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NURS 5334 > Module7Pharm > Flashcards

Module7Pharm Flashcards

1
Q

Activation of H1 receptors causes which of the following (choose all that apply):

a) vasodilation
b) vasoconstriction
c) mucous secretion
d) hypertension
e) itching

A

Answer: a, c,e

Activation of H1 can cause vasodilation of skin/face/upper body; CNS: itching, pain; and secretion of mucous.

Note: if extensive activation, hypotension can occur

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2
Q

True or false, with high levels of H1 involvement, hypotension can occur?

A

True.

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3
Q

Which is a therapeutic use for antihistamines (choose all that apply):

a) urticaria (transfusion reaction)
b) motion sickness
c) mild allergies
d) insomnia

A

Answer: all of the above are appropriate uses for anthistamines

Other uses include allergic conjunctivitis

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4
Q

What are side effects of first generation antihistamines?

a) hallucination
b) sedation
c) anticholinergic
d) muscarinic
e) seizures

A

Answer: a,b,c,e

Side effects include: sedation, dizziness, incoordination, confusion, hallucination, anticholinergic (can’t see can’t pee can’t shit can’t spit);

CNS stimulation at high doses and children are sensitive and can have seizures

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5
Q

Why are second generation antihistamines nonsedating?

a) they work through peripheral receptors
b) they cross the BBB easily
c) they have low affinity for H1 receptors of the CNS
d) None of the above

A

Answer: c) they have low affinity for H1 receptors in the CNS

They also cross the BBB poorly and can be mildly sedating.

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6
Q

Which drug would be the most effective option to treat allergic rhinitis?

a) Cromolyn
b) azelastine
c) Flonase
d) Ipratropium bromide

A

Answer: c) flonase

Intranasal glucocorticoids are the most effective option.

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7
Q

What is the MOA of intranasal glucocorticoids such as Flonase?

a) activate alpha-1
b) blocking cholinergic receptors
c) suppress histamine
d) decrease inflammation

A

Answer: d) decrease inflammation

Intranasal glucocorticoids are anti-inflammatory so they decrease congestion/rhinorrhea/sneezing/nasal itch/erythema

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8
Q

Side effects of Flonase include:

a) epistaxis
b) adrenal suppression
c) osteoporosis
d) slowed growth in children
e) somnolence

A

Answer: a,b,c,d

Side effects include: drying of nasal mucosa, itching/burning, sore throat, epistaxis, headache

Rare SE: adrenal suppression and slowing linear growth in children, osteoporosis

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9
Q

The NP should consider decreasing the dosage of Fexofenadine (Allegra) for a patient with what comorbidities?

a) liver disease
b) renal disease
c) heart disease
d) diabetes

A

Answer: b) renal disease

The drug can accumulate to high levels in renally impaired patients, and the doses should be decreased accordingly.

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10
Q

What should the patient avoid while taking Fexofenadine (Allegra)?

a) dairy
b) fruit juices
c) chelating agents
d) CNS depressants

A

Answer: b) fruit juices

Fruit juices can interfere with absorption.

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11
Q

True or false, intranasal antihistamines will decrease symptoms when taken as needed.

A

False. These drugs need to be used prophylactically.

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12
Q

What are side effects of intranasal antihistamines: azelastine (Astelin) and olopatadine (Patanase)?

a) epistaxis
b) adrenal suppression
c) slowed growth in children
d) somnolence

A

Answer: a & d

Side effects include: somnolence, nosebleed, headache, unpleasant taste

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13
Q

Ipratropium bromide (Atrovent) will help to relieve allergic rhinitis symptoms including:

a) sneezing
b) nasal congestion
c) postnasal drip
d) mucous secretions

A

Answer: d) mucous secretions

Because it is an anticholinergic agent it only acts to “dry up=can’t see can’t pee can’t shit can’t spit”.

It blocks muscarinic receptors.

It does NOT provide any relief of the other symptoms.

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14
Q

Cromolyn is ______ (highly/moderately) effective at managing allergic rhinitis and works by _______ (suppressing histamine/blocking cholinergic actions).

A

Answer: Cromolyn is an intranasal spray which is MODERATELY effective and works by suppressing histamine/inflammatory response. It takes up to 2 weeks to develop relief. It can be useful in asthma also.

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15
Q

Sympathomimetics are effective in treating allergic rhinitis due to what action?

a) drying secretions
b) decreasing inflammation
c) activating alpha-1
d) decrease histamine

A

Answer: c) activating alpha-1

By activating alpha-1 these drugs (phenylephrine, ephedrine, pseudoephedrine) cause vasoconstriction of nasal vessels

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16
Q

Benefits of pseudoephedrine in allergic rhinitis include:

a) decreased nasal congestion
b) reduced rhinorrhea
c) decreased itch
d) decreased stretch

A

Answer: a) decreased nasal congestion

These drugs stimulate alpha-1 which causes vasoconstriction to decrease congestion and facilitate drainage. They do not decrease other symptoms.

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17
Q

Side effects of pseudoephedrine/ephedrine/phenylephrine include:

a) sedation
b) vasodilation
c) abuse potential
d) rebound congestion

A

Answer: c &d

SE: CNS stimulation, vasoconstriction, abuse potential (pseudoephedrine) and rebound congestion with topical use exceeding 3-5 days

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18
Q

Topical sympathomimetics provide ______ (intense/moderate) relief which is _______ (rapid/delayed).

A

Topical sympathomimetics provide intense relief which is rapid. Topical effects are shorter and more likely to have rebound congestion when used beyond 3-5 days.

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19
Q

True or false, oral sympathomimetics are commonly associated with rebound congestion.

A

False.

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20
Q

What is the MOA of montelukast?

a) activate alpha-1
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation

A

Answer: c) block binding of leukotrienes

This blocking action will prevent vasodilation and thus relieve nasal congestion

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21
Q

Side effects of montelukast include:

a) anticholinergic effects
b) psych effects
c) epistaxis
d) headache

A

Answer: b) psychiatric effects

Including: agitation, aggression, depression, suidical thoughts

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22
Q

What is the MOA of the cough supressant dextromethorphan?

a) decreases respiratory stretch receptors to suppress cough
b) decreases sensitivity in local tissue to cough urge
c) works directly on the cough center of CNS
d) works in CNS but not as an opioid

A

Answer: c)works directly on cough center of CNS

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23
Q

True or false, dextromethorphan, codeine, and hydrocodone cough syrups all have abuse potential.

A

True.

The greatest abuse potential is with hydrocodone as it is more potent.

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24
Q

True or false, diphenhydramine (Benadryl) can be used for cough relief.

A

True, the MOA is unknown.

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25
Q

What is the MOA of the cough supressant Benzonatate (Tessalon)?

a) decreases respiratory stretch receptors to suppress cough
b) decreases sensitivity in local tissue to cough urge
c) raise cough threshold in CNS
d) works in CNS but not as an opioid

A

Answer: a) decreases respiratory stretch receptors to suppress cough

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26
Q

What are the side effects of Benzonatate (Tessalon)?

a) sedation
b) anticholinergic effects
c) constipation
d) psychiatric effects

A

Answer: a & c

SE include: sedation, dizziness, constipation

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27
Q

Your patient has been prescribed hypertonic saline/acetylcsteine as mucolytics. They call your office complaining of what normal side effect:

a) sedation
b) anticholinergic
c) bronchospasm
d) sulfur odor

A

Answer: c &d

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28
Q

The AAP recommends the use of cold medication be restricted to children ages ___+ whereas the manufacturers of cold medication recommend the use in children ages ____+.

A

Answer: Restrict use of cough/cold meds to children ages 6+ but manufacturers lowered the age to 4+.

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29
Q

What drug class does budesonide fall into for the management of asthma/COPD?

A

Glucocorticoids

endings “one”
Other drugs include fluticasone, beclomethasone

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30
Q

Side effects of fluticasone include:

a) slowed growth in children
b) bone loss
c) cataracts/glaucoma
d) peptic ulcer disease
e) hyperglycemia

A

Answer: a,b,c

Side effects of inhaled glucocorticoids include: adrenal suppression, oropharyngeal candidiasis, dysphonia, can slow growth in children (don’t decrease adult height), promote bone loss,[cataracts/glaucoma seen at higher doses for longer duration]

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31
Q

What is the MOA of fluticasone?

a) activate alpha-1
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation

A

Answer: d) decrease inflammation

It will also reduce bronchial hyperactivity and decrease mucous production in airway

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32
Q

True or false, a patient on oral corticosteroids for management of asthma/COPD for 10 or more days should be tapered off.

A

True

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33
Q

True or false, oral glucocorticoids can be used in asthma/COPD patients as first-line treatment.

A

False. These should be reserved to patients not responsive to other treatments (such as inhaled).

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34
Q

What are side effects of oral glucocorticoids when used long-term for asthma/COPD?

a) slowed growth in children
b) bone loss
c) cataracts/glaucoma
d) peptic ulcer disease
e) hyperglycemia

A

Answer a,b,d,e

Long term tx SE: adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression in children.

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35
Q

Which leukotriene modifier works by blocking leukotriene synthesis?

a) montelukast
b) zafirlukast
c) zileuton
d) all of the above

A

Answer: c) zileuton

The other two options work by blocking leukotriene receptors

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36
Q

True or false, leukotriene modifiers are used as 2nd line agents for patients not responsive to ICS or for those who cannot tolerate ICS.

A

True

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37
Q

Side effects of Zileuton include:

a) psychiatric
b) joint pain
c) liver injury
d) kidney injury

A

Answer: a&c

Zileuton can cause liver injury & psychiatric issues.

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38
Q

What drug levels can increase in patients taking Zileuton?

a) oral glucocorticoids
b) warfarin
c) metoprolol
d) theophylline

A

Answer: b&d

Drugs which can be increased by Zileuton include: warfarin, propranolol, theophylline

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39
Q

Omalizumab has what MOA?

a) decreasing production of eosinophils
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation

A

Answer: a)decreasing production of eosinophils

It is a monoclonial antibody typically used in allergy mediated/eosinophilic asthma

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40
Q

Side effects of Omalizumab include:

a) anaphylaxis
b) herpes zoster
c) liver injury
d) CV
e) viral infection

A

Answer: a,d,e

SE: BBW for anaphylaxis, viral infection, URI, CV,

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41
Q

True or false, before initiating treatment with Omalizumab, any helminth infections should be treated.

A

True.

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42
Q

Side effects of Mepolizumab include:

a) anaphylaxis
b) herpes zoster
c) malignancies
d) viral infection

A

Answer: b) herpes zoster

This drug can be administered at home now.

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43
Q

Side effects of Reslizumab include:

a) anaphylaxis
b) herpes zoster
c) malignancies
d) viral infection

A

Answer: c) malignancies

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44
Q

True or false, LABAs must be given with an ICS in asthmatics.

A

True. Without the concurrent treatment with both, the risk of death is increased.

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45
Q

An example of a SABA would be:

A

albuterol or levoalbuterol

They block beta-2 which promotes bronchoDILATION

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46
Q

An example of a LABA would be:

A

Inhaled LABA: formoterol, salmeterol, aformeterol

Oral LABA: albuterol & terbutaline

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47
Q

Albuterol is considered a ______ (SABA/LABA) when inhaled and a _____ (SABA/LABA) when taken orally.

A

Albuterol is considered a SABA when inhaled and a LABA when taken orally.

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48
Q

Methylanthines (theophylline) has what MOA:

a) decreasing production of eosinophils
b) blocking cholinergic receptors
c) relaxes smooth muscle in bronchi
d) decrease inflammation

A

Answer: c) relaxes smooth muscle in bronchi

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49
Q

What other asthma drug will increase the level of theophylline when given concurrently?

a) Zileuton
b) Omalizumab
c) albuterol
d) Cromolyn

A

Answer: a)Zileuton

Zileuton blocks leuotriene synthesis and is used in asthma.

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50
Q

SAMA/SAAC and LAMA/LAAC drugs have what MOA?

a) decreasing production of eosinophils
b) blocking muscarinic receptors
c) blocks leukotriene receptors
d) decrease inflammation

A

Answer: b) block muscarinic receptors (a subtype of cholinergic receptors) in the bronchi which causes bronchodilation

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51
Q

Which drug is a SAMA/SAAC (short-acting anticholinergic drug)?

a) ipratropium
b) tiotropium
c) revefenacin
d) umeclinidum

A

Answer: a) ipratropium

SE: glaucoma, dry mouth, irriation of pharynx, CV events

52
Q

Which LAMA is not approved for asthma?

a) ipratropium
b) tiotropium
c) revefenacin
d) umeclinidum

A

Answer: b)tiotropium

53
Q

The NP should avoid prescribing Umeclidinium (Ellipta) to a patient with what allergy?

a) egg
b) soy
c) dairy
d) peanut

A

Answer: c) dairy

It can cause a hypersensitivity reaction in those with a milk allergy

54
Q

Methylxanthine (theophylline) has what side effects above 20:

a) death
b) dysrhythmias
c) restlessness
d) nausea

A

Answer: c&d

SE above 20:n/v/d, insomnia, restless;

Above 30: severe dysrhythmias, convulsions, death

55
Q

In patients 12+ what are the step 1 &2, track #1 treatment options/plan?

a) low dose ICS when SABA taken
b) daily low dose ICS
c) low dose ICS+SABA as needed
d) low dose ICS+LABA as needed
e) low dose ICS+LAMA as needed

A

Answer: d) low dose ICS+LABA as needed

56
Q

In patients 12+ what are the step 1 &2, track #1 treatment options/plan?

a) low dose ICS when SABA taken
b) daily low dose ICS
c) low dose ICS+SABA as needed
d) low dose ICS+LABA as needed
e) low dose ICS+LAMA as needed

A

Answer: d) low dose ICS+formoterol (LABA) as needed

57
Q

A patient aged 12+ with asthma symptoms ____ would be considered for step 1 treatment, and a patient with asthma symptoms ____ would be considered a candidate for step 2 treatment.

A

Answer: Step 1=symptoms less than twice a month; Step 2=symptoms twice a month+ but NOT daily

58
Q

For patients 12+ what does step 3 track 1 treatment include?

a) low dose ICS when SABA taken
b) daily low dose ICS
c) low dose ICS+SABA as needed
d) low dose ICS+LABA as needed
e) low dose ICS+LABA daily

A

Answer: e) low dose maintenance ICS+ formoterol (LABA) daily

59
Q

A patient aged 12+ would be considered what step if they had symptoms most days, or waking with asthma once a week or more.

a) step 2
b) step 3
c) step 4

A

Answer: b)step 3

60
Q

A patient aged 12+ would be considered what step if they had symptoms most days, or waking with asthma once a week or more, or low lung function?

a) step 2
b) step 3
c) step 4

A

Answer: c)step 4

61
Q

For patients 12+ what does step 4 track 1 treatment include?

a) medium dose ICS when SABA taken
b) daily medium dose ICS
c) medium dose ICS+SABA as needed
d) medium dose ICS+LABA daily
e) medium dose ICS+LAMA daily

A

Answer: d) medium dose ICS+ formoterol (LABA) daily

62
Q

Asthma ages 6-11:

A

Step 1: Low dose ICS when SABA taken
Step 2: Daily low dose ICS or Daily leukotriene receptor antagonist (LTRA), or step 1
Step 3: Low dose ICS-LABA, or Medium dose ICS, or very low dose ICS-formoterol maintenance and reliever or low dose ICS + LTRA
Step 4: Medium dose ICS-LABA or low dose ICS formoterol maintenance and reliever therapy and refer
Step 5: refer for phenotyping plus a higher dose ICS-LABA

63
Q

The first step in acute care management of acute asthma exacerbation is:

a) administer LABA
b) administer SABA
c) give Epi
d) administer SAAC

A

Answer: b) administer SABA

64
Q

What is the FEV1/FVC that indicates COPD?

a) <0.5
b) <0.6
c) <0.7
d) <0.8

A

Answer: c)0.7

65
Q

What medication should be given to any patient with COPD for acute symptom control?

a) LABA
b) SABA
c) ICS
d) LAMA

A

Answer: b)SABA

66
Q

What is the first choice of treatment for group A & B in COPD?

a) ICS+formoterol
b) LAMA
c) LABA
d) ICS or LAMA
e) LAMA or LABA

A

Answer: b&c

LAMA or LABA are considered first choice for group A&B of COPD

If symptoms persist, give both LAMA/LABA combo.

67
Q

What is the first choice of treatment for group C in COPD?

a) ICS+formoterol
b) LAMA
c) LABA
d) ICS or LAMA
e) LAMA or LABA

A

Answer: b)LAMA

If symptoms persist, give LAMA/LABA (preferred) or LABA/IGC

68
Q

What is the treatment of choice for group D in COPD?

a) ICS+formoterol
b) LAMA
c) LABA
d) ICS or LAMA
e) LAMA or LABA

A

Answer: b) LAMA

other first line options include: LAMA/LABA or LABA/IGC

If persistent give all three (LAMA/LABA/IGC)

69
Q

Group A of COPD has ____(few/increased) symptoms and _____(low/high risk). Group B has ____(few/increased) symptoms and _____(low/high risk).

A

Answer: Group A is few symptoms and low risk. Group B is increased symptoms low risk.

70
Q

Group C of COPD has ____(few/increased) symptoms and Group D has _____(low/high risk).

A

Group C has few symptoms and high risk. Group D has increased symptoms high risk.

71
Q

True or false, inhaled corticosteroids in COPD can increase the risk for pneumonia.

A

True. Thus they are only added for worsened exacerbations.

72
Q

Managing COPD exacerbation includes what medications/treatments:

a) SABA
b) systemic glucocorticoids
c) antibiotics
d) monoclonial antibodies
e) SAMA

A

Answer: a,b,c

Exacerbations include inhaled SABA, glucorticoids (only added with worsened exacerbation), antibiotics, supplemental oxygen

73
Q

Rofluimilast (PDE-4) is useful in treating:

a) long term asthma
b) acute asthma exacerbation
c) acute exacerbation of COPD
d) long term COPD

A

Answer: c) acute exacerbation of COPD

It works by inactivating PDE which deactivates cAMP and ultimately reduces cough and mucous production

74
Q

What is the first line beta-blocker for glaucoma?

a) atenolol
b) metoprolol
c) timolol
d) betaxolol

A

Answer: c) timolol

75
Q

What is the only beta-blocker approved for asthmatic patients with glaucoma?

a) betaxolol
b) carteolol
c) levobunolol
d) timolol
e) metipranolol

A

Answer: a)betaxolol

It is the only cardioselective opthalmic beta-blocker

76
Q

What drugs are not considered first-line for glaucoma?

a) beta blockers
b) alpha 2 adrenergic agents (Brimonidine)
c) Prostaglandin analogs (Latanoprost)
d) cholinergic agonists

A

Answer: d) cholinergic agonists and carbonic anhydrase inhibitors are considered 2nd line

77
Q

How do beta-blockers work in managing glaucoma?

a) facilitating outflow of aqueous humor
b) causing mydriasis
c) reducing aqueous humor production
d) causing miosis

A

Answer: c) reducing aqueous humor production

They are used primarily for open-angle glaucoma

78
Q

Which is not a beta-blocker approved for glaucoma?

a) betaxolol
b) carvedilol
c) levobunolol
d) timolol
e) metoprolol

A

Answer: b & e

Approved beta-blockers are: glaucoma: Betaxolol, carteolol, levobunolol, metipranolol, and timolol

79
Q

Beta blockers are used primarily in ____ (open-angle/angle-closure) glaucoma.

A

Open angle.

80
Q

Which is not a side effect of beta blockers applied topically for glaucoma:

a) hypotension
b) bradycardia
c) bronchospasm
d) blurred vision

A

Answer: a) hypotension

SE: ocular stinging, conjunctivitis, blurred vision, photophobia, and dry eyes; bradycardia, bronchospasm

81
Q

What is the MOA for prostaglandin analogs in glaucoma?

a) facilitating outflow of aqueous humor
b) causing mydriasis
c) reducing aqueous humor production
d) causing miosis

A

Answer: a) facilitating outflow of aqueous humor

Drugs in this class include: Latanoprost, bimatroprost, latanoprostene, talfluprost

82
Q

Side effects of latanoprost include?

a) blurred vision
b) macular edema
c) brown pigmentation of iris
d) eyelash growth
e) subconjunctival hemorrhage

A

Answer: a,b,c,d

SE: harmless brown pigmentation of the iris, eyelid pigmentation, eyelash growth, blurred vision, burning/stinging/conjunctival issues, macular edema, dry eye, light intolerance, tearing

83
Q

True or false, travoprost was more effective in blacks, than nonblacks.

A

True.

84
Q

Which prostaglandin analog has also been marketed for eyelash growth?

a) Latanoprost
b) bimatroprost
c) latanoprostene
d) talfluprost

A

Answer: b) bimatroprost (Latisse)

85
Q

Rho Kinase inhibitors include Netarsudil (Rhopressa) and have what benefit over other glaucoma drugs?

a) faster onset with more severe side effects such as subjunctival hemorrhage
b) less side effects
c) less systemic impact
d) none of the above

A

Answer: b) less side effects

Note: this drug can cause HARMLESS subjunctival hemorrhage

86
Q

What is the MOA for alpha-2 adrenergic agonists (choose all that apply)

a) facilitating outflow of aqueous humor
b) causing mydriasis
c) reducing aqueous humor production
d) causing miosis

A

Answer: a & c

The drug lowers IOP by decreasing aqueous humor production and increasing outflow

87
Q

Apraclonidine and brimonidine are classified as what type of glaucoma medication?

A

Alpha-2 adrenergic agonists

Apraclonidine (short term use); brimonidine (long term use)

88
Q

Side effects of brimonidine (alpha-2 adrenergic agonist include):

a) hypotension
b) headache
c) dry mouth
d) blurred vision

A

Answer: all of the above

Brimonidine can cross the BBB (apraclonidine cannot) so it has side effects including: hypotension, fatigue, drowsiness, dry mouth, ocular hyperemia, local burning and stinging, headache, blurred vision, foreign body sensation, and itching

89
Q

Side effects of apraclonidine (alpha-2 adrenergic agonist include):

a) hypotension
b) headache
c) dry mouth
d) blurred vision

A

Answer: b,c,d

Apraclonidine doesn’t cross the BBB so less effects are seen in the CNS. Mild side effects include: headache, dry mouth, dry nose, altered taste, conjunctivitis, lid reactions, pruritus, tearing, and blurred vision

90
Q

Brimonidine and Apraclonidine are used primarily for what type of glaucoma?

A

Open angle glaucoma

91
Q

What drug is used for emergency management of acute angle-closure glaucoma?

A

Pilocarpine

Note it can be used as a 2nd line agent for OAG

92
Q

What is the MOA for pilocarpine?

a) facilitating outflow of aqueous humor
b) it acts as a muscarinic agonist
c) reducing aqueous humor production
d) it acts as a mucarinic antagonist

A

Answer: b) it acts as a muscarinic agonist

This stimulates cholinergic receptors in the eye causing miosis (constriction) which contracts the ciliary muscle. This lowers the IOP indirectly.

93
Q

Side effects of pilocarpine include:

a) hypotension
b) retinal detachment
c) impaired near vision
d) local irritation/pain

A

Answer: b&d

SE: retinal detachment, decreased visual acuity (can see near but distance vision impaired-contacts can help, local irritation/pain,

94
Q

True or false, Echothiopate is a cholinesterase inhibitor which has the same MOA as Pilocarpine?

A

True.

It has same ocular effects as pilocarpine (muscarinic agonist) and works by preventing the breakdown of acetylcholine at muscarinic receptors.

95
Q

Ethothiopate (cholinesterase inhibitor) has what side effects:

a) impaired distance vision
b) cataracts
c) SLUDGE
d) retinal detachment

A

Answer: b) cataracts and c) SLUDGE

96
Q

Carbonic Anhydrase Inhibitors (Dorzolamide & Brinzolamide) have what MOA?

a) facilitating outflow of aqueous humor
b) it acts as a muscarinic agonist
c) reducing aqueous humor production
d) it acts as a mucarinic antagonist

A

Answer: c) reducing aqueous humor production

They are used in open angle glaucoma

97
Q

Side effects of topical CAIs such as Dorzolamide include:

a) bitter taste
b) ocular stinging
c) acid-base issues
d) nephrolithiasis

A

Answer: a&b

SE: ocular stinging and bitter taste, allergic reaction (local), blurred vision, tearing, eye dryness, photophobia

98
Q

True or false, topical Brinzolamide (a CAI) is better tolerated than Dorzolamide and has less ocular burning.

A

True.

Note: the combo drug of both is called Simbrinza and it works better than each drug individually (they are potentiative)

99
Q

What advice should be given to a patient regarding the use of topical CAIs (Dorzolamide)?

a) avoid the use of OTC eye drops concurrently
b) wait 15 minutes before inserting contacts
c) contacts may become discolored
d) notify your doctor if you have flank pain as nephrolithiasis is a side effect of these drugs

A

Answer: b)Both drugs have a preservative so patients should wait 15 minutes after installation to put in their contacts

Note: oral CAIs are used less but have severe side effects including nephrolithiasis and electrolyte issues

100
Q

True or false, acetazolamide and methazolamide are topically used CAIs to manage glaucoma.

A

False, they are oral and used less frequently due to systemic side effects including acid-base issues, anorexia, and nephrolithiasis.

101
Q

Mydriatics will cause pupil _____ (dilation/constriction).

A

Answer: dilation

102
Q

Drugs used for allergic conjunctivitis include:

a) mast-cell stabilizers
b) beta-blockers
c) NSAIDS
d) ocular decongestants

A

Answer: a,c,d

Mast-cell stabilizers include Cromolyn&Lodoxamide

NSAIDS inhibit COX

Ocular decongestants include Phenylephrine and Naphazoline and activate alpha-1 to cause vasoconstriction (they do not impact immune response) and rebound congestion is common

103
Q

How is dry macular degeneration treated?

a) ocular decongestants
b) glucocorticoids
c) vitamins
d) intraocular injections

A

Answer: c) vitamins

104
Q

Glucorticoids used long term for ocular inflammation carry what risks?

a) near vision changes
b) discoloration of iris
c) cataracts
d) glaucoma

A

Answer: c & d

They can suppress host immune response

105
Q

If glucocorticoids are ordered for a viral/fungal optic infection, what can occur?

a) permanent discoloration of iris
b) permanent vision loss
c) adrenal insufficiency
d) retinal detachment

A

Answer: b) permanent vision loss

Thus, infective drugs are not needed for conjunctivitis

106
Q

Bacterial infections of the eye are usually contagious ____ days.

A

Answer: 1-2 days

Viral organisms can cause patient to be contagious longer

107
Q

True or false, patients can continue to use contacts with an eye infection.

A

False. They should be discontinued until the patient has recovered.

108
Q

What are the common causative bacteria for AOM?

a) H. influenzae
b) Staphylococcus aureus
c) Moraxella catarrhalis
d) Strep pneumoniae

A

Answer a,c,d

Most common are: haemophilus influenzae, Moraxella catarrhalis, and strep pneumoniae

109
Q

Which of the following does not reduce the incidence of AOM?

a) vaccinations
b) breastfeeding 6 months or more
c) avoid smoke exposure
d) decreased pacifier use at 6 months

A

Answer: they all decrease the incidence of AOM.

Other preventative measures include avoiding child care centers, avoiding supine bottles.

110
Q

AOM treatment usually includes:

a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above

A

Answer: d) none of the above

80% of AOM self resolve without antibiotics. Pain treatment may be indicated.

If antibiotics are indicated, the first choice is high-dose amoxicillin.

111
Q

If antibiotics are indicated for AOM, and the patient is severely allergic to penicillin, what medication is appropriate?

a) ciprofloxacin
b) ceftriaxone
c) azithromycin
d) clarithromycin

A

Answer: c &d

112
Q

If the patient has AOM and a high dose amoxicillin regimen has not decreased the infection. What can the NP prescribe?

a) longer course of high dose amoxicillin
b) amoxicillin-clavulante
c) ciprofloxacin
d) adding in a 2% solution of acetic acid

A

Answer: b) amoxicillin-clavulante

Note: this combination will inhibit beta-lactamase but can cause diarrhea

113
Q

Recurrent AOM is considered ____ times in _____ months.

A

Reccurent is 3+ times in 6 months or 4 times in 12 months

114
Q

Otitis media with effusion should be treated with:

a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above

A

Answer: d) none of the above

ABX are not indicated because otitis media with effusion is NOT caused by bacteria

115
Q

Most common causative organisms of otitis externa include:

a) Pseudomonas aeruginosa
b) Staphylococcus aureus
c) Haemophilus influenzae
d) Staphylococcus epidermidis

A

Answer: a,b,d

Common organisms: Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and Microbacterium otitidis

116
Q

The first line treatment for uncomplicated AOE is:

a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above

A

Answer: b) topical 2% acetic acid solution

This treatment is best for an uncomplicated OAE. If drops aren’t effective, a topical ABX (hydrocortisone+neomycin+polymyxin B) should be used.

117
Q

True or false, in uncomplicated AOE (drops were not effective) a topical antibiotic should be used such as (hydrocortisone+neomycin+polymyxin B) but the use carries a risk of ototoxicity.

A

True. Neomycin is ototoxic.

118
Q

What is another topical antibiotic option for an uncomplicated AOE which failed to respond to drops?

a) amoxicillin
b) ciprofloxacin
c) ceftriaxone
d) ampicillin

A

Answer: b) ciprofloxacin

119
Q

Complicated AOE should be treated with (choose all that apply):

a) high dose amoxicillin
b) high dose amoxicillin-clavulante
c) ciprofloxacin
d) cephalexin

A

Answer: c&d

Ciprofloxacin=if patient is 18+ due to risk of tendon rupture;

Cephalexin= if patient is less than 18

120
Q

What is a potential complication of AOE?

a) permanent hearing loss
b) necrotizing otitis externa
c) tinnitus
d) vertigo

A

Answer: b)necrotizing otitis externa

It can develop from AOE and infect mastoid/temporal/skull/cranial nerves.

121
Q

True or false, the most common causative organism of necrotizing otitis externa is pseudomonas.

A

True.

122
Q

What is the preferred treatment of necrotizing otitis externa?

a) high dose amoxicillin
b) high dose amoxicillin-clavulante
c) ciprofloxacin
d) azithromycin

A

Answer: c)oral ciprofloxacin

Other treatment is ofloxacin ear drops

123
Q

What patients are at risk for necrotizing otitis externa (choose all that apply)?

a) bottle-fed infants
b) diabetic patients
c) children attending day care
d) immune compromised

A

Answer: b & d

At risk patients are older individuals with DM and immunocompromised status.

124
Q

Treatment of choice for fungal OE is:

a) amoxicillin
b) 2% acetic acid
c) ethyl alcohol
d) hydrogen peroxide

A

Answer: b) 2% acetic acid used TID/QID

1) Acidifying drops 2)Clotrimazole 1% if acidifying drops ineffective
3) Itraconazole or Diflucan PO if drops ineffective

125
Q

Oral decongestants should be discouraged in patients with:

a) migraines
b) cardiovascular disease
c) allergic rhinitis
d) chronic bronchitis

A

Answer: b) CV disease

These can cause systemic vasoconstriction which can cause hypertension, arrhythmias, tachycardia, palpitations.

126
Q

Regarding the use of long-acting beta 2 agonists (LABAs), which of the following is NOT true?

a) LABAs enhance the anti-inflammatory actions of corticosteroids
b) use of LABAs is associated with a small increase in risk of asthma death
c) LABAs can be used as monotherapy to relieve bronchospasms in asthma
d) LABA use reduces the risk of asthma exacerbations

A

Answer: c) LABAs can be used as monotherapy to relieve bronchospasms in asthma

In asthma, LABAs MUST BE COMBINED with a ICS.

127
Q

What are the 2 most common fungal organisms for EOM?

a) aspergillus
b) pseudomonas
c) staphylococcus
d) candida

A

Answer: a&d

aspergillus & candida

NURS 5334 (12 decks)

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