chapter 7 Flashcards
what is pelvic organ prolapse and some treatment options for it?
part of wall of uterus or vagina coming down
oestrogen, pessary, oestrogen ring
what are the 3 types of bladder and urinary disorders?
urinary frequency
enuresis [loss of bladder control]
incontinence
define urinary retention
define urinary incontinency
define stress incontinence
define urgency incontinence
urinary retention: inability to voluntarily urinate
urinary incontinence: involuntary leakage of urine
stress incontinence: involuntary leakage of urine on effort/stress
urgency incontinence: involuntary leakage accompanied with the feeling of the sudden urge to pee
what drugs are 1st line, 2nd line and 3rd line in urinary incontinence?
1st line: antimuscarinics
2nd line: mirabegron
3rd line: tricyclic antidepressants
list some drugs that are used to treat urinary incontinence
duloxetine
oxybutynine
tolterodine
mirabegron
list the 4 antimuscarinics used to treat urine incontinence
dots
duloxetine
oxybutynin
tolterodine
solifenacin
what other treatment method works alongside drug therapy for urine incontinence/
non drug treatment eg pelvic floor exercises
what is nocturnal enuresis in children?
what is the common 1st and 2nd line treatment
involuntary leakage of urine during sleep
desmopressin 1st line and imipramine [TCA] 2nd line
what is a common side effect of desmopressin?
what is the counselling advice for desmopressin?
hyponatraemia and nausea
counsel on hyponatraemic convulsions. pt must avoid fluid overload as it will lead to hyponatraemia
what are the cautions of desmopressin?
avoid intranasal route due to side effects
limit fluid intake to minimum from hour before desmopressin
what are the 2 types of urinary retention? explain them and say what they are treated with
acute urinary retention: serious medical attention. painful unable to pass urine for hours. requires emergency catheterisation
chronic urinary retention: over months or years. painless. surgery or medicine eg alpha blockers. alfusozin, tamsulosin
what is the most common cause of urinary retention in men?
benign prostatic hyperplasia
what are the 3 complications of benign prostatic hyperplasia?
renal impairment
urinary retention
recurrent infection
what is the non drug treatment of urinary retention?
surgery
catheterisation
what is the drug treatment used in acute or chronic urinary retention?
alpha blockers: tamsulosin, alfuzosin, doxazosin
what is the pt and carer advice for alpha blockers eg doxazosin?
may cause drowsiness and affect driving/performance of skilled tasks
what is the 1st, 2nd and 3rd line treatment of urinary retention due to benign prostatic hyperplasia?
1st: alpha blockers
2nd line: 5a reductase inhibitors eg finasteride
3rd line: surgery
what is the contraception and conception advice of finasteride and dutasteride?
both excreted in semen
effective contraception must be worn
what is the handling and storage advice for finasteride and dutasteride?
women of child bearing potential must handle with care and not handle broken/crushed tablets
what is the pt and carer advice of finasteride and dutasteride?
both cause breast cancer so report changes of breast
what is the MHRA warning of finasteride?
causes depression and suicidal thoughts in men taking it for male baldness. stop if suicidal thoughts develop
give some examples of alpha blockers.
how do they work?
alfuzosin, doxazosin, tamsulosin,
works by relaxing smooth muscle and increasing urinary flow rate. can also reduce blood pressure
what are the cautions of alpha blockers? [2]
elderly
ppl having cateract surgery as it can cause floppy iris syndrome
what are the contraindications of alpha blockers?
postural hypotension
what are the side effects of alpha blockers? [6]
dry mouth diarrhoea hypotension headache vomiting dizziness
what is the counselling of alpha blockers?
counsel pt on the 1st dose hypotensive effect
what are the 3 types of contraception?
- hormonal contraception including progesterone only and combined hormonal contraception
- intrauterine devices. 2 types. drug one [hormonal] and non drug one [coil] produces local side effects
- barrier methods eg condoms, diaphragms. not effective alone but effective with spermicides
what are combined oral contraceptives? what are the main ingrediants
oestrogen [ethinylestradiol, estriol, mestranol] and progesterone [levonorgestrel, desogestrel] tablet
what age are combined oral contraceptives not recommended beyond and why?
beyond 50 years as safer alternatives exist like progesterone only pill
what formulations combined hormonal contraceptives available as?
patches
pills
vaginal rings
what are some advantages of combined hormonal contraceptive?
acne improvement
regular bleeding patterns
improved menstruation pain
reliable and reversible
what are the 2 types of combined oral contraceptive preparations?
- monophasic: fixed amounts of oestrogen and progesterone in each tablet
- multiphasic: varying amounts of oestrogen and progesterone in each tablet
give examples of brands that come under monophasic preparations?
yasmin
microgella
rigevidon
what are the 2 types of strengths of ethinylestradiol content?
low strength: 20mcg. for women with risk factors eg obesity, smoking
high strength: 30-35mcg for standard use
drospirenone is a progesterone that is a derivative of spironolactone. what is a caution of it?
hypokalaemia
give examples of monophasic combined oral contraceptibes
gederal microgynon rigevidon yasmin zoely femodette
give some examples of multiphasic combined oral contraceptives
logynon
triadene
qlaira
what should you do if a woman is not gettng breakthrough bleeding or their periods on the pill free week on the monophasic preparations?
switch them from mono to multiphasic
what should happen if a patient taking combined hormonal contraceptives is due for surgery?
stop CHC 4 weeks before surgery due to risk of DVT
what do you do if oestrogen cannot be stopped before surgery?
offer heparin or stockings
when can combined hormonal contraception be resumed after surgery?
2 weeks after mobilisation
what are the 9 reasons to stop HRT or COC?
- prolonged immobilisation after surgery [DVT]
- coughing/sob [pulmonary embolism]
- severe chest pains [PE]
- pain in calf/legs [DVT]
- migraines persistant
- hypertension [>160/95]
- stomach pain
- neurological effects eg slurred speech, headache
- jaundice, liver enlargement [liver disorder]
what are the cautions of combined hormonal contraceptives?
risk of venous thromboembolism
risk of breast cancer
risk of cervical cancer
what is the pt and carer advice regarding travel for women on CHCs?
increased risk of DVT when travelling for long distance due to immobilisation
exercise during journey or wear stockings
what is the pt and carer advice regarding diarrhoea and vomiting for women on CHC?
if vomiting occurs 3 hours after taking the pill, take another pill
if diarrhoea occurs for more than 24 hours take another pill
use non oral contraceptives if diarrhoea and vomiting persist
when should you use hormonal contraception with CAUTION or AVOID? [9 things]
- family history of VTE
- obesity with BMI over 30 [avoid if bmi over 35]
- long term immobilisation [avoid if confined to bed]
- history of superficial thrombophlebitis [disorder that causes blood clots]
- smoking [avoid if smoke 40 cigs a day]
- age over 35 [avoid if age over 50]
- diabetes [avoid if have complications]
- migraine WITHOUT aura [avoid if have migraine with aura or severe migraine]
- hypertension BP >140/90 [avoid if BP >160/95]
what is an alternative to combined hormonal contraceptives for people who cannot take them as they are cautioned/avoided?
progesterone only contraception
what is classed as a missed pill for CHC?
what is classed as a missed pill for zoely or qlaira?
what is classed as a missed pill for levonorgestrel or norethisterone?
- more then 24 hours late
- more than 12 hours late
- more than 3 hours late
what is happens if you miss a pill during the critical time period when taking CHC?
you will be extended the pill free week
what must you do if you miss a pill [CHC]?
take another active pill even if it means you will be taking 2 pills on the same day
what is the proper counselling for a patient that has missed 2 or more pills [chc]?
how long must you abstain from sex?
she must take another pill asap and resume normal pill taking
abstain from sex or use additional contraception for 7 days [9 days if on zoely or qlaira]
what is the proper counselling for a patient that has missed 2 or more pills during the last 7 days of the cycle?
omit the pill free week and start the new pack as normal
what must you recommend the patient takes if she has missed 2 or more pills from the first 7 tablets in a packet and unprotected sex has occurred since?
she must take emergency hormonal contraception
what are the 3 forms of progesterone only contraceptives?
oral
parenteral
intrauterine device [copper and progesterone hormone]
what is the mechanism of action of progesterone only contraceptives?
alter cervical mucus to prevent sperm penetration
what 3 types of progesterone are included in oral progesterone contraception?
levonorgestrel
desogestrel
norethisterone
when should progesterone only levonorgestrel contraception be taken?
what is the dose?
take within 72 hours of unprotected sex
1.5mg asap
what is the correct counselling advice for a patient who has missed a pill over 3 hours ago. she is taking progesterone only levonorgestrel?
pt is unprotected. must take another pill asap and use another contraceptive method eg barrier methods for 2 days
when should another pill be taken if a patient has experienced vomiting and diarrhoea on the progesterone only contraceptive?
if vomiting occurs within 2 hours of taking the contraception, then another pill must be taken.
a patient has vomited within 2 hours of taking the progesterone only contraception. she was meant to take a replacement pill but forgot. what is the appropiate advice for her?
additional contraception/precautions should be used whilst they are ill and for a further 2 days after recovery. eg condoms
what is the dose of progesterone only desogestrel contraception?
when should a pt take it?
take at same time every day
75mcg daily
start on day 1 of cycle
what should happen if a pt takes desogestrel pill after day 5 of her cycle?
wear additional contraception for 2 days
what is classed as a missed pill with desogestrel?
if a pt missed a dose 12 hours or more then protection is lost and it is classed as a missed pill
what should happen if a pt taking desogestrel contraceptives, has vomiting or diarrhoea within 2 hours of taking it?
take another pill.
if you fail to take another pill within 12 hours then use extra precaution during illness and for 2 days after
what types of parenteral progesterone contraception is there?
injections and implants
how long can medroxyprogesterone acetate injection last>
2 years
what is the MHRA warning of etonogestrel [nexplanon] implant?
neuromuscular injury and migration
what are the side effects of medroxyprogesterone acetate injection?
bleeding, menstrual disturbance, reduces bone mineral density, osteoporosis
give examples of intra-uterine progestogen only device?
how do they work?
jaydess, mirena
work by releasing levonorgestrel into uterine cavity
what are the advantages of intra-uterine progestogen only device?
reduction in blood loss, improvement in painful periods, reduction in pelvic diseases
what progesterone gets released from intra-uterine devices?
which types of woman is suitable for?
release levonorgestrel
suitable for women with very heavy periods
what is a good alternative for women taking CHC who are due for surgery?
change to progesterone only contraceptives
what is the MHRA warning of progesterone only contraception?
warn of uterine perforation during insertion.
seek medical attention if get pelvic pain, increased bleeding, changes in period, pain during intercourse
give examples of non hormonal contraception.
what are they recommended to be used with?
spermicidal eg gels, foams
to be used with diaphragms etc. NOT CONDOMS does not work
who is the copper IUD suitable for?
which types of patients is it less suitable for?
suitable for all women
but less suitable for women with increased risk of pelvic inflammatory disease [women under 25]
what is the caution with oil based lubricants?
more likley to damage condoms, diaphragms made from latex and make them less effective
how late can you offer emergency contraception to women who just had childbirth?
to women who have just had an abortion/misscarriage, ectopic pregnancy/uterine evacuation?
21 days after child birth
5 days after abortion/misscarriage
what is the 1st line emergency contraception?
how many days after unprotected sex can it be given?
copper iud
can be given 5 days after unprotected sex
what is 2nd line emergency contraception if copper iud is not acceptable?
how many days after unprotected sex can it be taken?
hormonal: levonorgestrel and ulipristal
levon can be taken up to 3 days after unprotected sex
ulipristal can be taken 5 days after unprotected sex
which out of levonorgestrel and ulipristal is the more effective emergency contraception and should be considered 1st line?
ulipristal
what effects the effectiveness of levonorgestrel??
body weight/bmi
what should you give [as hormonal emergency contraception] if bmi over 26 or if body weight over 70kg?
either given double the dose of levonorgestrel or give ulipristal
what is the EHC counselling advice? [4]
- if vomit within 3 hours then take another pill
- next period may be a few days earlier or later
- seek medical attention if lower abdominal pain
- take pregnancy test if period delayed by more than 7 days or if period is different to normal
how long should a woman wait to take her usual hormonal contraception after taking ulipristal emergency contraception?
ulipristal affects normal hormonal contraception so must wait 5 days after taking ulipristal
be advised to wear condoms in this time or abstain from sex
how long should a woman wait to take her normal hormonal contraception after taking levonorgestrel?
can take it immediately as there is no interaction
what drugs affect and interact with POCs, COCs etc?
enzyme inducers
what should a patient do if they have been taking an enzyme inducer together with a coc, poc etc?
use condoms or progesterone only contraception up to 4 weeks of stopping the enzyme inducer
what can you do if a patient on levonorgestrel is also taking an enzyme inducer?
double the dose
which types of drugs affect and interact with ulipristal?
h2 receptor antagonists, antacids, PPIs
name some contraceptives that are not affected by enzyme inducers
non hormonal contraception
iud
norethisterone
parenteral progesterone
which out of levonorgestrel and ulipristal can not be used more than once in the same cycle and why?
ulipristal can
levonorgestrel cant bc of side effects
can levonorgestrel and ulipristal be taken at the same time? how long do you have to wait?
ulipristal is affected by progesterone. must wait 5 days before taking levonorgestrel
how many hours after vomiting and diarrhoea must you take another pill for combined oral contraception?
for progesterone only contraception?
for emergency hormonal contraception?
combined oral contraception: 3 hours
progesterone only: 2 hours
ehc: 3 hours
what is classed as a missed pill for progesterone only pill? and for desogesterol?
progesterone only: more than 3 hours
desogestrel: more than 12 hours
what do prostaglandins and oxytocics do?
induce abortion and induce labour
which drugs are used for induction of abortion? [3]
misoprostol
mifepristone
gemeprost
which drugs can be used to induce labour? [3]
misoprostol
dinoprostone
oxytocin
what is ergometrine and oxytocin used together for?
bleeding from misscarriage or abortion
what is carboprost used for?
severe post partum haemorrhage
what is vaginal atrophy and what is the treatment?
thinning/inflamed vaginal walls caused by low oestrogen levels
treat with a cream containing oestrogen
what risk can erectile dysfunction increase?
increase risk of CVD
what are the risk factors for erectile dysfunction?
smoking lack of exercise obesity high cholesterol levels metabolic syndrome
what is the 1st line treatment of erectile dysfunction?
avanafil, sildenafil, vardanafil, tadafil
what is drug choice for erectile dysfunction dependant on?
frequency of sex and response to treatment
which drug is suitable for spontaneous/frequent and not scheduled sex and why?
tadafil bc it is long acting
what are the side effects of phosphodiesterase inhibitors [sildenafil etc]?
headaches, dizziness, vasodilation, arrhythmias
what are the contrainidcations of phosphodiesterase type 5 inhibitor?
recent stroke or MI, low systolic blood pressure
what are the interactions of phosphodiesterase inhibitors?
nitrates, ccb, alpha blockers
what is the 2nd line treatment of erectile dysfunction?
what route of administraiton is it given in?
what is the pt and carer advice associated with it?
alprostadil
not oral - intraurethral or topical etc
can cause painful erection lasting more than 4 hours. seek medical attention if this happens and apply ice pack
