OC Pharm Mt II
Questions and Answers
- 1.
Indicate which of the following are NOT ADEs of ocular decongestants.
- A.
Decreased IOP
- B.
Punctate keratitis
- C.
Palpitations & cardiac arrhythmias
- D.
Brow ache
- E.
Coronary occlusion
- F.
Decreased blood glucose
- G.
Dry eye
Correct Answer(s)
A. Decreased IOP
F. Decreased blood glucose
G. Dry eyeExplanation
Ocular Effects:
- sting/burn after instillation
- mydriasis
- inc'd redenss
- punctate keratitis
- lacrimation
- inc'd IOP
PHENYL specific:
- rebound miosis
- dec'd mydriatic response in older pts
CDV Effects:
- palpitatesion & arrythmias
- coronary occlusion
- subarachnoid hemorrhage
- MI & CVA
Others:
- HA & brow ache
- sweating
- dizzy/nausea
- nervousness
- weakness
- drowsiness
- ELEVATION OF BLOOD GLUCOSERate this question:
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- 2.
The maximum about of time one should use an ocular decongestant without seeing an eye doctor is ____hours.
Correct Answer(s)
48Explanation
The maximum amount of time one should use an ocular decongestant without seeing an eye doctor is 48 hours. This is because prolonged use of ocular decongestants can lead to rebound congestion, where the blood vessels in the eyes become dependent on the medication and worsen the symptoms. It is important to consult an eye doctor if the symptoms persist beyond 48 hours to ensure proper treatment and avoid any potential complications.Rate this question:
- 3.
Pts with glaucoma should NOT use ocular decongestants without the advice of an eye doctor.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Patients with glaucoma should not use ocular decongestants without the advice of an eye doctor because these medications can increase intraocular pressure, which is already elevated in glaucoma. This can potentially worsen the condition and lead to further damage to the optic nerve. Therefore, it is important for glaucoma patients to consult with their eye doctor before using any ocular decongestants to ensure that it is safe for their specific condition.Rate this question:
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- 4.
What is the concentration of phenyl that is used for ocular decongestants?
- A.
0.05%
- B.
0.12%
- C.
0.2%
- D.
0.5%
Correct Answer
B. 0.12%Explanation
1-2 gtt upto QID x 48 hours maxRate this question:
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- 5.
The PREG category for Phenyl is C. What is the PREG category for tetrahydrozoline?
- A.
A
- B.
B
- C.
C
- D.
D
- E.
Undetermined
Correct Answer
E. UndeterminedExplanation
The PREG category for tetrahydrozoline is undetermined because the given information does not provide any information about its PREG category.Rate this question:
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- 6.
Which ocular decongestant is found in decongestant/anti-H combos?
- A.
Naphazoline
- B.
Phenylephrine
- C.
Oxymetazoline
- D.
Tetrahydrozoline
Correct Answer
A. NaphazolineExplanation
Anti-A Component: PHENIRAMINE or ANTAZOLINERate this question:
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- 7.
Decongestant/Anti-A combos oftne include what type of vehicle to increase the viscosity of the solution (which increases contat time in the eye)?
- A.
Hydroxypropyl methylcellulose
- B.
Polyvinalpyrrolidine
- C.
Polyvinyl alcohol
- D.
Carboxymethylcellulose
- E.
A & b
- F.
A & c
- G.
B & c
- H.
B & d
Correct Answer
F. A & cExplanation
Mneumonic: "I need to be HYDRated..give me some ALCOHOL"Rate this question:
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- 8.
Topical Anti-As may produce what ADE?
- A.
Iritis
- B.
Posterior synechiae
- C.
Angle closure
- D.
Reduced IOP
Correct Answer
C. Angle closureExplanation
p. 78 --> caution in pts with narrow angles or hx of glcRate this question:
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- 9.
Which of the following is contraindicated when using antihistamines?
- A.
TCAs (Triacyclic Anti-depressants)
- B.
NSAIDs
- C.
Topical corticosteroids
- D.
MAOIs
Correct Answer
D. MAOIsExplanation
MAOIs (Monoamine oxidase inhibitors) are contraindicated when using antihistamines. This is because MAOIs can inhibit the breakdown of histamine in the body, leading to an accumulation of histamine and potentially causing adverse effects such as increased sedation, drowsiness, and anticholinergic effects. It is important to avoid combining these medications to prevent potential interactions and side effects.Rate this question:
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- 10.
The PREG category for antihistamines is ___.
Correct Answer
CExplanation
The PREG category for antihistamines is not provided in the question. Therefore, it is not possible to determine the correct answer or provide an explanation.Rate this question:
- 11.
Antihistamines are often used (although not recommeded) as a sleeping aid (esp. in elderly) due to it's potentially sedating effects
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Antihistamines have sedating effects, which can make them effective for promoting sleep. While they are not recommended as a sleeping aid, they are often used in elderly individuals who may have difficulty sleeping. Therefore, the statement that antihistamines are often used as a sleeping aid, especially in the elderly, is true.Rate this question:
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- 12.
Epinastine is a dual antihistamine & mast cell stabalizer. It has assocaited with increased risk of CNS effects and must be monitored closely.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Epinastine CANNOT cros the BB so there are minimal risks of CNS effectsRate this question:
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- 13.
Mast cell stabalizers have various MOAs, including intristic vasconstrictor activity, antihistaminic and anti-inflammatoyr activity.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
p. 82 --> Stabalize MCSs by inhbitig the degranulation of sensitized MCs after exposure to specific antigen. This prevent the release of histamine and other mediators involved in allergic rxns (they do NOT have theRate this question:
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- 14.
Pure mast cell stabalizers are used for which type(s) of conjuctivitis?
- A.
Perennial conjunctivitis
- B.
Seasonal conjunctivitis
- C.
GPC
- D.
VKC
Correct Answer(s)
B. Seasonal conjunctivitis
D. VKCExplanation
Pure mast cell stabilizers are used for seasonal conjunctivitis and VKC (vernal keratoconjunctivitis). Mast cell stabilizers work by preventing the release of histamine and other inflammatory mediators from mast cells, which are involved in the allergic response. Seasonal conjunctivitis, also known as hay fever or allergic conjunctivitis, is an allergic reaction to airborne allergens such as pollen. VKC is a chronic allergic condition that primarily affects children and is characterized by inflammation of the conjunctiva. Therefore, pure mast cell stabilizers are effective in managing the symptoms of both seasonal conjunctivitis and VKC.Rate this question:
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- 15.
Which mast cell stabalizer has the fastest onset of action?
- A.
Cromolyn
- B.
Lodoxamide
- C.
Nedocromil
- D.
Pemiroast
Correct Answer
C. NedocromilExplanation
Nedocromil is the mast cell stabilizer with the fastest onset of action.Rate this question:
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- 16.
Most mast cell stabalizers have a PREG category of B, however which of the following has PREG category C?
- A.
Cromolyn
- B.
Lodoxamide
- C.
Nedocromil
- D.
Pemirolast
Correct Answer
D. PemirolastExplanation
Mneumonic: PemiroLAST is the LAST MCS you want to take if you're pregoRate this question:
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- 17.
When should therapy with ophthalmic mast cell stabalizers be initiated?
- A.
?
- B.
?
- C.
?
- D.
?
Correct Answer
A. ? -
- 18.
There are only a few oral corticosteroids that can be Rx'd by ODs, but they are not often used.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Currently no ORAL corticosteroids in OD SOPRate this question:
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- 19.
Which of the following dual antihistamine/mast cell stabalizer combos are available OTC?
- A.
0.05% Azelastine SLN (Optivar)
- B.
0.05% epinastine SLN (Elestat)
- C.
0.1% olopatadine SLN (Patanol)
- D.
0.025% ketotifen fumarate SLN (Alaway, Zatidor)
Correct Answer
D. 0.025% ketotifen fumarate SLN (Alaway, Zatidor)Explanation
Ktotifen is the only anti-H/MCS that was presented in lecture that is available OTC; all others (Azelastine, Epinastine, and Olapatdine) are by Rx onlyRate this question:
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- 20.
Corticosteroids are more effective in chronic, rather than acute conditions.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Steroids are more effective in ACUTE cases..degenerative diseases are usually refractory to steroidsRate this question:
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- 21.
Steroids are usually not appropriate for use in mild ocular allergies because they are particularly damaging to ocular tissue with prolonged use.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The reason steroids aren't used for mild ocular allergies is because other modalities (with less ponteially serious comlications) are effective and widely availableRate this question:
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- 22.
Prolonged topical ophthalmic steroid use can cause:
- A.
Ocular hemorrhage
- B.
Ocular HTN & glaucoma
- C.
Corneal melt
- D.
Neovascularization of the iris
Correct Answer
B. Ocular HTN & glaucomaExplanation
IOP elevation RARELY occurs within in first 2 hours unless the pt is a STEROID RESPONDER
Withdrawal of the steroid usually results in return to baseline IOP within 2-4 weeksRate this question:
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- 23.
What should one suspect in any persistent corneal ulceration where a steroid has been used or is being used?
- A.
Bacterial resistance to the steroid
- B.
Fungal invasion
- C.
Hypersensitivity to the steroid
- D.
Herpes simplex keratitis
Correct Answer
B. Fungal invasionExplanation
In cases of persistent corneal ulceration where a steroid has been used or is being used, one should suspect fungal invasion. Steroids can suppress the immune response, making the cornea more susceptible to fungal infections. Fungal invasion can cause prolonged ulceration and may require specific antifungal treatment.Rate this question:
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- 24.
Dietary salt restriction and potassium supplementation may be necessary with topical steroid use.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
This is true for ORAL steroids, but not likely necesssary with topical formulationsRate this question:
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- 25.
Steroid use in contraindicated in active ocular herpes simplex infections.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Concern with corneal perforationRate this question:
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- 26.
Most routes of administration for steroids are PREG category C. However, which of the following has a PREG category of D?
- A.
Topical
- B.
Oral
- C.
Suspension
- D.
Intravitrea injection
Correct Answer
D. Intravitrea injectionExplanation
C (corticosteroid) = CRate this question:
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- 27.
Flurometholone is a steroid with many different formulations. It is prescribed a lot of OD's and also has the convenience of many OTC options.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Flurometholone is Rx onlyRate this question:
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- 28.
What is the 2nd most common drug Rx'd by ODs (after Fluroquinolones)?
- A.
Loteprednol
- B.
Fluorometholone
- C.
Difluprednate
- D.
Dexamethasone
Correct Answer
A. LoteprednolExplanation
The correct answer is Loteprednol. This drug is the second most commonly prescribed by ODs after Fluroquinolones.Rate this question:
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- 29.
NSAIDs can decrease the effectiveness of HTN meds & can caus vasoconstriction of renal vessles
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
NSAIDs, or nonsteroidal anti-inflammatory drugs, can indeed decrease the effectiveness of hypertension medications and cause vasoconstriction of renal vessels. This is because NSAIDs inhibit the production of prostaglandins, which play a role in maintaining blood flow to the kidneys and regulating blood pressure. By inhibiting prostaglandins, NSAIDs can lead to vasoconstriction and reduced blood flow to the kidneys, potentially worsening hypertension. Additionally, NSAIDs can interfere with the effectiveness of certain antihypertensive medications, making them less effective in controlling blood pressure. Therefore, it is true that NSAIDs can decrease the effectiveness of HTN meds and cause vasoconstriction of renal vessels.Rate this question:
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- 30.
Which NSAID is the best for SCL wearers?
- A.
Diclofenac
- B.
Bromfenac
- C.
Flubiprofen
- D.
Ketorolac
Correct Answer
D. KetorolacExplanation
SCL wearers experienced redness and irritation with Diclofenac & KetorolacRate this question:
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- 31.
Which of the following NSAIDs are associated with delayed wound healing?
- A.
Diclofenac
- B.
Suprofen
- C.
Nepafenac
- D.
Flurbiprofen
Correct Answer(s)
A. Diclofenac
D. FlurbiprofenExplanation
Mneumonic: Those Flurby toys were DICs and left a WOUND on my childhoodRate this question:
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- 32.
What is the PREG category for NSAIDs?
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
C. CExplanation
The PREG category for NSAIDs is category C.Rate this question:
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- 33.
What is the most common type of ADE for NSAIDs?
- A.
Blurry vision
- B.
Inc'd IOP
- C.
Corneal edema
- D.
Stinging & burning on instillation
Correct Answer
D. Stinging & burning on instillationExplanation
Diclofenac and Ketorolac have their own specific ADEs (p. 93)Rate this question:
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- 34.
Which of the following NSAIDs has been banned in Europe due to concern of ocular hemorrhage?
- A.
Bromfenac
- B.
Diclofenac
- C.
Flurbiprofen
- D.
Ketorolac
Correct Answer
D. KetorolacExplanation
Nepafenac has a lower incidence of bleeding compared to Ketorolac & DiclofenacRate this question:
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- 35.
Which of the following steroids has been approved for SAC and is preferred for pt's with glaucoma because it doesn't tend to increase IOP as much as others?
- A.
Prednisolone
- B.
Dexamethasone
- C.
Loteprednol
- D.
Rimexolone
Correct Answer
C. LoteprednolExplanation
Both Rimexolone and Loteprednol have less effect on IOP, however only Loteprednol is is approved for SACRate this question:
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- 36.
Describe what the role of cytokines are in the body and in the eye.
- 37.
Which of the following 2 drugs is involved in the off-label use for topical tx of CME after cataract sx?
- A.
Diclofenac
- B.
Flurbiprofen
- C.
Ketorolac
- D.
Bromfenac
Correct Answer(s)
A. Diclofenac
C. KetorolacExplanation
Diclofenac and Ketorolac are both drugs that can be used off-label for the topical treatment of cystoid macular edema (CME) after cataract surgery. These drugs belong to the class of nonsteroidal anti-inflammatory drugs (NSAIDs) and can help reduce inflammation and swelling in the eye, which can contribute to the development of CME. While the other options, Flurbiprofen and Bromfenac, are also NSAIDs, they are not commonly used for the off-label treatment of CME after cataract surgery.Rate this question:
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- 38.
What is the PREG cat for Restasis?
- A.
A
- B.
B
- C.
C
- D.
D
Correct Answer
C. CExplanation
The PREG cat for Restasis is C.Rate this question:
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- 39.
Dry eye secondary to aqueous deficiency is called _____
- A.
Meibomian gland dysfunction
- B.
Lacrimal gland dysfuncion
- C.
Cytokine-induced dry eye
- D.
Keratoconjunctivitis sicca
Correct Answer
D. Keratoconjunctivitis siccaExplanation
aqueous deficient dry eye is secondary to disorder of the lacrimal gland funciton or failure of lacrimal fluid transfer
evaporative dry eye demonstrates normal lacrimal function, but MGD or increased palpebral fissure width leads to increased evaporation or an anomaly of tear distributionRate this question:
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- 40.
Related to dry eye, underlying cyctokine and receptor-mediated inflammatory processes affecting the ocular surface and _____ resulting in decreased tear production and clearance.
- A.
Lacrimal gland
- B.
Palpebral fissure
- C.
Palpebral conjunctiva
- D.
Corneal epithelium
Correct Answer
A. Lacrimal glandExplanation
The lacrimal gland is responsible for producing tears, which help to keep the ocular surface lubricated and protected. In cases of dry eye, there is an underlying inflammatory process that affects the ocular surface and the lacrimal gland. This inflammation can lead to a decrease in tear production and clearance, resulting in the symptoms of dry eye.Rate this question:
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- 41.
What are the most common tear supplement products used in dry eye tx's?
- A.
Vinyl derivatives
- B.
Polysaccharides
- C.
Electrolyes
- D.
Buffers
Correct Answer
B. PolysaccharidesExplanation
e.g. cellulose esthers (methylcellulose, hydroxypropylcelluluse) and viscoelastic agents (sodium hyaluronate, sodium chondroitin)
- dissolve in water to produce varying degress of VISCOSITY
- lack of toxicity+ viscous props + beneficial effects on TF stability = useful in ATsRate this question:
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- 42.
Which popular artificial tear contains polyquaternium for a preservative?
- A.
Soothe XP
- B.
Refresh
- C.
Systane
- D.
Tears Again
Correct Answer
C. SystaneExplanation
Systane is the correct answer because it is a popular artificial tear that contains polyquaternium as a preservative. Polyquaternium is commonly used as a preservative in eye drops to prevent bacterial growth and maintain the sterility of the solution. Soothe XP, Refresh, and Tears Again are not known to contain polyquaternium as a preservative.Rate this question:
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- 43.
What type of antibiotic is Azasite (Azithromycin)?
- A.
Macrolide
- B.
Fluroquinolone
- C.
Cephalosporin
- D.
Penicillin
Correct Answer
A. MacrolideExplanation
MOA: binds to 50s ribosomal subunit of susceptible micorbes to interfere with PROTEIN SYNTEHSISRate this question:
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- 44.
What type of antibiotic is Besivance?
- A.
Macrolide
- B.
Fluroquinolone
- C.
Cephalosporin
- D.
Penicillin
Correct Answer
B. FluroquinoloneExplanation
MOA: interfere with DNA replication by inhibiting DNA gyraseRate this question:
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- 45.
What is the MOA of Polymyxin B?
- 46.
Corneal ulcers are associated with gram _____ 75% of the time.
Correct Answer
positive
+Explanation
Corneal ulcers are commonly caused by bacterial infections, and 75% of the time, these infections are associated with gram-positive bacteria. Gram-positive bacteria have a thick peptidoglycan layer in their cell walls, which makes them more resistant to antibiotics and more likely to cause infections. Therefore, it is likely that corneal ulcers are primarily caused by gram-positive bacteria.Rate this question:
- 47.
Fluroquinolones generally have better gram + spectrum of activity at this time, gram negative spectrum of activity is alos demonstrating some shift amont the fluroquinolones. Some highly probelmatic gram negative bacteria (e.g. Psuedomonas) are increasingly demonstrating resistance.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
p. 110Rate this question:
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- 48.
What is drug category is contraindicated after uncomplicated removal of corneal foreign bodies?
Correct Answer
abtibiotic/steroid combo productsExplanation
Antibiotics are contraindicated in epithelial herpes simplex, keratitis, vaccinia, varicella, mycobacterial eye infections, and fungal infections.Rate this question:
- 49.
Topical antibiotic preparations containing antibiotics not ordinarily administered sysmteically are not preferrerd.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Use of topical antibiotics may contraindicate (due to sensitization) the drug's later systemic use in serious infections. Topical preparations containing antibiotics not ordinarily administered systemically are preferred. (p. 125)Rate this question:
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- 50.
3-5% of persons with allergies to penicillins may cross react to _______.
Correct Answer
cephalosporinsExplanation
Some people who are allergic to penicillins may also have a cross-reactivity to cephalosporins. This means that if they are exposed to cephalosporins, they may experience an allergic reaction similar to the one they would have with penicillins. This cross-reactivity occurs because penicillins and cephalosporins have a similar chemical structure. However, it is important to note that not all individuals with a penicillin allergy will necessarily have a cross-reactivity to cephalosporins, as the percentage is relatively low at around 3-5%.Rate this question:
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