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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
What conditions are best for applying powders over other topical formulations?
Good for skin folds, feet, and axillae
26
What kind of topical formulation is a mixture of ointment and powder?
Paste
27
What conditions are best for applying pastes over other topical formulations?
Good for rashes (diaper rashes)
28
Indications for use of topical glucocorticoids?
To relieve inflammation and itching r/t dermatological conditions
29
What action increases the potency/absorption of topical glucocorticoids by 10X?
occlusive dressing
30
Is absorption of topical glucocorticoids local, systemic or both?
Both
31
What are the local adverse effects of topical glucocorticoids?
Infection | Atrophy of dermis and epidermis (thinning of skin)
32
What is a potential adverse reaction of topical glucocorticoids in children?
systemic toxicity (children have greater absorption of topical meds than adults)
33
What do Keratolytic Agents do?
Promote shedding
34
Give examples of Keratolytic Agents (2)?
Salicylic Acid | Sulpher
35
Adverse effect of topical Salicylic Acid?
Risk of salicylism (tinnitus, hyperpnea, psychologic disturbances)
36
What does topical sulfur promote?
peeling and drying
37
Indications for use of topical sulfur(4)?
Acne Dandruff Psoriasis Seborrheic dermatitis
38
How is MILD acne medically treated?
Topical antibiotics | Retinoids
39
How is MODERATE acne medically treated?
Oral Antibiotics Oral Contraceptives and Spironolactone
40
Nonpharmacological therapy of acne (2)?
Gentle, nonirritating soap | Avoiding oil-based makeup and moisturizers
41
Topical therapies for acne (2)?
Benzoyl peroxide | Tretinoin
42
What if the FIRST-LINE drug therapy for mild to moderate acne?
Benzoyl Peroxide
43
What does Benzoyl Peroxide do to the skin when treating for acne?
promotes drying and peeling
44
If resistance to Benzoyl Peroxide develops during the treatment of acne, what drug/drugs can be added to treatment?
Clindamycin | Erythromycin
45
Give examples of Retinoids?
Tretinoin | Adapalene
46
Indication for use of Tretinoin?
Mild to moderate acne
47
MOA of Tretinoin?
Causes thinning of epithelial cells
48
Adverse effects of Tretinoin?
localized reactions | Increased sun sensitivity
49
How long does it take for Adapalene to be beneficial?
8-12 weeks | WORSENING of acne when first beginning
50
What drug should Dapsone NOT be combined with for the treatment of acne and why?
Benzoyl Peroxide (causes skin discoloration when combined)
51
What four oral drugs can be used in the treatment of acne?
Doxycycline Minocycline Dapsone Isotretinoin (Accutane)
52
Indication for use of Doxycycline in the treatment of acne?
Moderate to severe acne
53
How long does it take for the maximum benefit of Doxycycline on acne?
3-6 months
54
Once acne is controlled by Doxycycline therapy, what change should be made to treatment?
Change from oral Doxycycline to topical antibiotic for long-term maintenance
55
Indication for use of Isotretinoin (Accutane)
SEVERE nodulocystic acne
56
True/false...a single dose of Isotretinoin (Accutane) can produce complete or prolonged remission of severe nodulocystic acne?
True
57
Adverse effects of Isotretinoin (Accutane) (9)?
``` 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
Isotretinoin (Accutane) drug interactions(3)?
Tetracyclines Vitamin A Alcohol Increase toxicity of these drugs and should be stopped when Accutane therapy initiated.
59
Special requirements when giving a prescription for Isotretinoin (Accutane) (4)?
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
Monitoring parameters with Isotretinoin (Accutane)?
Lipids & LFT every 2 weeks initially and decreased once stable Negative pregnancy test at each refill
61
Black Box warning for Isotretinoin (Accutane)?
HIGHLY teratogenic and associated with high risk of spontaneous abortion
62
Examples of hormonal agents for the treatment of acne?
Oral contraceptives
63
Examples of oral contraceptives that are used for the treatment of acne?
Estrostep ortho tri-cyclen Beyaz Yaz
64
What patients are eligible for consideration of oral contraceptives for the treatment of acne?
15 years or older who also want contraception and have not responded to topical drugs
65
How long does it take to show improvement in acne with treatment with oral contraceptives?
Up to 6 months or more
66
What drug can be considered for the treatment of acne after oral contraceptives have been ineffective?
Spironolactone (Aldactone)
67
Adverse effects of Spironolactone (Aldactone)?
teratogenic | hypercalcemia
68
SPF (Sun Protective Factor) should be at least how high to offer effect?
15
69
True or False...all sunscreens protect against UVB, but only some protect against UVA?
Ture | Broad Spectrum Sunscreen Protects against both
70
What are SECOND-LINE treatments for Eczema?
Topical immunosuppressants
71
Give examples of topical immunosuppressants for the treatment of Eczema?
Tacrolimus | Pimecrolimus
72
Indication for use of Tacrolimus ointment?
Moderate to severe eczema for reduction of inflammation
73
Adverse Effect of Tacrolimus ointment?
In children-Increased risk for varicella zoster | Increased risk for cancer
74
What is the indication for use of Pimecrolimus cream (Elidel)?
mild to moderate Eczema
75
What are the characteristics of Acute Otitis Media (3)?
Acute onset of s/s Middle ear effusion or if TM is ruptured, purulent otorrhea Middle ear Inflammation
76
What is the drug therapy for Acute Otitis Media?
Pain medication for ALL | Antibiotics for SOME
77
When should antibiotics be given for Acute Otitis Media?
After observing for 48-72 hours with no resolution of symptoms Anyone under age 6 months
78
What is the antibiotic of choice for the treatment of Acute Otitis Media?
Amoxicillin (high dose) | For severe PCN allergy use Azithromycin or Clarithromycin
79
What are the risk factors for antibiotic resistance related to the treatment of acute otitis media (4)?
daycare attendance younger than 2 Exposure to ABX in last 1-3. months Winter/Spring season
80
Name 6 preventative measures against contraction of otitis media in children
``` 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
What characterizes recurrent otitis media?
3 or more infections within 6 months or 4 within 12 months
82
How is recurrent otitis media treated(4)?
Short-term antibiotic therapy Prophylactic antibiotic therapy Vaccination against influenza Tympanostomy tubes (only drops can be used in these patients--ciprodex and otovel)
83
What is the treatment for otitis media when the patient has tympanostomy tubes?
Antibiotic ear drops only--Ciprodex and Otovel
84
What differentiates Otitis Media with effusion from other ear infections?
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
s/s of Acute Otitis Externa (swimmers ear) (4)?
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
Drug Therapy for Acute Otitis Extrena (swimmers ear)?
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
What oral antibiotics can be used for extensive Acute otitis Extrena (swimmers ear) in people over 18?
Cipro
88
What oral antibiotics can be used for extensive Acute Otitis Externa (swimmers ear) in people under 18?
Keflex
89
What is an ear infection that results from Acute Otitis Media invading mastoid or temporal bond?
Necrotizing Otitis Externa (NOE)
90
s/s of Necrotizing Otitis Externa?
Severe ear pain Purulent discharge from ear Granulation of tissue in the external auditory canal
91
What patients are at greater risk for necrotizing otitis extrena?
Immunocompromised (esp HIV) | Older adults with diabetes
92
Drug therapy for Necrotizing Otitis Externa?
Antipsuedomonal ear drops- Ofloxacin solution Oral Cipro Refer to specialist
93
What are the s/s of /fungal Otitis Externa (Otomycosis)?
Intense pruritus and erythema with or without pain or hearing loss
94
Drug treatment for Fungal Otitis Externa?
Cleansing | Application of acidifying drops (acetic acid 3-4 times a day for 7 days)

Pharm Exam 5 (5 decks)

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