Round Up Email May 2024

In this month's Round Up areas highlighted include the synergistic action of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes in the reduction of cardiovascular risk, aspirin and breast cancer, and exercise and inflammatory bowel disease (IBD).

Question 1
Finasteride – risk of psychiatric side effects and of sexual side effects – can the sexual dysfunction (including decreased libido and erectile dysfunction) associated with use of finasteride persist after the medication is stopped? Is depression or psychosis associated with use of finasteride?: Finasteride – risk of psychiatric side effects and of sexual side effects (which may persist after discontinuation of treatment)
With respect to the use of finasteride, which statement is false?
- Finasteride use is associated with an increased risk of depression
- Finasteride use is associated with an increased risk of schizophrenia
- Finasteride is associated with an increased risk of male impotence
Question 2
Postponement of menstruation – in order for norethisterone 5mg three times a day to be effective for postponement of menstruation then how long before the predicted menses should this medication be commenced? Oral medroxyprogesterone is an alternative to norethisterone in management of postponement of menses – can this drug affect fertility?: Postponing menstruation
With respect to the postponement of menstruation, which statement is false?
- norethisterone 5mg three times a day is licensed to delay periods
- if taking norethisterone to postpone menses then periods usually resume within 24 hours of discontinuing norethisterone
- oral medroxyprogesterone may inhibit ovulation so fertility can be affected
Question 3
Use of oxygen in chronic respiratory failure due to COPD – this section in GPnotebook has been updated: Oxygen therapy in chronic respiratory failure due to COPD
With respect to oxygen therapy in chronic respiratory failure in COPD, which statement is false?
- For best results oxygen therapy should be given for at least 12 hours a day at a flow rate sufficient to maintain the arterial oxygen tension above 8KPa
- Long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival in patients with severe chronic resting arterial hypoxemia
- long-term oxygen therapy does not lengthen time to death or first hospitalization or provide sustained benefit for any of the measured outcomes in patients with stable COPD and resting or exercise-induced moderate arterial oxygen desaturation
Question 4
Exercise and IBD – the relationship between exercise and IBD is summarised on GPnotebook.: Exercise and inflammatory bowel disease (IBD)
With respect to exercise and inflammatory bowel disease (IBD), which statement is false?
- Studies suggest that structured exercise programmes may be an effective non-pharmacological treatment option to counteract IBD manifestations and complications
- A systematic review provided evidence that high intensity exercise was more effective in reducing risk of development of ulcerative colitis than Crohn's disease.
- Reductions in pro-inflammatory cytokines, alterations of the gut microbiota, and improvements in health-related quality of life appear to be outcomes of both low-to-moderate- and high-intensity exercise interventions in IBD patients
Question 5
Aspirin and breast cancer – is aspirin an evidence based adjunctive therapy in breast cancer?: Aspirin in breast cancer
With respect to the use of aspirin in cancer, which statement is false?
- The study by Chen et al provides evidence of the effectiveness of aspirin as an adjunctive therapy in breast cancer.
- Evidence from a multi-country randomised controlled trial showed that taking 600 mg of aspirin daily for more than 2 years reduces the risk of colorectal cancer in people with Lynch syndrome.
- There is evidence relating to the effectiveness of aspirin as a chemoprophylaxis in people with a history of previous colorectal adenomas
Question 6
Use of combination of SGLT2 inhibitor plus GLP1 agonist and cardiorenal benefits – the benefits associated with combination of these agents is summarised on GPnotebook: SGLT2 inhibitors in comparison with (or in addition to) GLP1 agonists - cardiovascular and renal benefits
With respect to combination therapy with SGLT2 inhibitors and GLP-1 agonists, which statement is false?
- Addition of an SGLT-2 inhibitor to existing GLP-1 receptor agonist use was also associated with a reduced risk of cardiovascular mortality and heart failure compared with GLP-1 receptor agonists alone
- Combined use of GLP-1 receptor agonists and SGLT-2 inhibitors is associated with a reduced risk of major adverse cardiovascular events and serious renal events, compared with using either drug class alone.
- Evidence suggests GLP-1 receptor agonists reduce non-fatal stroke risk less than SGLT-2 inhibitors.

Round Up Email May 2024

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6