Review Question - QID 105181

Any woman of child-bearing age on isotretinoin must have a urine hCG checked to ensure she is not pregnant as it is a highly teratogenic medication.

Isotretinoin is a highly teratogenic drug, as it is a vitamin A derivative which affects the expression of several genes important for fetal development. Fetal malformations can include cleft palate as well as cardiac abnormalities. A pregnancy test must be performed before isotretinoin is prescribed for severe acne and the patient must be started on reliable contraception. When treating a patient for acne, the patient should first be started on less invasive medications including instructions in hygiene, topical benzoyl peroxide, and topical retinoids. If these interventions fail, topical or oral antibiotics can be started. If all initial measures fail, then isotretinoin can be started.

Incorrect Answers:
Answer 1: Administer bupropion could be appropriate in this smoking patient who is also possibly depressed as it could treat both conditions. Prior to starting an antidepressant, the diagnosis of depression should be confirmed. In addition, it is direr to first ensure the patient is not pregnant prior to giving a teratogenic agent.

Answer 3: Check prolactin could be appropriate in the initial workup of this patient if she was being assessed for infertility given her irregular menses.

Answer 4: Check TSH would be appropriate given this patient's obesity and depressed mood; however, it is direr to first check her pregnancy status prior to starting a highly teratogenic agent.

Answer 5: Recheck blood pressure in 1 week is appropriate as this patient is hypertensive. To confirm the diagnosis of hypertension, the patient must have more than 1 blood pressure confirming a diagnosis of hypertension (to rule out "white coat" hypertension).

Bullet Summary:
Women should have a urine hCG checked and be started on reliable contraception prior to administering isotretinoin.