genitourinary - premature ejaculation, PCOS Flashcards
what is premature ejaculation
common male sexual disorder
brief ejaculatory latency, loss of control, psychological distress
non drug treatment of premature ejaculation
includes psychosexual counselling, education and behavioural treatments
these are recommended in pt for whom PE causes few, if any, problems or in pt who prefer not to take drug treatment
they can also be used in addition to drug treatment
what management approach is recommended for pt with life long premature ejaculation
drug treatment
What is licensed to be used when required for premature ejaculation (but not continuous daily use) and what class of drugs does it belong to?
- dapoxetine
- short acting SSRI
Dopextine is a short acting SSRI which is licensed to be used prn for premature ejactulation.
True or false - other SSRIs and TCAs have been widely used unlicensed as regular daily treatment.
True
e.g. citalopram, fluoxetine, fluvoxamine, escitalopram, paroxetine, sertraline, clomipramine
How long after regular daily treatment with SSRIs/TCAs (unlicensed) does ejaculation delay happen?
Ejaculation delay may start a few days after the start of treatment, but it is more evident after 1 to 2 weeks, since receptor desensitisation requires time to occur.
If premature ejaculation is secondary to ED, which one should you treat first
ED
CI for dapoxetine
Hx bipolar disorder
Hx mania
Hx severe depression
Hx syncope
postural hypotension
significant cardiac disease
uncontrolled epilepsy
dose and how to take dapoxetine for premature ejaculation in men who meet all the relevant criteria
initially 30mg to be taken ~1-3 hours before sexual activity
subsequent doses adjusted according to response
max 1 dose per day
max 60mg daily
what is PCOS and who does it affect
one of the most common endocrine disorders affecting females of CBP
clinical features of PCOS
ovulation disorders, polycystic ovarian morphology, and hyperandrogenism (with the clinical manifestations of acne, hirsutism and oligomenorrhoea)
complications of PCOS
CVD
obstructive sleep apnoea
psychological disorders (anxiety, depression)
infertility
endometrial cancer
pregnant complications (gestational diabetes, pre-eclampsia)
metabolic disorders (insulin resistance, T2D)
true or false - complication of PCOS is CVD
true
1st line management PCOS
lifestyle modifications
healthy eating, regular physical exercise, maintaining healthy weight
if overweight or obese, offer weight loss advice or consider referral to dietician
true or false - in pt with PCOS who are overweight or obese, encourage weight loss because it can achieve menstrual regularity and reduce insulin resistance, hyperandrogegism and the risk of T2D and CVD
true
what is commonly used to treat acne, hisutism and menstrual irregularity in pt with PCOS
COC (unlicensed) if not planning pregnancy
COC commonly used in PCOS for acne, hirsutism, menstrual irregularity. Alt treatment for menstrual irregularities includes … (2)
- cyclical progestogen unlicensed
- LVNGTL IUS (unlicensed)
can a GP initiate treatment with insulin sensitising drugs in PCOS e.g. metformin
no specialist only
when can metformin be considered in PCOS
impaired glucose tolerance or are already undergoing lifestyle modifications with no improvement in impaired glucose tolerance [unlicensed indication]
what can metformin improve
may improve short-term insulin sensitivity and reduce androgen concentrations, but there is limited supporting evidence on the long-term benefits.
consider the following in females with PCOS who are pregnant or considering pregnancy
referral for gestational diabetes screening, and whether any changes to drug treatment(s) are required.
