Chapter 7 - Obstetrics, Gynecology and Urinary-tract Disorder Flashcards
Norethisterone alone is an oestrogen or progesterone only based preparation?
Progesterone
According to the latest FSRH guidelines on EC, what is the most effective form of EC?
Copper IUD
If oral emergency contraception is required, which two EHC are available under a PHD or for purchase from the pharmacy?
Ullipristal acetate - ellaOne
Levonorgestrel - Levonelle One step
What age can ullipristal and levorgestrel be given to women for EHC?
Ullipristal - women of child-bearing age; no distinct age mentioned
Levonorgestrel - can only be given to women 16yo or over
Ullipristal is effective EHC if taken at a maximum of how many hours after unprotected sex?
120 hours (5 days)
Levonorgestrel is effective EHC if taken at a maximum of how many hours after unprotected sex?
72 hours (3days)
If there is a ‘high risk’ of conception - meaning unprotected sex is likely to have taken place up to 5 days prior to ovulation, which EHC is most effective?
Ullipristal acetate
How do levonorgestrel and ullipristal work as EHC
Inhibit or delay ovulation
How long after taking ullipristal should a woman use extra protection (i.e condoms)?
Until next menstrual/ withdrawal bleed
Can ullipristal and levonorgestrel be taken more than once in the same menstrual cycle?
Yes
If a woman has taken ellaOne, how long after should she resume normal hormonal contraception?
5 days - this is because ullipristal is a selective progestogen receptor modulator, if a progestogen (normal hormonal contraception) is taken after taking ellaOne, the efficacy of ellaOne is reduced
How long after should a woman wait to resume normal contraception with levonelle?
Hormonal contraception can be started immediately after taking levonorgestrel
What factors reduces the efficacy of levonelle?
BMI >25
enzyme inducing drugs
If a woman is taking an enzyme inducing drug such as carbamazepine, and required EHC, what should be done?
Given double dose of levonorgestrel (3mg)
Unlicensed use - can only supply if stated under PGD, if not acting under a PGD, then woman will need referral
Which class of drugs are particularly useful and effective in the treatment of urinary frequency and incontinence?
Antimuscarinics e.g oxybutyinin
What are the most common side-effects of antimuscarinic drugs which prevents people from continuing with them?
Dry mouth, dilated pupils, dry skin, constipation, reduced bronchial secretions, photophobia, confusion, nausea, skin flushing
Oxybutyinin is particularly effective in controlling urinary frequency and incontinence in comparison to other antimuscarinics. Why?
Oxybutynin has a direct relaxant effect on the urinary smooth muscle, which reduces the need to urinate frequency and allows for an increase in bladder capacity
Mirabegron is another drug which can be used for urinary frequency and incontinence. What is the MOA?
Selective B3 agonist which relaxes bladder smooth muscle
What is first line treatment for nocturnal enuresis in children?
Enuresis alarm - non-pharmacological method which has a lower relapse rate than pharmacological methods
Which drugs are used for urinary retention?
Alpha1 blockers
eg doxazosin, prazosin, alfuzosin, indoramin
What can alpha blockers be also used for?
Hypertension
Which alpha 1 blockers are licensed for treatment of HTN?
Doxazosin, prazosin and indoramin
