Genito-urinary system Flashcards
What is the treatment for vulvovaginal candidiasis?
Oral ozale drug
or
Itraconazole
or
Intravaginal imidazole pessary or cream (clotrimazole, econazole or miconazole)
Can repeat course if fails to control symptoms or symptoms recur after 7 days
How do you treat recurrent vulvovaginal candidiasis?
Fluconazole
Initially 150 mg every 72 hours for 3 doses, then 150 mg once weekly for 6 months
What is used to treat urgency incontinence?
(bladder training for at least 6 weeks first)
1st line: Anticholinergic
- immediate release oxybutynin (avoid in frail older women - at risk of deteriorating their physical or mental health)
–> transdermal formulation can be used if oral not tolerated
- immediate release tolterodine
- darifenacin
2nd line: mirabegron or one of the following:
- fesoterodine
- propiverine
- solifenacin
- trospium
3rd line: botulinum toxin A
What should be used to treat urgency incontinence with troublesome nocturia?
Desmopressin
How do you treat stress incontinence?
1st line: pelvic floor muscle training for at least 3 months with at least 8 contractions 8 times a day
2nd line: when surgery inappropriate and women prefers pharmacological treatment = duloxetine
When should an enuresis alarm be considered for children?
more than 1-2 wet beds per week - review after 4 weeks and continue until minimum or 2 weeks with no accidents achieved
What is the drug treatment for nocturnal enuresis?
Children >5 where enuresis alarm inappropriate
- oral of sublingual desmopressin: assess after 4 weeks and continue for 3 months if response to it, can repeat course if required but withdraw gradually at regular intervals e.g. 1 week every 3 months
Specialist supervision: desmopressin + antimuscarinic e.g. oxybutynin
When nothing else works:
- TCA: imipramine - however, relapse common when withdrawn
What are common side effect of transdermal oxybutynin?
GI discomfort and increased risk of infection
Which drugs can cause urinary retention?
Antimuscarinics
Sympathomimetics
TCAs
What is the most common cause of urinary retention in men?
Benign prostatic hyperplasia
When is catheterisation used for urinary retention?
Relieve acute painful urinary retention or when no cause can be found
How do you treat acute urinary retention?
Catheterisation
Before catheter removed - Alpha blocker should be given for at least two days to manage acute urinary retention
- alfuzosin
- doxazosin
- tramsulosin
- prazosin
- indoramin
- terazosin
How do you treat chronic urinary retention?
1st line: intermittent bladder catheterisation
2nd line: indwelling catheter
When can catheters be used long-term?
When urinary retention is causing incontinence, infection or renal impairment and a surgical solution is not feasible
What are the adverse effects associated with catheters?
Recurrent urinary infection
Trauma to urethra
Pain
Stone formation
How can moderate-severe symptoms of urinary retention be treated?
Alpha blocker
- alfuzosin
- doxazosin
- tamsulosin
- terazosin
review every 4-6 weeks then every 6-12 months
When would you consider a 5a-reductase inhibitor for urinary retention in men?
When they have:
- an enlarged prostate
- raised PSA
- considered to be at high risk of progression e.g. elderly
e.g. finasteride or dutasteride
- can be combined with alpha blocker if symptoms remain a problem
What is a common side effect of alpha blockers?
1st dose hypotension - take at bedtime
Dizziness
Sexual dysfunction
Drowsiness
Dyspnoea
Cough
What are the common side effects of tamsulosin?
Dizziness and sexual dysfunction
What is the MHRA warning for finasteride?
Rare reports of depression and suicidal thoughts
What are 2 side effect to be aware of with 5a-reductase inhibitors?
Breast abnormalities and sexual dysfunction
When are patients susceptible to ureteric stones?
Decrease in urine volume and/or an excess of stone forming substances
What are the symptoms of renal and ureteric stones?
abrupt onset of sevre unilateral abdominal pain radiating to the groin accompained by:
- nausea
- vomiting
- haematuria
- increase urinary frequency
- dysuria
- fever: if infection present too
What is the lifestyle advice to avoid stone formation?
Drink 2.5-3L of water - with addition of lemon juice
Avoid carbonated drinks
Maintain calcium intake of 700-1200mg a day
Main salt intake 6g or less a day
How do you manage pain associated with renal and ureteric stones?
1st line: NSAID
2nd line: IV paracetamol
3rd line: opioids
Which class of drugs should be avoided if suspected renal and ureteric stones?
Antispasmodics
When would you consider alpha blockers for renal and ureteric stones?
In patients with distal ureteric stones less than 10mm in diameter
OR
adjunctive therapy for patients having shockwave lithotripsy for ureteric stones less than 10mm in diameter
When would you consider potassium citrate for prevention of recurrent stones?
Recurrent stones composed of at least 50% calcium oxalate
What is given for urethral pain?
Lidocaine hydrochloride gel
or
alkalisation of urine using potassium citrate - relieves discomfort of cystitis cause by LUTI
Which cancers do combined hormonal contraceptions reduce the risk of?
Ovarian
Endometrial
Colorectal
Which combined hormonal contraception can you use the tailored regimen with?
Only with monophasic CHC containing ethinylestradiol
The tailored regimens:
- shortened HFI: 21 days of continuous use followed by 4 day HFI
- extended use (tricycling): 9 weeks of continuous use followed by 4 or 7 days HFI
- flexible extended use: continuous use for 21 days or more followed by 4 HFI days when breakthrough bleeding occurs
- Continuous use: no HFI
When should CHC stop prior to surgery?
at least 4 weeks prior to major surgery, any surgery to the legs or pelvis, or surgery that involves prolonged immobilisation of a lower limb
Commence 2 weeks after remobilisation
How frequently is the depot medroxyprogesterone injection administered?
every 13 weeks
What adverse effect is the medroxyprogesterone injection associated with?
small loss of bone mineral density - largely recovers after discontinuation
What should patients be made aware of when stopping medroxyprogesterone depot?
There can be a delayed return of fertility of up to 1 year after discontinuation
What do females take when their partner undergoes a vasectomy?
Norethisterone - 8 weeks use until vasectomy effective
It is also used after a rubella immunisation to prevent pregnancy while virus is active
How long is the etonogestrel implant effective for?
3 years
How long is the licensed duration of use for the intra-uterine progesterone-only systems (IUS)?
3-10 years
When should females with an IUS seek medical advise?
If the patient develops symptoms of pelvis infection, pain, abnormal bleeding, non-palpable threads or feel stem of IUS