Sexual Health Flashcards
Which of the following is TRUE regarding the adverse effects acronym “ACHES” in relation to oral contraceptives:
a) “A” refers to acne
b) “C” refers to chest pain caused by an MI
c) “H” refers to hives from an allergic reaction
d) “E” refers to elevated blood pressure
e) “S” refers to severe menstrual cramps
B. ACHES refers to Abdominal pain, Chest pain, Headaches, Eye problems and Severe leg pain.
Which of the following is FALSE in regards to Emergency Contraception:
a) The Yuzpe method causes a higher rate of nausea than Plan B
b) All methods must be used within 24 hours of unprotected intercourse to be effective
c) The two (2) Plan B tablets can be taken as a single dose
d) The two (2) Plan B tablets can be taken 12 hours apart
e) A copper IUD can be used up to 7 days after unprotected intercourse
B. The nausea/vomiting rates for the Yuzpe method are 50.5%/18.8% while for Plan B they are 23.1%/5.6%. The efficacy is highest if used within 24 hours of unprotected intercourse, but the oral methods can be used up to 5 days and the copper IUD up to 7 days after unprotected intercourse. The dosing of Plan B is quite flexible, with the possibilities of taking 2 tablets together, or 1 q12h and second tablet up to 24 hours after the first dose (page 873, CTC, 7th edn).
All of the following are effective in the treatment of dysmenorrhea EXCEPT:
a) Topical heat therapy
b) Regular exercise
c) Mefenamic acid 500mg to start then 250mg q6h prn
d) Ibuprofen 200-600mg q6h
e) Naproxen sodium 550mg bid
C. All NSAIDS (except for ASA) are effective in 80% of dysmenorrhea cases and there is minimal difference between them; however, they should be taken on a regular schedule for 48 to 72 hours and should not be taken prn (page 879, CTC, 7th edn). Both topical heat and regular exercise are non-pharmacological therapies that provide relief for dysmenorrhea.
Which of the following statements about the treatment of dysmenorrhea is TRUE?
a) ASA is as effective as other NSAIDs for treating dysmenorrhea
b) Diclofenac should be used in conjunction with misoprostol or a PPI when used for dysmenorrhea
for most females
c) Combined oral contraceptives (COC) have not been found to be helpful to treat dysmenorrhea
d) NSAIDs and SSRIs used together for dysmenorrhea can increase the risk of gastrointestinal
bleeding
e) None of the above
D. The combination of NSAIDs and SSRIs has been associated with an increased risk of GI bleeds (Table 2, page 881, CTC, 7th edn). ASA is less effective than other NSAIDS for treating dysmenorrhea (page 879, CTC, 7th edn). Since NSAIDs are used for a short term, they do not need a gastroprotective agent to be used concomitantly unless the person is at high risk for peptic ulcers. Combined oral contraceptives are a reasonable first line option for dysmenorrhea.
All of the following medications can cause Female Sexual Dysfunction EXCEPT:
a) Paroxetine b) Amitriptyline c) Phenytoin
d) Testosterone e) Metoprolol
D. Physicians experienced in women’s sexual dysfunction are investigating the use of testosterone in its treatment. All of the other agents have sexual dysfunction as a recognized adverse drug reaction (Table 1, page 902, CTC, 7th edn).
Choose the TRUE statement regarding the treatment of Erectile Dysfunction:
a) SSRIs have been shown to be useful in treatment
b) Taladafil has the longest duration of action of the phosphodiesterase Type 5 (PDE5) Inhibitors
c) The PDE5 Inhibitors have no drug interactions of concern
d) Sildenafil will show an effect within 30 minutes
e) Vardenafil should be taken with a high fat meal
B. Taladafil has duration of effect of up to 36 hours, while sildenafil and vardenafil have a duration of effect of 8-12 hours. SSRIs have a recognized ADR of sexual/erectile dysfunction. All of the PDE5 Inhibitors have significant interactions, including with nitrates, CYP3A4 inhibitors, and grapefruit juice (Table 6, page 921, CTC, 7th edn). A high fat meal delays the absorption of vardenafil.
Red Flags by condition and drug induced conditions: Menopause
ESTROGEN THERAPY
CI: undiagnosed vaginal bleeding, active liver disease, active thromboembolic disorder, known or suspected carcinoma of the breast (or other estrogen-sensitive), pregnancy.
Caution in CVD
Red Flags by condition and drug induced conditions: Menopause
PROGESTERONE THERAPY
Undiagnosed vaginal bleeding, known or suspected carcinoma of the breast, pregnancy
Red Flags by condition and drug induced conditions: Sexual Dysfunction
CAUSES OF BIRTH CONTROL FAILURE
Excess OH, aprepitant
Antibiotics- rifampin, ampicillin, cotrimoxzaole, metronidazole, nitrofurantoin, neomycin, penicillin rifabutin, tetracycline, tigecycline (ALWAYS USE BACK UP FOR 7 DAYS WITH AB)
Anticonvulsants- carbamazepine, phenobarb, phenytoin, topiramate
Antivirals- (nelfinavir,ritonavir)- USE HIGHER ESTROGEN CONTAINING PRODUCT
Bosentan, Modafinil
Red Clover and St. John’s Wort
Red Flags by condition and drug induced conditions: Sexual Dysfunction
Causes of Erectile Dysfunction
Acetazolamide, alcohol (acute), alpha blockers, cimetidine, clobibrate, clonidine, digoxin, lithium, metoclopramide, phenothiazines, thiazide diuretics.
Red Flags by condition and drug induced conditions: Sexual Dysfunction
Causes of Hypoactive Sexual Desire Disorder & ED
5-alpha reductase inhibitors, alcohol, anti-androgens, barbiturates, beta blockers, carbamazepine, GnRH analogues, Ketoconazole, MAOIs, opioids, phenytoin, spironolactone, SSRIs, TCAs
Red Flags by condition and drug induced conditions: Sexual Dysfunction
Causes of FEMALE SEXUAL DYFN
Alcohol, alkylating agents, amphetamines, anticholinergics, antidepressants (MAOIs, SNRIs, SSRIs, TCAs, Antiandrogens (cimetidine, spironolactone), antiepileptic drugs, antihistamine, antipsychotics, aromatase inhibitors, barbiturates, benzodiazepines, beta blockers, clonidine, digoxin, GnRH agoinsts, Ketoconazole, lithium, methadone, metoclopramide, trazodone.
Red Flags by condition and drug induced conditions: Sexual Dysfunction
LOSS OF LIBIDO
5-alpha reductase inhibitors, alcohol, anti-androgens, barbiturates, beta blockers, carbamazeprine, GnRH anologues, Ketoconazole, MAOIs, opiods, phenytoin, spironolactone, SSRIs, TCAs
Vascular Erectile dysfunction can be a predictor of:
A. Cardiovascular Death
B. MI
C. Stroke
D. Heart Failure
E. All of the above
E. Vascular ED can be a byproduct of asymptomatic coronary artery disease and a potent predictor of ‘all cause’ mortality.
There is a multidimensional relationship between erectile dysfunction, coronary artery disease and:
A. Depression
B. Anxiety
C. Depression and Anxiety D. None of the above
A. Erectile dysfunction, coronary artery disease and depression are a common triad.
Premature ejaculation is defined as ejaculation that occurs within:
A. 10 seconds
B. 30 seconds
C. 1 minute
D. 2 minutes
of penetration
C. 1 minute
Which of the following is not associated with lower male sexual desire:
A. Depression
B. Anxiety
C. Insomnia
D. Age
E. Dyslipidemia
F. Insufficient physical activity
G. Lower alcohol intake
E. Dyslipidemia. This can negatively impact function but does not effect desire.
All of the following drugs are associated with hypoactive sexual desire and erectile dysfunction except:
A. Alcohol
B. Beta Blockers
C. Opioids
D. SSRIs
E. Sulfonylureas
E. Sulfonylureas are not associated with male sexual dysfunction.
What are the goals of therapy?
Treat underlying conditions and reversible causes, address contributing psychological and interpersonal factors, assess safety of resuming intercourse and orgasm after serious illness, choose appropriate and safe therapy, provide knowledge and understanding, encourage realistic expectations, restore sexual intimacy
Name 3 Phosphodiesterase Type 5 inhibitors used to treat ED.
Sildenafil Tadalafil Vardenafil
Which of these has the longest duration of action?
A. Sildenafil
B. Tadalafil
C. Vardenafil
B. Tadalafil has a 36 hour duration of action whereas Sildenafil and Vardenafil last approximately 8-12 hours.
Which of the following is not a side effect of Tadalafil?
A. Headache
B. Flushing
C. Fatigue
D. Mylagia
E. Visual disturbances
C. Fatigue is not one of the side effects of this class of drug. Other side effects include dyspepsia, nasal congestion, dizziness and skin rash.
Which of the following is contraindicated with PDE5 Inhibitors?
A. Beta blockers
B. Nitrates
C. ACE Inhibitors
D. All of the above
B. Nitrates
True or False Higher doses of Prostagladin E1 Analogues are often needed for Vascular Erectile Dysfunction?
True. Doses of 40 -60 mcg may be needed for Vascular ED. Whereas Neurogenic ED may only require 1-3 mcg.
What is a rare side effect of Alprostadil injection that is considered a urologic emergency?
Priapism (a persistent, painful erection, lasting more than 4 hours in absence of sexual stimulation). This risk is minimized by slow careful dose titration of injected drugs.
Which of the following are contraindications to use of intracavernosal alprostadil?
A. Anticoagulation
B. Previous priapism
C. Thrombocytopenia
D. Leukemia
E. Polycythemia
F. All of the above
F. All of these are contraindications also on the list of CI is myelofibrosis, sickle cell anemia and valve lesions.
True or False. Alprostadil can also be administered by urethral instillation.
True. This drug is given both by injection and urethral instillayion.
True or False Hypertension is a potential side effect of urethral instillation of Alprostadil.
False. Hypotension is a possible side effect
Which of the following is not commonly prescribed for premature ejaculation?
A. Paroxetine
B. Clomipramine C. Sertraline
D. Buproprion
E. Fluoxetine
D. Buproprion. These other medications work by increasing serotonergic transmission which slow down the ejaculatory reflex.
Which medication can have an eightfold delay on ejaculation?
A. Paroxetine
B. Clomipramine C. Sertraline
D. Fluoxetine
A. Paroxetine. The other drugs have a fourfold to fivefold delay on ejaculation.
What are the names of the sex therapy techniques used fro PE?
Adaptation Start/Stop Technique Squeeze Technique Quiet Vagina
Hypoactive Sexual Desire Disorder can result from which 2 hormone imbalances.
Low Testosterone High Prolactin
True or False. SSRI induced low sexual desire can be corrected with Sildenafil?
True
Assess safety of resumption of sexual
C. Cardiovascular Risk
