NAPLEX Question of the week – Dosage Form Focus: Transdermal Patches

Understanding how often patches are applied, when to remove them, correct location of patch placement, frequency of dosing, how to dispose, and other manipulations to the patch are important counseling points to remember when discussing with your patients.

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Match the following medications with the correct frequency of dosing. Please select all that apply.

a. Exelon® once daily

b. Vivelle-Dot® once daily

c. Catapres-TTS ® once weekly

d. Lidoderm® once weekly

e. Transderm Scop® once every 72 hours 

f. Duragesic® once daily




Answer with rationale:

 Answer A, rivastigmine (Exelon®) is correct. This is one of the daily patches. Test taking tip: remember with this exam you may see brand or generic names listed in answer choices which is why it is important to brush up on those you are unfamiliar. 

Answer B, estradiol patch (Vivelle-Dot®, Avelle®) is incorrect. This is a patch that you apply twice weekly. This patch can be three weeks on and one week off but you still apply the patch twice weekly for the “on” weeks. Counseling pearl: you apply this patch to the lower abdomen. Brand names matter. The brand Climara® is a form of estradiol that is a weekly patch. Test taking tip: knowing the location where you apply certain patches is also important.

Answer C, clonidine (Catapres-TTS®), is correct. This is a weekly patch. Counseling pearl: this patch must be removed prior to an MRI procedure. 

Answer D, lidocaine (Lidoderm®) is incorrect. You apply this patch every 12 hours and then counsel patients to remove the patch for the remaining 12 hours in the day. Counseling pearl: this is one of the few patches that you are allowed to cut if needed to adjust the size of the patch.

Answer E, scopolamine (Transderm Scop®) is correct. This is one of the patches that you apply every 72 hours as needed. Counseling pearl: the location for this patch is behind your ear. This patch must be removed prior to an MRI procedure. 

Answer F, fentanyl (Duragesic®) is incorrect. This is a patch applied every 72 hours typically and then must be removed or replaced. Counseling pearl: ensure you dispose of this patch by folding the patch together and flushing down the toilet to avoid any harmful exposure to children or others who may get their hands on it resulting in fatal overdose. 

I would like to give a huge thanks to my current academia resident, Adam Pizzuti, Pharm.D., for his work over the last 4 weeks in helping to create the question of the week.   

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.