Wk 29 - POM to P

Question 1

What is the indication of estradiol vaginal tablets (gina)?

Answer 1

Vaginal atrophy due to oestrogen deficiency in postmeno women +50 who haven’t had period in 1 yr +/- uterus

Question 2

What are the symptoms of vaginal atrophy?

Answer 2

• Dryness
• Soreness
• Itching
• Painful intercourse

Question 3

What is the dose of Gina?

Answer 3

• Initial: OD for 2 wks
• Maintenance: 1 twice a week
• Symptoms return after break - maintenance
• Symptoms not resolved - initial then maintenance
• Takes 8-12 wks for benefit

Question 4

How do you administer Gina?

Answer 4

• Intravaginal
• Open at plunger end
• Insert applicator til resistance
• Press plunger

Question 5

What are the CI of gina?

Answer 5

• Undiagnosed vag bleed
• Untreated endometrial hyperplasia
• Angina, heart attack, stroke
• Breast, ovarian + endometrial cancer
• VTE
• Liver disease

Question 6

When would you refer for Gina?

Answer 6

• No improvement in 7 wks
• <50
• Menstruation <1 yr
• Hx endometriosis/endometrial hyperplasia

Question 7

What are the s/e of gina?

Answer 7

• Headache
• Ab pain
• Vag discomfort
• Bleeding

Question 8

When would you seek urgent medical attention when taking Gina?

Answer 8

• Jaundice or deterioration of liver
• Inc BP
• New onset migraine
• Pregnancy

Question 9

What are the age restrictions for hana and lovima?

Answer 9

• Hana: 18+
• Lovima: any

Question 10

Can hana and lovima be used during breastfeeding?

Answer 10

Yes

Question 11

What are the s/e of hana/lovima?

Answer 11

• Irregular bleed patterns
• Mood alt
• Weight changes
• Headache
• Report if severe chest/abdominal pain, DVT

Question 12

When starting desogestrel, what are the rules for newly starting?

Answer 12

• Day 1 of period
• Days 2-5, 7 day barrier

Question 13

When starting desogestrel, what are the rules after COC?

Answer 13

• No break: next day
• After pill free period 7 day barrier

Question 14

When starting desogestrel, what are the rules after POP?

Answer 14

Start next day

Question 15

When starting desogestrel, what are the rules following missariage/abortion?

Answer 15

• ASAP or w/in 5 days
• After: barrier

Question 16

When starting desogestrel, what are the rules after birth?

Answer 16

Upto 21 days after birth

Question 17

When starting desogestrel, what are the rules after ECH?

Answer 17

• Levo: straight away, barrier for 7 days
• Ulipristal: wait 5 days then start, barrier for 7 days

Question 18

What happens when vomiting occurs w/in 3-4 hrs of taking desogestrel?

Answer 18

Consider miss pill - take missed pill ASAP + next as usual

Question 19

What are the CI of desogestrel?

Answer 19

• Known/suspected breast, uterine, ovarian malignancies
• VTE
• Severe hepatic disease
• Irregular vaginal bleeding

Question 20

When would you refer to the GP when taking desogestrel?

Answer 20

• Interaction w/ st johns, anticonvulsants
• Hx thrombosis or breast cancer
• Diabetes
• Uncontrolled HPT
• Depression, ectopic pregnant
• Due to have surgery or immobile

Question 21

What is the dose for omeprazole?

Answer 21

20mg upto 14 days

Question 22

When would you refer when taking omeprazole?

Answer 22

• <18, >55 new onset
• > 45 recurrent GORD
• Red flags of gastric cancer: dysphagia, unexplained weight loss, blood in stool, Hx gastric ulcer

Question 23

What are the interactions of omeprazole?

Answer 23

• Delay elimination of diazepam, phenytoin + warfarin bc metabolised by cytochrome P450
• Red abs ketoconazole bc dec intragastric acidity

Question 24

Upto how many days can you use esomeprazole + pantoprazole?

Answer 24

• Eso: 14 days
• Panto: 4 wks, refer if no improvement after 2 wks

Question 25

What is the dose + indication of orlistat?

Answer 25

• Indication: weight loss in >28kg/m2
• Dose: 60mg TDS, upto 1 hr after meal
• 6 months treatment

Question 26

When would you refer when taking orlistat?

Answer 26

• <18 or BMI <28
• No weight loss after 12 wks
• > 6months use
• Pregnant/breastfeeding
• Kidney disease, malabs
• Rectal bleeding
• Amiodarone, diabetes, HPT, warfarin

Question 27

What are the counselling points for orlistat?

Answer 27

• S/e: Flatulence, di, fatty oil stools
• Take multivits at bedtime
• Barrier method if on contraception + persistent di
• Lose 0.5-1kg/wk

Question 28

What is the indication + dose for fexofenadine?

Answer 28

• Relieve symptoms of allergy
• 1 tab before meal
• Not for pregnancy/breastfeeding

Question 29

What are the side effects of fexofenadine?

Answer 29

• Headache, drowsiness, nausea
• Apple juice + orange dec exposure

Question 30

What is the indication + dose of mometasone nasal spray?

Answer 30

• Treat symptoms of seasonal hay fever
• 2 spray in each nostril OD til symptoms controlled, then 1 spray
• Max. 3 months

Question 31

What are the s/e of mometasone?

Answer 31

• Epistaxis (nose bleed)
• Headache
• Upper respiratory tract infection
• Nasal discomfort/ulceration

Question 32

When do you not supply mometasone?

Answer 32

• <18
• > 3 months
• Untreated localised infection around nose
• Recent nasal surgery/trauma

Question 33

When would you refer when taking mometasone nasal spray?

Answer 33

• No improvement after 14 days
• Persist more than 3 months

Question 34

What is the dose + indication of otrivine nasal spray?

Answer 34

• Symptomatic treatment of nasal congestion in common cold
• 1 spray each nostril max TDS
• Max 7 days bc rebound congestion

Question 35

What are the side effects of otrivine?

Answer 35

• Visual disturbance
• Dizziness
• Fatigue
• Nasal dryness

Question 36

What are the CI + caution of otrivine?

Answer 36

• CI: Glaucoma, after nasal surgery, pregnant + breast feeding
• Caution: HPT, QT syndrome. hyperthyroidism, cystic fibrosis, diabetes, MAOI + TCA last 2 wks