Genito - Urinary System Flashcards
What is used for stress incontinence
Duloxetine (for women only)
Do not withdraw suddenly
Definitions
- urinary retention
- urinary incontinence
- stress incontinence
- urgency incontinence
- 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.
What is used first line for urinary frequency or incontinence
‘DOT’
- darifenacin
- oxybutynin
- tolterodine
What is used second line for urinary frequency or incontinence
Mirabegron
What type of drug is mirabegron?
Beta 3 adrenoreceptor agonist
Major Side effect of mirabegron
QT prolongation
Other drugs used in urinary frequency and incontinence
Tricyclic antidepressant
Eg. Imipramine
How do antimusaranic drugs work?
Reduce symptoms of urgency and urge incontinence and increase bladder capacity.
M/r preparations have less side effects
What is nocturnal enuresis in children
Bedwetting at night whilst sleeping
Children expected to stop at 5 years old
Treatment for nocturnal enuresis in children
- Non-drug treatments; advice on fluid intake, enuresis alarms and reward systems
- Desmopressin 200mcg OD - max 400mcg OD oral or sublingual
- Imipramine for children who do not respond to treatment
Common Side effect of desmopressin
- Hyponatraemia
- nausea
Counselling for decompression
- Risk of hyponatraemic convulsion
- avoid fluid over load
- STOP during an episode of vomiting or diarrhoea which leads to loss of sodium
Caution with desmopressin
- Avoid intranasal route due to increase Side effect.
- Limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards
Difference between acute and chronic urinary retention
Acute - painful and requires immediate treatment
Chronic - painless and gradually develop over months or years.
What is used to treat urinary retention
Alpha blockers;
- alfuzosin
- doxazosin
- indoramin
- prazosin
- tamsulosin
- terazosin
What is used to treat urinary retention in patients
- with enlarged prostate,
- raised PSA concentration and
- considered high risk of progression
5A reductase inhibitors;
- finasteride
- dutasteride
Patient counselling with 5A reductase inhibitors
Excreted in semen, use a condom if sexual partner is pregnant or likely to become pregnant
Handling and storage of 5A reductase inhibitors
Women of childbearing potential should avoid handling crushed or broken tablets of finasteride or leaking capsules of dutasteride
Signs to report with 5A reductase inhibitors
Can cause breast cancer; report any breast changes
MHRA warning with finasteride
Reports of depression and suicidal thoughts in men taking propecia for male pattern hair loss.
Stop immediately if depression develops
Alpha blockers in hypertension
They can reduce blood pressure
Patients on anti-hypertensives may need dose reduction and supervision
Caution with alpha blockers
- In elderly
- patients having cataract surgery - floppy iris syndrome
When are alpha blockers contraindicated
Postural hypotension
Micturition syncope (faint on urinating)
Side effect of alpha blockers
- Dry mouth
- dizziness
- postural hypotension
- drowsiness
Counselling point with alpha blockers
1st dose hypotensive effect and also drowsiness when driving
What are the different types of contraceptives
- IUD
- combine hormonal contraception (oestrogen and progesterone)
- progesterone only pills (levenorgestrel)
- barrier methods
Examples of oestrogen component of contraceptives
- Ethinylesradiol (main one)
- estradiol and mestranol
Examples of progestogen content of contraceptives
- Desogestrel
- gestogene drospirenone
- levonorgestrel
- noresthisterone
- nomegestrol
- dienogest
What forms are combined hormonal contraception available
- Combined oral contraceptives (coc)
- transdermal patches
- vaginal rings
When are combined hormonal contraceptives not recommended?
Beyond 50 years (cancer risk)
If taken, take one tablet daily for 3 weeks, I weeks pill free interval for withdrawal bleeding
Advantages of combined hormonal contraceptive
• 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)
What is monophasic coc
Have fixed amount of oestrogen and progestogen in each tablet.
- microgynon
- Rigevidon
- cilest
Which coc is given first line to minimise cardiovascular risk
Norestirone
What coc is usually used first line
A monophasic containing <30 mcg of ethinyestradiol
*Lower strength 20 mcg for women with risk of circulatory disease eg. Obesity, smoking, hypertension, MI
Choice of progesterone in coc
- levonogestrol : preferred
- desogestrol or drosprenone or gestodene : women with side effects eg. Acne, break through bleeding
Property of drospirenone
Derivative of spironolactone
hyperkalaemia
Combined hormonal contraceptives in surgery
- 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
What to do if oestrogen can’t be stopped before surgery
Offer thromboprophylaxis
- heparin
- graduated stockings
Reasons to stop HRT or COC
- 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
Use chc with caution or avoid if >2 factors
- 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
What to do if vomiting occurs 3 hours within taking the combined pill or if severe diarrhoea for more than 24 hours
Take another pill ASAP
use non oral contraception if diarrhoea and vomiting persists
What is considered a missed pill?
One that is >24 hours late
- >12 hours : zoely, qlaira, desogestrel
- > 3 hours : levonorgestrel, norethisterone
