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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
Side effects of alpha adrenoceptor blockers?
Hypotension notably postural hypotension - dizziness, fainting, blurred vision, tachycardia, palpitations Intra operative floppy iris sybdrome
26
Pt counselling on alpha adrenoceptor blockers?
Take first dose at bedtime | Driving can be impaired
27
When do you use finasteride or dutasteride?
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
28
Who can you sell tamsulosin to?
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
29
What group does finasteride and dutasteride belong to and how do they work?
5alpha reductase inhibitors Inhibitor of enzyme 5alpha reductase which metabolise testosterone into the more potent androgen, dihydrotestosterone
30
Safety info on finasteride?
Reports of depression and suicidal thoughts | Stop and report depression
31
Side effects and pt counselling on finasteride?
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
32
What's monophadic COC?
Contains fixes amounts of oestrogen and progestogen
33
What's phasic COC?
Contains varying amount of oestrogen and progestogen
34
What does low strength COC contain?
20mcg of ethinylestradiol
35
Low strength COC are particularly suitable for what kind of women?
Women with risk factors for Circulatory disease
36
What kind of oestrogen component does COC contain?
Ethinylestradiol (most common) Mestranol Estradiol
37
What's the strength of ethinylestradiol in standard strength preparations?
30/35 Or 30 - 40mcg in phased preparation
38
Phasic prepartion of COC are suitable for what kind of women?
Women who either do not have withdrawal bleeding or who have breakthrough bleeding with monophadic products
39
Side effects of COC?
``` Acne headache Depressjon Breast sy. Ptoms Breakthrough bleeding ```
40
Long term risk of oestrogen?
Increased risk of VTE Increased risk of arterial thromboembolism So oestrogen needs to be avoided if 2 or more risk factors are present
41
Risk factors for VTE?
``` Obesity of BMI over 39 Smokinh Primary relative under 45 with VTE Long term immobilisation Age over 35 ```
42
What type of progenstogeb further increases the risk of VTE?
Progestogen Desogestrel Gestodene drosperinone
43
Risk factors of arterial thromboembolism?
DM Hyoertentiin Migraine without aura
44
Contraceptive advice in surgery?
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
Post major surgery contraceptive advice
Progestogen only contraceptive is an alternative | Can restart COC on first menses at least 2wks after mobilisation
46
What to do if pt on oestrogen containing contraceptives and is gonna go through elective surgery?
Thromboprophylaxis
47
Advice to pt on oestrogen containing contraceptives who is going on a journey longer that 3hrs?
Reduce risk of VTE/ thromboembolism by wearing compression stocking and leg exercise
48
When to stop oestogen containing contraceptives or oestogen containing HRT?
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
How do COC work?
Inhibits ovulation
50
How to take COCs?
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
How do progestogen only contraceptive work?
Prevent pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg Alternative when COC is c/i
52
How to take POP?
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
Cancer side effects of COC?
Increase risk of cervical and breast
54
Cancer side effects of POP?
Breast cancer
55
Benefits of COC?
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
What's considered a missed pill for COC?
More than 24hrs Zoely and qlaria is more than 12hrs
57
What to do if 1 missed COC pill?
Take one pill ASAP and next one at normal even if it means taking 2 together No extra precautions required
58
What to do if 2 or more missed COC pills?
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
Whats considered a pissed pill with POP?
More than 3hrs | Desogestrel is more than 12 hrs
60
What to do if missed POP?
Take ASAP + use condom for 2 days EHC if unprotected sex occurs before 2 pills are taken correctly
61
What to do with COC if coming or diarrhiea occurs?
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
What to do with POP if vomiting or diarrhoea
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
Dose of transdermal contraceptive patches?
Weekly patch for 3wks, then 1wj patch free
64
What to do if contraceptive patch is detached for more than 24hrs? Or delayed application at beginning of cycle?
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
What can reduce the effect of ulpristal?
Drugs that increase gastric pH | Antacids. H2 receptor antagonists, PPIs
66
Within how long do you have to insert copper IUD as an emergency contraceptives?
Up to 5 days after unprotected Or Up to 5 days after the earliest calculated ovulation
67
What to do if pt requires an EHC but is over 70kg or BMI of greater than 26?
Levenogestrol is less effective so sell ulpristal or double up levonorgestrel (unlicensed so if pt requires this refer)
68
Pt counselling on after taking EHC?
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
Side effects of EHCs?
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
Intra uterine devices are less suitable for what kinda pts?
Under 25 due to increase risk of pelvic Inflammatory disease
71
Advantage of having levonorgestrel releasing copper?
Reduced bleeding and period pain | Lower risk of PID
72
Dose levonorgestrel containing copper need to be prescribed by brand?
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
Dose levonorgestrel containing copper need to be prescribed by brand?
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
Side effects of IUD?
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
MHRA warning on Intra uterine contraception?
Uterine perforation Report any severe pelvic pain Suddent changes jn periods Pain during sex
75
Removal of IUD?
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
Examples of parenteral contraceptives? | And how long do they last?
Medroxyprogesteronr lasts for 2yrs Noresthisterobe for 8wks Etonogestrel implant lasts for 3yrs
77
Side effects of medroxyprogesterone?
Delay in return to fertility and menstrual irregularities | Osteoporosis risk
78
MHRA warning on Etonogestrel implant?
Nexolanon has reports of implants reaching the lung via pulmonary artery If unable to locate implant in arm, use chest imaging
79
What to do if pts is on COC but started enzyme inducer drugs?
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
What does trocycling COC mean?
Taking three packets of monophadic tabs without a break followed by shortened tab free interval of 4 days
81
Whats used for abortion?
Gemeprost (prostaglandin analogue) Musoprostol Mifepeistone (anti progestogen)
82
What's used to induce or augment labour?
Dinoprostone (naturally occurring prostaglandin) Musoprostol Oxytocin (naturally occurring hormone)
83
What's used to prevent and treat bleeding labour, abortion and miscarriage?
``` Carbetocin Carboprost Ergometrine Misoprostol Oxytocin ```
84
What's used to manage ectopic pregnancy?
Methotrexate
85
What's used in premature labour?
SABA Atosibin (Oxytocin antagonist) Indomethacin Nifedipine
86
What's used for bacterial vaginosis?
Metronidazole 2g STAT
87
What's used for vaginal trichomoniasis?
Metronidazole 2g STAT
88
What's used for vaginal trichomoniasis?
Metronidazole 2g STAT
89
Treatment of candida vulvitis?
Imidazole external cream like miconazole, clotrimazole
90
Vaginal candidiasis treatment?
Imidazole pessary/internal cream If oral treatment required, fluconazole, itraconazole
91
Vulvovagibal thrush treatment in Preganancy?
Topical imidazole for 7 days like pessary
92
Recurrent vulvovagibal thrush treatment?
6 months treatment with Topical imidazole
93
Vaginal atrophy treatment?
Topical oestogen like vaginal tabs, rings and creams Or Non hormonal vaginal moisturiser
94
What is vaginal atrophy?
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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