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PRE REG > Genito-Urinary > Flashcards

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
Q

What is mirabegron contra-indicated in?

A

Severe high uncontrolled high blood pressure > 180 / > 110

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26
Q

What should be monitored whilst taking mirabegron?

A

BP

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27
Q

What are the indications for dutasteride and finasteride?

A

BPH

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28
Q

Finasteride has another indication what is it?

A

Androgenetic alopecia in men

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29
Q

What are the common side effects of dutasteride/finasteride?

A

Sexual dysfunction and breast disorder

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30
Q

What is the contraception and conception advise for 5a-reductase inhibitors?

A

Drug is excreted in semen so use of condom is recommended
Women of child-bearing potential should avoid handling crushed or broken tablets/capsules

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31
Q

State the patient and carer advice for 5a-reductase inhibitors?

A

Report any changes in breast tissue such as lumps, pain or nipple discharge

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32
Q

State the MHRA advice for finasteride?

A

Reports of depression and suicidal thoughts have reported. Report to GP

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33
Q

Which methods of contraception are considered ‘highly effective’?

A

Male and female sterilisation, long acting reversible contraceptives (IUD, IMP). imp should not take any drugs which could decrease effectiveness

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34
Q

What are the advantages of a combined oral contraceptive?

A

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

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35
Q

What age is COC not advised for?

A

50+

36
Q

How many weeks before should an oestrogen containing contraceptive be discontinued before major elective surgery?

A

4 weeks

37
Q

State the reasons to stop COC / HRT?

A
  • 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
Q

State two parenteral POPs:

A

Medroxyprogesterone acetate (depo-provera, sayana press) – prolonged action Lasts for 13 weeks protection

39
Q

State one side effect of the above when given in the immediate puerpium?

A

Troublesome bleeding (advice: delay first injection until after the first 6 weeks)

40
Q

When should the pop injection be given once a patient has given birth?

A

5 days after post-partum

41
Q

What are the side effects of medroxyprogesterone?

A

Delayed return to fertility and menstrual irregularities Osteoporosis risk

42
Q

How long does norethisterone enantate (noristerat) protect a patient for?

A

8 weeks – short term

43
Q

How long does etonogestrel-releasing implant (Nexplanon) last for?

A

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
Q

What is the MHRA warning on Nexplanon implant?

A

Implants may reach the lung via pulmonary artery

45
Q

Which IUD is licensed as a contraceptive, primary menorrhagia and for prevention of endometrial hyperplasia?

A

Mirena

46
Q

How long does Mirena last?

A

5 years

47
Q

How long does Levosert and Jaydess last?

A

3 years

48
Q

What is an advantage of an IUD?

A

Method of choice for women who have excessively heavy menses Can be used as an alternative to COC before a major elective surgery

49
Q

What is the advantage of Progestogen-IUD over copper IUD?

A
  • May improve dysmenorrhoea
  • Reduces blood loss
  • Frequency of PID reduced
  • Menstrual bleeding significantly reduced within 3-6 months
50
Q

What is a side effect of nonoxynol spermicidal contraceptive?

A

Associated with genital lesions

51
Q

What are emergency hormonal contraception methods?

A

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
Q

Why is it less suitable for prescribing IUD in patients under 25?

A

Due to risk of pelvic inflammatory disease

53
Q

What is uterine perforation risk in?

A

Given before 36 weeks post-partum and those patients breastfeeding

54
Q

What is the referral red flags for uterine perforation?

A

Severe pelvic pain after insertion, sudden change in periods, pain during sex, increased bleeding for moe than few weeks, unable to feel thread

55
Q

What advice to give if copper iud is removed after day 3 of menstrual cycle?

A

To abstain from sex for 7 days or use barrier method

56
Q

What is the most effective form of emergency contraception?

A

copper IUD. Can. be inserted up to 120 hours after unprotected sex or within 5 days of ovulation

57
Q

Which emergency contraceptive is more effective?

A

Uliprisital acetate

58
Q

How does a BMI over 26kg/m2 affect EHC?

A

Can reduce effectiveness, particularly levonorgestrel. If bw greater than 70kg, give ulipristal or double dose of levonorgestrel.

59
Q

What is the first line ehc

A

Ulipristal acetate

60
Q

Can EHC be used more than once in the same cycle?

A

Yes

61
Q

How long should females wait before starting HC after EHC?

A

5 days with ulipristal. Can start immediately with levonorgestrel

62
Q

Discuss drug interactions with contraceptives

A

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
Q

Discuss CHOC with short course of enzyme inducing drugs

A

Continue the coc with condoms during tx and for 4 weeks following

64
Q

Discuss coc with long term course of enzyme inducing drugs (over 2 months)

A

Monophasic coc, 3 packs back to back for duration and for four weeks after.

65
Q

What is the coc advice for women taking a long term course of rifampicin or rifabutin

A

An alternative method is recommended as they are potent enzyme inducing drugs, and for 4 weeks after

66
Q

What are the cautions with coc

A

Risk of venous thromboembolism
risk of cv disease

67
Q

What are the risk factors for vte with coc

A

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
Q

What are specific se for coc

A

Increased risk of breat and cervical cancer

69
Q

What are the directions for administration of coc

A
  • 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
Q

What is the patient/carer advice for coc

A
  • 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
Q

What are the side effects of pops

A

Less risk of breast cancer

72
Q

What is the patient/carer advice for pops

A

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
Q

Give eg of phosphodiesterase type-5 inhibitors: (all oral)

A

Sildenafil – 1 hour before sex
Avanafil – 15-30 minutes before sex
Tadalafil – 30 mins before sex
Vardenafil – 25-60 minutes before sex

74
Q

What is a side effect of alprostadil (prostaglandin analogue)

A

Harmful to pregnant women – stimulates uterine contractions and can cause miscarriages

75
Q

What are the side effects of phosphodiesterase type-5 inhibitors?

A

Hypotension, headache, migraine, tachycardia, palpitations, nasal congestion

76
Q

What are the interactions with phosphodiesterase type 5 inhibitors?

A

Nitrates, alpha-blockers, CCBs and Nicorandil

77
Q

Which one is long acting drug?

A

Tadalafil is only one long acting drug. Allows for spontaneity

78
Q

What is the classic definition of non-responder?

A

6 doses of medicine and it’s failed

79
Q

State one major side effect of phosphodiesterase inhibitors?

A

Priapism (erection for 4 hours) – medical emergency. Refer.

80
Q

Define premature ejaculation?

A

Common male sexual disorder characterised by brief ejaculatory latency, loss of control and distress

81
Q

What is the treatment of premature ejaculation?

A

1) Dapoxetine when required not daily use (ssri)
2) Citalopram, fluoxetine, fluvoxamine, escitalopram, sertraline, paroxetine, clomipramine all
OD dose

82
Q

Which TCA can be used for premature ejaculation but is unlicensed use?

A

Clomipramine

83
Q

Which SSRI is used as first line for premature ejaculation?

A

Short acting dapoxetine

84
Q

Which two drugs are used to induce abortion or induce or augment labour and minimise blood loss?

A

Prostaglandins and oxytocics
(oxytocin, carbetocin, ergotmetrine maleate, prostanglandins)

85
Q

what to use to terminate pregnancy?

A

Mifepristone is followed by administration of gemeprost / mistoprostol

86
Q

Which is another use for misoprostol:

A

Ulcers, gastric, peptic ulcer

87
Q

What is used for treatment of ectopic pregnancy?

A

Systemic methotrexate

PRE REG (24 decks)

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