QuestionSBA
QuestionChoice
Isotretinoin is a retinoid medication used to treat severe acne vulgaris. It should not be prescribed in the primary care setting or to a woman of childbearing age absent a pregnancy prevention plan due to its potent teratogenic effects
34031
b
Isotretinoin 20mg PO BD
QuestionChoice
This is an alternative topical treatment for acne vulgaris
34033
d
Nicotinamide gel topical BD
QuestionChoice
This is an oral treatment option for acne vulgaris that has not responded to topical treatments
34034
e
Tetracycline 500mg PO BD
QuestionChoice
For females with PCOS that have not improved following treatment with a first line option such as topical treatments, consider adding ethinylestradiol with cyproterone (co-cyprindiol) and review at 6 months, as per [NICE Guidance.](https://www.nice.org.uk/guidance/ng198/chapter/Recommendations)
34030
a
Co-cyprindiol 2000/35 micrograms PO OD
QuestionChoice
This is a combined contraceptive pill formulation. This is recommended as second line treatment (though it is unlicensed) for acne in patients with PCOS if co-cyprindiol is ineffective, as per [NICE Guidelance.](https://www.nice.org.uk/guidance/ng198/chapter/Recommendations)
34032
c
Combined oral contraceptive pill
QuestionComment
is co-cyprindiol not regarded as a COCP? im confused
61395
QuestionComment
i think they just want you to be more specific - co-cyprindiol is the best for hirsutism and pcos related symptoms out of all the cocp, and this is an SBA so it's a better answer. can try other formulations afterwards if co-cyprindiol not effective
61583
User
subscriber
Vaccine Complement
User
subscriber
Schistosomiasis
QuestionComment
the co-cyprindiol guidelines can be found under acne treatment summary and then 'reassessment and further treatment' If anyone was wondering :)
61628
User
subscriber
Vitals 'R' Us
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2750
Polycystic Ovary Syndrome
Topic
76
Obstetrics and Gynaecology
6817
Case Presentation: A 28 year old woman presents to her GP with a longstanding history of acne. She has tried various topical creams and ointments in the past that have only resulted in very modest improvement, and wonders if there is anything else that can be prescribed. **PH** acne vulgaris. **DH** benzoyl peroxide gel, azelaic acid 20% cream (Skinoren).


Her BMI is 28kg/m^2. On further questioning, she also reveals that she has had to engage in waxing her upper lip and chin since the age of 17, and describes erratic menstrual cycles ranging anywhere from 21 days to as long as 90 days. She has never been pregnant before, is sexually active and uses barrier protection as contraception as she is not looking to start a family.

Question: Select the most appropriate management at this stage.
a