Wk 29 - POM to P Flashcards
What is the indication of estradiol vaginal tablets (gina)?
Vaginal atrophy due to oestrogen deficiency in postmeno women +50 who haven’t had period in 1 yr +/- uterus
What are the symptoms of vaginal atrophy?
- Dryness
- Soreness
- Itching
- Painful intercourse
What is the dose of Gina?
- 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
How do you administer Gina?
- Intravaginal
- Open at plunger end
- Insert applicator til resistance
- Press plunger
What are the CI of gina?
- Undiagnosed vag bleed
- Untreated endometrial hyperplasia
- Angina, heart attack, stroke
- Breast, ovarian + endometrial cancer
- VTE
- Liver disease
When would you refer for Gina?
- No improvement in 7 wks
- <50
- Menstruation <1 yr
- Hx endometriosis/endometrial hyperplasia
What are the s/e of gina?
- Headache
- Ab pain
- Vag discomfort
- Bleeding
When would you seek urgent medical attention when taking Gina?
- Jaundice or deterioration of liver
- Inc BP
- New onset migraine
- Pregnancy
What are the age restrictions for hana and lovima?
- Hana: 18+
- Lovima: any
Can hana and lovima be used during breastfeeding?
Yes
What are the s/e of hana/lovima?
- Irregular bleed patterns
- Mood alt
- Weight changes
- Headache
- Report if severe chest/abdominal pain, DVT
When starting desogestrel, what are the rules for newly starting?
- Day 1 of period
- Days 2-5, 7 day barrier
When starting desogestrel, what are the rules after COC?
- No break: next day
- After pill free period 7 day barrier
When starting desogestrel, what are the rules after POP?
Start next day
When starting desogestrel, what are the rules following missariage/abortion?
- ASAP or w/in 5 days
- After: barrier
When starting desogestrel, what are the rules after birth?
Upto 21 days after birth
When starting desogestrel, what are the rules after ECH?
- Levo: straight away, barrier for 7 days
- Ulipristal: wait 5 days then start, barrier for 7 days
What happens when vomiting occurs w/in 3-4 hrs of taking desogestrel?
Consider miss pill - take missed pill ASAP + next as usual
What are the CI of desogestrel?
- Known/suspected breast, uterine, ovarian malignancies
- VTE
- Severe hepatic disease
- Irregular vaginal bleeding
When would you refer to the GP when taking desogestrel?
- Interaction w/ st johns, anticonvulsants
- Hx thrombosis or breast cancer
- Diabetes
- Uncontrolled HPT
- Depression, ectopic pregnant
- Due to have surgery or immobile
What is the dose for omeprazole?
20mg upto 14 days
When would you refer when taking omeprazole?
- <18, >55 new onset
- > 45 recurrent GORD
- Red flags of gastric cancer: dysphagia, unexplained weight loss, blood in stool, Hx gastric ulcer
What are the interactions of omeprazole?
- Delay elimination of diazepam, phenytoin + warfarin bc metabolised by cytochrome P450
- Red abs ketoconazole bc dec intragastric acidity
Upto how many days can you use esomeprazole + pantoprazole?
- Eso: 14 days
- Panto: 4 wks, refer if no improvement after 2 wks
What is the dose + indication of orlistat?
- Indication: weight loss in >28kg/m2
- Dose: 60mg TDS, upto 1 hr after meal
- 6 months treatment
When would you refer when taking orlistat?
- <18 or BMI <28
- No weight loss after 12 wks
- > 6months use
- Pregnant/breastfeeding
- Kidney disease, malabs
- Rectal bleeding
- Amiodarone, diabetes, HPT, warfarin
What are the counselling points for orlistat?
- S/e: Flatulence, di, fatty oil stools
- Take multivits at bedtime
- Barrier method if on contraception + persistent di
- Lose 0.5-1kg/wk
What is the indication + dose for fexofenadine?
- Relieve symptoms of allergy
- 1 tab before meal
- Not for pregnancy/breastfeeding
What are the side effects of fexofenadine?
- Headache, drowsiness, nausea
- Apple juice + orange dec exposure
What is the indication + dose of mometasone nasal spray?
- Treat symptoms of seasonal hay fever
- 2 spray in each nostril OD til symptoms controlled, then 1 spray
- Max. 3 months
What are the s/e of mometasone?
- Epistaxis (nose bleed)
- Headache
- Upper respiratory tract infection
- Nasal discomfort/ulceration
When do you not supply mometasone?
- <18
- > 3 months
- Untreated localised infection around nose
- Recent nasal surgery/trauma
When would you refer when taking mometasone nasal spray?
- No improvement after 14 days
- Persist more than 3 months
What is the dose + indication of otrivine nasal spray?
- Symptomatic treatment of nasal congestion in common cold
- 1 spray each nostril max TDS
- Max 7 days bc rebound congestion
What are the side effects of otrivine?
- Visual disturbance
- Dizziness
- Fatigue
- Nasal dryness
What are the CI + caution of otrivine?
- CI: Glaucoma, after nasal surgery, pregnant + breast feeding
- Caution: HPT, QT syndrome. hyperthyroidism, cystic fibrosis, diabetes, MAOI + TCA last 2 wks
