PCOS, ED and Vaginal atrophy Flashcards
(10 cards)
What are the non-drug treatment options for PCOS?
healthy eating, regular physical exercise and maintaining a healthy weight
What are the drug treatment options for PCOS?
COC (unlicensed) - for acne, hirsutism, menstrual irregularity
cyclical progestogen (unlicensed)
levonorgestrel IUD (unlicensed)
metformin
What are the treatment options for erectile dysfunction?
1st line - phosphodiesterase type-5 inhibitor: avanafil, sildenafil, vardenafil, tadalafil
2nd - intracavernosal, intraurethral or topical application of alprostadil (prostaglandin E1): if a non-responder (> 6 doses at max dose tried , > 2 types tried)
Which phosphodiesterase type-5 inhibitors are short vs long acting?
avanafil, sildenafil, vardenafil: short acting, good for occasional use
tadalafil: long acting, can be used long term at lower dosing for spontaneous sex
What are the main drug interactions for phosphodiesterase type-5 inhibitors?
nitrates, alpha blockers, CCBs: risk of increased hypotensive effects
What are the side effects associated with phosphodiesterase type-5 inhibitors?
headaches
GI discomfort
dizziness
vision disorders
arrhythmias
What is a side effects associated with alprostadil?
priapism: prolonged erection lasting four hours or more
- application of an ice pack to the upper-inner thigh may help
priapism: prolonged erection lasting six hours or more
- needs immediate treatment
Is contraception needed for alprostadil?
use barrier method to avoid local reactions to women of child bearing age
What is the treatment for vaginal atrophy?
topical oestrogens:
- estradiol pessaries and vaginal rings
- estriol pessaries, cream and gel
How is GINA used?
Initial dose: One vaginal tablet daily for two weeks.
Maintenance dose: One vaginal tablet twice a week.
if switching from previous topical oestrogen, start directly on maintenance dose
