Genito-urinary system (medium) Flashcards

1
Q

what are the 3 different types of urinary incontinence

A

stress: involuntary leakage from exertion/ sneezing/ coughing
urgency: urgent need to urinate
mixed: both urgency and stress but one usually dominates

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2
Q

non drug management for urinary incontinence

A

reduce caffeine
reduce weight if BMI >30
modify fluid intake
bladder training for 6 weeks for urgency incontinence
pelvic floor muscle training for 3 months for stress incontinence

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3
Q

what is the drug management for urgency incontinence (1st and 2nd line)

A

1st line: antimuscarinics: oxybutynin, tolterodine, darifenacin…
2nd line: beta agonist: mirabegron 50mg OD

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4
Q

drug management for stress incontinence

A

surgery or duloxetine

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5
Q

1st line for nocturnal enuresis (bed wetting)

A

after lifestyle management (fluid intake, toilet behaviour, rewards system…)

enuresis alarms:

  • review after 4 weeks
  • continue until 2 weeks of uninterrupted dry nights
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6
Q

drug management for nocturnal enuresis (1st, 2nd and 3rd line)

A

1st line: desmopressin

  • use S/L or oral - not intranasal due to increased side effects
  • no potent and longer DOA than vasopressin

2nd line: desmopressin +/- antimuscarinic (oxybutynin/ tolterodine)
3rd line: imipramine

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7
Q

management of acute urinary retention during emergency

A

immediate catheterisation - alleviates the pain

alpha blocker: doxazosin, alfuzosin, tamsulosin

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8
Q

what can cause urinary retention

A

antimuscarinics, TCAs, sympathomimetics

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9
Q

treatment of chronic urinary retention

A

catheter

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10
Q

treatment of BPH and the doses

A

alpha blocker- relaxes the smooth muscle

doxazosin: 1mg OD can be increased to 8mg OD
tamsulosin: 400mcg OD

5a reductase inhibitor - used if enlarged prostate/ risk of progression or hypotensive

finasteride: 5mg OD
dutasteride: 500mcg OD

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11
Q

MHRA warning for finasteride

A

reports of depression and suicidal thoughts

stop immediately and report

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12
Q

side effects of alpha blockers

A
postural hypotension - take before bed and lie down if dizzy/ fatigue
dizziness, 
tachycardia
palpitations
blurred vision
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13
Q

contraindications of alpha blockers

A
micturition syncope (fasting after urination)
postural hypotension
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14
Q

side effects of 5a reductase inhibitors

A

breast disorders- report lumps, nipple pain/ discharge - could be male breast cancer

sexual dysfunction: ejaculation disorders, impotence

depression - MHRA warning

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15
Q

cautions of 5a reductase inhibitors

A

avoid handling in women of childbearing potential
condoms should be used if women pregnant/ could become pregnant
excreted in semen

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16
Q

contraindications and MHRA warning of IUD

A

pelvic inflammatory disorder
unexplained vaginal bleeding

MHRA warning: risk of uterine perforation
replace every 5-10 years and remove in 1st trimester of pregnancy

17
Q

contraindications for COC

A

35 years plus + smoker/ stopped within a year ago
BMI >35
previous VTE or FH with VTE <45 years old
severe migraines especially with aura
diabetes
history of breast cancer

18
Q

what to do if you forget one missed pill of COC

A

take another one ASAP even if it means taking 2 at the same time
carry on taking the rest of the pills as normal
no extra contraception needed

19
Q

what to do if you miss 2 or more pills of COC

A

take as soon as you remember even if it means taking 2 at the same time

if its in the 1st week of the cycle or after finishing the pack and its been >9 days of pill free interval

  • use EHC if had unprotected sex
  • use extra contraception for 7 days

if during week 2/3 of cycle:

  • use extra contraception for 7 days
  • continue taking the pill as normal and if pills missed 7 days prior to PFI, miss this and start new pack
20
Q

what to do if you miss 2 or more pills of COC

A

take as soon as you remember even if it means taking 2 at the same time

if its in the 1st week of the cycle or after finishing the pack and its been >9 days of pill free interval

  • use EHC if had unprotected sex
  • use extra contraception for 7 days

if during week 2/3 of cycle:

  • use extra contraception for 7 days
  • continue taking the pill as normal and if pills missed 7 days prior to PFI, miss this and start new pack
21
Q

what’s considered as a missed dose and what to do

A

forgetting to take pill/ vomiting/ diarrhoea within 3 hours or 12 hours for desogestrel

take another one asap

22
Q

interactions of COCs

A

rifampicin/ rifabutin = reduces contraceptive effect (Potent cyp inducer)

anti-epileptic drugs: carbamazepine, ocarbazepine, phenytoin, phenobarbital, primidone, topiramate = reduces contraceptive effect

others: st johns wort, griseofulvin

23
Q

management of COC in surgery

A

stop 4 weeks prior to planned surgery and restart 2 weeks after full mobilisation

if emergency surgery- consider using thromboprophylaxis

24
Q

how to take POP

A

if started on day 1-5 works straight away - no additional contraception needed

if started on any other day, need 2 days of contraception

25
Q

how often are depot and implant progesterone contraception used and what are the cautions

A

depot: every 13 weeks
may delay fertility up to 1 year after treatment stopped

implant: every 3 years
MHRA warning with etonorgestrel: neuromuscular injury and migration of implant - remove ASAP

26
Q

non-drug management for erectile dysfunction

A

smoking cessation

reduce alcohol

27
Q

1st line drug management for erectile dysfunction and when are they considered as a non-responder

A

phosphodiesterase type 5 inhibitor:
short acting - sildenafil, varednafil, avanafil - use PRN
long acting - use PRN or regularly at low dose for spontaneous sexual activity

patient should have 6 doses with sexual stimulation before being considered as non responder

28
Q

2nd line treatment for erectile dysfunction and the caution

A

alprostadil: intracavernosal (injection at base of penis), intraurethral, topical
- under medical supervision

wear condom if partner is of childbearing age/ pregnant/ lactating

29
Q

contraindications for erectile dysfunction drugs (phosphodiesterase type 5 inhibitors and alprostadil)

A
taking nitrates
hypotensive
unstable angina/ stroke
angina during intercourse
patients who shouldn't have sex 

priapism: erection lasting longer than 4 hours - seek medical attention

30
Q

interactions of erectile dysfunction drugs (phosphodiesterase type 5 inhibitors and alprostadil)

A

nitrates

alpha blockers

31
Q

when can levnorgestrel be supplied to patient for EHC

A
  • up to 72 hours of UPSI
  • age >16
  • 2nd dose needed if V/D occurred within 3 hours
  • if BMI < 26 or weight < 70kg (give ulipristal if above)
  • usual pill contraceptive can be restarted immediately
  • can breastfeed immediately
  • avoid in severe liver impairment
  • interacts with CYP inducer e.g., anti epileptic drugs (give double dose of EHC)
  • caution in malabsorption
32
Q

when can ulipristal be supplied ECH

A
  • > 13 years old
  • up to 5 days after UPSI
  • 2nd dose needed if V/D within 3 hours
  • BMI >26 or weight >70kg
  • wait 5 days before restarting hormonal contraceptive pill (unless 1week of cycle) and use additional contraceptive for extra 7 days (12 days total)
  • can restart CHC immediately if in 1st week of cycle
  • wait 1 week before breastfeeding
  • caution: severe uncontrolled asthma using glucocorticoids
  • avoid in severe liver impairment
    interaction with CYP inducers - cannot sell double OTC - refer
33
Q

side effects of levonorgestrel and ulipristal

A

levonorgestrel: breast tenderness, D/V, fatigue, haemorrhage
ulipristal: menstrual irregularities, D/V, altered mood, dizziness