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GPhC BNF COPY ~ I 2025 > 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
MISSED DOSES- PATCHES&VAGINAL RINGS, WAY TOO MUCH INFO, CBA, TY BYE
26
CHC- MISSED DOSES 2+ MISSED PILLS Week 1? Week 2-3? 2+ missed pills in 7 days before HFI?
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)
27
CHC- MISSED DOSES | 1 MISSED PILL (48-72hrs since last active pill)?
1 MISSED PILL (48-72hrs since last active pill)? | Take ASAP-> no further action needed (assuming consistent use in previous 7 active pills)?
28
CHC- MISSED DOSES LATE START AFTER HFI (>9 days since last active pill)? What does this mean bruhhh
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
29
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?
'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!
30
PROGESTOGEN-ONLY- MISSED DOSES vomit/diarrhoea-> take pill within?
2hrs
31
CHC- SIDE-EFFECTS? A LOT OF CHANGES
``` Headache Unscheduled bleeding (breakthrough bleeding) Mood change Weight gain Libido change ```
32
CHC & SURGERY WHAT IF YOU CAN'T STOP THE CHC/TRAUMA??
THROMBOPROPHYLAXIS MAYBE!
33
CHC & SURGERY WHEN DO YOU RECOMMENCE CHC AFTER FULL REMOBILISATION?
AFTER 2 WEEKS
34
CHC & SURGERY DISCONTINUE AT LEAST 4 WEEKS PRIOR FOR..?
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)
35
OTHER REASONS TO STOP TAKING CHC?
``` 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
URGENT REASONS TO STOP TAKING CHC? big boys
``` 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
SWTICHING FROM A CHC TO OTHERS WEEK 2/3?
No extra precaution needed
38
SWTICHING FROM A CHC TO OTHERS WEEK 1? (or day 3-7 of HFI)+ UPSI since start of HFI Carry on with CHC until..?
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
What is the HFI period?
7 days free after Week 3 G
40
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?
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
SWITCHING TO A COMBINED HORMONAL CONTRACEPTIVES- RULES FROM CHC? FROM POP? FROM LEVONORGESTREL-IUD? FROM COPPER-IUD? OTHER?
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
Females on 21-day regimen have a monthly withdrawal bleed during...? Withdrawal bleeds do not represent..? 28 pack size?
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
CHC- PREPARATIONS MONOPHASIC? MULTIPHASIC? OESTROGEN COMPONENT?
MONOPHASIC? fixed amount of an oestrogen+progestogen in each active tablet MULTIPHASIC? varying amounts of 2 hormones OESTROGEN COMPONENT? ethinylestradiol/mestranol/estradiol
44
WHEN DO YOU AVOID CHCs?
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
COMBINED HORMONAL CONTRACEPTIVES DO NOT GIVE IN? BENEFITS?
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
PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES INJECTIONS? IMPLANTS?
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
PROGESTOGEN-ONLY CONTRACEPTIVES MISSED DOSES DESOGESTREL? OTHER POPs?
MISSED DOSES DESOGESTREL? Take within 12hrs of missed pill OTHER POPs? TakE within 3hrs of missed pill
48
PROGESTOGEN-ONLY CONTRACEPTIVES EXAMPLES? WHEN TO TAKE IT? ADDITIONAL PRECAUTIONS?
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
NON-HORMONAL CONTRACEPTION?
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
NOTE: HYPOTENSION IS associated with a-blockers (tamsulosin/doxazosin) NOT 5a-reductase inhibitors (finasteride/dutasteride)
51
5A-REDUCTASE INHIBITOR EXAMPLES? SIDE-EFFECTS? WOMEN CHILD-BEARING AGE? MHRA WARNING?
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
ALPHA BLOCKERS EXAMPLES? AVOID IN? SIDE-EFFECTS?
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
URINARY RETENTION- DRUG TREATMENT BENIGN PROSTATIC HYPERPLASIA 1st-line? Enlarged prostate/Raise prostate antigens/High risk of progression?
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
URINARY RETENTION- DRUG TREATMENT CHRONIC?
Long-term catheter, risk of UTIs? 7 days ABx other Ls- urethra trauma/pain/stone formation
55
URINARY RETENTION- DRUG TREATMENT ACUTE?
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
BENIGN PROSTATIC HYPERPLASIA (chronic- urinary retention) Features? Symptoms?
Features? Men- enlarged prostate | Symptoms? Urinary retention/urgency/frequency/nocturia
57
2 TYPES OF URINARY RETENTION?
Acute- medical emergency, abrupt development, can't pass urine couple hours Chronic- gradual over months- can't empty bladder completely
58
URINARY RETENTION What is it? Caused by?
Inability to voluntarily urinate caused by: Urethral blockage Meds- antimuscarinic drugs/sympathomimetics/antidepressants
59
DESMOPRESSIN FEATURES? SIDE-EFFECTS?
FEATURES? More potent+longer duration of action than vasopressin No vascoconstrictor effect SIDE-EFFECTS? Hyponatraemia Nausea
60
NOCTURNAL ENURESIS- DRUG TREATMENT Children>5 years DESMOPRESSIN? SPECIALIST? Still an L?
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
NOCTURNAL ENURESIS Alarm an L?
Add in/replace w/ Desmopressin
62
NOCTURNAL ENURESIS- NON-DRUG TREATMENT NO RESPONSE TO ADVICE? (>1-2 wet beds/week)
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
NOCTURNAL ENURESIS- NON-DRUG TREATMENT <5? Resolves it self ADVICE ON?
ADVICE ON? Fluid intake/diet/toileting behaviour/reward systems? Nuts
64
NOCTURNAL ENURESIS What is it?
Involuntary urination during sleep, common in children peak
65
ANTIMUSCARINICS EXAMPLES? SIDE-EFFECTS? COTRAINDICATEDIN IN? Can affect performance of..?
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
URINARY INCONTINENCE- TREATMENT MIXED?
MIXED? Bladder training 6 weeks AND Pelvir floor muscle training 3 months Treat pharmacologically in accordance to the predominant type
67
URINARY INCONTINENCE- TREATMENT STRESS?
STRESS? Pelvic floor muscle training 3 months Surgery Duloxetine
68
URINARY INCONTINENCE- TREATMENT URGENCY 1st LINE? 2nd LINE? 3rd LINE?
URGENCY 1st LINE? Bladder training 6 weeks 2nd LINE? Antimuscarinic (oxybutynin/tolterodine) 3rd LINE? Mirabegron
69
URINARY INCONTINENCE- TREATMENT NON-DRUG?
``` Modify fluid intake Weight loss (obese) Reduce caffeine ```
70
URINARY INCONTINENCE- RISK FACTORS? COOPS
``` COOPS Constipation Old age Obesity Pregnancy Smoking Family history Medicines (diuretics/alcohol/caffeine- can increase urine production+exacerbate incontinence) ```
71
3 TYPES OF URINARY INCONTINENCE Urgency? Stress? Mixed?
Urgency? sudden immediate need to pass urine Stress? effort/exert/sneez/cough-> leak peak Mixed? both above
72
URINARY INCONTINENCE What is it?
Involuntary leakage of urine
73
Which one of the drugs below can be used for the treatment of nocturnal enuresis in children?
IMipramine children desmopressin oxybutynin imipramine
74
duloxetine?
adults only
75
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?
tamoxifen | wow
76
LITHIUM COUNSELLING?
77
78
79
80
81
5A REDUCTASE?
FINASTERIDE
82
PHOSPHODIESTERASE?
SILDENAFIL | TADALAFIL
83
CHC MIGRAINE?
STOP ASAP!!!
84
OCTYL METHOXY?
doesn't protect against amiodarone, ok then
85
74. 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)
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
``` A- Desosest rel 712W missed pile tall ASAP useprotection forfurther 2days In this case only 4hourspassed noneedfor Erk ```
87
COC up to day 5?
no protection needed

GPhC BNF COPY ~ I 2025 (48 decks)

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