ACCP/ASHP 2025 Ambulatory Care Pharmacy Preparatory Review and Recertification Course – Dermatologic and Eyes, Ears, Nose, and Throat, and Immunologic Disorders

This set provides 200 practice flashcards across macular degeneration, glaucoma, dry eye, allergic rhinitis, urticaria, angioedema, infestations (scabies, pediculosis), acne, psoriasis, atopic dermatitis, and minor burns based on ACCP/ASHP 2025 Ambulatory Care notes.

What nutrients comprise the AREDS formulation shown to slow progression of intermediate to advanced AMD (AREDS formula)?

Vitamin C 500 mg, Vitamin E 400 IU, Beta-carotene 15 mg, and Zinc 80 mg.

Why is beta-carotene avoided in AREDS for current or former smokers?

Beta-carotene increases the risk of lung cancer in current or former smokers, so the AREDS formulation without beta-carotene is often used.

Name two primary risk factors for developing advanced age-related macular degeneration (AMD).

Age and genetic/familial predisposition (e.g., CFH gene variants) are main risk factors.

What test or tool is used to monitor macular degeneration progression noninvasively?

Fundus photography and optical coherence tomography (OCT); fluorescein angiography is used for neovascular AMD.

List two OTC vitamin regimens commonly discussed for macular degeneration against progression.

AREDS/AREDS2-based formulations; AREDS2 excludes beta-carotene for certain patients.

What is the most effective class of medications for lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG)?

Prostaglandin analogs provide the greatest IOP reduction among available therapies.

What is the typical target reduction in IOP for glaucoma therapy?

A 20–30% reduction from baseline IOP to delay progression of visual field loss.

When administering a single nightly prostaglandin analog drop, how many drops are typically needed per eye?

One drop per eye at bedtime is usually sufficient; extra drops do not increase efficacy.

Name two common ocular prostaglandin analogs.

Latanoprost and bimatoprost (others include travoprost, tafluprost, latanoprostene bunod).

Which formulation is LATANOPROSTENE BUNOD (Vyzulta) known for?

It increases outflow through both trabecular and uveoscleral pathways via a NO-donor moiety.

What is a notable cosmetic/iris-related side effect of prostaglandin analogs?

Increased brown pigmentation of the iris and growth of eyelashes.

Which beta-blocker is cardioselective among ocular hypotensives?

Betaxolol.

What is the primary limitation of topical beta-blockers when used for glaucoma?

Cardiovascular and respiratory side effects; may not be suitable as monotherapy in angle-closure glaucoma.

Name two topical beta-blockers used for glaucoma.

Timolol and Betaxolol.

What are first-line alpha-adrenergic agonists for glaucoma and one key safety note?

Apraclonidine and Brimonidine; caution in cardiovascular disease and potential systemic hypotension.

What is a major safety concern with topical alpha-agonists?

Systemic hypotension and bradycardia; caution around patients with cardiovascular disease.

What is a newer class of glaucoma medications that lowers IOP by increasing outflow via the NO pathway?

Rho kinase inhibitors (e.g., Netarsudil, Rhopressa).

What is a key safety issue with Netarsudil (Rhopressa)?

Conjunctival hyperemia and conjunctival hemorrhage are common adverse effects.

Which topical carbonic anhydrase inhibitors are used for glaucoma?

Dorzolamide and Brinzolamide.

Name two systemic carbonic anhydrase inhibitors used for glaucoma (less common).

Acetazolamide and Methazolamide.

What is a common dosing tip when using multiple eyedrops for glaucoma?

Only 1 drop is necessary per dosing; wait about 5 minutes between different eyedrops.

Which prostaglandin analog is often paired with a beta-blocker for additional IOP reduction?

Latanoprost or Travoprost can be combined with a beta-blocker for additive effect.

Which dry eye treatment uses an LFA-1 antagonist to reduce ocular surface inflammation?

Lifitegrast (Xiidra).

What is the mechanism of Lifitegrast?

LFA-1 (lymphocyte function–associated antigen-1) antagonist that reduces T-cell mediated inflammation.

Which agent is an ophthalmic calcineurin inhibitor used for dry eye that is 0.05% or 0.1%?

Cyclosporine (Restasis and higher concentration formulations such as Cequa).

What is a newer, non-prescription dry eye agent that acts as a nasal spray to stimulate tear production?

Varenicline nasal spray (Tyrvaya/ONSET trials).

Which dry eye agent is a nasal spray that can stimulate tear production via trigeminal nerve pathways?

Varenicline nasal spray (Tyrvaya).

What is perfluorohexyloctane (a dry eye treatment) used for?

A tear supplement that reduces dry eye symptoms by thinning tear film evaporation.

Which cholinergic agents are FDA-approved for xerostomia in Sjögren syndrome?

Cevimeline and Pilocarpine.

Which dry eye therapy is reported to have 12-hour dosing and can be used with artificial tears?

Topical lifitegrast (Lifitegrast) or topical cyclosporine; lifitegrast is usually BID; cyclosporine is q12h.

Name two systemic pharmacologic options for severe dry eye disease that may be considered after topical therapies fail.

Oral secretagogues and autologous serum tears; systemic immunomodulatory options may be considered in refractory cases.

What is the recommended initial management for seasonal allergic rhinitis?

Nonprescription intranasal corticosteroids (preferred) and/or intranasal antihistamines; oral second-gen antihistamines as options.

What are two intranasal antihistamines listed?

Azelaastine (Astepro) and Olopatadine (Patanase).

Which intranasal corticosteroids are commonly used for allergic rhinitis (OTC options included)?

Beclomethasone, Ciclesonide, Flunisolide, Triamcinolone; OTC options include Budesonide, Fluticasone, Mometasone, Triamcinolone.

Which systemic steroid strategy is commonly used for allergic rhinitis when needed?

Oral corticosteroid bursts (short course, e.g., 5-7 days) for flare-ups.

What is a useful add-on drug for perennial or seasonal rhinitis in patients not fully controlled with antihistamines and steroids?

Montelukast (a leukotriene receptor antagonist).

What test is used to diagnose allergic rhinitis after history and exam?

Skin prick testing or serum-specific IgE testing can be used; diagnosis often based on symptoms and response to therapy.

For allergic rhinitis, what is a non-pharmacologic core strategy?

Environmental control: reduce dust mites, mold, pets; pollen exposure management.

Which condition requires iPLEDGE before isotretinoin therapy?

Acne vulgaris (severe nodular or treatment-resistant acne).

What is the critical iPLEDGE requirement for isotretinoin regarding pregnancy?

Two negative pregnancy tests before starting and monthly testing; use two forms of contraception.

What is a major safety monitoring requirement for isotretinoin?

Monthly monitoring for liver enzymes, lipids, glucose, and mood changes; hepatic and psychiatric monitoring.

Which systemic therapy for psoriasis is associated with a higher risk profile but strong efficacy and is reserved for severe cases?

Methotrexate or Cyclosporine; biologics are often preferred when feasible.

Name three TNF inhibitors used in psoriasis management.

Adalimumab, Etanercept, Infliximab (others include Certolizumab, Golimumab).

What are common adverse effects of TNF inhibitors used in psoriasis?

Infections (including TB reactivation), headaches, infusion/injection reactions; monitor for infections.

Which IL inhibitors are used for psoriasis?

Secukinumab, Ixekizumab, Brodalumab, Ustekinumab, Guselkumab, Risankizumab, and Bimekizumab.

What safety concern is associated with brodalumab?

Black box warning for suicidality.

Which PDE-4 inhibitor is used for psoriasis and may cause weight loss and diarrhea?

Apremilast (Otezla).

What are common systemic agents used for psoriasis when topical therapy is insufficient?

Methotrexate, Cyclosporine, Acitretin; BRMs (biologics) and IL inhibitors are also used.

What topical agent is considered first-line for mild to moderate acne and is often combined with benzoyl peroxide?

Topical retinoids (adapalene, tretinoin, tazarotene, trifarotene).

Which topical antimicrobial is commonly used in acne and should not be used as monotherapy due to resistance concerns?

Clindamycin (topical); often combined with benzoyl peroxide.

What topical agent is known for strong comedolytic action and is combined with corticosteroids or vitamin D analogs in psoriasis treatment?

Calcipotriene (topical vitamin D analog) often used with topical steroids.

Which topical retinoid product is available OTC as adapalene?

Adapalene (Differin) 0.1%.

What is a common safety concern with topical retinoids?

Photosensitivity and skin irritation; teratogenic risk—avoid in pregnancy.

Which topical corticosteroid potency consideration is important in psoriasis management?

Potency should be stepped down as skin improves to minimize adverse effects; avoid ultra-high potency on large areas.

What is a first-in-class topical agent used for psoriasis that targets the aryl hydrocarbon receptor?

Tapinarof (Vtama).

What is the role of coal tar in psoriasis, and what is a major cosmetic drawback?

Historically used for psoriasis; odor and cosmetic staining are drawbacks.

Which topical immunosuppressants are commonly used off-label for facial or intertriginous psoriasis with a black box warning?

Tacrolimus and Pimecrolimus.

What is the typical dosing approach for methotrexate in psoriasis therapy?

Weekly dosing with folic acid supplementation; monitor CBC, LFTs, lipids; adjust for renal function.

Which systemic biologic agent requires subcutaneous dosing every other week initially for psoriasis?

Adalimumab (Humira) and similar TNF inhibitors—administration schedule varies by agent.

Which therapy is often considered for moderate-to-severe psoriasis or psoriatic arthritis when topical therapy fails?

Biologic agents (e.g., TNF inhibitors or IL inhibitors).

What is a key safety concern with monoclonal antibody therapies for psoriasis?

Infections risk, TB reactivation, and possible malignancies; screening and monitoring required.

Which therapy is recommended as first-line for mild-to-moderate atopic dermatitis (AD)?

Topical corticosteroids; moisturizers are foundational.

What nonsteroidal calcineurin inhibitors are used for AD and what is a key black box warning?

Tacrolimus and Pimecrolimus; black box warning for potential skin lymphoma and malignancies with long-term use.

Which agents are JAK inhibitors used for atopic dermatitis?

Baricitinib, Abrocitinib, Upadacitinib, and Ruxolitinib (topical).

What is the role of Dupilumab in atopic dermatitis?

IL-4 receptor antagonist used for moderate-to-severe AD.

What phototherapy options are used for psoriasis and atopic dermatitis?

Narrowband UVB, broadband UVB, UVA, PUVA; phototherapy is used after topical or systemic therapies.

In the management of urticaria, which class of antihistamines is recommended as first-line therapy?

Non-sedating H1 antihistamines (e.g., cetirizine, loratadine, desloratadine, fexofenadine, levocetirizine).

What is a common second-line option for chronic urticaria if first-line antihistamines are insufficient?

Omalizumab; cyclosporine may be used in refractory cases.

Which class of drugs is used to treat hereditary angioedema (HAE) acutely?

C1 esterase inhibitors (Cinryze), kallikrein inhibitors (ecallantide), bradykinin B2 receptor antagonist (icatibant).

What preventive therapy options exist for HAE?

Cinryze, Ruconest, Lanadelumab (Takhzyro).

What is the recommended initial treatment for scabies in most individuals?

Permethrin 5% cream as first-line therapy.

What is a second-line treatment option for scabies if permethrin fails?

Ivermectin (oral) or Lindane as a second-line; ensure coverage of all body surfaces.

What is a key infection control step when treating scabies in households?

Treat all close contacts within the past 30 days and decontaminate bedding/clothes.

What is a major risk factor for antibiotic resistance with topical acne antibiotics?

Using antibiotics as monotherapy; should be combined with benzoyl peroxide or retinoids.

What is a major benefit of combining topical corticosteroids with vitamin D analogs in psoriasis therapy?

Increased efficacy and reduced irritation compared to monotherapy.

What is a common first-line therapy for mild plaque psoriasis?

Topical corticosteroids and/or vitamin D analogs; often in combination.

Which psoriasis treatment is indicated for psoriatic arthritis and may be dosed twice weekly?

Etanercept (TNF inhibitor) or other TNF inhibitors; dosing varies by agent.

What characteristic marks moderate-to-severe plaque psoriasis when considering systemic therapy?

Extensive body surface area involvement or significant arthritis; consider biologics.

Which topical retinoid is available OTC in some markets and used for acne?

Adapalene (Differin) 0.1%.

What is the typical approach to isotretinoin dosing and safety monitoring?

Weight-based dosing, monthly labs (CBC, lipids, LFTs, glucose); strict iPLEDGE requirements; pregnancy prevention.

What is a common safety note about isotretinoin and sun exposure?

All patients should use sunscreen (SPF 15+); isotretinoin increases sunburn risk.

Which dermatologic condition is characterized by well-defined red, scaly plaques and can involve nails?

Psoriasis.

In atopic dermatitis, which cytokine pathway is a key target for newer biologics like dupilumab?

IL-4 and IL-13 signaling (IL-4 receptor alpha subunit).

What is the role of phototherapy in eczema and psoriasis?

Adjunctive treatment; used after topical therapies or as part of systemic regimens for certain patients.

What is the Psoriasis Area Severity Index (PASI) used for?

A measure of psoriasis severity in clinical trials, not routinely used in all clinical practice.

What diagnostic test is commonly used to screen for glaucoma risk before pupil dilation?

Goldmann applanation tonometry is the reference standard for diagnosing ocular hypertension and glaucoma.

What is the normal range for intraocular pressure (IOP) in mm Hg?

Approximately 13–18 mm Hg.

What is central corneal thickness (CCT) used for in glaucoma evaluation?

CCT helps assess risk and interpretation of IOP; measurements are used in diagnosing glaucoma and evaluating IOP.

What is a common footnote when educating glaucoma patients about eye drop administration?

Use nasolacrimal occlusion to reduce systemic absorption and adverse effects.

Which medication is a first-line option for open-angle glaucoma that is also available in a BAK-free formulation option?

Latanoprost; BAK-free formulation is available as Xelpros (latanoprost) or latanoprostene bunod Xelpros/Verzen? (clarify product names per region).

What is the role of beta-blockers in glaucoma therapy in patients with respiratory conditions?

Beta-blockers can worsen asthma/COPD; caution and consider alternatives like prostaglandin analogs.

What is a major advantage of prostaglandin analogs over other agents in glaucoma management?

They provide the greatest reduction in IOP and are generally well tolerated.

What is a safety concern with topical dorzolamide and brinzolamide (CA inhibitors)?

Possible stinging and blurred vision; systemic agents can cause broader sulfonamide-related adverse effects.

Which drug class is typically used as a last resort in glaucoma due to systemic adverse effects but may be used if other therapies fail?

Oral carbonic anhydrase inhibitors (acetazolamide, methazolamide) or systemic agents.

What is the clinical use of lifitegrast in dry eye disease?

Topical LFA-1 antagonist used to treat the signs and symptoms of dry eye syndrome.

Which test assesses tear production in dry eye disease (one of several used tests)?

Schirmer test measures tear production; tear break-up time test assesses tear film stability.

What is a common nonprescription approach to dry eye that addresses meibomian gland dysfunction (MGD)?

Eyelid hygiene and warm compresses; sometimes thermal pulsation devices are used.

Which agent is FDA-approved for short-term treatment of dry eye flares at 0.25% suspension?

Loteprednol etabonate (Eysuvis).

Which second-line oral agent may be used in allergic rhinitis for patients not responding to intranasal steroids and antihistamines?

Montelukast, a leukotriene receptor antagonist.

What is the role of intranasal cromolyn in allergic rhinitis?

OTC intranasal cromolyn is a mast cell stabilizer used as adjunctive therapy in some patients.