KMK pharamacology precise practice

Which of the following best describes furosemide?

A. Potassium sparing diuretic

B. Loop diuretic

C. Carbonic anhydrase inhibitor

D. Thiazide diuretic

Loop diuretic

Furosemid is classified as a loop diuretic as it selectively inhibits sodium chloride reabsorption in the thick ascending limb of Henle's loop. Acetazolamide is a CAI. hydrochlorothiazide is an example of a thiazide diuretic. Sprionolactone is a potassium sparing diuretic

All of the following are possible side effects of topical ophthalmic timolol in gel-forming solution EXCEPT:

A. tachycardia

B. Erectile dysfunction

C. decreased HDLs

D. dyspnea

E. alopecia

tachycardia

Timolol and most other nonselective ocular beta blockers have the potential to induce bradycardia. This is why blood pressure and heart rate should be monitored in glaucoma patients who use topical ophthalmic beta blockers. Decreased HDL cholesterol is well documented with topical ophthalmic timolol

Which of the following topical ophthalmic cycloplegic agents has the LEAST effect on accommodation?

A. tropicamide 1%

B. Homatropine 5%

C. Atropine 0.5%

D. Cyclopentolate

tropicamide 1%

in descending order, from greatest to least efficacy in inhibition of accommodation: atropine, scopolamine, homatropine, cyclopentolate, tropicamide

Which of the following medications is contraindicated in febrile pediatric patients?

A. Aspirin

B. diphenhydramine

C. ceterizine

D. Acetaminophen

aspirin

Aspirin should not be prescribed for febrile pediatric patients (eg secondary to chickenpox, influenza) due to the rare complication of Reye's syndrome, which is a fatal disease characterized by vomiting, lethargy, fatty liver degeneration, and encephalopathy. Acetaminophen is an alternative to aspirin in children. Diphenhydramine and cetirizine are not contraindicated in febrile pediatric patients

Posterior subcapsular cataract formation is a complication of steroid therapy that is most likely to:

A. occur with systemic steroid administration

B. occur with topical ocular steroid administration

C. reduce visual acuity to poorer than 20/60

D. be associated with concomitant steroid-induced infection

Occur with systemic administration

PSC formation associated with steroid use is usually seen in conjunction with long-term systemic steroid therapy. In these instances, VA is rarely worse than 20/60. The most common complication with topical ophthalmic steroid use is elevated IOP. Although it is possible, ocular infection associated with steroid use is quite rare

Mannitol is included in which of the following classes of diuretics?

A. loop

B. potassium sparing

C. osmotic

D. thiazide

osmotic

Osmotic diuretics affect the PCT, the thin descending loop of Henle, and the collecting ducts of the nephron. Furosemide acts on the thick ascending limb of Henle's loop. Hydrochlorothiazide is a thiazide diuretic that acts on the DCT. Spironolactone is a potassium sparing diuretic that acts on the late DCT and the collecting duct

Many systemically administered drugs, such as antihistamines and antianxiety agents, have anticholinergic effects. These drugs might produce any of the following ocular side effects EXCEPT:

A. pupillary dilation

B. dry eye

C. mild cycloplegia

D. bulbar conjunctival hyperemia

Bulbar conjunctival hyperemia

It is imperative to remember the autonomic innervation of ocular tissues. Blocking the cholinergic system would inhibit the iris sphincter (producing mydriasis), inhibit the ciliary muscle (producing cycloplegia), and inhibit the cholinergic innervation of the lacrimal gland (producing dry eye). Conjunctival hyperemia would result from alpha adrenergic blocking agents, such as dapiprazole

What is the mechanism of action of losartan?

A. alpha adrenergic receptor agonist

B. angiotensin receptor antagonist

C. calcium channel blocker

D. angiotensin converting enzyme inhibitor

Angiotensin receptor antagonist

Losartan's an angiotensin receptor antagonist that prevents angiotensin II from binding to its receptor, thus decreasing vasoconstriction and blood pressure. Prazosin is an example of an alpha adrenergic receptor antagonist. Verapamil is an example of a calcium channel blocker. Catopril is an example of an antiotensin converting enzyme inhibitor

Which of the following drug classes is typically delivered to the eye through the intracameral route of administration?

A. anesthetics

B. viscoelastic agents

C. corticosteroids

D. antiviral agents

Viscoelastic agents

Intracameral administration means delivery by injection into the anterior chamber. The most common clinical application is the injection of viscoelastic substances into the anterior chamber during cataract extraction and glaucoma filtering surgeries to protect against corneal endothelial cell loss and flattening of the anterior chamber

A drug that is in phase I clinical trials:

A. has never been used in animals

B. has never been used in patients with ocular disease

C. has been submitted to the FDA for approval

D. is classified as an orphan drug

B

During drug development in the US, phase 1 studies are initial investigations in normal human volunteers. The drug has already been used in animal models but has not yet progressed to use in patients with ocular disease. Orphan drugs are those that are developed to treat patients with rare diseases

An optometrist must obtain drug enforcement administration registration in order to use or prescribe:

A. controlled substances

B. any prescription drug product

C. investigational medications

D. drugs for therapeutic purposes

Controlled substances

DEA registration is required in order to manufacture, distribute, administer, or prescribe any controlled substance. Although state laws govern the local regulation of the optometric practice, DEA registration is a federal requirement

The use of topical ophthalmic sodium fluorescein to detect leakage of aqueous humor from the anterior chamber is known as:

A. Jones test

B. seidel test

C. Uhthoff test

D. Forbes test

Seidel test

Jones testing is used to evaluate the lacrimal drainage system. The Forbes test describes the use of indentation gonioscopy to evaluate the anterior chamber angle. Uhthoff's sign is a symptom associated with multiple sclerosis

Which of the following principles does NOT govern the use of topical ocular steroids for ocular inflammatory disease?

A. long-term high-dosage therapy should be tapered

B. pulse-dosing is generally used, followed by a lower dosing frequency until a desired response is obtained

C. difluprednate is generally considered the safest and most effective topical ophthalmic steroid

D. the type and location of inflammation determine the most appropriate routes of steroid administration

E. Short-term low-dosage therapy does not produce systemic side effects

C

Although difluprednate is one of the most effective ocular steroids, it is certainly not one of the safest. As a ketone based steroid, difluprednate demonstrates a prevalence of IOP elevations similar to that of prednisolone acetate. In long term, high dosage use, it can also cause cataracts

"Bull's eye" maculopathy and, more rarely, pseudoretinitis pigmentosa, are possible ocular side effects of which of the following systemic medications?

A. chlorpromazine

B. hydroxychloroquine

C. fluoxetine

D. diazepam

B.

The mechanism of ocular hypotensive action of carbonic anhydrase is:

A. creation of an osmotic barrier

B. alteration in uveoscleral outflow

C. enhanced trabecular outflow

D. inhibition of aqueous humor production

D

Which of the following is NOT true regarding the use of topical ophthalmic brimonidine in post-refractive surgery patients?

A. significant miosis occurs at 30 min and lasts 10-12 hours in scoptopic conditions

B. the drug is generally well tolerated when used post-surgically

C. the drug can decrease night vision problems such as halos and glare

D. there is no miosis under photopic conditions

A

Topical ophthalmic brimonidine is quite useful to improve symptoms of halos or glare in post-refractive surgery patients. when instilled 30 min before nighttime driving, the drug induces a relative miosis that will last 4-6 hours. the clinical effect is insignificant under photopic conditions

latanoprost is an example of an ophthalmic prodrug. A prodrug is one in which:

A. the drug exists at a lower pH in order to enhance lipophilicity

B. the drug's structure is converted to an active form after uptake

C. a cellular enzyme is inhibited after the drug penetrates the tissue

D. a drug manufacturer adds functional groups to increase solubility

B

all of the topical ocular prostaglandin analogs are prodrugs and must be converted by enzymes into free, active drug. In the case of prostaglandins, the ester-linked group is cleaved off after penetrating the cornea, with free acid remaining in the aqueous humor. prodrugs are used for their enhancing pharmacokinetic capabilities and lower dosing frequencies

Topical ophthalmic corticosteroid therapy inhibits all of the following EXCEPT:

A. collagen formation

B. corneal epithelial regeneration

C. corneal neovascularization

D. bacterial growth

D

topical ocular steroids can enhance replication of bacteria, viruses, and fungi. They also inhibit corneal neovascularization and corneal collagen formation (scarring), as well as corneal epithelial regeneration (although this latter action is not highly clinically significant)

oral steroids are contraindicated in patients with any of the following conditions EXCEPT:

A. hyperthyroidism

B. psychosis

C. immunosuppression

D. tuberculosis

E. pregnancy

A

since oral steroids are known to induce psychosis, reactivate tuberculosis, and worsen immunosuppression, they are contraindicated in these conditions. Further, oral steroids should generally be used with caution during pregnancy. Oral steroids are prescribed to patients with hyperthyroidism to treat thyroid-associated orbitopathy

Which of the following clinical responses would NOT be produced by a drug classified as a cholinergic agonist?

A. reduction in IOP

B. accommodative spasm

C. mydriasis

D. increased lacrimation

C

a cholinergic agonist, such as pilocarpine, activates muscarinic receptors in the iris sphincter and longitudinal muscle of the ciliary body. These actions result, respectively, in miosis, accommodative spasm, and reduction of IOP by enhancing conventional trabecular aqueous outflow. it will also result in increased lacrimation from the main lacrimal gland

Which of the following ophthalmic preservatives is MOST commonly associated with corneal toxicity?

A. oxychloro-complex

B. polyquad

C. BAK

D. sodium edetate

C

Which of the following combinations of ocular hypotensive agents would NOT be suitable for treating a patient who has primary open-angle glaucoma with a developing posterior subcapsular cataract?

A. latanoprost, pilocarpine, and brimonidine

B. dorzolamide-timolol and brimonidine

C. tafluprost and brimonidine-timolol

D. brinzolamide-brimonidine and betaxolol

A.

remember that pilocarpine is a cholinergic agonist that causes miosis by activating muscarinic receptors in the iris sphincter muscle. Patients with posterior subcapsular cataracts may have further visual impairment because of pupillary constriction induced by this drug

What is the mechanism of action of topical ophthalmic levobunolol?

A. it increases aqueous humor outflow through the uveoscleral meshwork

B. it decreases the production of bicarbonate in the ciliary processes

C. it increases aqueous humor outflow through the trabecular meshwork

D. it inhibits beta 2 adrenergic receptors within the ciliary body

D

Second generation oral H1 antihistamines are increasingly used more often than first generation oral H1 antihistamines because they:

A. are minimally or non-sedating at usual doses

B. are much more effective than first generation antihistamines

C. cause less insomnia when combined with decongestants than first generation antihistamines combined with decongestants

D. cost less than first generation antihistamines

A.

second generation usually preferred due to the fact that there is less blood-brain barrier penetration and consequently less sedation

Topical ophthalmic corticosteroids are indicated for all of the following conditions except:

A. acute epithelial herpes simplex keratitis

B. mechanical injury to the ocular surface without infection

C. seasonal allergic conjunctivitis

D. chemical injury to the cornea without infection

A

although steroids can be used for certain forms of herpes simplex keratitis affecting the corneal stroma, they must be avoided for corneal HSV epithelial infection. Topical ocular steroids have a well defined role in reducing itching and inflammation associated with allergic conjunctivitis

Which of the following systemic drugs does NOT cause corneal verticallata?

A. cocaine

B. Atovaquone

C. Hydroxychloroquine

D. Amiodarone

A

Some vehicles in ophthalmic formulations will cause increased corneal drug penetration by:

A. decreasing the drainage rate without affecting contact time

B. prolonging ocular contact time without affecting the drainage rate

C. decreasing the drainage rate while prolonging ocular contact time

D. prolonging ocular contact time while also increasing the drainage rate

E. decreasing the drainage rate while also decreasing ocular contact time

C

Increasing a drugs ocular retention time is associated with a decreased rate of drainage from the eye

Which of the following topical ophthalmic prostaglandins generally cause the MOST conjunctival hyperemia?

A. latanoprost 0.005%

B. bimatoprost 0.03%

C. Travoprost 0.004%

D. Bimatoprost 0.01%

B

Topical ophthalmic ketorolac 0.45% is FDA approved for postoperative use in cataract surgery. this drug is classified in which broad pharmacologic class?

A. ocular hypotensive

B. NSAID

C. antimicrobial

D. corticosteroid

B

which of the following chemical compounds affects receptors on postganglionic parasympathetic nerve fibers?

A. epinephrine

B. amphetamine

C. acetylcholine

D. pyridostigmine

C

Levothyroxine acts as a substitute for which of the following hormones?

A. TSH

B. T4

C. ACTH

D. TRH

B

Which of the following MOST accurately describes a chemical that is administered, absorbed, and distributed in the body before being converted into its active state?

A. secondary messenger

B. vasoactive peptide

C. prodrug

D. phosphorylation

C

which of the following systemic medications inhibits HMG-CoA reductase?

A. simvastatin

B. chloestyramine

C. Niacin

D. Gemfibrozil

A

Which of the following BEST classifies omeprazole?

A. mucosal protective agents

B. H2 receptor antagonist

C. prostaglandin analog

D. proton pump inhibitor

D

H2 receptor agonists (eg cimetidine, rantidine) inhibit acid secretion from stomach parietal cells. prostaglandin analogs inhibit acid secretion and aid in the protection of the stomach mucosal lining

What is the mechanism of action of lisinopril?

A. angiotensin converting enzyme inhibitor

B. adrenoreceptor antagonist

C. angiotensin receptor antagonist

D. Calcium channel blocker

A

Which of the following is an indirect acting sympathomimetic systemic drug?

A. pyridostigmine

B. phenylephrine

C. acetylcholine

D. cocaine

D

Which of the following types of drug elimination is dependent on the drug's half-life?

A. passive diffusion

B. first order kinetics

C. zero order kinetics

D. bulk flow

B

bulk flow and passive diffusion describe drug absorption, not elimination

What is the mechanism of action of topical ophtalmic olopatadine?

A. antihistamine/steroid combination

B. antihistamine/mast cell stabilizer combination

C. mast cell stabilizer

D. antihistamine

B

Which of the following systemic effects are associated with epinephrine? SELECT 4

A. mydriasis

B. bronchodilation

C. decreased peripheral vascular resistance

D. bradycardia

E. decreased gastrointestinal motility

F. increased salivary secretions

G. vasoconstriction

A, B, E, G

epinephrine results in increased peripheral vascular resistance

Which of the following oral medications cause the development of Clostridium difficile superinfections? SELECT 3

A. diphenhydramine

B. ceftriaxone

C. verapamil

D. hydroxychloroquine

E. dicloxacillin

F. propanolol

G. clindamycin

B, E, G

Cephalosporins, penicillins, and clindamycin are all associated with C. diff superinfections that result in diarrhea and pseudomembranous colitis. Although other antibiotics may cause GI irritation and nausea, they are not related to fatal C. diff superinfections

Which of the following oral medications cause mydriasis? SELECT 4:

A. chlorpheniramine

B. pyridostigmine

C. hydrocodone

D. edrophonium

E. diphenhydramine

F. amitriptyline

G. bromocriptine

A, E, F, G

Donepezil, echothiophate, edrophonium, and pyridostigmine are all AchE inhibitors that increase the concentration of Ach within the synpatic cleft, leading to an increase in parasympathetic nervous system activity, including miosis. Chlorpheniramine and diphenhydramine are antihistamines with anticholinergic effects, including mydriasis. Amitriptyline is a TCA that also has anticholinergic effects. Bromocriptine is a dopamine receptor agonist that causes mydriasis

Which of the following represents a DNA gyrase inhibitor with a broad spectrum of activity?

A. rifampin

B. ciprofloxacin

C. polymyxin

D. ethambutol

B

Penicillin is usually non-toxic to human cells because human cells lack which of the following?

A. peptidoglycan

B. topoisomerase

C. nuclear membrane

D. mitochondria

A

humans do not have peptidoglycans because they DO NOT Have cell walls

Which of the following is the mechanism of action of methotrexate?

A. inhibits dihydrofolate reductase

B. causes intra-strand DNA cross linking

C. causes DNA fragmenting

D. covalently x-links DNA at guanine N-7

A

which of the following systemic drugs may be administered during pregnancy?

A. tetracyclines

B. penicillins

C. sulfonamides

D. fluoroquinolones

B

Which of the following ocular side effects is NOT associated with amiodarone?

A. macular edema

B. non-arteritic anterior ischemic optic neuropathy

C. whorl keratopathy

D. anterior subcapsular crystalline lens deposits

A

All of the following oral medications inhibit bacterial protein synthesis by inhibiting the 50S bacterial ribosomal subunit EXCEPT:

A. clindamycin

B. erythromycin

C. gentamicin

D. chloramphenicol

C

All of the following ophthalmic dyes are used to evaluate ocular surface integrity EXCEPT:

A. fluorescein sodium

B. lissamine green

C. rose bengal

D. indocyanine green

D

Which of the following topical ophthalmic medications does NOT have an ester linkage?

A. benoxinate

B. tetracaine

C. proparacaine

D. lidocaine

D

Topical ophthalmic cyclosporine is BEST classified as a (an):

A. immunomodulator

B. hyperosmotic

C. lubricant

D. steroid

A

Which of the following side effects is associated with 5% sodium chloride ophthalmic solution?

A. halos around lights

B. corneal edema

C. Fuchs' endothelial dystrophy

D. stinging upon instillation

D

the most common side effect associated with hypertonic ophthalmic solutions is stinging upon instillation. halos around lights are a symptom of corneal edema, not a side effect of hypertonic ophthalmic solutions

Which of the following statements regarding topical ophthalmic pilocarpine is TRUE? SELECT 3

A. it prevents the development of anterior subcapsular vacuoles within the crystalline lens

B. it decreases aqueous humor outflow through the trabecular meshwork

C. it stimulates the iris sphincter muscle, causing miosis

D. it is a direct-acting cholinergic receptor agonist

E. it stimulates the ciliary muscle, causing an increase in accommodation

F. it decreases the risk of retinal breaks and detachments

G. it relieves head and brow aches associated with mydriasis

C, D, E

The original AREDS formula contains all of the following except:

A. vitamin K

B. vitamin E

C. zinc

D. vitamin C

A

original AREDS formula contains vitamin C, vitamin E, beta carotene, zinc oxide, cupric oxide

Which of the following statements CORRECTLY describes the mechanism of action of topical ophthalmic latanoprost?

A. it increases aqueous humor outflow through the uveoscleral meshwork

B. it decreases aqueous humor outflow through the trabecular meshwork

C. it decreases aqueous humor production by the nonpigmented ciliary epithelium

D. it increases aqueous humor outflow through the trabecular meshwork

A

Which of the following systemic medications acts as an adrenergic receptor antagonist?

A. amphetamine

B. cocaine

C. propanolol

D. phenylephrine

C

cocaine and amphetamine are indirect acting adrenergic agonists that increase sympathetic nervous system activity

Which of the following systemic medications inhibits angiotensin converting enzyme?

A. metoprolol

B. enalapril

C. clonidine

D. verapamil

B

Verapamil is a calcium channel blocker that decreases blood pressure by decreasing intracellular calcium within vascular smooth muscle

which of the following is a sympathomimetic oral medication?

A. salmeterol

B. echothiophate

C. sildenafil

D. ethambutol

A

Salmeterol is a long acting beta 2 selective agonist that causes bronchodilation and is used in the treatment of asthma

Which of the following oral medications are indicated for the treatment of hypertension? SELECT 4

A. enalapril

B. verapamil

C. gemfibrozil

D. metoprolol

E. prazosin

F. cholestyramine

G. dextroamphetamine

A, B, D, E

Cholestyramine is a bile acid binding resin that is used to treat hyperlipidemia. Gemfibrozil is a fibric acid derivative that is also used to treat hyperlipidemia. Dextroamphetamine is indicated for the treatment of ADHD

Which of the following topical ocular steroids should be used for a 15 year old white male with vernal conjunctivitis in order to minimize the risk of steroid induced ocular hypertension?

A. loteprednol etabonate 0.5%

B. prednisolone acetate 1.0%

C. prednisolone phosphate 0.25%

D. dexamethasone phosphate 0.25%

E. dexamethasone alcohol 1.0%

A

among these steroids, loteprednol etabonate has the least risk of elevating IOP because of rapid hydrolysis of unbound steroid by esterase enzymes in the cornea and uvea. Loteprednol is the only ester based steroid currently commercially available

Topical ophthalmic tafluprost decreases intraocular pressure primarily by:

A. increasing ultrafiltration

B. enhancing uveoscleral outflow

C. enhancing trabecular outflow

D. decreasing aqueous humor formation

B

Most topical ophthalmic prostaglandin analogs produce their ocular hypotensive effect by activating:

A. beta 1 adrenergic receptors in Schlemm's canal

B. beta 2 adrenergic receptors in the juxtacanalicular tissue

C. prostanoid FP receptors on the ciliary muscle

D. beta 2 adrenergic receptors in the ciliary body epithelium

C

Which of the following topical ophthalmic medications are NOT adrenergic agonists? SELECT 3

A. phenylephrine

B. hydroxyamphetamine

C. cocaine

D. tropicamide

E. homatropine

F. cyclopentolate

D, E, F

Which of the following drugs has the potential to offer neuroprotection?

A. brimonidine

B. trusopt

C. timolol

D. travatan

A

Which of the following statements regarding topical ophthalmic timolol maleate is INCORRECT?

A. it decreases the production of aqueous humor

B. it may cause bronchoconstriction and bradycardia

C. it inhibits beta 2 adrenergic receptors within the ciliary body

D. it stimulates beta 2 adrenergic receptors within the iris stroma

D