Module7Pharm Flashcards
Activation of H1 receptors causes which of the following (choose all that apply):
a) vasodilation
b) vasoconstriction
c) mucous secretion
d) hypertension
e) itching
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
True or false, with high levels of H1 involvement, hypotension can occur?
True.
Which is a therapeutic use for antihistamines (choose all that apply):
a) urticaria (transfusion reaction)
b) motion sickness
c) mild allergies
d) insomnia
Answer: all of the above are appropriate uses for anthistamines
Other uses include allergic conjunctivitis
What are side effects of first generation antihistamines?
a) hallucination
b) sedation
c) anticholinergic
d) muscarinic
e) seizures
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
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
Answer: c) they have low affinity for H1 receptors in the CNS
They also cross the BBB poorly and can be mildly sedating.
Which drug would be the most effective option to treat allergic rhinitis?
a) Cromolyn
b) azelastine
c) Flonase
d) Ipratropium bromide
Answer: c) flonase
Intranasal glucocorticoids are the most effective option.
What is the MOA of intranasal glucocorticoids such as Flonase?
a) activate alpha-1
b) blocking cholinergic receptors
c) suppress histamine
d) decrease inflammation
Answer: d) decrease inflammation
Intranasal glucocorticoids are anti-inflammatory so they decrease congestion/rhinorrhea/sneezing/nasal itch/erythema
Side effects of Flonase include:
a) epistaxis
b) adrenal suppression
c) osteoporosis
d) slowed growth in children
e) somnolence
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
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
Answer: b) renal disease
The drug can accumulate to high levels in renally impaired patients, and the doses should be decreased accordingly.
What should the patient avoid while taking Fexofenadine (Allegra)?
a) dairy
b) fruit juices
c) chelating agents
d) CNS depressants
Answer: b) fruit juices
Fruit juices can interfere with absorption.
True or false, intranasal antihistamines will decrease symptoms when taken as needed.
False. These drugs need to be used prophylactically.
What are side effects of intranasal antihistamines: azelastine (Astelin) and olopatadine (Patanase)?
a) epistaxis
b) adrenal suppression
c) slowed growth in children
d) somnolence
Answer: a & d
Side effects include: somnolence, nosebleed, headache, unpleasant taste
Ipratropium bromide (Atrovent) will help to relieve allergic rhinitis symptoms including:
a) sneezing
b) nasal congestion
c) postnasal drip
d) mucous secretions
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.
Cromolyn is ______ (highly/moderately) effective at managing allergic rhinitis and works by _______ (suppressing histamine/blocking cholinergic actions).
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.
Sympathomimetics are effective in treating allergic rhinitis due to what action?
a) drying secretions
b) decreasing inflammation
c) activating alpha-1
d) decrease histamine
Answer: c) activating alpha-1
By activating alpha-1 these drugs (phenylephrine, ephedrine, pseudoephedrine) cause vasoconstriction of nasal vessels
Benefits of pseudoephedrine in allergic rhinitis include:
a) decreased nasal congestion
b) reduced rhinorrhea
c) decreased itch
d) decreased stretch
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.
Side effects of pseudoephedrine/ephedrine/phenylephrine include:
a) sedation
b) vasodilation
c) abuse potential
d) rebound congestion
Answer: c &d
SE: CNS stimulation, vasoconstriction, abuse potential (pseudoephedrine) and rebound congestion with topical use exceeding 3-5 days
Topical sympathomimetics provide ______ (intense/moderate) relief which is _______ (rapid/delayed).
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.
True or false, oral sympathomimetics are commonly associated with rebound congestion.
False.
What is the MOA of montelukast?
a) activate alpha-1
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation
Answer: c) block binding of leukotrienes
This blocking action will prevent vasodilation and thus relieve nasal congestion
Side effects of montelukast include:
a) anticholinergic effects
b) psych effects
c) epistaxis
d) headache
Answer: b) psychiatric effects
Including: agitation, aggression, depression, suidical thoughts
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
Answer: c)works directly on cough center of CNS
True or false, dextromethorphan, codeine, and hydrocodone cough syrups all have abuse potential.
True.
The greatest abuse potential is with hydrocodone as it is more potent.
True or false, diphenhydramine (Benadryl) can be used for cough relief.
True, the MOA is unknown.
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
Answer: a) decreases respiratory stretch receptors to suppress cough
What are the side effects of Benzonatate (Tessalon)?
a) sedation
b) anticholinergic effects
c) constipation
d) psychiatric effects
Answer: a & c
SE include: sedation, dizziness, constipation
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
Answer: c &d
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 ____+.
Answer: Restrict use of cough/cold meds to children ages 6+ but manufacturers lowered the age to 4+.
What drug class does budesonide fall into for the management of asthma/COPD?
Glucocorticoids
endings “one”
Other drugs include fluticasone, beclomethasone
Side effects of fluticasone include:
a) slowed growth in children
b) bone loss
c) cataracts/glaucoma
d) peptic ulcer disease
e) hyperglycemia
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]
What is the MOA of fluticasone?
a) activate alpha-1
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation
Answer: d) decrease inflammation
It will also reduce bronchial hyperactivity and decrease mucous production in airway
True or false, a patient on oral corticosteroids for management of asthma/COPD for 10 or more days should be tapered off.
True
True or false, oral glucocorticoids can be used in asthma/COPD patients as first-line treatment.
False. These should be reserved to patients not responsive to other treatments (such as inhaled).
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
Answer a,b,d,e
Long term tx SE: adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression in children.
Which leukotriene modifier works by blocking leukotriene synthesis?
a) montelukast
b) zafirlukast
c) zileuton
d) all of the above
Answer: c) zileuton
The other two options work by blocking leukotriene receptors
True or false, leukotriene modifiers are used as 2nd line agents for patients not responsive to ICS or for those who cannot tolerate ICS.
True
Side effects of Zileuton include:
a) psychiatric
b) joint pain
c) liver injury
d) kidney injury
Answer: a&c
Zileuton can cause liver injury & psychiatric issues.
What drug levels can increase in patients taking Zileuton?
a) oral glucocorticoids
b) warfarin
c) metoprolol
d) theophylline
Answer: b&d
Drugs which can be increased by Zileuton include: warfarin, propranolol, theophylline
Omalizumab has what MOA?
a) decreasing production of eosinophils
b) blocking cholinergic receptors
c) blocking binding of leukotrienes
d) decrease inflammation
Answer: a)decreasing production of eosinophils
It is a monoclonial antibody typically used in allergy mediated/eosinophilic asthma
Side effects of Omalizumab include:
a) anaphylaxis
b) herpes zoster
c) liver injury
d) CV
e) viral infection
Answer: a,d,e
SE: BBW for anaphylaxis, viral infection, URI, CV,
True or false, before initiating treatment with Omalizumab, any helminth infections should be treated.
True.
Side effects of Mepolizumab include:
a) anaphylaxis
b) herpes zoster
c) malignancies
d) viral infection
Answer: b) herpes zoster
This drug can be administered at home now.
Side effects of Reslizumab include:
a) anaphylaxis
b) herpes zoster
c) malignancies
d) viral infection
Answer: c) malignancies
True or false, LABAs must be given with an ICS in asthmatics.
True. Without the concurrent treatment with both, the risk of death is increased.
An example of a SABA would be:
albuterol or levoalbuterol
They block beta-2 which promotes bronchoDILATION
An example of a LABA would be:
Inhaled LABA: formoterol, salmeterol, aformeterol
Oral LABA: albuterol & terbutaline
Albuterol is considered a ______ (SABA/LABA) when inhaled and a _____ (SABA/LABA) when taken orally.
Albuterol is considered a SABA when inhaled and a LABA when taken orally.
Methylanthines (theophylline) has what MOA:
a) decreasing production of eosinophils
b) blocking cholinergic receptors
c) relaxes smooth muscle in bronchi
d) decrease inflammation
Answer: c) relaxes smooth muscle in bronchi
What other asthma drug will increase the level of theophylline when given concurrently?
a) Zileuton
b) Omalizumab
c) albuterol
d) Cromolyn
Answer: a)Zileuton
Zileuton blocks leuotriene synthesis and is used in asthma.
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
Answer: b) block muscarinic receptors (a subtype of cholinergic receptors) in the bronchi which causes bronchodilation
Which drug is a SAMA/SAAC (short-acting anticholinergic drug)?
a) ipratropium
b) tiotropium
c) revefenacin
d) umeclinidum
Answer: a) ipratropium
SE: glaucoma, dry mouth, irriation of pharynx, CV events
Which LAMA is not approved for asthma?
a) ipratropium
b) tiotropium
c) revefenacin
d) umeclinidum
Answer: b)tiotropium
The NP should avoid prescribing Umeclidinium (Ellipta) to a patient with what allergy?
a) egg
b) soy
c) dairy
d) peanut
Answer: c) dairy
It can cause a hypersensitivity reaction in those with a milk allergy
Methylxanthine (theophylline) has what side effects above 20:
a) death
b) dysrhythmias
c) restlessness
d) nausea
Answer: c&d
SE above 20:n/v/d, insomnia, restless;
Above 30: severe dysrhythmias, convulsions, death
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
Answer: d) low dose ICS+LABA as needed
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
Answer: d) low dose ICS+formoterol (LABA) as needed
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.
Answer: Step 1=symptoms less than twice a month; Step 2=symptoms twice a month+ but NOT daily
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
Answer: e) low dose maintenance ICS+ formoterol (LABA) daily
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
Answer: b)step 3
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
Answer: c)step 4
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
Answer: d) medium dose ICS+ formoterol (LABA) daily
Asthma ages 6-11:
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
The first step in acute care management of acute asthma exacerbation is:
a) administer LABA
b) administer SABA
c) give Epi
d) administer SAAC
Answer: b) administer SABA
What is the FEV1/FVC that indicates COPD?
a) <0.5
b) <0.6
c) <0.7
d) <0.8
Answer: c)0.7
What medication should be given to any patient with COPD for acute symptom control?
a) LABA
b) SABA
c) ICS
d) LAMA
Answer: b)SABA
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
Answer: b&c
LAMA or LABA are considered first choice for group A&B of COPD
If symptoms persist, give both LAMA/LABA combo.
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
Answer: b)LAMA
If symptoms persist, give LAMA/LABA (preferred) or LABA/IGC
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
Answer: b) LAMA
other first line options include: LAMA/LABA or LABA/IGC
If persistent give all three (LAMA/LABA/IGC)
Group A of COPD has ____(few/increased) symptoms and _____(low/high risk). Group B has ____(few/increased) symptoms and _____(low/high risk).
Answer: Group A is few symptoms and low risk. Group B is increased symptoms low risk.
Group C of COPD has ____(few/increased) symptoms and Group D has _____(low/high risk).
Group C has few symptoms and high risk. Group D has increased symptoms high risk.
True or false, inhaled corticosteroids in COPD can increase the risk for pneumonia.
True. Thus they are only added for worsened exacerbations.
Managing COPD exacerbation includes what medications/treatments:
a) SABA
b) systemic glucocorticoids
c) antibiotics
d) monoclonial antibodies
e) SAMA
Answer: a,b,c
Exacerbations include inhaled SABA, glucorticoids (only added with worsened exacerbation), antibiotics, supplemental oxygen
Rofluimilast (PDE-4) is useful in treating:
a) long term asthma
b) acute asthma exacerbation
c) acute exacerbation of COPD
d) long term COPD
Answer: c) acute exacerbation of COPD
It works by inactivating PDE which deactivates cAMP and ultimately reduces cough and mucous production
What is the first line beta-blocker for glaucoma?
a) atenolol
b) metoprolol
c) timolol
d) betaxolol
Answer: c) timolol
What is the only beta-blocker approved for asthmatic patients with glaucoma?
a) betaxolol
b) carteolol
c) levobunolol
d) timolol
e) metipranolol
Answer: a)betaxolol
It is the only cardioselective opthalmic beta-blocker
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
Answer: d) cholinergic agonists and carbonic anhydrase inhibitors are considered 2nd line
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
Answer: c) reducing aqueous humor production
They are used primarily for open-angle glaucoma
Which is not a beta-blocker approved for glaucoma?
a) betaxolol
b) carvedilol
c) levobunolol
d) timolol
e) metoprolol
Answer: b & e
Approved beta-blockers are: glaucoma: Betaxolol, carteolol, levobunolol, metipranolol, and timolol
Beta blockers are used primarily in ____ (open-angle/angle-closure) glaucoma.
Open angle.
Which is not a side effect of beta blockers applied topically for glaucoma:
a) hypotension
b) bradycardia
c) bronchospasm
d) blurred vision
Answer: a) hypotension
SE: ocular stinging, conjunctivitis, blurred vision, photophobia, and dry eyes; bradycardia, bronchospasm
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
Answer: a) facilitating outflow of aqueous humor
Drugs in this class include: Latanoprost, bimatroprost, latanoprostene, talfluprost
Side effects of latanoprost include?
a) blurred vision
b) macular edema
c) brown pigmentation of iris
d) eyelash growth
e) subconjunctival hemorrhage
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
True or false, travoprost was more effective in blacks, than nonblacks.
True.
Which prostaglandin analog has also been marketed for eyelash growth?
a) Latanoprost
b) bimatroprost
c) latanoprostene
d) talfluprost
Answer: b) bimatroprost (Latisse)
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
Answer: b) less side effects
Note: this drug can cause HARMLESS subjunctival hemorrhage
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
Answer: a & c
The drug lowers IOP by decreasing aqueous humor production and increasing outflow
Apraclonidine and brimonidine are classified as what type of glaucoma medication?
Alpha-2 adrenergic agonists
Apraclonidine (short term use); brimonidine (long term use)
Side effects of brimonidine (alpha-2 adrenergic agonist include):
a) hypotension
b) headache
c) dry mouth
d) blurred vision
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
Side effects of apraclonidine (alpha-2 adrenergic agonist include):
a) hypotension
b) headache
c) dry mouth
d) blurred vision
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
Brimonidine and Apraclonidine are used primarily for what type of glaucoma?
Open angle glaucoma
What drug is used for emergency management of acute angle-closure glaucoma?
Pilocarpine
Note it can be used as a 2nd line agent for OAG
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
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.
Side effects of pilocarpine include:
a) hypotension
b) retinal detachment
c) impaired near vision
d) local irritation/pain
Answer: b&d
SE: retinal detachment, decreased visual acuity (can see near but distance vision impaired-contacts can help, local irritation/pain,
True or false, Echothiopate is a cholinesterase inhibitor which has the same MOA as Pilocarpine?
True.
It has same ocular effects as pilocarpine (muscarinic agonist) and works by preventing the breakdown of acetylcholine at muscarinic receptors.
Ethothiopate (cholinesterase inhibitor) has what side effects:
a) impaired distance vision
b) cataracts
c) SLUDGE
d) retinal detachment
Answer: b) cataracts and c) SLUDGE
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
Answer: c) reducing aqueous humor production
They are used in open angle glaucoma
Side effects of topical CAIs such as Dorzolamide include:
a) bitter taste
b) ocular stinging
c) acid-base issues
d) nephrolithiasis
Answer: a&b
SE: ocular stinging and bitter taste, allergic reaction (local), blurred vision, tearing, eye dryness, photophobia
True or false, topical Brinzolamide (a CAI) is better tolerated than Dorzolamide and has less ocular burning.
True.
Note: the combo drug of both is called Simbrinza and it works better than each drug individually (they are potentiative)
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
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
True or false, acetazolamide and methazolamide are topically used CAIs to manage glaucoma.
False, they are oral and used less frequently due to systemic side effects including acid-base issues, anorexia, and nephrolithiasis.
Mydriatics will cause pupil _____ (dilation/constriction).
Answer: dilation
Drugs used for allergic conjunctivitis include:
a) mast-cell stabilizers
b) beta-blockers
c) NSAIDS
d) ocular decongestants
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
How is dry macular degeneration treated?
a) ocular decongestants
b) glucocorticoids
c) vitamins
d) intraocular injections
Answer: c) vitamins
Glucorticoids used long term for ocular inflammation carry what risks?
a) near vision changes
b) discoloration of iris
c) cataracts
d) glaucoma
Answer: c & d
They can suppress host immune response
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
Answer: b) permanent vision loss
Thus, infective drugs are not needed for conjunctivitis
Bacterial infections of the eye are usually contagious ____ days.
Answer: 1-2 days
Viral organisms can cause patient to be contagious longer
True or false, patients can continue to use contacts with an eye infection.
False. They should be discontinued until the patient has recovered.
What are the common causative bacteria for AOM?
a) H. influenzae
b) Staphylococcus aureus
c) Moraxella catarrhalis
d) Strep pneumoniae
Answer a,c,d
Most common are: haemophilus influenzae, Moraxella catarrhalis, and strep pneumoniae
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
Answer: they all decrease the incidence of AOM.
Other preventative measures include avoiding child care centers, avoiding supine bottles.
AOM treatment usually includes:
a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above
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.
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
Answer: c &d
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
Answer: b) amoxicillin-clavulante
Note: this combination will inhibit beta-lactamase but can cause diarrhea
Recurrent AOM is considered ____ times in _____ months.
Reccurent is 3+ times in 6 months or 4 times in 12 months
Otitis media with effusion should be treated with:
a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above
Answer: d) none of the above
ABX are not indicated because otitis media with effusion is NOT caused by bacteria
Most common causative organisms of otitis externa include:
a) Pseudomonas aeruginosa
b) Staphylococcus aureus
c) Haemophilus influenzae
d) Staphylococcus epidermidis
Answer: a,b,d
Common organisms: Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and Microbacterium otitidis
The first line treatment for uncomplicated AOE is:
a) high dose amoxicillin
b) topical 2% acetic acid
c) ciprofloxacin
d) none of the above
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.
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.
True. Neomycin is ototoxic.
What is another topical antibiotic option for an uncomplicated AOE which failed to respond to drops?
a) amoxicillin
b) ciprofloxacin
c) ceftriaxone
d) ampicillin
Answer: b) ciprofloxacin
Complicated AOE should be treated with (choose all that apply):
a) high dose amoxicillin
b) high dose amoxicillin-clavulante
c) ciprofloxacin
d) cephalexin
Answer: c&d
Ciprofloxacin=if patient is 18+ due to risk of tendon rupture;
Cephalexin= if patient is less than 18
What is a potential complication of AOE?
a) permanent hearing loss
b) necrotizing otitis externa
c) tinnitus
d) vertigo
Answer: b)necrotizing otitis externa
It can develop from AOE and infect mastoid/temporal/skull/cranial nerves.
True or false, the most common causative organism of necrotizing otitis externa is pseudomonas.
True.
What is the preferred treatment of necrotizing otitis externa?
a) high dose amoxicillin
b) high dose amoxicillin-clavulante
c) ciprofloxacin
d) azithromycin
Answer: c)oral ciprofloxacin
Other treatment is ofloxacin ear drops
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
Answer: b & d
At risk patients are older individuals with DM and immunocompromised status.
Treatment of choice for fungal OE is:
a) amoxicillin
b) 2% acetic acid
c) ethyl alcohol
d) hydrogen peroxide
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
Oral decongestants should be discouraged in patients with:
a) migraines
b) cardiovascular disease
c) allergic rhinitis
d) chronic bronchitis
Answer: b) CV disease
These can cause systemic vasoconstriction which can cause hypertension, arrhythmias, tachycardia, palpitations.
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
Answer: c) LABAs can be used as monotherapy to relieve bronchospasms in asthma
In asthma, LABAs MUST BE COMBINED with a ICS.
What are the 2 most common fungal organisms for EOM?
a) aspergillus
b) pseudomonas
c) staphylococcus
d) candida
Answer: a&d
aspergillus & candida
