Genito-urinary tract system Flashcards by Ann Awini

Which drug is of benefit in stress incontinence in women (second line to surgery) ?

Duloxetine

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When should oxybutynin be avoided and why?

Avoid in frail elderly women due to risks of chronic confusion, acute delirium, impairment of daily functioning.

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When is mirabegron contraindicated?

Severe uncontrolled HTN ≥ 180/110

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What age are children expected to be dry?

How is nocturnal enuresis managed?

Expected to be dry by 5 years old
Consider treatment only when child reaches 7

1st line: enuresis alarm (+ reward system)
2nd line: desmopressin
3rd line: Antimuscarinics (e.g oxybutynin) or TCAs (e.g imipramine)

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What should be done before a catheter is removed?

Give an alpha blocker for at least 2 days.

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How is chronic urinary retention managed?

Alpha blockers (e.g tamsulosin)
Review after 4-6 weeks then every 6-12 months

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How is BPH managed?

1st line: alpha blocker

2nd line: 5a-reductase inhibitor (e.g finasteride) if prostate is enlarged

3rd line:combo of both/ surgery

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When should indoramin be avoided?

Parkinsons- exacerbates it

Epilepsy

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What are the side effects of alpha blockers?

When should they be avoided?

First dose hypotension (give at night)

cause sexual dysfunction
caution if pt on antihypertensives/ patients with HF

-AVOID if cataract surgery- risk of floppy iris syndrome

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What is the MHRA alert associated with 5a-reductase inhibitors (e.g finasteride + dutasteride) ?

rare reports of depression and suicidal thoughts- discontinue.

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What are the precautions surrounding use of finasteride and dutasteride?

Tablets- not handled by women of childbearing age.
Excreted in semen- men should use a condom
Can cause male breast cancer!!
Can hide markers of prostate cancer- evaluate regularly for prostate cancer.

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How is pain relieved in cystitis?

What are the referral criteria?

Alkalinisation of urine with:
potassium citrate
sodium bicarb

Refer if: symptoms >3 days, renal/ cardiac issues (due to treatment with sodium + potassium)

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Which are the progestogens?

How do they work?

Desogestrel, levonorgestrel, norethisterone.

They alter cervical mucus to prevent sperm penetration

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When should combined contraceptives or HRT be stopped immediately?

BP systolic >160 or diastolic >95
Unexplained leg swelling (DVT signs)
Sudden breathlessness
Sudden severe chest pain
Severe stomach pain
Signs of liver disorders (jaundice)
Prolonged immobility
Serious neurological effects: vision/ hearing/ seizures/ headaches

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When should oestrogen containing contraceptives be stopped before major surgery?

What about progestogen only?

4 weeks

Progestogen only can be continued

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When are copper IUDs less appropriate?

Women <25 due to higher risk of pelvic inflammatory disease

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Which progestogen can inhibit ovulation (no periods)?

Desogestrel

How long after childbirth can you have EHC?

What about after abortion/ miscarriage?

21 days after childbirth

5 days aft abortion/ miscarriage

What is the most effective contraception?

Is it also the most effective emergency contraceptive?

Hormonal contraceptives

No- most effective emergency is copper IUD

How long after sexual activity can you use copper IUD for emergency contraception?

5 days

Which EHC can be used more than once in the same cycle?

Ulipristal.

Levonorgesterel has more side effects when used more than once in a cycle.

How soon after using ulipristal for EHC can you restart your ongoing contraception?

5 days

When should ulipristal be avoided?

Severe asthma treated with oral steroids

Which medicines reduce effectiveness of hormonal contraception?

What should be done if a woman needs to go on this type of medicine?

Enzyme inducers:

Remember: CRAP GPS induce me to madness..

Switch her to copper IUD/ parenteral progestogen.

What are the side effects of combined oral contraceptives?

``` Breast cancer risk Cervical cancer risk Liver disorders VTE risk Neurological symptoms such as migraine, vision, hearing problems, seizures- discontinue if severe ```

What should be done if doses of combined oral contraceptive are missed? Which pills does this not apply too?

If ONE pill missed (24 hours+) take the missed pill then continue taking the rest as normal, no additional contraception is needed If TWO pills missed (48 hours+) take the latest missed pill then continue taking the rest as normal, use extra contraception for the next 7 days. If pill is missed in the first week, not protected- EHC may be needed if sex occurred. If pill is missed in third week (pills 15-21) omit the pill free interval. start new pack right after. Doesnt apply to : Zoely, Eloine (not protected after 24hrs missed dose) Qlaira (not protected after 12hrs of missed dose) Daylette

What is the MHRA alert associated with the copper IUD?

Risk of uterine perforation especially up to 36 weeks postpartum or if breastfeeding.

What should be done if doses of progestogen only (minipill) contraceptive are missed?

If less than 3 hours late (12 hours for desogestrel): take the missed pill asap. take the next pill at the usual time. You are protected- no extra precautions. If more than 3 hours late (12 hours for desogestrel): take one pill as soon as you remember, take next pill at usual time. You are not protected for the next 2 days (48 hours) use condoms and EHC needed if sex occurs.

How is erectile dysfunction managed?

Phosphodiesterase type-5 inhibitors: Sildenafil, avanafil, vardenafil- PRN Tadalafil- long acting can be used OD for regular sex. Six doses at max strength= non responder (refer) 2nd line: alprostadil (under medical supervision) Via: intracavernosal, intraurethral, topical

What is priapism? How is it treated?

Erection >4 hours Erection > 6 hours should be treated without delay. Penile aspiration/ lavage (blood drawn from penis) Penile injection of a sympathomimetic (e.g adrenaline/ metaraminol/ phenylephrine

When are the phosphodiesterase type-5 inhibitors contraindicated?

Cardiac issues: BP> 170/100 or systolic <90, HF | recent arrhythmias, MI , stroke, UA

What are some RARE side effects of sildenafil (and related drugs) that require treatment discontinuation?

optic neuropathy | sudden hearing loss

Which drugs should you avoid using sildenafil with?

ketoconazole, itraconaole, ritonavir Reduce dose with other potent inhibitors.

What can occur I sildenafil is taken with food?

Delayed onset

What medicines can be used for premature ejaculation?

Dapoxetine, clomipramine NOTE: May take 1-2 weeks to take effect

Which medicines can induce uterine contractions and hence can induce abortions or labour?

Prostaglandins and oxytocics Misoprostol, gemeprost, dinoprostone Mifepristone sensitises the uterus to the prostaglandins so you need a lower dose.

Which medicines can be used to postpone labour?

Atosiban Nifedipine B agonist (only delay delivery up to 48 hours) Associated with serious CV side efects. Indometacin (affects neonatal renal function)

How is bacterial vaginosis managed?

metronidazole (400mg BD for 5-7 days or 2g stat) metronidazole vaginal gel for 5 days clindamycin vaginal gel for 7 days DO NOT use the high dose 2g stat in pregnant women.

How is genital herpes managed?

aciclovir (400mg TDS for 5-10 days) | valaciclovir

How is urinary incontinence managed in women?

Bladder training (pelvic floor exercises) 1st line: antimuscarinics: oxybutynin, tolteridone or darifenacin - review after 4-6 weeks 2nd line: mirabegron