Otics

Question 1

is ciprofloxacin/dexamethasone ototoxic

Answer 1

nope

Question 2

What is the primary function of cerumen?
A. Improve hearing acuity
B. Protect the ear canal from pathogens and water
C. Dry the external auditory canal
D. Neutralize acidic pH

Answer 2

B. Protect the ear canal from pathogens and water

Question 3

a bulging tympanic membrane may indicate

Answer 3

otitis media

Question 4

is ciprofloxacin ototoxic?

Answer 4

nope

Question 5

A 20 y/o woman presents to the pharmacy with mild ear
discomfort and a wet feeling in her ear. She denies any
discharge from her ear. She states she has been swimming a
lot recently as she is trying to get in shape for a triathalon.
What is the best treatment for her at this time?
a) Carbamide peroxide in glycerin BID
b) 95% isopropyl alcohol in glycerin PRN
c) Acetic acid in propylene glycol soln
once daily
d) Ofloxacin soln once daily

Answer 5

b) 95% isopropyl alcohol in glycerin PRN

Question 6

ofloxacin frequency and duration

Answer 6

once daily for 7 days

Question 7

impacted cerumen can be caused by

Answer 7

blocking the natural cleansing of the ear canal (earbuds, hearing aids, ear plugs), q tips, atrophy of the ceruminous glands with old age

Question 8

is ofloxacin ototoxic

Answer 8

Nope

Question 9

Which factor most commonly disrupts the protective lipid
layer of the ear canal?
A. Aging
B. Swimming
C. Loud noise
D. Cold weather

Answer 9

B. Swimming

Question 10

what are the protective barriers in the external auditory canal (EAC)?

Answer 10

• hairs lining outer half of EAC
• acidic pH –> antimicrobial
• cerumen coating
• natural cleansing -> migration forward

Question 11

what is an alternative thing you could use to rinse after softening drops besides water

Answer 11

H2O2 rinse (50:50) or saline

Question 12

Which otic product is contraindicated with a perforated
tympanic membrane?
A. Ofloxacin
B. Ciprofloxacin/dexamethasone
C. Acetic acid products
D. Ciprofloxacin/hydrocortisone

Answer 12

C. Acetic acid products

Question 13

CI for neomycin/hydrocortisone/colistin/thonzonium otic

Answer 13

herpes simplex, varicella, vaccinia, perforated TM

Question 14

T/F: acute otitis externa is typically bacterial but can occasionally be fungal

Answer 14

T

Question 15

what is the tympanic membrane

Answer 15

separates the outer ear from the middle ear, smooth and translucent pearl gray structure, transmits sound waves and protects the middle ear

Question 16

what are the ingredients in the OTC alcohol drops for water logged ears

Answer 16

isopropyl alcohol + glycerin (prevents over drying)

Question 17

neomycin/hydrocortisone/polymyxin B otic frequency and duration

Answer 17

TID-QID x max 10 days

Question 18

A 65 y/o man presents to the pharmacy with symptoms of
gradual hearing loss and ear fullness. He denies any discharge
from his ear, itching, or ear pain. He asks you for your opinion
on using OTC and prescription otic medications to help him. He
has not seen a provider. Which of the following conditions is he
likely suffering from?
a) Impacted cerumen
b) Water clogged ears
c) Acute otitis externa
d) Acute otitis media

Answer 18

a) Impacted cerumen

Question 19

treatment of water clogged ears

Answer 19

OTC alcohol drops, blow dryer (low and away from ear), bending over and manipulating ear, cotton to absorb water

Question 20

neomycin/hydrocortisone/polymyxin B otic brand name

Answer 20

cortisporin

Question 21

ciprofloxacin/hydrocortisone frequency and duration

Answer 21

BID x 7 days

Question 22

acetic acid+ aluminum acetate dosing

Answer 22

Q2-3 hrs

Question 23

T/F: otorrhea can only come from acute otitis externa

Answer 23

F; can also be fore otitis media

Question 24

what are alternative ear wax softening agents besides carbamide peroxide

Answer 24

mineral oil, docusate, glycerin

Question 25

is ciprofloxacin/hydrocortisone ototoxic

Answer 25

nope

Question 26

what are some signs the patient is suffering from acute otitis externa (seen in the doctors office)

Answer 26

tenderness of the ear (on the outside), edema or erythema of the EAC sometimes otorrhea, lymphadenitis (swelling of lymph nodes), tympanic membrane erythema

Question 27

Ciprofloxacin 6% suspension frequency and duration

Answer 27

single dose administered by healthcare professional

Question 28

Which finding is required to diagnose acute otitis externa? A. Bulging tympanic membrane B. Tragus or pinna tenderness C. Fever D. Middle ear effusion

Answer 28

B. Tragus or pinna tenderness

Question 29

what is the point of tympanostomy tubes

Answer 29

to prevent fluid buildup in the middle ear... especially for recurrent middle ear infections

Question 30

is onset rapid or delayed for acute otitis externa

Answer 30

rapid

Question 31

what are contributing factors to acute otitis externa (7)

Answer 31

1. bacteria containing water 2. moisture (swimming/sweating) 3. trauma to EAC 4. hot, humid weather 5. hearing aids 6. chronic dermatologic disease 7. type A blood type

Question 32

Which organism is most commonly associated with AOE? A. Streptococcus pneumoniae B. Pseudomonas aeruginosa C. Haemophilus influenzae D. Candida albicans

Answer 32

B. Pseudomonas aeruginosa

Question 33

symptoms of acute otitis externa

Answer 33

otalgia (ear pain) itching fullness sometimes hearing loss sometimes jaw pain

Question 34

how do you instruct a patient to use Debrox (carbamide peroxide)

Answer 34

fill ear canal with drops, let sit for 15 mins, use bulb syringe to irrigate with warm water MAX BID for 4 days!

Question 35

how often are OTC alcohol drops used

Answer 35

as needed (no limit)

Question 36

A 13 y/o boy presents to his family practitioner with a 3 day history of (L) ear pain and itching. On otoscopy, his outer ear canal appears erythematous, has cerumen buildup, and otorrhea. His TM is intact. What is the best treatment for him at this time? a) Carbamide peroxide in glycerin BID b) 95% isopropyl alcohol in glycerin PRN c) Acetic acid in propylene glycol soln once daily d) Ofloxacin soln once daily

Answer 36

d) Ofloxacin soln once daily

Question 37

ciprofloxacin/dexamethasone frequency and duration

Answer 37

BID x 7 days

Question 38

symptoms of water clogged ears

Answer 38

wetness, acute hearing loss, fullness, mild pressure, mild discomfort

Question 39

A 65 y/o man presents to the pharmacy with symptoms of gradual hearing loss and ear fullness. He denies any discharge from his ear, itching, or ear pain. He asks you for your opinion on using OTC and prescription otic medications. He has not seen a provider. What is the best treatment for him at this time? a) 95% isopropyl alcohol in glycerin PRN b) Ofloxacin soln once daily c) Carbamide peroxide in glycerin BID d) Acetic acid in propylene glycol soln once daily

Answer 39

c) Carbamide peroxide in glycerin BID

Question 40

why would you use an antimicrobial+corticosteroid for AOE?

Answer 40

corticosteroid may help decrease pain and itching and may increase penetration of the AB

Question 41

symptoms of impacted cerumen

Answer 41

gradual hearing loss, fullness, pressure, itching/mild discomfort, dizziness/vertigo, tinnitus, cough

Question 42

what is the generic name of Debrox, the ear wax softening agent

Answer 42

carbamide peroxide

Question 43

is neomycin/hydrocortisone/polymyxin B ototoxic

Answer 43

YES! neomycin is ototoxic

Question 44

A 20 y/o woman presents to the pharmacy with mild ear discomfort and a wet feeling in her ear. She denies any discharge from her ear. She states she has been swimming a lot recently as she is trying to get in shape for a triathalon. Which of the following conditions is she likely suffering from? a) Impacted cerumen b) Water clogged ears c) Acute otitis externa d) Acute otitis media

Answer 44

b) Water clogged ears

Question 45

what is the recommended treatment length for AOE? when should follow up occur

Answer 45

7 days, 10-14 days for severe infections 48-72 hrs

Question 46

acetic acid + aluminum acetate CI

Answer 46

perforated tympanic membrane

Question 47

how can water clogged ears be prevented

Answer 47

swim cap, earplugs

Question 48

what are the two most common bacteria that cause acute otitis externa

Answer 48

pseudomonas aeruginosa, staphylococcus aureus

Question 49

neomycin/hydrocortisone/colistin/thonzonium otic frequency

Answer 49

TID-QID

Question 50

ingredients for homemade drying drops

Answer 50

isopropyl alcohol+ acetic acid 1:1 ratio

Question 51

is neomycin/hydrocortisone/colistin/thonzonium otic ototoxic

Answer 51

yes! neomycin

Question 52

T/F: ear candles can cause tympanic membrane perforation, otitis externa, and temporary hearing loss

Answer 52

T

Question 53

water clogged ears are caused by

Answer 53

water in the ears that doesnt naturally dissipate

Question 54

CI for acetic acid products

Answer 54

perforated tympanic membrane (its not ototoxic but acid is harsh)

Question 55

what are some ways that the lipid layer in the ear can be compromised

Answer 55

moisture, fingernails, q tips, piercing, hearing aids

Question 56

acute otitis externa is inflammation/cellulitis of the external auditory canal (EAC). what is a more common name for this?

Answer 56

swimmers ear

Question 57

A 13 y/o boy presents to his family practitioner with a 3 day history of (L) ear pain and itching. On otoscopy, his outer ear canal appears erythematous, has cerumen buildup, and otorrhea. You decide to treat him with an otic product. Which of the following patient counseling points about otic use is correct? a) Warm ear drops prior to instillation b) Fill ear as full as possible with drops c) Keep head down for 30min after instilling d) Avoid use of cotton balls in ears

Answer 57

a) Warm ear drops prior to instillation

Question 58

what are 3 methods to manage AOE

Answer 58

1. antimicrobial therapy 2. symptomatic tx for otalgia 3. +/- aural toilet

Question 59

how do you counsel a patient about their eardrops (9)

Answer 59

1. clean and dry ear 2. warm to body temp by holding in waistband 3. shake (if suspension) 4. tilt head, pull the ear back and up to open ear 5. dont touch dropper to ear canal 6. administer X drops 7. gently press the small, flat skin flap over the ear canal opening to force drops into the canal and get air bubbles out 8. keep head tilted for 3-5 mins to increase penetration of the drops 9. can use an ear wick if secretions are thick

Question 60

what is the purpose of cerumen

Answer 60

lubricates canal, traps dust and foreign materials, waxy waterproof barrier to pathogens and water

Question 61

Most cases of acute otitis externa are caused by: A. Viral infections B. Fungal infections C. Bacterial infections D. Allergic reactions

Answer 61

C. Bacterial infections

Question 62

ciprofloxacin/dexamethasone brand name

Answer 62

Ciprodex OTIC

Question 63

CI for neomycin/hydrocortisone/polymyxin B

Answer 63

herpes simplex, varicella, vaccinia, perforated TM (since its ototoxic)

Question 64

treatment of impacted cerumen

Answer 64

OTC ear wax softening agents + irrigation or physician office removal

Question 65

13 y/o boy presents to his family practitioner with a 3 day history of (L) ear pain and itching. On otoscopy, his outer ear canal appears erythematous, has cerumen buildup, and otorrhea. His TM is intact. Which of the following conditions is he likely suffering from? a) Impacted cerumen b) Water clogged ears c) Acute otitis externa d) Acute otitis media

Answer 65

c) Acute otitis externa

Question 66

acetic acid products dosing/frequency/duration/special administration

Answer 66

insert saturated cotton wick, keep wick moist for 24 hrs, remove and instill drops TID-QID

Question 67

The patient comes back to your pharmacy the next day and requests information on ear candles. What information is most appropriate to give him? a) Ear candles are safe b) Ear candles are effective c) Ear candles are not safe or effective d) I have no idea

Answer 67

c) Ear candles are not safe or effective