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NAPLEX - Ocular pharmacology McGraw Hill

Terms in this set (21)

KM is a 44-year-old African American woman with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past 2 weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.
Blood pressure is 140/95.
Diagnosis: Primary open angle glaucoma, hypertension, and insomnia
Medications: Amlodipine 5 mg daily, pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.
Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.
Which of KM's medications below is most likely responsible for her brow aches?
A
Amlodipine
B
Acetaminophen
C
Diphenhydramine
D
Pilocarpine
E
Latanoprost
D

Older centrally acting agents such as pilocarpine can cause brow aches.
During your Infectious Diseases rotation, one of your patients, SJ has just been diagnosed with fungal keratitis. Which medication below is appropriate and indicated for treating SJ's condition?
A
Trifluridine
B
Amphotericin B
C
Ganciclovir
D
Pilocarpine
B

.Amphotericin B is an antifungal agent and is used for treating fungal keratitis.

Answer a is incorrect.Trifluridine is an antiviral agent used to treat herpes simplex virus.
Answer c is incorrect.Ganciclovir is also an antiviral agent used to treat herpes simplex virus and cytomegalovirus (CMV) retinitis.
Answer d is incorrect.Pilocarpine is a parasympathomimetic and is used in glaucoma management.
An ophthalmologist wishes to prescribe a topical aminoglycoside for FT's blepharitis infection. Which of the following aminoglycoside antibiotics are formulated in a solution and ointment for ophthalmic use? Select all that apply.
A
Tobramycin
B
Azithromycin
C
Gentamicin
D
Erythromycin
A, C

.Tobramycin (Tobrex, others) and gentamicin (Garamycin) are aminoglycoside antibiotics for ophthalmic use formulated in a 0.3% solution and ointment.

Answers b and d are incorrect.Azithromycin (Azasite) and erythromycin (Ilotycin, others) are macrolide antibiotics. Azithromycin is available in a 1% solution and erythromycin is available in a 0.5% ointment.
Which of the following glaucoma treatment options works by decreasing aqueous humor production?
A
Latanoprost
B
Brinzolamide
C
Apraclonidine
D
Brimonidine
B

.Brinzolamide is a carbonic anhydrase inhibitor and works by decreasing aqueous humor production.

D a2 agonist technically does both
Which drug class is associated with darker, thicker, and longer eyelashes?
A
Prostaglandin analogs
B
Carbonic anhydrase inhibitors
C
α-Blockers
D
Sympathomimetics
E
β-Blockers
A

Prostaglandin analogs cause hyperpigmentation and hypertrichosis of the eyelashes.
Which of the following topical β-blockers utilized for the treatment of glaucoma are nonselective β-blockers? Select all that apply.
A
Timolol
B
Metipranolol
C
Carbachol
D
Betaxolol
A, B

.Carbachol is a direct-acting cholinergic agonist.

Answer d is incorrect.Betaxolol is a selective β-blocker.
Which of the following products contain timolol? Select all that apply.
A
Combigan
B
Timoptic
C
Azopt
D
Xalatan
A, B

Combigan is a combination product consisting of timolol and brimonidine.
Answer b is correct. Timoptic is the brand name for timolol.
Answer c is incorrect. Azopt is the brand name of brinzolamide.
Answer d is incorrect. Xalatan is the brand name for latanoprost.
KM is a 44-year-old African American female with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past 2 weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.
Blood pressure is 140/95.
Diagnosis: Primary open angle glaucoma (POAG), hypertension, and insomnia
Medications: Amlodipine 5 mg daily, Pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.
Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.
Which of the following are true about KM? Select all that apply.
A
She has at least two risk factors for glaucoma
B
Pilocar® is first-line therapy for POAG.
C
She could have drug-induced glaucoma.
D
Diphenhydramine may worsen glaucoma.
E
Amlodipine may worsen glaucoma.
A, C, D

KM risks for glaucoma include age > 40 years, African American, elevated IOP, and family history.
Answers c and d are correct. She is taking the antihistamine diphenhydramine (Tylenol PM), which can worsen glaucoma.
Answer b is incorrect.Pilocarpine is last-line therapy due to side effects.
Answer e is incorrect.Amlodipine does not worsen glaucoma.
Which of the following are topical fluoroquinolones used for the treatment of conjunctivitis? Select all that apply.
A
Quixin
B
Vigamox
C
Cidofovir
D
Ciloxan
A, B, D

Quixin is the brand name for levofloxacin; Vigamox is the brand name for moxifloxacin; and Ciloxan is the brand name for ciprofloxacin.
Answer c is incorrect.Cidofovir is an antiviral injection and is not a topical fluoroquinolone.
KM is a 44-year-old African American woman with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past 2 weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.
Blood pressure is 140/95.
Diagnosis: Primary open angle glaucoma, hypertension, and insomnia
Medications: Amlodipine 5 mg daily, pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.
Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.
Which glaucoma medication is contraindicated for KM?
A
Timolol
B
Iopidine
C
Brimonidine
D
Brinzolamide
E
Tafluprost
D

.Brinzolamide is a carbonic anhydrase inhibitor which contains sulfa. KM has a sulfa allergy.
Which of the following are true regarding counseling about nasolacrimal occlusion (NLO)? Select all that apply.
A
Medication effectiveness
B
Decrease side effects
C
Increase systemic absorption of eye drops
D
Increase the need for multiple eye drops
E
Increase the cost of therapy
A, B

NLO enhances eye drop absorption to improve efficacy and decrease all side effects.
Answers c, d, and e are incorrect. NLO may decrease systemic absorption, need for multiple eye drops, and the cost of therapy.
Which of the following products contains dorzolamide? Select all that apply.
A
Simbrinza
B
Cosopt
C
Combigan
D
Trusopt
B,D

Cosopt is a combination product containing timolol and dorzolamide. Trusopt is the brand name for dorzolamide.
Answer a is incorrect. Simbrinza is a combination product containing brinzolamide and brimonidine.
Answer c is incorrect. Combigan is a combination product consisting of timolol and brimonidine.
Which of the following medications can cause or worsen glaucoma? Select all that apply.
A
Corticosteroids
B
Antihistamines
C
Cimetidine
D
Lisinopril
E
Aspirin
A, B, C

Corticosteroids, antihistamines, and cimetidine are medications that can worsen glaucoma. Corticosteroids and antihistamines have a high risk and cimetidine has a low risk.
KM is a 44-year-old African American female with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past two weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.
Blood pressure is 140/95.
Diagnosis: Primary open angle glaucoma (POAG), hypertension, and insomnia
Medications: Amlodipine 5 mg daily, pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.
Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.
Which of the following could affect KM's glaucoma therapy? Select all that apply.
A
Titration of the blood pressure medication can affect IOPs.
B
Adherence may be an issue.
C
Pilocarpine causes systemic side effects and nasolacrimal occlusion (NLO) education could help.
D
Acetaminophen may increase IOP.
A, B, C

Changes in blood pressure affect IOP.
Answer b is correct. Adherence may be an issue due to KM's work schedule or financial difficulties. Additionally, adherence has been shown to be a contributing factor into glaucoma outcomes.
Answer c is correct. NLO will help decrease risk of side effects and improve efficacy of the eye drops.
Answer d is incorrect.Acetaminophen does not affect the IOP.
Which of the following antiviral agents is commercially available as a topical solution for ophthalmic use?
A
Trifluridine
B
Valacyclovir
C
Famciclovir
D
Foscarnet
A

.Trifluridine is available as a 1% topical solution for the treatment of herpes simplex keratitis.

Answers b, c, and d are incorrect.Valacyclovir and famciclovir are commercially available as oral tablets and foscarnet is for parenteral use.
Select the correct brand name for tafluprost.
A
Lumigan
B
Xalatan
C
Zioptan
D
Alphagan
C

Zioptan is the brand name for tafluprost.
Answer a is incorrect. Lumigan is the brand name for bimatoprost.
Answer b is incorrect. Xalatan is the brand name for latanoprost.
Answer d is incorrect. Alphagan is the brand name for brimonidine.
Which causative organism below is the typical, offending bacterium associated with hordeolum?
A
Bacillus anthracis
B
Staphylococcus aureus
C
Haemophilus species
D
Herpes simplex type 1
B

S. aureus is the primary, causative organism for hordeolum.
Answers a and c are incorrect.B. anthracis is the etiological agent of anthrax while H. species are commonly implicated in ocular disorders such as conjunctivitis.
Answer d is incorrect. Herpes simplex type 1 is a virus and does not cause hordeolum which is a bacterial infection.
Which of the following antiviral agents is available in parenteral, oral, and implant formulations?
A
Valganciclovir
B
Ganciclovir
C
Valacyclovir
D
Acyclovir
B

.Ganciclovir is utilized for the treatment of cytomegalovirus retinitis and is available in intravenous, oral, and intravitreal implants.

Answer a is incorrect.Valganciclovir is available orally.
Answer c is incorrect.Valacyclovir is available as tablets.
Answer d is incorrect.Acyclovir is available as tablets and capsules.
Which of the following antifungal agents is commercially available as a 5% topical suspension?
A
Amphotericin B
B
Natamycin
C
Fluconazole
D
Itraconazole
B

The only currently available topical ophthalmic antifungal preparation is natamycin. Other antifungal agents may be compounded for topical, subconjunctival, or intravitreal routes of administration.
JP is a 60-year-old male patient who has just been diagnosed with primary open-angle glaucoma (POAG). Currently, this is his only diagnosis. He is not on any other medications and has no known drug allergies. Which medication choice below would be indicated for first-line therapy in his situation?
A
Acetazolamide
B
Dipivefrin
C
Latanoprost
D
Pilocarpine
C

Prostaglandin analogs and β-blockers are used as first-line therapy in POAG treatment.
Answer a is incorrect. Topical therapy is always first-line.
Answers b and d are incorrect. Sympathomimetics and parasympathomimetics are reserved for last-line use due to high incidence of local and systemic side effects.
Which of the following medications are used for the management of "wet" age-related macular degeneration (AMD) and diabetic retinopathy? Select all that apply.
A
Bevacizumab
B
Verteporfin
C
Ranibizumab
D
Aflibercept
A, C, D

These vascular endothelial growth factor (VEGF) inhibitors are also indicated for the management of diabetic macular edema and diabetic retinopathy.

Answer b is incorrect.Verteporfin is a VEGF inhibitor that is only indicated for classical symptoms associated with wet AMD.
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