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Inori Pre Reg > Genito Urinary > Flashcards

Genito Urinary Flashcards

1
Q

Non drug management off urge incontinence?

A

Pelvic floor exercise and Bladder training

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2
Q

How to manage street incontinence?

A

Generally non drug methods

Duloxetine can be added as an adjunct for moderate to severe stress incontinence in women

Avoid abrupt withdrawal

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3
Q

How does antimuscarnics help in urge incontinence?

A

Reduce symptoms and increase Bladder capacity

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4
Q

Advise on how to initiate oxybutynin? What’s it used for?

A

First line for urge incontinence
Start at low dose to avoid side effects
Can use Mr as had fewer side effects and transdermal patches available

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5
Q

Advise on how often to check on efficacy of urge incontinence treatment?

A

Review every 4-6wks until symptom stabilises and then every 6-12 months

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6
Q

What is miravegron used for?

A

2nd line in urge incontinence

Licensed for urinary frequency, urgency and urge incontinence associated with overreactive Bladder syndrome

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7
Q

Caution and c/I on miravegron?

A

Caution in QT interval prolongation

C/I in severe uncontrolled hypertention

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8
Q

Side effects of antimuscarnics?

A

Constipation, dizziness, flushing, headache, dry mouth, urinary disorders

Caution driving

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9
Q

How often do you apply oxybutynin patches?

A

Every 3 to 4 days

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10
Q

Pt advice on miravegron?

A

Contraception advised in women

BP should be monitored before starting treatment and regularly during treatment esp in pts with pre existing hypertention

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11
Q

First line treatment for Nocturnal enuresis in children under 5?

A

Treatment is usually unnecessary as can be expected to have till 7yrs and occasionally till 10
Initially advice on fluid intake, diet, toileting behaviour and use of reward system should be sorted

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12
Q

What to do if children under 5 does not respond to non drug treatment?

A

An enuresis alarm should be given if more than 1 to 2 wet beds a week

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13
Q

How to review enuresis alarm treatment?

A

Reviewed after 4wks and continued until a minimum of 2 weeks uninterrupted dry nights

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14
Q

Second line treatment of Nocturnal enuresis in children

A

Can combine or mono therapy with oral or sublingual desmopressin if child is over 5

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15
Q

How to review desmopressin treatment?

A

Treatment should be assessed after 4wks and continued for 3 months if there are signs of response

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16
Q

How to stop desmopressin treatment?

A

Withdraw gradually

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17
Q

Side effects of desmopressin?

A

Hyppnatraemic convulsions

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18
Q

Pt counselling for pts treated for primary Nocturnal enuresis

A

Avoid fluid overload (including during swimming) restrict fluid intake 1hr before and until 8hrs after desmopressin

Stop desmopressin if vomiting and diarrhoea until normal fluid balance

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19
Q

What drug should be avoided being coadminsitered with desmopressin?

A

Avoid drugs that increase vasopressin secretion like Tricyclinc antidepressants

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20
Q

What’s 3rdline of Nocturnal enuresis treatment initiated by a specialist?

A 
Tricyclic antidepressants
Continue for 3 months then further continuation following a medical review every 3 months
Be aware of overdose
Withdraw gradually
Relapse is common
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21
Q

What’s the most common cause of urinary retention in men?

A

Benign prostatic hyperplasia

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22
Q

How is acute urinary retention treated?

A

Cathererisation

Before removing it. Use alpha adrenoceptor blockers e. G. Doxazosin, tamsulosin for at least 2 days to manage symptoms

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23
Q

What to use for chronic urinary retention?

A

Intermittent Bladder catheterisation

If moderate to severe symptoms and other treatment fails, adrenoceptor blockers should be used

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24
Q

How to review drug treatment in chronic urinary retention (not caused from benign prostatic hyperplasia) ?

A

Initially reviewed after 4-6 wks and then every 6-12 months

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25
Q

Side effects of alpha adrenoceptor blockers?

A

Hypotension notably postural hypotension - dizziness, fainting, blurred vision, tachycardia, palpitations

Intra operative floppy iris sybdrome

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26
Q

Pt counselling on alpha adrenoceptor blockers?

A

Take first dose at bedtime

Driving can be impaired

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27
Q

When do you use finasteride or dutasteride?

A

Kind of 2nd line
In pts with an enlarged prostate, and who are considered to be at high risk of progression e. G. Elderly

Can combine it with alpha adrenoceptor blockers

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28
Q

Who can you sell tamsulosin to?

A

For the treatment of functional symptoms of benign hyperplasia in men aged 45-75 to be taken up to 6wks before clinical assessment by a dr

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29
Q

What group does finasteride and dutasteride belong to and how do they work?

A

5alpha reductase inhibitors

Inhibitor of enzyme 5alpha reductase which metabolise testosterone into the more potent androgen, dihydrotestosterone

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30
Q

Safety info on finasteride?

A

Reports of depression and suicidal thoughts

Stop and report depression

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31
Q

Side effects and pt counselling on finasteride?

A

Sexual dysfunction
Cases of male breast cancer. Report any changes in breast tissues like lumps, pain or nipple discharge

Use condoms as can be excreted in semen
Women should avoid handling them

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32
Q

What’s monophadic COC?

A

Contains fixes amounts of oestrogen and progestogen

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33
Q

What’s phasic COC?

A

Contains varying amount of oestrogen and progestogen

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34
Q

What does low strength COC contain?

A

20mcg of ethinylestradiol

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35
Q

Low strength COC are particularly suitable for what kind of women?

A

Women with risk factors for Circulatory disease

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36
Q

What kind of oestrogen component does COC contain?

A

Ethinylestradiol (most common)
Mestranol
Estradiol

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37
Q

What’s the strength of ethinylestradiol in standard strength preparations?

A

30/35
Or
30 - 40mcg in phased preparation

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38
Q

Phasic prepartion of COC are suitable for what kind of women?

A

Women who either do not have withdrawal bleeding or who have breakthrough bleeding with monophadic products

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39
Q

Side effects of COC?

A 
Acne
headache
Depressjon
Breast sy. Ptoms
Breakthrough bleeding
40
Q

Long term risk of oestrogen?

A

Increased risk of VTE
Increased risk of arterial thromboembolism

So oestrogen needs to be avoided if 2 or more risk factors are present

41
Q

Risk factors for VTE?

A 
Obesity of BMI over 39
Smokinh
Primary relative under 45 with VTE
Long term immobilisation
Age over 35
42
Q

What type of progenstogeb further increases the risk of VTE?

A

Progestogen
Desogestrel
Gestodene
drosperinone

43
Q

Risk factors of arterial thromboembolism?

A

DM
Hyoertentiin
Migraine without aura

44
Q

Contraceptive advice in surgery?

A

For major surgery where immobilisation will be affected afterwards and all surgery to the legs, oestrogen containing contraceptives need to be discontinued 4 wks before the surgery

45
Q

Post major surgery contraceptive advice

A

Progestogen only contraceptive is an alternative

Can restart COC on first menses at least 2wks after mobilisation

46
Q

What to do if pt on oestrogen containing contraceptives and is gonna go through elective surgery?

A

Thromboprophylaxis

47
Q

Advice to pt on oestrogen containing contraceptives who is going on a journey longer that 3hrs?

A

Reduce risk of VTE/ thromboembolism by wearing compression stocking and leg exercise

48
Q

When to stop oestogen containing contraceptives or oestogen containing HRT?

A

Signs and symptoms of VTE and thromboembolism (sudden severe chest pain, sudden breathlessness of cough with blood stained sputum could mean PE)

Signs and symptoms of stroke

Serious neurological effects (prolonged severe headache, loss of vision, disturbance of hearing, seizure, weakness, numbness)

Liver dysfunction

Hypertention of above 160/95

49
Q

How do COC work?

A

Inhibits ovulation

50
Q

How to take COCs?

A

Take one tab daily for 3wks
+ 1wk pill free interval for withdrawal bleeding

Start any time in Menstural cycle but if started on day 6 or later, use protection for 7 days

51
Q

How do progestogen only contraceptive work?

A

Prevent pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg
Alternative when COC is c/i

52
Q

How to take POP?

A

Take one tab daily on a continuous basis starting on day 1 of cycle and taken at the same time each day

If started after day 5 of Menstural cycle, additional precautions is required for 2 days

53
Q

Cancer side effects of COC?

A

Increase risk of cervical and breast

54
Q

Cancer side effects of POP?

A

Breast cancer

55
Q

Benefits of COC?

A

Reduce risk of ovarian and endometrial cancer

Reduces dysmenorrhoea and menorrhoea
Premenstrual tension
Reduced risk of pelvic Inflammatory disease
Less benign breast cancer
Less symptomatic fibrosis or functional ovarian cysts

56
Q

What’s considered a missed pill for COC?

A

More than 24hrs

Zoely and qlaria is more than 12hrs

57
Q

What to do if 1 missed COC pill?

A

Take one pill ASAP and next one at normal even if it means taking 2 together

No extra precautions required

58
Q

What to do if 2 or more missed COC pills?

A

Take one pill ASAP + condom for 7 days
(9 days if zoely/qlaira)

Omiy pill free interval if missed in the last 7 days

Use EHC if missed in the first 7 days and unprotected sex occurs

59
Q

Whats considered a pissed pill with POP?

A

More than 3hrs

Desogestrel is more than 12 hrs

60
Q

What to do if missed POP?

A

Take ASAP + use condom for 2 days

EHC if unprotected sex occurs before 2 pills are taken correctly

61
Q

What to do with COC if coming or diarrhiea occurs?

A

If vomiting within 2hrs of taking, take another ASAP

If more than 24hrs of severe case
Protection until 7 days after recovery and pill is resumed
(9days if qlaira)

If it occurs in last 7 days
Omiy pill free interval

62
Q

What to do with POP if vomiting or diarrhoea

A

If vomiting within 2hrs of taking, take another dose ASaw

If severe case or if pill not taken within 3hrs of normal time
(12grs if Desogestrel)
Protection required until 2 days after recovery and pill is resumed

63
Q

Dose of transdermal contraceptive patches?

A

Weekly patch for 3wks, then 1wj patch free

64
Q

What to do if contraceptive patch is detached for more than 24hrs? Or delayed application at beginning of cycle?

A

Apply new patch ASAP
And start and new day 1 cycle + condom for 7 days

If delayed application jn the middle of cycle
(beginning of week 2/day 8 or week ř/day 15)
If within 48hrs, apply new patch and continue as normal
If more than 48hrs start a new day 1cycle + condom for 7 days

65
Q

What can reduce the effect of ulpristal?

A

Drugs that increase gastric pH

Antacids. H2 receptor antagonists, PPIs

66
Q

Within how long do you have to insert copper IUD as an emergency contraceptives?

A

Up to 5 days after unprotected
Or
Up to 5 days after the earliest calculated ovulation

67
Q

What to do if pt requires an EHC but is over 70kg or BMI of greater than 26?

A

Levenogestrol is less effective so sell ulpristal or double up levonorgestrel (unlicensed so if pt requires this refer)

68
Q

Pt counselling on after taking EHC?

A

Ulpristal reduces the effectiveness of
regular contraceptives so use additional barrier prote tion for 14 days for combined (16 if qlaira)
9 days for POP (14 if parenteral)

Also wait 5 days before starting regular

69
Q

Side effects of EHCs?

A

Menstural irregularities

Counsel thag
Next periods may be early or late
Use barrier until next period
If lower abdominal pain see gp
If periods are abnormal, take preg test which must be at least 3wk after unprotected sex
70
Q

Intra uterine devices are less suitable for what kinda pts?

A

Under 25 due to increase risk of pelvic Inflammatory disease

71
Q

Advantage of having levonorgestrel releasing copper?

A

Reduced bleeding and period pain

Lower risk of PID

72
Q

Dose levonorgestrel containing copper need to be prescribed by brand?

A

Yes as varying indication, duration of usr

Mirena is for 5yrs and used as contraception and menorrhoea

Levosert is for 3yrs and used as contraception and menorrhoea

Jaydess for 3yrs only for contraceptions

72
Q

Dose levonorgestrel containing copper need to be prescribed by brand?

A

Yes as varying indication, duration of usr

Mirena is for 5yrs and used as contraception and menorrhoea

Levosert is for 3yrs and used as contraception and menorrhoea

Jaydess for 3yrs only for contraceptions

73
Q

Side effects of IUD?

A

Pain on insertion and bleeding

Risk if infection

  • main excess risk in first 20 days
  • related to the carriage of existing STI

So pre insertion Chlamydia screening for high risk groups like under 25, new oartber
Antibiotics prophylaxis if for emergency contraception

74
Q

MHRA warning on Intra uterine contraception?

A

Uterine perforation
Report any severe pelvic pain
Suddent changes jn periods
Pain during sex

75
Q

Removal of IUD?

A

Do not remove IUD mid cycle unless additional contraceptive is used for 7 dats

Iif removal is essential and unprotected sex occurs, give EHC

If preganant, remove in 1st trimester

76
Q

Examples of parenteral contraceptives?

And how long do they last?

A

Medroxyprogesteronr lasts for 2yrs

Noresthisterobe for 8wks

Etonogestrel implant lasts for 3yrs

77
Q

Side effects of medroxyprogesterone?

A

Delay in return to fertility and menstrual irregularities

Osteoporosis risk

78
Q

MHRA warning on Etonogestrel implant?

A

Nexolanon has reports of implants reaching the lung via pulmonary artery
If unable to locate implant in arm, use chest imaging

79
Q

What to do if pts is on COC but started enzyme inducer drugs?

A

Switch to parenteral progestogen only contraceptives or IUD
Continued for the duration and for 4wks after stopping enzyme inducers
Or
Tricyclinc COC using high strength monophadic COC

80
Q

What does trocycling COC mean?

A

Taking three packets of monophadic tabs without a break followed by shortened tab free interval of 4 days

81
Q

Whats used for abortion?

A

Gemeprost (prostaglandin analogue)
Musoprostol
Mifepeistone (anti progestogen)

82
Q

What’s used to induce or augment labour?

A

Dinoprostone (naturally occurring prostaglandin)
Musoprostol
Oxytocin (naturally occurring hormone)

83
Q

What’s used to prevent and treat bleeding labour, abortion and miscarriage?

A 
Carbetocin
Carboprost
Ergometrine
Misoprostol
Oxytocin
84
Q

What’s used to manage ectopic pregnancy?

A

Methotrexate

85
Q

What’s used in premature labour?

A

SABA
Atosibin (Oxytocin antagonist)
Indomethacin
Nifedipine

86
Q

What’s used for bacterial vaginosis?

A

Metronidazole 2g STAT

87
Q

What’s used for vaginal trichomoniasis?

A

Metronidazole 2g STAT

88
Q

What’s used for vaginal trichomoniasis?

A

Metronidazole 2g STAT

89
Q

Treatment of candida vulvitis?

A

Imidazole external cream like miconazole, clotrimazole

90
Q

Vaginal candidiasis treatment?

A

Imidazole pessary/internal cream

If oral treatment required, fluconazole, itraconazole

91
Q

Vulvovagibal thrush treatment in Preganancy?

A

Topical imidazole for 7 days like pessary

92
Q

Recurrent vulvovagibal thrush treatment?

A

6 months treatment with Topical imidazole

93
Q

Vaginal atrophy treatment?

A

Topical oestogen like vaginal tabs, rings and creams
Or
Non hormonal vaginal moisturiser

94
Q

What is vaginal atrophy?

A

Thinning, drying and inflammation of the vaginal walls that may occur when the body has less oestrogen

Inori Pre Reg (22 decks)

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