NBRC Pharmacology and Therapeutics 2 — Questions and Answers
Question 1: Which drug is the first-line treatment for anaphylaxis causing severe bronchospasm?
- Diphenhydramine
- Methylprednisolone
- Epinephrine (Correct answer)
- Albuterol
Correct answer: Epinephrine
Epinephrine is the first-line treatment for anaphylaxis because it rapidly reverses bronchospasm, hypotension, and angioedema through alpha and beta adrenergic receptor stimulation.
Question 2: N-acetylcysteine (Mucomyst) works as a mucolytic by which mechanism?
- Increasing mucociliary clearance
- Cleaving disulfide bonds in mucus glycoproteins (Correct answer)
- Blocking leukotriene receptors
- Inhibiting phosphodiesterase
Correct answer: Cleaving disulfide bonds in mucus glycoproteins
N-acetylcysteine reduces mucus viscosity by breaking disulfide bonds within mucus glycoproteins, making secretions easier to expectorate.
Question 3: Heliox therapy is most appropriate for which clinical situation?
- Hypoxemia due to diffusion impairment
- Upper airway obstruction causing increased work of breathing (Correct answer)
- Hypercapnic respiratory failure
- Pulmonary edema
Correct answer: Upper airway obstruction causing increased work of breathing
Heliox (helium-oxygen mixture) reduces gas density, decreasing turbulent flow and work of breathing in conditions with upper airway obstruction such as croup or post-extubation stridor.
Question 4: Which drug used in respiratory care inhibits phosphodiesterase, resulting in increased cyclic AMP and bronchodilation?
- Montelukast
- Cromolyn sodium
- Aminophylline (Correct answer)
- Tiotropium
Correct answer: Aminophylline
Aminophylline (a prodrug of theophylline) inhibits phosphodiesterase, preventing breakdown of cyclic AMP, which leads to smooth muscle relaxation and bronchodilation.
Question 5: A respiratory therapist is preparing to administer racemic epinephrine via nebulizer. This treatment is most indicated for which condition?
- Acute asthma attack
- Post-extubation stridor (Correct answer)
- Bacterial pneumonia
- Pulmonary fibrosis
Correct answer: Post-extubation stridor
Racemic epinephrine causes local vasoconstriction and reduces subglottic edema, making it the drug of choice for post-extubation stridor and croup.
Question 6: Which inhaled agent is used to assess airway hyperresponsiveness during a bronchoprovocation challenge test?
- Albuterol
- Methacholine (Correct answer)
- Tiotropium
- Fluticasone
Correct answer: Methacholine
Methacholine is a cholinergic agonist that causes bronchoconstriction in a dose-dependent manner; a positive test (≥20% fall in FEV1) confirms airway hyperresponsiveness consistent with asthma.
Question 7: Sildenafil (Revatio) is used in respiratory care to treat which condition?
- Pulmonary arterial hypertension (Correct answer)
- Severe persistent asthma
- Acute respiratory distress syndrome
- Cystic fibrosis
Correct answer: Pulmonary arterial hypertension
Sildenafil inhibits phosphodiesterase-5, increasing cyclic GMP and causing pulmonary vascular smooth muscle relaxation, reducing pulmonary vascular resistance in pulmonary arterial hypertension.
NBRC Pharmacology and Therapeutics 2
Which drug is the first-line treatment for anaphylaxis causing severe bronchospasm?