Pharmacology CH9

Question 1

Use of eye drops would be advantageous:

a) if the drug needs to stay on the eye for a long time
b) if exterior parts of the eye are being treated
c) in case of a systemic infection
d) if the condition being treated is not very serious

Answer 1

b) Topical drops are best used to treat external eye problems. (That is not to say that they
do not have a place in treating intraocular problems, of course!)

Question 2

A disadvantage of eye drops is that:

a) they are expensive
b) they do not have prolonged contact with the eye
c) they must be refrigerated
d) they penetrate too deeply into the eye’s structures

Answer 2

b) Eye medications in drop form are prone to run out the lacrimal drainage system. Many
drops are expensive, but this is not the best answer.

Question 3

Use of eye ointments is advantageous because:
a) they are less expensive than drops
b) they penetrate more quickly than drops
c) they are easier to apply than drops
d) they remain in contact with the eye longer than drops

Answer 3

d) Because ointments are in a petroleum-type base, they do not drain off the eye as rapidly
as drops.

Question 4

A patient might complain about using eye ointment because:

a) it has to be used more often than drops
b) it is more expensive than drops
c) it blurs the vision
d) it is less effective than drops

Answer 4

c) Ointment creates a film in the tears, causing blurry vision. Ointment is generally used less
often (ie, fewer doses) than drops.

Question 5

All of the following are characteristics of locally injected drugs except:

a) a greater concentration of the drug can be given versus topical
b) the drug can be delivered directly to the site where it is needed
c) the drug takes effect quickly
d) the drug is absorbed through the digestive tract

Answer 5

d) Locally injected drugs have all the advantages listed except being absorbed through the digestive tract (which would describe medication given orally, not injected).

Question 6

Systemic drugs are those administered by:

a) applying the drug to the surface
b) injection or mouth
c) mouth only
d) injection only

Answer 6

b) Systemic drugs are “introduced into the system” by intravenous injection or by mouth.

Question 7

All of the following are examples of systemically administered drugs except:

a) acetazolamide pills for glaucoma
b) glycerol liquid drink to reduce intraocular pressure
c) mannitol intravenous injection to reduce intraocular pressure
d) timolol eye drops for glaucoma

Answer 7

d) Eye drops are topical, not systemic.

Question 8

When a child is to be given anesthetic drops, the assistant should:
a) give the drops without warning to avoid hassles
b) tell the child that the drops will not sting
c) let the physician do it
d) briefly explain what is to be done, then do it quickly

Answer 8

d) You could tell the child that the drops might sting for a second, but do not lie, and do not
drag it out. Surprises are unpleasant, too. The physician needs a good rapport with the child
in order to complete the exam and render treatment, so it is better if the doctor does not give the drops.

Question 9

A topical ophthalmic drug preparation is considered unsterile:
a) once it is opened
b) only if it touches the lashes or lids
c) only if bacteria can be cultured from it
d) none of the above

Answer 9

a) While the drug may be uncontaminated (ie, no bacteria or other organisms have gotten into it), it is no longer considered sterile once opened.

Question 10

The physician has asked you to dilate a patient’s eyes. The drops used to do this will
have:
a) a purple cap
b) a green cap
c) a white cap
d) a red cap

Answer 10

d) Eye drops that dilate (via mydriasis or cycloplegia) all have red caps.

Question 11

Having the patient look down when you instill topical anesthetics might be advantageous because:
a) the drop will sting less
b) the drop will be distributed over the cornea
c) the drop will stay on the eye longer
d) the tears will not dilute the solution

Answer 11

b) The theory is that if the patient looks down when the drop is instilled, afterwards when
he or she blinks, the eye will automatically roll up, giving better coverage over the cornea.
This would be true for most topical dyes (eg, rose bengal) as well. Otherwise, having the
patient look up during instillation is easier;

see answer 12.

ANSWER 12: Have the patient look up, and gently pull down the lower lid. The medication is then instilled in the lower cul-de-sac (pocket between the lid and eyeball).

Question 12

Dilating and medicinal topical drops/ointments are most easily instilled by:

a) having the patient look to one side
b) dropping directly on the cornea
c) using a cotton-tipped applicator
d) having the patient look up

Answer 12

d) Have the patient look up, and gently pull down the lower lid. The medication is then
instilled in the lower cul-de-sac (pocket between the lid and eyeball).

Question 13

You are instilling cycloplegic drops, and the dropper tip touches the patient’s eye-
lashes. You should:

a) wipe the dropper tip with alcohol
b) soak the tip in bleach solution
c) cap the bottle
d) discard the bottle and drops

Answer 13

d) If the tip of a multiple-use dropper bottle touches the lids, lashes, conjunctiva, or skin, it
should be discarded.

Question 14

Regarding the recapping of multiple-use ophthalmic drops:

a) it is unnecessary and inconvenient
b) it helps to prevent contamination
c) it needs to be done only at the end of the day
d) only single-use dispensers should be used

Answer 14

b) Immediate recapping of dilating and other drops used in the eye clinic helps to prevent
contamination of the medication via airborne dust and germs.

Question 15

All of the following should be done prior to pupil dilation except:
a) swinging flashlight test
b) keratometry
c) refractometry in a patient over the age of 45
d) pressure check

Answer 15

b) Dilation makes no difference in keratometry readings. (What could make a difference in
K readings is if you have applanated the cornea prior to keratometry, but that was not one of the choices.) The swinging flashlight test checks pupillary reaction and, thus, must be done prior to dilating. Patients over the age of 45 are probably going to need a reading add, which needs to be measured prior to “freezing” accommodation by dilating. A check of IOP is also needed before dilation to make sure the patient is not sitting on high pressure readings.

Question 16

Which of the following bottle cap colors are coded for glaucoma medications?
a) yellow, blue, red
b) purple, blue, yellow, green
c) yellow, white, red, purple
d) green, yellow, purple, white

Answer 16

b) Red is for cycloplegics/mydriatics, and white can be most anything (tears, anesthetic,
steroids, and antibiotics).

Question 17

After instillation of topical anesthetic, the patient should be told:
a) “Be sure to wear sunglasses when you go outside.”
b) “Your vision may be blurry for several hours.”
c) “Do not rub your eyes.”
d) “Do not drive until it has worn off.”

Answer 17

c) Because of the numbness induced by topical anesthetics, the patient should be reminded
not to rub his or her eyes. The danger is that he or she will accidentally rub and abrade the
cornea while it cannot feel anything.

Question 18

A patient who has undergone routine dilation for an eye exam can expect:
a) better night vision
b) better vision in bright light
c) blurred near vision
d) light sensitivity for 24 hours

Answer 18

c) Routine dilation “freezes” accommodation, so, of the choices offered, the patient can
expect to be blurred at near. There is generally some light sensitivity, too, but not for a full
24 hours.

Question 19

A disadvantage of drops used to reverse routine office dilation is:
a) it takes a long time to act
b) the patient is still light-sensitive
c) it clears near but blurs distant vision
d) it can cause headaches

Answer 19

d) The dilating reversal drops are miotics and can cause headaches.

Question 20

Home use of anesthetic eye drops is never prescribed because:
a) it causes a breakdown of the corneal surface
b) a patient in pain will schedule a return visit
c) it decreases the efficacy of other drugs
d) it is too expensive to justify home use

Answer 20

a) Repeated use of topical anesthetic causes corneal melting, which can interfere with healing.

Question 21

A patient has had a piece of metal removed from his cornea one morning. That after-
noon he calls the office and asks the doctor to prescribing numbing drops. You tell him:

a) the doctor will call it in as soon as possible
b) come by the office and pick some up
c) that medication is not prescribed because it interferes with healing
d) that medication is not prescribed because it can elevate eye pressure

Answer 21

c) See answer 20.

ANSWER 20: Repeated use of topical anesthetic causes corneal melting, which can interfere with healing.

Question 22

Patients who use nonpreserved artificial tears supplied in “bullets” should be told to:

a) use them only once a day
b) discard the leftover solution at the end of the day
c) use them only at night
d) make their own saline because it is cheaper

Answer 22

b) Because there is no preservative to retard bacterial growth, any solution remaining in the
bullet at the end of the day should be discarded. These drops may be used many times throughout the day. No one should use homemade saline in the eye because of the risk of contamination.

Question 23

Dry eye patients should be told to use artificial tears:
a) morning and night
b) only when the eyes water
c) four times daily
d) as often as needed to control symptoms

Answer 23

d) Dry eye is a condition that cannot be cured, only controlled. Thus, patients are advised
to use the drops as often as needed.

Question 24

The first choice of medicinal treatment for open-angle glaucoma is usually:
a) oral
b) topical
c) subconjunctival injection
d) intravenous

Answer 24

b) Topical medications are usually the treatment of choice in open-angle glaucoma.

Question 25

The patient should be told that his or her glaucoma medications:

a) need not be used on the day of the appointment
b) will cure the condition
c) do not need to be refilled
d) should be continued until told otherwise

Answer 25

d) Patient education is key to successful treatment of glaucoma using medications. The
patient should be told to continue the medication (including refilling it before it runs out) until instructed otherwise. In addition, the medication should be used on schedule, even
(especially) when the patient has an appointment that day; otherwise, it is more difficult to assess the treatment’s efficacy.

Question 26

Reasons that a patient fails to take his or her glaucoma medications properly include
all of the following except:

a) lack of symptoms suggesting the patient has a disease
b) side effects of glaucoma medications
c) he or she understands the serious nature of the disease
d) lack of visual improvement from the medication

Answer 26

c) If the patient understands the gravity of the disease, he or she will be more motivated to
use the medication. Answers a, b, and d are common reasons for noncompliance.

Question 27

If the patient is given oral antibiotics following surgery, he or she should be told to:

a) discontinue the pills once the danger of infection is over
b) take half of the prescription, then discontinue if no infection develops
c) take all of the medication until it is gone
d) take the pills only if infection seems to be developing

Answer 27

c) An oral antibiotic should be taken until gone; otherwise, its effectiveness may be reduced or nil.

Question 28

The patient is going to be using an ophthalmic medication that is labeled “suspen-
sion.” You tell the patient to:

a) keep the bottle refrigerated
b) shake the bottle prior to using
c) use twice the prescribed dose
d) warm the drops prior to using

Answer 28

b) A suspension means that the actual medication is in the form of particles, which may settle to the bottom of the bottle. Mixing is necessary to “suspend” the particles throughout the carrier solution. Otherwise, the patient may instill a drop full of “carrier” that has no medication in it.

Question 29

The doctor has diagnosed iritis and has asked you to explain the use of cyclopentolate
drops to the patient. You tell the patient:

a) “This will numb your eye and make you more comfortable.”
b) “This will dilate your pupil to make your eye more comfortable.”
c) “Don’t miss a single dose or your eye pressure may go up.”
d) “This will minify your pupil to make you more comfortable.”

Answer 29

b) Dilating/cyclopleging an eye with inflammation decreases discomfort by temporarily paralyzing accommodation and iris movement. This is analogous to putting a splint on a sprained wrist to limit movement. It also helps to prevent the iris from adhering to the corneal endothelium or to the lens.

Question 30

All of the following can be complications of eye drop use except:
a) the patient may have an allergic reaction
b) the patient may develop irritation of the eye or lids
c) the drops can become contaminated
d) the patient may develop a fever

Answer 30

d) Fever is a sign of infection, not allergy or drug reaction.

Question 31

Abnormal drug reactions may occur:

a) in patients who are debilitated
b) in the presence of other drugs
c) as toxic or chemical reactions
d) all of the above

Answer 31

d) All of the answers list possible scenarios for an abnormal drug reaction. In addition to
patients whose general health is compromised, the action of a drug may also not be what is anticipated if the patient is very old or very young. If more than one drug is being used, the medications may interact with one another. This could cause a chemical reaction, or it could accentuate or decrease the effect of one or both drugs. Some drugs can have a toxic effect on the body. (An example is the effect of chloroquine on the retinal cones.) Finally, a chemical reaction could cause toxicity, unexpected interactions, or other effects (such as forming deposits in tissues).

Question 32

Common signs and symptoms of a topical allergic reaction to ocular medication
include:
a) rash, itching, redness, and swelling
b) pain, redness, and discharge
c) pain, photophobia, and mid-dilated pupil
d) rash, redness, and anterior chamber reaction

Answer 32

a) A local allergic reaction to a topical ocular medication can include rash (of the eyelids),
itching, redness (conjunctival and lids), and swelling (conjunctiva and lids).

Question 33

Which of the following suggests a drug allergy in the skin?
a) redness and itching
b) increased perspiration
c) a feeling of heat in the skin
d) a prickling sensation

Answer 33

a) A drug allergy affecting the skin is often seen as a rash: swelling, redness, scaling, itching, and oozing can occur.

Question 34

Which of the following suggests a drug allergy in the conjunctiva?
a) a deep aching
b) a pus-like discharge
c) swelling and redness
d) decreased tearing

Answer 34

c) Conjunctival swelling (edema or chemosis) and redness may be seen in drug allergy.

Question 35

If a patient has a localized allergic reaction to a topical medication instilled in the office, one should:
a) irrigate the eye immediately
b) call 911
c) administer oxygen, cortisone, and epinephrine
d) check the pH of the eye and neutralize appropriately

Answer 35

a) A localized reaction is limited to one area, generally the area of drug administration. In
the eye, this would usually be evidenced by redness, swelling, watering, and itching. Irrigation is the first aid action you should take. It is also important to note the allergy in the patient’s chart so that the drug is avoided in the future. The items in answer c apply to
anaphylactic shock and would be administered by the physician.

Question 36

Over a period of time, use of steroid eye drops can cause all of the following except:

a) an increase in intraocular pressure
b) accelerated growth of certain organisms
c) iris cysts
d) slow wound healing

Answer 36

c) Iris cysts are associated with miotics, not steroids. The other items can occur when using steroid drops; thus, steroids are usually prescribed for short-term use.

Question 37

Which of the following has the highest risk of complications?

a) a drug given in drop form
b) a drug given in ointment form
c) a drug given in topical sustained-release form
d) a drug given via injection or oral form

Answer 37

d) A drug given in systemic form enters the entire body; thus, there is a greater risk of
complications.

Question 38

All of the following have potentially serious side effects or may cause allergy with
long-term usage except:
a) topical anesthetic
b) topical steroid
c) topical neomycin
d) topical preservative-free lubricant

Answer 38

d) Topical lubricants are not dangerous, and preservative-free preparations do not cause an allergic response. Long-term use of topical anesthetic can cause corneal melt, steroids can cause glaucoma, and neomycin is noted for its allergic response.

Question 39

Severe drug reaction may include:
a) nausea
b) dizziness
c) airway obstruction
d) rash

Answer 39

c) Any of the answers could be a drug reaction, but airway obstruction is the most severe
reaction listed.

Question 40

A patient having an allergic reaction involving shallow respiration should be given:
a) mouth-to-mouth resuscitation
b) mouth-to-nose resuscitation
c) oxygen from a portable unit
d) resuscitation through a mask

Answer 40

c) If the patient is breathing, give him or her oxygen. Do not give artificial respiration to a
person who is breathing on his or her own.