Genito Urinary Flashcards

Question

Tamsulosin OTC referral criteria

Answer 1

Glaucoma or cataracts surgery Symptoms lasting over 3 months, dysuria, haematuria, cloudy urine and fever No improvement after initial 2 week supply OR max supply exceeded and not been seen by Dr Taking interaction medication; verapamil, diclofenac, warfarin, anole-antifungals, alpha blocker, sildenafil Hx diabeties, urinary incontinence, prostate surgery, blurry or cloudy vision

Answer 2

For prescribing under 16 Best interest to the patient Patient understands advice and is competent Can’t persuade patient to inform their parents Continue to have sex Mental and psychical health will suffer

Answer 3

Hormonal - most effective, only used after first period Intra-uterine devices - highly effective, localised side effects used by all women of all ages but less appropriate in those with pelvic inflammation disease Barrier methods - condoms, diaphragms, less reliable but improvement with spermicides,

Answer 4

Contains oestrogen and progesterone Oestrogen content - ethinylestradiol range (20 to 40 mcg) Progesterone content - desogestrel, levonorgestrel, norehisterone etc Inhibits ovulation Can be monophasic - strengths of oestrogen and progestogen are constant or phasic when the strengths of the hormones components vary Typically 21 days followed by 7 day break Phasic for patients who do not have withdrawal bleeding or who have breakthrough bleeding with monophasic preparations

Answer 5

Reliable and reversible Reduced dysmenorrhea and menorrhea Reduces incidence of pre menstrual tension Less symptomatic fibroids and function ovarian cyst Less benign breast disease Reduces risk ovarian and endometrial cancer Reduce risk pelvic inflammatory disease

Answer 6

Microgynon Yasmin Rigevidon Cilest

Answer 7

Logynon Synphose Tradene

Answer 8

Low strength - 20 mcg used for women with risk factors for circulatory disease Standard strength - 30 to 35 mcg used

Answer 9

Ethinylestradiol + (desogestrol or drospierione or gestodene) used for women with side effects; such as acne, headache, depression , breast symptoms and breaththrough bleeding Dospirenone; derivative of spironolactone; hyperkalaemia caution

Answer 10

Discontinue oestrogen containing contraceptives 4 weeks before major elective surgery to legs, surgery which involve prolonged immobilisation to lower limb Offer POP and restart COC after mobilisation If oestrogen cant be stoped e.g trauma offer thromboprophylaxis (unfractionated or LMWH) and granulated stockings Not applicable for minor surgery e.g tooth extraction, laparoscopic sterilisation or women on oestrogen free contraceptive

Answer 11

Over 50 years BMI > 35 Sudden severe chest pain; PE or DVT risk Sudden breathlessness - cough with blood stained sputum Unexplained swelling or severe pain in calf of one leg Severe stomach pain Serious neurological effects (e.g prolonged headaches, seizure, fainting, loss vision) Hepatitis, jaundice, liver enlargement Hypertension Prolonged immobility after surgery or leg injury

Answer 12

Increased risk of venous thromboembolism Increase risk of breast and cervical cancer - risk disappears after stopping

Answer 13

History and predisposition to Venous thrombosis Heavy smokers BP >160/95 Valvular heart disease DM Vascular complications Migraine with aura

Answer 14

Nausea, abdominal pain, increased weight, headache, depressed, altered mood, breast pain, breast tenderness

Answer 15

Travel - increased risk DVT during travel; move legs, prevent long periods immobility, reduce risk by exercise during journey or compression hosiery Diarrhoea and vomiting - take another ASAP if vomit occurs within 2 hours of taking the pill

Answer 16

If you missed one pill anywhere in the pack or stated a new pack 1 day later = still protected Take next pill when you remember even if it means taking 2 together, carry on as normal If 2 or more pills missed anywhere in the pack or started a new pack 2/+ days late - protection can be affected. Consider using extra protection, take next pill asap even if it means taking 2, take rest of the pack as normal If 7 days run beyond end of pack, start the next packet and omit the free interval period If missed 2/+ from first 7 tablets of the pack consider EHC

Answer 17

When a pill is omitted at the beginning or the end of a cycle - it lengthens the pill free period Contraception is lost

Answer 18

When you come to the end of the pack, After missing 2/+ pills If there are MORE THAN 7 pills left on the pack after the last missed pill; take your 7 day pill free break as normal or take you inactive pills before you start next pack If there are LESS THAN 7 in pack after missed dose finish the pack and start a new pack the next day = missing out pill free break or not taking inactive pills

Answer 19

If you have missed 2 / + pills in the first week of a pack and had unprotected sex in the previous 7 days

Answer 20

Suitable alternative to when COC is contraindicated Alter cervical mucus and prevent sperm penetration - inhibit ovulation

Answer 21

Medroxprogesterone acetate Depo-provera; 2 years, delay fertility and return to menstrual irregularity, osteoporosis risk Long acting progestogen by injection Can cause troublesome bleeding Can reduce bone mineral density and cause osteoporosis Only use in adolescents when other measures are inappropriate E.g nonsterat, implanon, nexplanon

Answer 22

Implant report device in vasculative and lung reach pulmonary artery locate and remove ASAP

Answer 23

Les suitable if under 25 and inflammatory pelvic condition E.g minera (5 years), jaydess (3 years) and levosert (3 years) Release levonorgestrel into the uterine cavity Contraception of choice for women with excessive heavy periods MHRA warnings report severe pelvic pain after insertion, pain on sex, bleeding, feel threads Fertility rapid after removal Advantages over copper IUD; reduction in blood loss, improvement in period pain and pelvic disease

Answer 24

Safe to use Good alternative to COC

Answer 25

Reduced efficacy with - Carbamezapine, phenytoin, phenobarbital, primidone, topiramate, ulipristal, antiviral, Rifampicin, griseofluvin

Answer 26

Menstural irregularities Breast tenderness Ovarian cysts Ectopic pregnancy Increased breast cancer risk

Answer 27

Irregular bleed patterns Altered mood Depressed mood Decreased in libido Headaches Nausea Acne Breast pain Weight changes

Answer 28

Active thrombosis Active or history of liver disease or liver cancer Active or suspected sex-steroid sensitive cancer e.g breast, uterine or ovarian cancer Undiagnosed vaginal bleeding Allergic or intolerance to any ingredients LOVIMA CONTAINS SOY BEAN - AVOID IN PEANUT ALLERGY

Answer 29

Hana and lovima Desogesterol 75 mcg -Liecensed for women of child bearing age

Answer 30

No additional contraceptive method if started on day 1 of period If started on day 2 to 5 need additional contraception for first 7 days

Answer 31

Less than 12 hours late isn’t a missed pill - just take it within and no further action More than 12 hours - take asap and use additional 7 day contraception If vomiting occurs within 3-4 hours of taking pill advise above

Answer 32

Films, gels and foams Useful additional safeguard Not adequate protection alone unless fertility is already significantly diminished Not recommended with condoms or patients with high risk of STIs (inc HIV)

Answer 33

Less suitable for women with an increased risk of pelvic inflammatory disease Smaller devices have less side effects Used as a emergency contraception - most effective form Can be inserted up to 5 days after sexual intercourse Give antibiotic if there is a STI risk Not affected by BMI, body weight or other drugs

Answer 34

Petroleum jelly, baby oil and oil based vaginal and rectal preparations are likely to damage condoms and diaphragms made from latex rubber and render them less effective as a method of contraception and protection against STIs

Answer 35

Doesn’t replace effective contraception Occasional use to reduce risk pregnancy after unprotected intercourse Copper intra uterine device Hormonal methods (levenorgestrol and ulipristal)

Answer 36

16 years + 1.5 mg Regular hormone contraception can be continued immediately after taking this Vomiting occurs repeat dose within 3 hours Maximum effect if taken within 12 hours but must be taken within 72 hour window (efficacy decreases with time) Double dose if BMI >26 OR 70 kg Shouldn’t be used more than once in cycle due to s.e e,g menstrual irregularities

Answer 37

Ella One Considered as 1st line Effective when taken within 5 days of unprotected sex Is more effective than levonorgestrel Effectiveness may be reduced if patient has been taking progestogen For child bearing age Continue oral contraception after 5 days Not suitable for severe asthma controlled by glucocorticoids Can be used more than once in a cycle

Answer 38

Can provide advance supple Prior to unprotected sexual inter course or in case of failure of a contraceptive method

Answer 39

Take another if vomiting occurs within 3 hours Next period maybe a few days early or late Seek medical attention if have any lower abdominal pain - ectopic pregnancy Pregnancy test if next period is more than 7 days late, lighter than usual or any abdominal pain that’s atypical to usual period pain

Answer 40

Reduced effectiveness by enzyme inducers; CRAP GPs Carbamezapine Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbitone St John’s wart

Answer 41

Some parenteral POC e.g medroxyprogesterone Norhisterone IUD Non-hormonal

Answer 42

Induce abortion Induce or argument labour Minimise blood loss from the placenta Induce uterine contractions with different levels of pain

Answer 43

Gemeprost - prostaglandin given vaginally as pessaries induces abortion and ripens cervix before surgical abortion Misoprostol - prostaglandin given by mouth or vagina Mifepristone - can facilitate abortion, sensitise uterine to Porto gland in so shorter time and lower dose of prostaglandin needed

Answer 44

Bleeding from miscarriage or abortion can be controlled by ergometrine and oxytocin Oxytocin and ergometrine are more effective when given together in early pregnancy rather than alone Carboprost can be used in severe post parturition haemorrhage

Answer 45

Termination of pregnancy Single dose followed by prostaglandin (misoprostol or gemeprost)

Answer 46

Systemic methotrexate used as treatment

Answer 47

Vaginal; thinning, drying and inflammation of walls due to less oestrogen Creams containing oestrogen can be applied short term to improve symptoms Use in small amounts to prevent side effects Risk hyperplasia and carcinoma when systemic oestrogen used alone for long period of times E.g Ovestin, vagifem

Answer 48

Impotence Inability to attain and maintain an ejection that is sufficient to permit satisfactory sexual performance Physical and psychological causes Drugs cause it; antihypertensives, antidepressants, anti-epileptics, cytotoxic and recreational drugs Risk factors; sedentary lifestyle, obesity, smoking, metabolic syndrome, hypercholestolaemia Increases risk for CVD

Answer 49

Combination drug and lifestyle changes 1st line - phosphodiesterase type 5 inhibitor 2nd line alproxadil (injection base of penis or topical application)

Answer 50

S/e - hypotension, flushing, headache, migraine, nasal de congestion Increases blood flow to the penis Depends on frequency of intercourse and respond to treatment CI; MI, unstable, angina recent stroke, hypotension or taking nitrates Axandafil, sildenafil and vanadefil - short acting for occasional use Tadalafil - long acting, used when sex is not planned and is frequent

Answer 51

Brief latency and loss control and psychological distress No drug treatment - psychosexual counselling, education and behavioural treatment Drug treatment - dapoxetine (short acting SSRI) , TCA and other SSRI are unliecensed If premature ejaculation is secondary to erectile dysfunction the erectile dysfunction should be treated first

Answer 52

Lasts longer than 6 hours erection Penile aspiration is 1st line treatment to remove excess blood with a needle and syringe Second line is lavage

Answer 53

For men over 18 + no max age limit Max 50 mg per day, only for erectile dysfunction Sexual stimulation is required to be effective; take with water 1 hour before Food can delay activity of drug Contact GP within 6 months for clinical assessment Seek immediate medical assistance in painful erection lasting longer 4 hours (priapism) CI; severe hepatic impairment, hypotension, deformity of penis, loss vision or damage to optic nerve

Answer 54

Severe CV events Breathlessness or chest pain with light to moderate physical activity CV risk Renal impairment History bleeding disorder Active peptic ulceration Taking; antifungals, macrolides, nitrated, cimetidine, diltiazem, Rifampicin, alpha blockers

Answer 55

Bacterial vaginosis or vaginal trichomoniasis metronidazole 2 g single dose

Answer 56

Candida vulvitis - imidazole external creams; clotrimazole miconazole Vaginal candidiasis - imidazole pessaries or cream or oral fluconazole

Answer 57

Clotrimazole- external cream BD or TDS 11-2 weeks (1-2%) Internal cream 10% , pessaries 200mg or 500 mg Fluconazole state dose can be repeated one week later NOT for under 16 or over 60 years, more than 2 infections in last 6 months, pregnant

Answer 58

Clotrimazole BD or TDS for 2 weeks (1-2%) Fluconazole stat dose and can be repeated 1 week after Only if female sexual partner has thrush as well. Is 16-60 and no more 2 infections in past 6 months