Pharmacy Continuing Education (CE)
Questions with complete solution
From Topicals to Biologics: The Evolution of Atopic Dermatitis Treatment and
Pharmacist Implications (Article) - correct answer ✔UAN: 0430-0000-20-086-
H01-P
Credits: 2.0 hours (0.20 ceu)
How many Americans have atopic dermatitis?
A) 10 million
B) 20 million
C) 30 million
D) 40 million - correct answer ✔C) 30 million
Which of the following describes atopic dermatitis?
A) Most people with AD (about 70%) have mild disease, usually treatable in
primary care settings
B) Clinicians recognize AD quickly and usually treat it aggressively,
appropriately, and quickly
C) Poor adherence, treatment complexity, and formulary access are rarely
problems for patients with AD
D) AD is generally a steadily progressive disease, with severity increasing
over time - correct answer ✔A) Most people with AD (about 70%) have mild
disease, usually treatable in primary care settings
Despite its relatively high prevalence, AD is under-recognized as a chronic
disease and is often either undertreated or treated inappropriately. Treatment
failure is a leading concern in patients who have AD, and can be directly
traced to poor adherence, treatment complexity, and formulary access. AD's
,course is often punctuated by periods of exacerbations (flares), and periods of
remission of various lengths.
Jacie is a 22-year-old female with poorly controlled AD, a problem she has
experienced since infancy. She has a flare on her hands that is so itchy, it's
keeping her awake all night. She is moisturizing multiple times daily and using
fluticasone propionate ointment 0.005% twice daily. What would be the BEST
change to her regimen?
A) Switch fluticasone propionate ointment 0.005% to desonide gel 0.05%
B) Switch fluticasone propionate ointment 0.005% to hydrocortisone valerate
ointment 0.2%
C) Have her apply the fluticasone propionate ointment 0.005% twice daily
followed by a tepid bath
D) Switch fluticasone propionate ointment 0.005% to halcinonide ointment
0.1% - correct answer ✔D) Switch fluticasone propionate ointment 0.005% to
halcinonide ointment 0.1%
Fluticasone propionate ointment 0.005% is a medium potency TCS. Gels can
be drying so answer A is incorrect. Hydrocortisone valerate ointment 0.2% is a
lower-medium potency, and Jacie needs to step up, not down. Applying her
ointment before bathing will not help. Halcinonide ointment 0.1% is a step up,
and the correct answer
Which of the following lists topical medications in the order they would be tried
in a 9-year-old patient who has AD?
A) Tacrolimus 0.03%, crisaborole, triamcinolone acetonide ointment
B) Triamcinolone acetonide ointment twice daily for maintenance,
desoximetasone gel 0.05% for flares
C) Hydrocortisone cream, triamcinolone acetonide ointment, crisaborole
D) Crisaborole, triamcinolone acetonide ointment, hydrocortisone cream -
correct answer ✔C) Hydrocortisone cream, triamcinolone acetonide
ointment, crisaborole
,Tacrolimus comes in 0.03% and 0.1% strength - the 0.1% strength is
comparable to midpotency TCSs but FDA has only approved the 0.03%
strength in children aged 2 to 15 years, so A is incorrect. Usually, patients will
use low-potency TCSs twice daily 2 to 3 times weekly for maintenance
therapy and medium-to-high potency TCSs twice daily every day when they
experience acute flares. Answer D is backward.
Jacie steps up her TCS and uses wet wrap therapy to help address her itchy
flare. Her skin is not responding, and she says that she has not been able to
tolerate the TCNIs in the past. Her SCORAD index is 53. What is the BEST
next step?
A) Call the dermatologist and suggest she change Jacie's medication to
methotrexate weekly for at least 8 weeks to ensure any response will be fast
and enduring
B) Suggest that Jacie add crisaborole lotion as a moisturizer, applying it as
needed and under wet wraps to increase skin hydration
C) Explain that with a SCORAD index of 53, she now has severe AD and will
need to consider systemic therapy
D) Use motivational interviewing to ensure that Jacie is completely adherent,
and ask her to come back in a week - correct answer ✔C) Explain that with a
SCORAD index of 53, she now has severe AD and will need to consider
systemic therapy
MTX can take 4 weeks to provide a response, so answer A is incorrect.
Crisaborole is indicated for mild AD, and Jacie's SCORAD places her in a
severe category, so answer B is incorrect. Answer C is correct. Adherence
does not seem to be an issue, and Jacie needs relief, so answer D is
incorrect.
Which of the following patients may need systemic treatment with an
immunomodulatory drug or biologic?
, A) A 35-year-old man (SCORAD = 33) who experiences TCS-responsive
flares once annually, usually in the winter
B) A 25-year-old woman (SCORAD = 47) who has used TCSs for many years
and can no longer tolerate them and who refuses to use TCNIs
C) A newly diagnosed 4-month-old infant who has a typical AD presentation
for his age and is treatment-naive
D) A 19-year-old college student who indicated during motivational
interviewing that she has not followed her AD action plan - correct answer
✔B) A 25-year-old woman (SCORAD = 47) who has used TCSs for many
years and can no longer tolerate them and who refuses to use TCNIs
Patient A has moderate AD that responds to TCS, so systemic treatment is
unnecessary. Patients B is a good candidate because she is not responding
to or cannot tolerate topical treatment. It's too early to start systemic treatment
in patient C; medications from lower steps are more appropriate. Patient D
needs to adhere to her existing plan before stepping up to systemic treatment.
Gary is experiencing a significant flare. He is responding to his TCS, but not
as quickly or as well as usual. Which step may occlude his TCA, increase
penetration, and reduce excoriation?
A) Wet Wrap therapy
B) Phototherapy
C) Bleach baths
D) Evening primrose oil - correct answer ✔A) Wet Wrap therapy
For significant flares or unmanageable disease wet wrap therapy (WWT;
applying a topical product then covering it with a wet layer of bandages,
gauze, or a cotton suit, followed by a dry outside layer) helps. WWT occludes
topical medication and increases its penetration. It also decreases skin's water
loss and provides a physical barrier against scratching (thus preventing
excoriation).
Questions with complete solution
From Topicals to Biologics: The Evolution of Atopic Dermatitis Treatment and
Pharmacist Implications (Article) - correct answer ✔UAN: 0430-0000-20-086-
H01-P
Credits: 2.0 hours (0.20 ceu)
How many Americans have atopic dermatitis?
A) 10 million
B) 20 million
C) 30 million
D) 40 million - correct answer ✔C) 30 million
Which of the following describes atopic dermatitis?
A) Most people with AD (about 70%) have mild disease, usually treatable in
primary care settings
B) Clinicians recognize AD quickly and usually treat it aggressively,
appropriately, and quickly
C) Poor adherence, treatment complexity, and formulary access are rarely
problems for patients with AD
D) AD is generally a steadily progressive disease, with severity increasing
over time - correct answer ✔A) Most people with AD (about 70%) have mild
disease, usually treatable in primary care settings
Despite its relatively high prevalence, AD is under-recognized as a chronic
disease and is often either undertreated or treated inappropriately. Treatment
failure is a leading concern in patients who have AD, and can be directly
traced to poor adherence, treatment complexity, and formulary access. AD's
,course is often punctuated by periods of exacerbations (flares), and periods of
remission of various lengths.
Jacie is a 22-year-old female with poorly controlled AD, a problem she has
experienced since infancy. She has a flare on her hands that is so itchy, it's
keeping her awake all night. She is moisturizing multiple times daily and using
fluticasone propionate ointment 0.005% twice daily. What would be the BEST
change to her regimen?
A) Switch fluticasone propionate ointment 0.005% to desonide gel 0.05%
B) Switch fluticasone propionate ointment 0.005% to hydrocortisone valerate
ointment 0.2%
C) Have her apply the fluticasone propionate ointment 0.005% twice daily
followed by a tepid bath
D) Switch fluticasone propionate ointment 0.005% to halcinonide ointment
0.1% - correct answer ✔D) Switch fluticasone propionate ointment 0.005% to
halcinonide ointment 0.1%
Fluticasone propionate ointment 0.005% is a medium potency TCS. Gels can
be drying so answer A is incorrect. Hydrocortisone valerate ointment 0.2% is a
lower-medium potency, and Jacie needs to step up, not down. Applying her
ointment before bathing will not help. Halcinonide ointment 0.1% is a step up,
and the correct answer
Which of the following lists topical medications in the order they would be tried
in a 9-year-old patient who has AD?
A) Tacrolimus 0.03%, crisaborole, triamcinolone acetonide ointment
B) Triamcinolone acetonide ointment twice daily for maintenance,
desoximetasone gel 0.05% for flares
C) Hydrocortisone cream, triamcinolone acetonide ointment, crisaborole
D) Crisaborole, triamcinolone acetonide ointment, hydrocortisone cream -
correct answer ✔C) Hydrocortisone cream, triamcinolone acetonide
ointment, crisaborole
,Tacrolimus comes in 0.03% and 0.1% strength - the 0.1% strength is
comparable to midpotency TCSs but FDA has only approved the 0.03%
strength in children aged 2 to 15 years, so A is incorrect. Usually, patients will
use low-potency TCSs twice daily 2 to 3 times weekly for maintenance
therapy and medium-to-high potency TCSs twice daily every day when they
experience acute flares. Answer D is backward.
Jacie steps up her TCS and uses wet wrap therapy to help address her itchy
flare. Her skin is not responding, and she says that she has not been able to
tolerate the TCNIs in the past. Her SCORAD index is 53. What is the BEST
next step?
A) Call the dermatologist and suggest she change Jacie's medication to
methotrexate weekly for at least 8 weeks to ensure any response will be fast
and enduring
B) Suggest that Jacie add crisaborole lotion as a moisturizer, applying it as
needed and under wet wraps to increase skin hydration
C) Explain that with a SCORAD index of 53, she now has severe AD and will
need to consider systemic therapy
D) Use motivational interviewing to ensure that Jacie is completely adherent,
and ask her to come back in a week - correct answer ✔C) Explain that with a
SCORAD index of 53, she now has severe AD and will need to consider
systemic therapy
MTX can take 4 weeks to provide a response, so answer A is incorrect.
Crisaborole is indicated for mild AD, and Jacie's SCORAD places her in a
severe category, so answer B is incorrect. Answer C is correct. Adherence
does not seem to be an issue, and Jacie needs relief, so answer D is
incorrect.
Which of the following patients may need systemic treatment with an
immunomodulatory drug or biologic?
, A) A 35-year-old man (SCORAD = 33) who experiences TCS-responsive
flares once annually, usually in the winter
B) A 25-year-old woman (SCORAD = 47) who has used TCSs for many years
and can no longer tolerate them and who refuses to use TCNIs
C) A newly diagnosed 4-month-old infant who has a typical AD presentation
for his age and is treatment-naive
D) A 19-year-old college student who indicated during motivational
interviewing that she has not followed her AD action plan - correct answer
✔B) A 25-year-old woman (SCORAD = 47) who has used TCSs for many
years and can no longer tolerate them and who refuses to use TCNIs
Patient A has moderate AD that responds to TCS, so systemic treatment is
unnecessary. Patients B is a good candidate because she is not responding
to or cannot tolerate topical treatment. It's too early to start systemic treatment
in patient C; medications from lower steps are more appropriate. Patient D
needs to adhere to her existing plan before stepping up to systemic treatment.
Gary is experiencing a significant flare. He is responding to his TCS, but not
as quickly or as well as usual. Which step may occlude his TCA, increase
penetration, and reduce excoriation?
A) Wet Wrap therapy
B) Phototherapy
C) Bleach baths
D) Evening primrose oil - correct answer ✔A) Wet Wrap therapy
For significant flares or unmanageable disease wet wrap therapy (WWT;
applying a topical product then covering it with a wet layer of bandages,
gauze, or a cotton suit, followed by a dry outside layer) helps. WWT occludes
topical medication and increases its penetration. It also decreases skin's water
loss and provides a physical barrier against scratching (thus preventing
excoriation).
