Genitourinary system

Question 1

What drug is used to tx stress incontinent in women only

Answer 1

Duloxetine

Question 2

First line tx for urinary frequency

Answer 2

DOT
D- Darifenacine
O- Oxybutynin
T- Tolterodine
S- Solifenacin
They are Antimuscarinic

Question 3

State the 2nd line tx for urinary frequency and incontinent

Answer 3

Mirabegron
It’s a beta adrenoceptor agonist
Prolongs QT interval

Question 4

Other drugs used to tx urinary frequency and incontinent

Answer 4

Propantheline
TCA’s eg imipramine

Question 6

Non drug tx of urinary frequency and incontinent

Answer 6

Pelvic floor exercise and bladder training

Question 7

State the indication of oxybutynin

Answer 7

Reduce symptoms of urgency and urge incontinent and increase bladder capacity
MR preps have less side effect

Question 8

What is nocturnal enuresis

Answer 8

Involuntary discharge of urine during sleep

Question 9

Non drug tx of nocturnal enuresis

Answer 9

Reassurance, advice on fluids , diet, toileting behaviour, enuresis alarm

Question 10

Drug tx for nocturnal enuresis

Answer 10

Oral or SL desmopressin
( imipramine for children who do not respond to all tx)

Question 11

Commo n side effect of Desmopressin

Answer 11

Hyponatremia( too much water dilution ) and nausea

Question 12

Counselling for pt on desmopressin

Answer 12

Hypnonatremic convulsions. Warn pts to avoid fluid overload including during swimming) and to stop desmopressin during an episode of Vomiting or diarrhoea which can lead to loss of Na until fluid balance is normal

Question 13

Caution with Desmopressin

Answer 13

Avoid intranasal route due to increased side effects
Limit fluid intake to minimum from I hrs before desmopressin dose until 8 hrs afterwards

Question 14

What’s acute urinary retention

Answer 14

It’s an emergency
Inability to voluntarily urinate
Painful and require immediate Catheterization

Question 15

What’s chronic urinary retention

Answer 15

Gradual development over months or years or the inability to empty bladder completely
Painless

Question 16

Tx of Chronic urinary retention

Answer 16

Surgically or medically with alpha blockers

Question 17

Most common cause of urinary retention in men

Answer 17

BENIGN PROSTATIC HYPERPLASIA (BPH)

Question 18

What are the complications of BPH

Answer 18

Renal impairment, urinary retention or recurrent infection

Question 19

Men with enlarged prostate suffer from urinary retention, urgency or nocturnal, frequency. T/ F

Answer 19

True

Question 20

First line drug tx for urinary retention

Answer 20

Alpha blockers eg Alfuzosin, doxazosin, tamsulosin, prazosin, Indoramin and terazosin

Question 21

Aphasia blockers can impair driving and performance of skilled task. True or false,?

Answer 21

True

Question 22

2nd line tx for urinary retention

Answer 22

5 alpha reductase inhibitor
Finasteride and dutasteride
Used for pt with enlarged prostrate, raised prostrate specific antigen concentration considered to be high risk of progression

Question 23

MHRA advice for 5 alpha reductase Inhibitor

Answer 23

Conception and contraception
Both excreted in semen. Use of condom is recommended if sexual partner is pregnant or likely to due to teratogenicity

Question 24

Handling and storage for alpha reductase inhibitors

Answer 24

Women of child bearing potential should avoid handling crushed or broken tablets of Finasteride or leaking capsules of dutasteride

Question 25

Patient and carer advice for Alpha reductase inhibitors

Answer 25

Both cause Breast cancer
Report any breast changes eg lumps, pain, nipple discharge

Question 26

MHRA for Finasteride

Answer 26

Reports of depression and suicidal thoughts in men taking for male pattern hair loss. Stop immediately if depression develops

Question 27

Facts about Alpha blockers in elderly

Answer 27

Caution in elderly and pts having cataract surgery due to floppy iris syndrome risk

Question 28

Contraindications of alpha blockers eg Tamsulosin, Dozoxazin

Answer 28

Postural hypotension and micturition syncope ( faint on urinating)

Question 29

Side effects of alpha blockers

Answer 29

Ist dose hypotension
Postural hypotension
Vomiting
Dry mouth
Diarrhoea
Dizziness
Headache
Dry mouth
Malaise

Question 30

Common side effect of tamsulosin

Answer 30

Dizziness and sexual dysfunction

Question 31

Exception to legal category with Tamsulosin

Answer 31

Tamsulosin hydrochloride 400 microgram capsules can be sold to the public for the treatment of functional symptoms of benign prostatic hyperplasia in men aged 45–75 years to be taken for up to 6 weeks before clinical assessment by a doctor.