Genito-Urinary Flashcards
what are the different types of incontinence?
urgency - sudden, immediate need to pass urine
stress - leakage on exertion, coughing, sneezing
mixed - urgency and stress (treat as predominant type)
how do you treat urge incontinence?
1st bladder training for 6 weeks
2nd antimuscarinic (oxybutynin/ tolterodine)
3rd mirabegron
what are the contraindications to antimuscarinics?
glaucoma
GI obstruction
name the antimuscarinics?
oxybutynin, solifenacin, tolterodine, trospium
what are side effects to the anti-muscarinics?
constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia
how do you manage nocturnal enuresis in children?
1st enuresis alarm
2nd desmopressin (>5)
what is the major side effect of desmopressin?
hyponatraemic convuslions
what are the counselling points for desmopressin for nocturnal enuresis?
avoid fluid overload (restrict fluid overload 1 hour before food and until 8 hours after desmopressin)
stop desmopressin in V&D
what medications can be used for urinary retention?
alpha blockers
5 alpha reductase inhibitors
what are the side effects of alpha blockers?
postural hypotension, dizziness, intra-operative floppy iris syndrome
*take first dose before bed
what are the side effects of finasteride (5 alpha reductase inhibitor)?
male breast cancer
what is the MHRA alert for finasteride?
depression and suicidal thoughts
what is the advice regarding finasteride and its teratogenic effect?
women of CB age should not handle crushed/ broken tablets
men should use a condom if partner of CB age
what treatment options are available for erectile dysfunction?
phosphodiesterase type-5 inhibitors
prostaglandin analogue (alprostadil)
what effect dose food have on the phosphodiesterase type-5 inhibitors?
delayed effect
how long before sex should sildenafil be taken?
1 hour
how long before sex should tadalafil and avanafil be taken?
30 minutes
tadalafil is long acting, can be used once daily
how long before sex should vardenafil be taken?
25-50 minutes
what are the side effects of phosphodiesterase type-5 inhibitors?
flushing
dizziness
nasal congestion
migraine
priapism (erection > 4 hours) - medical emergency
what medications are used in abortions?
gemeprost
mifepristone
misoprostol
what medications are used to induce labour?
dinoprostone
misoprostol
oxytocin
what medications are used to prevent and treat bleeding in labour, abortion and miscarriage?
carbetocin
carboprost
ergometrine
misoprostol
oxytocin
what medication is used to treat an ectopic pregnancy?
methotrexate
what medications are used to treat premature labour?
salbutamol/ terbutaline
atosiban
indometacin
nifedipine
what non-hormonal contraceptive treatments are there?
barrier (condom - oil based products can damage latex)
IUD (copper coil)
what drugs are available in a POP?
levonorgestrel, northisterone, desogestrel
will additional contraception be required when starting the POP?
no additional precaution if started in first 5 days of cycle
2 days precaution if started at other point
if a dose of the POP is missed, within how many hours is it safe to take the missed dose without needing further contraception?
within 3 hours
12 hours if desogestrel
- if longer use condom for 2 days
what is the upper age limit for CHC?
50
what is the pill free period with CHC?
21 days
7 days pill free
will additional contraception be required when starting the CHC?
if started on day 6 of cycle or later, additional contraception for 7 days
if 1 pill of CHC has been missed, what should be done?
take ASAP, no further action
if 2 or more pills of CHC have been missed, what should be done?
take one pill ASAP + condom for 7 days
omit pill free interval
EHC - if missed in first 7 days of cycle and sex occurs
what is first line for emergency contraception?
IUD, up to 5 days after UPSI
what drug options are available for EHC?
levonorgestrel (72 hours)
ulipristal (120 hours) - 1 week delay of breastfeeding, can use more than once in each cycle, use barrier for 14 days if on CHC and 9 days if on POP, await 5 days before starting regular contraception
