540 - Drug Delivery Systems - Exam Iv - Vaginal Delivery

Front 1

Describe the premenopause size of the vagina.

Back 1

11 cm long & 2 cm wide

Front 2

Describe the postmenopause size of the vagina.

Back 2

4 to 5 cm long & 1 to 1.5 cm wide

Front 3

What mass of fluid or gel can the vagina hold without leakage?

Back 3

2 to 3 g

Front 4

How does the nerve supply and sensitivity to pain vary between the lower ¼ of the vagina and the upper vagina?

Back 4

The lower ¼ of the vagina has a peripheral nerve supply, which is sensitive to pain, while the nerve supply to the upper vagina is from the autonomic nervous system and is less sensitive to pain.

Front 5

List five histological features of the vagina.

Back 5

1) Stratified Squamous Epithelium, 2) Mucous Membrane, 3) High Vascularity, 3) Elastic Fibers, & 5) Dense Connective Tissues & Muscles

Front 6

Describe the vaginal rugae and the medical relevance of its properties.

Back 6

The vaginal rugae are a series of transverse epithelial ridges produced by folds of the wall of the outer third of the vagina. They provide the vagina with an increased surface area that readily expands, allowing objects to be placed into the vagina without injury, and it helps retain a medication in the vagina once placed there.

Front 7

Describe the arrangement of arteries and veins around the vagina.

Back 7

The arteries and veins around the vagina form a dense “plexus.”

Front 8

Does a medication administered vaginally undergo the first pass effect?

Back 8

No: venous blood does not immediately pass though the liver.

Front 9

At approximately what age does menopause occur?

Back 9

51 years old is the typical age of menopause.

Front 10

List seven age-related changes in the vagina caused by estrogen loss.

Back 10

1) The epithelium becomes thin and invaded with leucocytes; 2) pH increases, increasing the risk of infections; 3) Mitosis slows; 4) Glycogen is reduced; 5) Fewer blood vessels, leading to decreased blood flow; 6) Dryness, through a reduction in secretions; & 7) Increase in enzymes-acid phosphatase, non-specific esterases.

Front 11

List seven physical symptoms associated with vaginal atrophy due to a decline in estrogen.

Back 11

1) Irritation/burning/pressure, 2) Post-coital bleeding, 3) Purulent discharge, 4) Urinary tract infection, 5) Lack of lubrication with sexual arousal and orgasm, 6) Dyspareunia (pain during intercourse), & 7) Bacterial or yeast infections

Front 12

List five formulations for Estrogen Replacement Therapy (ERT).

Back 12

1) Creams, 2) Gels, 3) Suppositories, 4) Tablets, & 5) Rings

Front 13

List three uses of progesterone.

Back 13

1) Prevention of endometrial cancer, 2) IVF (In Vitro Fertilization): The woman must take progesterone for 8 to 10 weeks to thicken the lining of the womb to facilitate implantation of the transferred embryo, 3) PMS

Front 14

List four advantages of vaginal progesterone delivery.

Back 14

1) Targeted delivery, 2) No systemic side effects, 3) No first-pass metabolism, & 4) Infrequent dosing

Front 15

List three “advantages” of a topical contraceptive.

Back 15

1) It is applied vaginally (< 30 min), 2) The spermicide nonoxynol-9 enters cervical mucus, & 3) 24 hr activity (non-viral)

Front 16

What is the Mechanism of Action for Nonoxynol-9?

Back 16

Nonoxynol-9 is a surfactant that destroys the cell membrane of sperm. It has a similar structure to lipids.

Front 17

What are some advantages of Nonoxynol-9?

Back 17

It is easy to use. It can be used intermittently, without advanced planning. It has a sustained spermicidal action (morning after). And it is available without a prescription.

Front 18

What are some disadvantages of Nonoxynol-9?

Back 18

It has a high failure rate (29% with typical use). It offers no protection against STIs. And using it twice a day or more may cause tissue irritation that could increase susceptibility to HIV.

Front 19

What is the typical pH in the vagina?

Back 19

4.0 to 5.0

Front 20

How does enzyme activity in the vagina compare with that of the GI tract?

Back 20

Enzyme activity in the vagina is less than that of the GI tract.

Front 21

What two pathways of drug absorption do cyclic changes in the vaginal epithelium alter?

Back 21

Cyclic changes in vaginal epithelium alter both transcellular and paracellular drug uptake.

Front 22

How does the luteal phase influence the absorption of hydrophilic drugs?

Back 22

The luteal phase offers increased absorption possibilities for hydrophilic drugs.

Front 23

How does the proesterus and diesterus absorption of salicylic acid (Na+ salt) differ?

Back 23

Proestrus absorption of salicylic acid (Na+ salt) is 29%, while diestrus absorption is 66%.

Front 24

How does vidaribine absorption differ during diestrus?

Back 24

The permeability coefficient is 5 to 100 times higher during diestrus.

Front 25

What is the effective area of contact in the vaginal cavity?

Back 25

~60 cm2

Front 26

List four advantages of semi-solid vaginal dosage forms, such as gels and creams.

Back 26

1) Prolonged residence, 2) inexpensive, 3) ease of manufacture, & 4) spreadability

Front 27

List four disadvantages of semi-solid vaginal dosage forms, such as gels and creams.

Back 27

1) Messy, 2) frequent application, 3) difficult to remove, & 4) preservative

Front 28

What are the advantages and disadvantages of tablets as vaginal formulations?

Back 28

The advantage of tablets is simply easy of insertion. The disadvantages include expense, frequency of applications, difficult to dissolve, patient compliance, and lack of spreadability.

Front 29

What is a Pessary?

Back 29

According to Wikipedia, a pessary is a small plastic or silicone medical device which is inserted into the vagina or rectum and held in place by the pelvic floor musculature.

Front 30

List three advantages of pessaries / suppositories as vaginal formulations.

Back 30

1) Ease of insertion, 2) Relatively inexpensive, & 3) They can accommodate drugs in solution, emulsion, or in suspension.

Front 31

List three disadvantages of pessaries / suppositories as vaginal formulations.

Back 31

1) Frequent applications, 2) Poor retention in the vagina, & 3) Lack of spreadability

Front 32

List four mechanisms involved in the formulation of bio-adhesives.

Back 32

1) Electronic, 2) Adsorption, 3) Wetting, & 4) Diffusion

Front 33

List five types of interaction involved in the formulation of bio-adhesives.

Back 33

1) Covalent, 2) Hydrogen Bonding, 3) Electrostatic, 4) Hydrophobic, & 5) Van der Waals

Front 34

List four attractive features of vaginal ring technology.

Back 34

1) 30+ day of drug delivery, 2) Potential reduction in compliance burden, 3) Ease of use, & 4) “Low” cost.

Front 35

List four “unknowns” associated with vaginal ring technology.

Back 35

1) Acceptability in relevant populations, 2) Scale up manufacturability, 3) Feasibility of multi-drug combinations, & 4) Environmental impact

Front 36

What is PGE-2?

Back 36

PGE-2 (Prostaglandin E2) is an agent used to ripen the cervix for the induction of labor.

Front 37

What is a Microbicide?

Back 37

A microbicide is “a substance that can substantially prevent or reduce transmission of HIV when applied to the vagina.”

Front 38

What are the vaginal defenses?

Back 38

1) Flora
2) Immune Cells
3) pH

Front 39

What is the major cause of vaginitis?

Back 39

Infection