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Pradeepa's notes > Genito-Urinary Tract System > Flashcards

Genito-Urinary Tract System Flashcards

1
Q

urinary incontinence

A

involuntary leakage of urine - sudden, difficult to delay

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2
Q

stress incontinence

A

leakage on effort/excretion or on sneezing/cough

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3
Q

mixed incontinence

A

urgency + stress however one type predominant

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4
Q

risk factors for urinary incontinence

A

-old age
-pregnancy
-vaginal delivery
-obesity
-smoking
-constipation
-family history
-medicines (diuretics)
-caffeine inc urine production and can exacerbate incontinence

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5
Q

tx of urinary incontinence (urgency)

A

-non-drug modify fluid intake, weight loss, less caffeine
-drug tx
->1) bladder training 6WK at least
->2) antimuscarinic (oxybutynin or tolterodine)
->3) mirabegron

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6
Q

tx of urinary incontinence (stress)

A

-pelvic floor muscle training 3MT
-surgery or duloxetine

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7
Q

tx of urinary incontinence (mixed)

A

-bladder training >6wk + pelvic floor muscle training >3MT
-tx depends on dominating type

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8
Q

antimuscarinics examples

A

-fesoterodine, solifenacin, trospium, oxybutynin, tolterodine

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9
Q

nocturnal enuresis

A

involuntary urination during sleep = common children

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10
Q

non-drug tx of nocturnal enuresis

A

-children <5yr = no intervention needed
-advice on fluid intake, diet, toileting behaviour, use of reward systems
-no response to advice (>1-2 wet beds per week) - enuresis alarm
-> alarms in <7yr given depending on maturity, motivation, understanding
->alarms have less relapse than drug tx when discontinued
->review alarms after 4wk
->continue a min of 2wk of uninterrupted dry nights
-if alarm tx = x successful add/replace with desmopressin

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11
Q

nocturnal enuresis drug tx

A

-5yr+ = desmopressin
->if alarm = undesirable
->when needing rapid results (holiday)
->assess tx after 4wk continue for 3MT if pt = responding
->repeated courses should be withdrawn gradually at regular intervals
-specialist - desmopressin + antimuscarinic (oxybutynin/tolterodine)
-x responding to other tx; imipramine

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12
Q

desmopressin + s/e

A

-more potent + longer duration of action than vasopressin
-no vasoconstrictor effect
-s/e; hyponatraemia + nausea

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13
Q

urinary retention

A

inability to voluntarily urinate

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14
Q

urinary retention causes

A

-urethral blockage
-medications; antimuscarinic drugs, sympathomimetics, TCA

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15
Q

acute urinary retention

A

-unable to urinate even though they have a full bladder
-medical emergency abrupt development over period of hours

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16
Q

chronic urinary retention

A

gradual over months inability to completely empty bladder

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17
Q

benign prostatic hyperplasia urinary retention

A

-most common in men with enlarged prostate
-symp; urinary retention, urgency, frequency, nocturia

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18
Q

acute urinary retention tx

A

-immediate catherisation due to pain
-provide alpha blocker for 2x days before removing catheter

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19
Q

chronic urinary retention tx

A

-catheter used long-term
->may cause recurrent UTI, urethra trauma, pain, stone formation

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20
Q

benign prostatic hyperplasia urinary retention tx

A

-alpha blockers relaxes smooth muscle
-pt = enlarged prostate, raised prostate antigens, high risk of progression so 5a-reductase inhibitors (finasteride/dulasteride)

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21
Q

alpha blockers used in urinary retention

A

-defuzosin, doxazosin, tamsulosin, terazosin
-advice pt if history of mictuntion syncope + postural hypotension

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22
Q

alpha blockers s/e

A

-dizziness
-postural hypotension
-1st dose can cause collapse due to hypotensive effect so taken before bed and lie down if dizzy, fatigue, sweating develops

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23
Q

5a reductase inhibitor s/e + cautions

A

-breast disorder
-sexual dsyfunction
-male breast cancer reported; lumps, pain/nipple discharge
-excreted in semen = condom if pregn partner
-women = child-bearing age avoid crushed broken tabs
-finasteride; reports of depression + rare cases of suicidal thoughts stop immediately + report

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24
Q

non-hormonal contraception - barrier method

A

-condoms, diaphragms, cervical caps
->petroleum jelly, baby oil + oil based prep can damage condoms, contraceptive diaphragms; cap = latex rubber

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25
Q

non-hormonal contraception - spermicidal contraceptives

A

used alongside barrier methods

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26
Q

non-hormonal contraception - IUD

A

-intra-uterine device = copper coil
-CI in pelvic inflammatory disease or unexplained vaginal bleeding

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27
Q

progesterone only contraceptives

A

-levonorgestrel, norethisterone,
desogestrel
-no pill free week = OD
- no additional precaution needed if started in 1st 5DY of cycle - needs 2DY precaution if taken after that
-taken at same time each day for max efficacy
->desogestrel needs to be taken within 12HR otherwise missed dose
->other POP need to ben taken with 3HR otherwise - missed dose

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28
Q

parental progesterone only

A

-injections = 99.8% effective in correct usage
-depot medroxyprogestrone acetate - every 12WK
->loss of bone density can occur
->delayed return to fertility of upto 1yr after tx cessation
-implants = 99.95% effective in correct usage
->etongesterel (nexplanon)
->lasts up to 3yr
->MHRA ; neurovascular injury/migration of implant remove ASAP

29
Q

Combined hormonal contraceptives

A

-tablets, patches, vaginal rings
-not given 50yr+
-benefits;
->less risk of ovarian, endometrial + colorectal cancer
->aligns bleeding pattern
->less dysmenorrhea + menorrhagia
->manages symptoms of polystic ovaries, endometriosis, premenstrual syndrome
->improves acne
->less menopause symptoms
->maintains bone density in peri-menopausal (<50)

30
Q

when to avoid CHC

A

–35yr = smokes
-hypertension
-multiple risk factors for cardiovascular; smoking, hypertension, BMI > or = 30, dyslipidemia, diabetes,
-migraine with aura
-new onset migraine w/o aura use pf CHC

31
Q

Monophasic preparations

A

fixed amount of oestrogen + progesterone in each active tablet

32
Q

multiphasic preparations

A

varying amount of each hormone

33
Q

oestrogen

A

ethinylestradiol, mestrariol, estradiol

34
Q

withdrawal bleeding

A

-women on 21DY regimen have a monthly withdrawal bleed during the 7DY hormone free interval
-withdrawal bleeds x represent physiological
-some packs = 28 per month supply = 21 active pills + 7 dummy to inc coherence)

35
Q

switching to CHC from CHC

A

no additional contraception needed

36
Q

switching to CHC from POP, LNG-IUD

A

7 day extra precaution needed

37
Q

switching to CHC from copper IUD + other non-hormonal methods

A

-if CHC started up to day 5 of menstrual cycle no additional contraception needed
-if started after day 5 * 7DY extra precaution needed

38
Q

switching to CHC from others week 1 (day 3-7 of hormone free interval) + no UPSI since start of HFI

A

-CU-IUD = no extra precaution
-POP = 2DY precaution
-others = 7DY precaution

39
Q

switching to CHC from others week 1 (day 3-7 of hormone free interval) + UPSI since start of HFI

A

-carry on with CHC intil -7 consecutive days
-then act as week 2/3

40
Q

switching to CHC from others week 2/3

A

no extra pre-caution required

41
Q

reasons to stop CHC

A

-urgent medical review
->calf pain, swelling +/ redness (DVT)
->chest pain +/ breathlessness +/ coughing up blood (PE)
->loss of motor/sensory function (stroke)
->severe stomach pain (hepatotoxicity)
-> v.high BP (haemorrhagic stroke)

other reasons
-signs of breast cancer/lumps nipple pain
-50+
-new onset of migraine
-persistent unscheduled vag bleed
-high BP
-high BMI >OR= 35
-DVT/PE
-blood clotting abnormal
-angina, heart attack, stroke or peripheral vascular disease
-AF
-cardiomyopathy

42
Q

CHC + surgery

A

-discontinued for 4WK prior
->major elective surgery + surgeries to legs/pelvis
->surgery involving prolonged immobilisation to lower limb
-use alternative methods of contraception
-CHC recommends 2wk after full remobilisations
-if discontinued x possible trauma/pt still on CHC
-> consider thromboprophylaxis

43
Q

s/e of hormonal contraceptives

A

headaches
unscheduled bleeding
mood change
weight gain
libido (sex drive) change

44
Q

missed doses POP

A

-if pt vomits/omits/diarrhoea with 3HR of taking POP take another pill asap
-consider missed dose if >12hr for desogestrel or >3hr for rest
-take as soon as remembering
-take next pill = usual time (2x a day if needed)
-needs protection till 48hr of pills taken correctly (7DY for desogestrel)
-need emergency contraception if UPSI happened between missed dose + 2DY after restarting meds

45
Q

missed doses CHC

A

-if pt vomits/omits/diarrhoea with 3HR of taking CHC take another pill asap
-late start after HFI (>9dy since last active pill)
-emergency contraception if UPSI
-take immediately + use condoms till 7 consecutive days

46
Q

1 missed pill (48-72hr since last active pill)

A

-take asap no further action needed - providing consistent use in previous 7DY pills

47
Q

2+ missed pills (72hr+ since last active pill)

A

-WK1 cycle consider emergency contraception if UPSI happened within HFI + WK1 take asap + use condom for 7DY
-WK2/3 no emergency contraception needed take asap - 7DY condom
-2+ pills missed in 7DY before HFI carry on taking pill throughout HFI

48
Q

emergency contraception

A

-copper IUD
-ulipristal 30mg
-levonorgestel 1.5mg

taken ASAP

49
Q

copper IUD of emergency contraception

A

-1st line = most effective form of emergency contraception
-can be inserted up to 120HR (5DY) after 1st UPSI
-can be inserted up to 5DY after earliest estimated date of ovulation

50
Q

hormonal methods of emergency contraception

A

-levonorgestrel - 72hr (3DY)
-ulipristal -120hr (5DY)
-2nd doses if vomited or diarrhoea in 3hr
-ulipristal more effective than levonorgestrel for emergency contraception
-unlike the CU-IUD, BMI lower effectiveness (esp levon)
->BMI >26/ weight >70kg = ulipristal or double dose of levon
-ulpirstal + levon can be used = oral emergency contraception - more than once in same cycle (levo higher risk of s/e)

51
Q

when to reinitiate levonorgestrel

A

-start regular hormonal contraception immediately
-use condoms until effective

52
Q

when to reinitiate ulipristal

A

-wait 5DY after taking ulipristal before starting regular hormones again
->use condoms during 5DY + till tx effective
-if during wk1 - regular CHC
->CHC can be initiated immediately after
->ondom 7DY

53
Q

levonorgestrel 1.5mg s/e + CI

A

-breast feeding no delay
-caution in pt: malabsorption
-can cause breast tenderness, DVT, fatigue + haemorrhage
-avoid in severe liver impairment
-CYP inducer interaction

54
Q

Ulipristal 30mg s/e + CI

A
  • 1 week delay
    -severe asthmatic controlled - glucocorticoids
    -cycle irregularities, D+V, altered mood, dizziness
    -CYP inducer interaction
55
Q

CU-IUD s/e + CI

A

-MHRA = risk of uterine preforation
->severe pelvic pain after insertion, sudden change = period, pain during intercourse, unable to feel threads = check up
-replace every 5-10yr
-remove 1st trimester = pregn
-same for levonorgestrel IUD = less pain/bleeding S/E
-replace 3-10yr

56
Q

erectile dysfunction

A

persistent inability to attain and maintain erection physical or psychological causes + s/e of drugs

57
Q

erectile dysfunction 1st line tx

A

phosphodiesterase type 5 inhibitors
-inc blood flow to penis + still requires sexual stimulation

58
Q

erectile dysfunction 2nd line tx

A

intracavenosal, interauretival, topical alprotadil under medical supervision

59
Q

erectile dysfunction max number of doses before classsed as non-responder

A

6 doses at max doses with sexual stimulation

60
Q

phosphodiesterase type 5 inhibitors for erectile dysfunction s/e

A

flushing, dizzy, nasal congestion, migraine

61
Q

phosphodiesterase type 5 inhibitors for erectile dysfunction CI

A

-nitrates/hypotension, unstable angina/stroke during intercourse. x have sexual activity

62
Q

phosphodiesterase type 5 inhibitors for erectile dysfunction interactions

A

nitrates
alpha blockers

63
Q

phosphodiesterase type 5 inhibitors for erectile dysfunction short acting

A

avanafil, sildenafil + vardenafil = occasional PRN

64
Q

phosphodiesterase type 5 inhibitors for erectile dysfunction long acting example

A

tadalafil - PRN/regular lower daily dose to allow for spontaneous activity

65
Q

priapsm

A

-Introduction. Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation.
-last longer than 4HR = medical attention

65
Q

alpratadil

A

condom if partner = child bearing age, pregn, lactating

66
Q

antimuscarinics adverse effects in elderly

A

constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia

67
Q

antimuscarinics CI

A
  • single-closure glaucoma, GI obstruction
    -affects skilled performed tasks

Pradeepa's notes (12 decks)

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