Chapter 7- GU System Flashcards
What treatment is available for urinary incontinence
Pelvic floor exercise is used
Drug treatments includes:
Duloxetine for stress associated incontinence
Antimuscarinic (Oxybutinin, solifenacin) and selective B3 receptor stimulation (mirabegron)
Side effects of Antimuscarinic used in urinary incontinence
Constipation
Dry mouth
Sweating
Dilation of pupils
What’s used for bedtime wetting (enuresis) in children
Observe fluid intake
Set alarms
Desmopressin if alarm not effective
Imipramine (in children)
How is acute urinary retention managed
Catheterisation used to relieve symptoms Alpha blocker (doxazosin, tamsulosin) given for atleast 2 days to manage the acute urinary retention
Treatment for chronic urinary retention
Alpha blocker (doxazosin, tamsulosin)
5- alpha reductase inhibitor (finesteride, dutasteride) especially if enlarged prostate
(Or both)
Then surgery
What’s the most common cause of urinary retention in men?
Benign prostatic hyperplasia
Side effects of alpha blockers
Depression Dry mouth GI disturbances Dizziness (may cause hypotension on first dose so take sitting) Impair motor skilled tasks (driving) Floppy iris syndrome
Why should cataracts be cautioned in orients having cataract surgery
It can give floppy iris syndrome risk
What must you counsel for 5-alpha reductase inhibitors
Women of child bearing age should avoid handling crushed or broken tablets/ leaking caps
Excreted in semen so use of condom is recommended
Chance of male developing breast cancer so changes in breast tissue should be reported immediately
What’s the most effective form of contraception
Hormonal
When can hormonal contraceptives be used
Women who have started their menstrual cycle
What’s does the combined hormonal contraceptives contain
Oestrogen and progesterone
Advantages of the CHC
Reliable and reversible
Reduced dysmenorrhea (pain) and menorrhagia (heavy bleeding)
Less ovarian cysts
Less benign breast disease
Less risk of ovarian and endometrial cancer
Reduced risk of pelvic inflammatory disease
What’s monophasic and phasic COC pill
Monophasic= contains the same amount of eostrogen and progesterone
Phasic= contains varying amount
How long before major elective surgery, leg surgery or surgery that results in immobilisation should oestrogen containing contraception be stopped
4 weeks
When should CHC be stopped immediately
Sudden sever chest pain Sudden breathlessness Unexplained swelling or pain in calf Severe stomach pain BP above 160/95mmHg Serious neurological effects Hapatitis/ jaundice
What should be given if oestrogen containing contraceptives are not indicated
Progesterone only contraceptives
When can emergency contraception be offered to a person
After unprotected sex taken place:
On any day of their cycle
21 days after childbirths
5 days after abortion, miscarriage
Regular contraception been compromised
What are the emergency hormonal contraception and how long they effective for
Copper IUD first line- 5 days
Levonorgestrel- 3 days LEVONELLE
Ulipristal- 5 days (if obese) ELLAONE
How long should women wait after taking ulipristal before starting regular hormonal contraception
5 days
When is the risk of VTE greater when patients on hormonal contraception
Family history of VTE under 45 Obese Immobilised Age over 35, avoid if over 50 Smoker History of superficial thrombophlebitis
What is considered a missed pill with hormonal contraception combined pill
More that 24 hours late
Worse at the beginning or end of the cycle
What’s another method of emergency contraception
Intra uterine device
Can be inserted upto 5 days after unprotected sex and acts as contraception after
What’s the risk of intra- uterine device
Risk of infection in the first 20 days after insertion and a carriage of STI
Can you breastfeed after taking emergency hormonal pill
Levonorgestrel = yes
Ulipristal = wait 1 week
What are the 3 types of progesterone only pill and when is it considered a missed pill
Levonorgestrel -3hrs late
Desogestrel- 12hrs late
Norethisterone -3 hours late
What’s a missed contraceptive pill counselling
Take one as soon as you remember, may mean taking 2 in 24hours
Use barrier method for the next 24hours
What are the different types of hormonal contraception, what do they contain and how long do they last
COC pill (oestrogen and progesterone) take one daily with 7 day free period
Contraceptive patch (oestrogen and progesterone) last one week
Contraceptive injection (progesterone) last 2-3 months
Contraceptive implant (progesterone) lasts upto 3 years
Intra-uterine device (progesterone)
What medicines do EHC interact with
Enzyme inducing drugs:
Rifampicin, anti-epileptic, St. John’s wort, ritonavir, griseofulvin
What can you do to the levonorgestrel 1.5mg EHC if the patient is on an enzyme inducing drug or is obese
Give double (3mg) unlicensed
Or a non hormonal emergency contraceptive (copper IUD)
When is progesterone only pill more suitable than the combined one
Patients with VTE Older women Heavy smokers Hypertension Diabetes Heart disease Migraines from COC
What can be a cause of erectile dysfunction
Psychogenic Vascular Neurogenic Endocrine abnormalities And drugs (antihypertensives, antidepressants, antipsychotics)
What can be given for erectile dysfunction
Phosphodiestrase inhibitors (drugs that increase blood flow to the penis) are first line
Sildenafil
Tadalafil
Vardenafil
What’s licenced for the treatment of pre-ejaculation
Dapoxetine
A short acting SSRI
When is phosphodiestrase inhibitors contraindicated
Patient receiving nitrates
Recent stroke
Angina attacks
MI
How are prostaglandins and oxytocics used in obstetrics
They are used to induce abortion, induce labour and to minimise blood loss from the placenta site
By causing uterine contractions
Examples of obstetrics
Oxytocin
Carbetoxin
Ergometrine
Prostaglandin
What can be given for vagina atrophy
Oestrogen containing creams (small amount for shortest period of time) minimise s/e of endometrial hyperplasia and carcinoma
How are the different fungal vulval and vaginal infections treated
Candidal vulvitis- treated locally with cream (Imidazole)
Vaginal candidiasis- treated with antifungal cream of pessary inserted high into the vagina (Imidazole) or if oral route Triazole given
How are fungal vaginal infections treated in pregnancy
And how in persistent infections
Topical imodazole
May need longer course
Oral avoided
Treatment extended to 6 months in recurrent infections
How are non fungal vaginal infections usually treated?
metronidazole gel
What obstetrics is given for abortion
Gemeprost
Mifespristone
Misoprostol
What obstetrics is given to induce labour
Dinoprostone
Misoprostol
Oxytocin
What obstetrics is given to prevent or treat bleeding from labour, abortion or miscarriage
Carbetocin Carboprost Ergometrine Misoprostol OxyContin
What obstetrics is given for ectopic pregnancy
Methotrexate
What obstetrics is given for premature labour
SABA
Atosiban
Indometacin
Nifedipine
What other use does finesteride have other that urinary incontinence
Treat hair loss
Adverse affect of finesteride that may cause men might stop taking it
Gynaecomastia
What other use does alpha blocker have except urinary retention
Resistant hypertension
Side effect of finesteride
Male breast cancer
Depression and suicidal thoughts
What forms does the combined contraceptive come in
Oral
Transdermal patch
Vaginal ring
What does does the progestogen come in
Oral
Parenteral
Intrauterine device
When is the risk increased of arterial thromboembolism for patients on hormonal contraceptives
Diabetes
Hypertension
Migraine without aura
How long after major surgery can COC be restarted
2 weeks after being mobilised
What’s common with progestogen only pill
Menstrual irregularities, heavy or light periods
When should you get EHC for POP and COC when missed a pill
POP missed on pill and had unprotected sex within 2 days
COC missed 2 pills and had unprotected sex within 7 days
Which EHC can you give if a patient is on medication that interact (eg epileptic meds)
Copper IUD
3mg levonorgestrel
Ulipristal
What’s the risk of the hormonal implant?
MHRA alert of the implant reaching the lungs
Cancer side effect of COC and POP
COC increased risk of cervical and breast cancer
POP increased risk of breast cancer
How long should you use addiction barrier protection when you take Ulipristal when on other contraception
COC= 14 days POP= 9 days pill, 14 days parenteral
Which contraceptives are not effected by enzyme inducing drugs
Parenteral POP
IUD
What conditions can Antimuscarinic a worsen
Hyperthyroidism Coronary artery disease Congestive heart failure Hypertension Prostatic hyperplasia Arrhythmia Tachycardia
Is COC suitable in breast feeding
No
Advantages of parenteral POP
Protects against ectopic pregnancy
Not affected by enzyme inducing drugs
Disadvantages of parenteral POP
Delayed return of fertility
Irregular cycles
Advantages and disadvantages or implant POP
Advantages: highly effective and long lasting (3 years)
Disadvantage: affected by enzyme inducers
Why are long journeys while on COC risky
DVT risk with travels > 3 hours
According to frasers guidelines when can you provide contraception without parental consent to under 16?
She understands the doctors advice
She cannot be persuaded to inform her parents
She’s likely to have sex again
If her mental of physical health will suffer
It’s in her best interest
What bp should contraception be stopped
Above 160/95mmHg
What age can thrush treatment be sold otc
Between 16-60
When should progesterone pill be taken
On day 1 of the cycle
If started after day 5, additional precaution is required
What’s the main risk of giving phosphodiesterase type 5 inhibitors with cvd drugs
Hypotension
When should you advice patients to take sildenafil
1 hour before sex and before food
What’s the criteria to supply tamsulosin otc
Symptoms for 3 months
Men aged 45-
Initially 2 week supply
Of improvement further 4 weeks can be given then must have seen gp
What medication can cause cystitis
Tioprofenic acid
Which EHC can be taken again in the same cycle
Levonorgestrel
