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Genito-Urinary Flashcards

1
Q

What are the four main types of urinary incocntinence?

A

Urgency, mixed, stress and overflow

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2
Q

What is stress incontinence?

A

Involuntary leakage on effort or exertion and is associated with loss of pelvic floor support

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3
Q

What is urgency incontinence?

A

Involuntary leakage accompanied or preceded by a sudden impelling desire to pass urine that is difficult to delay

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4
Q

What is overflow incontinence?

A

Complication of chronic upper urinary retention and occurs when a person cannot empty their bladder completely and it becomes over distended.

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5
Q

Which drugs are used first line for urinary incontienence

A

Immediate release oxybutynin, tolterodine or darifenacin. IR oxy should not be used in women at risk of sudden deterioration in their physical or mental health.

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6
Q

Discuss the use of duloxetine for stress incontinence in females

A

Duloxetine is not recommended as a first line treatment for women with stress incontinence. it may be used second line where conservative treatment has failed

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7
Q

How do antimuscarinic drugs help in urinary frequency and incontinences?

A

Reduce symptoms of urgency and urge incontinence and increase bladder capacity

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8
Q

How does oxybutynin work?

A

Has a direct relaxant effect on urinary smooth muscle

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9
Q

What is the monitoring requirement for antimuscarinic drugs?

A

Every 4-6 weeks until symptoms stabilise and then every 6-12 months

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10
Q

Which TCA can cause cardiac side effects?

A

Imiprimine

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11
Q

What is mirabegron and what is it used for?

A

Beta3 agonist and is used for ^ with overactive bladder

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12
Q

What is the non-drug treatment for nocturnal enuresis?

A

Enuresis alarm

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13
Q

What is the drug treatment for nocturnal enuresis?

A

1) Oral/SL desmopressin (5+)
2) Desmopressin + oxybutynin/tolterodine (unlicensed)
3) Imipramine

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14
Q

What is a side effect of desmopressin?

A

Hyponatraemic convulsions

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15
Q

What advice would you give for patients treated for primary nocturnal enuresis?

A

Avoid fluid overload – including during swimming
Restrict fluid intake 1 hour before and 8 hours after desmopressin
Stop desmopressin in vomiting/diarrhoea and avoid in drugs that increase vasopressin secretion ie TCAs

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16
Q

Stater some side effects of antimuscarinics?

A

Constipation, tachycardia, dry mouth, dyspepsia, dizziness, headache, vomiting, vision disorders, urinary disorders

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17
Q

What are the dose adjustments due to interactions for solifenacin?

A

Maximum is 5 mg OD with concurrent use of potent inhibitors of CYP3A4 Maximum 5 mg daily if egfr is less than 30 ml

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18
Q

What is the treatment of acute urinary retention?

A

Alpha-adrenoreceptor blocker should be given for at-least 2 days

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19
Q

What is the contraception advice with mirabegron?

A

Contraception is advised in women of child bearing potential

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20
Q

What is the most common cause of urinary retention in males?

A

Benign prostatic hyperplasia

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21
Q

What drug increases detrusor muscle contraction?

A

Bethanechol chloride

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22
Q

What is the treatment of benign prostatic hyperplasia?

A

1) Alpha-blocker
2) 5a-reductase inhibitor (finasteride/dutasteride) given in patients with an enlarged prostate,
raised prostate specific antigen concentration, those considered at high risk of progression
i.e. elderly,
3) Alpha-blocker + 5a reductase inhibitor if symptoms persist

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23
Q

State some common side effects of alpha-blockers?

A

Postural hypotension, dizziness, blurred vision, tachycardia, palpitations, dry mouth

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24
Q

What are the counselling points for alpha-blockers?

A

Take first dose at night due to risk of possible first-dose postural hypotension

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25
What is mirabegron contra-indicated in?
Severe high uncontrolled high blood pressure > 180 / > 110
26
What should be monitored whilst taking mirabegron?
BP
27
What are the indications for dutasteride and finasteride?
BPH
28
Finasteride has another indication what is it?
Androgenetic alopecia in men
29
What are the common side effects of dutasteride/finasteride?
Sexual dysfunction and breast disorder
30
What is the contraception and conception advise for 5a-reductase inhibitors?
Drug is excreted in semen so use of condom is recommended Women of child-bearing potential should avoid handling crushed or broken tablets/capsules
31
State the patient and carer advice for 5a-reductase inhibitors?
Report any changes in breast tissue such as lumps, pain or nipple discharge
32
State the MHRA advice for finasteride?
Reports of depression and suicidal thoughts have reported. Report to GP
33
Which methods of contraception are considered 'highly effective'?
Male and female sterilisation, long acting reversible contraceptives (IUD, IMP). imp should not take any drugs which could decrease effectiveness
34
What are the advantages of a combined oral contraceptive?
Reliable and reversible - Reduced premenstrual tension - Reduced risk of pelvic inflammatory disease - Reduced risk of ovarian and endometrial cancer - Less benign breast disease - Less symptomatic fibroids and functional ovarian cysts
35
What age is COC not advised for?
50+
36
How many weeks before should an oestrogen containing contraceptive be discontinued before major elective surgery?
4 weeks
37
State the reasons to stop COC / HRT?
- Sudden severe chest pain - Sudden breathlessness (or cough with blood-stained sputum) - Unexplained swelling or severe pain in calf of one leg - Severe stomach pain - Severe prolonged headache / complete loss of vision / sudden disturbance of hearing / dysphasia / bad fainting / first seizure / marked numbness - Hepatitis / jaundice / liver enlargement - 160 mmHg / 95 mmHg
38
State two parenteral POPs:
Medroxyprogesterone acetate (depo-provera, sayana press) – prolonged action Lasts for 13 weeks protection
39
State one side effect of the above when given in the immediate puerpium?
Troublesome bleeding (advice: delay first injection until after the first 6 weeks)
40
When should the pop injection be given once a patient has given birth?
5 days after post-partum
41
What are the side effects of medroxyprogesterone?
Delayed return to fertility and menstrual irregularities Osteoporosis risk
42
How long does norethisterone enantate (noristerat) protect a patient for?
8 weeks – short term
43
How long does etonogestrel-releasing implant (Nexplanon) last for?
3 years – single flexible rod which is inserted sub dermally into lower surface of upper arm Bruising and itching can occur at insertion site
44
What is the MHRA warning on Nexplanon implant?
Implants may reach the lung via pulmonary artery
45
Which IUD is licensed as a contraceptive, primary menorrhagia and for prevention of endometrial hyperplasia?
Mirena
46
How long does Mirena last?
5 years
47
How long does Levosert and Jaydess last?
3 years
48
What is an advantage of an IUD?
Method of choice for women who have excessively heavy menses Can be used as an alternative to COC before a major elective surgery
49
What is the advantage of Progestogen-IUD over copper IUD?
- May improve dysmenorrhoea - Reduces blood loss - Frequency of PID reduced - Menstrual bleeding significantly reduced within 3-6 months
50
What is a side effect of nonoxynol spermicidal contraceptive?
Associated with genital lesions
51
What are emergency hormonal contraception methods?
Levonorgestrel 1500 mg – less than 72 hours of upsi. Ulpristal acetate 30 mg – less than 120 hours of upsi Ulpristal reduces effectiveness of regular contraceptives: Use additional barrier protection COC – 14 days (16 days if Qlaira) Progestogen-only - 9 days for pill (14 days if parenteral)
52
Why is it less suitable for prescribing IUD in patients under 25?
Due to risk of pelvic inflammatory disease
53
What is uterine perforation risk in?
Given before 36 weeks post-partum and those patients breastfeeding
54
What is the referral red flags for uterine perforation?
Severe pelvic pain after insertion, sudden change in periods, pain during sex, increased bleeding for moe than few weeks, unable to feel thread
55
What advice to give if copper iud is removed after day 3 of menstrual cycle?
To abstain from sex for 7 days or use barrier method
56
What is the most effective form of emergency contraception?
copper IUD. Can. be inserted up to 120 hours after unprotected sex or within 5 days of ovulation
57
Which emergency contraceptive is more effective?
Uliprisital acetate
58
How does a BMI over 26kg/m2 affect EHC?
Can reduce effectiveness, particularly levonorgestrel. If bw greater than 70kg, give ulipristal or double dose of levonorgestrel.
59
What is the first line ehc
Ulipristal acetate
60
Can EHC be used more than once in the same cycle?
Yes
61
How long should females wait before starting HC after EHC?
5 days with ulipristal. Can start immediately with levonorgestrel
62
Discuss drug interactions with contraceptives
Effectiveness can be considerably reduced with drugs that induce hepatic enzyme activity: carbamazepine, eslicarbazepine, oscarbazepine, phenytoin, phenonbarb, primidone, ritonavir, st johns wort, topiramate, rifabutin, rifampacin
63
Discuss CHOC with short course of enzyme inducing drugs
Continue the coc with condoms during tx and for 4 weeks following
64
Discuss coc with long term course of enzyme inducing drugs (over 2 months)
Monophasic coc, 3 packs back to back for duration and for four weeks after.
65
What is the coc advice for women taking a long term course of rifampicin or rifabutin
An alternative method is recommended as they are potent enzyme inducing drugs, and for 4 weeks after
66
What are the cautions with coc
Risk of venous thromboembolism risk of cv disease
67
What are the risk factors for vte with coc
40 yo+ 6 weeks-6months pp if bf, 3-6 weeks if not smoking obesity htn in pregnancy hx family hx of vte major surgery with prolonged immobilisation heart disease long qt syndrome lupus high altitudes
68
What are specific se for coc
Increased risk of breat and cervical cancer
69
What are the directions for administration of coc
- take same time daily - started on day 6+, use additional contraceptives for 7 days - can change straight away from another coc - from pop - start immediately and use barrier for 7 days - start 3 weeks post childbirth/6 weeks in presence of additional rf -
70
What is the patient/carer advice for coc
- move around on long journeys - if vomitting occurs within 3 hours, take another - take pill asap if missed dose, and next one at normal time - misses 2 or more pills, use barrier for 7 days. EHC recommended
71
What are the side effects of pops
Less risk of breast cancer
72
What is the patient/carer advice for pops
Changing from coc - start on the day after completion of cycle after childbirth - can start up to and including day 21 pp, if started after then use additional barrier for 2 days If vomit within 2 hours, take another If missed pill more than 12 hours, not protected so use barrier for 2 days
73
Give eg of phosphodiesterase type-5 inhibitors: (all oral)
Sildenafil – 1 hour before sex Avanafil – 15-30 minutes before sex Tadalafil – 30 mins before sex Vardenafil – 25-60 minutes before sex
74
What is a side effect of alprostadil (prostaglandin analogue)
Harmful to pregnant women – stimulates uterine contractions and can cause miscarriages
75
What are the side effects of phosphodiesterase type-5 inhibitors?
Hypotension, headache, migraine, tachycardia, palpitations, nasal congestion
76
What are the interactions with phosphodiesterase type 5 inhibitors?
Nitrates, alpha-blockers, CCBs and Nicorandil
77
Which one is long acting drug?
Tadalafil is only one long acting drug. Allows for spontaneity
78
What is the classic definition of non-responder?
6 doses of medicine and it’s failed
79
State one major side effect of phosphodiesterase inhibitors?
Priapism (erection for 4 hours) – medical emergency. Refer.
80
Define premature ejaculation?
Common male sexual disorder characterised by brief ejaculatory latency, loss of control and distress
81
What is the treatment of premature ejaculation?
1) Dapoxetine when required not daily use (ssri) 2) Citalopram, fluoxetine, fluvoxamine, escitalopram, sertraline, paroxetine, clomipramine all OD dose
82
Which TCA can be used for premature ejaculation but is unlicensed use?
Clomipramine
83
Which SSRI is used as first line for premature ejaculation?
Short acting dapoxetine
84
Which two drugs are used to induce abortion or induce or augment labour and minimise blood loss?
Prostaglandins and oxytocics (oxytocin, carbetocin, ergotmetrine maleate, prostanglandins)
85
what to use to terminate pregnancy?
Mifepristone is followed by administration of gemeprost / mistoprostol
86
Which is another use for misoprostol:
Ulcers, gastric, peptic ulcer
87
What is used for treatment of ectopic pregnancy?
Systemic methotrexate

PRE REG (24 decks)

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