Derm 2023 Exam 1

What is the rate limiting step for absorption of cutaneously delivered drugs?

• Drug diffusion through the stratum corneum

• Drug partitioning on the skin surface

• Drug diffusion to capillaries

• Drug release from the vehicle/delivery system

The PK profiles of transdermal drugs are different to that of an orally delivered drug. What are the potential advantages of a transdermal drug? Select all that apply

• Longer time spent in the therapeutic window

• Less trough-related inefficacy

• Longer t ½ compared to oral drugs

• Higher Cmax compared to oral dosing which gets the drug to a peak concentration faster

 Which transdermal design is matched INCORRECTLY with its mechanism of drug release?

• Reservoir patch – The concentration gradient drives the drug into the skin to give a “mini-loading dose.” The rest of the delivery is controlled by the membrane in the patch.

• Matrix patch – The membrane controls the rate of delivery of the drug for this patch. The membrane contains pores that allow the drug to seep through.

• Drug-in-adhesive patch – The skin controls the rate of delivery through this patch. Drug is in contact with the release liner and once applied to the skin, the skin is the layer that prevents dose dumping.

• Iontophoresis – Uses an electrical driving force to assist the transport of molecules through the stratum corneum.

A patient is started on the Duragesic Fentanyl patch. What are some counseling points that are important to convey to the patient? Select all that apply.

• Onset of the medication may lag before use, which is an important thing to keep in mind when you desire pain relief or may experience pain

• Fold the duragesic onto itself and place it in a trash container that is safe and away from any pets or animals, as the patch still contains active medication

• Rotate application sites after using one patch

• Dose dumping may occur if the patch is cut or if there is system malfunction

Which of the following forms of administration has the intention of only providing local effects on or in the skin itself (no systemic effects)?

• Transdermal

• Dermatological

• Topical

• All of the above

Which of the following are advantages of using transdermal drug administration compared to other delivery methods? (select all that apply)

• It avoids peak and trough plasma levels

• It undergoes first pass hepatic metabolism and allows for lower drug concentrations

• Removal of the patch immediately terminates the absorption of the drug

• There is less frequent dosing due to prolonged duration of action/release

TS presents to the dermatology clinic complaining of an area of redness on his left arm. His CC is that the area appeared a week ago and does not seem to be abating. TS’s PMH is significant for  hypertension and dyslipidemia. Upon inspection you notice that the area looks solid and is slightly elevated. The lesion is measured to be a size that is longer than 0.5 cm in diameter and spans a portion of his arm. Visual inspection confirms that there are no breaks in the skin and there is no fluid present. Upon palpation the color does not change.  What is the best characterization of the wound?

• Erythema

• Bulla

• Wheal

• Plaque

A 70 year old male patient comes to the pharmacy with dry skin. He has tried a lotion in the past, but complains that it is still just not helping with the dryness. You collect more information and find out that the dry skin is only on his lower legs and he has his wife help apply the lotion. He had been applying the lotion around 4-6 times a day with no relief. What would you recommend that this patient try next?

• Different brand of lotion

• Gel

• Eucerin cream

• Bath oil

Which of the following would be considered the highest potency corticosteroids? Select all that apply

• Betamethasone ointment

• Clobetasol cream

• Triamcinolone ointment

• Hydrocortisone cream

Which class of corticosteroids is matched correctly and would be appropriate for long term use for a 2 year old with atopic dermatitis on her arms?

• Class 1; Hydrocortisone 2% cream

• Class 7; Hydrocortisone 2% cream

• Class 5; Triamcinolone 0.1% ointment

• Class 7; Triamcinolone 0.1% cream