Chapter 70: OTC Eye, Ear and Mouth

Eyes
• Eye disorders that a ect the eye surface can be self-treated including dry
eye, allergic conjunctivitis, viral conjunctivitis, diagnosed corneal edema,
and minor ocular irritation.
• Dry eye and allergic conjunctivitis are the most common conditions OTC
meds are used.
• Assessment: Urgent referral to physician or emergence: pain or
photophobia, any disturbance of vision, blunt trauma to the eye, chemical
exposure, imbedded foreign body, heat exposure (e.g. welder arc) or eye
protrusion.
Eye Condition Action Therapy

Red Eye or Bacterial - Refer to a doctor if no improvement Polymyxin B/Gramicidin

Conjunctivitis with OTC treatments within 48 hours (Polysporin)
(purulent discharge) - Children: Refer to a physician; do not instilled QID for 7–10 days
recommend self-treatment. (OTC, Schedule III).
- Contact lens wearer: Red, irritated
eyes require referral to an eye care
practitioner.
- Rheumatoid arthritis & Diabetes:
requires referral.

Seasonal Allergic - Refer to a doctor if symptoms do not Instill topical decongestants

Conjunctivitis improve within 72 hours. (oxymetazoline) or lubricants
(watery discharge) - Children under 12 years: Refer. for irritation. Use preservative-
free eye drops.
Caution: Avoid >3 days to
prevent rebound hyperemia.

Viral Conjunctivitis Refer to a doctor to rule out other viral Instill lubricants for irritation;
causes. use preservative-free eye
drops.

Blepharitis (itchy, - Refer to a doctor or eye care specialist Maintain eyelid hygiene (use
red, scaly, sticky if new onset. eyelid scrubbers).
eyelids) - Refer for associated conditions such Apply warm compresses to
as acne, rosacea, or seborrheic loosen crust.
dermatitis.

Hordeolum (stye) Refer to a doctor or eye care specialist if Apply warm compresses.
drainage does not occur within 48
hours.

Dry Eye (gritty, sandy - With diabetes: Refer. Use lubricants. Symptoms may
feeling) - Without chronic illness: Refer if include sandy, scratchy,
symptoms persist >5 days to rule out burning, or fatigue in the eyes.
blepharitis or foreign objects.

Question:
• Ophthalmic conditions that require referral to a doctor? Pain and vision
changes, foreign body refer to doctor, contact lens wearer.

1
ff
 • Red irritated eye with purulent discharge is probably due to bacterial
conjunctivitis. Try self-care for >48 hours then refer.
• Red irritated eye with watery discharge and itching is probably due to
allergic conjunctivitis, self-care >72 hours then refer.
• Red irritated eyes and NO itching and NO discharge are probably due to
viral infection. Refer to doctor.
• The gritty, sandy feeling is probably due to dry eye for the patient
diabetes? Refer to a doctor
• Patient experiencing eyelid infection or Blepharitis with acne rosacea ?
Refer to a doctor
• What kind of self-care is available for red irritated watery discharge? Apply
cold compresses for allergic or viral conjunctivitis. Apply warm compresses
for bacterial conjunctivitis to help remove crusts, styes or chalazion to
reduce swelling: apply 2–3 times a day for 5–10 minutes followed by gentle
massage over the lesion
• A diabetic patient using amitriptyline 50 mg daily for diabetic neuralgia. The
patient presents at your pharmacy with blurred vision symptoms. What is
appropriate action? Refer to doctor for assessment

Dry eye is common disorder that occurs when the eye does not produce
enough tear or tear evaporate quickly or abnormality in the production of
mucus or lipid normally found in tear layer.

Symptoms: Dry eye, sandy, gritty sensation, photosensitivity and di culty

moving the eyelids. Etiology: Decrease lachrymal gland secretions.
• The lacrimal functional unit composed of the lacrimal gland, the ocular
surface (cornea and conjunctiva), and Meibomian gland. The lacrimal units
are connected to sensory motor nerve and control production of tear lm.
• The lm layer is composed of 3 layers: the mucus layer (mucin), the
aqueous layer and the lipid layer and these layers coats eyes.
• Mucin de ciency: Mucin is produced by goblet cells. Damage or
in ammation of goblet cells can be cause by condition erythema
multiforme.
• Lipid de ciency: Decrease lipid layer is common in patients with blepharitis.
• Epitheliopathies: Defects in the corneal epithelium that can impair tear lm
stability.

Non-pharmacological
• Cleanse eyes thoroughly.
• Blepharitis and hordeolum bene t from warm, moist compresses applied
for up to 15 minutes, 3 to 4 times a day.
• Cool, moist compresses have a soothing e ect for conjunctivitis and dry
eye.
• Refer if: The dry eye with diabetes condition. If no improvement in 5 days.

2
fl
fi
fi
fi
fi
ff
ffi
fi
fi
 Treatment:
Arti cial tear solutions chemically inert and coat the eyes, help to retain
moisture, protect from irritation, and slow turnover of tears. An ideal tear
replacement product would possess:
• Electrolytes in concentration similar to that normal tear.
• An osmolality of 2000 to 280 mOsm.
• Viscosity of less than 20 centipoise.
• No cytotoxic and preservative free.

Ophthalmic lubricants. Arti cial tears contain cellulose ethers examples

dextran, methylcellulose, hydroxypropyl methylcellulose and
carboxymethylcellulose 1%. Other vehicles include polyvinyl polymers such
as polyvinyl alcohol 1.4% and sodium hyaluronate and povidone.
• Ophthalmic ointments: the primary ingredient is petrolatum which acts
as a lubricant and an ointment base. Mineral oil which assists the
ointment to melting in body temperature.
• Arti cial tear inserts: Hydroxypropyl methyl cellulose.
• Pilocarpine, acetylcysteine, methylprednisolone.
• Instillation of arti cial tears every 1-6 hours for a trial period of 48
hours.
• Emollients can cause blurring of vision and are better suited at night.

Any eye irritation that fails to respond to nonprescription therapy 3 to 5 days

should be referred to an eye care professional for proper diagnosis.

Ophthalmic decongestant
• OTC ophthalmic decongestants include phenylephrine and imidazole type
such as naphazoline, tetrahydrozoline and oxymetazoline.
• Improve symptoms of burning, itching, and tearing associated with allergic
rhinitis.
• Avoid in glaucoma because decongestants produce a mild pupillary
dilation.
• Excessive use of ophthalmic decongestant can cause rebound congestion
of conjunctiva (hyperemia).
• Manufacturer recommends maximum 3 days use decongestants.

Question:
• Hyperemia side e ect of? red eye caused by the overuse of ophthalmic
decongestant.

How to administer eye drops

• Wash hands thoroughly. Tilt the head back or lie down.

3
fi
fi
fi
ff
fi
• With eyes open, gently pull the lower lid below the eyelashes away from the
eye to form a pouch.
• Approach the eye from the side and hold the container near the lid (at least
2 cm away). Do not touch the lid or lashes.
• Look toward the ceiling. Looking up moves the center of the eye away from
the instillation site, minimizing the blink re ex.
• Instill one drop into the pouch. Hold this position to let the drop fall as deep
as possible into the pouch.
• Look down for several seconds and then slowly release the lower lid.
Looking down brings the cornea into maximum contact with the drop.
• Gently close (don’t squeeze) the eyes for 1 to 2 minutes while applying
gentle pressure to the bridge of the nose for 30 to 60 seconds. Gentle
pressure prevents the drops from being drained from the eye, thus minimize
systemic side e ects.
• Closing the eye helps prevent loss of solution caused by blinking. If the eye
is closed too tightly, the medication may be expelled.
• Don’t rub the eye. Try not to blink.
• To apply several drops, wait 3-5 minutes after the instillation of each drop.

Eye care products: Contact lenses

There are two types of contact lenses, rigid gas permeable (RGP) and
hydrophobic. Hard lens made of silicone, uorosilicone acrylate, polymethyl
methacrylate (PMMA). The soft lenses are hydrophilic and made of
hydroxyethyl-methacrylate (HEMA).

Feature Hard Lenses (RGP) Soft Lenses

Material Polymethyl methacrylate (PMMA) Hydroxyethyl-methacrylate (HEMA)

Hydration Property Hydrophobic Hydrophilic

Lifespan Up to 5 years (until lost or damaged) 1 day to 1 year (depending on type)

Daily Wear Time Less than 12 hours More than 12 hours

Risk of Microbial Low High

Contamination

Usage Type Multi-use; strong and durable but Single-use or multi-use depending
fragile if mishandled on type

Storage Requires storage in contact lens Disposable lenses are single-use; no

solutions storage required, require no cleaning
Requires regular cleaning and care or solutions

Popularity Less commonly used Most commonly used

Contact lens solutions (cleaning solutions):

• Surface active cleaners: Surfactants: Disinfect and remove contaminants
from soft lens.

4
ff
fl
fl
 • Protein cleaners or enzyme cleaners: contain papain, pancreatin, or
subtilisin (enzyme). Remove protein deposits by catalyzing the natural
breakdown of debris into simple compounds.
• Wetting and rewetting solutions: Produce cushioning and lubricant e ect
between lens and eyelid, between eye and cornea (removes dryness).

Drugs interaction with contact lens:

• Oral contraceptive alters tear composition results decrease lubrication.
• Antihistamine, hypnotics, sedative decrease blink rate (blink increases
hydration).
• Anticholinergics, antihistamines, TCA’s decrease tear volume.
• Isotretinoin may cause itching and decrease wear time in soft lens users.
• ASA may cause ocular irritation, redness in soften wearers.
• Disinfecting solutions kills bacteria. Preservative; maintain sterility of
solution. Saline solution preservative minimizes the risk of contamination.
• Wetting and rewetting solutions provide wetting, lubrication and cushioning
functions.

Key Note:
• Contact lens should be stored in disinfecting solutions. Drying out is the
major (75%) problem for soft lens users.

Drugs that cause discoloration of soft lens

Dopamine Nitrofurantoin Sulfasalazine
Tetracycline Phenazopyridine Phenolphthalein
Rifampin Pyrantel pamoate

Question:
• Di erence of soft and hard lens? Soft lens is hydrophilic, single use
• Which contact lens is comfortable wearing for long time? Soft lens for over
12 hours
• What is purpose of adding surfactants in contact lens solutions? Removing
contaminant, debris, facilitate disinfection.
• Three major steps in administering eye drops? 1.While instilling all
ophthalmic drops, contact lens should be removed! 2. Tilt head back or lie
down. 3. After instilling eye drop apply gentle pressure to the bridge of nose
• After instilling eye drop why would you apply gentle pressure to the bridge
of nose? To keep the medication from going down the tear duct (prevent
systemic absorption).

5
ff
ff
 Mouth
A cold sore (also known as a fever blister) is a small, painful blister or group
of blisters that typically forms on or around the lips, mouth, or face. It is
caused by the herpes simplex virus (HSV-1), although in some cases, it may
be caused by HSV-2. Transmitted through direct contact to skin.

Symptoms: mild burning or itching on the lips. Small vesicles lled with clear
uid which eventually ruptures and crust over last for 7 to 10 days. Cold
sores improve without treatment.

Treatment: Goal is reduced discomfort, pain, itching, reduce duration and

prevent reoccurrence.

Topical anesthetics are used to relieve mild pain. Ester type: Benzocaine,
tetracaine; contact sensitizers Camphor, Menthol, And Benzyl Alcohol.
Benzocaine: most common, used to relieve pain associated with canker and
cold sores.

Analgesics such as acetaminophen, ibuprofen can be recommended to

control moderate to severe pain.

Counterirritants commonly found in cold sore balms. Use lip balms or

sunscreens to prevent sun-induced outbreaks.

Astringent: Burrow’s solution or cold compresses with tap water applied 3 to

4 times daily is helpful for cold sores. Sunscreen with SPF 15; recommended
to prevent cold sores in those with recurrence after exposure to sun.

Protectants Topical to prevent cracking, ssuring and excessive drying of

the HSV lesions. Example petrolatum, ZnO, Cocoa Butter, Allantoin, and
calamine

Antivirals: Acyclovir, valacycolovir, famcyclovir prevents the HSV from

spreading to healthy cells and reduce to duration of cold sore (4.1 days Vs 4.8
days). Docasanol topical is used for the treatment of recurrent cold sores

Question:
• Cold sore or fever blisters is? Contagious
• Cold sore is caused by? HSV1
• Natural healing time of cold sore is? 7 to 10 days.

Canker Sores or Aphthous ulcers. Recurrent aphthous stomatitis usually

appears on the cheeks, tongue, and soft palate oor of the mouth. Visible
manifestation of recurrent aphthous stomatitis.

6
fl
fi
fl
fi
 • Streptococcus sanguis partly the cause
• Autoimmune mechanism is also implicated. At least 20% is a ected.
• Women twice as susceptible as men. Susceptibility appears to be
inherited.

Symptom: Painful, recurrent ulcers in the oral mucosa require assessment

and treatment.
• 3-10 mm shallow lesions.
• Round with white center and red halo
• Persist for 7-14 days.

Treatment: Topical anesthetics, for short time pain relief apply.

• Ester type; Benzocaine (contain up to 20% benzocaine), and tetracaine;
contact sensitizers.
• Applied to only small areas of the mouth to prevent a “cotton-mouth”
feeling and loss of oral sensation.

Protectants: Provide temporary pain relief and protection.

• Petrolatum, ZnO, cocoa butter, allantoin.
• Emollient mixtures or denture adhesives can alleviate pain.

Natural product: clove oil

Prescription
• Benzydamine 0.15% topical solutions for painful ulcers used as rinse
every 3 hours on as-needed basis. The solution should NOT be swallowed.
• Magic mouthwash is mixture of various medication such as local
anesthetic, antibiotics, corticosteroids, antacids and antihistamine. The
purpose of magic mouth wash is to provide relief from pain, in ammation,
and irritation in the mouth.

Question: What is magic mouth wash?

Oral Thrush. Characterized by overgrowth of Candida albicans fungal

species in mouth. Also known as Candidiasis. Drugs commonly causes oral
thrush are inhaled corticosteroids and immunocompromised, and wear
dentures.
• Symptoms of thrush include cottage cheese-like, white discolorations or
plaques on the mouth structures, oral pain, minimal bleeding with
irritation, taste changes, severe cases di culty in swallowing.
• To prevent oral thrush associated with inhalers. Rinse mouth with water
after inhalation of corticosteroids spray and using aero chambers.
• Treatment: Nystatin suspension. Shake well, swish and swirl then
swallow.

7
ffi
ff
fl
• Store all other dosage forms at 15–30°C. Nystatin store oral powder in a
refrigerator (2–8°C).

Dry Mouth (Xerostomia): A dry mouth conditions in which there is no

salivary secretions and also caused by improper functioning of the salivary
gland (Sjogren’s syndrome).
Non-prescription medication: Ice chips, arti cial saliva, and sugarless
candies.
• Avoid irritants, such as alcohol, smoking, ca eine.
• Avoid salty and spicy food. Use humidi er at night.
• Treatment: Arti cial saliva substitutes, and pilocarpine oral tablets.

Question:
• If patient is using aero chamber with inhalers, as a pharmacist do you still
recommended rinse the mouth with water to patient? Yes recommend rinse
mouth after each inhalation
• How often is aero chamber cleaning is recommended? after every use

Teething pain
Nonpharmacological
• Hard, smooth and clean products may be given to the child to bite and
chew on such as frozen face cloth. Safe tethers cooled in refrigerator before
use can be helpful.
• Rubbing the back of a small, cold spoon on the gum.

Non-prescription medication: Oral analgesic. Acetaminophen and

ibuprofen. Topical anesthetic. Benzocaine 7.5% and 10% gel.

Oral Cysts: Treatment of eruption cysts

• In general cysts rupture, spontaneously.
• Rare cases surgically removed, if signi cant discomfort or interferes with
feeding occurs.

Dental Caries: Destruction of calci ed tissue resulting from infection. Dental

caries most commonly caused by Streptococcus mutans. This bacterium
produces acids that demineralized the enamel.

Treatment: Tooth paste contains

• Detergents or surfactants (sodium laurel sulfate, sodium N-lauryl
sarcosinate).
• Humectants (glycerin, propylene glycol).
• Whitener (peroxides; sodium triphosphate).
• Fluorides reduce caries formation.
• Mouth wash contains Cetyl pyridinium chloride may cause staining of teeth.

8
fi
fi
fi
fi
fi
ff
 • Chlorhexidine mouth wash; may cause stains, taste change, discoloration
of tongue.
• Triclosan: Antiplaque and antimicrobial agent that helps prevents gingivitis,
plaque cavities and tartar.

Trench mouth: This can cause acute necrotizing ulcerative gingivitis (ANUG)
is caused by overgrowth of spirochete and fusiform microorganism.

Gingivitis/periodontitis: The infection of gingival tissue is gingivitis.

Treatment: Mouth hygiene. Anesthetics; Benzocaine, and Eugenol.
Analgesic; Acetaminophen.

Endocarditis: In ammation and infection of the inner lining of the heart

chambers and valves.
• Resulting from the invasion of bacteria into the bloodstream, often due to
poor dental hygiene, invasive medical procedures, or pre-existing heart
conditions.
• Caused by S. viridian and S. aureus.
Prophylaxis
• Amoxicillin 1 g before (1 hr) surgery, followed by 500 mg TID for 3 days
or Amoxicillin 2 g single dose before surgery.
• Azithromycin 1 g/day followed by 500 mg OD x 2 to 3 days (for
patients allergic to betalactam).
• Clindamycin 600 mg followed by 300 mg QID x 3 days (for patients
allergic to beta-lactam).

Dental Abscess. Accumulation of puss in dental cavities.

Drug of choice is Pen V or amoxicillin or erythromycin (base for adults and
estolate for children).

Ear
Otic disorders: Excessive/impacted earwax
• Overactive ceruminous glands produce excessive ear wax.
• Narrowed ear canal.
• Large amount of hair in the canal occurs. Often in elderly.
• Ine ective or insu cient chewing or talking, especially in elderly.

Earwax softening agents

• Carbamide peroxides the only approved as safe and e ective agent for
earwax removal.
• To prevent vertigo, medication in the vial should be warmed in the hands
and put 5-10 drops in the ear BID for 4 days.
• Do not use if ear drainage, discharges, pain, and irritation or rash occurs.
Do not use if there is injury of perforation of eardrum.

9
ff
fl
ffi
ff
 • If the patient feels pain or severe fullness upon instilling the drops, this
might be an indication of ruptured tympanic membrane.

Question:
• Ceruminous gland produces? Earwax
• Earwax is removed by? Carbamide peroxide and mineral oil.
• Often elderly have more earwax because? Large amount of hair in the canal
occurs

Otitis Externa (Swimmer’s Ear) is also known as swimmer ear. It is the

in ammation of ear canal. This is commonly known as swimmer’s ear or hot
weather ear. Most often it occurs during summer 50% of this is cause by
Pseudomonas aeruginosa; other common microbes include Staph, Bacillus,
and Proteus organisms.
• Symptoms include itching, moving pain in air, and uid discharge from
canal in severe cases, decrease or loss of hearing.
• Drainage resulting from eczematous mild otitis externa can be self-treated,
if ear drainage clear liquid, can be external ear.
• Some cases clear or cloudy drainage Otitis media, or cerebrospinal uid
(CSF). If bloody drainage can be ear trauma.
• Prevention: Hot compresses; pain, discontinue sticking.

Treatment
• Acetic acid 2%, germicidin/polymyxin B (OTIC drops).
• Gentamycin otic solution (amino glycosides active against gram –ve,
(Pseudomonas), and S. aureus
• OTIC cipro oxacin, moxi oxacin ophthalmic solution (no ototoxicity)
active against Pseudomonas.

Question:
• How to consider it is otitis externa and otitis media?
• A patient is a swimmer but he has not done swim classes for a month. He
came to pharmacy to ask any solution for his ear infection? is it otitis
externa or media?
• Which is the most infective agents of otitis externa? P. aeruginosa
• Which is the most infective agents for otitis media? S. pneumonia, H.
in uenza, M. catarrhalis

Otitis Media (OM)

• Otitis media is the infection of middle ear. Symptoms: Pain in the ear and
fever.
• Acute otitis media most commonly caused by S. pneumonia, H. in uenza,
and M. catarrhalis. However, the types of OM chronic suppurative otitis
media otitis media with e usion.

10
fl
fl
fl
ff
fl
fl
fl
fl
• The drug of choice Amoxicillin or +/- clavulanate, ceftriaxone, cefuroxime
axetil, azithromycin. Children with frequent otitis media should vaccinated
by pneumococcal vaccine.

Vertigo and Dizziness

• Dizziness refers to a variety of sensations such as light-headedness,
fainting, spinning, and giddiness.
• Vertigo is de ned as sensation of motion in response given bodily
movement. Nausea and vomiting, pallor, and perspiration accompany
vertigo. It is vestibular disease as result of lesions or disturbances in inner
ear. e.g. Meniere's disease.

Meniere's disease
Prophylaxis; Diuretics (HCTZ, Triamterene), Q. Betahistine (histamine agonist)
is commonly used. Diet salt restrictions and avoid co ee, and smoking.

Boils: Infected hair follicles in the ear canal that usually cause by S. aureus.
This is self-limiting and is best treated by application of warm compress.

Condition Symptoms Treatment

Otitis Middle ear infection, ear pain, fever, - Antibiotics: Amoxicillin, Azithromycin,
Media hearing loss Clindamycin
- Self-care: Warm compress, elevate head
during sleep

Otitis Infection of the outer ear canal - OTC treatment for 48 hours
Externa (“swimmer’s ear”), ear pain, itching, - Antibiotic drops (e.g., cipro oxacin)
discharge - Steroid drops for in ammation
While both otitis media and otitis externa can present with ear pain and
discharge, fever is a distinguishing symptom of otitis media. It is often
associated with middle ear infections due to systemic involvement. In
contrast, itching is more characteristic of otitis externa, as it typically
involves the outer ear canal.

Questions
1. What is the optimal pH range for ophthalmic products?
• A. 2-3
• B. 4-5
• C. 5-6
• D. 6-8
• E. 8-10
Answer
2. Ophthalmic agents contraindicated in glaucoma patients include which of the following
substances?
• A. Antioxidants
• B. Decongestants
• C. Emollients

11
fi
fl
fl
ff
 • D. Antipruritic
• E. All of the above
Answer
3. Which of the following lenses can be worn continuously for 6 days?
• A. Soft lenses
• B. Extended wear soft lenses
• C. Frequent replacement soft lenses
• D. Hard lenses
• E. Soft and hard lenses
Answer
4. Image formed by the lens is received by:
• A. Iris
• B. Retina
• C. Sclera
• D. Conjunctiva
• E. Pupil
Answer
5. What is the correct statement about the treatment of eruption cysts in infants?
• A. In general, cysts rupture spontaneously.
• B. Use teeters to rupture cysts.
• C. Cysts can be manually removed.
• D. None of the above.
Answer
6. Which of the following treatment is used for cold sores symptom relief?
I. Antihistamine
II. Zinc oxide (ZnO)
III. Benzocaine 7.5% gel
• A. I only
• B. III only
• C. I and II only
• D. II and III only
• E. All of the above
Answer
7. What is the treatment of pruritic rash and macular to popular vesicular lesions before
crusting in chicken pox?
I. Calamine lotion
II. Oatmeal bath (micellar colloidal bath)
III. Antibiotics
• A. I only
• B. III only
• C. I and II only
• D. II and III only
• E. All of the above
Answer
8. Which of the following is the incorrect action of sympathetic alpha2 agonist drugs?
I. Increase of intraocular pressure (IOP).
II. Increase the drainage of H2O humor from the eye.
III. Decrease the H2O humor in the eye.
• A. I only
• B. III only
• C. I and II only
• D. II and III only
• E. All of the above
Answer
9. Which of the following ophthalmic conditions requires referral to a doctor?
• A. Red eye
• B. Pain in the eye

12
 • C. Blurred vision
• D. Dry eye
• E. B and C
Answer
10. The following ophthalmic conditions require referral to a doctor, EXCEPT:
• A. Red eye or pink eye
• B. Pain in eyes
• C. Blurred vision
• D. Dry eye in a diabetic patient
• E. Blepharitis
Answer
11. A customer of your pharmacy is using metformin 500 mg bid and glyburide QD.
He complains to have a gritty and sandy feeling in the eye. What is appropriate to
do?
• A. Refer to the doctor because of the diabetic condition.
• B. Refer to doctor because sandy and a gritty feeling in the eye indicate
conjunctivitis.
• C. Refer to a doctor because Glyburide’s side e ect is dry eyes.
• D. Refer to doctor because Metformin’s side e ect is dry eyes.
• E. Refer to a doctor because these are side e ects of anticholinergic drugs.
Answer
12. Which of the following can be used for earwax removal?
• A. Carbamide peroxide
• B. Soft mineral oil
• C. Burrow's solution (aluminum acetate)
• D. All of the above
Answer
13. Otitis externa (swimmers’ ear), is treated by which of the following over-the-
counter drugs?
• A. Amoxicillin high dose
• B. Amoxicillin + Clavulanate
• C. Aluminum acetate (Burrow's solution)
• D. Cephalosporin's
• E. Gramicidin/polymyxin B
Answer
14. A 60-year-old customer’s medical pro le includes metformin, glyburide,
amiodarone, rosuvastatin, and acetylsalicylic acid (ASA) 81 mg. Recently, a doctor
prescribed methotrexate to treat psoriasis. The patient reports sandy and gritty
eyes. The pharmacist directs the patient to see the doctor. Which of the following
drugs prompted pharmacist to refer patient to the doctor?
• A. Methotrexate
• B. Metformin
• C. Glyburide
• D. Amiodarone
• E. Rosuvastatin
Answer
15. A mother brings her child to the pharmacy with an itchy eye and tearing for 2
days, what do we have to do?
• A. Wait and watch
• B. Refer to doctor for eye assessment

13
fi
ff
ff
ff
 • C. Give some advice like washing eyes many times
• D. Give OTC decongestant ophthalmic drops
Answer
16. All of the following correctly applies to ear wax, EXCEPT:
• A. Accumulation may lead to hearing loss.
• B. Increase with age.
• C. Earbuds (Q-tips) are not allowed.
• D. Triethanolamine drops can be used.
• E. Mineral oil is used to remove it.
Answer
17. Which of the following eye conditions can be treated by non-prescription
therapy?
• A. Eye pain
• B. Vision changes
• C. Blepharitis
• D. Red eye
• E. Foreign object in the eye
Answer
18. What is incorrect about an ophthalmic lens?
• A. Soft lens is made of Hydroxyethyl methacrylate (HEMA).
• B. Surfactant in lens solution prevents infection.
• C. Protein cleaners in lens solution remove protein deposits.
• D. Wetting agents in lens solution produce lubricant e ect.
• E. Hard lens life 24 of lifespan and wearing time is >12 hours
Answer
19. What is true about ocular suspension?
• A. Ocular suspension has faster action than solution.
• B. Non-aqueous are used.
• C. Solution is more e ective than suspension.
• D. Agitation (shaking) is needed to form homogeneity and uniformity of
resultant particles.
Answer
20. A 58-year-old man brings a prescription of timolol 1gtt bid OD, prednisolone 1
gtt bid OD, and Voltaren (Diclofenac) 1 gtt bid OD after cataract surgery. What drug
causes burning and stinging sensation?
• A. Timolol
• B. Prednisolone
• C. Voltaren (diclofenac) eye drops
• D. Levocabastine
Answer

14
ff
ff