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PharmEducate Notes > Genito-urinary > Flashcards

Genito-urinary Flashcards

1
Q

What are the 2 types of urinary incontinence?

A

Urge and stress

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2
Q

What is urge incontinence?

A

Involuntary muscle contraction of the bladder causing a sudden urge to pass urine

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3
Q

What are the non-drug treatments for urinary incontinence?

A

Exercising pelvic floor muscles or bladder training

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4
Q

Drug treatment of urge incontinence?

A

1st line = antimuscarinic drugs which relax the bladder muscle

2nd line = beta-3 agonists (mirabegron) which causes the bladder to relax and store urine

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5
Q

Caution for mirabegron?

A

QT prolongation

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6
Q

Contraindication for mirabegron?

A

Severe uncontrolled hypertension as hypertension is a common side effect

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7
Q

What is stress incontinence?

A

When urine is leaked when stress is put on the bladder E.g. when you cough or sneeze

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8
Q

What are the drug treatments for stress incontinence in men?

A

There aren’t any

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9
Q

What are the drug treatments for stress incontinence in women?

A

Duloxetine (SNRI) for moderate - severe incontinence. Avoid abrupt withdrawal

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10
Q

First line treatment for nocturnal enuresis?

A

Enuresis alarm until 2 weeks of uninterrupted dry nights. Alarm has sensors which goes off when a child starts wetting which wakes them up and they can finish in the toilet.

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11
Q

Second line treatment of nocturnal enuresis?

A

Desmopressin SL/PO

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12
Q

What age is desmopressin licensed for?

A

5+

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13
Q

What route should desmopressin not be given due increased side effects?

A

Intranasally

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14
Q

Side effects of desmopressin?

A

Fluid retention which leads to hyponatraemia due to dilution of the blood. This can lead to hyponatraemic convulsions.

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15
Q

Counselling for desmopressin?

A

Avoid fluid overload
Restrict fluid intake 1H before and 8H after desmopressin
Avoid concomitant drugs that increase vasopressin E.g. TCAs

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16
Q

How long should desmopressin be stopped for during vomiting/diarrhoea?

A

Until fluid balance is normal due to loss of electrolytes. Particularly sodium

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17
Q

Treatment of acute urinary retention?

A

Catheterisation - via the bladder or or super pubric catheter inserted into the lower abdomen

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18
Q

Treatment of BPH?

A

Surgery or drugs such as alpha blockers

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19
Q

Examples of alpha blockers?

A

Alfuzosin
Tamsulosin

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20
Q

Side effects of alpha blockers?

A

Hypotension - particularly postural hypotension leading to: dizziness, fainting, blurred vision, tachycardia and palpitations

Intra-operative floppy iris syndrome

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21
Q

Contraindications for alpha blockers?

A

Postural hypotension

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22
Q

Patient counselling for alpha blockers?

A

Take first dose at bedtime due to first dose postural hypotension
Can impair driving

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23
Q

Alternatives to alpha blockers in BPH?

A

Finasteride - reduces prostate size to increase urinary flow

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24
Q

Side effects of finasteride?

A

Male breast cancer - report breast symptoms
Depression and suicidal thoughts - stop and report

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25
Q

What other indication can finasteride be used for?

A

Alopecia in men under a PGD

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26
Q

Is finasteride safe to use if partner is pregnant or likely to get pregnant?

A

No, use a condom as it is excreted in the semen

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27
Q

Finasteride caution for women of child-bearing age?

A

Avoid handling crushed finasteride (or leaked dutasteride capsules)

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28
Q

What oestrogen do the majority of COCs contain?

A

Ethinylestradiol

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29
Q

Example if progesterone content in contraceptives?

A

Desogestrel, Norethisterone, Levenogestrel

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30
Q

Which oral contraceptive requires a pill-free period?

A

COC

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31
Q

How are COCs taken?

A

OD for 3 weeks followed by 1 week pill-free interval for withdrawal bleeding

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32
Q

What age is COC licensed for?

A

Under 50

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33
Q

When can a COC be started?

A

Any time in the menstrual cycle

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34
Q

What must be done if a COC is started on day 6 or later of the menstrual cycle?

A

Use barrier protection for 7 days

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35
Q

Is withdrawal bleeding during the pill-free period in COCs the same as a normal bleeding?

A

No

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36
Q

What are the 4 different preparations for COC?

A

Monophasic
Phasic
Everyday
Low-strength

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37
Q

What is a monophasic preparation?

A

Fixed amount of oestrogen and progestogen

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38
Q

What is a phasic preparation of COC?

A

Varying amounts of oestrogen and progestogen

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39
Q

When is a phasic preparation of COC preferred?

A

Mimic the normal menstrual cycle for women who do not have withdrawal bleeding or have breakthrough bleeding with monophasic preparations

40
Q

What is an every day preparation of COC?

A

Pill-free period replaced with inactive tablets

41
Q

Example of a low strength oestrogen preparation?

A

20mg ethinylestradiol

42
Q

When is a low strength oestrogen preparation of COC preferred?

A

When there are significant risk factors for circulatory disease such as VTE

43
Q

Which contraceptives increase risk of VTE?

A

COC

44
Q

What are the risk factors for VTE?

A

Obesity (BMI > 30)
Smoking
Age > 35
Taking a COC
Certain types of progestogens e.g. desogestrel, gestodene, drosperinone

45
Q

Risk factors of arterial thromboembolism?

A

Diabetes, hypertension, migraine without aura

46
Q

When should the risk of VTE be considered too great to give COC?

A

Avoid if 2 or more risk factors present for VTE

47
Q

When should COC be stopped before surgery?

A

4 weeks before

48
Q

When can a patient restart COC after surgery?

A

On first menses at least 2 weeks after full mobilisation

49
Q

What can/should be done if COC could not be stopped 4 weeks prior to surgery?

A

Give thromboprophylaxis

50
Q

Does a POP have to be stopped before surgery?

A

No therefore can be used as an alternative in patients taking COC

51
Q

How does COC work?

A

Inhibits ovulation

52
Q

How do POPs work?

A

Thickens the mucus in the cervix to stop sperm reaching the egg

53
Q

When should stockings be considered if a PT taking COC is travelling?

A

Journeys longer than 3H

54
Q

Reasons to stop COC or HRT?

A

VTE? - sudden severe chest pain / breathlessness / cough with blood stained sputum - PE? Or DVT?

Stroke? - unusually severe prolonged headaches, loss of vision or hearing / serious neurological effects such as slurred speech

Liver dysfunction?

BP > 160/95 (can be one or the other)

55
Q

Can a patient with valvular heart disease take a COC?

A

No

56
Q

Can a patient with migraine history take a COC?

A

No

57
Q

Are menstrual irregularities more common with COC or POP such as heavy or light bleeding?

A

POP

58
Q

How are POPs taken?

A

OD on a continuous basis starting on day 1

59
Q

What should be done if a PT starts a POP after day 5 of their cycle?

A

Use barrier protection for 2 days

60
Q

Which oral contraceptive increases the risk of breast cancer?

A

Both

61
Q

Which oral contraceptive increases the risk of cervical cancer?

A

COC

62
Q

Which oral contraceptive decreases risk of ovarian or endometrial cancer?

A

COC

63
Q

How long is considered a missed dose for COC?

A

24 hours
Zoey / Qlaira = 12 hours

64
Q

How long is considered a missed dose for POP

A

Over 3 hours
Desogestrel = over 12 hours

65
Q

1 missed pill in COC?

A

Take one ASAP and next one at normal even if that means taking 2 in one go. No extra precautions needed

66
Q

2 missed pills in COC?

A

Take one pill ASAP + condom for 7 days (9 days for Zoely / Qlaira)

Omit pill free period - if missed in the last 7 days of the cycle

EHC - if missed in first 7 days of cycle and had unprotected sex

67
Q

Missed pill in POP?

A

Take ASAP and use condom for 2 days

EHC if unprotected sex before 2 pills taken correctly

68
Q

How does the response to a missed pill compare to nausea and diarrhoea in oral contraceptives?

A

It’s the same

69
Q

How are transdermal contraceptive patches (Evra) used?

A

Weekly patch for 3 weeks then 1 week patch free

70
Q

What can be done if a contraceptive patch is partially detached for < 24 hours or delayed application at the beginning of the cycle?

A

Reattach or apply new patch and restart cycle from day 1 using a condom for 7 days

71
Q

What can be done if delayed application of contraceptive patches after the first week?

A

< 48 hours = apply new patch and continue as normal

> 48 hours = restart cycle + condom for 7 days

72
Q

Which oral contraceptives are not effected by enzyme inducers?

A

Copper IUD (can also be used as EHC)
Progestogen only injection

73
Q

How long should the alternative be used for after stopping the interacting drug?

A

4 weeks

74
Q

First line emergency contraceptive?

A

Copper IUD

75
Q

How many days after unprotected sex can I copper IUD be used?

A

5

76
Q

If a patient’s BMI > 26 which EHC should be given?

A

Ulipristal or double the dose of levenogestrel

77
Q

What age is contraindicated for IUDs?

A

< 25 due to pelvic inflammatory disease risk

78
Q

If a patient has abdominal pain after taking EHC?

A

Visit GP to rule out ectopic pregnancy

79
Q

Levenogestrel EHC dose?

A

1500mg within 3 days of UPSI

80
Q

Cautions for levenogestrel?

A

Crohn’s disease
Past ectopic pregnancy
Ciclosporin
Depression

81
Q

Ulipristal dose?

A

30mg within 5 days

82
Q

Ulipristal causations?

A

Severe asthma treated with oral corticosteroids
Severe liver impairment

83
Q

Can Ulipristal be taken more than once in the same cycle?

A

No

84
Q

Impact of Ulipristal on regular contraceptives?

A

Reduces effectiveness, use barrier protection for 14 days in COC and 9 days in POP

85
Q

How long after taking Ulipristal can regular contraception be taken?

A

5 days

86
Q

Which IUD should be prescribed by brand?

A

Levenogestrel releasing IUDs

87
Q

How long does the medroxyprogesterone injection provide cover for?

A

2 years

88
Q

Side effects of medroxyprogesterone injection?

A

Risk of osteoporosis

89
Q

How long does the norethisterone injection probe cover for?

A

8 weeks

90
Q

How long does etonogestrel implant provide cover for?

A

8 weeks

91
Q

MHRA alert with etinogestrel implant?

A

Device has been found to travel to the lung or vasculature. Must be able to be felt. If not removal is required

92
Q

How long before sex does sildenafil need to be taken?

A

1 hour

93
Q

Main side effect of sildenafil?

A

Hypotension and other side effects similar to nitrates

94
Q

When is sildenafil contraindicated?

A

Ischaemic occlusion conditions such as MI or unstable angina as it reduces blood proliferation

95
Q

Treatment of bacterial vaginosis or vaginal trichomoniasis?

A

Metronidazole 2g as a single dose

96
Q

Treatment of vulvovaginal thrush?

A

Topical imidazole for 7 days E.g. clotrimazole pessary

PharmEducate Notes (8 decks)

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