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GPhC Exam > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is urgency incontinence

A

sudden immediate need to pee that is difficult to delay

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2
Q

What is stress incontinence

A

leakage on effort or exertion, or on sneezing or coughing

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3
Q

What is mixed incontinence

A

urgency and stress, however one type usually predominates

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4
Q

Risk factors of urinary incontinence

A

old age, pregnancy and vaginal delivery, obesity, smoking, constipation, family history, medicines (diuretics, alcohol, caffeine)

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5
Q

Non drug treatment for urinary incontinence

A

modify fluid intake, weight loss, reduce caffeine

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6
Q

urgency incontinence treatment

A
  1. bladder training for at least 6 weeks
  2. antimuscarinic (oxybutynin or tolterodine)
  3. mirabegron
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7
Q

stress incontinence treatment

A

pelvic floor for at least 3 months, surgery or duloxetine

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8
Q

Mixed incontinence treatment

A

bladder training > 6 weeks and pelvic floor > 3 months
treat pharmacologically in accordance to dominating type

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9
Q

Name antimuscarinics

A

fesoterodine, solifenacin, trospium, oxybutynin, tolterodine

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10
Q

antimuscarinics side effects

A

constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia, drowsy (affects skilled tasks/driving)

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11
Q

antimuscarinics contra-indications

A

angle-closure glaucoma and GI obstruction

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12
Q

What is nocturnal enuresis

A

involuntary urination during sleep
common in children

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13
Q

nocturnal enuresis non drug treatment step 1

A

under 5 yrs old
protective bedding, resolve on own
advice = no fluids 4 hours before sleep, diet, toileting behaviour, reward system

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14
Q

nocturnal enuresis non drug treatment step 2

A

if 1 unresponsive (> 1- 2 bed wets per week) = enuresis alarm
alarms in < 7 yrs depending on maturity, motivation and understanding
less relapse than drug tx when discontinued
r/v alarm after 4 weeks
continue until min 2 wks of uninterrupted dry nights

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15
Q

Nocturnal enuresis non drug treatment step 3

A

if 1 and 2 unsuccessful add in desmopressin

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16
Q

nocturnal enuresis drug treatment

A

> 5 yrs = desmopressin:
if alarm undesirable
if need rapid results (to cover holidays)
assess tx after 4 wks and =continue for 3 months if working
repeated courses withdrawn gradually at regular intervals
specialist = desmopressin +/- antimuscarinic (oxybutynin or tolterodine)
not responding to all other tx = imipramine

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17
Q

Desmopressin

A

more potent and longer duration of action than vasopressin
no vasoconstrictor effect
side effects = hyponatraemia = convulsions if given rapidly, nausea

18
Q

what is urinary retention

A

inability to voluntarily urinate

19
Q

causes of urinary retention

A

urethral blockage, medications (antimuscarinics, sympathomimetics, TCAs)

20
Q

Acute urinary retention

A

is a medical emergency
abrupt development over a period of hours

21
Q

Chronic urinary retention

A

gradual over months
inability to completely empty bladder

22
Q

what is benign prostatic hyperplasia

A

type of chronic urinary retention caused by enlarged prostate
symptoms = urinary retention, urgency, frequency, nocturne
tx = a-blockers (relaxes smooth muscle)

23
Q

Acute urinary retention treatment

A

catheter then a-blocker for 2+ days before removing catheter

24
Q

Chronic urinary retention treatment

A

catheter long term - may cause recurrent UTIs (7 days abx), urethra trauma, pain, stone formation

25
Q

BPH treatment

A

a-blocker (relaxes smooth muscle)
if enlarged prostate, increased prostate antigens, or at high risk of progression then 5a reductase inhibitor (finasteride/dutasteride)

26
Q

Name a-blockers

A

alfuzosin, tamsulosin, doxazosin, terazosin

27
Q

a-blockers contra indications

A

micturition syncope, postural hypotension

28
Q

a-blockers side effects

A

dizziness, postural hypotension
take first dose at night as may cause collapse due to postural hypotension. Lie down if fatigue, dizzy, sweating until feel better

29
Q

Name 5a reductase inhibitors

A

Finasteride, dutasteride

30
Q

5a reductase inhibitors side effects

A

breast disorder, sexual dysfunction, male breast cancer - report lumps/pain/nipple discharge, excreted in semen
use condom if partner preg/likely to be preg
women of child bearing age = avoid handling crushed/broken tablets

31
Q

Finasteride MHRA Warning

A

depression and rare cases of suicidal thoughts - stop immediately and inform healthcare professional

32
Q

What is erectile dysfunction

A

persistant inability to attain/maintain erection

33
Q

Causes of erectile dysfunction

A

physical, psychological or side effect of drugs

34
Q

Erectile dysfunction non drug treatment

A

smoking cessation and reduce alcohol intake

35
Q

Erectile dysfunction 1st line drug treatment

A
  • phosphodiesterase type 5 inhibitor
  • increase blood flow intake to penis - still need sexual stimulation
  • short acting - avanafil, sildenafil, vardenafil - PRN
  • long acting - tadalafil - PRN or lower dose daily for spontaneous
  • 6 doses at max dose with stimulation before classed as non-responder
36
Q

Erectile dysfunction 2nd line drug treatment

A

intracavernasal, intraurethral, or topical alprostadil - under careful medical supervision

37
Q

Phosphodiesterase type 5 inhibitors side effects

A
  • flushing, dizziness, nasal congestion, migraine
  • priapism (erection>4 hours) = medical attention
38
Q

Phosphodiesterase type 5 inhibitors contra indications

A
  • taking nitrates
  • have hypotension
  • unstable angina/stroke
  • angina during intercourse
  • people who shouldn’t have sexual activity
39
Q

Phosphodiesterase type 5 inhibitors interactions

A
  • nitrates
  • a-blockers
  • both cause hypotension
40
Q

Alprosadil warning

A

wear condom if partner of child bearing age, pregnant or lactating

GPhC Exam (22 decks)

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