Allergy, Nasal, and Eye Medicines

Which of the following statements about the action of antihistamine ingredients in oral allergy medicines is correct?

1. They stimulate the sympathetic nervous system to constrict blood vessels in the nasal mucosa, relieving nasal congestion and swelling.
2. They act by suppressing the release of histamine itself from mast cells.
3. They suppress the action of histamine by interfering with the reaction between histamine released from mast cells and its receptor.
4. They suppress parasympathetic nervous system activity, thereby suppressing nasal discharge and sneezing.

Which of the following statements about the mechanism by which allergies (hypersensitivity reactions) occur is correct?

1. Histamine released from mast cells reacts with its receptor to cause vasoconstriction and decreased vascular permeability, among other effects, which are thought to produce allergic symptoms such as hives.
2. Hives arise only from contact with an allergen and never result from physical stimulation of the skin, as in cold urticaria or solar urticaria.
3. Which substances become allergens is the same for everyone, and multiple substances cannot act as allergens for the same person.
4. When an allergen enters the body, mast cells are stimulated by immunoglobulins (antibodies) that specifically recognize the substance, releasing substances such as histamine and prostaglandins.

Which of the following statements about oral medicines containing antihistamine ingredients is incorrect?

1. Because antihistamine ingredients do not exhibit anticholinergic action, side effects such as difficulty urinating or dry mouth never occur.
2. Histamine plays a role in maintaining and regulating wakefulness in a region at the base of the brain that is heavily involved in sleep and wakefulness, so suppressing this action with an antihistamine ingredient promotes drowsiness.
3. After taking the medicine, one is advised to avoid operating a vehicle or machinery.
4. Ingredients containing diphenhydramine carry a risk that part of the absorbed diphenhydramine will transfer into breast milk and cause coma in a nursing infant.

According to the Guide, which of the following people is NOT listed as someone who should avoid using an oral nasal medicine containing pseudoephedrine hydrochloride?

1. A person diagnosed with a thyroid function disorder
2. A person with difficulty urinating due to prostatic hypertrophy
3. A person diagnosed with high blood pressure
4. A person diagnosed with anemia

Which of the following statements about pseudoephedrine hydrochloride is correct?

1. Compared with other adrenergic ingredients, it has a stronger action on the central nervous system, and side effects such as insomnia and nervous irritability can occur.
2. Use by a person being treated with a monoamine oxidase inhibitor such as selegiline hydrochloride does not make side effects more likely to occur.
3. It is a non-dependence-forming ingredient, and long-term continuous use carries no risk of leading to drug dependence.
4. It relieves nasal congestion and swelling by stimulating the parasympathetic nervous system to dilate blood vessels in the nasal mucosa.

Which of the following statements about anticholinergic ingredients contained in oral nasal medicines is correct?

1. They suppress secretion of mucus from the mucous glands in the nasal cavity and also suppress parasympathetic nervous system activity, which conveys stimulation within the nasal cavity, thereby suppressing nasal discharge and sneezing.
2. Belladonna is an herb of the Asteraceae (daisy) family whose flower spikes contain an alkaloid that enhances parasympathetic nervous system activity.
3. Isopropamide iodide is considered an adrenergic ingredient that relieves nasal congestion and swelling by stimulating the sympathetic nervous system to constrict blood vessels in the nasal mucosa.
4. Anticholinergic ingredients relieve nasal symptoms such as nasal discharge, sneezing, and congestion by suppressing the release of histamine itself from mast cells.

Which of the following statements about kampo formula preparations considered suited to people whose main symptoms are nasal is correct?

1. Shoseiryuto (小青竜湯, sho-seiryu-to) is a kampo formula preparation that contains ephedra (麻黄, mao) but does not contain licorice root (甘草, kanzo) as a constituent crude drug, and is considered suited to people whose main symptoms are nasal.
2. Shin'iseihaito (辛夷清肺湯, shin'i seihai-to) is a kampo formula preparation that contains licorice root (甘草, kanzo) as a constituent crude drug.
3. Kakkontokasenkyushin'i (葛根湯加川芎辛夷, kakkonto ka senkyu shin'i) contains ephedra (麻黄, mao) as a constituent crude drug and is considered suited to people with relatively robust constitutions who have nasal congestion, sinusitis (chikunosho), or chronic rhinitis.
4. Keigairengyoto (荊芥連翹湯, keigai rengyo-to) is a kampo formula preparation considered suited not to people whose main symptoms are nasal, but to people whose main symptoms are dermatological, and is used for acne.

Which of the following kampo formula preparations is considered suited to a person of medium build or weaker, with a tendency to feel cold, whose skin is dry, with eczema/dermatitis (with little discharge) and itching?

1. Inchinkoto (茵蔯蒿湯, inchinko-to)
2. Jumihaidokuto (十味敗毒湯, jumi haidoku-to)
3. Shofusan (消風散, shofu-san)
4. Toukiin-shi (当帰飲子, toki-inshi)

Which of the following statements about interactions and advice to seek medical care for oral allergy medicines is incorrect?

1. Because the same ingredient or ingredients with the same type of action can overlap between an oral medicine and an external medicine, as with an oral allergy medicine and a nasal spray, caution is needed.
2. No over-the-counter medicine (including kampo formula preparations) is intended for treating chronic eczema due to atopic dermatitis or the like.
3. If no improvement in symptoms is seen after use for five to six days, a response such as seeing a doctor is necessary.
4. Since over-the-counter allergy medicines are intended to improve one's constitution, it is desirable to continue using them for a long period even if no improvement in symptoms is seen.

Which of the following statements about rhinitis and sinusitis is correct?

1. Acute rhinitis is inflammation of the nasal mucosa caused by a hypersensitivity reaction to an allergen such as house dust or pollen.
2. Over-the-counter nasal sprays are intended to cover not only acute rhinitis but also chronic sinusitis such as chikunosho.
3. Among cases of allergic rhinitis, those caused by an allergen such as cedar pollen are generally called "chikunosho" (sinusitis/empyema).
4. Sinusitis is inflammation of the nasal mucosa that has extended to the paranasal sinuses; the chronic form is generally called "chikunosho."

Which of the following statements about nasal sprays containing an adrenergic ingredient is correct?

1. Naphazoline hydrochloride is an ingredient that stimulates the parasympathetic nervous system to constrict blood vessels in the nasal mucosa, relieving nasal congestion and rhinitis symptoms.
2. Rebound congestion occurs from excessive vasoconstriction of the nasal mucosa's blood vessels caused by overuse of a nasal spray containing an adrenergic ingredient.
3. Excessive use makes the blood vessels of the nasal mucosa stop responding, and the vessels instead dilate, causing rebound congestion, which tends to worsen nasal congestion.
4. Because a nasal spray is applied locally within the nasal cavity, its ingredients are never absorbed through the blood vessels of the nasal mucosa to produce a systemic effect.

Which of the following statements about adrenergic ingredients contained in nasal sprays is incorrect?

1. Adrenergic ingredients such as naphazoline hydrochloride, phenylephrine hydrochloride, and tetrahydrozoline hydrochloride are used.
2. The ingredient is readily absorbed into the circulating blood through the blood vessels running through the nasal mucosa and can produce systemic effects.
3. Because it is a medicine applied locally, excessive use never worsens nasal congestion.
4. They relieve nasal congestion and swelling by stimulating the sympathetic nervous system to constrict blood vessels running through the nasal mucosa.

Which of the following statements about sodium cromoglicate contained in nasal sprays is correct?

1. It suppresses rhinitis symptoms by interfering with the reaction between histamine released from mast cells and its receptor.
2. No serious side effect is known, so it can be used without consultation even by a person receiving allergy treatment at a medical institution.
3. It is also effective against rhinitis or sinusitis that is not allergic in nature.
4. It suppresses the release of histamine from mast cells and is usually combined with an antihistamine ingredient.

Which of the following statements about antiseptic/germicidal ingredients contained in nasal sprays is correct?

1. Benzalkonium chloride is an anionic surfactant ingredient and is included to keep the nasal mucosa clean and prevent secondary bacterial infection.
2. Cetylpyridinium chloride shows germicidal action not only against some general bacteria (Staphylococcus aureus, hemolytic streptococci) and fungi, but also against tuberculosis bacteria and viruses.
3. Antiseptic/germicidal ingredients are included to constrict blood vessels in the nasal mucosa and relieve congestion and swelling.
4. Benzalkonium chloride and benzethonium chloride show germicidal action against Staphylococcus aureus, hemolytic streptococci, and fungi such as Candida.

Which of the following statements about using a spray-type nasal medicine is incorrect?

1. Because the spray may flow back out along with nasal discharge after use, the nose should be blown well before use.
2. To prevent contamination, avoid letting the container touch the nose directly as much as possible.
3. After use, wipe the part that contacted the nose with a clean tissue and always store the bottle with the cap closed.
4. Sharing the same nasal spray among family members is acceptable.

Which of the following statements about ingredients in nasal sprays and their intended purpose is correct?

1. Dipotassium glycyrrhizinate is included to constrict blood vessels in the nasal mucosa and relieve congestion.
2. Ketotifen fumarate is included as a local anesthetic ingredient.
3. Lidocaine is a local anesthetic ingredient included to suppress hypersensitivity, pain, and itching of the nasal mucosa.
4. Chlorpheniramine maleate is an antiseptic/germicidal ingredient included to prevent secondary bacterial infection.

Which of the following statements about advice to seek medical care for nasal sprays is correct?

1. Because a nasal spray acts only locally within the nasal cavity, long-term continuous use never affects organs other than the nose.
2. If no improvement in symptoms is seen after about three days of use, a response such as visiting a medical institution (ENT) is needed rather than continuing use indefinitely.
3. Over-the-counter nasal sprays are intended to cover chronic sinusitis conditions such as chikunosho.
4. Even when the nasal mucosa has swollen into a polyp (hanatake), it is appropriate to address it with an over-the-counter nasal spray.

Which of the following statements about over-the-counter ophthalmic medicines is correct?

1. General eye drops are intended only to supplement tear components, and never contain an ingredient that suppresses symptoms such as eye fatigue, itching, or conjunctival hyperemia.
2. Eyewashes never contain a tear component, and contain only an anti-inflammatory ingredient and an antihistamine ingredient.
3. Antibacterial eye drops contain an antibacterial ingredient and are used for conjunctivitis (pinkeye), a stye (hordeolum), blepharitis (eyelid inflammation), and the like.
4. Artificial tears are intended to improve conjunctivitis (pinkeye), a stye (hordeolum), or blepharitis (eyelid inflammation) through the inclusion of an antibacterial ingredient.

Which of the following statements about the method of applying eye drops is correct?

1. The applied liquid may flow into the nasal cavity and be absorbed through the nasal mucosa or throat, but this never causes a side effect.
2. The capacity of the conjunctival sac is about 50 microliters, larger than the volume of one drop, about 30 microliters, so it is fine to apply several drops at once.
3. Because one drop is not enough, it is desirable to apply several drops at once.
4. The volume of one drop is about 50 microliters, whereas the capacity of the conjunctival sac is about 30 microliters, so applying multiple drops at once does not increase the effect.

Which of the following statements about the use of eye drops is incorrect?

1. The expiration date printed on the eye drop container applies to storage in an unopened state.
2. Closing the eyelid for a while after applying the drop, and pressing on the inner corner of the eye during that time, can effectively prevent the liquid from flowing into the nasal cavity.
3. It is acceptable to share eye drops that another person is using, as long as the tip of the container does not directly touch anything.
4. If the tip of the container touches the eyelid or eyelashes when applying the drop, germs can mix into the liquid and cause contamination.

Which of the following statements about the method of applying eye drops while wearing contact lenses is correct?

1. Because soft contact lenses do not readily absorb moisture, there is no risk of a preservative such as benzalkonium chloride being absorbed into the lens and causing corneal damage.
2. No single-use, preservative-free product exists that can be used while wearing soft contact lenses.
3. With hard contact lenses, it is acceptable to apply eye drops while wearing them regardless of what the package insert says.
4. Applying eye drops while wearing contact lenses, whether soft or hard, should not be done unless the package insert states that it is possible.

Which of the following statements about neostigmine methylsulfate is correct?

1. It suppresses the action of cholinesterase, thereby assisting the action of acetylcholine in the ciliary body, and improves the eye's accommodative function.
2. It is an ingredient included in general eye drops that suppresses histamine action to relieve eye itching and conjunctival hyperemia.
3. It is an ingredient that constricts blood vessels running through the conjunctiva to remove eye hyperemia.
4. It improves the eye's accommodative function by assisting the action of cholinesterase to promote the breakdown of acetylcholine in the ciliary body.

Which of the following statements about adrenergic ingredients included in eye drops to remove eye hyperemia is incorrect?

1. In a person diagnosed with glaucoma, they may raise intraocular pressure, worsening the glaucoma or interfering with its treatment.
2. Continuous or frequent use can cause abnormal glare sensitivity or, conversely, induce eye hyperemia.
3. Even if no improvement in symptoms is seen after five to six days of use, it is fine to keep using it as long as there is no side effect.
4. Naphazoline hydrochloride, tetrahydrozoline hydrochloride, and the like may be included to remove eye hyperemia by constricting blood vessels running through the conjunctiva.

Which of the following statements about ophthalmic medicine ingredients and their intended purpose is correct?

1. Epsilon-aminocaproic acid is used for its expected effect of improving reactions such as visual accommodation by being involved in the reaction by which photoreceptor cells sense light.
2. Sodium azulene sulfonate is an astringent ingredient that binds to protein in the ocular mucosa to form a protective film.
3. Sodium chondroitin sulfate is used to prevent drying of the cornea.
4. Zinc sulfate hydrate is included for its expected effect of promoting tissue repair in inflamed ocular mucosa.

Which of the following statements about sulfa drugs included in eye drops is correct?

1. Even if no improvement in symptoms is seen after three to four days of use, one can expect the effect to appear by continuing use as is.
2. Sulfa drugs such as sulfamethoxazole are used for conjunctivitis (pinkeye), a stye (hordeolum), and blepharitis caused by bacterial infection, and are considered effective against all microorganisms, including viruses and fungi.
3. There is no need to avoid use even in a person who has previously had an allergic reaction to a sulfa drug.
4. Sulfamethoxazole is used for the expected improvement of suppurative symptoms such as conjunctivitis (pinkeye), a stye (hordeolum), or blepharitis caused by bacterial infection, but has no effect against viral or fungal infection.