CHAPTER 40 – DRUGS AFFECTING FERTILITY OR SEXUAL FUNCTIONING

Question 1

Jane is an 18 year old woman who takes Carbamazepine and Valporate for the treatment of partial seizures. She has consulted her GP regarding contraception. The GP advised Jane that a copper intrauterine Device may be more suitable for her than combined oral contraceptive ‘pill’.

Answer 1

Jane is an 18 year old woman who takes Carbamazepine and Valporate for the treatment of partial seizures. She has consulted her GP regarding contraception. The GP advised Jane that a copper intrauterine Device may be more suitable for her than combined oral contraceptive ‘pill’.

Question 2

1. Explain the most likely reason why Jane’s GP has recommended a copper IUD rather than the pill.

Answer 2

.-long lasting=long term effect (10 years-depending on type used)

• no need to remember to take it orally each day
• very effective form of contraception
• does not contain hormones which could be beneficial to those who can’t use hormones
• immediate reversible
• -highly cost effective

Question 3

2. What other contraceptive options could be considered in Jane’s case?

Answer 3

• depo (hormonal) injection
• implant (Implanon)
• vaginal ring

Question 4

Phosphodiesterase-5 inhibitors are contraindicated in patients taking nitrates. If a nitrate is required, at least 24 hours should be allowed after the last dose of Sildenafil or Vardenafil, and 48 hours after Tadalafil before the nitrate is given.

Answer 4

Phosphodiesterase-5 inhibitors are contraindicated in patients taking nitrates. If a nitrate is required, at least 24 hours should be allowed after the last dose of Sildenafil or Vardenafil, and 48 hours after Tadalafil before the nitrate is given.

Question 5

1. Explain the mechanism and clinical basis for not using nitrates and phosphodiesterase-5 inhibitors together.

Answer 5

• they both can cause vasodilation of the blood vessels.
• PDE5 inhibitors interact with nitrates by decreasing the metabolism of nitric oxide induced activation of cGMP, thereby allowing more cGMP mediated smooth muscle relaxation or vasodilation.

Question 6

2. Why is it necessary for a longer period between treatment with Tadalafil and a nitrate?

Answer 6

It requires a longer period of time due Tadalafil has a longer half-life thereby needing a longer time before introducing a nitrate into the patients system.