Acne, Contraception & Erectile Dysfunction Flashcards
In order for acne to be diagnosed what must be present?
(comedones) which may be open (blackheads) or closed (whiteheads)
What are the possible underlying causes of acne?
Drugs
Hyperandrogenism
What 5 drugs can exacerbate or cause acne?
androgens, corticosteroids, isoniazid, ciclosporin and lithium
In a pt with acne what would menstrual irregularity and hirsutism suggest?
PCOS
5 advice points for someone with acne
To avoid over cleaning the skin - not caused by dirty skin
If make-up, pH close to the skin are recommended.
To avoid picking and squeezing spots
treatments are effective but take time to work (usually up to 8 weeks) and may irritate the skin, especially at the start of treatment.
To maintain a healthy diet
2 choices of treatment for mild-moderate acne?
Topical retinoid + benzoyl peroxide
Topical antibiotic + benzoyl peroxide (pregnant/breastfeeding)
Treatment option for moderate acne not responding to first line?
benzoyl peroxide + oral antibiotic
COCP + topical agents
How will progesterone only pill or implant affect acne?
Possible exacerbate it
When should you review acne treatment?
8-12 weeks
When should you refer acne to dermatologist?
Uncertainty
More sever forms
Not responding - isotretinoin is derm only
If a man has ED with gradual onset of symptoms, lack of tumescence, normal libido, and presence of risk factors then what is the likely cause?
Organic
If a man has ED with sudden onset of symptoms, decreased libido, good quality spontaneous or self-stimulated erections, major life events, problems or changes in a relationship, and previous psychological problems, what is the likely cause?
Psychogenic
What is the most common organic cause of ED
Vasculogenic
What 5 conditions are likely to result in an vasculgenic ED?
cardiovascular disease (CVD) hypertension hyperlipidaemia diabetes mellitus smoking
What classes of drugs are associated with ED?
Antihypertensive Diuretics Antidepressants Antiarrhythmics Recreational
What investigations would you perform for a man complaining of ED?
HbA1c
BP
BMI
Lipids
What are the contraindications for sildenafil?
recent history of stroke or myocardial infarction, severe hepatic impairment, and
hereditary degenerative retinal disorders
Key drug class interactions with sildenafil?
Alpha blockers
Cytochrome P450 inhibitors
Management of erectile dysfunction
Sildenafil
Modify lifestyle and risk factors
Council om drug use
Test for CVD
Rank contraception methods in terms of efficacy with usual use?
IMPLANT> MALE STERILISATION> IUS> FEMALE STERILISATION >IUD> INJECTABLE >PILLS, PATCHES RINGS> FEMALE DIAPHRAGM> CONDOMS> WITHDRAWL> FERTILITY BASED METHODS
What contraception methods help with painful periods?
Implant
IUS
Injection
COCP
What contraception methods are best for women with heavy periods?
Implant
IUS
Injection
COCP
For women with a history of ectopic pregnancy, what contraception methods can be used?
all methods can be used without restriction.
What methods of contraception are suitable for a woman with menorrhagia, fibroids, or a previous ectopic pregnancy?
All methods can be used.
Consider recommending:
The levonorgestrel intrauterine system (LNG-IUS) first-line.
The combined oral contraceptive (COC) pill second-line.
The progestogen-only pill (POP) and progestogen-only injectables third-line.
What contraception methods are exclude for women with migraine with aura?
COCP
What methods of contraception would you seek specialist advice for for a woman with multiple risk factors for cardiovascular disease?
Progestogen-only injectables.
Combined hormonal contraception (CHC)
What 6 risk factors exclude use of COCP?
Obesity — body mass index ≥ 35 kg/m2 (unless there is no suitable alternative).
Smoking — 40 or more cigarettes daily.
Diabetes mellitus — if complications are present.
Family history of arterial disease in first degree relative aged under 45 years — if atherogenic lipid profile.
Hypertension —blood pressure above or equal to systolic 160 mmHg or diastolic 100 mmHg.
Migraine — with aura
What contraceptives are contraindicated for a woman who smokes is over 35 and smokes more than 15 a day?
Combined hormonal devices
What contraception would you not start for women with STI?
Cu IUD
IUS
For women with PID what contraception would you not initiate?
Cu IUD
IUS
What methods of contraception are NOT suitable for a woman with a history of venous thromboembolism (VTE)?
Combined hormonal contraceptives (pill, transdermal patch or vaginal ring).
What is the only contraindication to the POP?
current breast cancer.
What is the only contraindication to the progesterone implant?
current breast cancer.
What are the non CVD contraindications to the COCP?
current breast cancer,
women who are breastfeeding and are less than 6 weeks postpartum,
and women aged 35 years or more and smoking 15 or more cigarettes daily
Migraine with aura
What is the CV risk event associated with COCP and what are the associated contraindications 5?
Systolic BP >160 History of VTE IHD Stroke Major surgery AF
What are the 3 contraindications to intra uterine device?
current breast cancer (LNG-IUS only),
pelvic inflammatory disease,
or unexplained vaginal bleeding.
What tests would you perform before insetting intrauterine device?
STI
Pregnancy
When assessing for STI re IUS/IUS insertion do you need to wait for STI results before insertion?
No can be inserted so long as she can be contacted afterwards
3 ways in which the COCP works
- Main way: stops the ovaries from releasing an egg each month
- Thickens the mucus from your cervix. This makes it difficult for sperm
to move through it and reach an egg - Makes the lining of the uterus (womb) thinner so it is less likely to
accept a fertilised egg.
When am i covered from when starting COCP?
Explain covered straight away if 1st-5th day of period, of not then condoms for 7 days
What do I do if i miss 1 COCP pill?
at any time is fine – take as soon as you remember
even if this means taking 2 at once.
What happens if I miss 2 COCP pills?
week dependent:
o Week 1 – emergency contraception needed if had sex in preceding 7 days
o Week 2 – take pill when first remember & condoms 7 days
o Week 3 – continue taking pills – omit 7 day break
Safety net with COCP
▪ Develops headaches ▪ Develops calf pain/swelling ▪ Severe chest pain/sob ▪ Suggest an app to help remember ▪ Return after agreed time [3 months]
Side effects of COCP
mood, menstrual changes, bloating, breast tenderness, abdominal discomfort
Personal characteristics to consider when prescribing COCP
Age
Post partum
Smoking
BMI
If a woman is obese, smoker, HTN, hyperlipidaemia, with diabetes what contraception is most appropriate?
Cu-IUD
Blood pressure cut off for COCP
160
