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genito-urinary system > chapter 7 > Flashcards

chapter 7 Flashcards

1
Q

what is pelvic organ prolapse and some treatment options for it?

A

part of wall of uterus or vagina coming down

oestrogen, pessary, oestrogen ring

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2
Q

what are the 3 types of bladder and urinary disorders?

A

urinary frequency
enuresis [loss of bladder control]
incontinence

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3
Q

define urinary retention
define urinary incontinency
define stress incontinence
define urgency incontinence

A

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

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4
Q

what drugs are 1st line, 2nd line and 3rd line in urinary incontinence?

A

1st line: antimuscarinics
2nd line: mirabegron
3rd line: tricyclic antidepressants

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5
Q

list some drugs that are used to treat urinary incontinence

A

duloxetine
oxybutynine
tolterodine
mirabegron

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6
Q

list the 4 antimuscarinics used to treat urine incontinence

A

dots

duloxetine
oxybutynin
tolterodine
solifenacin

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7
Q

what other treatment method works alongside drug therapy for urine incontinence/

A

non drug treatment eg pelvic floor exercises

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8
Q

what is nocturnal enuresis in children?

what is the common 1st and 2nd line treatment

A

involuntary leakage of urine during sleep

desmopressin 1st line and imipramine [TCA] 2nd line

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9
Q

what is a common side effect of desmopressin?

what is the counselling advice for desmopressin?

A

hyponatraemia and nausea

counsel on hyponatraemic convulsions. pt must avoid fluid overload as it will lead to hyponatraemia

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10
Q

what are the cautions of desmopressin?

A

avoid intranasal route due to side effects

limit fluid intake to minimum from hour before desmopressin

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11
Q

what are the 2 types of urinary retention? explain them and say what they are treated with

A

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

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12
Q

what is the most common cause of urinary retention in men?

A

benign prostatic hyperplasia

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13
Q

what are the 3 complications of benign prostatic hyperplasia?

A

renal impairment
urinary retention
recurrent infection

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14
Q

what is the non drug treatment of urinary retention?

A

surgery

catheterisation

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15
Q

what is the drug treatment used in acute or chronic urinary retention?

A

alpha blockers: tamsulosin, alfuzosin, doxazosin

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16
Q

what is the pt and carer advice for alpha blockers eg doxazosin?

A

may cause drowsiness and affect driving/performance of skilled tasks

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17
Q

what is the 1st, 2nd and 3rd line treatment of urinary retention due to benign prostatic hyperplasia?

A

1st: alpha blockers
2nd line: 5a reductase inhibitors eg finasteride
3rd line: surgery

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18
Q

what is the contraception and conception advice of finasteride and dutasteride?

A

both excreted in semen

effective contraception must be worn

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19
Q

what is the handling and storage advice for finasteride and dutasteride?

A

women of child bearing potential must handle with care and not handle broken/crushed tablets

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20
Q

what is the pt and carer advice of finasteride and dutasteride?

A

both cause breast cancer so report changes of breast

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21
Q

what is the MHRA warning of finasteride?

A

causes depression and suicidal thoughts in men taking it for male baldness. stop if suicidal thoughts develop

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22
Q

give some examples of alpha blockers.

how do they work?

A

alfuzosin, doxazosin, tamsulosin,

works by relaxing smooth muscle and increasing urinary flow rate. can also reduce blood pressure

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23
Q

what are the cautions of alpha blockers? [2]

A

elderly

ppl having cateract surgery as it can cause floppy iris syndrome

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24
Q

what are the contraindications of alpha blockers?

A

postural hypotension

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25
Q

what are the side effects of alpha blockers? [6]

A 
dry mouth
diarrhoea
hypotension
headache
vomiting
dizziness
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26
Q

what is the counselling of alpha blockers?

A

counsel pt on the 1st dose hypotensive effect

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27
Q

what are the 3 types of contraception?

A
  1. hormonal contraception including progesterone only and combined hormonal contraception
  2. intrauterine devices. 2 types. drug one [hormonal] and non drug one [coil] produces local side effects
  3. barrier methods eg condoms, diaphragms. not effective alone but effective with spermicides
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28
Q

what are combined oral contraceptives? what are the main ingrediants

A

oestrogen [ethinylestradiol, estriol, mestranol] and progesterone [levonorgestrel, desogestrel] tablet

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29
Q

what age are combined oral contraceptives not recommended beyond and why?

A

beyond 50 years as safer alternatives exist like progesterone only pill

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30
Q

what formulations combined hormonal contraceptives available as?

A

patches
pills
vaginal rings

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31
Q

what are some advantages of combined hormonal contraceptive?

A

acne improvement
regular bleeding patterns
improved menstruation pain
reliable and reversible

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32
Q

what are the 2 types of combined oral contraceptive preparations?

A
  1. monophasic: fixed amounts of oestrogen and progesterone in each tablet
  2. multiphasic: varying amounts of oestrogen and progesterone in each tablet
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33
Q

give examples of brands that come under monophasic preparations?

A

yasmin
microgella
rigevidon

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34
Q

what are the 2 types of strengths of ethinylestradiol content?

A

low strength: 20mcg. for women with risk factors eg obesity, smoking

high strength: 30-35mcg for standard use

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35
Q

drospirenone is a progesterone that is a derivative of spironolactone. what is a caution of it?

A

hypokalaemia

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36
Q

give examples of monophasic combined oral contraceptibes

A 
gederal
microgynon
rigevidon
yasmin
zoely
femodette
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37
Q

give some examples of multiphasic combined oral contraceptives

A

logynon
triadene
qlaira

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38
Q

what should you do if a woman is not gettng breakthrough bleeding or their periods on the pill free week on the monophasic preparations?

A

switch them from mono to multiphasic

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39
Q

what should happen if a patient taking combined hormonal contraceptives is due for surgery?

A

stop CHC 4 weeks before surgery due to risk of DVT

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40
Q

what do you do if oestrogen cannot be stopped before surgery?

A

offer heparin or stockings

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41
Q

when can combined hormonal contraception be resumed after surgery?

A

2 weeks after mobilisation

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42
Q

what are the 9 reasons to stop HRT or COC?

A
  1. prolonged immobilisation after surgery [DVT]
  2. coughing/sob [pulmonary embolism]
  3. severe chest pains [PE]
  4. pain in calf/legs [DVT]
  5. migraines persistant
  6. hypertension [>160/95]
  7. stomach pain
  8. neurological effects eg slurred speech, headache
  9. jaundice, liver enlargement [liver disorder]
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43
Q

what are the cautions of combined hormonal contraceptives?

A

risk of venous thromboembolism
risk of breast cancer
risk of cervical cancer

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44
Q

what is the pt and carer advice regarding travel for women on CHCs?

A

increased risk of DVT when travelling for long distance due to immobilisation
exercise during journey or wear stockings

45
Q

what is the pt and carer advice regarding diarrhoea and vomiting for women on CHC?

A

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

46
Q

when should you use hormonal contraception with CAUTION or AVOID? [9 things]

A
  1. family history of VTE
  2. obesity with BMI over 30 [avoid if bmi over 35]
  3. long term immobilisation [avoid if confined to bed]
  4. history of superficial thrombophlebitis [disorder that causes blood clots]
  5. smoking [avoid if smoke 40 cigs a day]
  6. age over 35 [avoid if age over 50]
  7. diabetes [avoid if have complications]
  8. migraine WITHOUT aura [avoid if have migraine with aura or severe migraine]
  9. hypertension BP >140/90 [avoid if BP >160/95]
47
Q

what is an alternative to combined hormonal contraceptives for people who cannot take them as they are cautioned/avoided?

A

progesterone only contraception

48
Q

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?

A
  1. more then 24 hours late
  2. more than 12 hours late
  3. more than 3 hours late
49
Q

what is happens if you miss a pill during the critical time period when taking CHC?

A

you will be extended the pill free week

50
Q

what must you do if you miss a pill [CHC]?

A

take another active pill even if it means you will be taking 2 pills on the same day

51
Q

what is the proper counselling for a patient that has missed 2 or more pills [chc]?
how long must you abstain from sex?

A

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]

52
Q

what is the proper counselling for a patient that has missed 2 or more pills during the last 7 days of the cycle?

A

omit the pill free week and start the new pack as normal

53
Q

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?

A

she must take emergency hormonal contraception

54
Q

what are the 3 forms of progesterone only contraceptives?

A

oral
parenteral
intrauterine device [copper and progesterone hormone]

55
Q

what is the mechanism of action of progesterone only contraceptives?

A

alter cervical mucus to prevent sperm penetration

56
Q

what 3 types of progesterone are included in oral progesterone contraception?

A

levonorgestrel
desogestrel
norethisterone

57
Q

when should progesterone only levonorgestrel contraception be taken?
what is the dose?

A

take within 72 hours of unprotected sex

1.5mg asap

58
Q

what is the correct counselling advice for a patient who has missed a pill over 3 hours ago. she is taking progesterone only levonorgestrel?

A

pt is unprotected. must take another pill asap and use another contraceptive method eg barrier methods for 2 days

59
Q

when should another pill be taken if a patient has experienced vomiting and diarrhoea on the progesterone only contraceptive?

A

if vomiting occurs within 2 hours of taking the contraception, then another pill must be taken.

60
Q

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?

A

additional contraception/precautions should be used whilst they are ill and for a further 2 days after recovery. eg condoms

61
Q

what is the dose of progesterone only desogestrel contraception?
when should a pt take it?

A

take at same time every day
75mcg daily
start on day 1 of cycle

62
Q

what should happen if a pt takes desogestrel pill after day 5 of her cycle?

A

wear additional contraception for 2 days

63
Q

what is classed as a missed pill with desogestrel?

A

if a pt missed a dose 12 hours or more then protection is lost and it is classed as a missed pill

64
Q

what should happen if a pt taking desogestrel contraceptives, has vomiting or diarrhoea within 2 hours of taking it?

A

take another pill.

if you fail to take another pill within 12 hours then use extra precaution during illness and for 2 days after

65
Q

what types of parenteral progesterone contraception is there?

A

injections and implants

66
Q

how long can medroxyprogesterone acetate injection last>

A

2 years

67
Q

what is the MHRA warning of etonogestrel [nexplanon] implant?

A

neuromuscular injury and migration

68
Q

what are the side effects of medroxyprogesterone acetate injection?

A

bleeding, menstrual disturbance, reduces bone mineral density, osteoporosis

69
Q

give examples of intra-uterine progestogen only device?

how do they work?

A

jaydess, mirena

work by releasing levonorgestrel into uterine cavity

70
Q

what are the advantages of intra-uterine progestogen only device?

A

reduction in blood loss, improvement in painful periods, reduction in pelvic diseases

71
Q

what progesterone gets released from intra-uterine devices?

which types of woman is suitable for?

A

release levonorgestrel

suitable for women with very heavy periods

72
Q

what is a good alternative for women taking CHC who are due for surgery?

A

change to progesterone only contraceptives

73
Q

what is the MHRA warning of progesterone only contraception?

A

warn of uterine perforation during insertion.

seek medical attention if get pelvic pain, increased bleeding, changes in period, pain during intercourse

74
Q

give examples of non hormonal contraception.

what are they recommended to be used with?

A

spermicidal eg gels, foams

to be used with diaphragms etc. NOT CONDOMS does not work

75
Q

who is the copper IUD suitable for?

which types of patients is it less suitable for?

A

suitable for all women

but less suitable for women with increased risk of pelvic inflammatory disease [women under 25]

76
Q

what is the caution with oil based lubricants?

A

more likley to damage condoms, diaphragms made from latex and make them less effective

77
Q

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?

A

21 days after child birth

5 days after abortion/misscarriage

78
Q

what is the 1st line emergency contraception?

how many days after unprotected sex can it be given?

A

copper iud

can be given 5 days after unprotected sex

79
Q

what is 2nd line emergency contraception if copper iud is not acceptable?
how many days after unprotected sex can it be taken?

A

hormonal: levonorgestrel and ulipristal

levon can be taken up to 3 days after unprotected sex

ulipristal can be taken 5 days after unprotected sex

80
Q

which out of levonorgestrel and ulipristal is the more effective emergency contraception and should be considered 1st line?

A

ulipristal

81
Q

what effects the effectiveness of levonorgestrel??

A

body weight/bmi

82
Q

what should you give [as hormonal emergency contraception] if bmi over 26 or if body weight over 70kg?

A

either given double the dose of levonorgestrel or give ulipristal

83
Q

what is the EHC counselling advice? [4]

A
  • 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
84
Q

how long should a woman wait to take her usual hormonal contraception after taking ulipristal emergency contraception?

A

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

85
Q

how long should a woman wait to take her normal hormonal contraception after taking levonorgestrel?

A

can take it immediately as there is no interaction

86
Q

what drugs affect and interact with POCs, COCs etc?

A

enzyme inducers

87
Q

what should a patient do if they have been taking an enzyme inducer together with a coc, poc etc?

A

use condoms or progesterone only contraception up to 4 weeks of stopping the enzyme inducer

88
Q

what can you do if a patient on levonorgestrel is also taking an enzyme inducer?

A

double the dose

89
Q

which types of drugs affect and interact with ulipristal?

A

h2 receptor antagonists, antacids, PPIs

90
Q

name some contraceptives that are not affected by enzyme inducers

A

non hormonal contraception
iud
norethisterone
parenteral progesterone

91
Q

which out of levonorgestrel and ulipristal can not be used more than once in the same cycle and why?

A

ulipristal can

levonorgestrel cant bc of side effects

92
Q

can levonorgestrel and ulipristal be taken at the same time? how long do you have to wait?

A

ulipristal is affected by progesterone. must wait 5 days before taking levonorgestrel

93
Q

how many hours after vomiting and diarrhoea must you take another pill for combined oral contraception?
for progesterone only contraception?
for emergency hormonal contraception?

A

combined oral contraception: 3 hours
progesterone only: 2 hours
ehc: 3 hours

94
Q

what is classed as a missed pill for progesterone only pill? and for desogesterol?

A

progesterone only: more than 3 hours

desogestrel: more than 12 hours

95
Q

what do prostaglandins and oxytocics do?

A

induce abortion and induce labour

96
Q

which drugs are used for induction of abortion? [3]

A

misoprostol
mifepristone
gemeprost

97
Q

which drugs can be used to induce labour? [3]

A

misoprostol
dinoprostone
oxytocin

98
Q

what is ergometrine and oxytocin used together for?

A

bleeding from misscarriage or abortion

99
Q

what is carboprost used for?

A

severe post partum haemorrhage

100
Q

what is vaginal atrophy and what is the treatment?

A

thinning/inflamed vaginal walls caused by low oestrogen levels
treat with a cream containing oestrogen

101
Q

what risk can erectile dysfunction increase?

A

increase risk of CVD

102
Q

what are the risk factors for erectile dysfunction?

A 
smoking
lack of exercise
obesity
high cholesterol levels
metabolic syndrome
103
Q

what is the 1st line treatment of erectile dysfunction?

A

avanafil, sildenafil, vardanafil, tadafil

104
Q

what is drug choice for erectile dysfunction dependant on?

A

frequency of sex and response to treatment

105
Q

which drug is suitable for spontaneous/frequent and not scheduled sex and why?

A

tadafil bc it is long acting

106
Q

what are the side effects of phosphodiesterase inhibitors [sildenafil etc]?

A

headaches, dizziness, vasodilation, arrhythmias

107
Q

what are the contrainidcations of phosphodiesterase type 5 inhibitor?

A

recent stroke or MI, low systolic blood pressure

108
Q

what are the interactions of phosphodiesterase inhibitors?

A

nitrates, ccb, alpha blockers

109
Q

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?

A

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

genito-urinary system (1 decks)

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