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Pharm Exam 5 > Unit XX Drugs for Eyes, Ears & Skin (Chapters 79, 87, 88, 89) > Flashcards

Unit XX Drugs for Eyes, Ears & Skin (Chapters 79, 87, 88, 89) Flashcards

1
Q

First line drug therapy for Primary Open Angle Glaucoma (POAG) (3)?

A

Beta-Blockers
Alpha 2 Agonist
Prostaglandin Analogs

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2
Q

Second-line drug therapy for Primary Open Angle Glaucoma (2)?

A

Cholinergic

Carbonic anhydrase inhibitors

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3
Q

Adverse Effects of Beta Blockers for tx of glaucoma (7)?

A 
Local effects include:
Stinging
Conjunctivitis
Blurred Vision
Photophobia
Dry Eye

Systemic effects include:
Bradycardia
AV Heart Block
Bronchospasms

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4
Q

Adverse Effects of Alpha 2 Agonist for tx of glaucoma (5)?

A

Hypotension
Dry Mouth

Blurred Vision
Foreign Body sensation in the eye
Itching

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5
Q

Adverse Effects of Prostaglandin Analogs for treatment of Glaucoma?

A

Pigmentation of iris and eyelids

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6
Q

What is the benefit of using prostaglandin analogs over beta blockers for treatment of glaucoma?

A

Prostaglandin analogs are as effective as beta blockers with fewer side effects.

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7
Q

What drug classes are used to treat Allergic Conjunctivitis(3)?

A

1) Mast Cell Stabilizers
2) H1 Receptor Blockers
3) Occular decongestants

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8
Q

Examples of Mast Cell Stabilizers(2)?

A

Cromolyn

Lodoxamine

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9
Q

MOA of Mast Cell Stabilizers?

A

Prevent release of inflammatory mediators

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10
Q

Disadvantage of using mast cell stabilizers for treating severe symptoms of allergic conjunctivitis?

A

It can take several days to have an initial effect, up to two weeks for full symptom relief.

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11
Q

Example of H1 Receptor Blocker for treatment of allergic conjunctivitis?

A

Emedastine

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12
Q

MOA of H1 Receptor Blocker for treatment of allergic conjunctivitis?

A

Blocks H1 Receptors and provides immediate relief of allergic conjunctivitis symptoms.

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13
Q

The adverse effect of ocular decongestants?

A

Rebound congestion with extended use (similar to nasal decongestants)

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14
Q

A thick, greasy topical formulation with oil or petroleum base is…..

A

Ointment

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15
Q

What kind of topical formulation provides the highest absorption of all formulations?

A

Ointment

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16
Q

What kind of topical formulation is an emulsion of oil and water?

A

Cream

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17
Q

What conditions are best for applying creams over other topical formulations?

A

Inflammed and dry skin, sensitive skin (better for intertriginous areas)

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18
Q

What kind of topical formulation is nongreasy, water-based, and tends to promote patient satisfaction?

A

Lotions

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19
Q

What conditions are best for applying lotions over other topical formulations?

A

Large or hairy areas and oily skin

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20
Q

What kind of topical formulation is prepared with water or alcohol, is nongreasy, and tends to have a drying effect?

A

Gels

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21
Q

What conditions are best for applying gels over other topical formulations?

A

Better for facial areas

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22
Q

What kind of topical formulation is an aerated solution?

A

Foam

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23
Q

What conditions are best for applying foams over other topical formulations?

A

Oily skin or large or hairy areas

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24
Q

What kind of topical formulation are talc or corn starch bases?

A

Powders

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25
Q

What conditions are best for applying powders over other topical formulations?

A

Good for skin folds, feet, and axillae

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26
Q

What kind of topical formulation is a mixture of ointment and powder?

A

Paste

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27
Q

What conditions are best for applying pastes over other topical formulations?

A

Good for rashes (diaper rashes)

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28
Q

Indications for use of topical glucocorticoids?

A

To relieve inflammation and itching r/t dermatological conditions

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29
Q

What action increases the potency/absorption of topical glucocorticoids by 10X?

A

occlusive dressing

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30
Q

Is absorption of topical glucocorticoids local, systemic or both?

A

Both

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31
Q

What are the local adverse effects of topical glucocorticoids?

A

Infection

Atrophy of dermis and epidermis (thinning of skin)

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32
Q

What is a potential adverse reaction of topical glucocorticoids in children?

A

systemic toxicity (children have greater absorption of topical meds than adults)

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33
Q

What do Keratolytic Agents do?

A

Promote shedding

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34
Q

Give examples of Keratolytic Agents (2)?

A

Salicylic Acid

Sulpher

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35
Q

Adverse effect of topical Salicylic Acid?

A

Risk of salicylism (tinnitus, hyperpnea, psychologic disturbances)

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36
Q

What does topical sulfur promote?

A

peeling and drying

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37
Q

Indications for use of topical sulfur(4)?

A

Acne
Dandruff
Psoriasis
Seborrheic dermatitis

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38
Q

How is MILD acne medically treated?

A

Topical antibiotics

Retinoids

39
Q

How is MODERATE acne medically treated?

A

Oral Antibiotics

Oral Contraceptives and Spironolactone

40
Q

Nonpharmacological therapy of acne (2)?

A

Gentle, nonirritating soap

Avoiding oil-based makeup and moisturizers

41
Q

Topical therapies for acne (2)?

A

Benzoyl peroxide

Tretinoin

42
Q

What if the FIRST-LINE drug therapy for mild to moderate acne?

A

Benzoyl Peroxide

43
Q

What does Benzoyl Peroxide do to the skin when treating for acne?

A

promotes drying and peeling

44
Q

If resistance to Benzoyl Peroxide develops during the treatment of acne, what drug/drugs can be added to treatment?

A

Clindamycin

Erythromycin

45
Q

Give examples of Retinoids?

A

Tretinoin

Adapalene

46
Q

Indication for use of Tretinoin?

A

Mild to moderate acne

47
Q

MOA of Tretinoin?

A

Causes thinning of epithelial cells

48
Q

Adverse effects of Tretinoin?

A

localized reactions

Increased sun sensitivity

49
Q

How long does it take for Adapalene to be beneficial?

A

8-12 weeks

WORSENING of acne when first beginning

50
Q

What drug should Dapsone NOT be combined with for the treatment of acne and why?

A

Benzoyl Peroxide (causes skin discoloration when combined)

51
Q

What four oral drugs can be used in the treatment of acne?

A

Doxycycline
Minocycline

Dapsone
Isotretinoin (Accutane)

52
Q

Indication for use of Doxycycline in the treatment of acne?

A

Moderate to severe acne

53
Q

How long does it take for the maximum benefit of Doxycycline on acne?

A

3-6 months

54
Q

Once acne is controlled by Doxycycline therapy, what change should be made to treatment?

A

Change from oral Doxycycline to topical antibiotic for long-term maintenance

55
Q

Indication for use of Isotretinoin (Accutane)

A

SEVERE nodulocystic acne

56
Q

True/false…a single dose of Isotretinoin (Accutane) can produce complete or prolonged remission of severe nodulocystic acne?

A

True

57
Q

Adverse effects of Isotretinoin (Accutane) (9)?

A 
Nosebleeds
Inflammation of lips and eyes
Back Pain
High risk of sunburn
Benign elevation of ICP
Pancreatitis
Hearing impairment
Decreased BD
Depression/suicidal thoughts
58
Q

Isotretinoin (Accutane) drug interactions(3)?

A

Tetracyclines
Vitamin A
Alcohol

Increase toxicity of these drugs and should be stopped when Accutane therapy initiated.

59
Q

Special requirements when giving a prescription for Isotretinoin (Accutane) (4)?

A

Oral AND written warning regarding fetal harm
Preliminary Pregnancy test (x2) before each refill
2 Confirmed forms of birth control (even if one has had a vasectomy or tubal ligation)
Register with iPLEDGE Program

60
Q

Monitoring parameters with Isotretinoin (Accutane)?

A

Lipids & LFT every 2 weeks initially and decreased once stable
Negative pregnancy test at each refill

61
Q

Black Box warning for Isotretinoin (Accutane)?

A

HIGHLY teratogenic and associated with high risk of spontaneous abortion

62
Q

Examples of hormonal agents for the treatment of acne?

A

Oral contraceptives

63
Q

Examples of oral contraceptives that are used for the treatment of acne?

A

Estrostep
ortho tri-cyclen
Beyaz
Yaz

64
Q

What patients are eligible for consideration of oral contraceptives for the treatment of acne?

A

15 years or older who also want contraception and have not responded to topical drugs

65
Q

How long does it take to show improvement in acne with treatment with oral contraceptives?

A

Up to 6 months or more

66
Q

What drug can be considered for the treatment of acne after oral contraceptives have been ineffective?

A

Spironolactone (Aldactone)

67
Q

Adverse effects of Spironolactone (Aldactone)?

A

teratogenic

hypercalcemia

68
Q

SPF (Sun Protective Factor) should be at least how high to offer effect?

A

15

69
Q

True or False…all sunscreens protect against UVB, but only some protect against UVA?

A

Ture

Broad Spectrum Sunscreen Protects against both

70
Q

What are SECOND-LINE treatments for Eczema?

A

Topical immunosuppressants

71
Q

Give examples of topical immunosuppressants for the treatment of Eczema?

A

Tacrolimus

Pimecrolimus

72
Q

Indication for use of Tacrolimus ointment?

A

Moderate to severe eczema for reduction of inflammation

73
Q

Adverse Effect of Tacrolimus ointment?

A

In children-Increased risk for varicella zoster

Increased risk for cancer

74
Q

What is the indication for use of Pimecrolimus cream (Elidel)?

A

mild to moderate Eczema

75
Q

What are the characteristics of Acute Otitis Media (3)?

A

Acute onset of s/s
Middle ear effusion or if TM is ruptured, purulent otorrhea
Middle ear Inflammation

76
Q

What is the drug therapy for Acute Otitis Media?

A

Pain medication for ALL

Antibiotics for SOME

77
Q

When should antibiotics be given for Acute Otitis Media?

A

After observing for 48-72 hours with no resolution of symptoms
Anyone under age 6 months

78
Q

What is the antibiotic of choice for the treatment of Acute Otitis Media?

A

Amoxicillin (high dose)

For severe PCN allergy use Azithromycin or Clarithromycin

79
Q

What are the risk factors for antibiotic resistance related to the treatment of acute otitis media (4)?

A

daycare attendance
younger than 2
Exposure to ABX in last 1-3. months
Winter/Spring season

80
Q

Name 6 preventative measures against contraction of otitis media in children

A 
Breastfeeding for at least 6 months
Avoid Daycare
Eliminate cigarette smoke
Reducing pacifier use in the second 6 months of life 
Avoid supine bottle feeding
Vaccinate against influenza (PCV)
81
Q

What characterizes recurrent otitis media?

A

3 or more infections within 6 months or 4 within 12 months

82
Q

How is recurrent otitis media treated(4)?

A

Short-term antibiotic therapy
Prophylactic antibiotic therapy
Vaccination against influenza
Tympanostomy tubes (only drops can be used in these patients–ciprodex and otovel)

83
Q

What is the treatment for otitis media when the patient has tympanostomy tubes?

A

Antibiotic ear drops only–Ciprodex and Otovel

84
Q

What differentiates Otitis Media with effusion from other ear infections?

A

Otitis Media with effusion has fluid in the middle ear with no evidence of local or systemic illness

Can cause mild hearing loss while present but not pain (resolves without treatment but can persist for weeks to. months after AOM has resolved)

85
Q

s/s of Acute Otitis Externa (swimmers ear) (4)?

A

Rapid onset associated with pruritus

Sensation of ear fullness

tenderness on manipulation of the external ear

Edema or erythema of the external ear canal

86
Q

Drug Therapy for Acute Otitis Extrena (swimmers ear)?

A

Acetic Acid
Alcohol plus acetic acid (for drying effect)

For extensive infections:
Quinolones (Cipro drops)
Fluoroquinolone drops
Glucocorticoids (drops) to decrease pain via reduction of swelling r/t inflammation

87
Q

What oral antibiotics can be used for extensive Acute otitis Extrena (swimmers ear) in people over 18?

A

Cipro

88
Q

What oral antibiotics can be used for extensive Acute Otitis Externa (swimmers ear) in people under 18?

A

Keflex

89
Q

What is an ear infection that results from Acute Otitis Media invading mastoid or temporal bond?

A

Necrotizing Otitis Externa (NOE)

90
Q

s/s of Necrotizing Otitis Externa?

A

Severe ear pain
Purulent discharge from ear
Granulation of tissue in the external auditory canal

91
Q

What patients are at greater risk for necrotizing otitis extrena?

A

Immunocompromised (esp HIV)

Older adults with diabetes

92
Q

Drug therapy for Necrotizing Otitis Externa?

A

Antipsuedomonal ear drops-
Ofloxacin solution

Oral Cipro

Refer to specialist

93
Q

What are the s/s of /fungal Otitis Externa (Otomycosis)?

A

Intense pruritus and erythema with or without pain or hearing loss

94
Q

Drug treatment for Fungal Otitis Externa?

A

Cleansing

Application of acidifying drops (acetic acid 3-4 times a day for 7 days)

Pharm Exam 5 (5 decks)

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