Chapter 7: Genito-urinary system Flashcards
How do you manage acute urinary retention?
Catheterisation
alpha blocker such as tamsulosin, doxazosin should be given at least 2 days beforehand
What is the pharmacological management of chronic urinary retention in men?
An alpha-adrenoceptor blocker (alfuzosin hydrochloride, doxazosin, tamsulosin hydrochloride or terazosin). Treatment should initially be reviewed after 4–6 weeks and then every 6–12 months.
What is the pharmacological treatment for benign prostate hyperplasia and raised PSA and high risk of progression eg elderly?
5a-reductase inhibitor - finasteride, dutasteride
This can be combined with an alpha blocker if symptoms remain an issue
What can be used for the pharmacological management of urinary incontinence?
Oxybutinin
Tolterodine
Fesoterodine
Solifenacin succinate
Mirabegron - only if antimuscarinics ineffective/not suitable
What is the suggested duration of treatment for an uncomplicated lower UTI in men and women?
7 days for men
3 for women
What 3 antibiotics can be used for long term low dose lower UTI prophylaxis?
Trimethoprim
Nitrofurantoin
Cefalexin
What antibiotics should be used for management of upper UTIs (acute pyelonephritis)?
How long should the treatment be?
IV Broad spectrum antibiotic e.g. cephalosporin, quinolone
Or IV gent if severely ill
10-14 days
What would be the most appropriate antibiotic classes for a pregnant lady with a UTI?
Penicillins or cephalosporins
If non drug treatment is unsuccessful (e.g. using an alarm, fluid intake) in children who have nocturnal enuresis, what would be the pharmacological management?
Oral desmopressin if > 5 years
For children under 5 years, this should resolve spontaneously
When starting alpha blockers for urinary retention/benign prostate hyperplasia, when should the first dose be taken and why?
At bedtime ideally as can cause hypotension and possibly a collapse
What is the MHRA warning regarding the use of finasteride?
Rare reports of depression and suicidal thoughts
What is used for the alkalinisation of urine?
Potassium citrate
Sodium bicarbonate
If a patient requires major elective surgery and is on an oestrogen-containing contraceptive, how is this managed?
Should be stopped 4 weeks before if it means the surgery will result in prolonged immobilisation of lower limbs
Should be restarted at the first menses occurring at least 2 weeks after full mobilisation
A progesterone only contraceptive may be provided as an alternative
Before surgery, if an oestrogen-containing contraceptive cannot be stopped beforehand, what is recommended?
Thromboprophylaxis
What would be the reasons to immediately stop combined hormonal contraceptives or HRT?
- Sudden severe chest pain (even if not radiating to left arm)
- Sudden breathlessness (or cough with blood-stained sputum)
-Unexplained swelling or severe pain in calf of one leg;
severe stomach pain
- Serious neurological effects including unusual severe, prolonged headache
- Hepatitis, jaundice, liver enlargement
- Blood pressure above systolic 160 mmHg or diastolic 95 mmHg; (in adolescents stop if blood pressure very high)
- Prolonged immobility after surgery or leg injury
What is an associated risk of the IUD in women under 25 years?
Increased risk of pelvic inflammatory disease
Copper has higher risk over the progesterone only IUD
Other than patient choice, in what groups of patients would you consider the progesterone only pill over the combined hormonal contraceptive?
When oestrogens are contra-indicated (including those with history of VTE, heavy smokers, those with hypertension above systolic 160 mmHg or diastolic 95 mmHg, valvular heart disease, diabetes mellitus with complications, and migraine with aura)
Intravesical is administration into where?
Bladder
Combined oral contraceptives reduce the risk of what types of cancer?
Ovarian and endometrial cancer
It is recommended that combined oral contraceptives are not continued beyond what age?
50 years as there are more suitable alternatives
Low strength preparations of combined contraceptive pill contain how much ethinylestradiol?
When would you use this?
20 micrograms
If risk factors for circulatory disease are present
Standard strength preparations of combined contraceptive pill contain how much ethinylestradiol?
30 or 35 micrograms
Phased preparations of the combined contraceptive pill is appropriate for what individuals?
Who either do not have withdrawal bleeding or who have breakthrough bleeding with monophasic products
Can progesterone only contraceptives be used during surgery?
Yes