Topicals Quiz

Question 1

A major therapeutic implication of extensive first pass metabolism is that much larger oral doses than IV doses are required to achieve equivalent responses.

Drugs in this category include all EXCEPT:

A) Opioids
B) Beta adrenergic antagonists
C) Corticosteroids
D) Amiodarone

Answer 1

C

Question 2

A few published studies show that oral estrogen increases levels of C-reactive protein (CRP), a marker of inflammation that is associated with heart disease. A few studies of topical estrogen do not show an increase in CRP.

What kind of evidence is this?

A) Level 1
B) Level 2
C) Level 3
D) Level 4
E) Level 5

Answer 2

E - level 5 evidence: expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”

Question 3

Most medications are weak bases (alkaloids), resulting in a highly water soluble drug. In solution, a base _____ a proton, and an acid _____ a proton.

Answer 3

Accepts; donates

Question 4

In solution propranolol hydrochloride is a:

A) Weak acid
B) Weak base
C) Neutral

Answer 4

B - most medications are weak bases, and epinephrine HCl has accepted a proton

Question 5

Which statement is correct?

A) Estring contains estradiol and Femring contains estrace
B) Estring and Femring have the same indications
C) Femring provides about 5x as much bioavailable estradiol as Estring
D) Estring provides about 40 times as much bioavailable estradiol as Femring

Answer 5

C

Question 6

Your patient today is a 24 year old woman asking about taking a combined oral contraceptive for pregnancy protection. Which of the following patient factors are contraindicated?

A) History of GERD successfully managed with prilosec OTC
B) History of PID
C) Evidence of hirsutism
D) History of migraine headache successfully managed with Imitrex

Answer 6

D – this increases the risk of CVD and ischemic stroke

Question 7

______ is a vagina ring inserted once monthly, that stays in for 3 weeks and then out for 1 week.

______ is used for estrogen replacement and is supplied as a ring for insertion. (stays in for 3 months)

Answer 7

NuvaRing; Femring

Question 8

Which estrogen containing medication undergoes first pass metabolism so extensively that it results in an ineffective oral product?

A) Diethylstillbesterol
B) Mestranol
C) Estradiol
D) Esterified estrogens

Answer 8

C - extensive first pass metabolism precludes the use of oral estradiol (first pass metabolism = extensive digestion of drug in one specific area of the body before it can distrubte elsewhere and become effective)