Genito- urinary tract system Flashcards
How is detrusor instabiliity, a type of incontinence managed?
by combining drug therapy with pelvic floor exercises and bladder training
How is stress incontinence managed?
generally managed by non-drug methods
Name some antimuscarinic drugs used to manage urinary frequency and incontinence (4)
oxybutynin
tolterodine
solifenacin
trospium
What is the mechanism of action of mirabegron in managing urinary frequency and incontinence?
Mirabegron has a relaxant effect on urinary smooth muscle
via selective beta3 receptor stimulation.
What are the common side effects associated with antimuscarinic drugs? (8)
- constipation
- dry mouth
- sweating
- dilation of pupils
- dry skin
- photophobia
- skin flushing
- can affect the performance of skilled tasks like driving
How is acute urinary retention treated?
by catheterization
What condition often causes chronic urinary retention in men, and how is it treated?
often caused by benign prostatic hyperplasia
and is treated either surgically or
medically with alpha-blockers
(Alternatives to alpha-blockers include dutasteride and finasteride)
What are examples of alpha-blockers used in the treatment of benign prostatic hyperplasia? (3)
alfuzosin
terazosin
prazosin
What is the potential risk associated with the first dose of alpha-blockers?
The first dose may cause collapse due to a hypotensive effect.
Therefore, it should be taken just before goind to bed
Patients should be warned to lie down if symptoms such as dizziness, fatigue, or sweating develop.
What precautions should be taken regarding conception and contraception while using dutasteride and finasteride?
Both dutasteride and finasteride are excreted in semen
and so the use of a condom is recommended if the sexual partner is pregnant or likely to become pregnant.
What caution should women of childbearing potential take regarding handling crushed or broken tablets of finasteride and leaking capsules of dutasteride?
Women of childbearing potential
should avoid handling crushed or broken tablets of finasteride
and leaking capsules of dutasteride.
What potential side effect of dutasteride and finasteride should be promptly reported to the doctor?
Changes to breast tissue such as:
* lumps
* pain
* nipple discharge
What are the advantages of combined hormonal contraceptives?
reliability and reversibility
reduced dysmenorrhea and menorrhagia
decreased incidence of premenstrual tension
risk reduction of symptomatic fibroids, functional ovarian cysts, benign breast disease, ovarian and endometrial cancer
lower risk of pelvic inflammatory disease.
How is the choice of combined hormonal contraceptive determined?
selecting a preparation with the lowest estrogen and progestogen content
that provides good cycle control
and minimal side effects.
Is it recommended to continue combined hormonal contraceptives beyond the age of 50?
No
more suitable alternatives exist at that age
What types of combined hormonal contraceptive preparations are suitable for women with risk factors for circulatory disease?
Low-strength preparations
What is a risk of standard- strength preparations of hormonal contraceptives?
deep vein thrombosis (DVT)
Which progestogens may be considered for women experiencing side effects with other progestogens?
**Desogestrel, drospirenone, and gestodene (in combination with ethinylestradiol)
**
may be considered for women experiencing side effects such as acne, headache, depression, breast symptoms, and breakthrough bleeding with other progestogens.
What symptoms or conditions warrant the immediate cessation of combined hormonal contraceptives or hormone replacement therapy (HRT)?
- sudden severe chest pain
- sudden breathlessness
- cough with blood
- unexplained swelling or severe pain in one leg
- severe stomach pain
- serious neurological effects
- hepatitis
- jaundice
- liver enlargement
- blood pressure above systolic 160 mmHg or diastolic 95 mmHg
- prolonged immobility after surgery or leg injury
- or detection of a risk factor that contraindicates treatment.
What neurological symptoms should prompt the immediate discontinuation of combined hormonal contraceptives or HRT?
- severe, prolonged headache
- sudden partial or complete loss of vision
- sudden disturbance of hearing
- bad fainting attack
- unexplained epileptic seizure or weakness
- motor disturbances
- very marked numbness suddenly affecting one side or one part of the body
What precaution should be taken for individuals traveling for long periods while using combined hormonal contraceptives?
Increased risk of deep-vein thrombosis during travel involving long periods of immobility (over 3 hours)
may be reduced by appropriate exercise and possibly by wearing graduated compression hosiery
What factors should be considered when assessing the risk of venous thromboembolism with combined hormonal contraceptives?
- family history of venous thromboembolism in a first-degree relative aged under 45 years
- obesity (avoid if BMI ≥ 35 kg)
- long-term immobilization (avoid if bed-bound)
- history of superficial thrombophlebitis
- age over 35 years (avoid if over 50 years)
- smoking
They should be used with caution if any of the mentioned factors are present, but they should be avoided if two or more factors are present.
What factors should be considered when assessing the risk of arterial disease with combined hormonal contraceptives?
- a family history of arterial disease in a first-degree relative aged under 45 years
- diabetes mellitus (avoid if diabetes complications present)
- hypertension (avoid if blood pressure above systolic 160 mmHg or diastolic 95 mmHg)
- smoking (avoid if smoking 40 or more cigarettes daily)
- age over 35 years (avoid if over 50 years)
- obesity (avoid if BMI ≥ 35 kg),
- migraine without aura (avoid if migraine with aura).
What is the association between combined hormonal contraceptives and breast cancer?
There is a small increase in the risk of benign breast cancer in women taking the combined pill.
However, the risk diminishes after stopping
and disappears by about 10 years.
How does long-term use of combined hormonal contraceptives relate to cervical cancer risk?
Use for 5 years or longer is associated with a small increased risk of cervical cancer
however, the risk diminishes after stopping
and disappears by about 10 years.
. When is a pill considered missed, and what should be done if only one pill is missed?
A missed pill is one that is 24 or more hours late.
If only one pill is missed, the woman should take an active pill as soon as she remembers and then resume normal pill-taking, even if this means taking 2 pills together.
No additional precautions are necessary.
What should be done if two or more pills are missed, especially from the first 7 in a packet?
If two or more pills are missed, especially from the first 7 in a packet, the woman may not be protected.
She should take an active pill as soon as she remembers and then resume normal pill-taking.
Additionally, she must either abstain from sex or use an additional method of contraception such as a condom for the next 7 days.
If these 7 days run beyond the end of the packet, the next packet should be started at once, omitting the pill-free interval.
What is recommended if 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred?
Emergency contraception is recommended in this scenario.
What action should be taken if vomiting occurs within 2 hours of taking a combined oral contraceptive pill?
Another pill should be taken as soon as possible.
When should additional contraception be used if vomiting or severe diarrhea persists?
If vomiting or severe diarrhea lasts for more than 24 hours, additional contraception should be used during and for 7 days after recovery.
What should be done if vomiting and diarrhea occur during the last 7 tablets of the pill pack?
: If vomiting and diarrhea occur during the last 7 tablets, the next pill-free interval should be omitted.
When are progestogen-only contraceptives considered suitable alternatives to combined hormonal contraceptives?
when estrogens are contraindicated, such as in individuals with:
- venous thrombosis or a past history of it
- heavy smokers
- hypertension above systolic 160 mmHg or diastolic 95 mmHg
- valvular heart disease
- diabetes mellitus with complications
- migraine with aura
What are the two types of hormonal emergency contraceptives mentioned?
levonorgestrel and ulipristal
Within what time frame is levonorgestrel effective if taken after unprotected intercourse?
if taken within 72 hours (3 days) of unprotected intercourse.
Within what time frame is ulipristal effective if taken after unprotected intercourse?
within 120 hours (5 days) of unprotected intercourse.
Within how many hours after unprotected sex can an intra-uterine device (IUD) be inserted?
It can be inserted up to 120 hours (5 days) after unprotected sex.
What should be done if intercourse has occurred more than 5 days previously? Can an intra-uterine device (IUD) still be inserted?
If intercourse has occurred more than 5 days previously, the device can still be inserted up to 5 days after the earliest likely calculated ovulation.
What factors increase the risk of infection after IUD insertion?
- women under 25 years old
- over 25 years old with a new partner
- have had more than one partner in the past year
- if their regular partner has other partners
Risk of infection occurs in the first 20 days after insertion and is believed to be related to existing carriage of a sexually transmitted infection.
What symptoms may indicate uterine perforation after IUD insertion? (4)
Symptoms such as
* severe pelvic pain
* increased bleeding
* period changes
* pain during intercourse
may require medical attention
What are the potential causes of erectile dysfunction?
psychogenic, vascular, neurogenic, and endocrine abnormalities.
can also be a side effect of certain drugs such as antihypertensives, antidepressants, antipsychotics, and cytotoxic drugs.
What are the treatment options for erectile dysfunction?
drugs that increase blood flow to the penis
such as alprostadil
and phosphodiesterase inhibitors like sildenafil, tadalafil, and vardenafil.
How are fungal vaginal infections typically treated?
Fungal infections are treated with topical clotrimazole or miconazole, or oral fluconazole.
What medications are indicated for bacterial vaginal infections? (2)
- clindamycin cream
- metronidazole gel
How is vaginal atrophy treated?
with a cream containing estrogen
applied on a short-term basis to improve the vaginal epithelium
It’s important to use the smallest effective amount to minimize systemic effects.
What risks are associated with the administration of systemic estrogen alone for vaginal atrophy? (2)
The risk of:
* endometrial hyperplasia
* carcinoma
What is duloxetine licensed for in the treatment of urinary incontinence?
Duloxetine is licensed for use in stress incontinence in women.
It may be more effective when used as an adjunct to pelvic floor exercises.
How do antimuscarinic drugs like Oxybutynin work in managing urinary incontinence? (2)
- reduce the urge to urinate
- increase bladder capacity
What are the limitations of using Oxybutynin for urinary incontinence, and how can they be mitigated?
Side effects limit the use of Oxybutynin, but they may be reduced by starting at a lower dose.
Additionally, a modified-release preparation is effective and has fewer side effects.
What is Mirabegron licensed for in terms of urinary incontinence?
is licensed for the treatment of urinary incontinence associated with overactive bladder syndrome
What is nocturnal enuresis, and when is it considered common?
the involuntary discharge of urine during sleep, which is common in young children.
Children are expected to be dry by a developmental age of 5 years.
What is the alternative treatment for nocturnal enuresis if the use of an enuresis alarm is inappropriate or undesirable?
Treatment with oral/sublingual desmopressin is recommended for children over 5 years old
Define urinary retention.
the inability to voluntarily urinate
What is acute urinary retention?
a medical emergency
characterized by the abrupt development of the inability to pass urine over a period of hours.
What is chronic urinary retention?
the gradual development of inability to empty the bladder completely over months or years.
What does COCs stand for?
Combined Oral Contraceptives
What are monophasic COCs?
Combined Oral Contraceptives
that contain a fixed amount of estrogen and progestogen in each active tablet
What are phasic COCs?
Combined Oral Contraceptives (COCs)
contain varying amounts of estrogen and progestogen
What should be given for at least 2 days before removing a catheter in the treatment of acute urinary retention?
an alpha adrenoceptor blocker (e.g. alfuzosin, tamsulosin, or doxazosin)
should be given for at least 2 days
Give examples of alpha adrenoreceptor blockers (3)
- alfuzosin
- tamsulosin
- doxazosin
What is the recommended treatment for chronic urinary retention before using an indwelling catheter?
Intermittent bladder catheterization
What can be used in patients with an enlarged prostate and considered to be at high risk of progression?
a 5 alpha-reductase inhibitor e.g. finasteride/dutasteride
can be used either alone or in combination with alpha-adrenoceptor blockers
Give examples of 5 alpha- reductase inhibitor
(2)
- finasteride
- dutasteride
What can reduce the effectiveness of COCs?
if they are if taken with enzyme inducers
such as carbamazepine, phenytoin, phenobarbital, ritonavir, St. John’s wort, and rifampicin.
When should patients take progestogen-only contraceptives or intrauterine devices instead of COCs? (2)
- if they are taking enzyme inducers
- if experiencing vomiting and diarrhea
What makes progestogen-only pills (POP) more suitable for patients with a history of venous thromboembolism (VTE)?
do not interact with enzyme inducers
making them more suitable for patients with a history of VTE.
What is the most effective form of emergency contraception?
The insertion of a copper intrauterine device (IUD)
How long after unprotected sexual intercourse (UPSI) can a copper IUD be inserted?
up to 5 days after UPSI.
What factors may reduce the effectiveness of oral emergency contraception, particularly Levonorgestrel?
A higher body weight or BMI
(especially if BMI is greater than 26 kg/m² or body weight is greater than 70 kg)
it is recommended that either ulipristal or a double dose of levonorgestrel (unlicensed) is given.
When should Levonelle not be taken? (4)
- already taken emergency contraception once before in that cycle (small chance it was unsuccessful and pt is pregnant)
- if the woman’s period is overdue
- if they have severe hepatic dysfunction
- if they have severe acute porphyria
What should women do after taking emergency contraception, and what symptoms should they watch for?
Women should use condoms until their next period
and seek medical attention if they experience lower abdominal pain (could indicate ectopic pregnancy) or if their next period is unusually light, heavy, or missing
What may be necessary if a patient is taking enzyme- inducing drugs and needs to take emergency contraceptive pills?
A double dose (3 mg) of Levonelle can be given (unlicensed) if necessary
but this may increase the chances of nausea and unusual bleeding.
What should patients do if they experience a prolonged erection lasting 4 hours or more with Alprostadil?
should seek medical help immediately
What can patients do at home to potentially alleviate priapism associated with Alprostadil?
Applying an ice pack to the upper-inner thigh for 10 minutes
(alternating between left and right thighs every 2 minutes)
What medication is licensed for premature ejaculation?
Dapoxetine (an SSRI)
How long does it take to see results with dapoxetine?
In a few days: may see ejaculation delay
However, results more evident after 1-2 weeks
as receptor desensitization takes time to occur
What are the medications used for inducing abortion? (2)
- Gemeprost (a prostaglandin) is administered vaginally as pessary
- Misoprostol (a prostaglandin) can be given orally, buccally, sublingually, or pessary
. How does pre-treatment with Mifepristone (before giving the prostaglandin) facilitate abortion?
Pre-treatment with Mifepristone sensitizes the uterus for the administration of prostaglandin
allowing abortion to occur in a shorter time and with a lower dose of prostaglandin.
What medications are used for the induction of labor? (3)
dinoprostone (available as vaginal tablets, gels, and pessaries)
oxytocin(administered as a slow intravenous infusion)
misoprostol (given orally or vaginally)
How is vulvovaginal candidiasis treated during pregnancy?
treated with vaginal application of an imidazole (such as clotrimazole)
and a topical imidazole cream for vulvitis.
Pregnant women may need a longer duration of treatment, usually about 7 days, to clear the infection.
Why should oral antifungal treatment be avoided during pregnancy?
due to potential risks to the fetus
What factors contribute to the recurrence of vulvovaginal candidiasis? (4)
- antibacterial therapy
- pregnancy
- diabetes
- oral contraceptive use
What are some drawbacks of progestogen-only pills (POP)?
require more strict dosing times
and do not provide protection if missed by just 3 hours.
What is the recommended treatment for nocturnal enuresis if changes to fluid intake, diet, and toileting behavior are ineffective?
An enuresis alarm is recommended
