Question 1

What is the most common adverse reaction to neomycin-containing otic preparations?

Accepted Answer

Contact dermatitis is the most common adverse reaction to neomycin-containing otic preparations. Shortness of breath, headache, tachycardia, and chest pain are not commonly associated with topical neomycin use.

Question 2

Which statement is not part of the American Academy of Family Physicians (AAFP)acute otitis media (AOM)guidelines?

Accepted Answer

The AAFP guidelines recommend against prescribing initial antibiotics for all children suspected of having AOM. Instead, they suggest offering parents the option of allowing a child to fight the infection on his/her own for 48 to 72 hours before prescribing antibiotics.

Question 3

After 1 week of treatment of otitis externa with a topical antibacterial preparation,a patient has no significant improvement.What is the next best appropriate step in the treatment of this patient?

Accepted Answer

If a patient shows no significant improvement after a week of treatment with a topical antibacterial preparation, it is important to consider the possibility of an overgrowth of nonsusceptible organisms. Obtaining cultures can help identify the specific organism causing the infection and guide appropriate treatment. Beginning an oral antibiotic agent or discontinuing the initial topical agent and prescribing a different preparation may also be options, but these decisions should be based on the results of the culture and the patient's clinical presentation. Suspecting an immunodeficiency disorder and ordering a complete hematologic panel is not an appropriate next step based solely on the lack of improvement with the topical treatment.

Question 4

Which anti-infective otic agent contains a steroid preparation?

Accepted Answer

Ciprofloxacin with hydrocortisone (Cipro HC Otic) contains a steroid preparation.

Question 5

Which ophthalmic preparation is contraindicated in a patient concurrently taking an aminoglycoside due to an effect on serum concentrations that may lead to toxicity?

Accepted Answer

Tobramycin ointment is contraindicated in a patient concurrently taking an aminoglycoside due to an effect on serum concentrations that may lead to toxicity.

Question 6

What property of propylene glycol in an over-the-counter (OTC)otic preparation enhances its antibacterial effect?

Accepted Answer

Propylene glycol can create a more acidic environment in the ear canal, which can inhibit the growth of bacteria, enhancing the antibacterial effect of the preparation.

Question 7

What is the proper method for instillation of eardrops in a child?

Accepted Answer

When instilling eardrops in a child, it is important to gently pull the earlobe down and back. This helps straighten the ear canal and ensures that the drops are properly directed into the ear. Pulling the earlobe up and back or up and forward may not properly open the ear canal and could result in the drops not reaching the eardrum. Pulling the earlobe down and up is not a proper technique for eardrop instillation.

Question 8

Under normal physiological conditions,some patients develop an excessive amount of cerumen.Why may this become problematic for the patient?

Accepted Answer

Excessive cerumen in the canal can lead to a blockage, which can result in a loss of hearing. This happens because the cerumen blocks sound waves from entering the ear canal and reaching the eardrum.

Question 9

Topical corticosteroids incorporated into a vehicle for application to the skin often have their chemical structure altered.What does this alteration result in?

Accepted Answer

The alteration in the chemical structure of topical corticosteroids to increase their lipid solubility results in increased potency. This is because the enhanced lipid solubility allows the corticosteroid to better penetrate the lipid-rich environment of the skin, leading to a more effective delivery of the medication to the site of action.

Question 10

Cerumenolytics are commonly used to dislodge excessive cerumen.Typically,an agent such as triethanolamine polypeptide oleate drops (Cerumenex)is placed in a patient's ear canal and held in place with a cotton plug to soften the earwax.The ear is then flushed with warm water.Under what circumstances can Cerumenex cause ear canal inflammation?

Accepted Answer

When left in the ear canal for 60 minutes, Cerumenex can cause ear canal inflammation.

Question 11

A 12-year-old patient presents with moderate left ear pain and serosanguineous discharge.On physical examination,blood is apparent in the external canal and the tympanic membrane appears perforated.Despite the patient's left ear pain,why should the health-care practitioner avoid prescribing benzocaine?

Accepted Answer

Benzocaine is contraindicated in patients with a perforated tympanic membrane because it can cause further damage to the ear and potentially lead to hearing loss. Other otic analgesics, such as acetaminophen and ibuprofen, may be more appropriate for pain management in this case.

Question 12

What is the purpose of including a corticosteroid in topical otic anti-infective agents?

Accepted Answer

Corticosteroids have anti-inflammatory properties and can help to reduce inflammation and pruritus, which are common symptoms of ear infections. However, they do not directly reduce the chance of infection, improve hearing, or reduce pain.

Question 13

When choosing a topical anti-infective agent,ointments are generally considered to be more potent.Why?

Accepted Answer

Ointments are considered to be more occlusive, meaning they form a barrier over the skin which prevents air and moisture from passing through. This enhances the absorption of the active ingredients in the ointment, making it more potent.

Question 14

Topically applied antibiotics used to treat bacterial otic infections are not typically absorbed through the skin.Under what condition(s)does such an antibiotic find its way into the systemic circulation?

Accepted Answer

Topically applied antibiotics can be absorbed into the systemic circulation when applied to denuded or abraded skin, where the protective barrier of the skin is compromised. This can lead to systemic effects and potential toxicity. Therefore, it is important to avoid applying topical antibiotics to areas of intact skin whenever possible.

Question 15

When using otic topical medications,patients commonly have difficulty keeping the medication in their ears.What patient education instruction can most successfully help to correct this problem?

Accepted Answer

Suggesting the use of a clean cotton plug in the ear immediately following medication application can help the patient keep the medication in the ear and prevent it from leaking out. This method allows the medication to be absorbed into the ear canal and remain there for a longer period of time, increasing the effectiveness of the treatment. Option B may be difficult for patients to achieve and may not be practical in all situations. Option C may not be necessary for all medications and may be difficult for patients to do. Option D is not recommended as it can push earwax and debris further into the ear canal and may not effectively deliver the medication to the affected area.

Question 16

When prescribing an antibacterial agent for otitis externa,the health-care practitioner must consider that certain agents have the potential for ototoxicity.Which agent has the greatest potential for this adverse effect?

Accepted Answer

Neomycin has the greatest potential for ototoxicity, especially when used in combination with other ototoxic drugs or in patients with pre-existing hearing loss or renal impairment. Ofloxacin and ciprofloxacin with hydrocortisone are quinolone antibiotics that can also cause ototoxicity, but they are generally considered safer than neomycin. Carbamide peroxide is a non-antibiotic agent used for the removal of earwax and does not have the potential for ototoxicity.

Question 17

Absorption of topical corticosteroid antibiotic agents is affected by which of the following?

Accepted Answer

Skin temperature and hydration can affect the absorption of topical corticosteroid antibiotic agents, as they can alter the integrity of the skin barrier and increase blood flow to the area, allowing for greater absorption of the medication. Age, gender, and ethnicity do not typically have significant effects on absorption.

Question 18

A patient presents with a red,painful right eye and complaints of purulent eye discharge.Culture of that discharge reveals Neisseria gonorrhoeae.The patient denies drug allergies.Which ophthalmic agent would be most effective for this patient?

Accepted Answer

The answer of A patient presents with a red,painful right...

Question 19

A patient has used carbamide peroxide (Debrox,Murine Ear)for 7 days to loosen excessive earwax in her left ear.She now presents with complaints of decreased hearing on the left side.What is the most likely etiology of this hearing loss?

Accepted Answer

Prolonged use of carbamide peroxide can cause irritation and damage to the tympanic membrane, leading to hearing loss. The outer ear canal is less likely to be affected, and damage to the auditory nerve is not a common side effect of this medication. The concentration of carbamide peroxide in otic preparations is typically 6.5%, and 8.5% solutions are not commonly used.

Question 20

What is the mechanism by which benzocaine exerts its analgesic effect?

Accepted Answer

Benzocaine is a local anesthetic that works by blocking voltage-gated sodium channels in nerve membranes, thereby inhibiting the influx of sodium ions that are essential for generating an action potential. Without these channels, nerve impulses cannot be transmitted, resulting in an analgesic effect.

Quiz 5: Drugs Used in the Treatment of Eye and Ear Disorders