Chapter 7 - Obstetrics, Gynecology and Urinary-tract Disorder

Question 1

Norethisterone alone is an oestrogen or progesterone only based preparation?

Answer 1

Progesterone

Question 2

According to the latest FSRH guidelines on EC, what is the most effective form of EC?

Answer 2

Copper IUD

Question 3

If oral emergency contraception is required, which two EHC are available under a PHD or for purchase from the pharmacy?

Answer 3

Ullipristal acetate - ellaOne

Levonorgestrel - Levonelle One step

Question 4

What age can ullipristal and levorgestrel be given to women for EHC?

Answer 4

Ullipristal - women of child-bearing age; no distinct age mentioned

Levonorgestrel - can only be given to women 16yo or over

Question 5

Ullipristal is effective EHC if taken at a maximum of how many hours after unprotected sex?

Answer 5

120 hours (5 days)

Question 6

Levonorgestrel is effective EHC if taken at a maximum of how many hours after unprotected sex?

Answer 6

72 hours (3days)

Question 7

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?

Answer 7

Ullipristal acetate

Question 8

How do levonorgestrel and ullipristal work as EHC

Answer 8

Inhibit or delay ovulation

Question 9

How long after taking ullipristal should a woman use extra protection (i.e condoms)?

Answer 9

Until next menstrual/ withdrawal bleed

Question 10

Can ullipristal and levonorgestrel be taken more than once in the same menstrual cycle?

Answer 10

Yes

Question 11

If a woman has taken ellaOne, how long after should she resume normal hormonal contraception?

Answer 11

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

Question 12

How long after should a woman wait to resume normal contraception with levonelle?

Answer 12

Hormonal contraception can be started immediately after taking levonorgestrel

Question 13

What factors reduces the efficacy of levonelle?

Answer 13

BMI >25

enzyme inducing drugs

Question 14

If a woman is taking an enzyme inducing drug such as carbamazepine, and required EHC, what should be done?

Answer 14

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

Question 15

Which class of drugs are particularly useful and effective in the treatment of urinary frequency and incontinence?

Answer 15

Antimuscarinics e.g oxybutyinin

Question 16

What are the most common side-effects of antimuscarinic drugs which prevents people from continuing with them?

Answer 16

Dry mouth, dilated pupils, dry skin, constipation, reduced bronchial secretions, photophobia, confusion, nausea, skin flushing

Question 17

Oxybutyinin is particularly effective in controlling urinary frequency and incontinence in comparison to other antimuscarinics. Why?

Answer 17

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

Question 18

Mirabegron is another drug which can be used for urinary frequency and incontinence. What is the MOA?

Answer 18

Selective B3 agonist which relaxes bladder smooth muscle

Question 19

What is first line treatment for nocturnal enuresis in children?

Answer 19

Enuresis alarm - non-pharmacological method which has a lower relapse rate than pharmacological methods

Question 20

Which drugs are used for urinary retention?

Answer 20

Alpha1 blockers

eg doxazosin, prazosin, alfuzosin, indoramin

Question 21

What can alpha blockers be also used for?

Answer 21

Hypertension

Question 22

Which alpha 1 blockers are licensed for treatment of HTN?

Answer 22

Doxazosin, prazosin and indoramin