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!Pharmacy Tech year 1 > 310 Endocrine and genito-urinary medicines > Flashcards

310 Endocrine and genito-urinary medicines Flashcards

1
Q

Which two hormones does the thyroid gland secrete into the bloodstream?

A
  • T4 thyroxine
  • T3 triiodothyronine
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2
Q

Which hormone controls the release of hormones from the thyroid gland?

A

Thyroid stimulating hormone (TSH) regulates the release of hormones T3 and T4 from the thyroid gland.

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3
Q

Which is the active thyroid hormone?

A

Triiodothyronine (T3) is the active thyroid hormone. T4 is converted to T3.

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4
Q

What is the role of the thyroid hormones?

A

The thyroid hormones control the rate of metabolism.

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5
Q

Where is thyroid stimulating hormone (TSH) secreted from?

A

Thyroid stimulating hormone (TSH) is secreted from the anterior pituitary.

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6
Q

What is hyperthyroidism?

A

An overactive thyroid, also known as hyperthyroidism or thyrotoxicosis, is where the thyroid gland produces too much of the thyroid hormones.

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7
Q

What causes hyperthyroidism?

A
  • Graves disease (3/4 people with hyperthyroidism)
    • autoimmune condition where body attacks thyroid gland
  • thyroid nodules
  • medicines containing iodine (eg amiodarone)
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8
Q

What are the signs & symptoms of hyperthyroidism?

A
  • weight loss
  • diarrhoea
  • warm sweaty skin
  • palpitations/tachycardia
  • hair loss
  • anxiety + nervousness
  • increased metabolic rate
  • swelling of the thyroid gland - noticeable lump in throat
  • hyperactivity & restlessness
  • needing to pee more often
  • mood swings
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9
Q

What are the treatments available for hyperthyroidism?

A
  • radioactive iodine treatment
    • radioactive iodine is ingested which accumulates in thyroid gland destroying some of the excess thyroid tissue
  • surgery
    • removal of part of the thyroid gland
  • medicine
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10
Q

What is goitre?

A

Goitre is a lump in the neck due to a swelling of the thyroid gland.

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11
Q

Which medicines are used to treat hyperthyroidism?

A
  • carbimazole
  • propylthiouracil
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12
Q

What is the mode of action of carbimazole?

A

Carbimazole decreases uptake of inorganic iodine by thyroid. This reduces formation of di-iodotyrosine & thyroxine, which reduces production of T3 and T4.

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13
Q

What are the common side effects associated with taking carbimazole?

A
  • no common side effects in BNF

​Other sources ((NHS, PIL, patient info) state for the first 8 weeks you may experience:

  • nausea
  • high temperature
  • altered taste
  • itchy rash
  • aching joints
  • headaches upset stomach
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14
Q

What are the counselling points for carbimazole?

A
  • MHRA advises women of childbearing age use contraception during active treatment (potential risk of malformations)
  • Warn patient or carers to tell doctor immediately if sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops. (signs of none marrow suppression)
  • see GP for regular blood test appointments to monitor
  • takes 4-8 weeks for treatment to be effective
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15
Q

What are the side effects of taking propylthiouracil?

A

There are no common side effects in the BNF, there are frequency not known.

The following side effects are obtained by collating knowledge from NHS (may experience for first 8 weeks), PIL, patient info:

  • feeling sick or being sick
  • stomach upsets
  • taste disturbance
  • headaches
  • hearing impairment
  • mild skin rashes
  • itching or reddening of the skin
  • hair loss
  • pain or stiffness of your muscles or joints
  • abnormal results of liver function tests
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16
Q

What is hypothyroidism?

A

Hypothyroidism or, an underactive thyroid gland is a disease of the endocrine system where your thyroid gland does not produce enough hormones.

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17
Q

What are the causes of hypothyroidism?

A
  • autoimmune - the body attacks the thyroid gland (most commonly Hashimoto’s)
  • treatment - surgery/radioactive idiodine treatment
  • iodine deficiency (not in UK)
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18
Q

What are the symptoms of hypothyroidism?

A
  • tiredness
  • being sensitive to cold
  • weight gain
  • constipation
  • depression
  • slow movements and thoughts
  • muscle aches and weakness
  • muscle cramps
  • dry and scaly skin
  • brittle hair and nails
  • loss of libido (sex drive)
  • pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
  • irregular periods or heavy periods
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19
Q

What is the medical treatment for an underactive thyroid?

A

levothyroxine and liothyronine

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20
Q

What is an FP92A?

A

FP92A is the medical exemption certificate form.

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21
Q

What are the side effects of taking levothyroxine?

A
  • There are no common side effects of taking levothyroxine according to the BNF, there are frequency not known side effects.
  • According to the NHS website: side effects usually only occur if you’re taking too much levothyroxine. This can cause problems including:*
  • sweating
  • chest pain
  • headaches
  • diarrhoea
  • vomiting.
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22
Q

What are the counselling points for levothyroxine?

A
  • Take at the same time every day, usually in the morning (not always)
  • Take 30 minutes before food, caffeine containing liquids and other medications
  • Continue to take these tablets until your doctor tells you to stop
  • Do not take with grapefruit juice
  • You will need regular blood tests to check your thyroid levels
  • If experience side effects, alert doctor as dose may need to be reduced
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23
Q

What is the mode of action of levothyroxine?

A

T4 is converted to T3 in the body.

The drug replaces T4 in the body.

Returns levels of T3 and T4 to normal

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24
Q

What are the side effects of liothyronine sodium?

A

There are no common side effects in the BNF.

Patient info states if side effects are experienced dose may need to be adjusted.

Possible side effects (according to patient info & netdoctor) include:

  • nausea & vomiting
  • diarrhoea
  • headache
  • palpitations or chest pain
  • restless
  • flushing
  • high temperature
  • weight loss
  • difficulty sleeping
  • itchy rash
  • cramps
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25
Q

What is polycystic ovary syndrome (PCOS)?

A

The main features of PCOS are:

  • irregular periods
  • excess androgens
  • polycystic ovaries - ovaries enlarged & contain many fluid-filled sacs
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26
Q

How many women in the UK have PCOS?

A

PCOS is very common and is thought to affect up to 1 in 5 women in the UK.

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27
Q

What are the symptoms of PCOS?

A
  • irregular/no periods
  • difficulty getting pregnant
  • excess hair growth (face/chest/back/buttocks)
  • weight gain
  • thin hair/hair loss
  • oily skin & acne
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28
Q

Which other conditions are associated with PCOS?

A

PCOS is associated with an increased risk of developing health problems later in life such as type 2 diabetes and high cholesterol levels.

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29
Q

What causes PCOS?

A
  • cause is unknown
  • often a familial link
  • associated with high insulin levels (body not as reactive to insulin so produces a lot to overcompensate)
    • high insulin levels also associated with obesity
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30
Q

How is PCOS diagnosed?

A
  • blood tests to check hormone levels
  • ultrasound scan - will show whether there is a high number of follicles in the ovaries
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31
Q

What treatments are available for PCOS?

A
  • cannot be cured, symptoms can be managed
  • weight loss (if overweight)
  • medications
    • irregular periods - contraceptive pill
    • thin out womb lining - IUD
    • fertility problems - clomifene/letrozole
    • reducing insulin levels - metformin
    • excess hair - some combined contraceptive pills/cyproterone acetate/spironolactone/flutamide/finasteride
  • surgery - if medications to help stimulate fertility are not effective
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32
Q

What are the common side effects of clomifene?

A

No common side effects in the BNF, frequency not known, according to patient.info:

  • hot flushes
  • nausea
  • headaches
  • breast discomfort
  • painful periods
  • breakthrough bleeding
  • abdo pain
  • pelvic pain
  • discomfort
  • bloating
  • weight gain
  • eyesight problems - blurred vision, flashes in front of eyes
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33
Q

What is the mode of action of clomifene?

A

Clomifene blocks feedback mechanism to the pituitary gland.

Pituitary gland releases more gonadotrophin, stimulates ovulation.

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34
Q

What should a patient taking clomifene be counselled on?

A
  • there is a risk of multiple pregnancies
  • do not take for more than 6 cycles - increased risk of ovarian cancer
  • may cause birth defects - stop taking if fall pregnant
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35
Q

What are the common side effects of metformin?

A

Common side effects in the BNF!!

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36
Q

What is osteoporosis?

A

Osteoporosis is a health condition that causes pores in the bones, weakening them, making them fragile and more likely to break.

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37
Q

What are the most common injuries (breaks) associated with osteoporosis?

A
  • broken wrist
  • broken hip
  • broken vertebrae
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38
Q

How is osteoporosis diagnosed/recognised?

A
  • usually recognised when develop a break
    • might not even realise - can break when sneeze and may just be living with a long-term pain
  • might walk with a characteristic stoop
  • DEXA scan (bone density)
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39
Q

Who is affected by osteoporosis?

A
  • over 3 million people in the UK
  • women more commonly (post menopause lose bone density) - particularly if had menopause <45
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40
Q

What are the risk factors/factors that make it more likely you will get osteoporosis?

A
  • old age
  • being female, post menopause (particularly menopause <45)
  • taking high dose steroids 3 months +
  • inflammatory conditions, hormone conditions, malabsorption conditions
  • family history
  • long-term use of medicines that affect bone density (eg anti-oestrogen tablets)
  • eating disorders (anorexia/bulimia)
  • low BMI
  • not exercising regularly
  • heavy drinking & smoking
  • lack of dietary calcium
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41
Q

How can osteoporosis/bone breaks be prevented?

A
  • exercise regularly
  • eating well - lots of calcium + vitamin D
  • 10 microgram vitamin D supplement
  • lifestyle changes - giving up smoking, reducing alcohol consumption
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42
Q

What medicines are available to treat osteoporosis?

A

A group of medicines called bisphosphonates.

These include alendronic acid and risendronic acid.

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43
Q

What are the side effects of alendronic acid?

A

There are common side effects of alendronic acid in the BNF.

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44
Q

What are the common side effects associated with risedronic acid?

A
  • there are no common side effects in the BNF, just frequency not known
  • the NHS website says side effects associated with bisphosphonates include:
    • irritation to the foodpipe
    • swallowing problems
    • stomach pain
  • patient.info states:
    • indigestion
    • nausea
    • stomach ache
    • diarrhoea
    • constipation
    • headache
    • muscle and joint pain
    • heartburn
    • pain or difficulty swallowing
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45
Q

What is the mode of action of aledronic acid?

A

Aledronic acid binds tightly to bone & prevents calcium being removed by osteoclasts - stops osteoclasts breaking down bone.

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46
Q

What are the counselling points a patient should be informed of if taking aledronic acid?

A
  • swallow tablet whole. Should be sitting or standing for at least 30 minutes after
  • Should be taken 30 minutes before breakfast or any other oral medication (empty stomach)
  • Take on the same day of the week
  • advised to seek medical advice if experience dysphagia, worsening heartburn, pain swallowing (oesophagal irratation)
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47
Q

Which hormones are secreted from the pancreas?

A

Insulin and glucagon are secreted from the pancreas

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48
Q

Which hormone do the alpha cells in the islets of langerhans secrete?

A

Alpha cells secrete glucagon.

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49
Q

Which hormone do beta cells in the islets of langerhans secrete?

A

Beta cells secrete insulin.

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50
Q

When is glucagon secreted & what is its action?

A

Glucagon is secreted in a response to a drop in blood glucose levels. Acts to prevent blood glucose levels dropping, converts glycogen to glucose by glyconeogenesis.

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51
Q

What is the role of insulin and when is it secreted?

A

Insulin is secreted when there is a rise in blood glucose levels. Receptor sites on cell surface membranes bind insulin and lead to changes in the permeability and enzyme action of the cell which in turn reduces blood glucose levels.

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52
Q

What happens in type 1 diabetes?

A
  • the body’s immune system attacks and destroys the beta cells that produce insulin
  • treatment for life
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53
Q

What is type 2 diabetes?

A
  • In type 2 diabetes the body does not produce enough insulin, or the body’s cells do not react to insulin
  • often a result of obesity
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54
Q

What are the symptoms of diabetes?

A
  • feeling thirsty
  • urinating more frequently (particularly at night)
  • feeling tired
  • weight loss & loss of muscle bulk
  • itching around the penis/vagina - frequent episodes of thrush
  • wounds that heal slowly
  • blurred vision
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55
Q

How long do rapid-acting insulins work for?

A
  • onset within 15 minutes
  • duration 2-5 hours
  • (eg insulin aspartate, insulin glulisine, insulin lispro)
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56
Q

When should short and rapid acting insulins be injected?

A

Short-acting & rapid-acting insulins should be injected 20 minutes before meals.

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57
Q

How long do short-acting insulins work for?

A
  • Onset 30-60 minutes
  • duration 2-5 hours
  • (eg humulins)
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58
Q

How long-acting are intermediate-acting insulins?

A
  • onset 1-2 hours
  • duration 11-24 hours
  • (eg insulin isophane)
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59
Q

How long do long-acting insulins take to work?

A
  • onset 1-2 hours
  • duration - up to 36 hours
  • (eg insulin glargine, insulin detemir)
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60
Q

What are the side effects of insulin?

A
  • hypoglycaemia
  • local reaction at injection site
  • fat deposits at injection sites
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61
Q

What are the symptoms of hypoglycaemia?

A
  • bizzare behaviour
  • faint
  • irritability
  • weakness
  • sweating
  • nausea
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62
Q

What treatment is used for hypoglycaemia?

A
  • 10-20g of glucose by mouth - liquid or granulated sugar (lumps)
  • 10g glucose in 2 heaped teaspoons sugar, 3 lumps
  • glucogel
  • glucagon injection (if not able to administer orally)
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63
Q

Which drugs are used to treat type 2 diabetes (generally)?

A
  • gliclazide (sulphonylureas)
  • metformin (biguanides)
  • nateglinide (other antidiabetics)
  • insulin
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64
Q

Name two drugs used to treat type 1 diabetes

A

Actrapid (rapid-acting) & insulin glargine (long-acting)

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65
Q

What side effects are there for insulin?

A
  • oedema
  • just memorise the ones given in class:
    • hypoglycaemia
    • local reaction at injection site
    • abnormal fat deposits at injection sites
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66
Q

What is the mode of action of actrapid? (or insulins more generally)

A

Stimulates peripheral glucose uptake primarily by skeletal muscle cells & fat by inhibiting glucose production & release by the liver.

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67
Q

What are the counselling points for actrapid? (or insulins more generally)

A
  • sharps bin + careful with needles
  • inform doctors taking insulin
  • if undergoing a hypo/hyper avoid manual tasks
  • take 30 minutes before food
  • inject at different sites
  • how to use
  • storage temperature/length (most insulins once opened are stored out of the fridge - shortened expiry)
  • insulin passport
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68
Q

What medicines are used to treat type 2 diabetes? (2 examples)

A

Metformin & gliclazide

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69
Q

What are the common side effects of metformin?

A

There are side effects for metformin in the BNF!

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70
Q

What is the mode of action of metformin?

A

Decreases gluconeogenesis by increasing peripheral utilisation of glucose.

71
Q

What are the side effects of gliclazide?

A

There are common side effects in the BNF for the drug group gliclazide belongs to, sulfononylureas!

72
Q

What are the counselling points for metformin?

A
  • gastrointestinal side effects are common
  • metformin + alcohol –> avoid excess consumption (lactic acidosis)
  • hypers/hypos - avoid manual tasks
  • take before a meal
  • if you miss a dose do not double up the next one
  • if m/r - swallow whole, do not crush
73
Q

What is the menopause?

A

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

74
Q

At what age does the menopause usually occur?

A

The menopause usually occurs between 45 and 55, the average age for a woman in the UK to reach the menoapause is 51.

75
Q

What are the symptoms of the menopause?

A
  • hot flushes
  • night sweats
  • vaginal dryness + discomfort during sex
  • difficulty sleeping
  • low mood + anxiety
  • reduced sex drive
  • problems with memory and concentration

Symptoms may start a few months or years before your periods stop, known as the perimenopause, and on average persist for around 4 years after your last period.

76
Q

What are the drug treatments available for the menopause?

A
  • combined HRT
  • estradiol
  • timbolone
77
Q

What are the common side effects associated with HRT?

A
  • bloating
  • breast tenderness/swelling
  • swelling in other parts of the body
  • feeling sick
  • leg cramps
  • headaches
  • indigestion
  • vaginal bleeding

These are the side effects according to the NHS website. Also states these side effects will often pass in a few weeks.

78
Q

What are the common side effects for estradiol?

A

There are common side effects in the BNF!!

79
Q

What are the common side effects associated with timbolone?

A

There are common side effects for timbolone in the BNF

80
Q

What is the mode of action of estradiol?

A

Estradiol is an agonist for the estrogen receptor (possibly both subtypes ER alpha and ER beta), modulating the gene transcription and expression in ER-expressing cells which in turn reduces symptoms of the menopause.

81
Q

What are the counselling points for estradiol?

A
  • go for mammograms and check breasts regularly (all types of HRT increase risk of breast cancer) - however radiological detection more difficult?
  • reducing risk of blood clots: maintain healthy weight, no (quit) smoking, regular movement
  • if prescribed cream/patch then how to administer/apply
  • may take a couple of weeks to work
82
Q

What is endometriosis?

A

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places such as the ovaries and fallopian tubes.

83
Q

What are the symptoms of endometriosis?

A
  • pain in lower tummy (pelvic pain) - worse during period
  • period pain that stops you doing normal activities
  • pain during or after sex
  • pain when peeing or pooing during your period
  • feeling sick, constipation, diarrhoea, or blood in your urine during your period
  • difficulty getting pregnant
84
Q

What treatments are available for endometriosis?

A
  • painkillers
    • ibuprofen + paracetamol
  • hormone medications/contraceptives
    • combined pill, contraceptive patch, intrauterine system, GnRH analogues
  • surgery to cut away patches of endometriosis tissue
  • operation to remove some or all of the organs affected. - eg hysterectomy to remove the womb
85
Q

What causes endometriosis?

A
  • genetics - tends to run in families
  • retrograde mestruation - womb lining flows up the fallopian tubes and embeds itself instead of leaving the body as a period
  • immune system problem
  • endometrium cells spreading through the body in the bloodstream or lymphatic system
  • not certain how or why, probably a combination of
86
Q

Which drug treatments are used for endometriosis? (2)

A

Paracetamol (to relieve pain) & the combined oral contraceptive pill.

87
Q

What are the common side effects of paracetamol?

A

No common, use frequency not known? Rarely causes side effects, and if it does could be a sign of overdose.

88
Q

What are the common side effects of the combined oral contraceptive pill?

A

There are some in the BNF (+common knowledge the pill is crap)

89
Q

What is the mode of action of the combined oral contraceptive?

A
  • suppresses ovulation
  • decreases secretion of FSH & LH
  • hormones in the pill cause the uterus lining to become thinner resulting in periods that are shorter and lighter, reducing endometriosis symptoms
90
Q

What are the counselling points for the combined oral contraceptive?

A
  • take at the same time everyday
  • increased risk of DVT (maintain healthy weight, quit/no smoking, move regularly)
  • if have an epiode of diarrhoea or vomiting, may need to take extra precautions during ex (if using as a contraceptive too)
91
Q

What is pelvic inflammatory disease (PID)?

A

Pelvic inflammatory disease is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.

92
Q

Who is affected by PID?

A

PID mainly affects sexually active women agen 15-24.

93
Q

What are the symptoms of PID?

A

Usually the symptoms of PID are mild, which makes it difficult to diagnose, and may include:

  • pain around the pelvis or lower abdomen
  • discomfort or pain puring sex that is felt deep inside the pelvis
  • pain when urinating
  • bleeding between periods or after sex
  • heavy periods
  • painful periods
  • unusual discharge, especially yellow or green

a few women will become very ill with:

  • severe abdomenal pain
  • high temperature
  • feeling and being sick
94
Q

What causes PID?

A
  • most cases caused by a bacterial infection
    • caused by STI - such as chlamydia or gonorrhoea
  • could be caused by bacteria that usually live in the vagina
95
Q

What are the treatments for PID?

A

usually be treated with 14 day abx course if caught early

96
Q

What are the drug treatments for PID? (2)

A

Doxycycline & metronidazole

97
Q

What are the common side effects associated with taking doxycycline?

A

There are common side effects for doxycycline in the BNF!

98
Q

What are the common side effects associated with taking metronidazole?

A

There are common side effects associated with metronidazole in the BNF!

99
Q

What is the mode of action of doxycyline?

A
  • broad spectrum antibiotic
  • inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing tRNA binding
  • stops replication of bacteria
  • bacteriostatic
100
Q

What are the counselling points for doxycycline?

A
  • doxycycline taken for PID/chlamydia
    • need to speak to sexual partners so that they can get checked (GUM clinics can do this anonymously for you)
    • decrease risk of PID by using condoms + getting new partners to have a sexual health check
  • take any antacids 2-3 hours after dose (BNF)
  • swallow whole with plenty of water (BNF)
  • should be taken with meals (BNF)
  • complete the course (BNF)
  • photosensitivity - sunlight/lamps should be avoided (BNF)
101
Q

What is dysmenorrhoea?

A

Dysmenorrhoea is painful cramping, usually in the lower abdomen occuring shortly before or after menstruation, or both.

May occur with or without pelvic pathology (pathologies = fibroids/endometriosis, PID, endometrial polyps)

Primary = without pathologies

Secondary = with pathologies

102
Q

What is primary dysmenorrhoea?

A
  • usually starts 6-12 months after menarche
  • pain usually starts shortly before onset of menstruation and lasts for up to 72 hours, improving as menses progresses
  • may also experience nausea, vomiting and migraine
103
Q

What is secondary dysmenorrhoea?

A
  • can start after several years of painless periods
  • pain can be present throughout menstrual cycle (not just during menses) - often exacerbated by menses
  • other gynaecological symptoms present
104
Q

What are the symptoms of dysmenorrhoea?

A
  • cramping in the abdomen
  • pain in the back
  • bloating
  • vomiting
105
Q

What causes dysmenorrhoea?

A
  • not sure why some women get them worse than others
  • cramps are a contraction of the uterus in an attempt to shed its lining
106
Q

What are the drug treatments for dysmennorrhoea?

A

Paracetamol & naproxen

107
Q

What are the common side effects of naproxen?

A

No common side effects but a list of side effects in the BNF.

The NHS website said:

  • confusion
  • headaches
  • ringing in the ears
  • changes in vision
  • tiredness and feeling sleepy
  • dizziness
  • rashes
108
Q

What is the mode of action of paracetamol?

A
  • not fully understood
  • thought to reduce production of prostaglandins in the brain and spinal cord, which reduces pain
109
Q

What are the counselling points for taking paracetamol?

A
  • no more than 8 in 24 hours
  • do not take with any other paracetamol containing products
  • no more than 2 at any one time
110
Q

What is amenorrhoea?

A

Amenorrhoea is when a woman doesn’t start her periods or misses periods. When a woman misses 3 or more menstrual periods she has amenorrhoea or if a girl doesn’t start her periods by the age of 15.

111
Q

What is primary amenorrhoea?

A

Primary amenorrhoea is the failure of menses to occur by the age 16 years in the presence of normal growth and secondary sexual characteristics.

112
Q

What is secondary amenorrhoea?

A

Secondary amenorrhoea is defined as the cessation of regular menses for 3 months or cessation of irregular menses for 6 months. - Many cases attributed to PCOS or medical reason.

113
Q

What can cause amenorrhoea?

A
  • pregnancy
  • stress
  • sudden weight loss
  • being overweight
  • over-exercising
  • taking the contraceptive pill
  • menopause
  • PCOS
114
Q

What are the symptoms of amenorrhoea?

A
  • cessation of menstruation
  • other symtoms are related to the cause of amenorrhoea (ie milky nipple discharge if pregnant)
115
Q

What are the medicines used to treat amenorrhoea? (3)

A

Clomifene, combined oral contraceptive pill & medroxyprogesterone

116
Q

What are the common side effects associated with medroxyprogesterone?

A

There are common side effects for medroxyprogesterone in the BNF!

117
Q

What is the mode of action of medroxyprogesterone?

A

Medroxyprogesterone inhibits the production of gondadotropin, preventing follicular maturation and ovulation and causes endometrial thinning.

118
Q

What are the counselling points for taking medroxyprogesterone?

A
  • likelihood of menstrual disturbance (BNF)
  • delay in return to fertility and irregular cycles may occur after discontinuation of treatment
119
Q

What is bacterial vaginosis?

A

Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. It is not a STI, but can increase your risk of getting an STI.

It is when the acidic environment of the vagina, which favours good bacteria, becomes less acidic allowing the overgrowth of anaerobic organisms that replace the normallactobilli.

120
Q

What causes bacterial vaginosis?

A

A change to the pH of the vagina which can be caused by:

  • using perfumed soaps and bubble baths
  • vaginal deodorants, washes or douches
  • strong detergents in underwear

Increased risk if:

  • sexually active
  • change in partner
  • have an IUD
  • used perfumed products in or around your vagina
121
Q

What are the symptoms of bacterial vaginosis?

A
  • 50% of women will not present with symptoms
  • unusual vaginal discharge, strong fishy smell
    • strong fishy smell particularly after sex
    • discharge that is white/grey
    • discharge that is thin/watery

Doesn’t usually cause soreness or itching

122
Q

When can bacterial vaginosis pose risks?

A

The condition is not usually serious.

It is important to seek treatment if you’re pregnant as there’s a small chance that BV can cause complications with pregnancy.

123
Q

What are the medicines used to treat bacterial vaginosis? (2)

A

Clindamycin 2% cream & metronidazole 0.74% cream.

124
Q

What are the common side effects associated with using clindamycin 2% cream?

A

There is only one side effect associated with clindamycin 2% cream in the BNF which is skin reactions.

125
Q

What are the common side effects associated with metronidazole 0.75% gel?

A

There are common side effects associated with metronidazole in the BNF!

126
Q

What is the mode of action of clindamycin?

A

Clindamycin inhibits the bacterial protein synthesis - prevents bacteria from producing proteins - essential for growth, which clears up infection.

127
Q

What are the counselling points associated with clindamycin 2% cream?

A
  • damages latex condoms and diaphragms so use alternative contraception (BNF)
  • avoid sex during infection
  • wash hands before/after use
  • administer at night (BNF)
  • how to use the applicator
128
Q

What is gonorrhoea?

A

Gonorrhoea is a sextually transmitted infection called by a bacteria called Neisseria gonorrhoeae gonococcus.

129
Q

How is gonorrhoea spread?

A
  • unprotected sex (vaginal or anal)
  • sharing sex toys that have not been washed/covered with condom
  • passed from pregnant woman to baby
130
Q

What are the symptoms of gonorrhoea?

A
  • thick yellow/green discharge from the vagina/penis
  • pain when urinating
  • bleeding between periods (women)
  • 1 in 10 men and half of women do not experience symptoms
131
Q

What are the drug treatments for gonorrhoea?

A

Oral ciprofloxacin or azithromycin. (as a single dose after a ceftriaxone injection)

132
Q

What are the common side effects associated with ciprofloxacin?

A

In the BNF the only common side effect is arthropathy (in children). Which will not be relevant for Gonorrhoea.

Cipro is taken as a stat dose for gonorrhoea, so side effects will probably not occur.

According to the NHS website, common side effects for ciprofloxacin are:

  • feeling sick
  • diarrhoea
133
Q

What are the common side effects associated with taking azithromycin?

A

In the BNF there is only arthralgia as a common side effect.

Azithromycin will be taken as a single dose so there likely will not be common side effects.

According to the NHS website:

  • feeling sick
  • diarrhoea
  • losing your appetite
  • headaches
  • feeling dizzy or tired
  • changes to your sense of taste
134
Q

What is the mode of action of ciprofloxacin?

A

Ciprofloxacin has actions which prevent DNA replication.

Prevents DNA replication by targeting the alpha subunits of DNA gyrase which prevents he bacterial DNA from supercoiling.

135
Q

What are the counselling points for taking ciprofloxacin for gonorrhoea?

A
  • avoid sex until infection has cleared (2 week follow up appointment to retest)
  • ensure using condoms when having sex
  • do not share sex toys
  • ciprofloxacin may affect performance of skilled tasks, this may be exacerbated by alcohol
136
Q

What is chlamydia?

A

Chlamydia is the most common sexually transmitted infection in the UK. It is caused by the bacterium Chlamydia trachomatis.

137
Q

What are the symptoms of chlamydia?

A

Most people do not experience symptoms with chlamydia infection.

If you do develop symptoms they may include:

  • pain when urinating
  • unusual discharge from the vagina, penis or bottom
  • for women, pain in the tummy, bleeding after sex and bleeding between periods
  • in men, pain and swelling in the testicles
138
Q

Is chalmydia infection serious?

A

Chlamydia infection can be serious if not treated early on. It can lead to PID, epdidymo-orchitis & infertility.

139
Q

What are the drug treatments for chlamydia?

A

doxycycline or ofloxacin

140
Q

What are the common side effects associated with taking ofloxacin?

A

There are no common side effects in the BNF, only frequency not known.

According to patient.info:

  • diarrhoea
  • headache
  • feeling dizzy
  • problems sleeping
  • eye irritation
  • cough
  • skin itchiness
141
Q

What is candidiasis?

A

Candidiasis is thrush. A fungal infection of the vagina, or penis.

142
Q

What are the symptoms of thrush in women?

A
  • watery white discharge
143
Q

What are the symptoms of thrush in men?

A
  • painful urination
  • white discharge (cottage cheese)
  • unpleasant smell
  • inflamed foreskin, difficult to retract
  • irritation, burning and redness around the head of the penis and under the foreskin
144
Q

What medications are used to treat candidiasis (thrush)? (2)

A

clotrimazole pessaries/creams & fluconazole

145
Q

What are the common side effects of using clotrimazole? (76)

A

There are no common side effects of clotrimazole in the BNF.

According to the NHS website you may experience:

  • red, irritated skin
  • pain or a burning or stinging sensation
146
Q

What are the common side effects of fluconazole? (BNF76)

A

There are common side effects for fluconazole in the BNF!!

147
Q

What is the mode of action of clotrimazole?

A

Clotrimazole alters permeability of the fungal cell wall. Inhibits production of components of the fungal cell membrane. This kills fungi and clears up infection.

148
Q

What are the counselling points for the use of clotrimazole creams/pessaries?

A
  • how to use pessary/applicator
  • be careful if using condoms/diaphragms as can reduce efficacy - use alternative contraceptive methods
  • do not use applicator if pregnant
  • wash hands before and after use
149
Q

What is benign prostatic hyperplasia?

A

Benign prostatic hyperplasia (BPH), or benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pass urine.

150
Q

Who is BPH common in?

A

BPH is common in men over 50.

151
Q

What are the treatments available for BPH?

A
  • lifestyle changes - drink less alcohol/caffeine/fizzy drinks; exercise more; avoid sweeteners; drink less in the evenings
  • medicines
  • surgery (severe cases)
152
Q

Which medicines are available for BPH?

A

alfuzosin & finasteride

153
Q

What are the common side effects of alfuzosin? (BNF 76)

A

There are common side effects for alfuzosin in the BNF!

154
Q

What are the common side effects of finasteride? (BNF 76)

A

There is only 1 common side effect in the BNF, however there are frequency not known.

Patient.info only reports sexual dysfunction (same as BNF).

Netdoctor is more specific:

  • decreased ejaculate volume
  • decreased sex drive
  • difficulty maintaining (or getting) an erection
155
Q

What is the mode of action of alfuzosin?

A

Alfuzosin is an alpha-adrenergic blocking agent that selectivity inhibits the alpha-adrenergic receptors in the lower urinary tract.

Inhibition of these receptors leads to the relaxation of smooth muscle in the bladder neck and prostate, resulting in the improvement in urine flow and a reduction in symptoms in benign prostate hyperplasia.

156
Q

What are the counselling points for alfuzosin?

A
  • first dose effect (take at bedtime, lay down)
  • can affect performance of skilled taks
  • take with or just after food
  • swallow whole
  • (all counselling points are in BNF)
157
Q

What is urinary retention?

A

Urinary retention happens when someone can’t completely empty their bladder. Instead of all the urine (wee) being passed out through the urethra, some remains in the bladder.

158
Q

What are the symptoms of urinary retention?

A
  • urge to urinate frequently
  • inability to urinate
  • still feeling need to urinate after finishing
159
Q

Who is affected by urinary retention?

A

Urinary retention affects more men than women, and is more common as you get older.

160
Q

What causes urinary retention?

A
  • structural problems with urethra eg - narrowing (stricture) or blockage
  • structural problems with bladder neck, sometimes following treatment for a congenital (present at birth) condition, such as posterior urethral valves or bladder exstrophy
  • weak bladder and pelvic floor muscles
  • problems with nerve messages travelling between the bladder and brain
  • side effects of some medications, including anaesthesia
  • surgery to the urinary system
  • constipation when the bowel is full of poo and presses on the bladder and urethra
161
Q

What medications are used for urinary retention?

A

Alfuzosin and finasteride

162
Q

What is erectile dysfunction?

A

Erectile dysfunction is the failure to maintain a satisfactory erection.

163
Q

What can be the causes of erectile dysfunction?

A
  • drinking too much
  • stress/anxiety
  • medication
  • tiredness
  • if it happens more regularly it may be caused by a physical/emotional problem
164
Q

What are possible medications used to treat erectile dysfunction?

A

Sildenafil & alprostadil

165
Q

What are the common side effects of sildenafil? (BNF76)

A

There are common side effects for sildenafil in the BNF 76!

166
Q

What are the common side effects of alprostadil? (BNF 76)

A

There are common side effects for all the different ways of using alprostadil in the BNF.

167
Q

What are the counselling points for sildenafil?

A
  • It usually takes 30 to 60 minutes for sildenafil to work for erectile dysfunction. You can take it up to 4 hours before you want to have sex.
  • You will also need to be aroused for it to work
  • can be sold OTC, so check not taking any other nitrate medications (can cause dangerous drop in blood pressure), already have low blood pressure, a history of heart or liver proble,s
  • do not take more than one dose in a day
  • best taken on an empty stomach, may take longer to work if taken with food
  • see your doctor if you experience chest pain or painful erections that last for 4 hours or more or loss of vision
168
Q

What is the mode of action of sildenafil?

A
  • Influx of nitric oxide into the corpus cavernosum is required for an erection
  • Sildenafil enhances effects of nitric oxide on the corpus cavernosum
  • Nitric oxide (NO) in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP
  • Sildenafil protects cyclic guanosine monophosphate (cGMP) from degradation by cGMP-specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum.
169
Q

FACTORS

A
  1. type of dialysis
  2. dialysis equipment used
  3. molecular weight of drug
  4. water solubility of drug
  5. protein binding
  6. affective volume of distribution
  7. usual route of clearance
  8. body weight
170
Q

CHARACTERISTICS

A
  1. molecular weight of the drug
  2. water solubility of the drug
  3. protein binding of the drug
  4. volume of distribution
  5. method of clearance
171
Q
A
172
Q
A
173
Q
A

!Pharmacy Tech year 1 (22 decks)

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