| Which of the following is indication for isotretinoin (Roaccutane/Xeractan/Curacne)? |
▪ All forms of acne ▪ Acne with oily skin with or without pores ▪ Acne on the cheek ▪ Severe nodular forms of acne resistant to regular treatment |
| What is the daily maximum dose of Isotretinoin? |
▪ 10 to 20 mg ▪ 30 to 40 mg ▪ 50 to 60 mg ▪ More than 70 mg |
| One of the side effects of the Acne? (Kindly answeryes/no/Do not know) |
Teratogenic effect: Yes No |
| (It affects fetus if you take during pregnancy time) Whatis your major source of information regarding side effectsof Isotretinoin? |
Doctors ▪ Pharmacists ▪ Internet/social media ▪ Leaflet given in the drug packet |
| Have you ever heard of Saudi Food and Drug Authority (SFDA) — Pregnancy Prevention Program (PPP) thatestablished guidelines for the Isotretinoin use amongfemales of reproductive age group (15 — 49 years)? |
Yes ▪ No |
| o Are you currently on Isotretinoin or used Isotretinoin in the past one year (Roaccutane/Xeractan/Curacne)? |
Yes ▪ No |
| Number of treatment courses with isotretinoin |
One Two More than two |
| Are you taking isotretinoin with doctor's prescription? |
▪ Yes ▪ NO |
| What is the duration of treatment? (Specify in months) |
|
| Have you been informed about the necessary of negative pregnancy test before to start treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you been informed about the necessary of negative pregnancy test during the treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you been informed about the necessary of negative pregnancy test that is necessary 5 weeks after stoppingthe treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you been informed about importance of use of two contraceptive methods before to start treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you been informed about importance of use of two contraceptive methods during the treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you been informed about importance of use of two contraceptive methods 4 weeks after stopping the treatment? |
▪ Yes ▪ No ▪ Not sure |
| Have you signed the patient's consent form before beginning the treatment? |
▪ Yes ▪ No ▪ Not sure |
