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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
***Genito-Urinary Tract System*** Name some 5-a reductase inhibitors.
- finasteride - dutasteride
26
***Genito-Urinary Tract System*** (1) What are the indications for 5-a reductase inhibitors? (2) What are the relevant doses?
- BPH - 5mg OD - Androgenic alopecia in men - 1mg OD
27
***Genito-Urinary Tract System*** What is a cautionary and advisory label for 5-a reductase inhibitors?
Label 25 - swallow this medicine whole, do not chew or crush
28
***Genito-Urinary Tract System*** What are some side effects of 5-a reductase inhibitors?
- sexual dysfunction - breast disorder/ abnormalities
29
***Genito-Urinary Tract System*** What is the important safety information for 5-a reductase inhibitors?
- 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
30
***Genito-Urinary Tract System*** When should alpha-blockers be avoided?
- postural hypotension - Hx of micturition syncope (fainting while urinating)
31
***Genito-Urinary Tract System*** What are some side effects of alpha-blockers?
- dizziness - postural hypotension - first dose may cause collapse (take before bed)
32
***Genito-Urinary Tract System*** Name some alpha-blockers.
- doxazosin - tamsulosin - alfuzosin - terazosin
33
***Genito-Urinary Tract System*** What dose of tamsulosin is used for BPH?
400micrograms M/R OD
34
***Genito-Urinary Tract System*** What are some contraindications for tamsulosin?
Hx of: - postural hypotension - micturition syncope
35
***Genito-Urinary Tract System*** What are some cautions for tamsulosin?
- severe hepatic impairment - renal impairment (if CrCl<10mL/min)
36
***Genito-Urinary Tract System*** For which age group can tamsulosin be sold for functional symptoms of BPH?
45-75yrs old
37
***Genito-Urinary Tract System*** What are some forms of non-hormonal contraception?
(1) Barrier methods - condoms/ diaphragms/ cervical caps (2) Spermicidal contraceptives (3) Intra-uterine device (copper coil)
38
***Genito-Urinary Tract System*** What is a contraindication for intra-uterine devices?
- unexplained vaginal bleeding - pelvic inflammatory disease
39
***Genito-Urinary Tract System*** (1) When does ‘missed dose’ advice apply for contraception? (2) What should be done if this applies?
(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
***Genito-Urinary Tract System*** For POP, what is the pill-free period?
There is not one, must be taken everyday
41
***Genito-Urinary Tract System*** What time period does desogestrel need to be taken within to not count as a missed pill?
Within 12hrs
42
***Genito-Urinary Tract System*** What type of drug is desogestrel?
Contraceptive Progesterone-only pill (POP)
43
***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?
(1) 3hrs (2) Desogestrel
44
***Genito-Urinary Tract System*** What is medroxyprogesterone acetate?
Parenteral POP
45
***Genito-Urinary Tract System*** What is an MHRA warning for implants?
Neurovascular injury and migration of implant (remove ASAP)
46
***Genito-Urinary Tract System*** What types of preparation are there of COCs?
Monophasic or multiphasic
47
***Genito-Urinary Tract System*** What forms does the combined hormonal contraception come in?
Tablets/ patches/ vaginal rings
48
***Genito-Urinary Tract System*** When should combined hormonal contraceptives be avoided?
- 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
***Genito-Urinary Tract System*** What precaution is needed for each type of contraception when switching TO a combined hormonal contraceptive?
From POP - 7 days extra precaution needed From levonorgestrel-IUD - 7 days extra precaution needed
50
***Genito-Urinary Tract System*** What are some reasons to STOP treatment with contraceptives for URGENT medical review?
- 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
***Genito-Urinary Tract System*** What are some reasons to STOP treatment with contraceptives for medical review?
- 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
***Genito-Urinary Tract System*** How should the combined hormonal contraceptive be managed for surgery?
Discontinue at least 4 weeks prior Use an alternative method of contraception Recommence 2 weeks after surgery
53
***Genito-Urinary Tract System*** Name some progesterone only pills.
- desogestrel - levonorgestrel - norethisterone
54
***Genito-Urinary Tract System*** Which forms of emergency contraception need to be taken ASAP?
- copper IUD - ulipristal 30mg - levonorgestrel 1.5mg
55
***Genito-Urinary Tract System*** What is the first line emergency contraception?
Copper IUD - most effective form
56
***Genito-Urinary Tract System*** Within what time period does levonorgestrel need to be taken as emergency contraception?
72hrs - 3 days
57
***Genito-Urinary Tract System*** Within what time period does ulipristal need to be taken as emergency contraception?
120hrs - 5 days
58
***Genito-Urinary Tract System*** When is a second dose of levonorgestrel or ulipristal required as emergency contraception?
If diarrhoea or vomiting within 3hrs
59
***Genito-Urinary Tract System*** Which is more effective as emergency contraception, ulipristal or levonorgestrel?
Ulipristal
60
***Genito-Urinary Tract System*** Which emergency contraceptives can be used in overweight patients (BMI>26)?
- ulipristal - levonorgestrel double dose
61
***Genito-Urinary Tract System*** What are some side effects of levonorgestrel?
- breast tenderness - D + V - fatigue - haemorrhage
62
***Genito-Urinary Tract System*** What are some side effects of ulipristal?
- cycle irregularities - D + V - altered mood - dizziness
63
***Genito-Urinary Tract System*** When should levonorgestrel and ulipristal be avoided?
Severe liver impairment
64
***Genito-Urinary Tract System*** What is an MHRA warning for IUDs?
Risk of uterine perforation
65
***Genito-Urinary Tract System*** What are the types of IUD?
(1) levonorgestrel IUD (2) copper IUD
66
***Genito-Urinary Tract System*** After how long should a copper IUD be replaced?
5-10 years
67
***Genito-Urinary Tract System*** After how long should a levonorgestrel IUD be replaced?
3-10yrs
68
***Genito-Urinary Tract System*** What are risk factors for ED?
- sedentary lifestyle - smoking - obesity - hypercholesterolaemia - metabolic syndrome
69
***Genito-Urinary Tract System*** What effect does ED have on risk of CVD?
Increases CVD risk
70
***Genito-Urinary Tract System*** What is the first line treatment for ED?
PDE-5 inhibitor
71
***Genito-Urinary Tract System*** What are some short-acting PDE-5 inhibitors?
- Sildenafil - vardenafil - avanafil
72
***Genito-Urinary Tract System*** What are some long-acting PDE-5 inhibitors?
Tadalafil
73
***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?
Max 6 doses
74
***Genito-Urinary Tract System*** What is the second line treatment for ED?
Intracavernosal/ intraurethral/ topical alprostadil
75
***Genito-Urinary Tract System*** What lifestyle changes can be implemented for ED?
- reduce alcohol intake - smoking cessation
76
***Genito-Urinary Tract System*** What is priapism?
Prolonged erection lasting longer than 4hrs

Pre-Reg (Trainee) Pharmacy (31 decks)

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