genito urinary Flashcards
first line urinary incontinence
antimuscs:
oxybutinin = direct relaxant tolterodine fesoterodine darifenacin solifenacin
second line urinary incontinence
beta3agonists
mirabegron
caution with mirabegron
QT prolongation
CI with mirabegron
severe uncontrolled hypertension
moderate-severe stress incontinence
duloxetine
women only
don’t withdraw abruptly
first line in child nocturnal enuresis
enuresis alarms - continue until 2 weeks uninterrupted dry nights
second line in child nocturnal enuresis
SL/PO desmopression in 5+
IN route shouldn’t be used in NE due to increased SEs
desmopressin side effects
hyponatramic convolusions
desmopressin counselling
avoid fluid overload - restrict fluid 1 hour before and 8 hours after
stop desmopressin in vomiting/diarhoea until normal
avoid concomitant drugs that increase vasopressin secretion e.g. TCADs
alpha blockers MOA
relaxes prostatic smooth muscle
alpha blockers
doxazosin tamsulosin alfuzosin indoramin terazosin
alpha blockers side effects
postural hypotension
intra-operative floppy iris syndrome
alpha blockers counselling
take first dose at bed
driving can be impaired
finasteride MOA
5Alpha Reductase inhibitor
finasteride & dutasteride counselling
report breast symptoms e.g. lumps/pain/nipple discharge
use condoms - excreted in semen
women of child-bearing age should avoid handelling
finasteride MHRA alert
report signs of depression and suicidal thoughts
fraser guidelines when prescribing contraception to under 16s without parental consent
- patient understands advice
- cannot be persuaded to inform parents
- likely to continue having sex
- in patient’s best interest to provide treatment
- if her physical or mental health will deteriorate without contraception
COC moa
inhibits ovulation
age CI for COC
> 50 yo
when to start COC
any time of cycle but if started day 6+, use protection for 7 days
increased risk of VTE
- BMI>30
- smoker
- primary relative under 45 with VTE
- superficial thrombophlebitis
- Long term immobilisation
- age>50
- desogestrel/gestodene/drosperinone
increased risk of arterial thromboembolism
- DM
- hypertension
- migraine without aura
when to stop COC for elective surgery
4 weeks before
prog-only as alternative
when to restart COC after surgery
on first menses at least 2 weeks after full mobilisation
what to do in emergency surgery if patient takes COC
thromboprophylaxis
what to do in journeys longer than 3 hours when patient takes COC
compression stockings and leg exercises
signs of VTE when on COC
PE:
- sudden chest pain
- sudden breathlessness
- sudden cough
- blood-stained sputum
DVT
-unexplained swelling or pain in one calf
signs of stroke when on COC
sudden neuro effects:
- sudden headache
- sudden visual/auditory disturbances
- dysphasia
- collapse
- first seizure
- motor disturbances
- unilateral numbness
other reasons to stop COC
- liver dysfunction
- BP > 160/95
- prolonged immobility after surgery(DVT risk)
POP moa
thickens cervical mucus
menstrual irregularities are associated with what pill
POP
how to take POP
if started on day 5 of cycle, additional precaution is required for 2 days
COC cancer SEs
breast
cervival
POP cancer SEs
breast
COC cancer benefits
endometrial
ovarian
other COC benefits
reduces:
dysmenorrhea and menorrhagia
PMT
PID
BBC
fibroids/cysts
COC missed pill
> 24hrs
COC missed pill exceptions
Zoely/Qlaira >12hrs
1 missed COC pill
take 1 pill asap + next one at normal time even if it means 2 together
no extra precautions
2 missed COC pills
take one pill asap + condom for 7 days (9 days with zoely/qlaira)
if COC pill missed in last 7 days
omit pill-free interval
if COC pill missed in first 7 days
EHC
missed POP
> 3hours
missed POP exception
desogestrel >12 hours
missed POP rules
take asap + condom for 2 days
when EHC is needed in POP
if UPS happens before 2 correct pills are taken
vomiting and diarrhoea COC
vomit <2hrs = take another asap
> 24 severe - protection until 7 days after recovery and pill resumed. (9 days if qlaira)
in last 7 days - omit pill free interval
vomiting and diarrhoea POP
vomit<2hrs = take another asap
severe or pill not taken within. hrs (12hrs desogestrel) = protection until 2 days after recovery and pill resumed
patch cycle
3 patch weeks and 1 week patch free
patch detached for >24hrs or delayed application at start of cycle
apply new one ASAP and start new day 1 + condom for 7 days
delayed application of patch on week 2 or week 3
<48hrs = apply new patch and continue as normal
> 48 hours = start new day 1 + condom for 7 days
what to do if patient is on an enzyme inducing drug
copper iud
PO injection
use until 4 weeks after stopping
EHC in patients on enzyme inducers
copper iud 3mg levonorgestrel (UL)
what is ulipristal efficacy affected by
antacids
H2RAg
PPIs
EHC first line
copper iud - most effective
copper iud
<120 hrs after ups or up to 5 days after earliest calculated ovulation
second line EHC
hormonal
levonorgestrel 1500mg < 72hrs
ulipristal 30mg <120hrs
EHC in BMI>26 or >70kg
uliptristal or levonorgestrel double dose
vomiting after levonelle and ellaone
<3 hours = replace dose
cautions with levonelle
crohns - malabsorption
past ectopic pregnancy
ciclosporin
cautions with ellaone
severe asthma w/ oral corticosteroids
sever liver impairment
ellaone CI
> 1 dose in same cycle
ulipristals effect on regular contraceptives
reduces effectiveness
use barrier for
COC - 14 days (16 if qlaira)
POP - 9 days (14 if parenteral)
wait 5 days before restarting hormonal contraception
hormonal contraception counselling
next period could be early/late
use barrier til next period
report lower ab pain to gp
take a pregnancy test > weeks post ups if periods are abnormal
what age is IUD nCI
<25
PID
which iud has reduced risk of pid
levonorgestrel releasing
iud brands
mirena - 5 years
levosert - 3 years
jaydess - 3 years
mirena indications
contraception
oestrogen-opposition in HRT
menorrhagia
levosert indications
contraception
menorrhagia
jaydess indications
contraception
IUD MHRA advice
uterine perforation so report
pelvic pain
change in periods
pain on sex
increased bleeding for a few weeks
removal of iud
dont remove midcycle unless additional contraceptive is used for 7 days
if removal is essential and ups occurs, give ehc
pregnant - remove in 1 TM
parenteral contraception
norethisterone - 8 weeks
medroxyprogesterone - 2 years
etonorgestrel (nexplanon) - 3 years
MHRA advice of nexplanon
implants may reach lung via pulmonary artery
must be able to feel it otherwise locate and remove
use chest imaging if unable to locate in arm
pd5i
sildenafil - 1 hr before sex & food
tadalafil - 30 mins before
vardenafil - 25-60 mins before
avanafil - 30 mins before
PGA
alprostadil (not PO)
report erection > 4hrs = priapism
PD5i moa
increased blood flow to penis
PD5i vasodilating side effects
flushing hypotension headache/migraine dyspepsia nasal congestion palpitations tachycardia
PD5i CI
reduced blood perfusion:
MI unstable angina recent stroke nitrates systolic <90
PD5i
nitrates
alpha blockers
CCB
nicorandil
abortion drugs
PGA:
gemeprost
misoprotol
Anti prog:
mifespristone
labour inducing drugs
DOM
dinoprostone (natural PG)
misoprostol
oxytocin (natural hormone)
prevent bleeding during labour/miscarriage/abortion
carbetocin carboprost ergometrine misoprostol oxytocin
ectopic pregnancy
MTX
premature labour
salbutamol/terbutaline
atosiban (oxytocin antag)
indometacin (COXi stops PG synth)
nifedipine
NISA
treating BV/VT
metronidazole 2g single dose
thrush in pregnancy
topical imidazole for 7 days
recurrent thrush
6 month treatment
