GU 1

Question 1

1. What are the most common types of bladder disorders?

Answer 1

The most common types of bladder disorders include urinary incontinence, urinary retention, enuresis, and frequency.

Question 2

2. What is urinary frequency?

Answer 2

Urinary frequency refers to the need to go to the toilet more often than normal to urinate, even when the volume of urine is small.

Question 3

3. What is urinary retention?

Answer 3

Urinary retention is the inability to empty the bladder fully or at all, often leading to a sensation of a full bladder and discomfort.

Question 4

4. What’s the difference between chronic and acute urinary retention?

Answer 4

Acute urinary retention happens suddenly and requires immediate medical attention, while chronic urinary retention develops gradually over time.

Question 5

5. What is urinary incontinence?

Answer 5

Urinary incontinence is the involuntary release of urine, leading to wetting oneself. It can be categorized into different types such as stress, urgency, mixed, and overflow incontinence.

Question 6

6. What is stress incontinence?

Answer 6

Stress incontinence occurs when urine leaks during activities that put pressure on the bladder, such as sneezing, coughing, or lifting.

Question 7

7. What is urgency incontinence?

Answer 7

Urgency incontinence, also known as overactive bladder, involves the sudden and strong urge to urinate, often leading to involuntary leakage.

Question 8

8. What are the main drugs used to treat urinary frequency and incontinence?

Answer 8

The main drugs used include antimuscarinic drugs (anticholinergics) like oxybutynin, tolterodine, fesoterodine, solifenacin, darifenacin, and trospium as first-line treatments. Mirabegron, a beta-3 agonist, is a second-line option.

Question 9

9. Which drug is used in stress incontinence in women only?

Answer 9

Duloxetine is used for moderate to severe stress incontinence in women, but it should be used with caution and not abruptly discontinued.

Question 10

10. What can be done to antimuscarinics to reduce the side effects?

Answer 10

To reduce side effects of antimuscarinic drugs, lower doses or modified-release preparations can be used. Medications can also be given to counteract specific side effects such as dry mouth (artificial saliva pastels) or constipation (laxatives).

Question 11

11. What is nocturnal enuresis?

Answer 11

Nocturnal enuresis, commonly known as bedwetting, refers to the involuntary discharge of urine during sleep, especially in children who are expected to be dry by the age of 5.

Question 12

12. What medication is used to treat nocturnal enuresis?

Answer 12

Enuresis alarms are the first-line treatment for bedwetting. Second-line options include desmopressin for children over 5 years of age and imipramine for those who don’t respond to other treatments.

Question 13

13. What no-drug treatment can be used to help children with nocturnal enuresis?

Answer 13

Non-drug treatments include ensuring children drink enough water, maintain a good diet, establish regular toilet routines, and using rewards systems. Waterproof mattress covers and enuresis alarms can also be helpful.

Question 14

14. What’s the main side effect of desmopressin, and how can it be prevented?

Answer 14

The main side effect of desmopressin is hyponatremic convulsions, which can be prevented by avoiding fluid overload, restricting fluid intake before and after taking the medication, and not consuming caffeine-containing products or fizzy drinks.

Question 15

15. Which route should be avoided when taking desmopressin?

Answer 15

Intranasal administration of desmopressin should be avoided because it is more likely to cause side effects such as hyponatremic convulsions.

Question 16

16. What’s the most common cause of urinary retention in men?

Answer 16

The most common cause of urinary retention in men is benign prostatic hyperplasia (BPH), which involves an enlargement of the prostate gland.

Question 17

17. What are the drug and non-drug treatments for urinary retention and BPH, and what counseling advice should be given to patients?

Answer 17

Drug treatments include alpha-blockers (e.g., tamsulosin) and 5-alpha reductase inhibitors (e.g., finasteride). Non-drug treatments may involve catheterization. Patients should be advised about potential side effects, and surgery may be necessary in severe cases.

Question 18

18. What’s the contraception and contraception advice with 5AR inhibitors, and what are the handling and storage rules?

Answer 18

5-alpha reductase inhibitors like finasteride and dutasteride can cause infertility if handled improperly. Women of childbearing potential should avoid handling crushed finasteride tablets and leaking dutasteride capsules. Condoms should be used if a partner is pregnant or likely to become pregnant due to excretion in semen.

Question 19

19. What’s the MHRA warning for finasteride?

Answer 19

The MHRA (Medicines and Healthcare products Regulatory Agency) has issued a warning about reports of depression and suicidal thoughts associated with finasteride. Patients should stop taking it immediately if these symptoms occur.

Question 20

20. What’s the patient and carer advice when using 5AR inhibitors?

Answer 20

Patients should stop taking the medication if they experience severe depression or thoughts of self-harm. They should also report any changes in their breasts, such as lumps, pain, or nipple discharge, as these may be signs of breast cancer.

Question 21

21. What are some examples of alpha blockers?

Answer 21

Examples of alpha blockers include alfuzosin, doxazosin, tamsulosin, terazosin, and indoramin.

Question 22

22. What are the contraindications of alpha blockers?

Answer 22

Alpha blockers should be used with caution in individuals at risk of postural hypotension, and the first dose is often recommended at bedtime. Postural hypotension can lead to fainting, especially when working in jobs that require standing for extended periods.

Question 23

23. What are the side effects of alpha blockers?

Answer 23

Common side effects of alpha blockers include dizziness, drowsiness, diarrhea, and dry mouth (the “Four Ds”). Other possible side effects include headaches, nausea, vomiting, and floppy iris syndrome.

Question 24

24. What counseling should be done when using alpha blockers?

Answer 24

Patients should be advised to take the first dose at bedtime to reduce the risk of postural hypotension, which can impair their ability to drive safely.

Question 25

25. What are the main forms of contraception?

Answer 25

The main forms of contraception include barrier methods (e.g., condoms), intrauterine devices (IUDs), hormonal contraception (combined hormonal and progesterone-only), and emergency contraception (morning-after pill).

Question 26

26. What are the main problems associated with barrier methods?

Answer 26

Barrier methods, such as condoms, can have problems such as decreased effectiveness, the risk of tearing, improper use, and potential allergies to materials used in these methods.

Question 27

27. What is the most effective form of contraception?

Answer 27

The most effective non-hormonal form of contraception is the copper IUD, while the most effective hormonal form is the progesterone-only IUD.

Question 28

28. What are CHCs?

Answer 28

CHCs (Combined Hormonal Contraceptives) are contraceptives that contain both estrogen and progestogen and are used to inhibit ovulation. They include oral contraceptives (the pill), patches, and vaginal rings.

Question 29

29. Which age should CHCs not be used and why?

Answer 29

CHCs should not be used in girls before puberty, as they can affect growth. They are also generally not recommended for women over the age of 50 because of an increased risk of certain cancers.

Question 30

30. What are the main factors that influence contraceptive failure?

Answer 30

Factors that can influence contraceptive failure include non-compliance, weight (especially in overweight or obese individuals), malabsorption (e.g., due to gastrointestinal conditions), drug-drug interactions, and certain medical conditions.

Question 31

31. What are the advantages of CHCs?

Answer 31

CHCs are reliable, reversible, and provide predictable bleeding patterns. They can reduce the risk of dysmenorrhea (painful periods), menorrhagia (heavy menstrual bleeding), and pelvic inflammatory disease (PID). CHCs may also improve acne and reduce the risk of ovarian, endometrial, and colorectal cancers.

Question 32

32. What’s the difference between monophasic and multiphasic pills in CHC?

Answer 32

Monophasic CHCs contain a fixed amount of both estrogen and progestogen, while multiphasic CHCs vary the levels of these hormones throughout the menstrual cycle. Multiphasic pills are often used when monophasic preparations lead to breakthrough bleeding.

Question 33

33. Which CHC is a first-line option?

Answer 33

Monophasic CHCs with lower doses of estrogen (≤30mcg) combined with levonorgestrel or norethisterone are typically recommended as first-line options due to their lower risk of myocardial infarction (MI).

Question 34

34. What dose adjustments need to be made when given CHC, and why?

Answer 34

The goal is to use the lowest effective dose of estrogen and progestogen to minimize side effects and risks. Some individuals may need to switch from standard strength to lower strength ethinylestradiol due to concerns about cardiovascular risks.

Question 35

35. Besides contraception, what else can CHC’s be used for?

Answer 35

CHCs can be used to manage various conditions such as acne, dysmenorrhea (painful periods), menorrhagia (heavy menstrual bleeding), endometriosis, and polycystic ovary syndrome (PCOS).

Question 36

36. What should be done with CHC when considering surgery, and what should be done if CHC can’t be adjusted?

Answer 36

CHCs should be stopped before surgery, especially major surgery or surgery involving the legs, to reduce the risk of venous thromboembolism (VTE). If CHC cannot be adjusted, thromboprophylaxis (e.g., compression stockings) may be recommended.

Question 37

37. When should HRT and CHC be stopped immediately?

Answer 37

HRT and CHC should be stopped immediately if certain conditions or symptoms occur, such as severe chest pain, sudden breathlessness, coughing with blood-stained sputum, unexplained swelling or severe pain in the calf, neurological effects like severe headaches or vision disturbances, liver dysfunction, high blood pressure, or signs of a stroke.

Question 38

38. What are the cautions and contraindications regarding CHC’s?

Answer 38

Caution should be exercised in individuals with a family history of VTE, migraines (especially with aura), age over 40, smoking, diabetes, and high BMI. Contraindications include severe obesity, smoking over 40, age over 50, complications from diabetes, confirmed cancer influenced by estrogen, and more.

Question 39

39. What’s the advice on traveling and diarrhea when using CHC’s?

Answer 39

During travel, especially long journeys, individuals should take precautions to reduce the risk of venous thromboembolism (VTE). In the case of diarrhea, if it lasts for more than 24 hours or if vomiting occurs within 3 hours after taking the pill, extra measures may be necessary.

Question 40

40. What’s the definition of a missed pill for all forms of contraception?

Answer 40

A missed pill for all forms of contraception is when the prescribed pill is not taken at the specified time or within the recommended window of time for that particular contraceptive method. The definition varies between different forms of contraception.

Question 41

41. If someone is taking CHC’s when must EHC be given, and what’s the full procedure in terms of extra precautions?

Answer 41

EHC (Emergency Hormonal Contraception) must be given if two or more CHC pills are missed during the first 7 days of the menstrual cycle, and unprotected sex occurs. Extra precautions include taking EHC, continuing the CHC as usual, and using condoms for additional protection.

Question 42

42. What should a woman do if she has missed her CHC pill, but hasn’t had UPSI?

Answer 42

If a woman has missed her CHC pill but has not had unprotected sexual intercourse (UPSI), she can simply take the missed pill as soon as possible and continue taking the rest of the pills as scheduled. Extra precautions, such as condom use, may be advised for the next 7 days.

Question 43

43. What are the 3 main forms of POP’s?

Answer 43

The three main forms of POPs (Progesterone-Only Pills) are oral pills, parenteral injections, and intrauterine devices (IUDs). Examples of POPs include desogestrel, norethisterone, and levonorgestrel.

Question 44

44. What’s the definition of a missed pill for POC’s, and what must be done in terms of extra precautions?

Answer 44

A missed pill for POCs (Progesterone-Only Contraceptives) is when an oral pill is not taken within the specified time window (usually 3 hours) or for certain pills like desogestrel, the time window may be 12 hours. Extra precautions may be needed, including taking the missed pill as soon as possible and using condoms for additional protection if UPSI occurred.

Question 45

45. What’s the advice on diarrhea and vomiting when taking a POC?

Answer 45

If taking a POC and experiencing vomiting within a certain time frame or severe diarrhea, extra precautions may be necessary. This can include taking another pill if vomiting occurs, using additional protection during diarrhea, and seeking medical advice if needed.

Question 46

46. What dose and advice should be given when someone takes desogestrel?

Answer 46

Desogestrel is typically taken at a dose of 75mcg daily. If a dose is missed by 12 hours or more, the missed pill should be taken as soon as possible, and extra precautions may be required for the next 2 days. If vomiting occurs within 2 hours of taking it, another pill should be taken. For severe diarrhea, extra precautions should be taken during the episode and for 2 days after.

Question 47

47. How long does each of the long-acting POCs last for?

Answer 47

The duration of action for each long-acting POC varies: Depo-Provera injections last for 12 weeks, the Nexplanon implant lasts for 3 years, and hormonal IUDs such as Mirena can last for up to 5 years.

Question 48

48. What are the potential side effects of Depo-Provera injections?

Answer 48

Common side effects of Depo-Provera injections include menstrual irregularities, weight gain, mood changes, and a decrease in bone density with long-term use.

Question 49

49. What’s the mechanism of action for Nexplanon and how is it inserted?

Answer 49

Nexplanon is a small, flexible rod that is inserted under the skin of the upper arm. It releases a progestogen hormone (etonogestrel) that inhibits ovulation, thickens cervical mucus, and makes the uterine lining less receptive to implantation.

Question 50

50. What are some potential side effects of Nexplanon?

Answer 50

Common side effects of Nexplanon include changes in menstrual bleeding patterns, headaches, mood swings, weight gain, and breast pain. Some individuals may experience no periods at all.