NUR 909 Final Exam Study Guide
EYE DOs - correct answer
True or False. All eye drops must be sterile to be considered safe for use. - correct answer True;
ear drops are generally more acidic than eye drops, so eye drops can be used in the ear but not
vice versa (PPT)
Name 3 bacteria that are most commonly associated with bacterial conjunctivitis. - correct
answer Staph aureus, Strep pneumoniae, H. influenzae (PPT)
How many gtts = approx 1 mL? - correct answer 20 gtts = approx 1 mL (PPT)
The Centers for Disease Control recommends all newborn infants receive prophylactic
administration of __________________ within 1 hour of birth to prevent ______________. -
correct answer Erythromycin ointment; gonococcal conjunctivitis (can cx blindness) (PPT)
Describe the mechanism of action of prostaglandin analogs used for glaucoma. - correct answer
Reduces the intraocular pressure (IOP) by increasing outflow of aqueous humor (PPT)
What unique indication is bimatroprost FDA-approved for? - correct answer Hypotrichosis of
eyelashes, may increase % & duration of hairs in the growth phase resulting in eyelash growth;
brand name Latisse (PPT); need rx (Google)
Arrange the medications used for glaucoma by greatest reduction in intraocular pressure to
least. Timolol, acetazolamide, latanoprost, brinzolamide - correct answer MOST timolol (BB)
reduces IOP by 20-25%, acetazolamide & brinzolamide (carbonic anhydrase) reduce IOP by 15-
20% topical, 20-25% PO, lantoprost LEAST
Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because -
correct answer The additive effects may include bradycardia
Naphazoline-containing eye drops should not be used for more than 72 hours due to concern
for what? - correct answer Potential rebound redness; less likely w/this & tetrahydrozoline
compared to other ocular vasoconstrictors (PPT)
Which 2 classes of medications should only be prescribed by an ophthalmologist? - correct
answer Ocular NSAIDs d/t risk for permanent damage if used in wrong pt & steroids (PPT)
EAR DOs - correct answer
What bacteria is the most common cause of acute otitis externa and what class of otic
antibiotics are most effective at treating? - correct answer Pseudomonas; more susceptible to
fluoroquinolones (PPT)
A suspension/solution is preferred for the treatment of acute otitis externa when the tympanic
membrane is ruptured. - correct answer Suspension, solutions can be very irritating to ruptured
TMs (PPT)
,NUR 909 Final Exam Study Guide
What is the role of otic steroids in the treatment of acute otitis externa? - correct answer Use
of a topical abx w/a corticosteroid may shorten time to sx resolution; PO abx are INEFFECTIVE
-Ciprodex (ciprofloxacin + dexamethasone)
-Cortisporin (neomycin, polymyxin B, hydrocortisone) (PPT)
Describe the mechanism of action of carbamide peroxide. - correct answer Releases hydrogen
peroxide, which softens impacted cerumen d/t foaming axn (PPT)
ABX RESISTANCE - correct answer
What factors contribute to antibiotic resistance? - correct answer -Prophylaxis (surgery, dental
procedures, daily use in immunosuppressed pts [HIV/AIDS, CF], recurrent UTI) (PPT)
-Increasing populations of immunocompromised pts, increases in the # & complexity of invasive
medical procedures, & increased survival of pts w/chronic diseases; spread of resistant
organisms assoc w/day care for young children, overcrowding, travel & use of abx in agriculture
(pg 714)
-Excessive & inappropriate use of abx; ex's: prescribing abx for viral infx, inadequate dosing,
excessive duration of therapy, & increased empirical use of broad-spectrum abx when not
required (714)
List some of the leading risk factors for having a drug resistant pathogen. - correct answer
Recent use of abx, younger than 2 yo or older than 65 yo, daycare attendance, exposure to
young children, multiple medical comorbidities, recent hospitalization, immunosuppression
(714)
True or False. Resistance has developed in every class of antibiotics. - correct answer T (714)
BETA-LACTAMS - correct answer
List the antibiotic classes in the beta-lactams category. - correct answer Penicillins,
cephalosporins, carbapenems & monobactams (715)
Describe the mechanism of action of penicillin antibiotics. - correct answer Hinder bac growth
by inhibiting the biosynthesis of a bacterial cell wall mucopeptide (known as murein or
peptidoglycan) (715)
Penicillins have activity primarily against gram-________ organisms. - correct answer +
anaerobic (PPT)
Explain how the activity of aminopenicillins are different than that of penicillins. What causes
this difference? - correct answer -Cover gram + & - organisms; 1st group of penicillins w/activity
against gram - bac (PPT)
, NUR 909 Final Exam Study Guide
-Aminopenicillins have greater activity against gram - bac bc of their enhanced ability to
penetrate these organisms' outer membrane (715)
How is the activity of an aminopenicillin enhanced by adding a beta-lactamase inhibitor? -
correct answer -BLIs protect hydrolysable penicillins form inactivation by beta-lactamases (PPT)
-BLIs prevent the destruction of beta-lactam abx by serving as a competitive inhibitor of beta-
lactamase; BLIs also contain a beta-lactam ring but have poor antimicrobial activity alone (715)
Amoxicillin is prescribed to children with acute otitis media at a dose of 80 to 90 mg/kg/day.
How does this dose compare to dosing for other indications? What is the rationale for this
dosing regimen? - correct answer Cost - affordable, high efficacy & long hx of safe use; taste &
convenience
-amoxicillin requires 2-3 doses/day, penicillin V requires 2-4 doses/day (723)
What percentage of patients are truly allergic to penicillins? - correct answer 10% (PL)
Describe the major difference between the generations of cephalosporins: 1st gen - correct
answer gram + (cocci & most streptococci)
Describe the major difference between the generations of cephalosporins: 2nd gen - correct
answer as same 1st gen w/increased activity against H. influenzae, limited activity against
anaerobes, each 2nd generation cephalosporin has a slightly diff spectrum of activity so don't
assume & do a C&S
Describe the major difference between the generations of cephalosporins: 3rd gen - correct
answer have activity against streptococcal species, active against uncommon gram - pathogens
(use discouraged d/t poor ability to detect inducible beta-lactamases that can inactivate this rx
class)
Describe the major difference between the generations of cephalosporins: 4th gen - correct
answer broader spectrum of activity, more resistant to beta-lactamases that may inactivate 3rd
gen; active against gram + & - organisms
Describe the major difference between the generations of cephalosporins: 5th gen only beta-
lactam w/activity against MRSA (725-726)
Look at generations of cephalosporins image - correct answer
Patients with what type of penicillin allergy should probably not be prescribed a cephalosporin?
- correct answer IgE-mediated rxns to penicillin (i.e., Type I rxns) (PPT)
EYE DOs - correct answer
True or False. All eye drops must be sterile to be considered safe for use. - correct answer True;
ear drops are generally more acidic than eye drops, so eye drops can be used in the ear but not
vice versa (PPT)
Name 3 bacteria that are most commonly associated with bacterial conjunctivitis. - correct
answer Staph aureus, Strep pneumoniae, H. influenzae (PPT)
How many gtts = approx 1 mL? - correct answer 20 gtts = approx 1 mL (PPT)
The Centers for Disease Control recommends all newborn infants receive prophylactic
administration of __________________ within 1 hour of birth to prevent ______________. -
correct answer Erythromycin ointment; gonococcal conjunctivitis (can cx blindness) (PPT)
Describe the mechanism of action of prostaglandin analogs used for glaucoma. - correct answer
Reduces the intraocular pressure (IOP) by increasing outflow of aqueous humor (PPT)
What unique indication is bimatroprost FDA-approved for? - correct answer Hypotrichosis of
eyelashes, may increase % & duration of hairs in the growth phase resulting in eyelash growth;
brand name Latisse (PPT); need rx (Google)
Arrange the medications used for glaucoma by greatest reduction in intraocular pressure to
least. Timolol, acetazolamide, latanoprost, brinzolamide - correct answer MOST timolol (BB)
reduces IOP by 20-25%, acetazolamide & brinzolamide (carbonic anhydrase) reduce IOP by 15-
20% topical, 20-25% PO, lantoprost LEAST
Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because -
correct answer The additive effects may include bradycardia
Naphazoline-containing eye drops should not be used for more than 72 hours due to concern
for what? - correct answer Potential rebound redness; less likely w/this & tetrahydrozoline
compared to other ocular vasoconstrictors (PPT)
Which 2 classes of medications should only be prescribed by an ophthalmologist? - correct
answer Ocular NSAIDs d/t risk for permanent damage if used in wrong pt & steroids (PPT)
EAR DOs - correct answer
What bacteria is the most common cause of acute otitis externa and what class of otic
antibiotics are most effective at treating? - correct answer Pseudomonas; more susceptible to
fluoroquinolones (PPT)
A suspension/solution is preferred for the treatment of acute otitis externa when the tympanic
membrane is ruptured. - correct answer Suspension, solutions can be very irritating to ruptured
TMs (PPT)
,NUR 909 Final Exam Study Guide
What is the role of otic steroids in the treatment of acute otitis externa? - correct answer Use
of a topical abx w/a corticosteroid may shorten time to sx resolution; PO abx are INEFFECTIVE
-Ciprodex (ciprofloxacin + dexamethasone)
-Cortisporin (neomycin, polymyxin B, hydrocortisone) (PPT)
Describe the mechanism of action of carbamide peroxide. - correct answer Releases hydrogen
peroxide, which softens impacted cerumen d/t foaming axn (PPT)
ABX RESISTANCE - correct answer
What factors contribute to antibiotic resistance? - correct answer -Prophylaxis (surgery, dental
procedures, daily use in immunosuppressed pts [HIV/AIDS, CF], recurrent UTI) (PPT)
-Increasing populations of immunocompromised pts, increases in the # & complexity of invasive
medical procedures, & increased survival of pts w/chronic diseases; spread of resistant
organisms assoc w/day care for young children, overcrowding, travel & use of abx in agriculture
(pg 714)
-Excessive & inappropriate use of abx; ex's: prescribing abx for viral infx, inadequate dosing,
excessive duration of therapy, & increased empirical use of broad-spectrum abx when not
required (714)
List some of the leading risk factors for having a drug resistant pathogen. - correct answer
Recent use of abx, younger than 2 yo or older than 65 yo, daycare attendance, exposure to
young children, multiple medical comorbidities, recent hospitalization, immunosuppression
(714)
True or False. Resistance has developed in every class of antibiotics. - correct answer T (714)
BETA-LACTAMS - correct answer
List the antibiotic classes in the beta-lactams category. - correct answer Penicillins,
cephalosporins, carbapenems & monobactams (715)
Describe the mechanism of action of penicillin antibiotics. - correct answer Hinder bac growth
by inhibiting the biosynthesis of a bacterial cell wall mucopeptide (known as murein or
peptidoglycan) (715)
Penicillins have activity primarily against gram-________ organisms. - correct answer +
anaerobic (PPT)
Explain how the activity of aminopenicillins are different than that of penicillins. What causes
this difference? - correct answer -Cover gram + & - organisms; 1st group of penicillins w/activity
against gram - bac (PPT)
, NUR 909 Final Exam Study Guide
-Aminopenicillins have greater activity against gram - bac bc of their enhanced ability to
penetrate these organisms' outer membrane (715)
How is the activity of an aminopenicillin enhanced by adding a beta-lactamase inhibitor? -
correct answer -BLIs protect hydrolysable penicillins form inactivation by beta-lactamases (PPT)
-BLIs prevent the destruction of beta-lactam abx by serving as a competitive inhibitor of beta-
lactamase; BLIs also contain a beta-lactam ring but have poor antimicrobial activity alone (715)
Amoxicillin is prescribed to children with acute otitis media at a dose of 80 to 90 mg/kg/day.
How does this dose compare to dosing for other indications? What is the rationale for this
dosing regimen? - correct answer Cost - affordable, high efficacy & long hx of safe use; taste &
convenience
-amoxicillin requires 2-3 doses/day, penicillin V requires 2-4 doses/day (723)
What percentage of patients are truly allergic to penicillins? - correct answer 10% (PL)
Describe the major difference between the generations of cephalosporins: 1st gen - correct
answer gram + (cocci & most streptococci)
Describe the major difference between the generations of cephalosporins: 2nd gen - correct
answer as same 1st gen w/increased activity against H. influenzae, limited activity against
anaerobes, each 2nd generation cephalosporin has a slightly diff spectrum of activity so don't
assume & do a C&S
Describe the major difference between the generations of cephalosporins: 3rd gen - correct
answer have activity against streptococcal species, active against uncommon gram - pathogens
(use discouraged d/t poor ability to detect inducible beta-lactamases that can inactivate this rx
class)
Describe the major difference between the generations of cephalosporins: 4th gen - correct
answer broader spectrum of activity, more resistant to beta-lactamases that may inactivate 3rd
gen; active against gram + & - organisms
Describe the major difference between the generations of cephalosporins: 5th gen only beta-
lactam w/activity against MRSA (725-726)
Look at generations of cephalosporins image - correct answer
Patients with what type of penicillin allergy should probably not be prescribed a cephalosporin?
- correct answer IgE-mediated rxns to penicillin (i.e., Type I rxns) (PPT)
