AGNP BOARD EXAM QUESTIONS EYE EAR NOSE THROAT Prescription (102 Questions and explanations | Download To Score A

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AGNP BOARD EXAM QUESTIONS EYE EAR NOSE THROAT Prescription (102 Questions) Question: Oral tetracycline (Sumycin), for the treatment of acute frontal sinusitis, should be administered: with milk... . with meals. on an empty stomach. Correct with an antacid. Explanation: Tetracycline (Sumycin) should be administered on an empty stomach (i.e., 1 hour prior to, or 2 hours after meals) to increase total absorption and with adequate amount of fluid to reduce the risk of esophageal irritation and ulceration. It should be administered at least 1 to 2 hours prior to, or 4 hours after, an antacid containing aluminum and magnesium cations. It may chelate with tetracycline (Sumycin) and reduce its total absorption. Serum concentrations may be decreased if taken with dairy products. Question: The brand name for sulfacetamide ophthalmic is: AzaSite. Bleph-10. Correct Besivance. Garamycin. Explanation: The brand name of sulfacetamide ophthalmic is Bleph-10. AzaSite is the brand name of azithromycin. Besifloxacin is the generic name for Besivance. The generic name of Garamycin is gentamicin sulfate. Question: The generic name for Polytrim ophthalmic is: trimethoprim and polymyxin B. Correct bacitracin/polymyxin B. azithromycin. besifloxacin. Explanation: The generic name for Polytrim is trimethoprim and polymyxin B. Polycin is the brand name for bacitracin/polymyxin B. The brand name for azithromycin is AzaSite. Besifloxacin brand name is Besivance. Question: Which of the following does NOT cause a drug-disease interaction when using a decongestant/antihistamine medication such as Naphazoline/pheniramine (Naphcon-A)? Cardiovascular disease Angle-closure glaucoma Prostatic hypertrophy Hypothyroidism Correct Explanation: Contraindications/cautions when using naphazoline/pheniramine (Naphcon-A) include angle- closure glaucoma, MAOI inhibitor use within 14 days, cardiovascular disease, hypertension, diabetes mellitus, prostatic hypertrophy and urinary tract obstruction. Question: The maximum daily dose of acetaminophen for ages 12 years and older is: 1200 milligrams/day. 2000 milligrams/day. 3000 milligrams/day. 4000 milligrams/day. Correct Explanation: Acetaminophen generally is safe to use. In high doses, however, it can cause liver damage. Doses of 4000 mg (4 grams) per day should not be exceeded in patients 12 years and older. Maximum dose in neonates is 60 mg/kg/day and 75 mg/kg/day in infants and children. Question: For treatment of blepharitis, patients should be instructed to apply erythromycin ointment to the affected eye using: a 0.5 inch ribbon 3 times daily for 5 days. a 0.5 cm ribbon 3 times daily for 5 days. a 1-inch ribbon 5 times daily for 7 days. a 1-cm ribbon 5 times daily for 7 days. Correct Explanation: Patients should be instructed to apply a 1-cm ribbon of erythromycin ophthalmic ointment up to 6 times daily for up to 10 days. Question: Ophthalmic cromolyn inhibits the degranulation of sensitized mast cells. It is indicated in the treatment of: acute conjunctivitis. vernal conjunctivitis. Correct fungal keratitis. herpes keratoconjunctivitis. Explanation: Ophthalmic cromolyn is a mast cell stabilizer used to prevent or control allergic conditions. It is indicated in the treatment of vernal keratoconjunctivitis, vernal conjunctivitis, and vernal keratitis. Vernal conjunctivitis is long-term inflammation of the outer lining of the eyes. It is due to an allergic reaction. Question: The most effective treatment for eradication of group A streptococcus in those who are apparent carriers is: a single dose of intramuscular penicillin (Bicillin). oral rifampin (Rifadin) for 4 days. oral clindamycin (Cleocin) for 10 days. Correct a single dose of intramuscular ceftriaxone (Rocephin). Explanation: The most effective treatment for eradication of group A streptococcus in those who are carriers is oral clindamycin (Cleocin) for 10 days. A single dose of intramuscular penicillin (Bicillin) plus 4 days of oral rifampin (Rifadin) is also effective. Question: The generic name for Dramamine is: doxylamine. diphenhydramine. brompheniramine. dimenhydrinate. Correct Explanation: The generic name of Dramamine is dimenhydrinate. Question: For empiric treatment of patients with acute bacterial rhinosinusitis (ABRS) who are allergic to penicillin, the best alternative first-line therapy is: azithromycin (Zithromax). clarithromycin (Biaxin). doxycycline (Vibramycin). Correct metronidazole (Flagyl). Explanation: Doxycycline (100 mg orally twice daily or 200 mg orally daily) is a reasonable alternative for first-line therapy and can be used in patients with penicillin allergy. A respiratory fluoroquinolone (levofloxacin 500 mg orally or moxifloxacin 400 mg orally once daily) is another alternative for penicillin-allergic patients. However, fluoroquinolones should be reserved for those who have no alternative treatment options, because the serious adverse effects associated with fluoroquinolones generally outweigh the benefits for patients with acute sinusitis. Macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, and second- or third-generation cephalosporins are not recommended for empiric therapy because of high resistance rates of S. pneumoniae. Question: Dosing of oseltamivir (Tamiflu) for adults and adolescents with active influenza is administered orally: based on weight twice daily for 5 days. 75 mg daily x 5 days. 75 mg twice daily x 5 days. Correct 75 mg twice daily x 10 days. Explanation: Dosing of oseltamivir (Tamiflu) for adults and adolescents with active influenza is 75 mg twice daily for 5 days. No dosage adjustment is necessary in the morbidly obese patient. Prophylactic dosing of oseltamivir (Tamiflu) for adults and adolescents who have been exposed to influenza is 75 mg by mouth daily x 10 days. Question: The vasoconstrictive properties of alpha-1 agonist medications make them beneficial for the treatment of: benign prostatic hypertrophy. closed-angle glaucoma. sinus congestion. Correct hypertension. Explanation: Because of their properties as vasoconstrictive agents, alpha-1 agonists are used to reduce edema and inflammation within the sinus cavities. Alpha-1 agonist medications are also known as decongestants. Common decongestant drugs include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin) nasal. Question: The use of oral acyclovir (Zovirax) in older adults is more likely to cause: confusion and hallucinations. Correct constipation and hypertension. headache and peripheral edema. increased liver enzyme activity. Explanation: Older adults are more likely to have renal or CNS adverse events when receiving acyclovir (Zovirax). With respect to CNS adverse events observed during clinical practice, somnolence, hallucinations, confusion, and coma are reported more frequently in older adults. The most frequently reported side effects are malaise, headache, nausea, vomiting and diarrhea. Cardiovascular side effects have not been reported. Increased liver enzyme activity may occur with parenteral administration. Question: Cephalosporins are classified as: macrolides. beta-lactam antibiotics. Correct non beta-lactam antibiotics. aminoglycosides. Explanation: Beta-lactam antibiotics are among the most commonly prescribed drugs, grouped together based upon a shared structural feature, the beta-lactam ring. Beta-lactam antibiotics include penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors. Question: The onset of action of oxymetazoline (Afrin) is: 5 minutes. 10 minutes. Correct 30 minutes. 60 minutes. Explanation: Oxymetazoline (Afrin) has an onset of action of 10 minutes and a duration of action of 12 hours. Oxymetazoline is a decongestant that shrinks blood vessels in the nasal passages. Indicated for short-term temporary relief of nasal congestion. Do not use in larger or smaller amounts or for longer than recommended. Overuse may cause rebound congestion. Recommended dosing is 2-3 sprays in each nostril every 10-12 hours as needed. Question: Erythromycin (Ilotycin) ophthalmic ointment is classified as a(n): aminoglycoside. macrolide. Correct fluoroquinolone. sulfonamides. Explanation: Erythromycin (Ilotycin) ophthalmic ointment is classified as a macrolide. Ofloxacin ophthalmic is a fluoroquinolone. Gentamicin ophthalmic is an aminoglycoside. Sulfacetamide ophthalmic is a sulfonamide. Question: A common side effect of amoxicillin in children is: nausea. joint pain. abdominal pain. Correct headache. Explanation: The most common side effects in children who take amoxicillin are abdominal pain or cramps, black tarry stools, diarrhea, chest pain and bleeding gums. Hypersensitivity reactions are a major problem with the use of penicillins such as amoxicillin (Amoxil). Symptoms of hypersensitivity reactions include adverse reaction resulting in nausea, vomiting, pruritus, urticaria, wheezing, laryngeal edema and ultimately, cardiovascular collapse. Question: The first-line antibiotic for acute otitis media in a child with a potential for beta-lactam resistance is: amoxicillin (Amoxil). amoxicillin-clavulanate (Augmentin). Correct azithromycin (Zithromax). trimethoprim-sulfamethoxazole (TMP-SMX). Explanation: Amoxicillin-clavulanate (Augmentin) is the first-line therapy for children with acute otitis media who are treated with antibiotics and are at increased risk for beta-lactam resistance. Trimethoprim-sulfamethoxazole (TMP-SMX) may be useful in regions where pneumococcal resistance to TMP-SMX is not a concern, but TMP-SMX should not be used if group A Streptococcus (S. pyogenes) is suspected. While macrolide or lincosamide antibiotics may be beneficial in patients with penicillin allergy, resistance is common and they may not be effective. Question: The ophthalmic preparation that is NOT available over the counter is: hydroxypropyl cellulose (Lacrisert), a lubricant. Correct propamidine (Brolene), an antimicrobial. xylometazoline-antazoline (Otrivine-Antistin), an antihistamine. sodium cromoglicate (Opticrom), a mast-cell stabilizer. Explanation: Hydroxypropyl cellulose (Lacrisert) is a prescription strength lubricant. Propamidine (Brolene) an antimicrobial, xylometazoline-antazoline (Otrivine-Antistin), an antihistamine, and sodium cromoglicate (Opticrom), a mast-cell stabilizer can all be purchased over-the-counter. Question: Refractory blepharitis is best treated with: oral antibiotics. Correct topical corticosteroid therapy. antibiotic/steroid ophthalmic drops. topical antibiotics. Explanation: Blepharitis that is unresponsive to topical antibiotics or corticosteroids alone may benefit from oral antibiotic therapy. Blepharitis that involves the cornea with visual impairment should also be treated with oral antibiotics. Tetracyclines are the drug of choice as they inhibit the lipase production from Staphylococcus epidermidis strains that are known to cause blepharitis. Question: A serious adverse reaction to clindamycin (Cleocin) is: esophageal ulcerations. nephrotoxicity. Clostridium difficile-related colitis. Correct photosensitivity. Explanation: A serious adverse reaction to clindamycin (Cleocin) is diarrhea and Clostridium difficile-related colitis. Nephrotoxicity has been seen with vancomycin (Vancocin). Doxycycline (Doryx) has been associated with esophageal ulcerations and photosensitivity. Question: Which of the following is NOT a potential adverse effect of sulfacetamide ophthalmic (Bleph- 10) for the treatment of acute conjunctivitis? Acute renal insufficiency Correct Agranulocytosis Toxic epidermal necrolysis Fulminate hepatic necrosis Explanation: Concerns related to adverse effects of sulfonamides, including ophthalmic preparations, include blood dyscrasias (i.e. agranulocytosis), dermatologic reactions (i.e. toxic epidermal necrolysis) and hepatic necrosis (i.e. fulminant hepatic necrosis). Acute renal insufficiency hasn't been indicated as a potential adverse reaction. Question: The preferred class of oral antibiotic therapy for blepharitis with visual impairment is: tetracyclines. Correct macrolides. quinolones. penicillins. Explanation: The preferred class of antibiotics to treat blepharitis with visual impairment is tetracyclines. Tetracyclines are the drug of choice as they inhibit the lipase production from Staphylococcus epidermidis strains that are known to cause blepharitis. Question: Ocular steroids indicated for the treatment of allergic conjunctivitis can be used in patients with: ocular hypertension. epithelial herpes simplex. herpes zoster keratitis. Correct open-angle glaucoma. Explanation: Ocular steroids indicated for the treatment of allergic conjunctivitis, such as dexamethasone (Maxidex), are also indicated for treatment of herpes zoster keratitis. Ocular steroids are contraindicated in patients with ocular hypertension, epithelial herpes simplex, and open-angle glaucoma. Question: The brand name for meclizine is: Antivert. Correct Atarax. Cyclivert. Sominex. Explanation: The brand name for meclizine is Antivert. The generic name of Atarax is hydroxyzine; Cyclivert is cyclizine; Sominex is diphenhydramine. Question: Oxymetazoline nasal spray, a nasal decongestant, is manufactured under the brand name: Afrin. Correct Astelin. AsthmaNefrin. Omnaris. Explanation: Oxymetazoline is a decongestant nasal spray manufactured under several brand names, including Afrin, Neo-Synephrine 12 Hour Spray and Sinex. All are available over the counter. Azelastine (Astelin) is a nasal antihistamine. AsthmaNefrin is an inhaled bronchodilator. Ciclesonide (Omnaris) is a nasal corticosteroid. Question: The most effective method to minimize dizziness associated with the administration of otic solutions is to: apply a cotton ball to the ear canal after administration of the drops. push the tragus in over the canal after instilling the drops for 2-3 minutes. warm the suspension by holding in the hand for 1-2 minutes. Correct use a wick for application of the drops. Explanation: Instillation of cold fluids in the ear may cause dizziness. To minimize dizziness, warm the suspension by holding the bottle in the hand for 1-2 minutes. Question: Intranasal antihistamines are indicated in the treatment of: epistaxis. nasal congestion. rhinosinusitis. vasomotor rhinitis. Correct Explanation: Intranasal antihistamines are indicated in the treatment of seasonal allergic rhinitis, perennial allergic rhinitis and vasomotor rhinitis. Epistaxis and nasopharyngitis are the most commonly reported adverse reactions. Intranasal antihistamines are not indicated for nasal congestion. Question: Due to potential drug-drug interactions, therapy should be monitored when a patient is receiving erythromycin (Eyemycin) ointment and: cyclosporine ophthalmic (Restasis). dexamethasone ophthalmic (Maxidex). lovastatin (Mevacor). warfarin (Coumadin). Correct Explanation: Erythromycin (Eyemycin) ophthalmic ointment may increase the serum concentration of Vitamin K antagonists, such as warfarin (Coumadin). Question: When prescribing polymyxin B sulfate/bacitracin zinc (Polycin-B), patients should be instructed to: discontinue at 3 days, even if conjunctivitis persists. discontinue as soon as symptoms resolve. discontinue if blurred vision occurs immediately after use. complete therapy, even if symptoms resolve. Correct Explanation: Patients with bacterial conjunctivitis should respond in 1 to 2 days with a decrease in discharge, redness, and irritation. However, therapy should be continued for 7-10 days depending upon severity. Blurred vision is a common occurrence after the administration of an ointment. Question: Ceruminolytics are safe to use in patients with history of: conductive hearing loss. Correct infections. perforations. tympanostomy tubes. Explanation: Ceruminolytics are safe to use in patients with conductive hearing loss. Conductive hearing loss may be related to cerumen impaction. They should not be used if the patient has a recent history of infection, perforation, or otologic surgery. Ceruminolytics should be avoided if tympanic membrane damage is suspected. If a patient has a history of drainage from the ear, ear pain, or frequent ear infections, the tympanic membrane may be impaired and ceruminolytics should not be employed. Question: Polymyxin B/trimethoprim ophthalmic is NOT indicated for: adult bacterial conjunctivitis. pediatric bacterial conjunctivitis. blepharoconjunctivitis. ophthalmia neonatorum. Correct Explanation: Polymyxin B/trimethoprim ophthalmic is NOT indicated in the treatment of ophthalmia neonatorum as it does not treat the most common bacterial causes, including Neisseria gonorrhea and Chlamydia trachomatis. Chlamydial conjunctivitis may be treated with erythromycin drops or oral erythromycin. Gonococcal conjunctivitis should be treated with IV Penicillin G, topical bacitracin or erythromycin. Topical 1% silver nitrate, 0.5% erythromycin, and 1% tetracycline are considered equally effective for prophylaxis of ocular gonorrhea infection. Question: A common side effect of azelastine (Optivar) ophthalmic drops used for allergic conjunctivitis is: ocular edema. elevated blood pressure. a bitter taste. Correct dizziness. Explanation: The most frequently occurring side effects of azelastine (Optivar), an antihistamine/mast cell stabilizer combination, include headaches, transient burning/stinging, and bitter taste. Question: If ocular steroids are to be used for more than 10 days, monitoring should include: blood pressure. ocular pressure. Correct BUN. capillary blood sugar. Explanation: If ophthalmic steroids are used for more than 10 days there is an increased risk for Intraocular pressure; therefore this should be monitored. Question: Oxymetazoline (Visine-LR) is an ophthalmic: antihistamine. decongestant. Correct mast cell stabilizer. antihistamine/mast cell stabilizer. Explanation: Oxymetazoline (Visine-LR) is an ophthalmic vasoconstrictor or decongestant used to reduce hyperemia in the eye by causing vasoconstriction. Question: Potential adverse reactions of glucocorticoid nasal sprays do NOT include: epistaxis. nasal septal perforation. nasopharyngitis. sialorrhea. Correct Explanation: Sialorrhea (excessive salivation) has not been associated with nasal glucocorticoid use. Epistaxis and nasopharyngitis are the most commonly reported adverse reactions. Nasal septal perforation has been reported and may be related to spraying the nasal spray into the septum, rather than away from it. Question: The mechanism of action of trifluridine (Viroptic), an ophthalmic antiviral, used in the treatment of herpes simplex conjunctivitis is: stimulation of alpha adrenergic receptors. interference with viral replication by inhibiting thymidylate synthetase. Correct inhibition of leukocyte migration. increase in cell wall permeability and inhibition of nucleic acid and protein synthesis. Explanation: Trifluridine (Viroptic), an ophthalmic antiviral, works by interfering with viral replication through the inhibition of thymidylate synthetase. It is not a cure for the infection, but treatment of an outbreak can speed up healing and decrease swelling in the eye to lower the risk of complications. Question: After the administration of olopatadine (Pataday) ophthalmic for allergic conjunctivitis, contact lenses should not be inserted for at least: 5 minutes. 10 minutes. Correct 20 minutes. 30 minutes. Explanation: After instilling olopatadine (Pataday) ophthalmic drops, wait at least 10 minutes before inserting contact lenses. Do not insert contacts if eyes are red. Question: The duration of action of meclizine (Antivert) is: 2 hours. 4 hours. 6 hours. 8 hours. Correct Explanation: Meclizine (Antivert) is a first generation antihistamine, used in the treatment of nausea/vomiting, vertigo and motion sickness. The duration of meclizine (Antivert) is approximately 8-24 hours. The onset of action is about 1 hour with a half-life of 6 hours. Question: A common side effect of oral phenylephrine (Sudafed), a decongestant, is: anxiety. Correct blurred vision. hypotension. peripheral vasoconstriction. Explanation: The side effects of phenylephrine (Sudafed), an oral decongestant, include anxiety, headache, nausea, dry mouth, dizziness, insomnia, elevated blood pressure, and CNS stimulation. Question: Polycin-B is the brand name for: polymyxin and trimethoprim. polymyxin B, gramicidin, and neomycin. polymyxin B and chloramphenicol. polymyxin B and bacitracin. Correct Explanation: Polycin-B is the brand name for polymyxin B and bacitracin. Polytrim is the brand name for trimethoprim and polymyxin B. Neosporin eye drops contain polymyxin B, gramicidin and neomycin. Question: Naphazoline/pheniramine (Naphcon-A) is indicated in the treatment of: allergic conjunctivitis. Correct viral conjunctivitis. trachoma. hordeolum. Explanation: Naphazoline/pheniramine (Visine-A) is a combination decongestant/antihistamine used in the treatment of allergic conjunctivitis. It is used as a decongestant for reducing eye redness and an antihistamine for relieving itchy/watery eyes, as is seen in allergic conjunctivitis. Question: An example of a drug that is a cholinergic agonist is: epinephrine. atropine. Correct ephedrine. dopamine. Explanation: Atropine is considered a cholinergic agonist. Cholinergic agonists mimic the action of acetylcholine. The remainder of the choices are adrenergic antagonists, which act to inhibit the action of catecholamines at the adrenergic receptors. Question: Bacitracin (Ocu-Tracin) ophthalmic ointment inhibits bacterial cell wall synthesis by: inhibiting RNA-dependent protein synthesis at the chain elongation step. binding to 30S ribosomal subunit. preventing the transfer of mucopeptides into the growing cell wall. Correct inhibiting DNA-gyrase in susceptible organisms. Explanation: Bacitracin (Ocu-Tracin) ophthalmic ointment inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into the growing cell wall. Question: Which risk factor would NOT prohibit the nurse practitioner from prescribing prednisolone acetate (Pred Forte)? Recent history of cataract surgery Epithelial herpes simplex keratitis History of corneal thinning Superficial punctate keratitis Correct Explanation: Prednisolone is contraindicated in hypersensitivity to prednisolone, any component of the formulation, or other corticosteroids; acute untreated purulent ocular infections; viral diseases of the cornea and conjunctiva (e.g., epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella); mycobacterial or fungal infections of the eye; and use after uncomplicated removal of a superficial corneal foreign body (prednisolone sodium phosphate solution only). It is indicated in the treatment of superficial punctate keratitis. Question: The duration of action of ocular decongestants such as oxymetazoline (Visine-LR) is approximately: 2 hours. 4 hours. 6 hours. Correct 8 hours. Explanation: The duration of action of ocular decongestants such as oxymetazoline (Visine-LR) is 6 hours. Therefore, patients should be advised to apply 1-2 drops in the affected eye every 6 hours as needed. Question: Systemic absorption of ocular decongestants, such naphazoline (Naphcon) may cause: increased appetite. insomnia. hypotension. tachycardia. Correct Explanation: Symptoms of systemic absorption of ophthalmic decongestants such as naphazoline (Naphcon) include fast, irregular, or pounding heartbeat, mydriasis, hypertension, headache, lightheadedness, nervousness, trembling and drowsiness. Question: A common side effect related to the administration of cetirizine (Zyrtec) is: drowsiness. Correct conjunctivitis. constipation. dysuria. Explanation: The most commonly reported side effect of cetirizine (Zyrtec) is drowsiness. It is better tolerated when administered at bedtime. Other central nervous system effects include fatigue and headache, malaise and dizziness. Question: Patients being treated with trifluridine (Viroptic) for herpes simplex 1 keratoconjunctivitis should be advised to return to the clinic if they do not experience symptom improvement within: 3 days. 5 days. 7 days. Correct 10 days. Explanation: If there are no signs of improvement in herpes keratoconjunctivitis after 7 days of therapy or complete re-epithelialization has not occurred after 14 days of therapy, other forms of therapy should be considered. Continuous administration of trifluridine (Viroptic) ophthalmic solution 1% for periods exceeding 21 days should be avoided because of potential ocular toxicity. Question: Which of the following organisms is NOT susceptible to sulfacetamide ophthalmic (Bleph-10)? Staphylococcus aureus Streptococcus pneumonia Pseudomonas aeruginosa Correct Haemophilus influenzae Explanation: Conjunctivitis and other superficial ocular infections are caused by susceptible microorganisms such as Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridians group), Haemophilus influenzae, Klebsiella species, and Enterobacter species. Topically applied sulfonamides, such as sulfacetamide ophthalmic (Bleph-10), do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. Question: Which patient should be closely monitored for systemic effects of prolonged ocular steroid therapy? Diabetes insipidus Diabetes Mellitus Correct Hypertension Hyperthyroidism Explanation: Patients with diabetes mellitus who are receiving long term treatment with topical steroids should have regular blood glucose checks with the expectation that a more intensive diabetes regimen could be required. Question: Penicillins are primarily prescribed for the treatment of infections caused by: Escherichia coli. Staphylococcus aureus. Pseudomonas aeruginosa. Streptococcus pyogenes. Correct Explanation: Penicillins are primarily prescribed for the treatment of infections caused by Streptococcus pyogenes, Streptococcus agalactiae, and Clostridium perfringens. They can be used to treat numerous other bacteria but these are the most common. Question: The mechanism of action for mast cell stabilizers is: stimulation of alpha adrenergic receptors. stimulation of histamine-2 receptors and mast cells to release calcium. antagonization of alpha adrenergic receptors. inhibition of histamine release and slow reacting substances of anaphylaxis. Correct Explanation: Mast cell stabilizers act on mast cells and prevent them from releasing substances that cause allergic reactions. They block a calcium channel that is important for degranulation (which occurs after exposure to specific antigens) of sensitized mast cells, and inhibits the release of histamine and slow-reacting substances of anaphylaxis. Mast cell stabilizers are used to prevent asthma attacks and the symptoms of seasonal or chronic allergic rhinitis and allergic conjunctivitis. Question: For patients who anticipate exposure to a specific known eye allergen, such as pollen, the best preventive therapy is a topical ophthalmic: decongestant. antihistamine/steroid. antihistamine/mast cell stabilizer. Correct antihistamine/decongestant. Explanation: For patients who premedicate prior to exposure to a specific allergen, a topical antihistamine with mast cell stabilizing properties can be used to prevent symptoms of allergic eye conditions. The medication is used starting the day before exposure and continued for 1 day after. Question: Tetracyclines should be avoided in patients who are allergic to: levofloxacin (Levaquin). amoxicillin (Amoxil). doxycycline (Vibramycin). Correct azithromycin (Zithromax). Explanation: Doxycycline (Vibramycin), demeclocycline (Declomycin) and minocycline (Minocin) are tetracycline derivatives. If a patient has a known allergy to one of these, tetracyclines should be avoided. Question: The standard concentration of acetaminophen liquid for pediatric use is: 80 mg/0.8 mL. 100 mg/2.5 mL. 160 mg/5 mL. Correct 200 mg/5 mL. Explanation: Currently, one standard concentration of liquid acetaminophen (160 mg/5 mL) is available for infants and children. Question: Second-generation antihistamines: activate interleukin-4 (IL-4) and interleukin-13 (IL-13) production. are prone to pharmacological tolerance. are more effective than glucocorticoid nasal sprays. have a variety of anti-inflammatory properties. Correct Explanation: Second-generation antihistamines have a variety of anti-inflammatory properties, including decreased mast cell mediator release and downregulation of adhesion molecule expression. Inhibition of interleukin-4 (IL-4) and interleukin-13 (IL-13) production may explain reports of their dose-dependent beneficial effect in asthma. They are less effective than glucocorticoid nasal sprays, and patients receiving them are not prone to developing pharmacological tolerance. Question: Long-term or repeated use of polymyxin B/trimethoprim ophthalmic drops may cause: fungal infections. Correct trichiasis. photosensitivity. depigmentation. Explanation: Long-term or repeated use of polymyxin B/trimethoprim ophthalmic drops may predispose patients to fungal infections. Photosensitivity has been associated with oral trimethoprim but not with ophthalmic use. Trichiasis (ingrown or misdirected eye lashes) or depigmentation of eye lashes are not associated with long-term use of polymyxin B. Question: After instilling ophthalmic drops, patients should be instructed to hold pressure to the medial punctum and nasolacrimal sac. The purpose of this is to: keep the drops in the conjunctival pocket. reduce burning related to eye drops. prevent obstruction of the nasolacrimal duct. decrease risk of absorption and systemic effects. Correct Explanation: After instilling ophthalmic drops, instruct patient to apply finger pressure to the lacrimal sac during and for 1 to 2 minutes after instillation of solution to decrease risk of absorption and systemic effects. Question: The mechanism of action for macrolides is to: block synthesis of folic acid by bacteria and inhibit replication. uncouple mitochondrial oxidative metabolism and inhibit cell growth. block the dissociation of peptidyl tRNA from ribosomes. Correct inhibit protein synthesis by preventing ribosomal translocation. Explanation: Macrolides inhibit bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Other antibacterials are either bacteriostatic or bactericidal and inhibit protein synthesis by preventing ribosomal translocation. Sulfa agents block synthesis of folic acid by bacteria and thus inhibit bacterial replication. First- generation cephalosporins inhibit cell wall synthesis by bacteria. Antifungals uncouple mitochondrial oxidative metabolism and inhibit cell growth. Question: The mechanism of action for meclizine (Antivert) is to: block postsynaptic mesolimbic antidopaminergic receptors in the brain. prevent histamine response in sensory nerve endings and blood vessels. selectively antagonize dopamine D2 receptors. suppress vestibular end-organ receptors and inhibit activation of central cholinergic pathways. Correct Explanation: The mechanism of action for meclizine (Antivert) is to suppress vestibular end-organ receptors and inhibit activation of central cholinergic pathways. Meclizine is classified as a first generation antihistamine used in the treatment of motion sickness and vertigo. Question: Brand names of sulfamethoxazole/trimethoprim do NOT include: Azulfidine. Correct Bactrim DS. SMX-TMP DS. Sulfatrim. Explanation: Brand names of sulfamethoxazole/trimethoprim do NOT include sulfasalazine (Azulfidine). Question: Dosing of oseltamivir (Tamiflu) for older adult patients with active influenza and a creatinine clearance between 30-60 mL/min is: 30 mg by mouth daily for 10 days. 30 mg by mouth twice daily for 5 days. Correct 75 mg by mouth daily x 5 days. 75 mg by mouth twice daily x 10 days. Explanation: Dosing of oseltamivir (Tamiflu) for older adult patients with active influenza and a creatinine clearance between 30-60 mL/min is reduced to 30 mg twice daily for 5 days. In renally impaired adult patients (creatinine clearance >10-30 mL/min), dosing should be reduced to 30 mg once daily for 5 days. Question: The mechanism of action of pheniramine is that it: stimulates alpha adrenergic receptors. stimulates histamine-2 receptors. antagonizes alpha adrenergic receptors. antagonizes histamine-1 receptors. Correct Explanation: Pheniramine antagonizes histamine-1 receptors. Pheniramine is found in combination with naphazoline (Visine-A), acetaminophen and phenylephrine (Theraflu), and caffeine and phenylephrine (Scot-Tussin). Pheniramine is used in the treatment of allergies. Question: Which of the following is a cholinergic agonist used in the treatment of glaucoma? Epinephrine (Eppy/N) ophthalmic Pilocarpine (Pilopine HS) ophthalmic Correct Brinzolamide (Azopt) ophthalmic Latanoprost (Xalatan) ophthalmic Explanation: Pilocarpine ophthalmic is a cholinergic agonist used in the treatment of angle-closure glaucoma. Cholinergic agonists mimic the action of acetylcholine. Epinephrine (Eppy/N) is a sympathomimetic agent that is an adrenergic and dopaminergic. Intraocular pressure is reduced by the use of brinzolamide (Azopt) ophthalmic, a carbonic anhydrase inhibitor and latanoprost (Xalatan) ophthalmic, a prostaglandin analog. Question: The correct method for instilling ophthalmic ointments is to: tilt head back and lift the upper lid to apply ribbon of ointment. clean the tip of the ointment tube with alcohol prep after each application. blink a few times to spread the ointment. Correct rub eyes gently with pinky finger to distribute ointment. Explanation: Instructions for applying ophthalmic drops are: wash hands; tilt head back; pull lower lid away from eye with index finger forming a pocket; hold tube up to eye and squeeze gently to apply a thin line of ointment into pocket, taking care to NOT contaminate the tip; close eyes for a second and then blink several times to distribute ointment (DO NOT RUB EYE). Question: Erythromycin (Ilotycin) ophthalmic ointment is NOT indicated in the treatment of: anterior acute blepharitis. ophthalmia neonatorum prophylaxis. traumatic corneal abrasion. conjunctivitis. Correct Explanation: Erythromycin (Ilotycin) ophthalmic ointment is classified as a macrolide antibiotic. It is indicated in the treatment of anterior acute blepharitis, ophthalmia neonatorum prophylaxis (given within 24 hours of birth) and traumatic, foreign body, or recurrent abrasions of the cornea. It is NOT indicated in the treatment of conjunctivitis. Question: A patient is receiving amoxicillin (Amoxil) for the treatment of otitis media. A hypersensitivity reaction would present with symptoms of: candidiasis, black hairy tongue and diarrhea. vomiting, pruritus, and urticaria. Correct fever, headache and dermatitis. dizziness, diarrhea and abdominal pain. Explanation: Hypersensitivity reactions are a major problem with the use of penicillins such as amoxicillin (Amoxil). Symptoms of hypersensitivity reactions include adverse reaction resulting in nausea, vomiting, pruritus, urticaria, wheezing, laryngeal edema and ultimately, cardiovascular collapse. While candidiasis, diarrhea, nausea, dermatitis, and a black hairy tongue are considered common side effects of amoxicillin, they are not considered a hypersensitivity reaction. Question: An alternative treatment for a child who has Strep throat and who has had a Type I hypersensitivity reaction to penicillin is: fluoroquinolone. cephalosporin. macrolide. Correct tetracycline. Explanation: Macrolides (e.g., erythromycin) may be used in patients who are allergic to penicillin. For children with a non-Type I hypersensitivity reaction to penicillin, cephalexin, cefadroxil, clindamycin, clarithromycin, or azithromycin may be used. For children who have had an immediate Type I hypersensitivity reaction (e.g., hives, itching, wheezing, anaphylaxis) to penicillin, clindamycin, clarithromycin, or azithromycin may be used. Tetracyclines and fluoroquinolones have limited use in pediatrics and are not indicated in this situation. Cephalosporins should not be used in children who have had a Type I hypersensitivity reaction to penicillin. Question: Patients should be advised to administer polymyxin B/trimethoprim every: 2 hours, maximum 8 doses. 2 hours, maximum 12 doses. 3 hours, maximum 6 doses. Correct 3 hours, maximum 8 doses. Explanation: Patients should be advised to administer polymyxin B/trimethoprim every 3 hours with a maximum of 6 doses in a 24-hour period. Question: Penicillins are primarily prescribed for the treatment of infections caused by: Escherichia coli. Staphylococcus aureus. Pseudomonas aeruginosa. Streptococcus pyogenes. Correct Explanation: Penicillins are primarily prescribed for the treatment of infections caused by Streptococcus pyogenes, Streptococcus agalactiae, and Clostridium perfringens. They can be used to treat numerous other bacteria, but these are the most common. Question: First-line treatment for children who are diagnosed with Strep pharyngitis is: doxycycline (Doryx). azithromycin (Zithromax). amoxicillin (Amoxil). Correct clarithromycin (Biaxin). Explanation: First-line treatment of Strep pharyngitis in children is amoxicillin because of narrow spectrum, once daily dosing and palatability. Macrolides, such as azithromycin and clarithromycin, may be utilized if the patient is allergic to penicillins. However, these are broad spectrum and present a risk for antibiotic resistance. Doxycycline (Doryx) is not recommended for the treatment of streptococcal pharyngitis. Question: The most common symptoms of penicillin allergy include hives, itchy eyes, and: diarrhea. anorexia. headache. swollen lips. Correct Explanation: Common allergic reactions to penicillin include rashes, hives, itchy eyes, and swollen lips, tongue, or face. Question: Patients and caregivers should be advised to stop oseltamivir (Tamiflu) and notify the provider immediately if the patient develops: confusion and hallucinations. Correct nausea and vomiting. increased cough and fatigue. symptoms lasting longer than 7 days. Explanation: Rare occurrences of neuropsychiatric events (including confusion, delirium, hallucinations, and/or self-injury) have been reported with the use of oseltamivir (Tamiflu), primarily in pediatric patients. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease. Nausea and vomiting is a commonly reported side effect and may be related to the influenza virus. It usually resolves within a few days. Increased cough and fatigue may indicate a developing pneumonia and should be reported, but it is not likely related to oseltamivir. Question: Azelastine (Astelin), for treatment of allergic rhinitis, is classified as a nasal: antihistamine. Correct decongestant. glucocorticoid. antihistamine/glucocorticoid combo. Explanation: Azelastine (Astelin) is a nasal antihistamine. It is used for the treatment of seasonal and perennial allergic rhinitis. It is also indicated for vasomotor rhinitis. Administration is 1-2 actuations in each nostril twice daily. Oseltamivir (Tamiflu) is an antiviral agent, further classified as a(n): adamantane antiviral. neuraminidase inhibitor. Correct protease inhibitor. purine nucleoside. Explanation: Oseltamivir (Tamiflu) is an antiviral agent, further classified as a neuraminidase inhibitor. Acyclovir and famciclovir are purine nucleosides. Protease inhibitors are used in the treatment of human immunodeficiency virus (HIV infection) and acquired immune deficiency syndrome (AIDS). Adamantane antivirals are only active against influenza A virus, an RNA virus, but has no action against influenza B virus. It is not recommended in the treatment of influenza due to widespread resistance. Question: A benefit of prescribing an ophthalmic antihistamine with a mast cell stabilizer property would be that the mast cell stabilizer provides: prevention of allergen penetration. an extended duration of action. Correct inflammation reduction. relief from rhinorrhea. Explanation: Second generation antihistamines with mast cell stabilizers have a longer duration of action due to their high affinity to the H-1 receptor. Dosing therefore is twice/day rather than 4 time/day. Antihistamine/mast cell stabilizers provide the immediate relief of an antihistamine combined with the extended duration of action of a mast cell stabilizer. Question: The best topical antibiotic choice for the treatment of acute blepharitis is: tobramycin (Tobrex) ophthalmic ointment. erythromycin (Eyemycin) ophthalmic ointment. Correct polymyxin B/trimethoprim (Polytrim) ophthalmic solution. ciprofloxacin (Ciloxan) ophthalmic ointment. Explanation: Erythromycin (Eyemycin) or bacitracin (Ocu-Tracin) ophthalmic ointments are effective against staphylococcal species isolated from the eyelid. Other topical agents such as polymyxin B/trimethoprim ophthalmic solution, aminoglycosides (tobramycin [Tobrex]) and quinolones (ciprofloxacin [Ciloxan]) may be effective, but are not recommended due to the high risk of adverse effects with long-term use. Question: Ocular decongestants such as oxymetazoline (Visine-LR) are used to reduce: corneal edema. itching. redness. Correct dryness. Explanation: Ocular decongestants such as oxymetazoline (Visine-LR) cause a narrowing of swollen blood vessels in the eyes to reduce eye redness. It is used for temporary relief of minor eye redness or discomfort caused by minor irritants. Question: The mechanism of action of polymyxin B/trimethoprim ophthalmic is: antimetabolite activity/inhibition of protein synthesis. inhibition of cell wall synthesis/inhibition of protein synthesis. inhibition of cell wall synthesis/inhibition of nucleic acid and protein synthesis. increased cell wall permeability/inhibition of nucleic acid and protein synthesis. Correct Explanation: Polymyxin B is bactericidal for a variety of gram-negative organisms, especially Pseudomonas aeruginosa. It increases the permeability of the bacterial cell membrane by interacting with the phospholipid components of the membrane. Trimethoprim blocks production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the enzyme dihydrofolate reductase. Binding is stronger for bacterial enzyme than for corresponding mammalian enzyme, therefore it selectively interferes with bacterial biosynthesis of nucleic acids and proteins. Question: Patients who are using a glucocorticoid nasal spray should be advised to: avoid using if nasal stinging occurs after use. clean the tip of the nasal spray with alcohol after each use. prime the pump prior to first use or if unused for more than a week. Correct shake vigorously before each use. Explanation: Prime pump (press 6 times until fine spray appears) prior to first use or if spray unused for =7 days. Once weekly, nasal applicator may be removed and rinsed with warm water to clean. Stinging or sneezing may occur for a few seconds right after use. Application tip may be cleaned with a dry tissue after each use. Question: When a patient must administer more than one ophthalmic medication, they should be instructed to administer the drops: at the same time. at least 5 minutes apart. Correct at least 30 minutes apart. at least 1 hour apart. Explanation: When administering multiple eye medications, the patient should be instructed to wait at least 5 minutes between each medication in order to prevent dilution. Question: Which of the following is classified as a second-generation antihistamine? Fexofenadine (Allegra) Correct Hydroxyzine (Vistaril) Montelukast (Singulair) Pseudoephedrine (Sudafed) Explanation: Fexofenadine (Allegra) is a second-generation antihistamine. Hydroxyzine (Vistaril) is a first- generation antihistamine. Montelukast (Singulair) is a leukotriene inhibitor. Pseudoephedrine (Sudafed) is a decongestant. Question: A patient is diagnosed with group A Streptococcus pharyngitis. The best choice for antimicrobial therapy is a: sulfonamide. fluoroquinolone. tetracycline. penicillin. Correct Explanation: Antibiotic options for treatment of group A Streptococcus (GAS) pharyngitis include penicillin, cephalosporins, macrolides, and clindamycin. Sulfonamides, fluoroquinolones, and tetracyclines should NOT be used for treatment of GAS pharyngitis because of high rates of resistance to these agents and their frequent failure to eradicate even susceptible organisms from the pharynx. Antimicrobial resistance has not been a significant issue in the treatment of GAS. Question: The brand name for cetirizine is: Allegra. Claritin. Xyzal. Zyrtec. Correct Explanation: The brand name for cetirizine is Zyrtec. The generic name for Allegra is fexofenadine; Claritin is loratadine; Xyzal is levocetirizine. Question: Sulfacetamide/prednisolone (Blephamide) is NOT indicated in: corneal injury from chemicals. prevention of bacterial ocular infection. chronic anterior uveitis. ocular mycobacterial infection. Correct Explanation: Sulfacetamide/prednisolone (Blephamide) is contraindicated in the treatment of ocular mycobacterial infection. Mycobacterial infections, or ocular tuberculosis, require anti- tuberculosis treatment. Blephamide is used in the treatment of chronic anterior uveitis, corneal injury from chemicals, radiation or thermal burns, and in superficial bacterial infections. It is also used prophylactically when there is a risk of bacterial ocular infection. Question: Prolonged use of bacitracin ophthalmic may result in: hypersensitivity. fungal overgrowth. Correct entropion. corneal nodules. Explanation: Prolonged use of bacitracin ophthalmic ointment may result in overgrowth of non-susceptible organisms, particularly fungi. Bacitracin ophthalmic is bacteriostatic or bactericidal, depending on susceptibility and concentration. Question: The most effective treatment for allergic rhinitis is: fexofenadine (Allegra). fluticasone (Flonase). Correct montelukast (Singulair). pseudoephedrine (Sudafed). Explanation: Glucocorticoid nasal sprays, such as fluticasone (Flonase), are the most effective single maintenance therapy for allergic rhinitis and cause few side effects at the recommended doses. Question: The generic name of Pataday ophthalmic drops used in the treatment of allergic conjunctivitis is: azelastine. bepotastine. epinastine. olopatadine. Correct Explanation: The generic name for Pataday is olopatadine. The brand name for azelastine is Optivar; bepotastine is Bepreve; and epinastine is Elestat. Question: A medication that acts on the hypothalamus to produce antipyresis is: aspirin. ibuprofen. a nonsteroidal anti-inflammatory drug (NSAID). acetaminophen. Correct Explanation: A medication that acts on the hypothalamus to produce antipyresis is acetaminophen. Question: The appropriate duration of oral penicillin for a patient who has been diagnosed with group A Streptococcus pharyngitis is: 5 days. 7 days. 10 days. Correct 14 days. Explanation: Oral penicillin V is the agent of choice for treatment of group A Streptococcus (GAS) pharyngitis given its proven efficacy, safety, narrow spectrum, and low cost. The appropriate duration of therapy is 10 days. Question: The most effective treatment for eradication of group A streptococcus in those who are carriers is: a single dose of intramuscular penicillin (Bicillin). oral rifampin (Rifadin) for 4 days. oral clindamycin (Cleocin) for 10 days. Correct a single dose of intramuscular ceftriaxone (Rocephin). Explanation: The most effective treatment for eradication of group A streptococcus in carriers is oral clindamycin (Cleocin) for 10 days. A single dose of intramuscular penicillin (Bicillin) plus 4 days of oral rifampin (Rifadin) is also effective. Question: The generic name for Restasis is: cyclosporine. Correct betaxolol. cycloserine. cromolyn. Explanation: The generic name for Restasis is cyclosporine. It is a partial immunomodulator, resulting in tear production. Betaxolol (Betoptic S) is an ophthalmic beta blocker. Cycloserine (Seromycin) is an ophthalmic antibacterial. Cromolyn (Crolom) is an ophthalmic mast cell stabilizer for allergies. Question: The generic name for AzaSite ophthalmic drops is: bacitracin/polymyxin B. besifloxacin. azithromycin. Correct gatifloxacin. Explanation: The generic name for AzaSite ophthalmic drops is azithromycin. The generic name for Polytrim is trimethoprim and polymyxin B. Zymaxid is the brand name of gatifloxacin. Besifloxacin brand name is Besivance. Question: Which of the following is NOT a mechanism of action of ocular steroids? Inhibits leukocyte migration Inhibits fibrin deposition Promotes capillary proliferation and dilation Correct Reduces collagen formation Explanation: Ocular steroids reduce inflammation by inhibiting edema, leukocyte migration, fibrin deposition, capillary proliferation and dilation, collagen deposition and scar formation. Question: Due to the potential development of pseudo tumor cerebri, tetracycline (Sumycin) should not be administered concomitantly with: lactobacillus acidophilus (Acidophilus). isotretinoin (Claravis). Correct colesevelam (Welchol). ferric gluconate (Ferrlecit). Explanation: Tetracycline (Sumycin) and its derivatives may enhance the adverse/toxic effect of retinoic acid derivatives. The development of pseudo tumor cerebri is of particular concern. Exceptions include adapalene, bexarotene (topical) and tretinoin (topical). Risk X: Avoid combination. Drug-drug interactions can occur with the other medications, but not specifically related to pseudo tumor cerebri. Question: The most important caution when prescribing aminoglycosides for treatment of otitis externa is: oral candidiasis. ototoxicity. Correct otomycosis. pharyngitis. Explanation: Aminoglycosides are a significant potential source for iatrogenic hearing loss and balance dysfunction, particularly in the presence of tympanic membrane perforation. Ototoxicity is the most important concern with aminoglycoside agents, including neomycin, tobramycin, and gentamicin. Question: The duration of action of azelastine (Optivar) ophthalmic drops is: 3 hours. 4 hours. 6 hours. 8 hours. Correct Explanation: The duration of action of azelastine (Optivar) is 8 hours with a half life of 22 hours. Question: A 38-year-old man has been receiving oral tetracycline for the treatment of refractory blepharitis. The patient should be referred to ophthalmology if experiencing: feeling of a foreign body and blurred vision. Correct photosensitivity. trichiasis. dry eye. Explanation: Ulceration and perforation need to be managed with aggressive antibiotics and should be referred to an ophthalmologist for management. Symptoms of ulceration include a feeling of a foreign body and blurred vision. Trichiasis (misdirection of eyelashes) and dry eye may also occur, but are not cause for referral. Photosensitivity is an adverse reaction to tetracycline. Question: The brand name of prednisolone acetate ophthalmic is: Bleph-10. Besivance. Pred Forte. Correct FML Forte. Explanation: The brand name of prednisolone acetate ophthalmic is Pred Forte. Bleph-10 is sulfacetamide. Besivance is besifloxacin. FMC Forte is fluorometholone. Question: Which of the following is NOT an antihistamine? Prochlorperazine (Compro) Correct Dimenhydrinate (Dramamine) Cycline (Cyclivert) Meclizine (Antivert) Explanation: Antihistamines include diphenhydramine (Benadryl), dimenhydrinate (Dramamine), cycline (Cyclivert), and meclizine (Antivert). Prochlorperazine (Compro) is an antipsychotic medicine in a group of drugs known as phenothiazines. Question: The LEAST concerning side effect of first-generation antihistamines (i.e., dimenhydrinate) in patients older than 65 for the treatment of vertigo is: blurred vision. bradycardia. Correct constipation. confusion. Explanation: Bradycardia is not a side effect of first-generation antihistamines. First-generation antihistamines are more likely to cause peripheral and central anticholinergic side effects. Peripheral side effects include dry mouth, constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, and decreased sweating. Central side effects include impaired concentration, confusion, attention deficit, and memory impairment. [Show More]

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