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MULTIPLE CHOICE
REF: p. 173
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.
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
REF: p. 175
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
REF: p. 176
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
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.
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
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
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
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
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