COA® Pharmacology Study Guide

Pharmacology is 6% of the COA® exam under IJCAHPO’s content outline effective August 1, 2025. Expect questions on putting drops in safely, the dilating drops you’ll use most days (mydriatics widen the pupil; cycloplegics also relax focusing), what to tell patients, how medication orders are written, and the different forms eye drugs come in.

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For exam study only. Follow your ophthalmologist’s orders and your clinic’s policies for any medication.

What the exam covers

Pharmacology is 6% of the COA exam (COA content areas, effective 8/1/2025). Older IJCAHPO handbooks show a lower share, so go by the current outline. At the COA level, IJCAHPO’s content breakdown covers the following. This grouping and wording are ours; see the PDF for the official list.

• At the chair: putting drops and ointments in, and being able to explain how you do it.
• Dilating the patient: why the pupil-widening and focus-relaxing drops are used, who shouldn’t get them, and what side effects to watch for.
• Sending the patient home: teaching them how to use their medicines.
• Reading the chart: what a written medication order contains.
• Background: the forms eye drugs come in, and the trade-offs between them.

Glaucoma drugs, anti-infectives, steroids and other drug classes appear at the COT and COMT levels (same content breakdown, COT and COMT columns).

Drug delivery

The outline names five forms. In the order you’re likely to meet them: drops and ointments put on the eye, drugs that act on the whole body (such as pills), shots given in or near the eye, and slow-release forms that let a drug out over time. Be ready to give a pro and a con for each from your study materials.

One point the drug labels make directly: eye drops can be absorbed into the body. That’s why the tropicamide and cyclopentolate labels say to press on the lacrimal sac (inner corner of the eye) for 2–3 minutes once the drop is in, to cut down systemic absorption (tropicamide label, cyclopentolate label).

Parts of a prescription

A federal rule for controlled-substance prescriptions (21 CFR 1306.05) lists the parts a prescription must have. It’s a handy checklist:

• date issued and the prescriber’s signature;
• patient’s full name and address;
• drug name, strength and dosage form;
• quantity prescribed;
• directions for use;
• prescriber’s name, address and registration number.

Instilling drops

The steps below are our summary. Check them against IJCAHPO’s best-practice procedure (PDF) and your clinic’s policy.

1. Before you start: clean your hands, then confirm you have the right patient, the right order and no allergy to the drug.
2. Check the bottle: right drug, not expired, and the right eye. For a dilating drop, look at how deep the anterior chamber is first.
3. Tell the patient what you’re about to do and what they might feel.
4. Position: head tipped back, eyes up. Ease the lower lid down to make a small pocket and let a single drop fall into it.
5. Keep the tip clean: it should never touch the eye, lids or lashes. If it does, treat the bottle as contaminated and follow clinic policy.
6. Afterward: cap the bottle straight away and ask the patient to keep the eye softly closed for a short while.
7. Write it down: note which drug and what time in the chart.

Mydriatics and cycloplegics

• Mydriatic: dilates the pupil (mydriasis).
• Cycloplegic: paralyzes accommodation (cycloplegia), the eye’s ability to focus up close.

Sources: tropicamide label, cyclopentolate label (DailyMed).

Patient instructions

Both labels tell patients:

• don’t drive or do hazardous activities while the pupils are dilated;
• expect light sensitivity, and protect the eyes in bright light;
• keep the bottle tip from touching anything, to keep it clean;
• parents: don’t let a child get the drops in their mouth, and both of you should wash up after use.

Practice questions

1. A drug that dilates the pupil but does not mention paralysis of accommodation is best called a:

   Show answer

   Mydriatic. A cycloplegic paralyzes accommodation.

2. Before instilling a dilating drop, IJCAHPO’s procedure says to check:

   Show answer

   Anterior chamber depth (plus patient identity, the order, allergies, the label, expiration and which eye).

3. Where does the drop go?

   Show answer

   Into the pocket made by easing the lower lid down while the patient looks up.

4. Why should the bottle tip never touch the eye or lashes?

   Show answer

   Touching contaminates the bottle.

5. Per its label, how long can complete recovery of accommodation take after cyclopentolate?

   Show answer

   Usually 6 to 24 hours.

6. Why hold pressure on the lacrimal sac for a few minutes after these drops go in?

   Show answer

   To reduce systemic absorption, as the tropicamide and cyclopentolate labels say.

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