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extra bnf flashcards > genito urinary > Flashcards

genito urinary Flashcards

1
Q

first line urinary incontinence

A

antimuscs:

oxybutinin = direct relaxant
tolterodine
fesoterodine
darifenacin
solifenacin
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2
Q

second line urinary incontinence

A

beta3agonists

mirabegron

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3
Q

caution with mirabegron

A

QT prolongation

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4
Q

CI with mirabegron

A

severe uncontrolled hypertension

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5
Q

moderate-severe stress incontinence

A

duloxetine

women only

don’t withdraw abruptly

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6
Q

first line in child nocturnal enuresis

A

enuresis alarms - continue until 2 weeks uninterrupted dry nights

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7
Q

second line in child nocturnal enuresis

A

SL/PO desmopression in 5+

IN route shouldn’t be used in NE due to increased SEs

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8
Q

desmopressin side effects

A

hyponatramic convolusions

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9
Q

desmopressin counselling

A

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

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10
Q

alpha blockers MOA

A

relaxes prostatic smooth muscle

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11
Q

alpha blockers

A 
doxazosin
tamsulosin
alfuzosin
indoramin
terazosin
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12
Q

alpha blockers side effects

A

postural hypotension

intra-operative floppy iris syndrome

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13
Q

alpha blockers counselling

A

take first dose at bed

driving can be impaired

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14
Q

finasteride MOA

A

5Alpha Reductase inhibitor

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15
Q

finasteride & dutasteride counselling

A

report breast symptoms e.g. lumps/pain/nipple discharge

use condoms - excreted in semen

women of child-bearing age should avoid handelling

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16
Q

finasteride MHRA alert

A

report signs of depression and suicidal thoughts

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17
Q

fraser guidelines when prescribing contraception to under 16s without parental consent

A
  • 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
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18
Q

COC moa

A

inhibits ovulation

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19
Q

age CI for COC

A

> 50 yo

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20
Q

when to start COC

A

any time of cycle but if started day 6+, use protection for 7 days

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21
Q

increased risk of VTE

A
  • BMI>30
  • smoker
  • primary relative under 45 with VTE
  • superficial thrombophlebitis
  • Long term immobilisation
  • age>50
  • desogestrel/gestodene/drosperinone
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22
Q

increased risk of arterial thromboembolism

A
  • DM
  • hypertension
  • migraine without aura
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23
Q

when to stop COC for elective surgery

A

4 weeks before

prog-only as alternative

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24
Q

when to restart COC after surgery

A

on first menses at least 2 weeks after full mobilisation

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25
Q

what to do in emergency surgery if patient takes COC

A

thromboprophylaxis

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26
Q

what to do in journeys longer than 3 hours when patient takes COC

A

compression stockings and leg exercises

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27
Q

signs of VTE when on COC

A

PE:

  • sudden chest pain
  • sudden breathlessness
  • sudden cough
  • blood-stained sputum

DVT
-unexplained swelling or pain in one calf

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28
Q

signs of stroke when on COC

A

sudden neuro effects:

  • sudden headache
  • sudden visual/auditory disturbances
  • dysphasia
  • collapse
  • first seizure
  • motor disturbances
  • unilateral numbness
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29
Q

other reasons to stop COC

A
  • liver dysfunction
  • BP > 160/95
  • prolonged immobility after surgery(DVT risk)
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30
Q

POP moa

A

thickens cervical mucus

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31
Q

menstrual irregularities are associated with what pill

A

POP

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32
Q

how to take POP

A

if started on day 5 of cycle, additional precaution is required for 2 days

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33
Q

COC cancer SEs

A

breast

cervival

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34
Q

POP cancer SEs

A

breast

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35
Q

COC cancer benefits

A

endometrial

ovarian

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36
Q

other COC benefits

A

reduces:

dysmenorrhea and menorrhagia

PMT

PID

BBC

fibroids/cysts

37
Q

COC missed pill

A

> 24hrs

38
Q

COC missed pill exceptions

A

Zoely/Qlaira >12hrs

39
Q

1 missed COC pill

A

take 1 pill asap + next one at normal time even if it means 2 together

no extra precautions

40
Q

2 missed COC pills

A

take one pill asap + condom for 7 days (9 days with zoely/qlaira)

41
Q

if COC pill missed in last 7 days

A

omit pill-free interval

42
Q

if COC pill missed in first 7 days

A

EHC

43
Q

missed POP

A

> 3hours

44
Q

missed POP exception

A

desogestrel >12 hours

45
Q

missed POP rules

A

take asap + condom for 2 days

46
Q

when EHC is needed in POP

A

if UPS happens before 2 correct pills are taken

47
Q

vomiting and diarrhoea COC

A

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

48
Q

vomiting and diarrhoea POP

A

vomit<2hrs = take another asap

severe or pill not taken within. hrs (12hrs desogestrel) = protection until 2 days after recovery and pill resumed

49
Q

patch cycle

A

3 patch weeks and 1 week patch free

50
Q

patch detached for >24hrs or delayed application at start of cycle

A

apply new one ASAP and start new day 1 + condom for 7 days

51
Q

delayed application of patch on week 2 or week 3

A

<48hrs = apply new patch and continue as normal

> 48 hours = start new day 1 + condom for 7 days

52
Q

what to do if patient is on an enzyme inducing drug

A

copper iud
PO injection

use until 4 weeks after stopping

53
Q

EHC in patients on enzyme inducers

A 
copper iud
3mg levonorgestrel (UL)
54
Q

what is ulipristal efficacy affected by

A

antacids
H2RAg
PPIs

55
Q

EHC first line

A

copper iud - most effective

56
Q

copper iud

A

<120 hrs after ups or up to 5 days after earliest calculated ovulation

57
Q

second line EHC

A

hormonal

levonorgestrel 1500mg < 72hrs

ulipristal 30mg <120hrs

58
Q

EHC in BMI>26 or >70kg

A

uliptristal or levonorgestrel double dose

59
Q

vomiting after levonelle and ellaone

A

<3 hours = replace dose

60
Q

cautions with levonelle

A

crohns - malabsorption
past ectopic pregnancy
ciclosporin

61
Q

cautions with ellaone

A

severe asthma w/ oral corticosteroids

sever liver impairment

62
Q

ellaone CI

A

> 1 dose in same cycle

63
Q

ulipristals effect on regular contraceptives

A

reduces effectiveness

use barrier for
COC - 14 days (16 if qlaira)
POP - 9 days (14 if parenteral)

wait 5 days before restarting hormonal contraception

64
Q

hormonal contraception counselling

A

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

65
Q

what age is IUD nCI

A

<25

PID

66
Q

which iud has reduced risk of pid

A

levonorgestrel releasing

67
Q

iud brands

A

mirena - 5 years
levosert - 3 years
jaydess - 3 years

68
Q

mirena indications

A

contraception
oestrogen-opposition in HRT
menorrhagia

69
Q

levosert indications

A

contraception

menorrhagia

70
Q

jaydess indications

A

contraception

71
Q

IUD MHRA advice

A

uterine perforation so report

pelvic pain
change in periods
pain on sex
increased bleeding for a few weeks

72
Q

removal of iud

A

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

73
Q

parenteral contraception

A

norethisterone - 8 weeks

medroxyprogesterone - 2 years

etonorgestrel (nexplanon) - 3 years

74
Q

MHRA advice of nexplanon

A

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

75
Q

pd5i

A

sildenafil - 1 hr before sex & food
tadalafil - 30 mins before
vardenafil - 25-60 mins before
avanafil - 30 mins before

76
Q

PGA

A

alprostadil (not PO)

report erection > 4hrs = priapism

77
Q

PD5i moa

A

increased blood flow to penis

78
Q

PD5i vasodilating side effects

A 
flushing
hypotension
headache/migraine
dyspepsia
nasal congestion
palpitations
tachycardia
79
Q

PD5i CI

A

reduced blood perfusion:

MI
unstable angina
recent stroke
nitrates
systolic <90
80
Q

PD5i

A

nitrates
alpha blockers
CCB
nicorandil

81
Q

abortion drugs

A

PGA:
gemeprost
misoprotol

Anti prog:
mifespristone

82
Q

labour inducing drugs

A

DOM

dinoprostone (natural PG)
misoprostol
oxytocin (natural hormone)

83
Q

prevent bleeding during labour/miscarriage/abortion

A 
carbetocin
carboprost
ergometrine
misoprostol
oxytocin
84
Q

ectopic pregnancy

A

MTX

85
Q

premature labour

A

salbutamol/terbutaline
atosiban (oxytocin antag)
indometacin (COXi stops PG synth)
nifedipine

NISA

86
Q

treating BV/VT

A

metronidazole 2g single dose

87
Q

thrush in pregnancy

A

topical imidazole for 7 days

88
Q

recurrent thrush

A

6 month treatment

extra bnf flashcards (6 decks)

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