Symptoms in pharmacy Women's Health Flashcards
1
Q
Conditions for womens health
A
- Cystitis
- Vaginal thrush
- Dysmenorrhoea
- Menorrhagia
- Emergency hormonal contraception
- Progestogen only contraception
- Menopause and perimenopause
2
Q
Cystitis
Upper Urinary Tract Infection
(UTI)
A
- Infections of kidney and infection or inflammation of ureter
3
Q
Lower Urinary Tract Infection
(UTI)
A
- Infection/ inflammation of
bladder - Urethritis
- Infection/inflammation of
urethra
4
Q
Cystitis
A
- Collection of urinary symptoms including
dysuria (pain on urinating), frequency and urgency - Occurs when bacteria pass up along urethra and enter and multiply within the bladder, causing inflammation
- Usually caused by bacteria from the GI tract, most commonly E.coli
5
Q
Who is most likely going to be effected
A
- 1 in 2 women will experience an episode during their lifetime
- Rare in males as urethra is longer, so harder for bacteria to reach the bladder
6
Q
Causes of cystitis
A
- Wiping back to front, exposing urethra to faecal bacteria
*Previous infection not fully clearing
*Diabetes- sugary environment for bacteria to thrive
*‘Honeymoon cystitis’- sexual intercourse causing minor trauma or pushing bacteria along urethra - Post menopause change in vaginal lining
7
Q
Symptoms of UTI
A
- itching or pricking sensation in urethra
- More frequent desire to pass urine
- Urgent need to pass urine throughout day and night
- Can only pass few burning, painful drops of urine (dysuria)
- Bladder may not feel completely empty after urinating
- Cloudy and strong-smelling urine: sign of bacterial infection
8
Q
Symptoms Needing Referral UTI
A
- Blood in urine - kidney stone pain and potential bladder cancer
- Suggesting upper UTI symptoms
- Abnormal vaginal discharge
- Longer than 3 days
9
Q
Cystitis – Self-management
A
- Avoiding irritants - Vagina self cleans
- Drink plenty of water - drinks loads to encourage urination to flush out the bacteria, but this will cause discomfort.
- Wait 20 seconds after passing urine then strain to empty final drops. Leaning back may help, rather than the usual sitting posture - enable fully empty
- Wipe front to back
- Urinate after sex
10
Q
Home remidies for UTI
A
- 300mL every day has a bacteriostatic effect Cramberry juice
11
Q
OTC management of UTI
A
- Paracetamol and/or ibuprofen for up to 2 days
- Help with dysuria and any discomfort felt
- Potassium citrate or sodium citrate
*Idea is that they make urine more alkaline to help with dysuria
*Will cause symptomatic relief but not treat the cause (infection)
12
Q
Cautions of taking alkalising agents
A
- Take stated dose of product- some cases of severe hyperkalaemia reported
- Contraindicated in patients taking medication
- Unplesent taste so dilute with cold water
- Contraindications if pregnant
13
Q
Antibiotics for UTI
A
- Some community pharmacies involved in a pilot scheme to test and treat UTIs within the pharmacy
- treat uncomplicated UTIs in women aged 16-65 year
- Use urine dipstick positive, or if symptoms strongly suggestive of UTI
- Trimethoprim or Nitrofurantoin for 3 days usually
14
Q
Vaginal Candidiasis (Thrush)
A
- Common yeast infection, known as thrush
- Caused by Candida albicans
- Usually harmless, but can be uncomfortable and recurrent
- Not an STI
15
Q
Symptoms of Vaginal thrush
A
- Itch (pruritis) around the vagina - intense burn scraching check if it is caused by new toiletries could be dermatitis
- Vaginal discharge - white cream coloured cottage cheese
- Bacterial infection - green yellow odor
- Vaginal soreness
*Dysuria - pain on urination
*Dyspareunia - pain during sex
16
Q
Risk factors vaginal thrush
A
- Yeast likes to grow in warm, moist conditions and develops if the balance of vaginal bacteria changes
- women of childbearing age due to low vaginal pH and presence of glycogen
- Recently taken a course of antibiotics
- Pregnancy
- Diabetes (especially if poorly controlled)
- Weakened immune system
17
Q
Prevention of Thrush
A
- Dry area properly after washing
*Avoid tight/nylon tights or underwear - Avoid perfumed soaps and shower gels, vaginal douches and deodorants, and foam baths
- Wipe front to back after bowel motions
18
Q
Vaginal thrush management
A
- Topical vaginal cream
- Pessary
- Oral capsule
19
Q
External creams for Trush
A
- Clotrimazole 2% cream Canestan
- Used for immediate symptomatic relief of itch
- Apply thinly to vulva and surrounding area BD-TDS until symptoms disappear
20
Q
Side effects of creams for thrush
A
- Itching/burning sensation
- Can damage latex contraceptives- use alternative precautions for at least 5 days after using product
- Need to be motivated to continue using it if using alone
21
Q
Internal cream for vaginal cream
A
- Clotrimazole 10% cream Canesten
- intravaginally using the applicator supplied
*One-off treatment, best administered at night
22
Q
Internal cream side effects of vaginla thrush
A
- Itching/burning sensation
- Convenient but some women uncomfortable with the formulation
- Can damage latex contraceptives- use alternative precautions for at least 5 days after using product
- Not to be used during periods- may wash out
23
Q
Pessary treatment for vainal thrush
A
- Clotrimazole 500mg, 200mg or 100mg Canesten
- 500mg pessary one off treatment at night repeated for 7 days
- 200mg pessary - One pessary daily at night for 3 days
- 100mg pessary - Two pessaries daily at night for 3 days OR one pessary daily at night for 6 days
24
Q
Side effects of pessary for vaginal thrush
A
- Convenient but some women uncomfortable with the formulation
- If using longer course, must be motivated to complete course
- Can damage latex contraceptives- use alternative precautions for at least 5 days after using product
- Check patient understanding with regards to application
- Not to be used during periods- may wash out
- Do not use tampons
25
Oral capsule canestan for vaginal thrush
Fluconazole 150mg oral capsule - oral capsule
- One-off dose, to be swallowed whole
- May take 12-24 hours for symptoms to improve
26
Drug interactions with Fluconazole
- Warfarin
- Statins,
- Phenytoin
- Rifampicin
- Ciclosporin
- Cheophylline
- Single dose may not affect drug levels too much
27
Thrush symptoms for males
- Male may catch infection from a female partner
- Irritation, burning and redness around the head of the penis and under the foreskin
- White/cream-coloured discharge, thick in consistency like cottage cheese
- Discharge which may or may not have an unpleasant smell
- Difficulty pulling back the foreskin
28
Treatment for male thrush
- Azole external cream BD for 6 days or oral fluconazole STAT
29
Refer to the GP for thrush
- First occurrence of symptoms- to confirm diagnosis
- Allergic to antifungals
- Pregnant or breast feeding
* Immunocompromised
* More than 2 thrush attacks in previous 6 months
* Previous exposure to STI or partner with STI
* Women aged under 16 or over 60
30
Primary Dysmenorrhoea
- Pain without underlying causes
- Manage in community pharmacy
- 1 in 2 women suffer peaking at 17-25 years of age
| Period pains
31
Secondary Dysmenorrhoea
- Pain with underlying disease, e.g.
endometriosis or pelvic inflammatory disease
- Older women refer to the GP >30
32
Symptoms of Primary Dysmenorrhoea
- Cramping lower abdominal pain that often begins the day before bleeding starts
- Pain gradually eases and is gonew after the first day
- Not in first few months from first period as ovulation doesn't occour
33
Mittelschmerz
Ovulation pain. This pain is mid-cycle at the time of ovulation. It usually lasts a few hours, some report some bleeding too
34
# non-drug
Management of Primary Dysmenorrhoea
- Exercise (endorphins help)
* TENS machine (alters ability to receive/perceive pain signals)
* Acupuncture
* Locally applied low-level heat (heat pads or even warm bath)
* Supplements like fish oil or vitamin B- evidence is patchy
35
# Drug management
Management of Primary Dysmenorrhoea
- Simple analgesia (NSAIDs best)
- Hyoscine butylbromide (antispasmodic)– evidence is patchy
- Caffeine (enhance analgesic effect)
36
Dysmenorrhoea- NSAIDs
- Pain of dysmenorrhoea linked to increased prostaglandin activity
- NSAIDs block synthesis of prostaglandins, which is why they are effective in treating period pains
- If not working then naproxen
37
Menorrhagia
- Term refers to heavy menstrual bleeding
- This excessive blood loss interferes with a woman’s physical, social, emotional and material quality of life
- Loss of 60-80ml of blood about 20ml more
38
Treatment for Menorrhagia
- Tranexamic acid
- Inhibits fibrinolysis
- Increased clot formation
- Reduced blood loss
- Take once heavy bleeding has started
- Two x 500mg tablets TDS until symptoms alleviated max of 4
- Repeat each menstration
39
When do you refer to the GP vaginal bleeding
- Women under 18 or over 45 years of age
- Tried tranexamic acid for three menstrual cycles without a reduction in bleeding and contraindications
- Breastfeeding
- Obease and diabetic
- Signs of anaemia and spotting with clots
40
# Oral Contraception
Oral Contraception
* Type of progesterone-only pill (POP)
* Can be 99% effective in preventing pregnancy
* Lovima and Hana only licecenced and contraceptive for women of childbearing age 18
* 1 tablet daily no breaks between packs
41
Oral Contraception contraindications
- Blood clots, cancer, peanut allergy as Lovima contains soya bean oil
- Refer anyone with clinically relevant interaction such as antiepileptics
42
How should the contraceptive pill be taken
- Day 1 of period, otherwise will need additional barrier contraception if starting on days 2-5.
- Under 12 hours take ASAP and continue as normal
- Over 12 hours take ASAP and use barrier methods for 7 days and may need EHC if unprotected sex occours
43
Side effects of oral contraception
- Irregular periods, altered mood, headaches, nausea, weight changes
* If vomits within 3-4 hours, follow missed pill rules
44
Regulations when supplying oral contraceptives
- First supply- up to 3 months can be supplied
- Repeat supply- up to 12 months can be supplied
- Women under 18- up to 3 months can be supplied
- Not pregnant
- No bleeding between period/after sex
- No health conditions or meds taken currently
- No allergies
45
Emergency Hormonal
Contraception
- Handle in private area as it is sensitive
- Levonorgestrel 1500 microgram tablet Levonelle
- Ulipristal acetate 30mg tablet Ella One
- Can sell over age of 16
- If PGD is obtained then able to sell from age 13
- Next period may be sooner, later or on time if 3 days later take preg test
46
# Why?
Sale and supply of EHC
- Failure of barrier contraceptive method
* Missed contraceptive pills
- Unprotected sex
47
# When?
Questioned asked before supply of EHC
- Careful when wording this question & explain why asking
* EHC most effective the sooner it is taken after unprotected sex
* The answer will influence what you can supply them
48
Ulipristal Acetate
- Can be used within 5 days of unprotected sex
- Can still supply if patient is over 70kg
- Vomit in three hours can take another
- Avoid in severe liver impairment and severe
asthma using glucocorticoids
- Avoid in those taking enzyme inducers
- Avoid breastfeeding for 7 days
- Use barrier until next period
49
Levonorgestrel
- Only use within 3 days
- Less effective if over 70kg
- Vomit in 3 hours take another ASAP
- Avoid in severe liver impairment, inflammation of fallopian tubes and severe malabsorption syndromes
- Not harmful if straight after breastfeeding
- Continue with regular contraceptive
50
Long-term contraception and sexual health
- May be appropriate to discuss long-term contraception options at point of supply if coming back to the pharmacy multiple times
- EHC doesn’t protect against STIs – may need referring to sexual health clinic
51
Perimenopause
Woman has irregular cycles of ovulation and menstruation leading up to menopause, continues for 12 months after final period
52
Menopause
Biological state having occurred when a woman has not had her period for 12 consecutive months. The ovaries stop maturing eggs and secreting oestrogen + progesterone, menstruation stops and she can no longer conceive.
53
Symptoms of menopause
- Hot flushes, sweats
- Joint and muscle pain
- Vaginal dryness, urinary frequency, UTIs
- Low mood, reduced libido
54
# Menopause
Self management from hot flushes
- light clothing, cool showers, using fans
- Keep bedroom cool at night
- Avoid triggers- caffeine, spicy food, smoking, alcohol
- Exercise & lose weight if overweight
55
# Menopause
Management of Weak bones
- Due to decreased oestrogen theres an increased risk of osteoporosis
- Resistance exercise, healthy diet with sources of calcium, getting some sunlight
- Stop smoking, less alcohol & calcium/vit D supplements
56
OTC meds for Vasomotor symptoms of menopause
- Black cohosh - some evidence but not robust and interactions with meds
* Isoflavones
* St John’s Wort
57
OTC meds for Urogenital Symptoms of menopause
* Vaginal dryness- OTC vaginal moisturisers and lubricants
58
Estradiol tablets
Local vaginal HRT to treat post-menopausal vaginal atrophy caused by low oestrogen
59
Symptoms of vaginal atrophy
Vaginal dryness, soreness, itching, burning, irritation, painful sexual intercourse
60
# Menopause tablet
Gina
- 10 microgram vaginal tablets
- 1 tablet inserted intravaginally daily for two weeks
- Dose Maintenance: 1 tablet inserted intravaginally twice a week
- Try to use for shortest effective duration
61
Selling Estradiol OTC
- Treatment of vaginal atrophy
- Aged 50 and over who havent had a period for a year
62
Contraindications Estradiol
- Liver disease, current
- recent heart attack or ischaemic
- stoke
- breast/ovarian/vaginal infection
63
Counselling Points for menopause meds
- tablets are NOT to be taken orally! Should be an applicator in the box too to correctly administer intravaginally
- May take 8-12 weeks to fully feel benefit
64
Ongoing supply of meopause meds
- No restriction of max quantity
- return to pharmacy for review after 7 weeks if using for the first time OR every three months thereafter
- Supply one box at a time
