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GPhC Exam '22 > CH7: GENITO CLINICAL > Flashcards

CH7: GENITO CLINICAL Flashcards

1
Q

What are 3 types of urinary incontinence

A

• Stress incontinence: involuntary leakage on exertion/ sneezing/ coughing…
• Urgency incontinence: urgent need to urinate – difficult to delay (overactive bladder)
• Mixed incontinence: both urgency and stress – one type usually more predominant

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2
Q

Risk factors of urinary incontinence

A
  • age
  • pregnancy/vaginal delivery
  • Family history
  • Meds (diuretics, alcohol, caffeine - increase urine production)
  • Obesity
  • smoking
  • constipation
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3
Q

What is the first line treatment for urgency incontinence

A

bladder training for 6 weeks

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4
Q

what is the 2nd line treatment for urgency incontinence

A

antimuscarinics
Oxybutynin, tolterodine
other: fesoterodine, solifenacin, trospium, darifenacin (7.5-15mg/day)

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5
Q

what is the 3rd line treatment for urgency incontinence

A

beta agonist = Mirabegron

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6
Q

Treatment for stress urinary incontinece

A

1st line - pelvic floor training for 3 months
2nd line - surgery or duloxetine (SSRI)

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7
Q

Treatment for Mixed urinary incontinence

A

1st line - bladder training for 6 weeks AND pelvic floor training for 3 months
2nd line - will depend on the predominant type of urinary incontinence

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8
Q

What is nocturnal enuresis in children

A

involuntary urination during the night

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9
Q

At what age would we not consider interventions for treating a child’s nocturnal enuresis?

A

under the age of 5

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10
Q

What are the non-pharmacological treatments of nocturnal enuresis in children

A
  • advise on fluid intake, diet and toilet training
  • no improvements = urinating 1-2 times a week = initiate 1st line
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11
Q

Briefly state the treatment pathway for nocturnal enuresis in children

A

1st line - Euresis alarm
2nd line - Desmopressin (+/- euresis alarm)
3rd line - Desmopressin (+/- antimuscarinic e.g. oxybutynin/tolterodine - specialist initiation)
4th line - Imipramine (TCA)

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12
Q

Counselling for nocturnal enuresis in children

A
  • avoid fluid overuse - stop 1hr before bed (8 hrs after taking desmopressin
  • stop desmopressin if N/V until fluid balance is restored.
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13
Q

what is urinary retention & its cause

A

inability to urinate voluntarily
cause - urethra blockage, medication (TCAs, antimuscarinics and sympathomimetics)

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14
Q

treatment & management for ACUTE urinary retention

A
  • medical emergency (abrupt development/over period of hours)
  • immediate catheterisation = alleviate pain
  • alpha blocker (doxazocin, tamsulosin, terazosin, alfuzocin) - giver for 2 days before catheter removable
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15
Q

treatment & management for CHRONIC urinary retention

A
  • gradual over months
  • long term use of catheter
  • at risk of recurrent UTIs, urethra trauma, pain, stone formation
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16
Q

What is BPH

A

Benign prostatic hyperplasia (BPH)
- it is a type of chronic urinary retention
- common in men when they age
- enlargement of the prostate
- symptoms: frequency, urgency, urinary retention and nocturia

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17
Q

Treatment of BPH

A
  1. Alpha blockers = to relax the smooth muscles
  2. 5 a-reductase inhibitors (e.g. finasteride/dutasteride)
    • if pt is at high risk of progression/ has the BPH antigen

Can be combined if symptoms remain problematic

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18
Q

Examples of non-hormonal contraceptives

A

Barrier methods
- Condoms, diaphragms, cervical caps
- Petroleum jelly (Vaseline), baby oil and oil-based products can damage condoms, contraceptive diaphragms and caps made from latex rubber – can damage

Spermicidal contraception
-Used in ADDITION only (not alone)

IUD
-Copper coil – most effective out of all contraceptives
-Contraindications: pelvic inflammatory disease or unexplained vaginal bleeding

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19
Q

Briefly state the procedure of supplying contraceptives to pts under 16 years old

A

• Follow Fraser guidelines – can provide contraception without parental consent if:
- She understands doctors’ advice
- Cannot be persuaded to inform her parents
- Very likely to continue having sex
- Unless she received contraception her mental and physical health will suffer
- In her best interests to provide treatment

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20
Q

Examples of progesterone only contraceptives

A
  • Levonorgestrel
  • desogestrel
  • norethisterone
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21
Q

Briefly explain how POPs are taken?

A

• No pill free period – take every day
• No additional precaution needed if:
- Started in the first 5 days of cycle
- Need 2 days of other contraception if taken outside of the first 5 days
(takes 2 days to have effect basically)
• Take at the same time each day for maximum efficacy

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22
Q

state how many hours desogestrol can be taken until it is considered as a missed pill?

A

to be taken within 12 hours

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23
Q

state how many hours until other POPS can be taken until it is considered as a missed pill?

A

to be taken within 3 hours

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24
Q

State the 2 types of POPs & how long they last for?

A

Injections: 99.8% effective when used correctly
• Depot medroxyprogesterone acetate or norethisterone: every 13 weeks

Implants: 99.95% effective in correct usage
• etonorgestrel: lasts up to 3 years

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25
Q

what are the risks of ‘depot medroxyprogesterone acetate or norethisterone’ injection POPs?

A
  • loss of bone density may occur
  • delayed return to fertility up to 1 year after treatment stopped
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26
Q

what are the risks of ‘etonorgestrel’ implant POPs?

A
  • MHRA warning: neurovascular injury and migration of the implant – remove ASAP
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27
Q

what are the examples (drugs and preparations available) of combined hormonal contraceptives (CHC)?

A
  • MoA: inhibits ovulation
  • Preparations: Tablets, patches, vaginal rings

Examples
Oestrogen: ethinylestradiol, oestradiol, mestranol

28
Q

what are the contra-indications of CHC

A

• Hypertension
• Age over 35 who smoke
• Women with multiple CVD risk factors (if one factor might be okay, but avoid with multiple)
- Smoking
- Hypertension
- BMI >30
- Dyslipidaemia
- Diabetes
• Migraine with aura
• New onset of migraine without aura during use of CHC

29
Q

Briefly explain the two different ways CHC can be taken?

A

Monophasic
• Fixed amount of oestrogen and progesterone in each active tablet

Multiphasic
• Varying amounts of 2 hormones

• To improve adherence, non-active tablet can be taken during pill free period
- Some packs have 28-day supply for month (21 active and 7 non-active)
• 7-day withdrawal bleed = hormone free interval

30
Q

state the precautions that should be taken for switching CONTRACEPTIVE to DIFFERENT CHC

A

No additional contraception

31
Q

state the precautions that should be taken for switching CONTRACEPTIVES to POPs

A

7 days extra precaution

32
Q

state the precautions that should be taken for switching CONTRACEPTIVES to LEVONORGESTREL IUD

A

7 days extra precaution needed

33
Q

state the precautions that should be taken for switching CONTRACEPTIVES to COPPER IUD/OTHER NON-HORMONAL METHODS
< if starting CHC in 1st 5 days of cycle >

A

No additional contraception

34
Q

state the precautions that should be taken for switching CONTRACEPTIVES to COPPER IUD/OTHER NON-HORMONAL METHODS
< if starting CHC after 5 days of cycle >

A

7 days extra precaution needed

35
Q

state the precautions that should be taken for switching CHC to Copper IUD
< in week 1 or day 3-7 of pill free interval + no sex since pill free interval >

A

No extra precaution

36
Q

state the precautions that should be taken for switching CHC to POPs
< in week 1 or day 3-7 of pill free interval + no sex since pill free interval >

A

2 day precautions

37
Q

state the precautions that should be taken for switching CHC to OTHERS
< in week 1 or day 3-7 of pill free interval + no sex since pill free interval >

A

7 day precautions

38
Q

state the precautions that should be taken for switching CHC to OTHERS contraceptives
< in week 1 or day 3-7 of pill free interval + sex during pill free interval >

A
  • Carry on with CHC until 7 consecutive days taken
  • Then continue as week 2/3
39
Q

state the precautions that should be taken for switching CHC to OTHER contraceptives
< in week 2 or 3>

A

no extra precautions needed

40
Q

State the reasons to stop CHCs

A

• Calf pain, swelling/ redness -> DVT
• Chest pain, SOB, coughing up blood -> PE
• Loss of motor/ sensory function -> stroke
• Severe stomach pain -> hepatotoxicity
• Very high blood pressure -> haemorhhagic stroke

41
Q

Briefly explain the procedure of taking CHCs in surgery

A

• Discontinue for 4 weeks if:
- Major planned surgery
- Any surgery of legs/ pelvis
- Surgery that involves prolonged immobilisation of lower limb
• Use alternative contraceptive
• CHC can be restarted 2 weeks after full mobilisation
• If CHC can’t be stopped/ emergency surgery
- Consider thromboprophylaxis

42
Q

Side effects of all hormonal contraceptives

A

• Headache
• Unscheduled bleeding (breakthrough bleeding)
• Mood change
• Weight gain
• Libido change

43
Q

Missed doses of POPs
- when to take the pill?
- any extra protection?

A

• Take pill ASAP even if 2 taken on same day
• Take the next pill at the usual time

• Need extra protection:
- 7 days for desogestrel
- 2 days for other POPs

• Emergency contraception if:
- Unprotected sex between missed pill and 2 or 7 days after restarting medication

44
Q

Missed doses of CHCs, if pt. is hormone free interval been over >9 days (starting new pack late)?

A
  • take pill immediately and use condom until 7 consecutive days taken
  • EHC needed if unprotected sex
45
Q

Missed doses of CHCs, if pt. has missed ONE pill (2-3 days after last active pill)?

A
  • Take ASAP – no further action as long as previous 7 days were consistent.
46
Q

Missed doses of CHCs, if pt. has missed TWO + pill (>3 days since last active pill)?
< at week 1 of cycle >

A

EHC if sex within hormone free interval and week 1 and use condom until 7 consecutive days of pill taken

47
Q

Missed doses of CHCs, if pt. has missed TWO + pill (>3 days since last active pill)?
< at week 2-3 of cycle >

A

no EHC, take pill ASAP + 7 days condom

48
Q

Missed doses of CHCs, if pt. has missed TWO + pill (>3 days since last active pill)?
< if 2+ pills missed 7 days before pill free period >

A

continue taking pill throughout interval

49
Q

examples of emergency contraceptives

A
  • Copper IUD
  • Ulipristal 30mg (EllaOne)
  • Levonorgestrel 1.5mg

Hormonal contraceptive can be given more than once in same cycle

50
Q

When is a copper IUD advised to be inserted & if any precautions?

A

• 1st line – most effective
• Can be inserted up 5 days after 1st unprotected sex
• Can be inserted up to 5 days after earliest estimated date of ovulation

51
Q

when can a pt be offered EHC after UPSI after childbirth

A

after day 21 of child birth

52
Q

What is the MHRA alert of copper IUD

A

• MHRA: risk of uterine perforation
- Severe pelvic pain after insertion
- Sudden changes in period
- Pain during intercourse
- Unable to feel threads

53
Q

When should a copper IUD be replaced?

A

Every 5-10 years

54
Q

At what circumstances should copper IUD be removed?

A

After 1st trimester of pregnancy

55
Q

How would you differentiate between copper IUD and levonorgestrel IUD?

A
  • Levonorgestrel IUD is known to be less painful and have reduced bleeding SE compared to copper IUD
56
Q

priapism

A

erection lasting longer than 4 hours – seek medical attention

57
Q

advice on restarting combined oral contraception after childbirth

A

➢ May be started from day 21 and additional contraception should be used for the first 7 days
➢ Increased risk of VTE in users of COC particularly during the first year and possibly after restarting combined hormonal contraceptives following a break of four weeks or more

58
Q

advice on restarting combined oral contraception after childbirth and breastfeeding

A

➢ Absolute contraindication if breastfeeding <6 weeks- COC reduce breast milk production in lactating mothers
➢ Caution if breastfeeding 6 weeks to 6 months post-partum

59
Q

advise a pt on when to start COC

A
  • first day of your next period (days 1-5 of a 28-day cycle)
  • if taking after first 5 days of the cycle: use additional contraception for 7 days e.g. condom
  • How to take→ one tablet everyday for 21 days with a 7-day
    break after
60
Q

Vulvovaginal candidiasis features ‘genital thrush’

A

thick white discharge and vulvovaginal irritation.

61
Q

treatment of vulvovaginal candidiasis in pregnancy

A
  • Treated with vaginal application of an imidazole (such
    as clotrimazole), and a topical imidazole cream for vulvitis
  • Pregnant women need a longer duration of treatment, usually
    about 7 days, to clear the infection
  • Oral antifungal treatment should be avoided during pregnancy
62
Q

features of bacterial vaginosis

A
  • 50% may be asymptomatic
  • Thin, white/grey vaginal discharge - ‘Fishy’ smelling vaginal odour
  • not a STI
63
Q

treatment of bacterial vaginosis (non-pregnancy)

A

Po Metronidazole (7 days)
or Metronidazole cream (5 days)
or clindamycin cream (5 days)

64
Q

contraindications of progesteron-only contraception

A
  • Current or past history of breast cancer
  • Liver cirrhosis or tumours
  • Stroke or coronary heart disease
  • Lower efficacy in women over the weight of 70kg
65
Q

features and causatives of Trichomonas vaginalis

A

sexually transmitted infection via parasite

features:
- offensive, green/yellow vaginal discharge
- itching
- dysuria - pain, tingling on urination

66
Q

treatment for trichomonas vaginalis

A

Refer to GP or sexual health clinic for vaginal swab and treatment
- Oral metronidazole 400–500 mg twice a day for 5– 7 days, OR
- Single 2g dose of oral metronidazole OR
- Oral tinidazole

Sexual abstinence should be advised for at least 1 week and until the person and their partner(s) have completed treatment and follow up.

GPhC Exam '22 (16 decks)

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