Genito - Urinary System

Question 1

What is used for stress incontinence

Answer 1

Duloxetine (for women only)
Do not withdraw suddenly

Question 2

Definitions
- urinary retention
- urinary incontinence
- stress incontinence
- urgency incontinence

Answer 2

• Urinary retention: Inability to voluntarily urinate.
• Urinary incontinence: Involuntary leakage of urine and can range in severity and nature.
• Stress incontinence: Involuntary leakage on effort and exertion(e.g sneezing or coughing).
• Urgency incontinence: Involuntary leakage which is accompanied by a sudden compelling desire to pass urine that is difficult to delay.

Question 3

What is used first line for urinary frequency or incontinence

Answer 3

‘DOT’

• darifenacin
• oxybutynin
• tolterodine

Question 4

What is used second line for urinary frequency or incontinence

Answer 4

Mirabegron

Question 5

What type of drug is mirabegron?

Answer 5

Beta 3 adrenoreceptor agonist

Question 6

Major Side effect of mirabegron

Answer 6

QT prolongation

Question 7

Other drugs used in urinary frequency and incontinence

Answer 7

Tricyclic antidepressant
Eg. Imipramine

Question 8

How do antimusaranic drugs work?

Answer 8

Reduce symptoms of urgency and urge incontinence and increase bladder capacity.

M/r preparations have less side effects

Question 9

What is nocturnal enuresis in children

Answer 9

Bedwetting at night whilst sleeping

Children expected to stop at 5 years old

Question 10

Treatment for nocturnal enuresis in children

Answer 10

1. Non-drug treatments; advice on fluid intake, enuresis alarms and reward systems
2. Desmopressin 200mcg OD - max 400mcg OD oral or sublingual
3. Imipramine for children who do not respond to treatment

Question 11

Common Side effect of desmopressin

Answer 11

• Hyponatraemia
• nausea

Question 12

Counselling for decompression

Answer 12

• Risk of hyponatraemic convulsion
• avoid fluid over load
• STOP during an episode of vomiting or diarrhoea which leads to loss of sodium

Question 13

Caution with desmopressin

Answer 13

• Avoid intranasal route due to increase Side effect.
• Limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards

Question 14

Difference between acute and chronic urinary retention

Answer 14

Acute - painful and requires immediate treatment

Chronic - painless and gradually develop over months or years.

Question 15

What is used to treat urinary retention

Answer 15

Alpha blockers;

• alfuzosin
• doxazosin
• indoramin
• prazosin
• tamsulosin
• terazosin

Question 16

What is used to treat urinary retention in patients
- with enlarged prostate,
- raised PSA concentration and
- considered high risk of progression

Answer 16

5A reductase inhibitors;

• finasteride
• dutasteride

Question 17

Patient counselling with 5A reductase inhibitors

Answer 17

Excreted in semen, use a condom if sexual partner is pregnant or likely to become pregnant

Question 18

Handling and storage of 5A reductase inhibitors

Answer 18

Women of childbearing potential should avoid handling crushed or broken tablets of finasteride or leaking capsules of dutasteride

Question 19

Signs to report with 5A reductase inhibitors

Answer 19

Can cause breast cancer; report any breast changes

Question 20

MHRA warning with finasteride

Answer 20

Reports of depression and suicidal thoughts in men taking propecia for male pattern hair loss.

Stop immediately if depression develops

Question 21

Alpha blockers in hypertension

Answer 21

They can reduce blood pressure

Patients on anti-hypertensives may need dose reduction and supervision

Question 22

Caution with alpha blockers

Answer 22

• In elderly
• patients having cataract surgery - floppy iris syndrome

Question 23

When are alpha blockers contraindicated

Answer 23

Postural hypotension
Micturition syncope (faint on urinating)

Question 24

Side effect of alpha blockers

Answer 24

• Dry mouth
• dizziness
• postural hypotension
• drowsiness

Question 25

Counselling point with alpha blockers

Answer 25

1st dose hypotensive effect and also drowsiness when driving

Question 26

What are the different types of contraceptives

Answer 26

• IUD
• combine hormonal contraception (oestrogen and progesterone)
• progesterone only pills (levenorgestrel)
• barrier methods

Question 27

Examples of oestrogen component of contraceptives

Answer 27

• Ethinylesradiol (main one)
• estradiol and mestranol

Question 28

Examples of progestogen content of contraceptives

Answer 28

• Desogestrel
• gestogene drospirenone
• levonorgestrel
• noresthisterone
• nomegestrol
• dienogest

Question 29

What forms are combined hormonal contraception available

Answer 29

• Combined oral contraceptives (coc)
• transdermal patches
• vaginal rings

Question 30

When are combined hormonal contraceptives not recommended?

Answer 30

Beyond 50 years (cancer risk)

If taken, take one tablet daily for 3 weeks, I weeks pill free interval for withdrawal bleeding

Question 31

Advantages of combined hormonal contraceptive

Answer 31

• Reliable and reversible
• Predictable bleeding pills
• reduced menopausal symptoms
• Improvement of acne
• maintain bone density in peri-menopausal women under 50 years
• reduced risk of ovarian, endometrial andcolorectal cancer (progestogen)

Question 32

What is monophasic coc

Answer 32

Have fixed amount of oestrogen and progestogen in each tablet.

• microgynon
• Rigevidon
• cilest

Question 33

Which coc is given first line to minimise cardiovascular risk

Answer 33

Norestirone

Question 34

What coc is usually used first line

Answer 34

A monophasic containing <30 mcg of ethinyestradiol

*Lower strength 20 mcg for women with risk of circulatory disease eg. Obesity, smoking, hypertension, MI

Question 35

Choice of progesterone in coc

Answer 35

• levonogestrol : preferred
• desogestrol or drosprenone or gestodene : women with side effects eg. Acne, break through bleeding

Question 36

Property of drospirenone

Answer 36

Derivative of spironolactone

hyperkalaemia

Question 37

Combined hormonal contraceptives in surgery

Answer 37

• Discontinue 4 weeks before major elective surgery and all surgery of legs or pelvis or prolonged immobilisation to lower limb.
• offer alternative method of contraception
• chc may be recommended 2 weeks after mobilisation

Question 38

What to do if oestrogen can’t be stopped before surgery

Answer 38

Offer thromboprophylaxis
- heparin
- graduated stockings

Question 39

Reasons to stop HRT or COC

Answer 39

• Sudden severe chest pain
• sudden breathlessness
• unexplained swelling or severe pain in calf of one DVT sign
• severe stomach pain
• serious neurological reflects
• signs of stroke
• sign of liver failure
• hypertension
• migraines

Question 40

Use chc with caution or avoid if >2 factors

Answer 40

• Family history of VTE
• obesity (bmi >30)
• long term immobilisation
• history of superficial thrombophilitis
• dyslipidaemia
• long QT syndrome
• smoking (avoid if greater than 40 daily)
• diabetes (avoid if complications)
• migraine
• hypertension - seek specialist advice

Question 41

What to do if vomiting occurs 3 hours within taking the combined pill or if severe diarrhoea for more than 24 hours

Answer 41

Take another pill ASAP

use non oral contraception if diarrhoea and vomiting persists

Question 42

What is considered a missed pill?

Answer 42

One that is >24 hours late

• >12 hours : zoely, qlaira, desogestrel
• > 3 hours : levonorgestrel, norethisterone