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Pre-reg Exam > Genito-urinary tract system > Flashcards

Genito-urinary tract system Flashcards

1
Q

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

A

Duloxetine

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2
Q

When should oxybutynin be avoided and why?

A

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

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3
Q

When is mirabegron contraindicated?

A

Severe uncontrolled HTN ≥ 180/110

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4
Q

What age are children expected to be dry?

How is nocturnal enuresis managed?

A

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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5
Q

What should be done before a catheter is removed?

A

Give an alpha blocker for at least 2 days.

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6
Q

How is chronic urinary retention managed?

A 
Alpha blockers (e.g tamsulosin)
Review after 4-6 weeks then every 6-12 months
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7
Q

How is BPH managed?

A

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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8
Q

When should indoramin be avoided?

A

Parkinsons- exacerbates it

Epilepsy

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9
Q

What are the side effects of alpha blockers?

When should they be avoided?

A

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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10
Q

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

A

rare reports of depression and suicidal thoughts- discontinue.

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11
Q

What are the precautions surrounding use of finasteride and dutasteride?

A

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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12
Q

How is pain relieved in cystitis?

What are the referral criteria?

A

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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13
Q

Which are the progestogens?

How do they work?

A

Desogestrel, levonorgestrel, norethisterone.

They alter cervical mucus to prevent sperm penetration

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14
Q

When should combined contraceptives or HRT be stopped immediately?

A 
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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15
Q

When should oestrogen containing contraceptives be stopped before major surgery?

What about progestogen only?

A

4 weeks

Progestogen only can be continued

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16
Q

When are copper IUDs less appropriate?

A

Women <25 due to higher risk of pelvic inflammatory disease

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17
Q

Which progestogen can inhibit ovulation (no periods)?

A

Desogestrel

18
Q

How long after childbirth can you have EHC?

What about after abortion/ miscarriage?

A

21 days after childbirth

5 days aft abortion/ miscarriage

19
Q

What is the most effective contraception?

Is it also the most effective emergency contraceptive?

A

Hormonal contraceptives

No- most effective emergency is copper IUD

20
Q

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

A

5 days

21
Q

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

A

Ulipristal.

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

22
Q

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

A

5 days

23
Q

When should ulipristal be avoided?

A

Severe asthma treated with oral steroids

24
Q

Which medicines reduce effectiveness of hormonal contraception?

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

A

Enzyme inducers:

Remember: CRAP GPS induce me to madness..

Switch her to copper IUD/ parenteral progestogen.

25
Q

What are the side effects of combined oral contraceptives?

A 
Breast cancer risk
Cervical cancer risk
Liver disorders
VTE risk
Neurological symptoms such as migraine, vision, hearing problems, seizures- discontinue if severe
26
Q

What should be done if doses of combined oral contraceptive are missed?

Which pills does this not apply too?

A

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

27
Q

What is the MHRA alert associated with the copper IUD?

A

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

28
Q

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

A

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.

29
Q

How is erectile dysfunction managed?

A

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

30
Q

What is priapism? How is it treated?

A

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

31
Q

When are the phosphodiesterase type-5 inhibitors contraindicated?

A

Cardiac issues: BP> 170/100 or systolic <90, HF

recent arrhythmias, MI , stroke, UA

32
Q

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

A

optic neuropathy

sudden hearing loss

33
Q

Which drugs should you avoid using sildenafil with?

A

ketoconazole, itraconaole, ritonavir

Reduce dose with other potent inhibitors.

34
Q

What can occur I sildenafil is taken with food?

A

Delayed onset

35
Q

What medicines can be used for premature ejaculation?

A

Dapoxetine, clomipramine

NOTE: May take 1-2 weeks to take effect

36
Q

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

A

Prostaglandins and oxytocics

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

37
Q

Which medicines can be used to postpone labour?

A

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

38
Q

How is bacterial vaginosis managed?

A

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.

39
Q

How is genital herpes managed?

A

aciclovir (400mg TDS for 5-10 days)

valaciclovir

40
Q

How is urinary incontinence managed in women?

A

Bladder training (pelvic floor exercises)

1st line: antimuscarinics: oxybutynin, tolteridone or darifenacin - review after 4-6 weeks

2nd line: mirabegron

Pre-reg Exam (15 decks)

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