. Take no action and deliver the following dose with the same small volume nebulizer
d. Double the amount of medication administered during the next treatment

 

 

ANS:  C

There is nothing wrong with the nebulizerdead volumes of 0.5 to 1 mL are common. Doubling the amount of medication not only is unnecessary but in some cases may pose a serious risk to the patient.

 

REF:   p. 42

 

  1. Which of the following statements is true concerning the recommended volume of solution when delivering an aerosol treatment via a small volume nebulizer?
  2. A volume between 3 mL and 5 mL of solution is recommended.
  3. Increasing the volume results in a decrease in the concentration of drug remaining in the dead volume when nebulization ceases.
  4. Patient compliance of therapy is directly proportional to its convenience.
  5. Increasing the volume of solution results in a net increase in the amount of active drug in the nebulizer.

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  C

Increasing the volume of solution has no effect on the net amount of active drug; the only result is that it may take longer to administer an aerosol, and the patient may receive a higher percentage of the available dose.

 

REF:   p. 42 | p. 43

 

  1. You are administering an aerosol treatment to a patient via a small volume nebulizer when you realize that the output appears to be much less than normal. On checking the flow meter, you see that it is set to 4 L/min. Your next action is to:
a. Decrease the flow to 2 L/min
b. Increase the flow to 20 L/min
c. Leave the flow rate unchanged and search for other sources of decreased output
d. Increase the flow rate to 8 L/min

 

 

ANS:  D

A flow rate of 2 L/min is insufficient to produce an effective mass median aerodynamic diameter (MMAD), whereas a flow rate of 20 L/min is too high for a gas-powered small volume nebulizer. The flow rate of 4 L/min is low enough to be causing the problem and should be addressed before searching for other solutions. On the basis of the results of Hess and colleagues in Figures 3-5 and 3-6, an average optimal volume and flow rate for many nebulizers is a volume of 5 mL with a flow rate of 6 to 8 L/min. Also, each model of jet nebulizer is designed to work best at a specific flow. It is important to operate a jet nebulizer with a compressor or a gas flow that matches the intended design.

 

REF:   p. 43 | p. 44

 

  1. The physician has ordered your patient to receive continuous administration of heliox with racemic epinephrine secondary to postextubation stridor. As you approach the bedside to deliver the ordered dose of racemic epinephrine via small volume nebulizer, what outcome should you expect with a gas flow of 10 L/min of heliox?
a. The nebulization time will be less than when using oxygen as a power gas.
b. The mass median aerodynamic diameter (MMAD) of the aerosolized medication will be greater than when using oxygen as a power gas.
c. There will be a twofold increase in nebulization time (compared with oxygen as a power gas).
d. The MMAD and nebulization time will remain unchanged.

 

 

ANS:  C

At a given flow rate, nebulization time using heliox is approximately twice that of oxygen. Although the nebulization times are doubled, heliox provides a decrease in particle size. Research has shown a twofold increase in nebulization time when using heliox versus oxygen.

 

REF:   p. 44

 

  1. Your patient is receiving gentamicin (a high-viscosity antibiotic solution) via gas-powered small volume nebulizer. To compensate for the increased viscosity of the aerosol solution, you should
a. set the gas flow to 6 L/min.
b. set the gas flow to 12 L/min.
c. recommend a different method of drug delivery.
d. both A and C.

 

 

ANS:  B

Higher viscosity antibiotic solutions such as gentamicin or carbenicillin require 10 to 12 L/min power gas flow rates to produce suitably small aerosol particles for inhalation. There is no need at this time to recommend a different method of delivery; delivery of antibiotics directly to the lung has been shown to produce fewer side effects and to require fewer dose administrations when used to combat or prevent lung infection.

 

REF:   p. 44

 

  1. You are instructing the parents of a 4-year-old child with asthma on how to deliver aerosolized medication at home via a traditional small volume jet nebulizer. When the parents ask how much of the medication actually reaches the childs lungs, you answer:
a. 5% to 10% of the total drug dose.
b. 10% to 15% of the total drug dose.
c. 50% to 60% of the total drug dose.
d. Nearly 100% of the total drug dose.

 

 

ANS:  B

For a traditional small volume jet nebulizer, a typical emitted dose pattern results in the deposition of approximately 10% to 15% of the total drug dose.

 

REF:   p. 32

 

  1. All metered dose inhalers (MDIs) are powered by which propellant?
a. Chlorofluorocarbons (CFCs)
b. Soy lecithin
c. Hydrofluoroalkanes (HFAs)
d. Oleic acid

 

 

ANS:  C

In agreement with the Montreal Protocol, all MDIs in the United States ceased use of CFCs by the end of 2008. Soy lecithin is not a propellant used to power an MDI; it is a surfactant used to prevent aggregation of drug particles and to lubricate the valve mechanism. HFAs are the new propellant of choice and became a requirement in 2008. Oleic acid, similar to soy lecithin, is a surfactant used to prevent the aggregation of drug particles and to lubricate the valve mechanism. CFCs and HFAs are the two types of propellants used with pressurized MDIs (pMDIs). Although CFC propellants used with pMDIs to create an aerosol were blends of liquefied gas (CFCs) in the past, because 1 CFC molecule can destroy 100,000 molecules of stratospheric ozone, the U.S. Food and Drug Administration (FDA) banned the use of CFC pMDIs. Hydrofluorocarbons (HFCs), also termed HFAs, have been identified as propellants that are nontoxic to the atmosphere and to the patient and that have properties suitable for MDI aerosol generation.

 

REF:   p. 46

 

  1. Which of the following are problems associated with patient use of an MDI?
  2. Failure to coordinate inhalation and actuation of the inhaler
  3. A too-rapid inspiratory flow rate
  4. Failure to shake and mix canister contents
  5. Cessation of inspiration as the aerosol strikes the throat

 

a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

Factors affecting MDI performance include poor patient coordination, oropharyngeal impaction because of high inspiratory flows, settling of canister contents (failure to shake), and abruptly ending inspiration because of oropharyngeal impaction.

 

REF:   p. 50

 

  1. Your patient carries an albuterol MDI, which she claims to use every few weeks. She complains that the first dose actuated from the device seems to have no effect on her bronchospasm. What suggestion would you make to correct the problem?
a. Discharge a waste dose before using the MDI
b. Replace the device
c. Administer three actuations instead of the two that her physician prescribed
d. Recommend use of a small volume nebulizer

 

 

ANS:  A

Findings suggest discharging a waste dose if 4 hours have elapsed since the last use of an albuterol MDI (or if the device is stored in the valve-down position). The patient has not suggested that the device does not function, only that the initial dose seems to have no effect on her bronchospasm. A new device would likely produce the same result. Although the initial dose may have little or no effect, the practitioner should never change a patients prescribed dosage without first consulting the physician (unless following a physician-prescribed protocol). A small volume nebulizer is not nearly as portable as an MDI and may cause compliance issues with the patient. Proper instruction would allow the MDI to be used with greater effectiveness.

 

REF:   p. 48 | p. 49

 

  1. Advantages of using portable ultrasonic drug nebulizers include that they
a. require an electrical source.
b. are inexpensive.
c. are very durable.
d. are small in size.

 

 

ANS:  D

Advantages

Small size

Rapid nebulization with shorter treatment times

Smaller drug amounts with no diluent for filling volume

Can be used during car travel or camping

Disadvantages

Expense

Fragility, lack of durability

Require electrical source (either AC or DC)

Possible degrading effect on drug must be determined

 

REF:   p. 42

 

  1. Your patient asks how long to wait between the first and second doses from her albuterol MDI. You suggest that she
a. pause 15 minutes between actuations.
b. not pause at all, but deliver both actuations as quickly as possible, preferably over a time period of 1 second.
c. pause 1 to 5 minutes between actuations.
d. pause 30 minutes between actuations.

 

 

ANS:  C

A pause of 1 to 5 minutes has been advocated between each puff of a bronchodilator MDI in an attempt to improve distribution of the inhaled drug in the lung. Also, rapid actuations may provide lower dosages of drug to the lung, probably as a result of turbulence and coalescence of particles.

 

REF:   p. 50

 

  1. Barring any issues regarding patient coordination or ability to use the device correctly, how should you suggest that a patient administer a drug with an MDI if no spacer is available?
a. Insert the MDI into the mouth and make a tight seal with the lips.
b. Hold the MDI several centimeters in front of the open mouth.
c. Never use the device without a spacer.
d. Insert the MDI into the mouth and make a loose seal with the lips.

 

 

ANS:  B

Insertion into the mouth increases oropharyngeal impaction of the drug. Theoretically, actuating the MDI several centimeters in front of the mouth allows for slowing of particle velocity and evaporation of aerosol particles, resulting in less oropharyngeal impaction and loss. Barring the patients inability to coordinate such a maneuver, this is the recommended method of administration. During acute episodes, it is understandably pertinent that a patient receive his or her medication, whether or not a spacing device happens to be available at the time.

 

REF:   p. 50

 

  1. Your patient informs you that she keeps her albuterol MDI stored in her refrigerator because she feels that this keeps the medication fresher for a longer time. What is your best response?
a. Tell her that is a fine idea and that you may make the same recommendation to other patients.
b. Suggest that she put it in the freezer instead because the colder temperature may keep the drug fresher for a longer time.
c. Request that she no longer refrigerate the canister but instead store it at room temperature.
d. Tell her to place the MDI in the bottom drawer of the refrigerator because this will keep it the freshest.

 

 

ANS:  C

Data indicate that dose delivery from CFC-propelled MDIs of albuterol decreases with temperature, with a 65% to 70% reduction in dose observed at 10 C.

 

REF:   p. 49

 

  1. You are teaching proper use of a metered dose inhaler (MDI) to an elderly man who is having trouble coordinating actuation of the device with an inspiratory effort. What suggestion(s) would you make to help him with his problem?
a. Suggest adding a reservoir device
b. Suggest that if he cannot effectively use the MDI, he may need to switch to an SVN
c. Both A and B
d. Neither A nor B

 

 

ANS:  C

The addition of a reservoir device offers an alternative for individuals who find it difficult to coordinate MDI actuation with inhalation. The practitioner should never suggest an increase in the dosage of a drug unless he or she has consulted the physician or is following a physician-prescribed protocol. An SVN may need to be used if the patient cannot effectively use the MDI.

 

REF:   p. 50

 

  1. The physician has requested that you provide a patient with a reservoir device to use in conjunction with a metered dose inhaler (MDI). Given a choice, which type of device would you give the patient?
a. Spacer
b. Traditional holding chamber
c. Antistatic valved holding chamber
d. Non-antistatic valved holding chamber

 

 

ANS:  C

Although the use of a spacer is preferred over no reservoir device at all, valved holding chambers can increase drug delivery, decrease oropharyngeal impaction, and help with coordination. Valves in the holding chamber act as a baffle reducing particle size, which reduces oropharyngeal impaction, and allow the patient to exhale without disrupting the aerosol inside the chamber. Valved holding chambers are superior to spacers. A traditional holding chamber has the advantage of a one-way valve compared with a spacer; it also has an inherent electrical charge that may affect drug delivery. Antistatic holding chambers reduce the electrostatic charge and can increase delivery of the aerosolized drug by 70%.

 

REF:   p. 52

 

  1. The greatest limitation to patient use of a dry powder inhaler (DPI) is
a. patient preference.
b. patient coordination.
c. patient ability to provide an inspiratory flow rate of 30 to 90 L/min.
d. cost.

 

 

ANS:  C

Although patient preference may have a large effect on patient compliance, sufficient inspiratory flows are necessary to deliver aerosolized medication through a DPI. Because DPIs are breath-actuated devices, the need for patient coordination is reduced compared with delivery devices such as metered dose inhalers (MDIs). Flow rates of 30 to 90 L/min are necessary for effective delivery of medication from a DPI. Cost of DPI and MDI may be similar depending on medication availability.

 

REF:   p. 53

 

  1. The physician has granted your request to change a patient from a small volume nebulizer (SVN) to a metered dose inhaler (MDI) for administration of albuterol. The dose via SVN was 2.5 mg of drug. What is the equivalent dose via MDI to administer to your patient?
a. 1 puff
b. 2 puffs
c. 3 puffs
d. 4 puffs

 

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