GENITOURINARY MEDICINE Flashcards
Cystitis in who should always be referred?
Men.
Symptoms of Cystitis include:
Dysuria (painful urination, burning, stinging)
Increased urinary frequency and urgency but only passing small amounts of urine.
Nocturia.
Haematuria (urine might be dark and strong smelling)
Pain above the pubic bone, lower back or abdomen.
Some women feel systemically unwell.
Children younger than what age should be referred if experiencing symptoms of cystitis?
Under 12
In which patient groups should a referral be made for symptoms of cystitis?
Diabetics Elderly women Immuno-compromised patients of either gender Pregnancy If vaginal discharge is present.
Differential diagnosis for cystitis includes:
Thrush
Pylonephritis - sign of systemic infection
Vaginitis
STIs
Medicine induced cystitis: NSAIDS
Oestrogen deficiency - post menopause - frequent cases.
How do we manage cystitis in the community pharmacy?
Make urine more alkaline, relieve symptoms of dysuria.
Limited evidence of efficacy of cystopurin, Cymalon, Cystemme, Canesten Oasis.
Cystitis symptoms lasting longer than how many days is a sign for referral?
longer than 7 days.
What advice should be given to those presenting with cystitis? [7]
- Paracetamol and ibuprofen can help reduce discomfort and any associated fever.
- Drink plenty of water and avoid alcohol.
- Avoid intercourse till symptoms resolve.
- Avoid perfumed cosmetics/bubble bath etc.
- Avoid ignoring the call to urinate.
- Good personal hygiene
- Urinate following sex/use of lubricants.
Cystitis can be medically induced by
NSAID usage
Patients with what other symptoms including those associated with cystitis should be referred?
Associated fever, nausea, vomiting and flank pain.
Duration of longer than 7 days.
What are the three most common causes of vaginal discharge?
Vulvovaginal candidiasis (thrush-curd-like discharge, little to no odour)
Bacterial vaginosis (white discharge, strong fishy odour)
Trichomoniasis (malodorous, green-yellow in colour)
How can thrush be distinguished from vaginosis and trichomoniasis?
Vaginal itching is more prominent in thrush.
Sudden onset of symptoms is less common in vaginosis and trichomoniasis.
No odour in discharge.
Those presenting with thrush should be referred when?
- First case.
- Diabetes
- Discharge with strong smell
- OTC medicine failure
- Pregnant women
- Recurrent attacks
- Women under 16 and over 60.
Malodorous, green-yellow in colour describes
Trichomoniasis.
Can lead to infertility.
Women of what ages should be referred when presenting with thrush?
under 16
over 60
White discharge, strong fishy odour describes
Bacterial vaginosis
Should a women experiencing thrush for the first time be referred?
Yes
Should a pregnant woman with thrush be referred?
Yes
Curd like discharge, little to no odour describes
Vulvovaginal candidiasis
What advice should be given to someone receiving topical treatment for thrush?
All internal preparations should be taken at night.
Preparations might affect latex contraceptives.
What advice should be given to someone receiving systemic treatment for thrush?
Fluconazole can cause GI disturbances.
Fluconazole should not be used in pregnancy or where there is a chance the patient is pregnant.
What practical advice should be given to people receiving treatment for thrush?
Avoid tight clothing, perfumed soaps.
Symptoms should resolve within 3 days, see GP if they do not show improvement in 7 days.
Treat partner if appropriate.
What are the conditions for OTC supply of tamsulosin?
Men 45-75
Suffering for at least 3 months.
Must not be supplied if:
Who is tranexamic acid for?
Women
Aged 18-45
Heavy menstrual loss over several cycles
Have a regular cycle of 21-35 days
Canestan oasis is used to treat what?
Cystitis
What does canestan oasis contain?
Sodium citrate - make urine less acidic/more alkaline.