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Pharmacy Professionalism & practice > RTS- women's health > Flashcards

RTS- women's health Flashcards

1
Q

treatments for dysmenorrhoea (periods pain)

A
  1. NSAIDS
    (a) ibuprofen 200-400mg TDS - neurofen, feminax
    (b) Naproxen 250mg tabs- day 1 2 tabs to start then 1 every 6-8 hours. day 2&3 - 1 tab every 6-8 hours. MAX 3 DAYS USE - and 750mg nail. only licensed for dysmenorrhea.

If NSAIDS contra indicated -

(a) paracetamol - 500-1000mg up to QDS
(b) codeine with ibuprofen or para - co-codamol 8/500mg, solpadeine = 200/12.8g

(c) dihydrocodeine - 7.46g with paracetamol 500mg - paramol
(d) hycosine butylbromide - 10mg tabs- buscopan cramps

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2
Q

what is the limit on naproxen for dysmenorrhoea

A

max 3 days use, 750mg daily

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3
Q

brand names for ibuprofen and naproxen for period pain

A

ibuprofen - feminax, neurofen

naproxen - feminax ultra, boots period pain relief

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4
Q

red flags for dysmenorrhoea

A

pain and bleeding between periods, after sex or urination
sudden severe pain
amenorrhoea/menorrhagia
post menopausal women
unpleasant discharge
IUD
painkillers used for 3-4 cycles and not worked

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5
Q

what is menorrhagia?

A

heavy period - excessive menstrual blood loss which interferes with women physical, emotional and social quality of life.

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6
Q

treatment for menorrhagia?

A

tranexamic acid tablets - OTC (switched from POM to P in 2011)
2 x 500mg tablets TDS - for a max 4 days
Up to 4g daily (8 tabs)

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7
Q

Mechanism & indication of tranexamic acid tablets

A

anti-fibrinolytic competitive inhibitor of activation of plasminogen to plasmin
Indication - to reduce menstrual bleeding for ages 18-45 years with regular 21-35 day cycles

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8
Q

red flags for menorrhagia

A 
irregular bleeding
increase blood loss 
pain in sex
discharge
pelvic pain
tranexamic acid tabs oTC not suitable
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9
Q

physical & psychological symptoms of pre menstrual syndrome

A

physical - bloated, pain, headache, sleep issues weight gain (1kg)
Psychological - mood swings, irritable, anxiety, forgetfulness, tired, restless, loss of libido

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10
Q

how is PMS treated?

A

(a) symptom specific - NSAIDS, paracetamol, buscopan
(b) holistic - changes to diet e.g reduction in caffeine, evening primrose oil, calcium ,magnesium,
Herbal - vitex agnus -castus

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11
Q

What is thrush?

A

vulvovaginal candida

common opportunistic infection with yeast like fungus Candida albicans - vaginal area

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12
Q

precipitating factors of thrush

A 
ages 20-30
pregnancy
antibiotics
immunocompromised
diabetes mellitus
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13
Q

symptoms of thrush

A

vaginal - itchy, burn, sore, discharge or creamy and curd like or thin and watery - odourless
Dysuria- pain / sting on urination
dyspareunia - pain in sex

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14
Q

what is treatment for thrush?

Topical imidazole antifungals

A
  1. Clotrimazole:
    canesten pessary 500mg alone or with +2% thrush cream
    canesten 10% vaginal cream, +2% thrush cream
    canesten 200mg pessary x3
    canesten 100mg pessary x6
  2. Miconazole cream 2% for vulval use
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15
Q

Treatment for thrush - oral triazole antifungals

A

fluconazole - capsule 150mg single dose (canesten oral or generic)

  • Also marketed as canesten duo (fluconazole capsule and clotrimazole cream)
  • LOTS of contra indications e.g. preg/BF, under 16, >60

fluconazole 150mg / clotrimazole 2% cream is licensed for balanitis

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16
Q

Can clotromazole be used in pregnancy?

A

Yes under the physician supervision - the pessary must be inserted without an applicator

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17
Q

red flags for thrush

A 
first occurrence
>2 in 6 months
under 16 or over 60 
pregnancy 
discharge is yellow/green
blisters
abnormal bleeding
lower abdominal pain
pain in sex or urination
treatment fail
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18
Q

what is cystitis?

A

inflammation of the bladder - usually caused by bacterial infection - caused by e.g not emptying the bladder properly, bacteria transferred from anus to urethra (common as urethra shorter), soaps, chemicals, medication

19
Q

what bacteria causes cystitis?

A

E.coli

staphylococcus saprophyticus

20
Q

symptoms of cystitis

A

frequency/urgency
pain during urine
pain in blader
strong smelling urine and cloudy

21
Q

red flags of cystitis

A 
first time occurring
very dark or cloudy urine (indicates haematuria)
fever is 38 degrees or above 
vomiting
discharge
3 or more occurrences in a year
lasting longer than2 days
pregnancy 
men and children
22
Q

cystitis treatment

A 
plenty of water
avoid alcohol, caffeine, tea juices 
avoid sex until clear
paracetamol and ibuprofen 
alkalinising agents e.g - sodium citrate/bicarbonate, potassium citrate/bicarbonate
23
Q

what are the medication interactions with the alkalinising agents sodium and potassium citrate/bicarbonate?

A

sodium - lithium
Potassium - ACE inhibitors (e.g ramipril),
K+ sparing diuretics e.g amiloride,
aldosterone antagonists

24
Q

what are sodium and potassium bicarbonate contra-indicated in in cystitis?

A 
heart disease
renal disease
pregnancy 
men
children 
(sodium in hypertension)
25
Q

Name 2 types of emergency hormonal contraception

Do they interrupt existing pregnancies?

A
  1. levonelle one step (levonorgestrel 1500mcg, 1.5 mg)
  2. EllaOne - ulipristal acetate 30mg

Neither EHC interrupt existing pregnancies

26
Q

describe levonelle one step EHC?

A

prevents ovulation & fertilisation if the intercourse is in the preovulatory phase, when the likelihood is the highest
- ineffective once implantation has begun
License - >16 years

27
Q

Time frame for levonelle one step?

A

within 72 hours of intercourse - 3 days

28
Q

describe EllaOne EHC?

A

inhibits/postpones ovulation via binding to the progesterone receptor and suppress LH surge.
LICENSE- any woman of child bearing age including adolescents

29
Q

Time frame for EllaOne?

A

120 hours- 5 days

30
Q

side effects of EHC?

A

nausea, abdominal pain, headache, dizziness, fatigue, menstrual cycle disruption
NOTE: must repeat dose if vomit within 3 hours of taking.
- Must wear a barrier method e.g condoms until the next period and continue with oral contraception as usual

31
Q

how is pregnancy detected?

A

pregnancy tests - used from day 1 of missed period - measures human chorionic gonadotrophin - clearblue

32
Q

Common pregnancy symptoms

A

morning sickness (goes by week 20)
heartburn/indigestion
Constipation
Haemorrhoids - enlarged veins around anus
itching - due to stretching of skin or increased blood perfusion of skin
backache

33
Q

how can morning sickness be treated?

A 
small frequent meals
acupressure bands
ginger-  capsules, lozenges, biscuits 
pregnancy vitamins e.g pregnacare
folic acid
34
Q

treatment of haemorrhoids symptom pregnancy?

A

diet, moist wipes, sudocrem, germoloids

35
Q

treatment of itching during pregnancy

A

emollient creams etc, bio oil

if It is severe then it may be possible obstetric cholestasis - so refer then

36
Q

what is menopause?

A

end of menstruation caused by reduction in oestrogen levels.
45-55 years old it starts
Usually gradual i.e
perimenopausal stage heavy or lighter periods, and longer intervals between them

37
Q

Symptoms of menopause? last for 2-5 years

A 
hot flushes
loss of libido
vaginal atrophy - dryness, pain
headaches
moods - depression
insomnia 
UTIs
38
Q

what are treatments for vaginal dryness and hot flushes in menopause?

A

vaginal dryness - replens MD, sylk
balance activ moisture plus
acidic intravaginal moisturisers

flushes: avoid triggers e.g caffeine, exercise, cool room

39
Q

what are alternative treatments for menopause?

A

yoga, aromatherapy
vitamin D
evening primrose oil (helps breast pain) BUT contains gamma linolenic acid which is bad for flushes
red clover, soya, flaxseed - contains phytoestrogens for flushes
- st johns wort, Agnus Casus, valerian root

40
Q

What are the common minor ailments in women health?

A
  • dysmenorrhoea (period pain)
  • Menorrhagia (heavy period)
  • pre menstrual syndrome
  • thrush
  • bacterial vaginosis
  • cystitis
  • suspected pregnancy/pregnancy
  • menopause
41
Q

what is bacterial vaginosis?

A

shift in the bacterial flora - anaerobic bacterial growth which increases pH - leads to discharge, fishy odour, white, thin, grey colour.
Usually caused by soaps, IUD, sex, douching, antibiotics

42
Q

treatments for BV

A

POM - metronidazole tablets, gel, clindamycin vaginal cream

OTC - balance activ BV gel, pessaries
Canesbalance gel (contains lactic acid and glycogen which restores ph to 4-4.5) - use daily 1 week

also use of yoghurts, acidifiers (replace lactobacilli bacteria)

43
Q

how can thrush be prevented?

A

wash vagina with water
avoid soaps
use emollient e.g E45 as soap substitute and greasy moisturiser to protect vagina
toilet hygiene - wipe front and back with different paper
avoid tight clothing

ALSO pharmaceutically: yoghurt/probiotic supplements, canesflor vaginal capsules - lactobacillus planar - 1 cap each night for 6 days then 1 cap weekly for 4 weeks

Pharmacy Professionalism & practice (25 decks)

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