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PRE-REG-Thuri > GU SYSTEM- BLADDER ISSUES, CONTRACEPTION, ED > Flashcards

GU SYSTEM- BLADDER ISSUES, CONTRACEPTION, ED Flashcards

1
Q

MOA of oxybutynin?

A

Direct relaxant of urinary muscle

e.g patches

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2
Q

What method is 1st line treatment for urinary urge incontinence?

A

Bladder training 6 weeks

Then add a drug (antimuscarinic)

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3
Q

What are the 3 types of urinary incontinence?

A

Urge

Stress
Mixed - both urge + stress

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4
Q

What is urgent incontinence?

A

Sudden need to pee, can’t hold it due to weak muscles.

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5
Q

What is stress incontinence?

A

leaking when sneezing or coughing

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6
Q

What are 6 risk factors of urinary incontinence?

A

old age

Pregnancy

obesity + smoking

family hx

medicines- diuretics, alcohol

constipation

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7
Q

What are non drug treatments of urinary incontinence?

A

Stop smoking, reduce alcohol and caffeine, weight loss, change fluid intake

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8
Q

What should not be used to treat urinary incontinence, unless the person has severe cognitive or mobility impairment?

A

Absorbent products, hand-held urinals and toileting aids

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9
Q

When should Intravaginal and intraurethral devices should only be used?

A

Prevent leaking during exercise

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10
Q

What is 2nd line treatment for urge incontinence?

A

Antimuscarinics

e.g. oxybutynin, tolterodine. solifenacin

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11
Q

What is 3rd line drug for urge incontinence?

A

Mirabegron

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12
Q

What is 1st line treatment for Stress incontinence
?

A

Trial supervised pelvic floor muscle training for at least 3 months,

Should include at least 8 contractions performed 3x day.

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13
Q

what is 2nd line tx for Stress incontinence
after trying pelvic floor exercise?

A

Duloxetine or surgery

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14
Q

What is 1st line for mixed incontinence?

A

bladder training 6 weeks + pelvic floor training

Drug treatment based on what is more dominating.

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15
Q

What is a contraindication for mirabegron?

A

Severe uncontrolled HTN

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16
Q

What is a caution of mirabegron?

A

QT prolongation

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17
Q

When + who should duloxetine be used for in urinary incontinence?

A

Mod-severe stress incontinence

Women ONLY

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18
Q

List some antimuscarinics?

A

Oxybutinin

Solifenacin

tolterodine

fesoterodine

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19
Q

What are 5 antimuscarinic side effects?

A

Constipation

Dry mouth

dizziness/drowsy

flushing

tachycardia

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20
Q

What 2 conditions are antimuscarinics contra-indicated in?

A

Angle-closure glaucoma;
GI obstruction

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21
Q

Can you drive when taking antimuscarinics?

A

NO- affects driving

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22
Q

What medication is needed for women when taking mirabegron?

A

Contraception

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23
Q

Class of mirabegron?

A

Beta 3 agonist

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24
Q

What renal function to avoid mirabegron?

A

avoid if eGFR less than 30

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25
Q

When to do with mirabegron if eGFR is 30-89 and taking other enzyme inhibitor drugs?

A

Manufacturer advises reduce dose to 25 mg once daily.

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26
Q

What 3 antimuscarinic drugs can be prescribed if patient with urge incontinence taking anticholinergic for dementia?

A

Immediate release oxybutynin, tolterodine, or darifenacin = 1st line

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27
Q

When to review drug treatment for urge incontinence?

A

4 weeks, or sooner if required

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28
Q

When to review women for urge incontinence If treatment is effective?

A

review the woman again at 12 weeks, then annually or every 6 months if the woman is over 75 years of age.

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29
Q

What to do if treatment not tolerated in urge incontinence?

A

Alternative anticholinergic drug, dose adjusted or, mirabegron trialled; review again after 4 weeks.

Alternative anticholinergics include, an untried 1st-line drug, or 1 below; fesoterodine fumarate, propiverine hydrochloride, solifenacin succinate, trospium chloride, OR an extended release formulation of either oxybutynin or tolterodine.

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30
Q

What is nocturnal enurisis?

A

urinating during sleep - common in children

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31
Q

What to do if woman presents with Pelvic organ prolapse symptoms?

A

examined to rule out pelvic mass or other pathology + history taken

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32
Q

What is counselling for Pelvic organ prolapse?

A

Reduce heavy lifting, preventing or treating constipation, and if their BMI is 30 kg/m² or greater, encouraged to lose weight. A programme of supervised pelvic floor muscle training for at least 16 weeks may also be tried for some women.

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33
Q

What is treatment for nocturnal enurisis in children under 5?

A

no treatment needed

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34
Q

What is non drug treatment for nocturnal enuresis in children over 5?

A

advice on fluid intake (no fluids 4 hrs before bed), diet, toileting behaviour, and use of reward systems

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35
Q

What is treatment for nocturnal enuresis in children over 5 if lifestyle does not work?

A

enuresis alarm

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36
Q

When is an enuresis alarm given?

A

More than 1-2 wet beds in 1 week.

review in 4 weeks

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37
Q

Who are enuresis alarms given to?

A

Children between 5-7 who understand purpose

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38
Q

Why are enuresis alarms 1st line for enuresis?

A

Less relapse than drug treatment

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39
Q

How long to continue enuresis alarms?

A

2 weeks of uninterrupted dry nights.

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40
Q

What drug to add if enuresis alarm is ineffective or not appropriate?

A

oral or sublingual Desmopressin (over 5+)

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41
Q

What age is desmopressin given to?

A

OVER age of 5

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42
Q
A
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43
Q

When to assess patient on desmopressin for enuresis?

A

4 weeks after initiation + continue for 3 months if working.

Withdraw repeated courses gradually at regular 3month intervals

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44
Q

What is specialist treatment for nocturnal enuresis?

A

Desmopressin + antimuscarinic

OR

imipramie

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45
Q

What are 2 SEs of desmopressin?

A

nausea

hyponatraemia (convulsions)

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46
Q

What is urinary retention?

A

Cannot pee due to medication or urothelial blockage

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47
Q

What 3 medication classes can cause urinary retention?

A

Anitmuscarinic, TCAs, sympathomimetics

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48
Q

What is acute urinary retention?

A

Emergency - happens quickly

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49
Q

What is chronic urinary retention?

A

Long time to develop cannot fully empty bladder

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50
Q

What condition is a common cause of urinary retention?

A

BPH - enlarged prostate

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51
Q

Symptoms of BPH?

A

Retention, urgency , frequency + nocturia (night)

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52
Q

1st line for Acute retention?

A

catheterisation- removes pain

Then alpha blocker given before removing it.

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53
Q

1st line for chronic retention not by BPH?

A

intermittent bladder catheterisation should be offered before an indwelling catheter.

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54
Q

What catheter given first?

A

Intermittent bladder catheterisation

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55
Q

What to give for chronic urinary retention due to BPH?

A

Alpha blockers

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56
Q

What are some SEs of using catheters?>

A

recurrent UTIs, trauma to the urethra, pain, + stone formation.

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57
Q

List 4 alpha blockers?

A

Terazosin

Doxazosin

alfuzosin

tamsulosin

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58
Q

When is treatment with alpha blockers reviewed?

A

Treatment should initially be reviewed after 4–6 weeks + then every 6–12 months.

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59
Q

What is given for BPH with enlarged prostate, raised antigens + increase risk of progression?

A

Finasteride or dutasteride

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60
Q

What 2 conditions to avoid alpha blockers in?

A

Postura hypotension

micturition syncope

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61
Q

What are 2 main SEs of alpha blockers?

A

Hypotension, dizziness/fainting, tachycardia, palpitations

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62
Q

What is a key counselling point for alpha blockers?

A

Take 1st dose at night due to risk of first dose postural hypotension

Driving can be affected.

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63
Q

What is 5-a inhibitors?

A

finasteride,
dutasteride

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64
Q

What are 2 main SEs with 5-a inhibitors?

A

male breast cancer

sexual dysfunction

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65
Q

What to counsel male patients on 5-a inhibitors?

A

Report breast symptoms - lump, pain.

Drug is excreted in semen - use contraception

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66
Q

Can women touch 5-a inhibitors?

A

No- avoid touching tablets if off child bearing age

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67
Q

What is a key SE for finasteride?

A

Rare cases of depression + suicidal thoughts - stop immediately

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68
Q

What drug is used for urological pain or pain linked to catethers?

A

Lidocaine hydrochloride gel

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69
Q

Why is Alkalinisation of urine done?

A

Relieve discomfort of cystitis caused by lower UTI.

69
Q

What is used to cause Alkalisation of urine?

A

potassium citrate

Sodium bicarbonate= in metabolic + renal disorders.

70
Q

What is given for bladder irrigation + common symptoms in patients with an indwelling urinary catheter?

A

Chlorhexidine solution

70
Q

What does chlorhexidine NOT work against?

A

Pseudomonas spp.

70
Q

What is used for Continuous bladder irrigation to treat fungal infections?

A

amphotericin B (Fungizone®) 50 micrograms/mL

71
Q

What 2 drugs are used for bladder cancer instillation?

A

doxorubicin hydrochloride and mitomycin

72
Q

Instillation of BCG helps do what?

A

Treatment of primary or recurrent bladder carcinoma in-situ

+

for the prevention of recurrence following transurethral resection.

73
Q

What drug is used for urological surgery irrigation?

A

Glycine irrigation solution 1.5% is licensed for use in transurethral surgical procedures such as prostatic resection

74
Q

What is recommended for Erectile dysfunction 1st line?

A

Life style changes- reduce smoking + alcohol

75
Q

What is 1st line Drug tx for Erectile dysfunction?

A

Phosphodiesterase type 5 inhibitors e.g. sildenafil

50mg 1 hr before sex

76
Q

MOA of Phosphodiesterase type 5 inhibitors?

A

Increases blood flow

77
Q

What are 3 short acting Phosphodiesterase type 5 inhibitor?

A

Sildenafil (1 hr before sex)

avanafil (30 mins before)

vardenafil (25-60 mins before)

78
Q

What is 1 long acting Phosphodiesterase type 5 inhibitor?

A

Tadalafil -PRN or daily lower dose (take 30 mins before)

79
Q

What is max dose of Phosphodiesterase type 5 inhibitor before being classified as a non-responder?

A

6 doses with sexual stimulation

80
Q

What is 2nd line treatment for Erectile dysfunction?

A

Intracavernosal, intraurethral or topical application of alprostadil.

81
Q

What is alprostadil?

A

prostaglandin E1

82
Q

What are 5 SEs of Phosphodiesterase type 5 inhibitor?

A

PRIAPISM, flushing, dizziness, migraine , nasal congestion

hypotension.

83
Q

What are 4 Contra-indications of Phosphodiesterase type 5 inhibitor?

A

Hypotension

taking nitrates

unstable angina/ stroke

If told not to have sexual activity

84
Q

What is priapism?

A

erection lasting longer than 4 hrs - A + E

85
Q

What 2 drugs interact with Phosphodiesterase type 5 inhibitor?

A

Nitrates

A blockers

86
Q

What is a key specific counselling point for alprosatadil?

A

Wear condom if partner pregnant, lactating, or of child bearing age.

87
Q

List 3 non- hormonal contraceptive methods?

A

Barrier

spermicidal - use in addition

IUD

88
Q

What 2 conditions are contra-indicated with IUD?

A

PID

unexplained bleeding

89
Q

What is most effective contraceptive?

A

IUD - copper

90
Q

List 3 progesterone contraceptives (POP)?

A

Desogestrel (better)

levonorgestrel

Norethiresterone

91
Q

What are 3 features of POP?

A

No pill free period - take everyday

No additional precaution needed i started within 5 days of cycle

92
Q

What to do if POP started after 5 days of cycle?

A

Extra precaution needed

93
Q

What POP needs to be taken within 12 hours or it is considered a missed pill?

A

Desogestrel

94
Q

How many hours should other POP be taken within to ensure max efficacy?

A

3 hrs

95
Q

What is the efficacy of parenteral POP injections?

A

99.8%

96
Q

What is an example of POP injection and when taken?

A

Medroxyprogesterone depot

every 13 weeks

97
Q

What are 2 negatives about Medroxyprogesterone depot
?

A

Loss of bone density

return to fertility after stopping delayed by 1 year

98
Q

What is efficacy of POP implant?

A

99,5%

99
Q

Example of POP implant?

A

Nexplanon (etonogesterel)

100
Q

How long does Nexplanon implant (etonogesterel) last?

A

lasts up to 3 years

101
Q

What is MHRA warning for Nexplanon implant (etonogesterel)?

A

migration of implant + neurovascular injury = remove it asap.

102
Q

What age is COC not given?

A

In women 50+ - safer options exist

103
Q

What 3 formulations do COC exist as?

A

Tablet

patches

vag rings

104
Q

What are 5 benefits of COC?

A

Reduced risk of ovarian, endo + colorectal cancer

aligns bleeding pattern

reduces pain + bleeding

manages endometriosis, pcos, acne, menopausal symptoms

Maintains bone density in peri-menopausal women under 50

105
Q

What 5 criteria to avoid Combined hormonal contraceptives?

A

Hypertension

35 years + who smoke

Multiple risk factor for CVD: smoking, hypertension, high BMI, DM

migraine with aura

new onset migrane without aura when using this.

106
Q

What is monophasic?

A

fixed amount of eostrogen + progesterone in each active tablet

107
Q

What is multiphasic?

A

varying amounts of two hormones

For women without withdrawal bleeding or have breakthrough bleeding with monophasic prep.

108
Q

List 3 oestrogens used for COC?

A

ethinylesterol

Mestranol

estradiol

109
Q

How does COP regime work?

A

Take 1 tablet for 3 weeks + leave 1 week for withdrawal bleeding to happen.

110
Q

Why do some COC come as packs of 28 tabs?

A

7 pills are used as dummies to increase compliance

111
Q

What to do if COC started day 6 or later of menstrual cycle?

A

Use protection for 7 days

112
Q

What precaution needed if switching from COC to COC?

A

Nothing extra needed

113
Q

What precaution needed if switching from POP to COC?

A

7 days extra precaution needed.

114
Q

What precaution needed if switching from levonogestrel-IUD to COC?

A

7 days extra precaution needed.

115
Q

What precaution needed if switching from copper-IUD to COC?

A

If combined contraceptive started up to 5 day of menstrual cycle = no additional contraception needed

If started after day 5 then = need 7 days of precaution

116
Q

What to do when switching from COC to Cu-IUD and in week 1 of cycle with no unprotected sex since start of hormonal free interval?

A

No extra precaution

117
Q

What to do when switching from COC to POP and in week 1 of cycle with no unprotected sex since start of hormonal free interval?

A

2 days precaution

118
Q

What to do when switching from COC to others and in week 1 of cycle with no unprotected sex since start of hormonal free interval?

A

7 days precaution

119
Q

What to do when switching from COC to others and in week 1 of cycle with unprotected sex since start of hormonal free interval?

A

carry on with COC until 7 days taken then no extra precaution

120
Q

What are 5 urgent reasons to STOP COP?

A

calf pain - DVT

chest pain - PE

loss of motor - stroke

stomach pain - liver effected

v high BP- stroke

121
Q

What are other reasons to stop the pill?

A

sign of breast cancer

new migraine

High BP/ BMI

vaginal bleeding

AF/ Cardiomyopathy

DVT

122
Q

When to stop the contraceptive before elective surgery?

A

stop 4 weeks before - use alternative contraceptive

123
Q

When is COC recommended after surgery?

A

2 weeks after full remobilisation

124
Q

What are 5 common SEs of hormonal contraceptives?

A

Headache

unscheduled bleeding

mood change

weight gain

libido changes

125
Q

What counts as a missed dose for contraceptives?

A

If patient diarrhoea, vomiting within 2 hrs after taking POP/COC

take another asap

126
Q

What is POP missed pill advice? (3)

A

Take as soon as you remember even if it means taking 2 in 1 day.

Need protection till 48 hrs of pill taken correctly (7 for desogestrel)

Need emergency pill if has had sex between missed pill and 2 days after restarting

127
Q

How many days of protection needed for desogestrel if taken after 2 days of period?

A

7 days of protection needed.

128
Q

What should patient do if patient missed COC after their 7 day interval?

A

Emergency contraception if unprotective sex

use condom until pill taken for next 7 days.

129
Q

What should patient do if they miss 1 pill of COC?

A

take asap

130
Q

What should patient do if they miss 2+ pills of COC and in week 1 of cycle?

A

Emergency contraception if it happened between hormonal free period and week 1.

Take pill and use condom 7 days.

131
Q

What should patient do if they miss 2+ pills of COC and in week 2-3 of cycle?

A

No emergency contraception needed

Take ur pill and 7 days condom

132
Q

What should patient do if they miss 2+ pills of COC before hormone free period?

A

take contraceptive throughout hormonal free period

133
Q

list 3 emergency contraceptives?

A

Copper IUD
ulipristal 30mg
Levonorgestral 1.5mg

134
Q

what is 1st line emergency contraception?

A

Copper iud

135
Q

When can IUD be inserted?

A

upto 5 days of unprotected sex + earliest estimated date of ovulation

136
Q

Which emergency contraception has the longest period after unprotected sex?

A

Copper IUD or ulipristal

137
Q

When to give levonorgestrel?

A

Within 72 hrs (3 days) of unprotected sex

138
Q

When to give ulipristal?

A

Within 5 days of unprotected sex

139
Q

When should 2nd dose of emergency contraceptive be given if needed?

A

if patient vomited or had diarrhoea within 3 hrs

140
Q

What hormonal emergency contraception is more effective?

A

Ulipristal

141
Q

What affects efficacy of hormonal emergency contraception?

A

BMI - give double dose of levongestrel if over >26 BMI OFF LABEL

142
Q

When to start regular contraception after levonorgestrel?

A

start regular contraception asap

use condoms until effective (7)

143
Q

When to start regular contraception after ulipristal?

A

wait 5 days before taking normal method but use condom during these days

144
Q

When to start regular contraception after ulipristal during week 1 + taking COC?

A

can start COC straight after but use condom 7 days

145
Q

What emergency contraception has 1 week delay with breastfeeding?

A

Ulipristal

146
Q

What is strength of ulipristal?

A

30mg

147
Q

What is strength of leveonorgestel?

A

1.5mg

148
Q

What is a caution for levonorgestel?

A

patients with malabsorption

149
Q

When to avoid emergency contraception?

A

severe liver impairment

150
Q

What is a caution for ulipristal?

A

severe asthmatics controlled by gluccocorticoids

151
Q

What are 4 SEs of levonorgestel?

A

breast tenderness

D + V

fatigue

haemorrhage

152
Q

What are 4 SEs of ulipristal?

A

Cycle irregularities

Altered mood

dizziness

D + V

153
Q

What does contraceptive interact with to reduce efficicacy?

A

Inducers - st john’s wort, phenytoin, carbamazepine, phenobarbital etc.

154
Q

What is an MHRA warning related to copper iud?

A

risk of uterine perforation

Severe pelvic pain, changes in period, unable to feel threads

155
Q

When is IUD removed?

A

In first trimester of pregnancy

replaced every 5-10 yrs

156
Q

When to replace levonogestrel IUD?

A

Replace 3 to 10 years

157
Q

How to take ulipristal for uterine fibroids in a missed dose over 12 hrs?

A

If a dose is more than 12 hours late, the missed dose should not be taken + the next dose should be taken at the normal time.

158
Q

Why is levonogestrel IUD better than copper?

A

Reduced bleeding + period pain + lower risk of PID

159
Q

How often is mirena changed?

A

5 years

160
Q

When not to remove IUD?

A

Mid cycle unless additional contraceptive used for 7 days.

161
Q

What does phosphodiesterase 5 inhibitors and food do?

A

Cause delayed effect

162
Q

What is first line for life-long premature ejaculation?

A

Dapoxetine - SSRI

163
Q

What is 1st line for premature ejaculation for patients not wanting drugs?

A

psychosexual counselling, education, + behavioural treatments.

164
Q

Is ulipristal recommended for patients who have taken cyp3a4 inducing meds/herbals in past 4 weeks?

A

No

165
Q

What ECP to give if patient taken CY3A4 inducer/ herbal product within 4 weeks and IUD not suitable?

A

Give 2 tablets of levonorgestrel within 72 hrs of unprotected sex.

166
Q

Which EHC pill is less effective if BMI >26kg/m2?

A

Levonorgestrel – can double up as OFF LABEL

167
Q

Levonorgestrel and ciclosporin?

A

Increase toxicity as it stops ciclosporin metabolism

168
Q

What should be monitored in patients taking mirabegron?

A

BP should be monitored before starting treatment + regularly during treatment, especially in patients with pre-existing HTN.

PRE-REG-Thuri (44 decks)

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