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Pre-Reg (Trainee) Pharmacy > MID WEIGHTING - Genito-Urinary Tract System > Flashcards

MID WEIGHTING - Genito-Urinary Tract System Flashcards

1
Q

Genito-Urinary Tract System

What are the four main types of urinary incontinence?

A

(1) Stress
(2) Urgency
(3) Mixed
(4) Overflow

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2
Q

Genito-Urinary Tract System

What are some risk factors for urinary incontinence?

A
  • old age
  • pregnancy + vaginal delivery
  • obesity
  • smoking
  • constipation
  • FHx
  • lack of supporting tissue
  • medicines
    • diuretics/ alcohol/ caffeine - all increase urine production
    • ACEi - can cause cough
    • a-blockers - relax bladder outlet and urethra
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3
Q

Genito-Urinary Tract System

What is some non-pharmacological advice for urinary incontinence?

A
  • modify fluid intake
  • weight loss (if obese)
  • reduce caffeine
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4
Q

Genito-Urinary Tract System

(1) When should a urine dipstick test be done in urinary incontinence? (2) Why?

A

(1) All women with incontinence

(2) Test for active infection of haematuria

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5
Q

Genito-Urinary Tract System

What is the first line treatment for urgency incontinence?

A

Bladder training for at least 6 weeks

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6
Q

Genito-Urinary Tract System

What is the second line treatment for urgency incontinence?

A

Antimuscarinic (oxybutynin/ tolterodine/ darifenacin)

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7
Q

Genito-Urinary Tract System

When should immediate-release oxybutynin not be used for urgency incontinence?

A

Frail, older women at risk of severe deterioration in physical/ mental health

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8
Q

Genito-Urinary Tract System

What is the third line treatment for urgency incontinence?

A

Mirabegron

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9
Q

Genito-Urinary Tract System

How often should patients with urgency incontinence be reviewed?

A
  • treatment review after 4 weeks
  • if effective, after 12 weeks, then annually
  • every 6 months in women >75yrs
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10
Q

Genito-Urinary Tract System

What is the first line treatment for stress incontinence?

A

Supervised pelvic floor muscle training - minimum 3 months

Should include at least 8 contractions TDS

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11
Q

Genito-Urinary Tract System

What is the second line treatment for stress incontinence?

A

Duloxetine/ surgery
- duloxetine should only be offered if surgery not appropriate

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12
Q

Genito-Urinary Tract System

What is the first line treatment for mixed incontinence?

A

Bladder training for (>6 weeks) AND supervised pelvic floor training (3 months)

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13
Q

Genito-Urinary Tract System

What are some of the symptoms of pelvic organ prolapse?

A
  • vaginal bulge
  • sensation of something coming down
  • urinary/ bowel/ sexual symptoms
  • pelvic/ back pain
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14
Q

Genito-Urinary Tract System

What is the management/ treatment of pelvic organ prolapse?

A
  • minimise heavy lifting
  • prevent/ treat constipation
  • lose weight (if obese)
  • supervised pelvic floor muscle training (>16 weeks)
  • vaginal oestrogen (for women with signs of vaginal atrophy)
  • vaginal pessary
  • surgical management
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15
Q

Genito-Urinary Tract System

What is the non-pharmacological treatment of nocturnal enuresis?

A

Advice on fluid intake (no fluids 4hrs before sleep), diet, toilet behaviour, use of reward systems

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16
Q

Genito-Urinary Tract System

(1) What is second line non-pharmacological treatment for nocturnal enuresis? (2) What if this is unsuccessful?

A

(1) Alarm

(2) Alarm + desmopressin (just desmopressin if alarm not helping)

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17
Q

Genito-Urinary Tract System

In what age group can desmopressin be used for nocturnal enuresis?

A

> 5 yrs

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18
Q

Genito-Urinary Tract System

What is the specialist drug treatment for nocturnal enuresis?

A

Desmopressin +/- antimuscarinic (e.g. oxybutynin/ tolterodine)

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19
Q

Genito-Urinary Tract System

What pharmacological treatment can be offered for nocturnal enuresis, if not responding to all other treatment?

A

Imipramine

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20
Q

Genito-Urinary Tract System

What is the most common cause of urinary retention issues in men?

A

Benign Prostatic Hyperplasia

(BPH)

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21
Q

Genito-Urinary Tract System

What is the first line treatment for acute urinary retention?

A
  • immediate catheterisation to prevent pain
  • alpha-blocker for 2+ days
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22
Q

Genito-Urinary Tract System

What is the first line treatment for chronic urinary retention?

A

Long-term catheter

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23
Q

Genito-Urinary Tract System

What is the first line treatment for benign prostatic hyperplasia (BPH)?

A

Alpha blocker (to relax smooth muscle)

Finasteride or duasteride - if worsened or at high risk of progression

Surgery if very severe

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24
Q

Genito-Urinary Tract System

Besides first line treatment for acute urinary retention, what other medication can be used?

A

Neostigmine/ pyridostigmine

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25
Q

Genito-Urinary Tract System

Name some 5-a reductase inhibitors.

A
  • finasteride
  • dutasteride
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26
Q

Genito-Urinary Tract System

(1) What are the indications for 5-a reductase inhibitors? (2) What are the relevant doses?

A
  • BPH - 5mg OD
  • Androgenic alopecia in men - 1mg OD
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27
Q

Genito-Urinary Tract System

What is a cautionary and advisory label for 5-a reductase inhibitors?

A

Label 25 - swallow this medicine whole, do not chew or crush

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28
Q

Genito-Urinary Tract System

What are some side effects of 5-a reductase inhibitors?

A
  • sexual dysfunction
  • breast disorder/ abnormalities
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29
Q

Genito-Urinary Tract System

What is the important safety information for 5-a reductase inhibitors?

A
  • male breast cancer reported
  • excreted in semen (use a condom if partner likely to get pregnant)
  • finasteride: reports of depression and rare causes of suicidal thoughts
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30
Q

Genito-Urinary Tract System

When should alpha-blockers be avoided?

A
  • postural hypotension
  • Hx of micturition syncope (fainting while urinating)
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31
Q

Genito-Urinary Tract System

What are some side effects of alpha-blockers?

A
  • dizziness
  • postural hypotension
  • first dose may cause collapse (take before bed)
32
Q

Genito-Urinary Tract System

Name some alpha-blockers.

A
  • doxazosin
  • tamsulosin
  • alfuzosin
  • terazosin
33
Q

Genito-Urinary Tract System

What dose of tamsulosin is used for BPH?

A

400micrograms M/R OD

34
Q

Genito-Urinary Tract System

What are some contraindications for tamsulosin?

A

Hx of:
- postural hypotension
- micturition syncope

35
Q

Genito-Urinary Tract System

What are some cautions for tamsulosin?

A
  • severe hepatic impairment
  • renal impairment (if CrCl<10mL/min)
36
Q

Genito-Urinary Tract System

For which age group can tamsulosin be sold for functional symptoms of BPH?

A

45-75yrs old

37
Q

Genito-Urinary Tract System

What are some forms of non-hormonal contraception?

A

(1) Barrier methods - condoms/ diaphragms/ cervical caps
(2) Spermicidal contraceptives
(3) Intra-uterine device (copper coil)

38
Q

Genito-Urinary Tract System

What is a contraindication for intra-uterine devices?

A
  • unexplained vaginal bleeding
  • pelvic inflammatory disease
39
Q

Genito-Urinary Tract System

(1) When does ‘missed dose’ advice apply for contraception? (2) What should be done if this applies?

A

(1) If a patient omits a dose or has vomiting/ diarrhoea within 2hrs of taking COC or POP

(2) Take ASAP - aim to be inside effective time period

40
Q

Genito-Urinary Tract System

For POP, what is the pill-free period?

A

There is not one, must be taken everyday

41
Q

Genito-Urinary Tract System

What time period does desogestrel need to be taken within to not count as a missed pill?

A

Within 12hrs

42
Q

Genito-Urinary Tract System

What type of drug is desogestrel?

A

Contraceptive

Progesterone-only pill (POP)

43
Q

Genito-Urinary Tract System

(1) Within what time period do most POPs need to be taken to not count as a missed dose? (2) Which one is the exception?

A

(1) 3hrs

(2) Desogestrel

44
Q

Genito-Urinary Tract System

What is medroxyprogesterone acetate?

A

Parenteral POP

45
Q

Genito-Urinary Tract System

What is an MHRA warning for implants?

A

Neurovascular injury and migration of implant (remove ASAP)

46
Q

Genito-Urinary Tract System

What types of preparation are there of COCs?

A

Monophasic or multiphasic

47
Q

Genito-Urinary Tract System

What forms does the combined hormonal contraception come in?

A

Tablets/ patches/ vaginal rings

48
Q

Genito-Urinary Tract System

When should combined hormonal contraceptives be avoided?

A
  • HTN
  • migraine with aura
  • new onset migraine without aura during use of CHC
  • women with multiple risk factors for CVD (smoking, hypertension, obese, dyslipidaemia, diabetes)
49
Q

Genito-Urinary Tract System

What precaution is needed for each type of contraception when switching TO a combined hormonal contraceptive?

A

From POP - 7 days extra precaution needed
From levonorgestrel-IUD - 7 days extra precaution needed

50
Q

Genito-Urinary Tract System

What are some reasons to STOP treatment with contraceptives for URGENT medical review?

A
  • DVT - calf pain, swelling or redness
  • PE - chest pain, breathlessness, coughing up blood
  • Stroke - loss of motor/ sensory function
  • Haemorrhagic stroke - very high BP
  • Hepatotoxicity - severe abdo pain
51
Q

Genito-Urinary Tract System

What are some reasons to STOP treatment with contraceptives for medical review?

A
  • signs of breast cancer
  • new onset migraine
  • persistent unscheduled vaginal bleeding
  • high BP
  • obesity
  • DVT/ PE
  • abnormal blood clotting
  • ACS/ stroke/ PVD
  • AF
  • cardiomyopathy
52
Q

Genito-Urinary Tract System

How should the combined hormonal contraceptive be managed for surgery?

A

Discontinue at least 4 weeks prior

Use an alternative method of contraception

Recommence 2 weeks after surgery

53
Q

Genito-Urinary Tract System

Name some progesterone only pills.

A
  • desogestrel
  • levonorgestrel
  • norethisterone
54
Q

Genito-Urinary Tract System

Which forms of emergency contraception need to be taken ASAP?

A
  • copper IUD
  • ulipristal 30mg
  • levonorgestrel 1.5mg
55
Q

Genito-Urinary Tract System

What is the first line emergency contraception?

A

Copper IUD - most effective form

56
Q

Genito-Urinary Tract System

Within what time period does levonorgestrel need to be taken as emergency contraception?

A

72hrs - 3 days

57
Q

Genito-Urinary Tract System

Within what time period does ulipristal need to be taken as emergency contraception?

A

120hrs - 5 days

58
Q

Genito-Urinary Tract System

When is a second dose of levonorgestrel or ulipristal required as emergency contraception?

A

If diarrhoea or vomiting within 3hrs

59
Q

Genito-Urinary Tract System

Which is more effective as emergency contraception, ulipristal or levonorgestrel?

A

Ulipristal

60
Q

Genito-Urinary Tract System

Which emergency contraceptives can be used in overweight patients (BMI>26)?

A
  • ulipristal
  • levonorgestrel double dose
61
Q

Genito-Urinary Tract System

What are some side effects of levonorgestrel?

A
  • breast tenderness
  • D + V
  • fatigue
  • haemorrhage
62
Q

Genito-Urinary Tract System

What are some side effects of ulipristal?

A
  • cycle irregularities
  • D + V
  • altered mood
  • dizziness
63
Q

Genito-Urinary Tract System

When should levonorgestrel and ulipristal be avoided?

A

Severe liver impairment

64
Q

Genito-Urinary Tract System

What is an MHRA warning for IUDs?

A

Risk of uterine perforation

65
Q

Genito-Urinary Tract System

What are the types of IUD?

A

(1) levonorgestrel IUD
(2) copper IUD

66
Q

Genito-Urinary Tract System

After how long should a copper IUD be replaced?

A

5-10 years

67
Q

Genito-Urinary Tract System

After how long should a levonorgestrel IUD be replaced?

A

3-10yrs

68
Q

Genito-Urinary Tract System

What are risk factors for ED?

A
  • sedentary lifestyle
  • smoking
  • obesity
  • hypercholesterolaemia
  • metabolic syndrome
69
Q

Genito-Urinary Tract System

What effect does ED have on risk of CVD?

A

Increases CVD risk

70
Q

Genito-Urinary Tract System

What is the first line treatment for ED?

A

PDE-5 inhibitor

71
Q

Genito-Urinary Tract System

What are some short-acting PDE-5 inhibitors?

A
  • Sildenafil
  • vardenafil
  • avanafil
72
Q

Genito-Urinary Tract System

What are some long-acting PDE-5 inhibitors?

A

Tadalafil

73
Q

Genito-Urinary Tract System

What is the maximum number of doses of a PDE-5 inhibitor that a patient should have before being classified as a non-responder?

A

Max 6 doses

74
Q

Genito-Urinary Tract System

What is the second line treatment for ED?

A

Intracavernosal/ intraurethral/ topical alprostadil

75
Q

Genito-Urinary Tract System

What lifestyle changes can be implemented for ED?

A
  • reduce alcohol intake
  • smoking cessation
76
Q

Genito-Urinary Tract System

What is priapism?

A

Prolonged erection lasting longer than 4hrs

Pre-Reg (Trainee) Pharmacy (31 decks)

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