TEST BANK For Rau’s Respiratory Care Pharmacology, 10th Edition by Gardenhire, Verified Chapters 1 - 23, Complete Newest Version.pdf

TEST BANK for Rau’s Respiratory Care
Pharmacology 10th Edition Gardenhire
Chapters 1 - 23

Description
Table of Contents
Unit I: Basic Concepts and Principles in Pharmacology
1. Introduction to Respiratory Care Pharmacology
2. Principles of Drug Action
3. Administration of Aerosolized Agents
4. Calculating Drug Doses
5. The Central and Peripheral Nervous Systems
Unit II: Drugs Used to Treat the Respiratory System
6. Adrenergic (Sympathomimetic) Bronchodilators
7. Anticholinergic (Parasympatholytic) Bronchodilators
8. Xanthines
9. Mucus-Controlling Drug Therapy
10. Surfactant Agents
11. Corticosteriods in Respiratory Care
12. Nonsteroidal Antiasthma Agents
13. Aerosolized Antiinfective Agents
14. Antimicrobial Agents
15. Cold and Cough Agents
16. Selected Agents of Pulmonary Value
17. Neonatal and Pediatric Aerosolized Drug Therapy
Unit III: Critical Care, Cardiovascular, and Polysomnography Agents
18. Skeletal Muscle Relaxants (Neuromuscular Blocking Agents)
19. Diuretic Agents
20. Drugs Affecting the Central Nervous System
21. Vasopressors, Inotropes, and Antiarrythmic Agents
22. Drugs Affecting Circulation: Antihypertensives, Antianginals, Antithrombotics
23. Sleep and Sleep Pharmacology

Chapter 01: Introduction to Respiratory Care Pharmacology Gardenhire:
Rau’s Respiratory Care Pharmacology, 10th Edition
MULTIPLE CHOICE
1. What is the name of the receptor sites that are located in the peripheral vasculature, the heart,
bronchial muscle, and bronchial blood vessels?
a. Beta 2 receptors c. Alpha receptors
b. Gamma receptors d. Beta 1 receptors
ANSWER: C
Alpha receptors are located in the peripheral vasculature, the heart, bronchial muscle, and
bronchial blood vessels.
PTS: 1
2. Which receptor site results in tachycardia, an increased potential for arrhythmias, and an
increased cardiac output?
a. Beta 1 receptor c. Alpha receptor
b. Beta 2 receptor d. Delta receptor
ANSWER: A
Stimulation of the beta-1 receptors results in tachycardia, an increased potential for arrhythmias,
and an increased cardiac output. In administering drugs to the pulmonarysystem, stimulation of
the beta-1 sites is not desired. However, most respiratory pharmacologic agents have some beta-1
stimulatory effect.
PTS: 1
3. Stimulation of the beta 2 receptors causes
a. peripheral vasoconstriction and mild bronchoconstriction in the lungs.
b. tachycardia, an increased potential for arrhythmias, and an increased cardiac output.
c. bronchodilation.
d. peripheral vasodilation, bradycardia, and decreased cardiac output.
ANSWER: C
Stimulation of the beta-2 receptors in the lungs causes bronchodilation.

4. Acetylcholine stimulates
a. the Vagus nerve.
b. the adrenergic receptors.
c. the sympathetic nervous system.
d. the cholinergic receptors.
ANSWER: D
Acetylcholine stimulates the cholinergic receptors.
PTS: 1
5. What immunoglobulin antibody sensitizes the mast cell?
a. Leukotrienes c. Histamine

b. IgE d. Prostaglandins
ANSWER: B
The IgE (reagin) antibodies sensitize the mast cell. Repeated exposure to the antigen causes the
degranulation of the mast cell.
PTS: 1
6. Which of the following is caused by histamine release from the mast cells?
I. Bronchodilation
II. Increased bronchial gland secretion
III. Increased amount of mucus present in the airways
a. I and II only c. III only
b. II and III only d. I, II, III
ANSWER: B
Histamine is also a potent bronchoconstrictor. In addition to its bronchoconstrictive activity,
histamine
II) increases bronchial gland secretion, causing III) an increase in the amount of mucus present in
the airways. Histamine may also have an effect on vascular permeability similar to the effect of-
SRS-A.
PTS: 1
7. A sympathomimetic drug would cause
a. bronchodilation. c. Histamine release.
b. bronchoconstriction. d. Vagus nerve stimulation.
ANSWER: A
A sympathomimetic drug would cause bronchodilation. Sympathomimetic agents are the drugs
most commonly used to reverse bronchospasm.
PTS: 1
8. Stimulation of the sympathetic nervous system causes
a. vascular permeability. c. bronchodilation.
b. decreased blood pressure. d. bronchoconstriction.
ANSWER: C
Sympathetic nervous systemstimulation causes bronchodilation.

9. Which of the following wouldNOT cause a bronchospasm or bronchoconstriction?
a. Leukotrienes c. Histamine
b. Beta 1 receptors d. Prostaglandins
ANSWER: B
Beta-1 receptors would not cause a bronchospasm or bronchoconstriction. Leukotrienes are one of
many chemical mediators released by the mast cells. Leukotrienes cause a direct, strong
bronchoconstriction. Histamine is also a potent bronchoconstrictor. Prostaglandins cause a strong
bronchospasm, especially in asthmatic patients.
PTS: 1

10. Place the following intracellular events of the Beta 2 receptor stimulation in order.
I. Phosphodiesterasebreaks down cyclic 3’, 5’-AMP into 5’-AMP
II. Adenylate cyclase combines with magnesium and ATP to formcyclic 3’,5’-AMP
III. Cyclic 3’,5’-AMPresults in bronchial smooth muscle relaxation
IV. Beta-2 stimulation causes the formation of adenylate cyclase
a. I, II, III, IV c. IV, II, III, I
b. III, IV, I, II d. IV, III, II, I
ANSWER: C
The following order is correct: IV) Beta-2 stimulation causes the formation of adenylate cyclase.
II) Adenylate cyclase combines with magnesium and ATP (adenosine triphosphate) to form
cyclic 3’,5’- AMP (adenosine monophosphate). III) Cyclic 3’,5’-AMP results in bronchial smooth
muscle relaxation and hence bronchodilation. Cyclic 3’,5’-AMP is not a long-lived agent. It is
readily broken down by another enzyme present in the lungs called phosphodiesterase. I)
Phosphodiesterase breaks 3’,5’-AMP down into 5’-AMP, which no longer causes bronchodilation.
PTS: 1
11. Release of acetylcholine will cause
a. bronchodilation. c. stimulation of cyclic 3’5’AMP.
b. Mast cell stabilization. d. bronchospasm.
ANSWER: D
Cholinergic receptors are cells that respond when stimulated by acetylcholine. Cholinergic
receptors cause profound bronchospasm in the lungs when stimulated. Cholinergic receptors are
found in the parasympathetic nervous system.
PTS: 1
12. Which of the followingis NOT an example of a sympathomimetic drug?
a. Salmeterol Xinafoate c. Pirbuterol Acetate
b. Formoterol fumarate d. Atropine Sulfate
ANSWER: D
Atropine sulfate is a anti-cholinergic bronchodilator. Salmeterol, formoterol, andpirbuterol are all
sympathomimetic bronchodilators.
PTS: 1

13. Which of the following sympathomimetic drugs are intended for maintenance therapy only?
I. Levalbuterol

II. Salmeterol
III. Formoterol
IV. Pirbuterol
a. II, III, and IV c. II and III
b. I and IV d. I, II, III, and IV
ANSWER: C
II) Salmeterol and III) Formoterol areintended for maintenance therapy only.
PTS: 1
14. A pediatric patient is admitted to the emergency department from a physician’s office with
the suspected diagnosis of croup. An inspiratory stridor is heard. Which aerosolized
sympathomimetic would you recommend to decrease the stridor?

a. Racemic epinephrine c. Levalbuterol
b. Albuterol d. Isoproterenol
ANSWER: A
Racemic epinephrine (Vaponephrine) is a sympathomimetic drug. However, its alpha effects are
strong and it is commonly used to relieve croup and epiglottitis symptoms in children.
PTS: 1
15. Aminophylline causes bronchodilation by
a. stimulating the production of cyclic 3’5’AMP.
b. blockingthe parasympathetic nervous system.
c. inhibiting the enzyme phosphodiesterase.
d. causing Mast cell degranulation.
ANSWER: C
Aminophylline is a phosphodiesterase inhibitor. It is an example of drugs in the xanthine group.
Common phosphodiesterase drugs are found in the methylxanthine group. Cyclic 3’,5’-AMPis
broken down into 5’-AMP by the enzyme phosphodiesterase. If the action of phosphodiesterase
can be blocked or inhibited, more 3’,5’-AMP will remain in the lungs, resulting in better
bronchodilation.
Phosphodiesteraseinhibitors actinthis way.
PTS: 1
16. Inhibition of the sympathetic nervous system would cause
a. bronchoconstriction.
b. stridor.
c. bronchodilation.
d. relaxation of the bronchial smooth muscle.
ANSWER: A
If the sympathetic nervous system is inhibited, it would cause bronchoconstriction.
PTS: 1
17. Which of the following drugs cause bronchodilation by inhibiting the effects of the
parasympathetic nervous system?
I. Atropine sulfate
II. Ipratropium bromide
III. Tiotropium bromide

IV. Terbutaline sulfate
a. I and IV c. I, II, III
b. II and III d. IV only

ANSWER: C
I) Atropine, II) ipratropium, and III) tiotropium are all examples of antocholinergic
bronchodilators (bronchodilators that work by blocking the parasympathetic nervous
system). Anticholinergic drugs block the cholinergic receptor sites, preventing that route of
bronchospasm.
PTS: 1
18. Corticosteroids:
a. cause brondilation directly.
b. reduce inflammation.
c. stabilize Mast cells.

d. should always be administered with a bronchodilator.
ANSWER: B
Corticosteroids are widely used in the management of the inflammatory process associated
with asthma, reactive airways disease, and other pulmonary disorders.
PTS: 1
19. A patient is ready to be discharged to her home. At home the patient has a compressor and a
small volume nebulizer. Which of the following corticosteroids is in solution and is intended
to be administered via a small volume nebulizer?
a. Prednisone c. Budesonide
b. Dexamethasone d. Triamcinolone
ANSWER: C
Budesonide (Pulmocort) is available as both an inhalant solution (0.25 mg/ mL once daily) and a
dry powder formulation (200 mcg/dose twice daily). In aerosol form, this anti-inflammatory
medication targets the lungs specifically with fewer side effects.
PTS: 1
20. Salmeterol and Fluticasone are combined into a DPI preparation. What is the purpose of these
two drugs combined?
a. Maintenance bronchodilation and Mast cell stabilization
b. Mucolysis andanti-inflammation
c. Bronchodilation by stimulating the sympathetic nervous system and
inhibiting the parasympathetic nervous system
d. Maintenancebronchodilation and anti-inflammation
ANSWER: D
Fluticasone propionate (Flovent) and salmeterol (Serevent) have been combined into a DPI
preparation containing 100 mcg of fluticasone propionate and 50 mcg of salmeterol. By taking both
drugs together, the long-term effects of both d) maintenance bronchodilation and anti-inflamation
can be achieved.
PTS: 1
21. Which of the following drugs stabilize mast cells?
a. Ipratropium c. Albuterol
b. Cromolyn sodium d. Fluticasone

ANSWER: B
Cromolynsodium is a prophylactic agent; it prevents mast cell degranulation. Apatient must use the

drug on a regular basis to prevent acute bronchospastic episodes.
PTS: 1
22. Montelukast, Zarfirlukast, and Zileuton are all used as maintenance therapy for asthma.
How do they work?
a. They stabilize the Mast cells.
b. The cause bronchodilation.
c. They are mucolytics.
d. They are leukotriene inhibitors.

ANSWER: D
Montelukast (Singulair), Zarfirlukast (Accolate), and Zileuton (Zyflo) are leukotriene
inhibitors used for maintenance therapy in asthma.
PTS: 1
23. One of the side effects of Acetylcysteine is bronchospasm. How can this side effect be avoided?
a. By giving Acetylcysteine with a bronchodilator.
b. By giving the patient a corticosteroid after the treatment.
c. By administering half of the therapy, allowing the patient to rest, then finishing the therapy.
d. By simultaneous use of sodium bicarbonate.
ANSWER: A
Usually, acetylcysteine is given with a bronchodilator to prevent the bronchospastic side effect.
PTS: 1
24. Which of the following is a frequently nebulized antibiotic for patients with cystic fibrosis?
a. Pentamidine c. Sodiumbicarbonate
b. Ribvirin d. Tobramycin
ANSWER: D
Tobramycin (TOBI) and gentamicin are sometimes aerosolized for use in patients with cystic fibrosis
and have shown some efficacy in treatment of the recurrent infections these patients experience.
PTS: 1
25. MDI spacer devices are used in conjunction with MDIs to:
a. serve as a baffle, removing smaller particles from suspension.
b. enhancethe effectiveness of aerosol deposition and improve medication delivery.
c. act as a reservoir that helps to decrease the evaporation of the MDI propellant.
d. a, b, and c.
ANSWER: B
MDI spacer devices are usedin conjunction with MDIs and enhance the effectiveness of aerosol
deposition and improve medication delivery
PTS: 1
ESSAY
1. An aerosol drug is ordered on a patient in MDI form. The propellant causes a reflex

bronchospasm in the patient. What can be done?

ANSWER:
The drug could be delivered to the patient in other forms such as DPI form or in solution by a
small volume nebulizer. A spacer could be used to allow for partial evaporation of the propellant
from the MDI. If the drug is available in pill form or oral solution it could be delivered via
mouth.
PTS: 1
2. A small volume nebulizer is ordered for a patient on a mechanical ventilator. To prevent
condensation and secretions from draining into the nebulizer and contaminating it, what could
be done?

ANSWER:
A heated wire circuit should decrease the amount of condensation in the ventilator tubing and
therefore the amount of solution that could get into the nebulizer cup. Position the nebulizeer so
that the upper end of the reservoir would be higher than the ventilator tubing. Use barriers (one-
way valve) between the nebulizer cup and the and the ventilator circuit. It could also be
suggested to the physician that an MDI be used instead of the SVN and the device could be
removed immediately after the therapy.
PTS: 1
3. After delivery of an adrenergic bronchodilator with a small volume nebulizer, a patient
complains of “shakiness” and feeling “nervous”. He notes palpitations and his heart feels like it
is racing. What is happening and how could these problems be corrected?
ANSWER:
The patient is having adverse side effects from the bronchodilator. The patient’s bronchodilator
could be given with more diluting solution, the amount of medication could be decreased, or the
patient could be given another bronchodilator with fewer side effects.
PTS: 1

Chapter 01: Introduction to Respiratory Care Pharmacology Gardenhire:
Rau’s Respiratory Care Pharmacology, 10th Edition
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
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 manufacturer’s
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
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
The chemical name indicates the drug’s chemical structure. The generic name is assigned by the
United States Adopted Name Council and is usually based loosely on the drug’s 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 Pharmacopeia–
National 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
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 & Gilman’s 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

Drugs may be obtained from plants (e.g., digitalis), animals (e.g., insulin), and minerals
(e.g., magnesium sulfate).
REF: p. 5
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
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
A prescription may be written by a physician, osteopath, dentist, and veterinarian and
some other practitioners but not by chiropractors.

REF: p. 7
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
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.

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.
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.
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 -blocking agents and nitroglycerin
Anticoagulant and thrombolytic agents, such as heparin and streptokinase
Diuretics, such as thiazides and furosemide
REF: p. 9
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

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 DiMasi’s calculations, they estimated companies now spend over $1
billion to bring a new drug to market.
REF: p. 6

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
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
Latin, English, and metric and apothecary measures may all be used for drug orders.
REF: p. 7

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

REF: p. 8
BOX 1-1 Major Steps in the Process of Marketing a Drug in the United States
REF: p. 6
q3h means every 3 hours. If first given at 0700, 1000 would be 3 hours later.
REF: p. 8
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
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.
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

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

REF: p. 3
Pharmacology is the study of drugs (chemicals), including their origin, properties, and
interactions with living organisms.
REF: p. 3
REF: p. 3
REF: p. 3
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

Chapter 02: Principles of Drug Action
Gardenhire: Rau’s Respiratory Care Pharmacology, 10th Edition
MULTIPLE CHOICE
1. During which phase of drug action is a drug made available to the body?
a. Administration
b. Pharmacokinetic
c. Pharmacodynamic
d. Pharmacogenetic
ANSWER: A
A drug dose is made available to the body during the drug administration phase. The
pharmacokinetic phase involves the time course and disposition of a drug in the body, based on its
absorption, distribution, metabolism, and elimination. The pharmacodynamic phase involves the
mechanisms of drug action by which a drug molecule causes its effect on the body. Pharmacogenetics
is the study of variations among patients in their responses to drugs that are caused by hereditary
differences.
REF: p. 12
2. A drug’s portal of entry into the body is known as the
a. formulation.
b. dosage.
c. route of administration.
d. additive.
ANSWER: C
Formulation involves the physical state of the drug in association with nondrug components (e.g.,
the vehicle). Dosage involves the amount of active drug being administered. The route of
administration is the portal of entry for the drug into the body, such as by oral (enteral)
administration, injection, or inhalation. Additives are agents that help deliver the drug. For
example, a metered dose inhaler (MDI) uses propellants to move the drug, a dry powder inhaler
(DPI) uses bulking agents to improve dispersion of the drug, and capsules use a gelatinous material
on the outside to allow the drug to be swallowed more easily.
REF: p. 12

3. Which of the following are routes of drug administration?
2. Parenteral
1. Enteral

3. Ointment
a. 1 and 4 only
b. 1, 2, and 3 only
d. 1, 2, 3, and 4
ANSWER: C
Enteral (gastrointestinally), parenteral (other than gastrointestinally, generally injected), and
inhalation are three of the five broad categories of drug administration (the other two are
transdermal and topical). Ointment describes the formulation of a drug that may be
administered topically.
REF: p. 13
4. Which of the following methods of drug delivery are commonly considered
parenteral?
1. Intravenous
c. 1, 2, and 4 only
4. Inhalation

3. Paste
4. Aerosol
a. 1 and 4 only
b. 1 and 2 only
c. 3 and 4 only
d. 1, 2, 3, and 4
ANSWER: B
Technically, the term parenteral means “besides the intestine,” which implies any route of
administration other than enteral. However, the parenteral route is commonly taken to mean
injection of a drug. Various options are available for injection of a drug, the most common of which
are the following:
Intravenous (IV): Injected directly into the vein, allowing nearly instantaneous access to
the systemic circulation. Drugs can be given as a bolus, in which case the entire dose is given
rapidly, leading to a sharp increase in the plasma concentration, or as a steady infusion to
avoid this precipitous increase.
(IM): Injected deep into a skeletal muscle. Because the drug must be absorbed from the
muscle into the systemic circulation, the drug effects occur more gradually than with
intravenous injection, although typically more rapidly than by the oral route.
Subcutaneous (SC): Injected into the subcutaneous tissue beneath the epidermis and dermis.
Intraosseous (IO): Injected into the marrow of the bone.
REF: p. 13
5. Which of the following methods of drug administration requires a needle?
1. Transdermal
2. Inhalation
a. 1 and 3 only
b. 2 and 4 only
c. 1 and 2 only
d. 3 and 4 only
ANSWER: D
Subcutaneous administration involves the use of a needle to inject drug into the tissue beneath the
4. Intravenous
3. Subcutaneous
2. Intramuscular

epidermis and dermis. Intravenous administration involves the use of a needle to inject drug directly
into a vein or via a catheter put in place for this purpose. With transdermal administration, drug is
absorbed percutaneously, obviating the need for a hypodermic needle and decreasing the
fluctuations in plasma

drug levels that can occur with repeated oral administration. Inhalation involves administering the
drug in an aerosolized form directly to the lung.
REF: p. 13
6. Which of the following is not a part of the pharmacokinetic phase of a drug?
a. Absorption
b. Receptor site
c. Metabolism
d. Elimination
ANSWER: B
Absorption, distribution, metabolism, and speed and method of elimination are factors that
influence the course of a drug after it is introduced in the body. Receptors participate in the
pharmacodynamic phase of drug action.
REF: p. 14

7. The process of incorporating a substance into a cell by engulfment and transport to
the cell interior in vesicles is termed
a. aqueous diffusion.
b. lipid diffusion.
c. bioavailability.
d. pinocytosis.
ANSWER: D
Aqueous diffusion describes the absorption of a substance into the aqueous compartments of the
body, such as the interstitial spaces. Lipid diffusion describes the movement of a drug across lipid
membranes en route to its place of action. Bioavailability indicates the portion of a drug that
reaches the systemic circulation. Pinocytosis describes the incorporation of a substance into a cell
by a process of membrane engulfment and transport of the substance to the cell interior in vesicles,
allowing translocation across a membrane barrier.
REF: p. 15
8. Which of the following factors may have an effect on drug absorption?
a. 1 only
b. 1 and 2 only
c. 1 and 4 only
d. 1, 2, 3, and 4
ANSWER: D
The route of administration determines which barriers to absorption must be crossed by a drug.
Such barriers can affect the drug’s time to onset and time to peak effect. Intravenous
administration bypasses the need for absorption from the gastrointestinal tract seen with oral
administration, generally gives a very rapid onset and peak effect, and provides 100% availability of
the drug in the bloodstream. The amount of drug in the bloodstream (its bioavailability) is
influenced not only by absorption but also by inactivation caused by stomach acids and by
metabolic degradation, which can occur before the drug reaches the main systemic compartment.
Another important variable governing absorption and bioavailability is blood flow to the site of
absorption.
REF: p. 15
4. Blood flow to absorption site
3. Inactivation by stomach acids
2. Metabolic degradation
1. Route of administration

9. Which of the four major body compartments contains the smallest average volume in

liters?
a. Intracellular fluid
b. Vascular space
c. Interstitial fluid
d. Fat
ANSWER: B
Intracellular fluid accounts for an average of 20 L of volume. Blood accounts for an average of 5 L
of volume. Interstitial fluid accounts for an average of 10 L of volume. Fat accounts for an average
of 14 to 25 L of volume.
REF: p. 16
a.
10.
brain.
The principal organ for drug metabolism is
the
b. liver.
c.
d.
stomach
. lung.

ANSWER: B
Other tissues, such as the lung, intestinal wall, and endothelial vascular wall, can transform or
metabolize drugs; however, the liver is the principal organ for drug metabolism.
REF: p. 17
11. Which of the following routes of drug administration help to reduce the first-
pass effect?
1. Oral administration
a. 1 and 3 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, and 4 only
ANSWER: C
Oral administration allows the drug to travel from the stomach or intestine to the branches of the
portal vein, which drain directly into the liver, allowing for a large portion of the drug to be
terminated before reaching the systemic circulation. The following routes avoid first-pass
circulation through the liver: injection, buccal or sublingual tablets, transdermal (e.g., patch) or
rectal (e.g., suppositories) administration, and inhalation. These routes of administration bypass the
portal venous circulation of the liver, allowing drugs to be generally distributed in the body before
being circulated through the liver and ultimately metabolized. They also bypass metabolic
degradation occurring in the gut as a result of specific metabolic enzymes (e.g., cytochrome P450
family 3 [CYP3]) or bacterial flora.
REF: p. 17
12. Which of the following organs is considered the primary site of drug excretion?
a. Kidney
b. Liver
c. Small intestine
d. Stomach
ANSWER: A
The primary site of drug excretion in the body is the kidney. The liver is the site of much drug
4. Rectal administration
3. Sublingual tablets
2. Injection

metabolism, and the kidney is important for removing drug metabolites produced by the liver.
Some drugs are not metabolized and are eliminated from the circulation entirely by the kidney.
The small intestine and stomach are potential sites for drug absorption.

REF: p. 17
13. Inhaled aerosols may have which types of intended effects on the body?
1. Enteral
4. Oral
a. 1 and 3 only
b. 2 and 4 only
d. 1, 2, 3, and 4
ANSWER: C
c. 2 and 3 only
3. Systemic
2. Local

Enteral and oral describe possible routes of drug administration. Inhaled aerosols are deposited on
the surface of the upper or lower airway and are a form of topically administered drug. As topically
deposited agents, inhaled aerosols can be intended for either a local effect in the upper or lower airway
or a systemic effect as the drug is absorbed and distributed in the blood.
REF: p. 19 | p. 20
14. Approximately what percentage of an inhaled aerosol reaches the lower
respiratory tract with current delivery devices?
a. 0% to 10%
b. 10% to 30%
c. 50% to 60%
d. 90% to 100%
ANSWER: B
Although 10% is the generally accepted amount of drug that actually reaches the lower respiratory
tract, this number may range from 10% to 30% based on the delivery device and patient
technique.
REF: p. 21
15. Out of the total systemically available drug, the proportion of drug available from
the lung is known as the
a. TI
b. VD
c. L/T ratio
d. T1/2
ANSWER: C
The therapeutic index (TI) is the difference between the minimal therapeutic and toxic concentrations of
a drug. The volume of distribution (VD) is the ratio of the amount of drug administered versus the
plasma concentration of the drug. For an aerosol drug (bronchodilator, corticosteroid, mediator
antagonist) that targets the respiratory tract, the L/T ratio is defined as the proportion of drug
available from the lung out of the total systemically available drug. Plasma half-life (T1/2) describes
the amount of time required for the plasma concentration of a drug to decrease by one-half.
REF: p. 21 | p. 22
16. The mechanism of drug action by which a drug molecule causes its effect in the
body is known as the
a. pharmacodynamic phase.

b. elimination phase.
c. pharmacokinetic phase.

d. administration phase.
ANSWER: A
Pharmacokinetics describes what the body does to a drug, and pharmacodynamics describes what
the drug does to the body. Elimination describes the removal of a drug from the body; the kidney is
the primary site of drug elimination. The pharmacokinetic phase describes the time course and
deposition of a drug in the body. The administration phase describes the method by which a drug
dose is made available to the body.
REF: p. 23
17. The relationship between a drug’s chemical structure and its clinical activity is known
as
a. bioavailability.
b. biotransformation.
c. pharmacokinetics.

d. structure-activity relationship.
ANSWER: D
Bioavailability refers to the amount of a drug that reaches the systemic circulation.
Biotransformation is the transformation of a drug into a metabolite or inactive form.
Pharmacokinetics describes the time course and disposition of a drug in the body. The relationship
between a drug’s chemical structure and its clinical effect or outcome on the body is termed the
structure-activity relationship (SAR).
REF: p. 23
18. Given the following information, which drug is most potent?
Drug ED50
A 10 mg
B 5 mg
C 1 mg
D 15 mg
a. Drug A
b. Drug B
c. Drug C
d. Drug D
ANSWER: C
The dose at which 50% of the response to the drug occurs is indicated in Figure 2-13 and is referred to
as the ED50, the dose of drug that produces 50% of the maximal effect. This may also be denoted as
the EC50, for effective concentration giving 50% of the maximal response. Potency refers to the
concentration (EC50) or dose (ED50) of a drug producing 50% of that drug’s maximal response. The
potency of two drugs, A and B, can be compared on the basis of the ED50 values of the two drugs:
relative potency, A and B = ED50 (B)/ED50 (A).
REF: p. 27
19. Which of the following drugs has the greatest potential of crossing over
from a therapeutic effect to a toxic effect?
Drug TI
A 2
B 20
C 5
D 15

c. Drug C
d. Drug D
ANSWER: A
The ratio of the dose that is toxic to 50% of test subjects (LD50) to the dose that provides relief to
50% of subjects (ED50) is the clinical therapeutic index (TI). This index represents the safety margin
of the drug. The smaller the TI, the greater the possibility of crossing from a therapeutic effect to a
toxic effect. Drug A has the narrowest TI.
REF: p. 27
20. The drug albuterol binds to its corresponding receptor to initiate its intended
response of bronchodilation. By definition, albuterol is known as a(n)
a. agonist.
b. antagonist.

c. both A and B.
d. neither A nor B.
ANSWER: A
An agonist is a drug or chemical that binds to a corresponding receptor (has affinity) and initiates a
cellular effect or response (has efficacy). An antagonist is a drug or chemical that is able to bind to a
receptor (has affinity) but causes no response (zero efficacy).
REF: p. 28
21. Two different drugs (each with its own mechanism of action) are administered
to a patient in an attempt to relieve bronchoconstriction. The ordering physician hopes that
the effect of the drug pair will be greater than the sum of the separate effects of each
individual drug. If successful, this would be an example of
a. potentiation.
b. synergism.
c. additivity.
d. tolerance.
ANSWER: B
Potentiation is a special case of synergism in which one drug has no effect but can increase the activity
of another drug. Synergism occurs when two drugs act on a target organ by different mechanisms of
action and the effect of the drug pair is greater than the sum of the separate effects of the drugs.
Additivity occurs when two drugs act on the same receptors and the combined effect is the simple
linear sum of the effects of the two drugs, up to a maximal effect. Tolerance describes a decreasing
intensity of response to a drug over time.
REF: p. 28
22. Mrs. Johnson is a 37-year-old woman who has been taking medication for lower
back pain for the last 18 months. She reports to her physician that although the
medication initially rendered her pain-free, she now receives very little relief from her daily
dose. This situation is described by which of the following terms used to refer to drug
responsiveness (assuming that her condition has not actually worsened)?
a. Hypersensitivity
b. Idiosyncratic effect
c. Tolerance
d. Tachyphylaxis
ANSWER: C

Hypersensitivity describes an allergic or immune-mediated response to a drug, which can be
serious, requiring airway maintenance or ventilatory assistance. An idiosyncratic effect is one
that is unusual,

opposite to, or has no effect compared with the predicted usual effect in an individual. Tolerance
describes a decreasing intensity of response to a drug over time. Tachyphylaxis describes a rapid
decrease in response to a drug.
REF: p. 29
a. 0
23. A perfectly efficient aerosol delivery device would theoretically have an L/T ratio
of which of the following?
b. 0.5
c. 0.75
d. 1.0
ANSWER: D

For an aerosol drug that targets the respiratory tract, the L/T ratio can be defined as the proportion of
drug available from the lung, out of the total systemically available drug. Theoretically, if a 10-mg
dose was administered, and a resulting 10 mg was available systemically, the L/T ratio would be 10
divided by 10, which equals 1.
REF: p. 21
24. Which of the following factors can increase the lung availability/total
systemic availability ratio of inhaled drugs?
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4
ANSWER: D
Any action that reduces the swallowed portion of the inhaled drug can increase the L/T ratio; a high
first- pass metabolism rate can also increase the L/T ratio.
REF: p. 21 | p. 22
25. The drug methacholine can stimulate parasympathetic receptors in the airways,
causing bronchoconstriction. Epinephrine can stimulate b2 receptors in the airways, causing
bronchodilation. These two opposing effects that cancel each other out are an example of
a. chemical antagonism.
b. functional antagonism.
c. competitive antagonism.
d. synergism.
ANSWER: B
Chemical antagonism is a direct chemical interaction between a drug and a biologic mediator,
which inactivates the drug. Functional antagonism occurs when two drugs each produce an effect and
the effects cancel each other out. Competitive antagonism occurs when a drug has an affinity for a
receptor but no efficacy and at the same time blocks the active agonist from binding to and
stimulating the receptor.
Synergism occurs when two drugs act on a target organ by different mechanisms of action and the
4. Use of a reservoir device
3. Mouth washing
2. Inhaled drugs with a high first-pass metabolism rate
1. Efficient delivery devices

effect of the drug pair is greater than the sum of the separate effects of the drugs.
REF: p. 28

26. The lining of the lower respiratory tract presents barriers to drug absorption
and includes which of the following elements?
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4
ANSWER: D
4. Interstitium
3. Epithelial cells
2. Capillary vascular network
1. Airway surface liquid

The lining of the lower respiratory tract presents barriers to drug absorption. This mucosal barrier
consists of the following five identifiable elements: airway surface liquid, epithelial cells, basement
membrane, interstitium, and capillary vascular network.
REF: p. 14
27. The study of genetic factors and their influence on drug response is termed
a. pharmacogenetics.
b. functional antagonism.
c. competitive antagonism.
d. pharmacokinetics.
ANSWER: A
Functional antagonism occurs when two drugs each produce an effect and the effects cancel each
other out. Competitive antagonism occurs when a drug has an affinity for a receptor but no efficacy
and at the same time blocks the active agonist from binding to and stimulating the receptor.
Pharmacokinetics is the time course and disposition of a drug in the body, based on its absorption,
distribution, metabolism, and elimination.
REF: p. 29
28. The difference between the minimal therapeutic and toxic concentrations of a
drug is known as the
a. TI.
b. VD.
c. L/T ratio.
d. T1/2.
ANSWER: A
REF: p. 18
a. TI
.
29. A measure of how quickly a drug is eliminated from the body is known as the

c. L/T ratio.
d. T1/2.
ANSWER: D
REF: p. 18

30. Mr. Ashoor is a 29-year-old asthmatic patient who takes MDI albuterol for
wheezing and typically gets quick relief following two puffs. After he mowed the lawn today, he
realized he was having a rapid decrease in responsiveness to his albuterol. He tried taking it
again but still had no relief. This situation is described by which of the following terms used
to refer to drug responsiveness?
a. Hypersensitivity
b. Idiosyncratic effect
c. Tolerance
d. Tachyphylaxis
ANSWER: D
serious, requiring airway maintenance or ventilatory assistance. An idiosyncratic effect is one
that is unusual, opposite to, or has no effect compared with the predicted usual effect in an
individual. Tolerance describes a decreasing intensity of response to a drug over time.
Tachyphylaxis describes a rapid decrease in response to a drug.
REF: p. 29
31. Which is the term that refers to the concentration (EC50) or dose (ED50) of a
drug producing 50% of the maximal response of the drug?
a. Potency
b. Hypersensitivity
c. Potentiation
d. Additivity
ANSWER: A
serious, requiring airway maintenance or ventilatory assistance. Potency refers to the concentration
(EC50) or dose (ED50) of a drug producing 50% of the maximal response of the drug. Additivity
occurs when two drugs act on the same receptors and the combined effect is the simple linear sum of
the effects of the two drugs, up to a maximal effect. Potentiation is a special case of synergism in
which one drug has no effect but can increase the activity of another drug.
REF: p. 27 | p. 28
32. An allergic or immune-mediated reaction to a drug, which can be serious,
requiring airway maintenance or ventilatory assistance is called
a. potency.
b. hypersensitivity.

d. additivity.
ANSWER: B
REF: p. 29
33. A special case of synergism in which one drug has no effect but can increase
the activity of another drug is known as
a. potency.
b. hypersensitivity.
c. potentiation.

d. additivity.
ANSWER: C
REF: p. 28
34. This term is used to describe when two drugs act on the same receptors and
the combined effect is the simple linear sum of the effects of the two drugs, up to a maximal
effect.
a. Potency
b. Hypersensitivity
c. Potentiation
d. Additivity
ANSWER: D
REF: p. 28
35. Why is lipid diffusion an important mechanism for drug absorption?
a. Many epithelial membranes must be crossed if a drug is to distribute in the body
b. Epithelial cells do not have lipid membranes, so a drug must be water-soluble
to diffuse across such a membrane.
c. It is directly related to the proportion of a drug that reaches the systemic circulation.
d. Lipid diffusion has no importance in drug absorption because the body has very
few epithelial membranes drugs must cross.
ANSWER: A
Lipid diffusion is an important mechanism for drug absorption because many epithelial membranes
and reach its target organ.

must be crossed if a drug is to distribute in the body and reach its target organ.
REF: p. 15

36. The term used to indicate the proportion of a drug that reaches the systemic
circulation is
a. bioavailability.
c. pharmacokinetics.
d. structure-activity relationship.
ANSWER: A
Biotransformation is the transformation of a drug into a metabolite or inactive form.
Pharmacokinetics describes the time course and disposition of a drug in the body. The relationship
between a drug’s chemical structure and its clinical effect or outcome on the body is termed the
structure-activity relationship (SAR).
REF: p. 11

37. The process by which a drug is transported to its sites of action, eliminated, or
stored is referred to as
a. bioavailability.
c. drug distribution.
d. plasma half-life.
ANSWER: C
Biotransformation is the transformation of a drug into a metabolite or inactive form. Drug
distribution is the process by which a drug is transported to its sites of action, eliminated, or stored.
Plasma half-life (T1/2) is the time required for the plasma concentration of a drug to decrease by one-
half.
REF: p. 15 | p. 16
38. The time required for the plasma concentration of a drug to decrease by one-
half is referred to as
a. bioavailability.
c. drug distribution.
d. plasma half-life.
ANSWER: D
Biotransformation is the transformation of a drug into a metabolite or inactive form. Drug
distribution is the process by which a drug is transported to its sites of action, eliminated, or stored.
Plasma half-life (T1/2) is the time required for the plasma concentration of a drug to decrease by one-
half.
REF: p. 18
39. After inhalation of an aerosol by a spontaneously breathing patient with no
artificial airway, a proportion of the aerosol does which of the following?
4. Is exhaled
a. 1 and 2 only
3. Is absorbed by the lungs
2. Is swallowed
1. Impacts in the oropharynx

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

ANSWER: C
After inhalation of an aerosol by a spontaneously breathing patient with no artificial airway, a
proportion of the aerosol impacts in the oropharynx and is swallowed, and a proportion is inhaled
into the airway. Because a portion of an inhaled aerosol is swallowed, the inhalation route leads to
gastrointestinal absorption, as well as lung absorption of the drug. The traditional percentages
given for stomach and airway proportions, based on Stephen Newman’s classic measures in 1981
with an MDI, are approximately 90% and 10%, respectively.
REF: p. 20 | p. 21
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