CH7: GENITO DRUGS Flashcards
Oxybutynin
- Antimuscarinic = relaxes the urinary smooth muscles
- Dose= 5-20mg/day
- MR prep = reduce SE
- Available in transdermal patches
Tolterodine
- Antimuscarinic
- Used to treat urgency incontinence
- Dose: 1-2mg BD or 4mg OD MR prep
- Can cause peripheral oedema
What are the cautions & contraindications for Tolterodine
C= CVD, susceptibility of glaucoma, UC, elderly
CI= glaucoma, severe UC, urinary retention, bladder outflow obstruction, GI obstruction
Mirabegron
- beta-agonist = used for treating urinary incontinence
- SE= QTc prolongation, tachycardia, UTI
- used in elderly/dementia (if anticholinergics are CI/not effective)
Caution use of Mirabegron
uncontrolled hypertension
what are the side effects of antimuscarinic
e.g. trospium, oxybutynin, tolterodine, solifenacin
CD3FT
Constipation
Drowsiness
Dry mouth
Dizziness
Flushing
Tachycardia
what are the contraindications of antimuscarinics
- angle closure glaucoma
- GI obstruction
what are the caution of antimuscarinic
- elderly (increased risk of these SE)
- SE can affect one’s ability to perform - driving
euresis alarm
- 1st line for nocturnal euresis in children
- device that is triggered by wetness- altering the child to wake up and use the toilet
- review alarm after 4 weeks
- continue until 2 weeks of uninterrupted urination
desmopressin
- 2nd line treatment for nocturnal euresis in children, also used for rapid results (.e.g traveling)
- > 5 years
- Used +/- with euresis alarm
- S/L and PO preparation is appropriate (avoid intranasal = increases SE)
- More potent + Longer DOA compared to vasopressin
- no vasoconstriction
- review after 4 weeks
- continue for 3 months if pt responds
what are the side effects of desmopressin
- nausea
- hyponatraemic convulsions
Interactions of desmopressin
- TCAs
examples of alpha blockers
doxazocin
terazocin
alfuzosin
tamsulosin
side effects of alpha blockers
- postural hypotension
- dizziness
- palpitations
- tachycardia
- blurred vision
contradictions of alpha blockers
if pt has history of;
- postural hypotension
- micturition syncope (fainting after urinating)
dose of doxazocin and tamsulosin for treating BPH
D = 1mg OD can be increased to 8mg OD
T = 400mcg OD
what are the side effects of 5 a-reductase inhibitor
e.g. finasteride & dutasteride
- breast cancer = report if lumps, nipple discharge or pain
- MHRA suicide/depression (to stop finasteride immediately and inform HCP
- sexual dysfunction
cautions for using 5 a-reductase inhibitors
- excreted in semen = use condom if partner is pregnant/planning to get pregnant
- women with childbearing age should avoid handling crushed/broken tablets
oestrogen
- COPC
- Not given in age over 50 – safer alternatives exist
what are the benefits of oestrogen as a COPC?
- Reduces risk of ovarian, endometrial, and colorectal cancer
- Aligns bleeding patterns (if irregular bleeds)
- Reduces dysmenorrhoea and menorrhagia
- Manages symptoms of PCOS, endometriosis, PMS
- Improves acne
- Reduces menopausal symptoms
- Maintains bone density in peri-menopausal women (under 50)
Up to how many hours since unprotected intercourse is levonorgestrel effective for EHC?
Up to 72 hours after unprotected sex
age limit for Levonorgestrel?
above 16 years old only
What to do if a patient vomits or has diarrhoea after taking levonorgestrel?
- offer 2nd dose if N/V occurs within 3 hours
If a pt. has BMI > 26 or weight > 70 kg, what type of EHC would you advice?
- Offer ulipristal (ellaONE)
OR - Give double dose of Levonorgestrel
what is the effect of levonorgestrel in breastfeeding women?
No delay, can be offered to BF women
State the precautions & when to start hormonal contraceptive after EHC
- Use condom until effective
- 2 days for POP
- 7 days for combined pill
what is the caution of levonorgestrel use?
Malabsorption
what are the side effects of levonorgestrel?
- breast tenderness
- D/V
- fatigue
- haemorrhage
if a pt has severe liver impairment are they able to take levonorgestrel?
No, to be avoided
What are the drug interactions of Levonorgestrel?
CYP inducers: phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids
Advice you would offer to a pt. taking carbamazepine and levonorgestrel
- offer double dose if on carbamazepine
Up to how many hours since unprotected intercourse is ulipristal (ellaOne) effective for EHC?
up to 5 days
age limit for Ulipristal (ellaOne)
can be given under 16s
What to do if a patient vomits or has diarrhoea after taking Ulipristal ?
- offer 2nd dose if v/d within 3 hours
When would you advice patients to start taking their regular hormonal contraceptives, after taking Ulipristal?
- after 5 days
- If during 1st week of taking CHC, CHC can be restarted immediately (wear condom for 7 days)
Advise on how long to use extra precautions until treatment is effective when taking Ulipristal for EHC?
- Use condom for 5 days and until treatment is effective (7 days)
-Total 12 days
what is the effect of ulipristal (ellaOne) in breastfeeding women?
- wait 1 week before breastfeeding
what is the caution of ulipristal use?
- severe in asthmatics controlled by glucocorticoids
what is the side effects of ulipristal use?
- Menstrual irregularities
- Diarrhoea
- Vomiting
- Altered mood
- Dizziness
if a pt has severe liver impairment are they able to take Ulipristal?
No, it should be avoided
drug interactions of ulipristal
CYP inducers: phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids
state the non-pharmacological management of erectile dysfunction
- smoking cessation
- reduce alcohol intake
1st line treatment of erectile dysfunction
• 1st line: phosphodiesterase type-5 inhibitor
- Increases blood flow to penis – still requires sexual stimulation
- Short-acting: avanafil, sildenafil, vardenafil – occasional use PRN
- Longer-acting use PRN or as regular lower daily dose to allow for spontaneous sexual activity
At what max dose of phosphodiesterase type-5 inhibitor (with sexual stimulation) until they are classified to be a non-responder?
6 doses of the maximum doses of phosphodiesterase type-5 inhibitor
2nd line treatment of erectile dysfunction
• 2nd line: intracavernosal, intraurethral or topical alprostadil
- Under medical supervision
Alprostadil and counselling points to patient about alprostadil.
- Topical prep is used as a 2nd line treatment of ED
- Caution: Wear condom if partner is childbearing age/ pregnant/ lactating
- Report if has prolonged erection – priapism (>4hours)
Priapism
- Seek medical help if a prolonged erection lasting four
hours or more occurs
- Apply an ice pack to the upper-inner thigh (alternating
between the left and right thighs every two minutes for up
to ten minutes)
- If priapism has lasted more than six hours, treatment should
not be delayed
Side effects of phosphodiesterase type-5 inhibitor
DNMF
Dizziness
Nasal congestion
Migraine
Flushing
Contraindications of phosphodiesterase type-5 inhibitor
• Patients taking nitrates/ have hypotension
• Patients with unstable angina/ stroke
• Patients with angina/ stroke
• Patients with angina during intercourse
• Patients who shouldn’t have sexual activity
what are the drug interactions of phosphodiesterase type-5 inhibitor
• Nitrates
• Alpha blockers
when should pts restart their regular contraception after taking levonorgestrol for EHC
- can start straight away after taking levonorgestrol
name the drugs that reduce the contraceptive effectiveness
CYP inducers = reducing effect of COC = increase dose of COC
Carbamazepine,
Topiramate,
Phenytoin,
Phenobarbital
St. John’s Wort
Rifampicin
Griseofulvin
Rifampicin
Rifabutin
name the drugs that reduce the efficacy of copper IUD, levonorgestrel and ulipristal acetate
meds that reduce stomach acid = antacids, PPIs and H2 antagonists.
state the type of patients who are able to be prescribed treatment for erectile dysfunction via NHS prescription
- Have diabetes, multiple sclerosis, Parkinson’s disease, poliomyelitis, prostate cancer, severe pelvic injury, single gene neurological disease, spina bifida, or spinal cord injury;
- Are receiving dialysis for renal failure;
- Have had radical pelvic surgery, prostatectomy, or
kidney transplant;
what are urological pain and its features
Renal or ureteric stones can cause pain and obstruct urine flow
* Stones may pass spontaneously but may require surgery in some cases
- Features:
- unilateral abdominal pain radiating to the groin (renal
colic), - n/v,
- haematuria,
- increased urinary frequency,
- dysuria
- fever (if concomitant urinary infection is present)
treatment for urological pain
Pain management:
➢1st line→NSAIDs
➢2nd line→Paracetamol ➢3rd line→Opioids
➢ Avoid antispasmodics
advice on restarting POP after childbirth
➢ Can start at any time post-partum (breastfeeding and non-breastfeeding women)
➢ If started after day 21, additional contraception should be used for the first 2 days
advice on restarting IUD/IUS after childbirth
➢ Can be inserted within 48 hours of childbirth or after 4 weeks
