NAPLEX Question of the Week: Dosage Forms

There are two areas I believe strongly where pharmacists are truly experts and invaluable in medicine: Dosage forms and drug interactions. There are a number of important questions answered or interventions made on a daily basis regarding dosage forms. This important area is found in NABP Competency Statement 1.2.14: Routes and methods of administration, dosage forms, and delivery systems. Today's question will focus on this vital area to pharmacy practice.

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GG is a 63-year old male who was diagnosed with Parkinson’s disease (PD) two years ago with a primary symptom of uncontrollable tremor which was initially treated with amantadine.  The neurologist has decided now to switch to a dopamine agonist due to increased rigidity and bradykinesia. She asks your expertise regarding dosage form availability of dopamine agonists as there is some concern for inability to swallow after GG experienced a stroke several weeks ago. Which of the following dosage forms are dopamine agonists available? Select all that apply.

a. Intravenous piggyback

b. Oral tablets

c. Oral suspension

d. Sublingual tablet

e. Transdermal patch

Answer with Rationale:

The correct answers are b and e. Dosage form modification is a common need in healthcare due to individualized needs within a patient such as inability to take oral (stroke, significant nausea/vomiting, etc.). This is a common occurrence in both the inpatient and outpatient setting. Nitroglycerin is a classic example of a medication with a number of different dosage forms including sublingual tablet, capsule, spray, intravenous, etc. because of the urgent need to give it in the setting of acute coronary syndromes.

For this patient unfortunately there are not a lot of non-oral dosage forms available for dopamine agonists. The only ones available are oral tablets (most all agents) and one agent (Rotigotine-Neupro) is available for transdermal administration.

Have you started studying yet? Do you have a plan? Now is the time to get rolling. The exam will be here before you know it!

Christopher M. Bland

Clinical Associate Professor, University of Georgia College of Pharmacy