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bnf > Genito Urinary > Flashcards

Genito Urinary Flashcards

1
Q

What treatment options are there for incontinence?

A

Stress usually treated with non drug methods (pelvic floor, bladder training). Duloxetine can be added.
Urge incontinence - antimuscarinics, propantheline, tricyclic antidepressants, mirabegron

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2
Q

When should children be treated for Nocturnal enuresis?

A

Not under 5 years (not expected to be dry).

Consider at 7 years but symptoms may persist until 10.

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3
Q

What non drug approaches are taken for Nocturnal enuresis?

A

Advice on fluid intake, diet, toileting and reward systems. If still more than 1 - 2 wet beds per week, enuresis alarm recommended (lower relapse than drugs). Continue until minimum 2 weeks dry nights.

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4
Q

What are the side effects of antimuscarinics?

A

Constipation, dry mouth, urinary disorders, vision disorder, drowsiness, confusion

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5
Q

When should antimuscarinic use be reviewed in urinary incontinence?

A

Every 4 to 5 weeks until symptoms stabilise then every 6 - 12 months

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6
Q

What could be causing urinary retention?

A

Drugs (antimuscarinics, tricyclic antidepressants), blockage, benign prostatic hyperplasia.

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7
Q

How is acute urinary retention managed?

A

Immediate catheterization (medical emergency) and alpha blocker at least 2 days before removal.

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8
Q

What drugs may be given in benign prostatic hyperplasia?

A

Alpha blockers.
5alpha reductase inhibitor if enlarged prostate, raised antigen or high risk of progression.
Combine if symptoms remain a problem.

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9
Q

What advice should be given with alpha blockers?

A

Some cause first dose hypotension. Affect driving and skilled tasks.

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10
Q

When can tamsulosin be sold to the public?

A

45 - 75 yo for up to 6 weeks before doctors clinical assessment

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11
Q

What advice should be given with 5alpha reductase inhibitors?

A

Use condoms if partner pregnant or likely to become pregnant. Women of childbearinh potential should avoid handling. Report any changes in breast tissue. May decrease prostate cancer markers.

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12
Q

What are the advantages and disadvantages of combined oral contraceptives?

A

Reduced dysmenorrhoea and menorrhagia
Redcued incidence of premenstrual tension
Less symptomatic fibroid or cysts
Less benign breast disease
Less risk of overian and endometrial cancer or pelvic inflammatory disease

Increased risk of breast cancer and cervical cancer

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13
Q

What type of preparation is yasmin?

A

Combined monophasic 21 day

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14
Q

What type of preparation is levest?

A

Combined monophasic 21 day

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15
Q

What type of preparation is cilest?

A

Combined monophasic 21 day

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16
Q

What type of preparation is microgynon 30 ED

A

combined monophasic 28 day

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17
Q

What type of preparation is logynon?

A

Combined phasic 21 day

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18
Q

What type of preparation is qlaira

A

Combined phasic 28 day

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19
Q

Why are phasic contraceptive preperations useful?

A

For women who do not have withdrawal bleeding or have Breakthrough bleeding with monophasic

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20
Q

Which would be most suitable for someone with risk factors of circulatory disease? Femodene, mercilon or logynon?

A

Mercilon as 20 micrograms (low strength) ethinylestradiol

21
Q

A patient is experiencing acne with microgynon, what should she be swapped to? What is she then increased risk of?

A

Desogestrel, drospirenone or gestodene containing pill. Eg yasmin, marvelon or femodene. VTE increased risk.

22
Q

When should oestrogen containing contraceptives be stopped before surgery?

A

4 weeks and then restarted at first menses at least 2 weeks after mobilisation

23
Q

When are oestrogen containing contraceptives contraindicated?

A

With or past history of thrombosis. Heavy smoker. >160/95mmhg, valvular heart disease, diabetes with complications, migraine with aura.

24
Q

What counselling should be given regarding medroxyprogesterone injections?

A

Prolonged action so may cause menstrual disturbance and delay of full fertility upon discontinuation
Troublesome bleeding in immediate puerperium so could delay injection until 6 weeks after birth. But may be given within 5 days.
Risk of osteoporosis

25
Q

A patient has requested emergency contraception recently after childbirth, how many days must have passed for it to be appropriate to offer?

A

21 days unless criteria for lactational amenorrhoea are met.

26
Q

A patient has requested emergency contraception recently after abortion or loss of pregnancy, how long must it have been for it to be appropriate to offer?

A

5 days

27
Q

When can the UID be inserted to prevent pregnancy after unprotected intercourse

A

Up to 120 hours after inyercourse or earliest likely ovulation

28
Q

An overweight patient requires emergency hormonal contraception, what should be given?

A

Ella one or 2 levonelle.

29
Q

A patient has had unprotected sexual intercourse 2 days ago and her estimated time of ovulation is in the next 2 days, which EHC should she be offered?

A

Ella one. First line if UPSI likely to have taken place during the 5 days before the estimated day of ovulation.

30
Q

How long after taking EHC should patients take their normal contraception?

A

After levonelle, straight away but use barrier until effective again.
After Ella one, wait 5 days and use barrier during this time and until effective again. Additional precautions required for 14 days for combined/parenteral, 16 days for qlaira and 9 days for POC.

31
Q

A patient on carbemazepine needs an oral contraceptive, what are her options?

A

Use of condoms during treatment and for 4 weeks after stopping.
Using 50mcg ethinylestradiol containing preparation and use extended or tricycling regime during and for 4 weeks after stopping.

IUD or other alternative always recommended if potent enzyme inducer (rifampicin)

32
Q

A patient has used EHC once already in the current cycle, which can be given again?

A

Ella one.

33
Q

What day of the cycle can contraceptives be started?

A

Any day but if day 6 or later extra precautions should be used for 7 days.
Immediately after other preparations (barrier for 7 days if from progestogen only)
3 weeks after birth or additional precautions for 7 days.
Same day as abortion or miscarriage.

34
Q

A patient has persistent vomiting lasting more than 24 hours and is on the 4th pill from the end of her pack, what should be done?

A

Barrier methods during and 7 days after recovery. Omit next pill free or inactive pills.

35
Q

When should extra precautions be taken with missed pills?

A

If 2 or more missed (24 hours or more late). 7 day precautions and if runs until end of packet omit pill free or inactive pills. EHC recommended missed pills are from first 7 days and UPSI occurred since finishing the last.

36
Q

What contraceptive preparations differ in their advice for missed pills and what else is different about these?

A

Qlaira & zoely - missed pill is 12 or more hours late.
Thhey also have different numbers of active tablets - Qlaira having 26 active and 2 inactive, and zoely having 24 active and 4 inactive.
Desogestrel - missed pill is 12 hours late use extra precautions for 2 days.
Levonorgestrel - missed pill is 3 hours late use extra precautions for 2 days.

37
Q

What advice is given with Nuvaring?

A

If expelled for less than 3 hours, wash and reinsert.
If more than 3 hours or unknown or insertion delayed, use extra precautions for 7 days (or insert a new ring/allow for withdrawal if in week 3).
If removal delayed for more than 1 week rule out pregnancy and insert new ring.

38
Q

What advice should be given with evra patches?

A

If detached less than 24 hours, reapply to same area or replace. Change on normal day. If more than 24 hours or unknown or delayed, stop cycle and apply new patch as day 1 using extra precautions for 7 days.
Mid cycle, extra precautions are needed if delayed swap of more than 48 hours.

39
Q

What drugs can cause erectile disfunction?

A

Antihypertensives, antidepressants, antipsychotics, cytotoxics, and recreational

40
Q

What lifestyle advice should be given to someone with erectile disfunction?

A

Regular exercise, reduction in bmi, smoking cessation, reduced alcohol

41
Q

Which phosphodiesterase 5 inhibitor is used if a patient wants to be spontaneous with their sexual activity

A

Tadalafil.

42
Q

A patient has tried sildenafil at the highest dose for the past 4 nights and nothing has happened, what action should be taken?

A

Keep trying. Should receive six doses before being classified as non responder.

43
Q

What advice should be given with alprostadil?

A

If prolonged erection lasts four hours or more seek medical attention. Can use ice pack to upper inner thigh up to 10 minutes.

Use barrier protection

44
Q

Should phosphodiesterase type 5 inhibitors be taken with or without food?

A

Without. With may delay onset.

45
Q

What drugs can be used for premature ejaculation?

A

SSRI (dapoxetine is licensed). Clomipramine

46
Q

What is used to manage ectopic pregnancy?

A

Methotrexate

47
Q

Which drugs are used to delay premature labour and when can they be used?

A

Atosiban (oxytocin receptor antagonist) between 24 to 33 weeks.
Nifedipine
Beta 2 agonists between 22 and 37 weeks.
Indometacin

48
Q

How long should people treat with imidazole topical for candida?

A

1 to 14 days (short courses). Longer in pregnancy at around 7 days.

49
Q

What advice should be given with antifungal cream and pessaries?

A

May damage latex condoms and diaphragms.

bnf (15 decks)

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