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BNF Chapters > GUM > Flashcards

GUM Flashcards

1
Q

What is nocturnal enuresis

A

Involuntary discharge urine during sleep

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2
Q

When are children expected to be dry

A

5 years

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3
Q

When do you consider treatment for children

A

7 years

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4
Q

Non drug nocturnal emesis treatment

A

Fluid, toileting behaviour, reward systems, alarms , reward systems

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5
Q

Drug treatment for nocturnal emesis

A

Oral/sublingual desmopressin ig alarm can’t be used or if short term results needed can be combined with an antimuscarininc for 3 months. Imipramine can be used instead

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6
Q

What reduces contraceptive effectiveness

A

Inducers

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7
Q

What is ideal contraception strategy for HIV patients

A

Condom with long acting method like a injectable contraceptive

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8
Q

What to do if on Combined hormonal contraceptive and taking enzyme inducing drugs with griseofulvin

A

Change to reliable contraceptive namely parenteral progestogen only like norethisterone/ medroxyprogesterone or IUD like levonorgestrel. For duration of treatment on inducer and four weeks after stopping

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9
Q

CHC with short course of inducing drug

A

Can continue but use condoms for duration and for 4 weeks after

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10
Q

What is not recommended if on inducer/griseofulvin (except rifampicin/rifabutin)

A

Contraceptive patches/vaginal rings

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11
Q

Long term of inducer course when on CHC

A

Can try ethinylestradiol 50mg or more for extended or continuous regimen back to back basically if breakthrough bleeding occurs increase dose in increments of 10mcg up to 70 mcg,

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12
Q

How to use contraception when on rifampicin or rifabutin

A

IUD always recommended because it is too potent

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13
Q

Using inducers with oral progesterone

A

Change as reduced efficacy or use condoms during course and 4 weeks after

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14
Q

Using inducers with parenteral progestegen only

A

It is not affected, implants like etonogestrel may be reduced so an alternate is recommended during treatment and at least 4 weeks after or condoms during and 4 weeks after.

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15
Q

Emergency contraception interactions

A

Levonorgestrel and ulipristal acetate are induced so use copper IUD instead or increase levonorgestrel

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16
Q

When can you start contraception after emergency contraception

A

Not until 5 days after ulipristal as its effect would be reduced

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17
Q

Can you use ulipristal more than once in the same cycle

A

Yes

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18
Q

Can you use levonorgestrel more than once in cycle

A

No

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19
Q

Can you use the two EHC drugs close to each other

A

Not within 5 days

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20
Q

Which EHC is not recommended in corticosteroid treated/severe asthma

A

ulipristal

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21
Q

LARC

A

Long acting reversible contraceptives

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22
Q

CuIUD

A

Copper intrauterine device

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23
Q

Barrier methods

A

Condoms, diaphragms and cervical caps, less effective contraception but good at protecting against STI

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24
Q

spermicidal

A

can;t be used alone can be used with caps/diaphragms no evidence for doing anything more with condoms, example is noxinol

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25
Q

What may damage condoms

A

Oil based lubricants, vaseline, baby oil,

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26
Q

IUD who can/can’t use

A

Can be used for all ages except those with pelvic inflammatory disease/ unexplained vaginal bleeding

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27
Q

Bladder infection treatment

A

Chlorhexidine irrigation, possibly sodium chloride or amphotericin B

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28
Q

Bladder cancer treatment

A

Doxorubicin and mitomycin

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29
Q

Urological surgery irrigation

A

glycine

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30
Q

Highly effective contraception

A

LARC/CuIUD/ Levonorgestrel intrauterine system and progestogen only implant

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31
Q

Forms of CHC

A

Tablets, patches. Vaginal rings.

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32
Q

Effectiveness of CHC when used correctly

A

Fails 1

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33
Q

When to not recommend CHC

A

> 50

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34
Q

Monophasic coc

A

Fixed amount of oestrogen and progestogen in each active tablet

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35
Q

multiphasic

A

Varying amounts of the two hormones

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36
Q

When should non oral CHC be considered

A

Those who weigh more than 90kg

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37
Q

Disadvantages of traditional regimen

A

may be associated with disadvantages such as heavy or painful withdrawal bleeds, headaches, mood changes, and increased risk of incorrect use with subsequent unplanned pregnancy

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38
Q

What needs to be checked on COC follow ups

A

BMI, BP

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39
Q

What to do if on CHC and have a surgery

A

Stop 4 weeks before and start 2 weeks after full remobilisation

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40
Q

progestrogen only moa

A

Thicken cervical mucus to prevent penetration and may inhibit ovulation

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41
Q

When to not give parenteral progestogen

A

Without full counselling backed by pil

42
Q

What to counsel parenteral progestogen

A

Medroxyprogesterone, delayed returned of fertility and irregular cycles after discontinuation, no evidence of permanent infertility

43
Q

When is norethisterone used

A

Long acting provides contraception for 8 weeks, used as a short term interim

44
Q

What is etonogestrel releasing implant ad counselling

A

Contraception for up to 3 years, may not last three years in heavier women

45
Q

Intrauterine progestogen only device use and counselling

A

Release levonorgestrel, used for primary menorrhagia and contraception, fertility return is rapid

46
Q

Surgery and progestogen

A

Can be used as normal so often chc is switched to progestogen

47
Q

When should EHC be given after childbirth

A

21 days after

48
Q

When should EHC be given after abortion/miscarriage/ectopic pregnancy

A

5 days

49
Q

Most effective EHC

A

Copper IUD

50
Q

When can copper IUD be used

A

5 days/5 days after earliest likely calculated ovulation

51
Q

What may be given concomitantly with CuIUD

A

Antibiotic

52
Q

Is copper iud affected by bmi

A

No

53
Q

Is CUIUD affected by drugs

A

No

54
Q

Two hormonal EHC

A

Levorgestrel and ulipristal acetate

55
Q

When is levonorgestrel used

A

3 days(96 hours unlicensed)

56
Q

When is ulipristal used

A

5 days

57
Q

What is more hormonal oral effective ehc

A

Ulipristal

58
Q

High BMI >26/70kg and ehc

A

Levonorgestrel efficacy reduced so use uliprstal or double dose levonorgestrel not known what is more effective

59
Q

When to start normal contraception after levonorgestrel

A

Immediately but use condoms/abstain until effective

60
Q

When to start contraception after ulipristal

A

Wait 5 days, use a condom even afterwards until contraception kicks in

61
Q

Treating vaginal atrophy

A

Topical oestrogen in smallest effective amount can also use MR vaginal tablets and impregnated vaginal ring

62
Q

Issues with systemic vagnal atrophy treatment

A

risk of endometrial hyperplasia and carcinoma is increased

63
Q

Treating fungal vaginal infections

A

Imidazoles 114 days (clotri/miconazole) can be repeated or oral fluconazole/itracconzole use

64
Q

Treating candiasis in pregnancy

A

Clotrimazole longer treatment often needed to avoid oral

65
Q

Predisposing factors to candida

A

antibacterial therapy, pregnancy, diabetes mellitus, or possibly oral contraceptive use.

66
Q

Bacterial vaginosis treatment

A

Clindamycin cream and metronidazole gel

67
Q

Preventing vaginal infections

A

Vaginal preparations intended to restore normal acidity may prevent recurrence of vaginal infections

68
Q

Herpes treatment

A

Aciclovir, famciclovir, valaciclovir

69
Q

Trichonomal infection treatment

A

Metro/tinidazole

70
Q

Gynae surgery/antibiotic treatment gram negative

A

Metro

71
Q

Issue with aqueous medicated douches

A

may disturb normal vaginal acidity and bacterial flora

72
Q

Inducing abortion

A

Mifepristone, misoprostol, gemeprost (prostaglandins and progesterone receptor modulators )

73
Q

Inducing/augmenting labour

A

Dinoprostone, oxytocin

74
Q

Preventing labour

A

Corticosteroids/ nifedipine / oxytocin

75
Q

Treating urological pain

A

Lidocaine

76
Q

Urinary alkanising agent

A

Sodium bicarbonate

77
Q

Treating premature ejaculation

A

Dapoxetine or other SSRI even TCA

78
Q

What should be treated first erectile dysfunction or premature ejaculation

A

Erectile dysfunction

79
Q

Urinary retention is

A

Inability to voluntarily urinate

80
Q

Cause of urinary retention

A

Drugs(antimuscarinic, TCA) , BPH

81
Q

When are catheters used to treat urinary retention

A

No cause or to relieve acute painful urinary retention

82
Q

Treating acute urinary retention

A

Immediate catheterization then alphaadrenoceptor blocker when its removed for at least 2 days (alfuzosin, doxazosin, tamsulosin)

83
Q

Treating chronic urinary retention

A

Intermittent catheters if not working then indwellin catheter. If moderatesevere then offer alpha adrenoceptor blocker reviewed every 6 weeks then 6 months. If not then bethanechol

84
Q

Treating urinary retention due to BPH

A

Alpha adrenoceptor blocker, relax smooth muscle in BPH and produce an increase in urinary flow rate if enlarged then 4alpha reductase (finasteride/dutasteride) if not the surgery

85
Q

Consideration for dutasteride and finasteride

A

Contracption needed, report lumps in breasts, women of childbearing potential should avoid , excreted in semen

86
Q

Renal stone made from

A

Calcium mainly, uric acid

87
Q

When are patients susceptible to stone formation

A

decrease in urine volume and/or an excess of stone forming substances in the urine

88
Q

Stone formation risk factors

A

dehydration, change in urine pH, males aged between 40 TO 60 years, positive family history, obesity, urinary anatomical abnormalities, and excessive dietary intake of oxalate, urate, sodium, and animal protein

89
Q

Symptoms of renal stones

A

abdominal pain radiating to the groin (known as renal colic) that may be accompanied with nausea, vomiting, haematuria, increased urinary frequency, dysuria and fever

90
Q

Non drug renal stone treatment

A

Surgery, drink lots of water, avoid fizzy and limit calcium and salt, avoid oxalate rich foods like nuts or urate rich products like liver kidney

91
Q

Incontinence treatment

A

Antimuscarinic, smooth muscle

92
Q

Antimuscarinic drugs

A

Oxybutynin, tolterodine, slifenacin

93
Q

Smooth muscle drugs

A

mirabegron

94
Q

Antimuscarinic side effects

A

Antimuscarinic side effects constipation, dry mouth, sweating, dilation of pupils, dry skin, photophobia, skin flushing, NOTE antimuscarinics can affect the performance of skilled tasks e.g. driving

95
Q

When to stop HRT

A

sudden severe chest pain, sudden breathlessness (or cough with blood) unexplained swelling or severe pain in one leg severe stomach pain serious neurological effects including severe, prolonged headache, sudden partial or complete loss of vision, sudden disturbance of hearing, bad fainting attack, unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body , hepatitis, jaundice, liver enlargement , c/i, blood pressure above systolic 160 mmHg or diastolic 95 mmHg , prolonged immobility after surgery or leg injury

96
Q

COC cautions

A

Migraine (report), travel, VTE risk, risk of arterial disease, risk of arterial disease (migraine,obesity,>35, diabetes, hypertension, family history of arterial disease, smoking)

97
Q

COC side effects

A

Breast cancer risk increases then disappears 10 years after stopping,

98
Q

Vomiting/diarrhoea and coc

A

If within 2 hours take another pil if persistent vomiting in 24 hours and use additional contraception 7 days after recovery

99
Q

When can you use an emergency contraception IUD and how

A

Within 120 hours, prophylactically ABx given and STI test, Under 25yo over 25yo and have new partner/recent new partner, or partner has other partner

100
Q

Who is at higher risk of infection when given IUD and when

A

First 20 days after insertion

101
Q

General COC benefits

A

Reduced risk of ovarian, endometrial and colorectal cancer, Predictable bleeding patterns , Reduced dysmenorrhoea and menorrhagia, Management of symptoms of polycystic ovary syndrome, endometriosis and premenstrual syndrome, Improvement of acne, Reduced menopausal symptoms, Maintaining bone mineral density in perimenopausal females under the age of 50 years

BNF Chapters (11 decks)

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