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2021 Pre-registration > Chapter 7 - Genito-urinary > Flashcards

Chapter 7 - Genito-urinary Flashcards

1
Q

What is urinary incontinence?

A

Involuntary leakage of urine

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2
Q

4 main types of urinary incontinence?

A

1) Stress
2) Urgency
3) Mixed
4) Overflow

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3
Q

What happens in stress incontinence?

A

Involuntary leakage on exertion/effort e.g. sneezing/coughing - lack of pelvic floor support/urethral sphincter damage

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4
Q

What happens in urgency incontinence?

A

Involuntary muscle contractions that cause an urgency to pass urine (difficult to hold it in)

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5
Q

What happens in mixed incontinence?

A

Urgency + Stress (one is more predominant)

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6
Q

What happens in overflow incontinence?

A

Incomplete emptying of the bladder (frequent loss of small quantities of urine)

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7
Q

Situational incontinence may occur during certain activities e.g. sex/giggling. True or false?

A

True

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8
Q

Give some risk factors for incontinence.

A 
Older age
Obesity
Pregnancy
Vaginal delivery 
Constipation
Smoking
Family History
Surgical removal which cause lack of support e.g. hysterectomy
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9
Q

State some drugs that can cause urinary incontinence.

A

Ace inhibitors –> cause a cough

A-blockers –> e.g. doxazosin relax the bladder and urethra

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10
Q

Which conditions can worse incontinence?

A 
UTI
Oestrogen deficiency
Stroke
Dementia
Parkisons
Diabetes
Hypercalcaemia
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11
Q

What drugs can increase detrusor muscle activity and contribute to incontinence?

A 
Cholinesterase inhibitors
Anticholinergics
Constipation causing drugs
Diuretics
Alcohol
Caffeine
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12
Q

Lifestyle modifications for incontinence?

A
  • reduce weight if obese (BMI>30)
  • reduce caffeine intake
  • modify fluids
  • Strengthen pelvic muscles e.g. pelvic floor exercises
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13
Q

As 1st line for incontinence, bladder training is recommended. How long should this training be done until drug therapy can be initiated?

A

Urgency - 6 weeks

Stress - 3 months (8contractions TDS)

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14
Q

What would prompt you to do an urgent referral in women with incontinence?

A

> 45yrs and visible/persistent haematuria but no UTI (could be bladder cancer)

and

> 60yrs: non-visible haematuria + dysuria/increased white cells

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15
Q

What should be used 1st line for urgency incontinence?

A

Anticholinergics:

1) IR oxybutynin (also available as transdermal)
2) IR Tolterodine

3) Mirabegron
4) Solifenacin
5) MR Oxybutynin/MR tolterodine
6) Botox (paralyses portion of bladder)

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16
Q

If anticholinergics are not tolerated, what would be recommended as 2nd line?

A

Mirabegron (prolong QT and not for uncontrolled hypertension)

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17
Q

In what specific type of patient would anticholinergics e.g. oxybutynin not be suitable?

A

Frail, elderly as they are at risk of sudden physical/mental health deterioration.

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18
Q

How often should incontinence treatment be reviewed?

A
  • every 4 weeks
  • if tx is effective then review after 12 weeks
  • then annually
  • if >75yrs: every 6 months
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19
Q

Is duloxetine used 1st line for stress incontinence? why?

A

No - only use if pelvic floor training has failed
Only if mod-severe
Do not withdraw abruptly

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20
Q

What is nocturnal enuresis?

A

Involuntary urine discharge whilst asleep. Common in children upto 5yrs. Treatment initiated if still continues upto 7yrs.

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21
Q

1st line treatment for nocturnal enuresis in <5yrs?

A

Nil - reassure parents that it is self-limiting

Use bedwetting alarms

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22
Q

Non-drug therapy for nocturnal enuresis in <5yrs?

A

Bedwetting alarms (have a sensor that detect wetness which urges the child to get up and go to the bathroom) - use for 2 weeks and r/v in 4 weeks

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23
Q

1st line treatment for nocturnal enuresis in >5yrs when alarm is unsuitable?

A

1) desmopressin

2 - if no response) TCA - imipramine

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24
Q

Desmopressin counselling for children >5yrs using it for noctural enuresis?

A

Formulation: sublingual/oral

Side-effects: hyponatraemic convulsions as can dilute blood too much.

Counsel: - restrict fluid intake 1hr before and 8hrs after
- STOP in vomiting/diarrhoea

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25
Q

Give examples of some anti-muscarinic drugs.

A

Oxybutynin
Tolterodine
Solifenacin (max 5mg if egfr <30)

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26
Q

What drug class does mirabegron fall under?

A

Beta-3 agonist

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27
Q

Contra-indications for anti-muscarinic drugs?

A 
angle-closure glaucoma
GI obstruction
Severe ulcerative colitis
Toxic megacolon
Urinary retention
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28
Q

Side-effects of antimuscarinic drugs?

A 
Dry mouth
blurred vision
constipation
dizzy/drowsy
palpitations
vomiting
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29
Q

Cautions and STOPP criteria for antimuscarinic drugs?

A

Caution: elderly

1) Treating EPS of antipsychotics (increased risk of antimusc toxicity)
2) With delirium/dementia (exacerbation of cognitive impairment)
3) 2/more antimusc drugs = risk of antimusc toxicity

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30
Q

Antimuscarinic drugs CAL

A

Can affect driving - do not drive/operate heavy machinery/tools

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31
Q

Antimuscaranics prolong QT, true or false?

A

True

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32
Q

What is the maximum dose of solifenacin in someone with an egfr < 30?

A

5mg

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33
Q

Which drug used for incontinence requires the use of effective contraception?

A

Mirabegron

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34
Q

if a patient is on mirabegron and is prescribed a CYP3A4 inhibitor, what dose reduction is required?

A

Normal dose mirabegron: 50mg OD

Concominant inhibitor/mild hepatic impairment: reduce dose to 25mg OD

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35
Q

Give examples of CYP3A4 inhibitors.

A

Sickfaces.com

Sodium valproate
Isoniazide
Clarithromycin/macrolides
Ketoconazole/antifungals 
Fluconazole
Alcohol
Cimetidine
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

+ grapefruit juice, amiodarone, quinidine

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36
Q

What is urinary retention?

A

The inability to voluntarily urinate.

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37
Q

Drugs that can cause urinary retention?

A

Anti-muscuranics
Sympathomimetics
TCA

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38
Q

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

A

BPH (benign prostatic hyperplasia) - enlarged prostate

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39
Q

How would you manage acute urinary retention?

A

inability to pass urine over hours (medical emergency).

1) immediately catheterise (give a-blocker 2 days before catheter)

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40
Q

Give examples of a-blockers.

A 
DIPT
Doxazosin
Prazosin
Indoramin (can exacerbate parkinsons)
Tamsulosin (take ON)
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41
Q

What should be offered for mod-sev symptoms of urinary retention in men?

A

a-blockers e.g. tamsulosin, doxazosin

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42
Q

How often should a-blocker treatment be reviewed?

A

after 4-6weeks then every 6-12months

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43
Q

How do a-blockers work in BPH?

A

They relax smooth muscles in BPH causing an increase in urinary flow and an improvement in obstructive symptoms

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44
Q

What drug treatment would be recommended for those with an enlarged prostate, raised prostate specific antigen and at high risk of progression (eg elderly)?

A

5a-reductase inhibitors e.g. finasteride/dutasteride

use combo with a-blockers if symptoms are persistent

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45
Q

A-blockers side-effects and counselling?

A

e.g. tamsulosin/doxazosin: can cause postural hypotension (dizzy, blurred vision, tachycardia, palpitations)

Rare - SJS

Contra-indicated: postural hypotension

Counsel: 1st dose at bedtime due to PH, can make you drowsy so avoid driving/alcohol/heavy machinery

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46
Q

A doctor would like to switch a patient from IR doxazosin to MR, he asks if this requires a change in dose, what would you advise.

A

They are both bioequivalent so prescribe the same dose.

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47
Q

Usual dose of tamsulosin for BPH?

A

400mcg ON

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48
Q

Can tamusolin be sold OTC? If so, what are the conditions?

A

Yes.
Age: 45-75yr old men
Max: 6 weeks supply before doctor r/v
Pack size: 14 capsules

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49
Q

How do 5-alpha reductase inhibitors work?

A

Inhibit 5-a reductase that metabolises testosterone into its active form of dihydrotestosterone.

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50
Q

Side-effects of 5-a reductase inhibitors (dutasteride/finasteride)

A

1) Breast disorders - can cause male breast cancer so report lumps, pain/nipple discharge
2) Sexual dysfunction

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51
Q

Patient x has been initiated on finasteride and reports changes in texture of his nipple - what is this indicative of?

A

Breast cancer - report STAT

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52
Q

There is an MHRA warning with one of the 5-a reductase inhibitors, which is it and what does the warning state?

A

Finasteride

Risk of suicidal thoughts/depression - Stop STAT

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53
Q

What indication can 5-a reductase inhibitors be used for?

A

1) Urinary retention due to BPH - dutasteride/finasteride

2) Male pattern hair loss (androgenic alopecia) - (Not on NHS primary care) finasteride

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54
Q

what is the conception and pregnancy advice regarding 5-a reductase inhibitors?

A

1) Women of child-bearing age should avoid handling broken/crushed tablets
2) finasteride is excreted in semen and so condoms should be used if partner is pregnant/likely to become pregnant. (birth defects in male babies)

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55
Q

What are the 2 different types of contraception?

A

1) Combined

2) Progestogen only

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56
Q

What formulations are available for combined contraception?

A
  • Oral
  • Transdermal - Evra
  • Vaginal ring - Nuva ring
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57
Q

What ingredients are in combined contraception?

A

Oestrogen and progestogen

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58
Q

Give examples of oestrogen in contraception?

A

Ethinylestradiol

Estradiol

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59
Q

Give examples of progestogen in contraception?

A

Levonorgestrel
Desogestrel
Norethisterone

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60
Q

What formulations are available for progestogen only contraception?

A

1) oral - deso/levo and norethisterone
2) parenteral - medroxyprogesterone, norethisterone injections
3) intrauterine device

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61
Q

What is the difference between monophasic and multiphasic preparations?

A

Monophasic - fixed amount of oestrogen and progestogen

Multiphasic - varying amounts of oestrogen and progestogen

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62
Q

Give examples of some common contraception brands that are combined?

A 
Gedarel
Femodette
Loestrin
Marvelon
Yasmin
Microgynon 30
Cilest 
Rigevidon
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63
Q

What contraception is considered ‘highly effective’?

A

Copper IUD
Levonorgestrel intrauterine system
Progestogen-only implant

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64
Q

If going for surgery, when should COC be stopped and restarted?

A

Stop 4 weeks prior and restart 2 weeks after full mobilisation.

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65
Q

How does combined oral contraception work?

A

Inhibits ovulation

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66
Q

How does Progestogen only contraception work?

A

alters (thickens) cervical mucus and prevents sperm penetration that could inhibit ovulation

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67
Q

How would you counsel a patient newly starting COC?

A

Once daily for three weeks followed by one-week pill free period for withdrawal bleed.

Start taking it anytime during the cycle. If taken on day 6 or later, use barrier method for seven days

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68
Q

COCs are contra-indicated in what age category?

A

Over 50yrs (risk of VTE/STROKE increases)

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69
Q

Risks of COCs?

A

1) VTE
2) Travel >3hrs - use stocking/compression socks
3) Cervical and breast cancer
4) Stroke
5) Liver dysfunction
6) High blood pressure (>160/95) - contraindicated

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70
Q

How many risk factors of VTE would prompt you to get a patient to avoid COCs?

A

2 or more

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71
Q

Name some risk factors for VTE?

A
  • obese BMI>30/90kg
  • on progestogen pills too
  • smoking
  • family history
  • Diabetes with complications
  • hypertension
  • migraine without aura
  • immobility
72
Q

What BP would deem unsuitable for a COC (where it is contra-indicated)

A

> 160/95

73
Q

When would you stop a COC?

A

1) VTE - chest pain, unilateral swelling and calf pain, breathless, coughing blood
2) Stroke - neuropsychiatric reactions e.g. headache, vision disorders, hearing and speech difficulties, numbness
3) Liver dysfunction - abdominal pain, dark urine, pale stools, jaundice, pruritus
4) BP >160/95

74
Q

Benefits of COCs?

A

Reduced risk of endometrial and ovarian cancer

Helps with dysmenorrhoea and menorrhagia

75
Q

If a patient vomits on a COC what would be the advise?

A

Vomit <2hrs: take one STAT

Vomit >24hrs or severe: use barriers for 7 days

76
Q

If a patient misses a COC for more than 24 hrs what would you advise?

A

Take one STAT and the next at the normal time even if it means you take two.

77
Q

A patient misses 2 or more pills of their COC what are her options

A

Take one STAT then use condoms for 7 days

if missed 2 or more within last 7 days then omit pill free period

78
Q

When would you recommend EHC for a patient that has missed COC pills?

A

If pills are missed onthe first 7 days and they have unprotected sex

79
Q

Why would you use a POP over a COC?

A

if COC contra-indicated e.g. heavy smoker, obese, >50yrs, >160/95, DM + complications

80
Q

How would one take a POP?

A

One tablet daily and at the same time each day

if started on day 5 and barrier for 2 days

81
Q

What cancer does POP increase the risk of?

A

breast

82
Q

What are the time periods for missed POP pills?

A

> 3hrs for all POPs (levonorgestrel, norethisterone) except desogestrel (>12hrs)

83
Q

Which POP is considered a missed pill after 12hrs?

A

Desogestrel

84
Q

A patient misses a POP pill of desogestrel >12hrs, what would you recommend?

A

Take one STAT and barrier for 2 days

85
Q

A patient misses a POP pill >3hrs, what would you recommend?

A

Take one STAT and barrier for 2 days

86
Q

When would you recommend EHC in a patient taking a POP?

A

if they have missed 2 regular pills and unprotected sex occurs

87
Q

How many hours does one have to vomit between after taking another POP?

A

If vomit occurs <2hrs

88
Q

If vomiting with a POP is severe and if a patient has not taken the POP within normal time fram (within 3 hrs or within 12hrs of desogestrel) what would you advise?

A

barrier for 2 days then resume pill once stable

89
Q

What contraceptives are suitable before major elective surgery?

A

Progestogen-only contraceptives

90
Q

When is a contraceptive patch considered ‘missed’

A

if detached >24hrs or delayed

91
Q

how would you advise dosing a transdermal patch e.g. evra?

A

1 cycle: weekly patch for 3 weeks and then 1 week patch-free period

92
Q

If a patient has their patch detached >24hrs or delayed at the start of their cycle what would you advise?

A

1) apply patch STAT

2) start a new day 1 cycle and barriers for 7 days

93
Q

If a patient has their patch delayed e.g. middle of cycle (day 8 or day 15) what would you advise?

A

= 48hrs: new patch and continue as normal

> 48hrs - new day 1 cycle and 7 days barrier

94
Q

What drugs reduce contraceptive effectiveness?

A

Enzyme inducers
CRAPGPs

Carbamazepine
Rifampicin
Alcohol
Phenytoin
Griseofulvin
Phenobarbitol
St Johns Wort/sulfonylurea
95
Q

Women using combined contraceptives and that have been prescribed concominant inducers, what would be the action step?

A

change to parenteral prog-only contraceptive e.g. medroxyprogesterone or IUD
(continue this form of contraception for up to 4 weeks after stopping the inducing drug)

96
Q

3 available options for EHC

A

Copper iUD
Levonorgestrel
Ulipristal

97
Q

1st line for EHC

A

Copper iUD

98
Q

How long after unprotected sex does copper iUD have to be inserted for effectiveness?

A
  • after 5 days (120hrs) OR up to 5 days after the earliest, calculated ovulation
99
Q

Which EHC is more effective levonorgestrel or ulipristal?

A

Ulipristal

100
Q

With time _________ decreases

A

hormonal contraceptive efficacy decreases

101
Q

What is the max time frame after unprotected sex in which levonorgestrel is effective?

A

3 days after (within 72hrs)

102
Q

What is the max time frame after unprotected sex in which ulipristal is effective?

A

5 days (max 120hrs)

103
Q

How many hrs after unprotected sex would taking levonorgestrel be unlicensed?

A

72-96hrs

104
Q

What factors would require you to suggest a double dose of levonorgestrel would be more suitable? is this licensed? What could you do instead?

A

BMI >26 or >70kg
Unlicensed
Give ulipristal

105
Q

Which EHC is licensed for <16yrs?

A

Ulipristal

Levonorgestrel is unlicensed

106
Q

if a patient vomits within 3hrs of taking levonorgestrel, what would be the course of action?

A

Give another pill however this is unlicensed.

107
Q

how long after EHC levonorgestrel can a woman resume her normal pill?

A

After levonorgestrel - start STAT + barriers

108
Q

how long after EHC ulipristal can a woman resume her normal pill?

A

After ulipristal - wait 5 days: use barriers in those 5 days or abstain from sex

109
Q

How does levonorgestrel work, what is the dose for EHC?

A

Prevents ovulation and fertilisation

1500mg STAT or double dose if vomit/obese

110
Q

Cautions for levonorgestrel use as a EHC?

A

previous ectopic pregnancy

ciclosporin (toxicity

Chrohns

111
Q

How does ulipristal work, what is the dose for EHC?

A

Inhibits or delays ovulation , 30mg (give another dose if vomit in <3hrs)

112
Q

Cautions for ulipristal?

A

severe asthma treated by corticosteroids (not recommended)

avoid in severe liver impairment

113
Q

Can levonorgestrel be used again in the same menstrual cycle?

A

otc - unlicensed

manufacturer: avoid due to irregularities

114
Q

Can ulipristal be used again in the same menstrual cycle?

A

yes

115
Q

MHRA Advice for copper iud?

A

uterine perforation: symptoms are severe pelvic pain, pain or increased bleeding, sudden period changes, pain during intercourse, cant feel the threads

116
Q

MHRA advice for ulipristal?

A

Liver injury and hepatic failure (esmya)

117
Q

Hormonal contraception EHC side-effects?

A 
Menstrual irregularities
Next period: early/late
Barrier until next period 
report lower abd pain: ectopic pregnancy
abnormal periods: light/heavy/brief/absent and so take a pregnancy test (3wks after unprotected sex)
118
Q

What age category is IUD less suitable for?

A

<25yrs due to risk of pelvic inflammatory disease

119
Q

What are the two types of IUDs?

A

1) Copper

2) Levonorgestrel-releasing

120
Q

Benefits of levonorgestrel-releasing IUD?

A

Reduced bleeding and period pain
Lower risk of PID
Brand specific due to effectiveness

121
Q

How long are different brands of levonorgestrel-releasing iUDs effective for?

A

Kyleena - 5yrs
Jaydess - 3yrs
Levosert - 5/6yrs
Mirena - 5yrs

122
Q

Side-effects of IUD

A

Pain on insertion and bleeding

Uterine perforation

Risk of infection (ab prophylaxis/chlamydia screening)

123
Q

If removing IUD mid-cycle, what would you recommend for contraception cover?

A

Additional contraceptive for 7 days

124
Q

If removal of IUD is essential and unprotected sex occurs, what do you do ?

A

EHC

125
Q

A woman on IUD becomes pregnant and wants to keep the baby. When would you remove iUD

A

1st trimester

126
Q

Give examples of some barrier methods.

A

Condoms, femidoms, diaphragms and cervical caps

127
Q

Do condoms provide protection against STI?

A

Yes

128
Q

Are spermicides adequate as stand alone contraception?

A

No

129
Q

What does IUD increase the risk of?

A

PID (pelvic inflammatory disease) especially <25yrs

130
Q

Give some oil based lubricants. what are the disadvantages?

A

vaseline, baby oil - likely to damage condoms and contraceptive diaphragms - render them less effective

131
Q

How many days after childbirth and having unprotected sex, would a woman require EHC?

A

From day 21 after childbirth

132
Q

How many days after abortion/ectopic pregnancy/miscarriage would a woman require EHC?

A

from day 5

133
Q

How can hormonal contraception affect the menstrual cycle?

A

Can cause menstrual irregularities. May get spotting, may get a late/early next period

134
Q

After using hormonal contraception, what would you advise a woman until their next period

A

Use barriers

135
Q

a 28yr old female who has recently taken levonorgestrel as EHC from your pharmacy walks in. She reports severe lower abdominal pain. What would be your thoughts and what action would you take?

A

Ectopic pregnancy - refer STAT, go to GP

136
Q

How long after unprotected sex and abnormal periods would you advise a patient to take a pregnancy test?

A

atleast 3 weeks after.

Can be light/heavy/brief/absent

137
Q

Give some examples of parenteral contraception

A

medroxyprogesterone injection - 2 years
norethisterone injection - 8 weeks
etonogestrel implant - 3 years

138
Q

What are the risks with medroxyprogesterone injections?

A

delay in return to fertility and menstrual irregularities

osteoporosis risk

139
Q

MHRA advise with etonogestrel implant?

A

reports of device in vasculature and lungs

implants can reach lung via pulmonary artery

140
Q

Risks with spermicidal contraceptives?

A

increased risk of genital lesions and acquiring infections

141
Q

What is erectile dysfunction?

A

Inability to attain and maintain an erection to perform sufficient sexual performance

142
Q

Erectile dysfunction increases the risk of ___________

A

cardiovascular disease

143
Q

What drugs can cause ED?

A 
antihypertensives
antidepressants
antipsychotics
cytotoxics
recreational drugs
144
Q

How do phosphodiesterase inhibitors work in ED?

A

Increase blood flow to the penis

145
Q

Can PDE5 inhibitors stimulate an erection without sexual arousal?

A

no - sexual arousal is required

146
Q

Which PDE5 inhibitors are short acting?

A

Avanafil
Sildenafil
Vardenafil
(suitable for planned sexual activity)

147
Q

Which PDE5 inhibitor is long acting?

A

Tadalafil - use PRN (suitable for spontaneous activity)

148
Q

How many doses of PDE5 inhibitors is required to deem a person a ‘non-responder’?

A

6 doses at the maximum dose

specialist input required –> use alprostadil

149
Q

What two PDE5 inhibitors must be taken 30mins before sex?

A

Tadalafil and avanafil

150
Q

Which PDE5 inhibitors must be taken 60mins before sex?

A

sildenafil/vardenafil

151
Q

Give an example of a prostaglandin analogue used in ED?

A

Alprostadil

152
Q

What is the warning sign associated with alprostadil?

A

Urgent medical attention if the erection lasts >4hrs (priapism)

153
Q

Contra-indications for PDE5 inhibitors and why?

A

BP: <90 (systolic)

MI

recent stroke

USING NITRATES

Angina especially unstable (as nitrates also vasodilate) can cause post hypotension/heart block due to v.low bp

154
Q

What drug type interacts with PDE5 inhibitors that would prompt you to do a dose reduction?

A

CYP3A4 inhibitors

155
Q

A patient asks if he can take sildenafil with food, what would you advise?

A

Taking it with food/heavy carb/large meals prolongs the onset of action of sildenafil

156
Q

Side-effects of pDE5 inhibitors:

A

Vasodilators so hypotension, dizzy/drowsy, headache, migraine, palpitations and tachycardia

157
Q

PDE5 inhibitor interactions?

A

Due to LOW BP

  • nitrates (further reduce BP)
  • alpha blockers - tamsulosin/doxazosin
  • CCBs
  • nicorandil
158
Q

What are prostaglandins and oxytocics used for?

A

inducing abortion/inducing labour (contractions) to minimise blood loss from placenta

contractions vary in terms of pain and strength

159
Q

What drugs can be used for abortion?

A

misoprostol
gemeprost
mifespristone

160
Q

what drugs can be used to induce/augment labour?

A

Dinoprostone
Oxytocin
Misoprostol

161
Q

what drugs can be used to prevent and treat bleeding in labour, abortion and miscarriage?

A 
carbetocin
carboprost
ergometrine
misoprostol (unlicensed)
oxytocin
162
Q

What drug can be used in ectopic pregnancy (hint: it can cause pulmonary toxicity)

A

methotrexate

163
Q

Methotrexate counselling?

A

1) Gi toxicity - diarrhoea, stomach inflammation
2) liver toxicity - cirrhosis
3) pulmonary toxicity - report dyspnoea, cough, fever
4) blood dyscrasia - bone marrow suppression: monitor white cells and platelets

164
Q

Drugs used for premature labour?

A

terbutaline/salbutamol

atosiban

indometacin (unlicensed)

nifedipine

165
Q

Safery info with oxytocin?

A

at high doses can cause volume depletion which can result in water intoxication with hyponatraemia

166
Q

What products are used for vaginal atrophy?

A

Common in post-menopausal women
topical oestrogens to help relieve dryness: use at the lowest effective dose to avoid systemic effects e.g. hyperplasia and carcinoma. E.g. vagifem

moisturisers include Replens MD

167
Q

What drugs can be used for vaginal candidiasis?

A

Anti-fungals such as pessaries/internal cream like clotrimazole, miconazole

PO treatment is recommended if compliance is an issue e.g. fluconazole/itraconazole

168
Q

How would you treat vulvovaginal thrush in pregnancy?

A

Avoid oral antifungals. Can give topical for 7 days e.g. pessary/cream

169
Q

How would you treat recurrent vulvovaginal candidiasis?

A

6 month treatment (check if pt is diabetic, on oral contraception, pregnant, on antibiotics)

170
Q

What thrush medication is available OTC?

A

age: 18-60yrs
canesten: cream, pessary, oral capsule 150mg fluconazole

171
Q

OTC oral dose of fluconazole for thrush?

A

150mg capsule OD

172
Q

Antifungals are_____

A

CYP inhibitors

173
Q

What species causes thrush?

A

candida albicans

174
Q

Symptoms of vaginal thrush?

A

Cottage-cheese like white discharge and fishy smelling
Painful urination
red/swollen vagina
splits in genitalia

175
Q

Metronidazole dose for Bacterial vaginosis or vaginal trichomoniasis?

A

2g STAT or 400-500mg BD for 5-7 days

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