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GPhC BNF > GENITO-URINARY TRACT > Flashcards

GENITO-URINARY TRACT Flashcards

1
Q

COMBI ED
28 day cycle
Pack size?

A

84

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2
Q

COMBI (X ED)
21 day cycle+7 day free pill period
Pack size?

A

63

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3
Q

PHOSPHODIESTERASE TYPE-5 INHIBITORS

ALPROSTADIL ADVICE?

A

Wear condom if partner is of child-bearing age/pregnant/lactating

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4
Q

PHOSPHODIESTERASE TYPE-5 INHIBITORS

MHRA WARNING?

A

Priapism (erection>4hrs)- MEDICAL ATTENTION ASAP!

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5
Q

PHOSPHODIESTERASE TYPE-5 INHIBITORS

INTERACTIONS?

A

Nitrates
Alpha-blockers

Hypotension?

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6
Q

PHOSPHODIESTERASE TYPE-5 INHIBITORS

CONTRAINDICATIONS?

A 
Nitrates/have hypotension (<90mmHg)
Unstable angina
Stroke
Angina during intercourse
Advised not to have sexual inactivity
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7
Q

PHOSPHODIESTERASE TYPE-5 INHIBITORS- SILDENAFIL!

SIDE-EFFECTS? FDNM

A

FLUSHING
DIZZINESS
NASAL CONGESTION
MIGRAINE

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8
Q

ED- TREATMENT

SECOND LINE?

A

Intracarvenosal/Intraurethral/Topical ALPROSTADIL

Under careful medical superivison!

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9
Q

ED- TREATMENT

At what dose for a non-responder?

A

Six doses (maximum) with sexual stimulation

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10
Q

2 TYPES OF PHOSOPHODIESTERASE TYPE-5 INHIBITORS?

A

SHORT-ACTING- avanafil/sildenafil- PRN

LONG-ACTING- Tadalafil- PRN or regular lower daily dose to allow for spontaneous sexual activity

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11
Q

ED- TREATMENT

1ST LINE?

A

PHOSPHODIESTERASE TYPE-5 INHIBITOR

Increases blood flow to the penis-> still requires sexual stimulation

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12
Q

ED- LIFESTYLE CHANGES?

A

SMOKING CESSATION

REDUCED ALCOHOL INTAKE

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13
Q

ERECTILE DYSFUNCTION

What is it?

A

Persistent inability to attain and maintain an erection- physical/psychological causes/side-effects of drugs

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14
Q

LEVONORGESTREL IUD?

Same as COPPER IUD but reduced pain/bleeding side-effects

And replace every..?

A

3-10 years

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15
Q

INTRA-UTERINE DEVICE (COPPER)

MHRA WARNING? Risk of uterine perforation

Replace every?

Further notes?

Removed in?

A 
MHRA WARNING? Risk of uterine perforation
Severe pelvic pain after insertion
Sudden change in period
Pain during intercourse
Unable to feel threads

Replace every?
5-10 years

Further notes?
Check up if you can’t feel threads
Replace /5-10 years

Removed in?
First trimester of pregnancy

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16
Q

ULIPRISTAL ACETATE (30mg)

BREAST-FEEDING?
CAUTIONED IN?
CAN CAUSE?
AVOID IN?
INTERACTION?
A

BREAST-FEEDING? 1 week delay

CAUTIONED IN? Severe asthmatics controlled by glucocorticoids

CAN CAUSE? Cycle irrregularities/D+V/altered mood/dizziness

AVOID IN? severe liver impairment

INTERACTION? CYP inducers, decrease efficacy of contraceptie, e.g. Rifampicin

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17
Q

LEVONORGESTREL (1.5mg)

BREAST-FEEDING?
CAUTIONED IN?
CAN CAUSE?
AVOID IN?
INTERACTION?
A

BREAST-FEEDING? No delay

CAUTIONED IN? Patients w/ malabsorption

CAN CAUSE? Breast tenderness/D+V/fatigue/haemorrhage

AVOID IN? severe liver impairment

INTERACTION? CYP inducers, decrease efficacy of contraceptie, e.g. Rifampicin

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18
Q

WHEN DO YOU INITIATE REGULAR CONTRACEPTION?
Taken ULIPRISTAL?

During week 1 in females taking regular CHC?

A

Taken ULIPRISTAL? Wait 5 days after taking ulipristal before starting regular hormones again
Use condom during 5 days+till fully effective

During week 1 in females taking regular CHC? Can be restarted immediately/wear condom for 7 days

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19
Q

WHEN DO YOU INITIATE REGULAR CONTRACEPTION?

Taken LEVONORGESTREL?

A

Taken LEVONORGESTREL?

Can start regular hormonal contraception ASAP but use condoms till effective (2 days POP, 7 days CHC)

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20
Q

EMERGENCY HORMONAL CONTRACEPTION

ULIPRISTAL/LEVONORGESTREL can be used as emergency contraception >once in the same cycle BUT..?

A

ULIPRISTAL/LEVONORGESTREL can be used as emergency contraception >once in the same cycle BUT..? Levonorgestrel has increased risk of side-effects :(

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21
Q

EMERGENCY CONTRACEPTION- HORMONAL

LEVONORGESTREL?

ULIPRISTAL?

WHICH ONE MORE EFFECTIVE?

BMI EFFECT?
BMI >26kg/m^2/>70kg?

A

LEVONORGESTREL? 72hrs/3 days

ULIPRISTAL? 120hrs/5 days

WHICH ONE MORE EFFECTIVE? Ulipristal more effective than levonorgestrel

BMI EFFECT? Reduces effectiveness, especially levonorgestrel (unlike CU-IUD!)
BMI >26kg/m^2/>70kg? Give ulipristal/double dose of levonorgestrel

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22
Q

EMERGENCY CONTRACEPTION- HORMONAL

Vomiting/diarrhoea

Levonorgestrel?

Ulipristal?

A

Levonorgestrel? 2 hours

Ulipristal? 3 hours

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23
Q

EMERGENCY CONTRACEPTION

COPPER-IUD
Can be inserted up to 120hrs (5 days) after the…?
Can be inserted up to 5 days after the earliest estimated…?

A

COPPER-IUD
Can be inserted up to 120hrs (5 days) after the…? first UPSI
Can be inserted up to 5 days after the earliest estimated…? date of ovulation

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24
Q

EMERGENCY CONTRACEPTION

3 EXAMPLES?

A

COPPER-IUD (most effective
ULIPRISTAL 30mg
LEVONORGESTREL 1.5mg

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25
Q

MISSED DOSES- PATCHES&VAGINAL RINGS, WAY TOO MUCH INFO, CBA, TY BYE

A
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26
Q

CHC- MISSED DOSES

2+ MISSED PILLS
Week 1?
Week 2-3?

2+ missed pills in 7 days before HFI?

A

2+ MISSED PILLS?
Week 1-> emergency contraception needed if UPSI between HFI and week 1
*Take ASAP+use condom till 7 consecutive doses taken

Week 2-3-> no emergency contraception needed- take ASAP- 7 days condom

2+ missed pills in 7 days before HFI? Carry on taking pill throughout HFI (so no break)

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27
Q

CHC- MISSED DOSES

1 MISSED PILL (48-72hrs since last active pill)?

A

1 MISSED PILL (48-72hrs since last active pill)?

Take ASAP-> no further action needed (assuming consistent use in previous 7 active pills)?

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28
Q

CHC- MISSED DOSES

LATE START AFTER HFI (>9 days since last active pill)? What does this mean bruhhh

A

LATE START AFTER HFI (>9 days since last active pill)?
Emergency contraception if UPSI has occurred
Take immediately+use condom till 7 consecutive days taken

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29
Q

PROGESTOGEN-ONLY PILL- MISSED DOSES

‘Missed’ if its?
What do you do?
Take next pill?
Need protection till?

UPSI between missed pill/2 days after restarting medication, what do you need?

A

‘Missed’ if its? >12hrs for desogestrel OR >3hrs for others

What do you do? Take pill ASAP

Take next pill? At usual time (2 in 1 day calm)

Need protection till? 2 days

UPSI between missed pill/2 days after restarting medication, what do you need? NEED EMERGENCY CONTRACEPTION!

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30
Q

PROGESTOGEN-ONLY- MISSED DOSES

vomit/diarrhoea-> take pill within?

A

2hrs

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31
Q

CHC- SIDE-EFFECTS? A LOT OF CHANGES

A 
Headache
Unscheduled bleeding (breakthrough bleeding)
Mood change
Weight gain
Libido change
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32
Q

CHC & SURGERY

WHAT IF YOU CAN’T STOP THE CHC/TRAUMA??

A

THROMBOPROPHYLAXIS MAYBE!

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33
Q

CHC & SURGERY

WHEN DO YOU RECOMMENCE CHC AFTER FULL REMOBILISATION?

A

AFTER 2 WEEKS

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34
Q

CHC & SURGERY

DISCONTINUE AT LEAST 4 WEEKS PRIOR FOR..?

A

DISCONTINUE AT LEAST 4 WEEKS PRIOR FOR..?
-Major elective surgery/any surgery to legs/pelvis
-Surgery that involves prolonged immobilisation of lower limb
(Use alternative in meantime)

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35
Q

OTHER REASONS TO STOP TAKING CHC?

A 
Breast cancer (lump/nipple pain)
New onset migraine
Persistent unschedule vaginal bleeding
High BP
High BMI, <35kg/m^2
DVT/PE
Blood clotting abnormality
Angina/heart attack/stroke/PVD
Atrial fibrillation
Cardiomyopathy
36
Q

URGENT REASONS TO STOP TAKING CHC? big boys

A 
CALF PAIN/SWELLING/REDNESS (DVT)
CHEST PAIN/BREATHLESSNESS/COUGHING BLOOD (PE)
LOSS OF MOTOR/SENSORY FUNCTION (STROKE)
SEVERE STOMACH PAIN (HEPATOTOXICITY)
VERY HIGH BP (HAEMORRHAGIC STROKE)
37
Q

SWTICHING FROM A CHC TO OTHERS

WEEK 2/3?

A

No extra precaution needed

38
Q

SWTICHING FROM A CHC TO OTHERS

WEEK 1? (or day 3-7 of HFI)+ UPSI since start of HFI

Carry on with CHC until..?

A

WEEK 1? (or day 3-7 of HFI)+ UPSI since start of HFI

Carry on with CHC until..? 7 consecutive days taken, act as week 2/3

39
Q

What is the HFI period?

A

7 days free after Week 3 G

40
Q

SWITCHING FROM A CHC TO OTHERS

WEEK 1? (or day 3-7 of HFI)+NO! UPSI since start of HFI

to Cu-IUD?
to POP?
to OTHERS?

A

WEEK 1? (or day 3-7 of HFI)+NO! UPSI since start of HFI

FROM Cu-IUD? no extra precaution
FROM POP? 2 days precaution
FROM OTHERS? 7 days precaution

41
Q

SWITCHING TO A COMBINED HORMONAL CONTRACEPTIVES- RULES

FROM CHC?
FROM POP?
FROM LEVONORGESTREL-IUD?

FROM COPPER-IUD?

OTHER?

A

FROM CHC? No additional contraception needed
FROM POP? 7 days extra precaution needed
FROM LEVONORGESTREL-IUD? 7 days extra precaution needed

FROM COPPER-IUD?
If CHC started on up to day 5 of cycle-> no additional contraception needed
If CHC started after day 5-> 7 days extra precaution needed

OTHER? Same as copper-IUD

42
Q

Females on 21-day regimen have a monthly withdrawal bleed during…?

Withdrawal bleeds do not represent..?

28 pack size?

A

Females on 21-day regimen have a monthly withdrawal bleed during…? 7-DAY HORMONE FREE INTERVAL

Withdrawal bleeds do not represent..? PHYSIOLOGICAL MESNTRUATION

28 pack size? 21 active pills, 7 dummy

43
Q

CHC- PREPARATIONS

MONOPHASIC?
MULTIPHASIC?

OESTROGEN COMPONENT?

A

MONOPHASIC? fixed amount of an oestrogen+progestogen in each active tablet
MULTIPHASIC? varying amounts of 2 hormones

OESTROGEN COMPONENT? ethinylestradiol/mestranol/estradiol

44
Q

WHEN DO YOU AVOID CHCs?

A

Hypertension
>/35 year olds, smoking
Migraine w/ aura
New onset migraine w/o aura during use of CHC

Multiple risk factors for CVD:
Smoking
Hypertension
High BMI (>/= 30kg/m^2)
Dyslipidaemias
Diabetes
45
Q

COMBINED HORMONAL CONTRACEPTIVES

DO NOT GIVE IN?

BENEFITS?

A

DO NOT GIVE IN? 50+ years, there are safer alternatives

BENEFITS?
Reduces risk of ovarian/endometrial/colorectal cancer
Aligns bleeding patterns
Reduces dysmenorrhoea/menorrhagia
Manages symptoms of: polycystic ovaries/endometriosis/premenstrual syndrome
Improves acne
Reduces menopausal symptoms
Maintains bone density in peri-menopausal females under 50

46
Q

PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES

INJECTIONS?

IMPLANTS?

A

INJECTIONS? 99.8% effective in correct usage
Depot medroxyprogesterone- /13 weeks
*Loss of bone density
*Delayed return to fertility of up to 1 year after treatment cessation

IMPLANTS? 99.9% effective in correct usage
Etonogesterel (Nexplanon)
*Lasts up to 3 years
MHRA warning: Neurovascular injury+migration of implant- remove ASAP

47
Q

PROGESTOGEN-ONLY CONTRACEPTIVES

MISSED DOSES
DESOGESTREL?
OTHER POPs?

A

MISSED DOSES
DESOGESTREL? Take within 12hrs of missed pill
OTHER POPs? TakE within 3hrs of missed pill

48
Q

PROGESTOGEN-ONLY CONTRACEPTIVES

EXAMPLES?
WHEN TO TAKE IT?
ADDITIONAL PRECAUTIONS?

A

EXAMPLES? Levonorgestrel/Norethisterone/Desogestrel

WHEN TO TAKE IT? Take everyday, no pill-free period

ADDITIONAL PRECAUTIONS? Not needed if started in FIRST 5 DAYS OF CYCLE
2 days precaution needed if taken after that (takes 2 days to work, duh)

49
Q

NON-HORMONAL CONTRACEPTION?

A

BARRIER- condoms/diaphragms/cervical caps
Avoid vaseline/baby oil, can damage, peak

SPERIMICIDE- used in ADDITION only (not alone)

INTRA-UTERINE DEVICE- copper coil
Contraindicated in pelvic inflammatory disease/unexplained vaginal bleeding

50
Q

NOTE: HYPOTENSION IS associated with a-blockers (tamsulosin/doxazosin) NOT 5a-reductase inhibitors (finasteride/dutasteride)

51
Q

5A-REDUCTASE INHIBITOR

EXAMPLES?
SIDE-EFFECTS?
WOMEN CHILD-BEARING AGE?
MHRA WARNING?

A

EXAMPLES? finasteride/dutasteride

SIDE-EFFECTS?
breast disorder
sexual dysfunction
male breast cancer? report lumps/pain/nipple discharge
semen excretion- use condoms

WOMEN CHILD-BEARING AGE? Avoid handling crushed/broken tablets

MHRA WARNING? Depression/suicidal thoughts. STOP ASAP!

52
Q

ALPHA BLOCKERS

EXAMPLES?
AVOID IN?
SIDE-EFFECTS?

A

EXAMPLES? alfuzosin/doxazosin/tamsulosin/terazosin

AVOID IN? micturition syncope/postural hypotension

SIDE-EFFECTS?
dizziness
postural hypotension
*take 1st dose before bed (risk of fall due to hypotensive effect)
   dizzy/fatigue/sweating- lie down
53
Q

URINARY RETENTION- DRUG TREATMENT

BENIGN PROSTATIC HYPERPLASIA
1st-line?
Enlarged prostate/Raise prostate antigens/High risk of progression?

A

BENIGN PROSTATIC HYPERPLASIA
1st-line?
Alpha-blocker (relaxes smooth muscle)

Enlarged prostate/Raise prostate antigens/High risk of progression?
5a-reductase inhibitor (finasteride/dutasteride)

54
Q

URINARY RETENTION- DRUG TREATMENT

CHRONIC?

A

Long-term catheter,
risk of UTIs? 7 days ABx
other Ls- urethra trauma/pain/stone formation

55
Q

URINARY RETENTION- DRUG TREATMENT

ACUTE?

A

Immediate catheterisation due to pain
Give alpha-blocker for 2+days before removing catheter (to manage the retention)
Alpha-blocker examples- alfuzosin/doxazosin/tamsulosin/terazosin

56
Q

BENIGN PROSTATIC HYPERPLASIA (chronic- urinary retention)

Features?
Symptoms?

A

Features? Men- enlarged prostate

Symptoms? Urinary retention/urgency/frequency/nocturia

57
Q

2 TYPES OF URINARY RETENTION?

A

Acute- medical emergency, abrupt development, can’t pass urine couple hours
Chronic- gradual over months- can’t empty bladder completely

58
Q

URINARY RETENTION

What is it? Caused by?

A

Inability to voluntarily urinate caused by:
Urethral blockage
Meds- antimuscarinic drugs/sympathomimetics/antidepressants

59
Q

DESMOPRESSIN

FEATURES?

SIDE-EFFECTS?

A

FEATURES?
More potent+longer duration of action than vasopressin
No vascoconstrictor effect

SIDE-EFFECTS?
Hyponatraemia
Nausea

60
Q

NOCTURNAL ENURESIS- DRUG TREATMENT
Children>5 years

DESMOPRESSIN?

SPECIALIST?

Still an L?

A

DESMOPRESSIN?
Alarm undesirable
Need rapid results (to cover holidays)
Assess treatment after 4 weeks+continue for 4 months if patient’s responding
Withdraw repeated courses gradually at regular intervals

SPECIALIST?
Desmopressin with/without Antimuscarinic (oxybutynin/tolterodine)

Still an L? Imipramine

61
Q

NOCTURNAL ENURESIS

Alarm an L?

A

Add in/replace w/ Desmopressin

62
Q

NOCTURNAL ENURESIS- NON-DRUG TREATMENT

NO RESPONSE TO ADVICE? (>1-2 wet beds/week)

A

NO RESPONSE TO ADVICE? (>1-2 wet beds/week)
Alarm <7yrs- consider maturity? motivation? understanding?
Alarms have a lower relapse rate than drug treatment when discontinued
Review alarm after 4 weeks
Continue until a minimum of 2 weeks of uninterrupted dry nights

63
Q

NOCTURNAL ENURESIS- NON-DRUG TREATMENT
<5? Resolves it self

ADVICE ON?

A

ADVICE ON? Fluid intake/diet/toileting behaviour/reward systems? Nuts

64
Q

NOCTURNAL ENURESIS

What is it?

A

Involuntary urination during sleep, common in children peak

65
Q

ANTIMUSCARINICS

EXAMPLES?
SIDE-EFFECTS?
COTRAINDICATEDIN IN?
Can affect performance of..?

A

EXAMPLES? Fesoterodine/Solifenacin/Trospium/Oxybutynin/Tolterodine

SIDE-EFFECTS? elderly its peak
constipation/dry mouth/flushing/dizziness/drowsiness/tachycardia

COTRAINDICATEDIN IN? Angle-closure glaucoma
G-I obstruction

Can affect performance of..? skilled tasks

66
Q

URINARY INCONTINENCE- TREATMENT

MIXED?

A

MIXED?
Bladder training 6 weeks AND Pelvir floor muscle training 3 months
Treat pharmacologically in accordance to the predominant type

67
Q

URINARY INCONTINENCE- TREATMENT

STRESS?

A

STRESS?
Pelvic floor muscle training 3 months
Surgery
Duloxetine

68
Q

URINARY INCONTINENCE- TREATMENT

URGENCY
1st LINE?
2nd LINE?
3rd LINE?

A

URGENCY
1st LINE? Bladder training 6 weeks
2nd LINE? Antimuscarinic (oxybutynin/tolterodine)
3rd LINE? Mirabegron

69
Q

URINARY INCONTINENCE- TREATMENT

NON-DRUG?

A 
Modify fluid intake
Weight loss (obese)
Reduce caffeine
70
Q

URINARY INCONTINENCE- RISK FACTORS? COOPS

A 
COOPS
Constipation
Old age
Obesity
Pregnancy
Smoking
Family history
Medicines (diuretics/alcohol/caffeine- can increase urine production+exacerbate incontinence)
71
Q

3 TYPES OF URINARY INCONTINENCE

Urgency?
Stress?
Mixed?

A

Urgency? sudden immediate need to pass urine
Stress? effort/exert/sneez/cough-> leak peak
Mixed? both above

72
Q

URINARY INCONTINENCE

What is it?

A

Involuntary leakage of urine

73
Q

Which one of the drugs below can be used for the treatment of nocturnal enuresis in
children?

A

IMipramine

children

desmopressin
oxybutynin
imipramine

74
Q

duloxetine?

A

adults only

75
Q

Miss G 42 years old, has presented a prescription for Fluoxetine 20mg capsules – One to be
taken daily. After checking Miss G’s PMR you notice that she currently takes a medicine
which interacts with the Fluoxetine and decide to ring the prescriber to flag this to them.
Which of the medicines below is most likely to prompt you to ring the prescriber due
to an interaction with the Fluoxetine?

A

tamoxifen

wow

76
Q

LITHIUM COUNSELLING?

81
Q

5A REDUCTASE?

A

FINASTERIDE

82
Q

PHOSPHODIESTERASE?

A

SILDENAFIL

TADALAFIL

83
Q

CHC MIGRAINE?

A

STOP ASAP!!!

84
Q

OCTYL METHOXY?

A

doesn’t protect against amiodarone, ok then

85
Q
  1. A 48-year-old female and has been experiencing menopausal symptoms and would like to trial hormone replacement therapy (HRT). Her medical record shows a previous hysterectomy. After assessing the patient’s family history and physiological health parameters, the patient satisfies the criteria for HRT.
    Which of the following would be the most appropriate choice of HRT for this patient?

A Desomono 75microgram tablets (Desogestrel 75 microgram)
B Estraderm MX 25 patches (Estradiol 25 microgram per 24 hour)
C Evorel Conti patches (Estradiol 50 microgram & Norethisterone 170 microgram per 24 hour)
D FemSeven Sequi (Estradiol 50 microgram& Levonorgestrel 7 microgram per 24 hour)
E Femoston-conti 0.5mg/2.5mg tablets (Dydrogesterone 2.5 mg & Estradiol 500 microgram)

A

B (Estraderm MX 25 patches)

An oestrogen alone is suitable for continuous use in women without a uterus.

  • Women with a uterus should use a HRT with small doses of an oestrogen together with a progestogen (endometrial cancer is reduced by a progestogen)
  • Options C, D and E contain a progesterone.
  • Desogestrel (alone) is progesterone indicated for contraception.
86
Q
A 
A- Desosest rel 712W
missed pile tall
ASAP useprotection
forfurther 2days
In this case only
4hourspassed
noneedfor Erk
87
Q

COC up to day 5?

A

no protection needed

GPhC BNF (48 decks)

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