Deck 20: Drugs for Eyes, Ears, and Skin

Question 1

A patient with open-angle glaucoma has a history of chronic obstructive pulmonary disease. Which ophthalmic $\beta$ blocker will the provider prescribe?

A) Betaxolol
B) Timolol
C) Levobunolol
D) Metipranolol

Answer 1

Betaxolol

Question 2

Amoxicillin is prescribed for a 12-month-old child who developed a second middle ear infection since age 8 months. Three days later, the parent calls to report that the child continues to have a temperature of 39.5 $\degree$ C and is unable to sleep well because of pain. What action will the provider take to provide effective care to this child?

A) Discuss prescribing amoxicillin/clavulanate with the child's parents.
B) Prescribe a medication that promotes sleep.
C) Advise continuing the amoxicillin as ordered and provide a schedule of prn dosing for ibuprofen for pain.
D) Discuss with the parent the child's need for probably surgery for tympanostomy tubes placement to reduce infections.

Answer 2

Discuss prescribing amoxicillin/clavulanate with the child's parents.

Question 3

A patient who was prescribed cromolyn ophthalmic drops for severe allergic conjunctivitis reports persistence of allergic symptoms after 2 days of treatment. What additional drug will the provider consider prescribing while waiting for cromolyn to reach maximal effectiveness?

A) An ophthalmic demulcent
B) H₁-receptor antagonists
C) Glucocorticoid drops
D) Ocular decongestants

Answer 3

H₁-receptor antagonists

Question 4

A patient has been diagnosed with fungal otitis externa (otomycosis). What will the provider prescribe initially?

A) Acidifying ear drops for 1 week
B) Antifungal ear drops for 14 days
C) Intravenous (IV) antifungal agents
D) Oral antibiotics for 7 days

Question 5

A 2-year-old child presents to the clinic with otalgia and fever. The left tympanic membrane (TM) is erythematous and bulging; the right TMs is perforated and draining. The child's parent states, "This is the fifth ear infection this year. What can we do?" What action will the provider take to address the child's ear problems?

A) Prescribe both ceftriaxone [Rocephin] IM with benzocaine ear drops for pain.
B) Discuss beginning prophylactic antibiotic therapy with trimethoprim/sulfamethoxazole.
C) Prescribe amoxicillin/clavulanate and refer the child to an otolaryngologist.
D) Prescribe both high-dose amoxicillin and the influenza vaccine.

Question 6

A patient has severe acne that has been refractory to treatment with tetracycline, topical tretinoin, and benzoyl peroxide. The provider plans to begin treatment with isotretinoin. The provider will include which statement when teaching this patient about this drug?

A) "Alcohol may be consumed in moderation when taking this drug."
B) "Skin rash and excessive body hair growth are common with this drug."
C) "Tetracycline must be discontinued before beginning the isotretinoin."
D) "Two pregnancy tests are required before each monthly refill of your prescription."

Question 7

An adolescent patient with moderate acne has begun a regimen consisting of combination clindamycin/benzoyl peroxide and tretinoin. Which statement by the patient indicates understanding of this medication regimen?

A) "I should apply the Retin-A immediately after bathing."
B) "I should apply the Retin-A twice daily."
C) "I should augment this therapy with an abrasive soap."
D) "I should use sunscreen every day."

Question 8

A 60-year-old patient asks about using tretinoin to minimize wrinkles. What response will the provider give?

A) This drug is only approved for treating acne.
B) Results may be visible within a few weeks of starting therapy.
C) Systemic toxicity is a common side effect in patients with sensitive skin.
D) The drug is not effective on coarse wrinkles or sun-damaged skin.

Question 9

An 18-month-old child with a 24-hour history of fever and otalgia is seen in the clinic. The child's parents tell the provider that the child was inconsolable during the night. The provider examines the child and notes a bulging, immobile, erythematous tympanic membrane. What action will the provider take to provide the child with effective care?

A) Institute watchful waiting and ask the parent to return to the clinic if the child's symptoms worsen.
B) Discuss a referral to an ear, nose, and throat specialist for follow-up treatment.
C) Advise the parent to give analgesics for 3 days while observing for worsening symptoms.
D) Prescribe amoxicillin at 45 mg/kg/dose twice daily.

Question 10

A patient with glaucoma will begin using brimonidine for long-term reduction of increased ocular pressure. The medication education provided by the prescriber appears to have been effective when the patient makes which statement?

A) "After using the drops, I should wait 15 minutes before putting in contacts."
B) "Because this is a topical medication, drowsiness will not occur."
C) "My blood pressure may increase when using this medication."
D) "If my eyes begin to itch or turn red, it means I am allergic to this drug."

Question 11

An adolescent has recently developed scattered comedones across the forehead and nose. Which medication does the provider recommend to the patient and parents?

A) Benzoyl peroxide
B) Topical clindamycin
C) Topical erythromycin
D) Topical retinoids

Question 12

To provide effective protection against the full range of ultraviolet (UV) radiation, an organic sunscreen must contain which agent?

A) Avobenzone
B) para-Aminobenzoic acid (PABA)
C) Titanium dioxide
D) Zinc oxide

Question 13

A 6-year-old child presents with crying due to ear pain. Tympanic membranes are erythematous, bulging, and immobile, but intact. In addition to antibiotic therapy, what will the provider recommend for pain management?

A) Low dose aspirin
B) Lidocaine ear drops
C) Prednisone
D) A tympanostomy to relieve pressure in the middle ear

Question 14

A patient will begin initial treatment for severe acne. Which regimen will the provider order?

A) Clindamycin/benzoyl peroxide and tretinoin
B) Doxycycline and tretinoin
C) Erythromycin and benzoyl peroxide
D) Topical clindamycin and isotretinoin

Question 15

An adolescent with acne who uses benzoyl peroxide lotion twice daily reports experiencing drying and burning of the skin. What action will the prescriber take?

A) Recommend applying lotion to the skin after applying the drug.
B) Advise the patient to reduce the frequency to one application a day.
C) Discontinue the medication to prevent further localized allergic reaction.
D) Prescribe a gel formulation of the drug.

Question 16

A provider prescribes the keratolytic agent salicylic acid for a patient with extensive acne on the face, shoulders, trunk, and back. What drug information does the providers give to the patient?

A) "Peeling and drying are desired effects of this drug."
B) "Call the clinic if you develop nausea, vomiting, or ringing in the ears."
C) "Tinnitus is a common side effect of little concern."
D) "The only adverse effect of this drug is some localized stinging with application."

Question 17

A 14-year-old female patient has moderate acne that has not responded to topical drugs. Which treatment will the provider discuss with the patient and parents?

A) Combination oral contraceptives
B) Doxycycline
C) Isotretinoin
D) Spironolactone

Question 18

A provider considers prescribing timolol for a patient with primary open-angle glaucoma. Which condition could be worsened if this drug is prescribed?

A) Asthma
B) Hypertension
C) Migraine headaches
D) Supraventricular tachycardia

Question 19

A patient who uses latanoprost ophthalmic drops tells the provider, "My eyes used to be greenish-brown, but now they're brown." What response will the provider give to address the patient's concern?

A) Reassure the patient that eye-color change is a harmless side effect.
B) Refer the patient to an ophthalmologist.
C) Explain that the eye color is unchanged but color perception is a drug side effect.
D) Tell the patient that this effect will reverse when the medication is withdrawn.

Question 20

A child with eczema has been treated unsuccessfully with a topical glucocorticoid for a year and now has skin atrophy and hypopigmentation. What change in therapy will the provider recommend to the parents?

A) Higher potency topical glucocorticoids
B) Topical keratolytic agents
C) Topical immunosuppressants
D) Topical nonsteroidal anti-inflammatory drugs (NSAIDs)