Deck 5: Drugs Used in the Treatment of Eye and Ear Disorders

Question 1

What is the most common adverse reaction to neomycin-containing otic preparations?

A)Shortness of breath
B)Headache
C)Contact dermatitis
D)Tachycardia and chest pain

Answer 1

Contact dermatitis

Question 2

Which statement is not part of the American Academy of Family Physicians (AAFP)acute otitis media (AOM)guidelines?

A)Relieve pain,especially within the first 24 hours,with ibuprofen or acetaminophen
B)Prescribe initial antibiotics for all children suspected of having AOM
C)Encourage families to prevent AOM by eliminating exposure to passive tobacco smoke
D)Offer parents the option of allowing a child to fight the infection on his/her own for 48 to 72 hours before prescribing antibiotics

Answer 2

Prescribe initial antibiotics for all children suspected of having AOM

Question 3

After 1 week of treatment of otitis externa with a topical antibacterial preparation,a patient has no significant improvement.What is the next best appropriate step in the treatment of this patient?

A)Begin an oral antibiotic agent
B)Discontinue use of the initially prescribed topical agent and prescribe a different preparation
C)Suspect an immunodeficiency disorder and order a complete hematologic panel
D)Suspect an overgrowth of nonsusceptible organisms and obtain cultures

Answer 3

Suspect an overgrowth of nonsusceptible organisms and obtain cultures

Question 4

Which anti-infective otic agent contains a steroid preparation?

A)neomycin (Myciguent)
B)ofloxacin (Floxin)
C)ciprofloxacin with hydrocortisone (Cipro HC Otic)
D)mupirocin (Bactroban)

Question 5

Which ophthalmic preparation is contraindicated in a patient concurrently taking an aminoglycoside due to an effect on serum concentrations that may lead to toxicity?

A)sulfacetamide ointment
B)tobramycin ointment
C)polymyxin B/bacitracin ointment
D)ciprofloxacin drops

Question 6

What property of propylene glycol in an over-the-counter (OTC)otic preparation enhances its antibacterial effect?

A)Propylene glycol creates a more basic pH in the ear canal.
B)Propylene glycol creates a more acidic pH in the ear canal.
C)Propylene glycol releases oxygen,which releases impacted bacteria as it bubbles.
D)Propylene glycol prevents protein synthesis in the bacteria.

Question 7

What is the proper method for instillation of eardrops in a child?

A)Gently pull the earlobe up and back
B)Gently pull the earlobe down and back
C)Gently pull the earlobe up and forward
D)Gently pull the earlobe down and up

Question 8

Under normal physiological conditions,some patients develop an excessive amount of cerumen.Why may this become problematic for the patient?

A)Excessive cerumen in the canal may be cosmetically displeasing.
B)Excessive cerumen in the canal may create an unpleasant otic odor.
C)Excessive cerumen in the canal may potentiate a middle ear infection.
D)Excessive cerumen in the canal may create a loss in hearing.

Question 9

Topical corticosteroids incorporated into a vehicle for application to the skin often have their chemical structure altered.What does this alteration result in?

A)An increase in lipid solubility,resulting in increased potency
B)An increase in lipid solubility,resulting in decreased potency
C)A decrease in lipid solubility,resulting in increased potency
D)A decrease in lipid solubility,resulting in decreased potency

Question 10

Cerumenolytics are commonly used to dislodge excessive cerumen.Typically,an agent such as triethanolamine polypeptide oleate drops (Cerumenex)is placed in a patient's ear canal and held in place with a cotton plug to soften the earwax.The ear is then flushed with warm water.Under what circumstances can Cerumenex cause ear canal inflammation?

A)When combined with a corticosteroid
B)When left in the ear canal for 60 minutes
C)When flushed with cold water
D)When continued use occurs

Question 11

A 12-year-old patient presents with moderate left ear pain and serosanguineous discharge.On physical examination,blood is apparent in the external canal and the tympanic membrane appears perforated.Despite the patient's left ear pain,why should the health-care practitioner avoid prescribing benzocaine?

A)Benzocaine is the least commonly prescribed otic analgesic.
B)Benzocaine is contraindicated in patients with a perforated tympanic membrane.
C)Repeated use of benzocaine decreases the risk of subsequent sensitization.
D)Benzocaine is indicated only for adult patients with a perforated tympanic membrane.

Question 12

What is the purpose of including a corticosteroid in topical otic anti-infective agents?

A)To reduce inflammation and pruritus
B)To reduce the chance of infection
C)To improve hearing
D)To reduce pain

Question 13

When choosing a topical anti-infective agent,ointments are generally considered to be more potent.Why?

A)Ointments are considered to be more occlusive.
B)Ointments are considered to be less occlusive.
C)Ointments alter the pH level of the skin,increasing absorption.
D)Ointments alter the pH level of the skin,decreasing absorption.

Question 14

Topically applied antibiotics used to treat bacterial otic infections are not typically absorbed through the skin.Under what condition(s)does such an antibiotic find its way into the systemic circulation?

A)When applied to a small area on a patient with third-degree burns
B)When applied to denuded or abraded skin
C)When applied to an area prepped with isopropyl alcohol
D)When applied to an area that has been thoroughly cleaned and dried

Question 15

When using otic topical medications,patients commonly have difficulty keeping the medication in their ears.What patient education instruction can most successfully help to correct this problem?

A)Suggest using a clean,cotton plug in the ear immediately following medication application.
B)Suggest the patient remain lying down for 60 minutes immediately following medication application.
C)Suggest warming the ototopical preparation just prior to application into the ear.
D)Suggest the patient apply the ototopical preparation to a clean cotton swab and then wipe the inside of the ear canal with the medication-laden swab.

Question 16

When prescribing an antibacterial agent for otitis externa,the health-care practitioner must consider that certain agents have the potential for ototoxicity.Which agent has the greatest potential for this adverse effect?

A)ofloxacin (Floxin)
B)ciprofloxacin with hydrocortisone (Cipro HC Otic)
C)neomycin/polymyxin B (Cortisporin)
D)carbamide peroxide (Debrox,Murine Ear)

Question 17

Absorption of topical corticosteroid antibiotic agents is affected by which of the following?

A)Skin temperature and hydration
B)Age of patient
C)Gender of patient
D)Ethnicity of patient

Question 18

A patient presents with a red,painful right eye and complaints of purulent eye discharge.Culture of that discharge reveals Neisseria gonorrhoeae.The patient denies drug allergies.Which ophthalmic agent would be most effective for this patient?

A)erythromycin ophthalmic preparation
B)bacitracin ophthalmic preparation
C)tobramycin ophthalmic preparation
D)sulfacetamide ophthalmic preparation

Question 19

A patient has used carbamide peroxide (Debrox,Murine Ear)for 7 days to loosen excessive earwax in her left ear.She now presents with complaints of decreased hearing on the left side.What is the most likely etiology of this hearing loss?

A)Damage to the tympanic membrane due to use of carbamide peroxide for 7 days
B)Damage to the outer ear canal due to use of carbamide in the otic preparation
C)Damage to the auditory nerve due to use of peroxide in the otic preparation
D)Damage to the tympanic membrane due to its 8.5% solution

Question 20

What is the mechanism by which benzocaine exerts its analgesic effect?

A)The blockage of nerve sodium channels with a resultant termination of signal propagation
B)The blockage of nerve calcium channels with a resultant stagnation of signal propagation
C)The interruption of synaptic signals with a resultant increase in action potential
D)The blockage of sympathetic nervous system innervation

Question 21

What medication may interact with ophthalmic vasoconstrictors,inducing a side effect of an increase in intraocular pressure (IOP)?

A)Monoamine oxidase inhibitors
B)Anti-hypertensives
C)Birth control pills
D)ibuprofen

Question 22

What is the best definition of a hordeolum?

A)Infection of the sebaceous gland of the eyelash
B)An isolated allergic reaction to pollen and/or dust
C)A benign growth of the eyelash hair follicle
D)An ingrown eyelash that causes chronic red eye

Question 23

What is the mechanism of action of an ophthalmic topical anesthetic agent?

A)Acting at the systemic level,they block the effects of histamine release,thereby blunting its symptoms and decreasing the sensation of pain.
B)Acting locally,they block initiation and conduction of nerve impulses by decreasing the neuronal membrane's sensitivity to sodium ions,thereby decreasing the sensation of pain.
C)Acting at the cellular level,they inhibit dihydrofolate synthesis,thereby decreasing the sensation of pain.
D)Acting at the systemic level,they prevent the protein synthesis required for sodium ion transport,thereby decreasing the sensation of pain.

Question 24

Patients who frequently use tetrahydrozoline for temporary relief of eye redness may experience what adverse reaction?

A)"Rebound" congestion
B)Hyperlubrication
C)Decreased eyelash distribution and growth
D)Eyelid ecchymosis

Question 25

Contact lens users are at greater risk for which type of ophthalmic infection?

A)Viral
B)Bacterial
C)Fungal
D)Autoimmune

Question 26

What health-care education should be given to a geriatric patient who is using a sulfacetamide solution for his left eye that was prescribed 2 months ago?

A)If the solution has turned a dark color,it has lost its potency and should be discarded.
B)It is not necessary to clean the left eye of debris prior to application.
C)If the left eye becomes transiently irritated immediately following application,the solution should be discontinued.
D)The solution should also be applied to the right eye for prophylaxis.

Question 27

Which ophthalmic preparation inhibits the enzymatic destruction of acetylcholine by deactivating cholinesterase and permitting acetylcholine to continue a short-term state of induced miosis?

A)Echothiophate
B)Pilocarpine
C)Xalatan
D)Latanoprost

Question 28

Miotic ophthalmic preparations used to treat glaucoma cause iris sphincter muscle contraction,resulting in constriction of the pupil.By what mechanism does this decrease IOP?

A)As the pupil constricts,the trabecular meshwork opens the canal of Schlemm,increasing the outflow of aqueous humor.
B)As the pupil dilates,the trabecular meshwork relaxes and opens the canal of Schlemm,increasing the outflow of aqueous humor.
C)An increase in aqueous humor causes increased pressure on the canal of Schlemm.Acting as a pressure release valve,the canal opens,increasing the outflow of aqueous humor.
D)Nerve endings in the cornea are triggered by an increase of aqueous humor and intraocular pressure.This stimulation causes the canal of Schlemm to close,shutting off a negative feedback mechanism,increasing the outflow of aqueous humor.

Question 29

A patient suffering from dry eyes was prescribed Refresh Lacri-Lube Eye Ointment 3 weeks ago.She visits your office with continued complaints of eye dryness despite daily use of the ointment.Assuming that no other underlying condition is responsible for her symptoms,what important health history information is most likely responsible for the ineffectiveness of the ointment?

A)The patient applies the ointment in the early morning,prior to leaving for work.
B)The patient warms the solution prior to application.
C)The patient cleans the tip of the applicator prior to application.
D)The patient closes her eyes for 10 minutes immediately following application of the ointment.

Question 30

Sulfacetamide is incompatible with any other ophthalmic drops that contain which agent?

A)tobramycin
B)erythromycin
C)thiomersal
D)propylene glycol

Question 31

A mother accompanies her 6-year-old daughter for an office visit.The young girl is diagnosed with Streptococcus pneumoniae conjunctivitis.The mother asks how she can prevent the girl's 3- and 8-year-old siblings from "catching" the eye infection.What advice is least likely to help the mother and her children?

A)The mother should make hand sanitizer available to the children at home.
B)The children should keep their hands away from their faces and eyes.
C)The children should not share bathroom washcloths or towels.
D)The children may continue to share beds at nighttime.

Question 32

A patient currently using an ophthalmic mast cell stabilizer for an allergic eye disorder continues to complain of unremitting symptoms despite 4 weeks of therapy.What disease entity must be excluded?

A)Acute open-angle glaucoma
B)Herpes keratitis
C)Gonococcal keratitis
D)Macular degeneration

Question 33

By what mechanism does cyclosporine (Restasis Ophthalmic)prevent corneal transplant rejection?

A)It inhibits both cellular and humeral immune responses by inhibiting a proliferative factor needed for T-cell activity.
B)It exclusively inhibits cellular immune responses by inhibiting a proliferative factor needed for T-cell activity.
C)It exclusively inhibits humeral immune responses by inhibiting a proliferative factor needed for T-cell activity.
D)It inhibits both cellular and humeral immune responses by inhibiting a proliferative factor needed for B-cell activity.

Question 34

What is vernal conjunctivitis?

A)Short-term swelling of the outer lining of the eyes due to allergies
B)Long-term swelling of the outer lining of the eyes due to an upper respiratory infection
C)Long-term swelling of the outer lining of the eyes due to an allergy
D)Short-term swelling of the outer lining of the eyes due to gonococcal keratitis