Test Bank for Raus Respiratory Care Pharmacology 9th Edition by Gardenhire

Test Bank for Raus Respiratory Care Pharmacology

9th Edition by Gardenhire

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Chapter 10: Surfactant Agents
Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

MULTIPLE CHOICE

1. Another name for surface-active agents is

a. mucolytic.
b. detergent.
c. bronchodilator.
d. antibiotic.
ANS: B
Surface-active agents lower alveolar surface tension and allow lower pressures to be used for
alveolar inflation. Soap and various forms of detergent have similar surface tension–lowering
capabilities, and surface-active agents, or surfactants, have also been termed detergents.

REF: p. 173

2. As it relates to an alveolus, LaPlace’s law is written as

a. pressure = (4  surface tension)/radius
b. dyn/cm
c. pressure = surface tension/radius
d. pressure = (2  surface tension)/radius

ANS: D
For an alveolus (one air-liquid interface), LaPlace’s law is written as follows: pressure = (2 
surface tension)/radius.
For a bubble (two air-liquid interfaces), LaPlace’s law is written as follows: pressure = (4 
surface tension)/radius.
The unit of measure for surface tension is usually dynes per centimeter (dyn/cm).

REF: p. 173

3. Lack of pulmonary surfactant in respiratory distress syndrome (RDS) of the newborn typically
results in
a. high surface tension.
b. low surface tension.
c. no effect on surface tension.
d. increased compliance.
ANS: A
The basic problem in RDS of the newborn is lack of pulmonary surfactant secondary to lung
immaturity, which results in high surface tension in the liquid-lined, gas-filled alveoli.

REF: p. 173 | p. 174

4. The term used to describe surfactant produced outside of the patient’s body is
a. endogenous.
b. exogenous.
c. natural.
 d. bovine.
ANS: B
Endogenous surfactant is produced within a patient’s own body. The term exogenous, when
used to describe this class of drugs, refers to surfactant preparations made outside the patient’s
own body. These preparations may be obtained from other humans, from animals, or by
laboratory synthesis. Natural surfactant may be either bovine or porcine and still be produced
outside the patient’s own body. Bovine refers to a substance produced in or gathered from a
cow.

REF: p. 174

5. Endogenous surfactant is produced by

a. alveolar type II cells.
b. goblet cells.
c. alveolar type I cells.
d. macrophages.
ANS: A
Pulmonary surfactant is a complex mixture of lipids and proteins produced by alveolar type II
cells. Goblet cells produce mucus. Alveolar type I cells form the thin blood-gas barrier
through which gas exchange occurs. Macrophages are phagocytic cells that defend alveoli
against foreign invaders.

REF: p. 175

6. Surfactant is primarily composed of

a. proteins.
b. phospholipids.
c. neutral lipids.
d. water.
ANS: B
Proteins comprise only about 10% of whole surfactant by weight. Phospholipids account for
85% to 90% of whole surfactant by weight. Neutral lipids comprise only about 10% of whole
surfactant by weight. Water is not a major component of surfactant by weight.

REF: p. 175

7. Surfactant is stored in
a. alveoli.
b. type II alveolar cells.
c. lamellar bodies.
d. lipids.
ANS: C
Surfactant is produced by type II alveolar cells and stored in vesicles termed lamellar bodies.
Surfactant is composed mostly of lipids and is introduced into the alveoli as it is needed.

REF: p. 176

8. The major stimulus for secretion of surfactant into the alveolus is

 a. lung inflation.
b. lung deflation.
c. cough.
d. infection.
ANS: A
The major stimulus for secretion of surfactant-containing lamellar bodies into the alveolar
space seems to be inflation of the lung via a chemically coupled stretch response.

REF: p. 176

9. Which of the following are natural surfactant preparations?

1. Surfaxin®
2. Curosurf®
3. Survanta®
4. Infasurf®

a. 1 and 2 only
b. 2 and 3 only
c. 3 and 4 only
d. 2, 3, and 4
ANS: D
Curosurf® is a modified natural porcine (pig) surfactant. Survanta® and Infasurf® are modified
natural bovine (cow) surfactants. Surfaxin® is a synthetic surfactant recently approved by the
U.S. Food and Drug Administration (FDA).

REF: p. 174

10. ____________ is not a method to obtain natural surfactant.

a. Amniotic fluid extraction
b. In vitro preparation
c. Human alveolar wash
d. Animal alveolar wash
ANS: B
Natural surfactant is a descriptive term for the category of surfactants obtained from animals
or humans by alveolar wash or from amniotic fluid. The term synthetic natural surfactant
would be used to describe surfactant that is genetically engineered by in vitro recombinant
DNA technology. No products of this type are available for general use at the present time.

REF: p. 176 | p. 177

11. Which of the following are approved indications for surfactant therapy?
1. Prophylaxis of respiratory distress syndrome (RDS) in infants with very low birth weight
(<1250 g)
2. Prophylaxis of RDS in infants with higher birth weight (>1250 g) but with immature lungs
3. Rescue treatment in infants with RDS
4. Acute respiratory distress syndrome (ARDS) in adults
 a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4
ANS: C
Clinical indications for use of exogenous surfactants include the following: (1) prevention of
RDS in infants with very low birth weight or infants with higher birth weight but with
evidence of immature lungs and (2) rescue treatment of infants who have developed RDS.
Exogenous surfactants are being investigated for clinical use in disease states such as ARDS,
MAS, and pneumonia.

REF: p. 178

12. Which of the following are currently used methods for delivering surfactant into infants?
1. Instillation through side-port adapter
2. Instillation through catheter
3. Nebulization
4. Extracorporeal membrane oxygenation (ECMO)

a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4
ANS: A
Surfactant may be delivered either through a special side-port adapter that is part of some
neonatal endotracheal tubes (ETTs) or via a 5-F catheter positioned inside the ETT. The aim
is to achieve a high rate of lung deposition and to avoid having the surfactant adhere to the
sides of the ETT. Surfactant is not administered by nebulization or by ECMO.

REF: p. 178

13. You are assessing a 36-week gestational age newborn immediately after birth. The newborn
weighs 2200 g. On assessment, you find the newborn has good color, no retractions, no nasal
flaring, respiratory rate of 25 breaths/min, heart rate of 110 beats/min, and pulse oximetry of
96% on room air. Which of the following would you choose?
a. Calfactant
b. Albuterol
c. Beractant
d. No indication for drug therapy at this time
ANS: D
Exogenous surfactants are clinically indicated for the treatment or prevention of respiratory
distress syndrome in the newborn. This newborn is not currently exhibiting any signs of
respiratory distress, and drug therapy is not indicated at this time.

REF: p. 173
14. A newborn weighing 1000 g exhibits symptoms of respiratory distress syndrome (RDS),
including poor color, suprasternal retractions, nasal flaring, and desaturation. The respiratory
therapist should recommend
a. Ipratropium bromide.
b. Poractant alfa.
c. Salmeterol.
d. Dornase alfa.
ANS: B
Exogenous surfactants are clinically indicated for the treatment or prevention of RDS in the
newborn. Ipratropium bromide, salmeterol, and dornase alfa are not surfactants.

REF: p. 173 | p. 174

15. __________ is a synthetic surfactant recently approved by the FDA for use in infants at risk
for RDS.
a. Beractant
b. Calfactant
c. Lucinactant
d. Poractant alfa
ANS: C
Lucinactant is a synthetic peptide containing surfactant replacement therapy.
Natural surfactant refers to the category of surfactants obtained from animals or humans by
alveolar wash or from amniotic fluid.

REF: p. 179

16. What is the typical method of administering exogenous surfactant to infants?

a. Direct instillation to the airway
b. Nebulization
c. Intravenously
d. Rectal suppository
ANS: A
The calculated dose is given in quarters from a syringe and instilled into the trachea through a
5-F catheter placed into the endotracheal tube. The catheter is removed, and the infant is
manually ventilated for at least 30 seconds, or until stable, between doses. The remaining
doses are given in similar fashion. During each quarter dose, the infant is placed in a different
position.

REF: p. 178

17. Which of the following is considered the mode of action for surfactant?
a. To replace missing surfactant
b. To accelerate lung maturity
c. To emulsify lung secretions
d. To relax bronchial smooth muscle
ANS: A
Exogenous surfactants replace missing pulmonary surfactant in newborns with RDS.
 REF: p. 179

18. ____________ is not a hazard or complication of exogenous surfactant.

a. Airway occlusion
b. Overoxygenation
c. Tachycardia
d. Pulmonary insult via barotrauma
ANS: C
In the dosing procedure, relatively large volumes of suspension are instilled in neonatal-size
airways; this can block gas exchange, causing desaturation and bradycardia. The effect of the
drug in improving pulmonary compliance can lead to overventilation, excessive volume
delivery from pressure-limited ventilation, and overoxygenation with dangerously high
arterial oxygen pressure (PaO2) levels. Complications of prematurity generally may affect the
response to exogenous surfactant.

REF: p. 180

19. You are assessing a 26-week gestational age newborn immediately after birth. The newborn
weighs 1200 g. On assessment, you find the newborn has poor color, substernal retractions,
nasal flaring, respiratory rate of 45 breaths/min, and heart rate of 140 beats/min. You note that
it is difficult to ventilate the newborn with the bag mask. Which of the following agents would
you recommend?
a. Cromolyn sodium
b. Albuterol
c. Beractant
d. Solu-Medrol®
ANS: C
Exogenous surfactants are clinically indicated for the treatment or prevention of respiratory
distress syndrome (RDS) in the newborn. This newborn is showing signs of impending RDS
(prematurity, retractions, nasal flaring, poor lung compliance) and needs prophylactic
administration of exogenous surfactant. Albuterol (a bronchodilator), and Solu-Medrol® (a
corticosteroid) are not indicated at this time.

REF: p. 178

20. A key feature of surfactant production is

a. the recycling activity.
b. to mature lungs immediately.
c. to break up lung secretions.
d. to relax bronchial smooth muscle.
ANS: A
A key feature of surfactant production, which is the basis for the success of replacement
therapy with exogenous compounds, is the recycling activity in surfactant production. Most
surfactant (90% to 95%) is taken back into the alveolar type II cell, reprocessed, and
resecreted. For this reason, exogenously administered surfactant is successful in replacing
missing surfactant with one or two doses. The exogenous surfactant is taken into the type II
cells and becomes the surfactant pool, through the reuptake and recycling mechanism.
 REF: p. 176

21. You are called to the room of a 28-week gestational age newborn boy who was placed on
pressure-limited mechanical ventilation and given surfactant therapy 2 hours ago. He is
hypocapnic, and his tidal volumes are higher than were previously documented. What may be
the cause of this finding?
a. Airway occlusion
b. Overoxygenation
c. Lung compliance has improved
d. He needs another dose of surfactant
ANS: C
As lung compliance improves, peak ventilating pressure, expiratory baseline pressures, and
ventilatory rate must be adjusted, or overventilation, leading to hypocapnia (low blood CO2),
and pneumothorax may occur.

REF: p. 180

22. Which of the following is the trade name for the generic exogenous surfactant preparation
lucinactant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta
ANS: B
Rationale:
Exogenous Surfactant Preparations Currently Approved for Use in the United States*
DRUG BRAND NAME FORMULATION AND INITIAL DOSE
Beractant Survanta 8-mL vial, 25 mg phospholipids/mL with 0.5-1.75
mg/mL triglycerides, 1.4-3.5 mg/mL free fatty
acids, and <1 mg/mL protein
Dose: 100 mg phospholipids/kg (4 mL/kg) in four
divided doses by tracheal instillation
Calfactant Infasurf 3-mL and 6-mL vial, 35 mg phospholipids/mL,
with 0.65 mg proteins
Dose: 3 mL/kg in two divided doses of 1.5 mL/kg
by tracheal instillation
Poractant alfa Curosurf 1.5-mL vial, 80 mg phospholipids, with 1 mg of
proteins, or 3-mL vial, 160 mg phospholipids,
with 2 mg of proteins
Dose: 2.5 mL/kg (200 mg/kg) in two divided
doses by tracheal instillation
Lucinactant Surfaxin 8.5-mL vial, 30 mg phospholipids, 4.05 mg of
palmitic acid, and 0.862 sinapultide
Dose: 5.8 mL/kg in four divided doses by tracheal
instillation

REF: p. 174
23. Which of the following is the trade name for the generic exogenous surfactant preparation
calfactant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta
ANS: A
Rationale:
Exogenous Surfactant Preparations Currently Approved for Use in the United States*
DRUG BRAND NAME FORMULATION AND INITIAL DOSE
Beractant Survanta 8-mL vial, 25 mg phospholipids/mL with 0.5-1.75
mg/mL triglycerides, 1.4-3.5 mg/mL free fatty
acids, and <1 mg/mL protein
Dose: 100 mg phospholipids/kg (4 mL/kg) in four
divided doses by tracheal instillation
Calfactant Infasurf 3-mL and 6-mL vial, 35 mg phospholipids/mL,
with 0.65 mg proteins
Dose: 3 mL/kg in two divided doses of 1.5 mL/kg
by tracheal instillation
Poractant alfa Curosurf 1.5-mL vial, 80 mg phospholipids, with 1 mg of
proteins, or 3-mL vial, 160 mg phospholipids,
with 2 mg of proteins
Dose: 2.5 mL/kg (200 mg/kg) in two divided
doses by tracheal instillation
Lucinactant Surfaxin 8.5-mL vial, 30 mg phospholipids, 4.05 mg of
palmitic acid, and 0.862 sinapultide
Dose: 5.8 mL/kg in four divided doses by tracheal
instillation

REF: p. 174

24. Which of the following is the trade name for the generic exogenous surfactant preparation
beractant?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta
ANS: D
Rationale:
Exogenous Surfactant Preparations Currently Approved for Use in the United States*
DRUG BRAND NAME FORMULATION AND INITIAL DOSE
Beractant Survanta 8-mL vial, 25 mg phospholipids/mL with
0.5-1.75 mg/mL triglycerides, 1.4-3.5 mg/mL
free fatty acids, and <1 mg/mL protein
Dose: 100 mg phospholipids/kg (4 mL/kg) in
four divided doses by tracheal instillation
Test Bank for Raus Respiratory Care Pharmacology 9th Edition by Gardenhire

Calfactant Infasurf 3-mL and 6-mL vial, 35 mg phospholipids/mL,

with 0.65 mg proteins
Dose: 3 mL/kg in two divided doses of 1.5
mL/kg by tracheal instillation
Poractant alfa Curosurf 1.5-mL vial, 80 mg phospholipids, with 1 mg of
proteins, or 3-mL vial, 160 mg phospholipids,
with 2 mg of proteins
Dose: 2.5 mL/kg (200 mg/kg) in two divided
doses by tracheal instillation
Lucinactant Surfaxin 8.5-mL vial, 30 mg phospholipids, 4.05 mg of
palmitic acid, and 0.862 sinapultide
Dose: 5.8 mL/kg in four divided doses by
tracheal instillation

REF: p. 174

25. Which of the following is the trade name for the generic exogenous surfactant preparation
poractant alfa?
a. Infasurf
b. Surfaxin
c. Curosurf
d. Survanta
ANS: C
Rationale:
Exogenous Surfactant Preparations Currently Approved for Use in the United States*
DRUG BRAND NAME FORMULATION AND INITIAL DOSE
Beractant Survanta 8-mL vial, 25 mg phospholipids/mL with 0.5-1.75
mg/mL triglycerides, 1.4-3.5 mg/mL free fatty
acids, and <1 mg/mL protein
Dose: 100 mg phospholipids/kg (4 mL/kg) in four
divided doses by tracheal instillation
Calfactant Infasurf 3-mL and 6-mL vial, 35 mg phospholipids/mL,
with 0.65 mg proteins
Dose: 3 mL/kg in two divided doses of 1.5 mL/kg
by tracheal instillation
Poractant alfa Curosurf 1.5-mL vial, 80 mg phospholipids, with 1 mg of
proteins, or 3-mL vial, 160 mg phospholipids,
with 2 mg of proteins
Dose: 2.5 mL/kg (200 mg/kg) in two divided doses
by tracheal instillation
Lucinactant Surfaxin 8.5-mL vial, 30 mg phospholipids, 4.05 mg of
palmitic acid, and 0.862 sinapultide
Dose: 5.8 mL/kg in four divided doses by tracheal
instillation

REF: p. 174

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