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GPhC Exam '22 > CH7: GENITO DRUGS > Flashcards

CH7: GENITO DRUGS Flashcards

1
Q

Oxybutynin

A
  • Antimuscarinic = relaxes the urinary smooth muscles
  • Dose= 5-20mg/day
  • MR prep = reduce SE
  • Available in transdermal patches
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2
Q

Tolterodine

A
  • Antimuscarinic
  • Used to treat urgency incontinence
  • Dose: 1-2mg BD or 4mg OD MR prep
  • Can cause peripheral oedema
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3
Q

What are the cautions & contraindications for Tolterodine

A

C= CVD, susceptibility of glaucoma, UC, elderly
CI= glaucoma, severe UC, urinary retention, bladder outflow obstruction, GI obstruction

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4
Q

Mirabegron

A
  • beta-agonist = used for treating urinary incontinence
  • SE= QTc prolongation, tachycardia, UTI
  • used in elderly/dementia (if anticholinergics are CI/not effective)
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5
Q

Caution use of Mirabegron

A

uncontrolled hypertension

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6
Q

what are the side effects of antimuscarinic

A

e.g. trospium, oxybutynin, tolterodine, solifenacin

CD3FT

Constipation
Drowsiness
Dry mouth
Dizziness
Flushing
Tachycardia

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7
Q

what are the contraindications of antimuscarinics

A
  • angle closure glaucoma
  • GI obstruction
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8
Q

what are the caution of antimuscarinic

A
  • elderly (increased risk of these SE)
  • SE can affect one’s ability to perform - driving
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9
Q

euresis alarm

A
  • 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
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10
Q

desmopressin

A
  • 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
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11
Q

what are the side effects of desmopressin

A
  • nausea
  • hyponatraemic convulsions
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12
Q

Interactions of desmopressin

A
  • TCAs
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13
Q

examples of alpha blockers

A

doxazocin
terazocin
alfuzosin
tamsulosin

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14
Q

side effects of alpha blockers

A
  • postural hypotension
  • dizziness
  • palpitations
  • tachycardia
  • blurred vision
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15
Q

contradictions of alpha blockers

A

if pt has history of;
- postural hypotension
- micturition syncope (fainting after urinating)

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16
Q

dose of doxazocin and tamsulosin for treating BPH

A

D = 1mg OD can be increased to 8mg OD
T = 400mcg OD

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17
Q

what are the side effects of 5 a-reductase inhibitor

A

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
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18
Q

cautions for using 5 a-reductase inhibitors

A
  • excreted in semen = use condom if partner is pregnant/planning to get pregnant
  • women with childbearing age should avoid handling crushed/broken tablets
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19
Q

oestrogen

A
  • COPC
  • Not given in age over 50 – safer alternatives exist
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20
Q

what are the benefits of oestrogen as a COPC?

A
  • 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)
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21
Q

Up to how many hours since unprotected intercourse is levonorgestrel effective for EHC?

A

Up to 72 hours after unprotected sex

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22
Q

age limit for Levonorgestrel?

A

above 16 years old only

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23
Q

What to do if a patient vomits or has diarrhoea after taking levonorgestrel?

A
  • offer 2nd dose if N/V occurs within 3 hours
24
Q

If a pt. has BMI > 26 or weight > 70 kg, what type of EHC would you advice?

A
  • Offer ulipristal (ellaONE)
    OR
  • Give double dose of Levonorgestrel
25
Q

what is the effect of levonorgestrel in breastfeeding women?

A

No delay, can be offered to BF women

26
Q

State the precautions & when to start hormonal contraceptive after EHC

A
  • Use condom until effective
  • 2 days for POP
  • 7 days for combined pill
27
Q

what is the caution of levonorgestrel use?

A

Malabsorption

28
Q

what are the side effects of levonorgestrel?

A
  • breast tenderness
  • D/V
  • fatigue
  • haemorrhage
29
Q

if a pt has severe liver impairment are they able to take levonorgestrel?

A

No, to be avoided

30
Q

What are the drug interactions of Levonorgestrel?

A

CYP inducers: phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids

31
Q

Advice you would offer to a pt. taking carbamazepine and levonorgestrel

A
  • offer double dose if on carbamazepine
32
Q

Up to how many hours since unprotected intercourse is ulipristal (ellaOne) effective for EHC?

A

up to 5 days

33
Q

age limit for Ulipristal (ellaOne)

A

can be given under 16s

34
Q

What to do if a patient vomits or has diarrhoea after taking Ulipristal ?

A
  • offer 2nd dose if v/d within 3 hours
35
Q

When would you advice patients to start taking their regular hormonal contraceptives, after taking Ulipristal?

A
  • after 5 days
  • If during 1st week of taking CHC, CHC can be restarted immediately (wear condom for 7 days)
36
Q

Advise on how long to use extra precautions until treatment is effective when taking Ulipristal for EHC?

A
  • Use condom for 5 days and until treatment is effective (7 days)
    -Total 12 days
37
Q

what is the effect of ulipristal (ellaOne) in breastfeeding women?

A
  • wait 1 week before breastfeeding
38
Q

what is the caution of ulipristal use?

A
  • severe in asthmatics controlled by glucocorticoids
39
Q

what is the side effects of ulipristal use?

A
  • Menstrual irregularities
  • Diarrhoea
  • Vomiting
  • Altered mood
  • Dizziness
40
Q

if a pt has severe liver impairment are they able to take Ulipristal?

A

No, it should be avoided

41
Q

drug interactions of ulipristal

A

CYP inducers: phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids

42
Q

state the non-pharmacological management of erectile dysfunction

A
  • smoking cessation
  • reduce alcohol intake
43
Q

1st line treatment of erectile dysfunction

A

• 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

44
Q

At what max dose of phosphodiesterase type-5 inhibitor (with sexual stimulation) until they are classified to be a non-responder?

A

6 doses of the maximum doses of phosphodiesterase type-5 inhibitor

45
Q

2nd line treatment of erectile dysfunction

A

• 2nd line: intracavernosal, intraurethral or topical alprostadil
- Under medical supervision

46
Q

Alprostadil and counselling points to patient about alprostadil.

A
  • 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

47
Q

Side effects of phosphodiesterase type-5 inhibitor

A

DNMF

Dizziness
Nasal congestion
Migraine
Flushing

48
Q

Contraindications of phosphodiesterase type-5 inhibitor

A

• 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

49
Q

what are the drug interactions of phosphodiesterase type-5 inhibitor

A

• Nitrates
• Alpha blockers

50
Q

when should pts restart their regular contraception after taking levonorgestrol for EHC

A
  • can start straight away after taking levonorgestrol
51
Q

name the drugs that reduce the contraceptive effectiveness

A

CYP inducers = reducing effect of COC = increase dose of COC

Carbamazepine,
Topiramate,
Phenytoin,
Phenobarbital
St. John’s Wort
Rifampicin
Griseofulvin
Rifampicin
Rifabutin

52
Q

name the drugs that reduce the efficacy of copper IUD, levonorgestrel and ulipristal acetate

A

meds that reduce stomach acid = antacids, PPIs and H2 antagonists.

53
Q

state the type of patients who are able to be prescribed treatment for erectile dysfunction via NHS prescription

A
  • 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;
54
Q

what are urological pain and its features

A

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)
55
Q

treatment for urological pain

A

Pain management:
➢1st line→NSAIDs
➢2nd line→Paracetamol ➢3rd line→Opioids
➢ Avoid antispasmodics

56
Q

advice on restarting POP after childbirth

A

➢ 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

57
Q

advice on restarting IUD/IUS after childbirth

A

➢ Can be inserted within 48 hours of childbirth or after 4 weeks

GPhC Exam '22 (16 decks)

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