Week 5 Pharmacology

6. The length of treatment for sinusitis in a low-risk adult patient should be: 1. 5 to 7 days 2. 7 to 10 days 3. 14 to 21 days 4. Seven days beyond when symptoms cease

1. 5 to 7 days

20. When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include: 1. All members of the household and personal contacts should also be treated. 2. Infants should have permethrin applied from the neck down. 3. The permethrin is washed off after 10 to 20 minutes. 4. Permethrin is flammable and to avoid open flame while the medication is applied.

1. All members of the household and personal contacts should also be treated.

4. Treatment for a low-risk child with sinusitis is: 1. Amoxicillin 2. Azithromycin 3. Cephalexin 4. Levofloxacin

1. Amoxicillin

11. The most cost-effective treatment for two or three impetigo lesions on the face is: 1. Mupirocin ointment 2. Retapamulin (Altabax) ointment 3. Topical clindamycin solution 4. Oral amoxicillin/clavulanate (Augmentin)

1. Mupirocin ointment

13. An adolescent football player presents to the clinic with athlete's foot. Patients with tinea pedis may be treated with: 1. OTC miconazole cream for four weeks 2. Oral ketoconazole for six weeks 3. Mupirocin ointment for two weeks 4. Nystatin cream for two weeks

1. OTC miconazole cream for four weeks

6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete's foot) would be: 1. Over-the-counter (OTC) topical azole (clotrimazole, miconazole) 2. Oral terbinafine 3. Oral griseofulvin microsize 4. Nystatin cream or ointment

1. Over-the-counter (OTC) topical azole (clotrimazole, miconazole)

15. Scabies treatment for a 4-year-old child includes a prescription for: 1. Permethrin 5% cream applied from the neck down 2. Pyrethrin lotion 3. Lindane 1% shampoo 4. All of the above

1. Permethrin 5% cream applied from the neck down

2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for: 1. Short-term or intermittent treatment of atopic dermatitis 2. Topical treatment of fungal infections (Candida) 3. Chronic, inflammatory seborrheic dermatitis 4. Recalcitrant nodular acne

1. Short-term or intermittent treatment of atopic dermatitis

15. A patient is prescribed tazarotene for their psoriasis. Patient education regarding topical tazarotene includes: 1. That tazarotene is applied in a thin film to the psoriasis plaque lesions 2. To apply it liberally to all psoriatic lesions 3. To apply tazarotene to nonaffected areas to prevent breakout 4. That tazarotene may cause hypercalcemia if it is overused

1. That tazarotene is applied in a thin film to the psoriasis plaque lesions

6. An adult patient presents to the clinic with symptoms of allergic conjunctivitis and is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding cromolyn eye drops includes: 1. They should not wear soft contacts while using the cromolyn eye drops. 2. Cromolyn drops are instilled once a day to prevent allergy symptoms. 3. Long-term use may cause glaucoma. 4. They may experience bradycardia as an adverse effect.

1. They should not wear soft contacts while using the cromolyn eye drops.

4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes: 1. Throw away eye makeup and purchase new. 2. Redness and intense burning is normal with ophthalmic antibiotics. 3. When applying eye ointment, set the tip of the tube on the lower lid and squeeze in 1/4 inch. 4. Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac.

1. Throw away eye makeup and purchase new.

3. Long-term treatment of moderate atopic dermatitis includes: 1. Topical corticosteroids and emollients 2. Topical corticosteroids alone 3. Topical antipruritics 4. Oral corticosteroids for exacerbations of atopic dermatitis

1. Topical corticosteroids and emollients

18. A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg. Normal adverse effects of silver sulfadiazine cream include: 1. Transient leukopenia on days two to four that should resolve 2. Worsening of burn symptoms briefly before resolution 3. A red, scaly rash that will resolve with continued use 4. Hypercalcemia

1. Transient leukopenia on days two to four that should resolve

7. Patient education for a patient who is prescribed antibiotics for sinusitis includes: 1. Use of nasal saline washes 2. Use of inhaled corticosteroids 3. Avoiding the use of ibuprofen while ill 4. Use of laxatives to treat constipation

1. Use of nasal saline washes

7. Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis includes: 1. Apply thickly to affected psoriatic areas two to three times a day. 2. A maximum of 100 g per week may be applied. 3. Do not use calcipotriene in combination with other topical corticosteroids. 4. Calcipotriene may be augmented with the use of coal tar products.

2. A maximum of 100 g per week may be applied.

8. First-line treatment for an afebrile 2-year-old with otitis media would include: 1. Azithromycin 2. Amoxicillin 3. Ceftriaxone 4. Trimethoprim/sulfamethoxazole

2. Amoxicillin

5. Treatment for sinusitis in an adult who has a child in daycare is: 1. Azithromycin 500 mg a day for five days 2. Amoxicillin-clavulanate 500 mg bid for seven days 3. Ciprofloxacin 500 mg bid for five days 4. Cephalexin 500 mg qid for five days

2. Amoxicillin-clavulanate 500 mg bid for seven days

1. A child presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. Their parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment? 1. Mupirocin (Bactroban) 2. Bacitracin and polymyxin B (generic double antibiotic ointment) 3. Retapamulin (Altabax) 4. Oral cephalexin (Keflex)

2. Bacitracin and polymyxin B (generic double antibiotic ointment)

12. First-line therapy for a patient with acute otitis externa (swimmer's ear) and an intact tympanic membrane includes: 1. Swim-Ear drops 2. Ciprofloxacin and hydrocortisone drops 3. Amoxicillin 4. Gentamicin ophthalmic drops

2. Ciprofloxacin and hydrocortisone drops

2. A patient is a nasal methicillin-resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes: 1. Take the oral medication exactly as prescribed. 2. Insert one-half of the dose in each nostril twice a day. 3. Alternate treating one nare in the morning and the other in the evening. 4. Nasal MRSA eradication requires at least four weeks of therapy, with up to eight weeks needed in some patients.

2. Insert one-half of the dose in each nostril twice a day.

8. __________ is/are prescribed to prevent swimmer's ear. 1. Ciprofloxacin otic drops (Ciloxan) 2. Isopropyl ear drops (EarSol) 3. Colistin (Coly-Mycin S Otic) 4. Gentamicin otic drops

2. Isopropyl ear drops (EarSol)

4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: 1. Topical antipruritics 2. Oral corticosteroids for 2 to 3 weeks 3. Thickly applied topical intermediate-dose corticosteroids 4. Isolation of the patient to prevent spread of the dermatitis

2. Oral corticosteroids for 2 to 3 weeks

12. A child has classic tinea capitis. Treatment for tinea on the scalp is: 1. Miconazole cream thoroughly rubbed in for four weeks 2. Oral griseofulvin for 6 to 8 weeks 3. Ketoconazole shampoo daily for six weeks 4. Ciclopirox cream daily for four weeks

2. Oral griseofulvin for 6 to 8 weeks

7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include: 1. Spread penciclovir liberally all over lips and the area surrounding lips. 2. Penciclovir therapy is started at the first sign of a cold sore outbreak. 3. Skin irritation is normal with penciclovir and it should resolve. 4. Penciclovir should be used a minimum of two weeks to prevent recurrence.

2. Penciclovir therapy is started at the first sign of a cold sore outbreak.

11. Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about: 1. Using decongestants to provide faster symptom relief 2. Providing adequate pain relief for at least the first 24 hours 3. Using complementary treatments for acute otitis media, such as garlic oil 4. Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better

2. Providing adequate pain relief for at least the first 24 hours

12. A patient who has had eczema for many years reports that their corticosteroid cream is not working as well as it was previously. They may be experiencing tolerance to the corticosteroid. Treatment options include: 1. Increase the potency of the corticosteroid cream. 2. Recommend an interrupted or cyclic schedule of application. 3. Increase the frequency of dosing of the corticosteroid. 4. Discontinue the corticosteroid because it isn't working any longer.

2. Recommend an interrupted or cyclic schedule of application.

5. A patient was prescribed betaxolol ophthalmic drops by their ophthalmologist to treat glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because: 1. There may be an antagonistic reaction between the two. 2. The additive effects may include bradycardia. 3. They may potentiate each other and cause respiratory depression. 4. The additive effects may cause metabolic acidosis.

2. The additive effects may include bradycardia.

9. A 17-year-old competitive runner presents with hip pain that began after falling while running. Their only medical problem is severe acne for which they take isotretinoin (Accutane). What should the provider be concerned about? 1. The patient may have pulled a muscle and needs to rest to recover. 2. They are at risk for bone injuries and need to be evaluated for fracture. 3. Isotretinoin interacts with ibuprofen, which is the pain medication of choice. 4. Teen athletes are at risk for repetitive stress injuries.

2. They are at risk for bone injuries and need to be evaluated for fracture.

18. An adult male has male pattern baldness on the vertex of his head and has been using Rogaine for two months. He asks how effective minoxidil (Rogaine) is. Minoxidil: 1. Provides a permanent solution to male pattern baldness if used for at least four months 2. Will show results after four months of twice-a-day use 3. May not work for his type of baldness 4. Works better if he also uses hydrocortisone cream daily on his scalp

2. Will show results after four months of twice-a-day use

1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be: 1. Intermediate potency corticosteroid ointment (Kenalog) 2. A combination of a corticosteroid and an antifungal (Lotrisone) 3. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%) 4. A high-potency corticosteroid cream (Diprolene AF)

3. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%)

16. A patient has been diagnosed with scabies. Education would include: 1. She should leave the scabies treatment cream on for an hour and then wash it off. 2. Scabies may need to be retreated in a week after initial treatment. 3. All members of the household and close personal contacts should be treated. 4. Malathion is flammable and she should take care until the solution dries.

3. All members of the household and close personal contacts should be treated

11. A 6-month-old infant with severe eczema would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include: 1. Apply liberally to all areas with eczema. 2. Double the frequency of application when the eczema is severe. 3. Apply sparingly to eczema areas. 4. Cover the eczema area with an occlusive dressing after applying a corticosteroid.

3. Apply sparingly to eczema areas.

9. A 15-month-old patient has been on amoxicillin for two days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for the child? 1. Continue the amoxicillin for the full 10 days. 2. Change the antibiotic to azithromycin. 3. Change the antibiotic to amoxicillin/clavulanate. 4. Change the antibiotic to trimethoprim/sulfamethoxazole.

3. Change the antibiotic to amoxicillin/clavulanate.

8. An adolescent has been prescribed isotretinoin (Accutane) by their dermatologist and is presenting to their primary care provider with symptoms of sadness and depression. The Beck Depression Inventory results indicate they have mild to moderate depression. What would be the best option at this point? 1. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant. 2. Refer them to a mental health therapist. 3. Contact their dermatologist about discontinuing the isotretinoin. 4. Reassure them that mood swings are normal and schedule follow up in a week.

3. Contact their dermatologist about discontinuing the isotretinoin.

9. An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include: 1. He should see an improvement in his acne within the first two weeks of treatment. 2. If there is no response in a week, double the daily application of adapalene (Differin). 3. He may see an initial worsening of his acne that will improve in 6 to 8 weeks. 4. Adapalene may cause bleaching of clothing.

3. He may see an initial worsening of his acne that will improve in 6 to 8 weeks.

14. Patients who are treated with more than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for: 1. High vitamin D levels 2. Hyperkalemia 3. Hypercalcemia 4. Hyperuricemia

3. Hypercalcemia

6. Appropriate initial treatment for psoriasis would be: 1. An immunomodulator (Protopic or Elidel) 2. Wet soaks with Burow's or Domeboro solution 3. Intermittent therapy with intermediate potency topical corticosteroids 4. Anthralin (Drithocreme)

3. Intermittent therapy with intermediate potency topical corticosteroids

3. A young adult patient comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be: 1. None, wait for the culture results to determine the course of treatment 2. Ciprofloxacin (Ciloxan) ophthalmic drops 3. Intramuscular (IM) ceftriaxone 4. High-dose oral amoxicillin

3. Intramuscular (IM) ceftriaxone

14. A patient presents with fungal infection of two of their toenails (onychomycosis). Treatment for fungal infections of the nail includes: 1. Miconazole cream 2. Ketoconazole cream 3. Oral griseofulvin 4. Mupirocin cream

3. Oral griseofulvin

7. Ciprofloxacin otic drops are contraindicated in: 1. Children 2. Patients with acute otitis externa 3. Patients with a perforated tympanic membrane 4. Patients with swimmer's ear

3. Patients with a perforated tympanic membrane

3. Patients who should be cautious about using decongestants for a URI include: 1. School-age children 2. Patients with asthma 3. Patients with cardiac disease 4. Patients with allergies

3. Patients with cardiac disease

5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for: 1. Cleaning the weeping area of dermatitis 2. Bathing the patient to prevent infection 3. Relief of inflammation 4. Providing a barrier layer to protect the surrounding skin

3. Relief of inflammation

19. Instructions for the use of malathion (Ovide) for head lice include: 1. Use a blow dryer to dry the hair after applying. 2. Use malathion (Ovide) daily for a week until all lice are dead. 3. Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours. 4. Use gloves to apply the malathion (Ovide).

3. Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.

4. A patient who used clotrimazole (Lotrimin AF) for athlete's foot developed a red, itchy rash consistent with a hypersensitivity reaction. They now have athlete's foot again. What would be a good choice of antifungal? 1. Miconazole (Micatin) powder 2. Ketoconazole (Nizoral) cream 3. Terbinafine (Lamisil) cream 4. Griseofulvin (Grifulvin V) suspension

3. Terbinafine (Lamisil) cream

13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that: 1. Tacrolimus is most effective if it is used continuously for four to six months. 2. Tacrolimus should be spread generously over the affected area. 3. The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans. 4. The FDA recommends that patients be screened for cancer before prescribing tacrolimus.

3. The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.

17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Regarding the use of topical diphenhydramine, patients or parents should be instructed that: 1. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine. 2. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak. 3. Topical diphenhydramine should not be used in children younger than age 2. 4. When applying topical diphenhydramine, apply the cream liberally to all areas that itch.

3. Topical diphenhydramine should not be used in children younger than age 2.

9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes: 1. Fill the canal with the drops with each dose. 2. Some redness and itching around the ear canal is normal. 3. Warm the bottle of ear drops in his or her hand before administering. 4. Cipro HC otic may cause ototoxicity.

3. Warm the bottle of ear drops in his or her hand before administering.

3. Instructions for applying a topical antibiotic or antiviral ointment include: 1. Apply thickly to the infected area, spreading the medication well past the borders of the infection. 2. If the rash worsens, apply a thicker layer of medication to settle down the infection. 3. Wash hands before and after application of topical antimicrobials. 4. Crusted lesions can be scrubbed off with a clean nailbrush.

3. Wash hands before and after application of topical antimicrobials.

10. A child may warrant "watchful waiting" instead of an antibiotic prescription for acute otitis media if they: 1. Are low risk with temperature of less than 39oC or 102.2oF 2. Have reliable parents with transportation 3. Are older than two years 4. All of the above

4. All of the above

13. First-line therapy for a school-age child with group A streptococcal pharyngitis is: 1. Azithromycin 10 mg/kg on day one, then 5 mg/kg/day on days 2 to 5 2. Amoxicillin 80 mg/kg/day (maximum of 2 g/day) for 10 days 3. Clindamycin 20 mg/kg/dose b.i.d. for 10 days 4. Amoxicillin 50 mg/kg/day (maximum 1,000 mg/day) for 10 days

4. Amoxicillin 50 mg/kg/day (maximum 1,000 mg/day) for 10 days

17. A child has head lice and their mother is asking which products are available that are not neurotoxic. The only non-neurotoxic head lice treatment is: 1. Permethrin 1% (Nix) 2. Lindane shampoo 3. Malathion (Ovide) 4. Benzoyl alcohol (Ulesfia)

4. Benzoyl alcohol (Ulesfia)

1. The Centers for Disease Control recommends all newborn infants receive prophylactic administration of __________ within one hour of birth. 1. Gentamicin ophthalmic ointment 2. Ciprofloxacin ophthalmic drops 3. Erythromycin oral suspension 4. Erythromycin ophthalmic ointment

4. Erythromycin ophthalmic ointment

2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with: 1. Sulfacetamide 10% ophthalmic solution (Bleph-10) 2. Bacitracin/polymyxin B (Polysporin) ophthalmic drops 3. Ciprofloxacin (Ciloxan) ophthalmic drops 4. High-dose oral amoxicillin-clavulanate

4. High-dose oral amoxicillin-clavulanate

10. A patient presents to the clinic with hard earwax in both ear canals. Instructions regarding home removal of hard cerumen include: 1. Moisten a cotton swab (Q-tip) and swab the ear canal twice daily. 2. Instill tap water in both ears while bathing. 3. Squirt hydrogen peroxide into ears with each bath. 4. Instill carbamide peroxide (Debrox) twice daily until canals are clear.

4. Instill carbamide peroxide (Debrox) twice daily until canals are clear.

2. A 3-year-old patient presents with a URI. Treatment for their URI would include: 1. Amoxicillin 2. Diphenhydramine 3. Pseudoephedrine 4. Nasal saline spray

4. Nasal saline spray

8. Mild acne may be initially treated with: 1. Topical combined antibiotic 2. Minocycline 3. Topical retinoid 4. Over-the-counter (OTC) benzoyl peroxide

4. Over-the-counter (OTC) benzoyl peroxide

10. An adolescent female calls the clinic with concerns that her acne is worse one week after starting topical tretinoin. What would be the appropriate care for her? 1. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin. 2. Switch her to an oral antibiotic to treat her acne. 3. Advise her to apply an oil-based lotion to her face to soothe the redness. 4. Reassure her that the worsening of acne is normal and it should improve with continued use.

4. Reassure her that the worsening of acne is normal and it should improve with continued use.

10. A young adult female has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: 1. Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane). 2. Prescribe Accutane after educating her on the adverse effects. 3. Recommend she try oral antibiotics (minocycline). 4. Refer her to a dermatologist for treatment.

4. Refer her to a dermatologist for treatment.

16. Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include: 1. Shampoo daily and rinse well. 2. Worsening of seborrhea for the first week is normal. 3. Seborrhea usually clears up after a few weeks of treatment. 4. Shampoo twice a week for two weeks, then weekly.

4. Shampoo twice a week for two weeks, then weekly.

5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to: 1. Mix the griseofulvin with ice cream before administering. 2. Take the griseofulvin until the tinea clears, in approximately four to five weeks. 3. Shampoo with baby shampoo daily while taking the griseofulvin. 4. Take the griseofulvin with a high-fat food.

4. Take the griseofulvin with a high-fat food.

1. An adult presents with an upper respiratory infection (URI). Treatment for his URI would include: 1. Amoxicillin 2. Diphenhydramine 3. Phenylpropanolamine 4. Topical oxymetazoline

4. Topical oxymetazoline