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OTC > Women's & Men's Health > Flashcards

Women's & Men's Health Flashcards

1
Q

What are the common bacteria responsible for cystitis? (3)

A
  1. E.coli
  2. Staphylococcus
  3. Proteus (Gram -ve)
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2
Q

Name the symptoms of cystitis? (4)

A
  1. Dysuria (pain)
  2. Increased frequency
  3. Increased urgency
  4. Cloudy & smelly urine
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3
Q

Red flags/Referral for cystitis? (11)

A 
1. Men
2 Children
3. Pregnant women
4. Recurrent x3 in 12 months or x2 in 6 months
5. Deep abdo pain (kidney?)
6. Blood in urine  
7. Failed treatment
8. Loin pain
9. Fever, vomiting & nausea 
10. Longer than 48 hours 
11. Vaginal discharge
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4
Q

Treatment options for cystitis? in normal and pregnant patients.

A

Pain relief - paracetamol/ibuprofen
Fluids (to avoid dehydration)

  1. Nitrofurantoin 100mg MR BD for 3 days (Avoid at term & avoid eGFR below 45)
    OR
  2. Trimethoprim (if low risk of resistance) 200mg BD for 3 days. (Avoid in pregnancy)

If no improvement after 48 hours:

  1. Pivmecillin 400mg initial dose then 200mg TDS for a total of 3 days
  2. Fosfomycin 3g single dose
Pregnant:
1. Nitrofurantoin 100mg MR BD for 7 days (avoid at term)
2. If cultures specified: 
Amoxicillin  500mg TDS for 7 days
Cefalexin 500mg BD for 7 days
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5
Q

Should you recommend potassium citrate/sodium citrate/cranberry to patients in cystitis?

What patients should avoid each of these?

A

No - no longer recommended by NICE

Potassium citrate:
those taking potassium-sparing diuretics, aldosterone antagonists & ACE inhibitors

Sodium citrate:
hypertensive patients, heart disease & pregnant women

Cranberry juice:
Diabetics

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6
Q

Symptoms of vaginal thrush? (3)

A
  1. Itch (Puritis)
  2. Burning/discomfort in vaginal area
  3. Watery/Thick cream curd like discharge
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7
Q

Referral points for vaginal thrush? (11`)

A
  1. Yellow/Green discharge - bacterial vaginosis? chlamydia? gonorrhea?
  2. Recurrent x2 in 6 months
  3. First time
  4. History of STI
  5. Under 16 or over 60
  6. Blood in discharge
  7. Abdo pain or dysuria
  8. Pregnant or suspected pregnancy
  9. Vaginal sores, ulcers
  10. Abnormal or irregular bleeding
  11. No improvement within 7 days of treatment
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8
Q

Treatment options for thrush? include drug class and dose

How about for over 60?
12-15 age?
Breastfeeding?

A
  1. Clotrimazole (imidazole)
    10% cream - 5g in 1 dose
    Pessary - 200mg 3 nights OR 500mg 1 night
2. Fluconazole (triazole)
150mg capsule (not licensed for under 16)

Over 60?
Oral antifungals instead of intravaginal for ease of administration

12-15?
topical clotrimazole 1% or 2% applied 2–3 times a day. NO ORAL OR INTRAVAGINAL

Breastfeeding?
Initial course of intravaginal clotrimazole or miconazole, or oral fluconazole (if an intravaginal antifungal is unacceptable to the woman)

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9
Q

Which medicines can cause medicine induced thrush? (7)

A
  1. Abx
  2. Corticosteroids
  3. Immunosuppressants
  4. Oral contraceptives
  5. Tamoxifen (used to prevent/treat breast cancer)
  6. HRT
  7. Raloxifene
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10
Q

Fluconazole interacts with other medicines - such as?

A
  1. Anticoagulants
  2. Ciclosporin
  3. Rifampicin
  4. Tacrolimus
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11
Q

Counselling points for thrush?

A
  1. Oral treatments may take 12-24 hours to take effect
  2. Sexual partners may use the cream - recommended
  3. Avoid wearing nylon tights, tight underwear - instead wear cotton & loose fitting clothes
  4. Avoid perfumes and deodorants
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12
Q

What are the two EHC available & in what time period/age group can they be used?

A

Levonelle (Levonorgestrel) 150mg
To be used within 72 hours (*between 72-96 hours - unlicensed use)
16 years and above

EllaOne (Ulipristal acetate) 30mg
Within 120 hours
Any female of childbearing age

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13
Q

Can EllaOne (Ulipristal) be used in…?

  1. Breastfeeding
  2. Hepatic Impairment
  3. Renal Impairment
A
  1. Avoid breastfeeding for 1 week after taking it as it is present in milk
  2. Avoid in severe hepatic impairment
  3. N/A
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14
Q

What patient advice should be given for EllaOne?

A
  1. if vomiting occurs within 3 hours - take another dose
  2. next period may be early or late
  3. seek medical attention if any lower abdo pain occurs because this could signify ectopic pregnancy

Also:
Barrier method should be used
pregnancy test should be performed if next period is more than 7 days late or lighter than usual
pregnancy test should be done if hormonal contraception is started soon after use

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15
Q

What’s the difference in doses of Levonorgestrel for emergency contraception and contraception?

A

Emergency:
1.5mg for 1 dose preferably within 12 hours no later than 72 hours.
OR
3mg for 1 dose - this dose should be considered for patients with body weight over 70kg or BMI over 26 (UNLICENSED USE)

Contraception:
30micrograms daily starting on day 1 of the cycle. dose taken same time of day. if later than 3 hours should be regarded as a missed pill

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16
Q

Levo orally for ECH with an enzyme inducer. What happens and what should change?

A

effectiveness of levo is decreased with enzyme inducers (even upto 4 weeks after stopping).

A copper intra-uterine device should be used preferably.
if not then dose of levo should be increased to 3mg.

No need to increase dose for ECH if pt taking abx that are not enzyme inducers

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17
Q

What are some LEVO intrauterine devices available?

A

Kyleena 19.5mg
Jaydess 13.5mg
Levosert 20micrograms/24hours
Mirena 20micrograms/24hours

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18
Q

What is contraindication for oral use of levonorgestrel?

A
  1. Acute porphyrias
    Great care must be taken when prescribing for patients with acute porphyria, since certain drugs can induce acute porphyric crises. Since acute porphyrias are hereditary, relatives of affected individuals should be screened and advised about the potential danger of certain drugs.
  2. History of breast cancer but can be used after 5 years if no evidence of disease & non-hormonal contraceptive methods unacceptable
  3. Severe arterial disease
  4. Undiagnosed vaginal bleeding
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19
Q

What are the Enzyme Inducers? SCRAP GPS

A 
Sulfonyureas
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin

Griseoluvin
Phenolbarbitone
St Johns Wort

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20
Q

What is there a risk of when stopping Levo for contraception?

A

Small risk of breast cancer with oral use of levo

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21
Q

Can Levonelle be used in…?

  1. Breastfeeding
  2. Hepatic Impairment
  3. Renal Impairment
A
  1. Yes - Progestogen-only contraceptives do not affect lactation.
  2. Avoid in severe hepatic impairment
  3. N/A
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22
Q

Patient advice with Levo for ECH ?

A
  1. Vomiting occurs within 3 hours - replacement
  2. Next period may be early or late
  3. Seek help with abdo pain
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23
Q

What age can Levonelle One Step be sold to as ECH?

A

16 years old

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24
Q

in which patients should there be a caution with EllaOne

A

Uncontrolled severe asthma

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25
Q

What’s an alternative to oral ECH and up to when can it be used?

A

Intra-uterine device

up to 5 days/120 hours after unprotected sex or within 5 days of expected ovulation

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26
Q

Does Levonelle or EllaOne contraindicate the continuation of regular hormonal contraception?

A

Levonelle no

EllaOne - not contraindicated but can reduce its contraceptive action

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27
Q

After how many days after taking Levonelle or EllaOne should a woman be referred if her periods are delayed by how many days?

A

5 days with Levo One Step

7 days with EllaOne

28
Q

What is Naproxen OTC used for & what age group?

A

Dysmenorrhoae

women aged 15-50 years

29
Q

How does Naproxen work?

A

It inhibits prostaglandin synthesis by it’s action on cyclo-oxygenase

30
Q

Cautions and when to refer with Naproxen?

A
  1. Peptic ulceration/GI bleeding
  2. Hypersensitivity to naproxen and naproxen sodium
  3. Bronchial asthma or allergic disease since previous use of naproxen/NSAIDs
  4. Pregnant/breastfeeding
  5. Heart failure, kidney/liver disease
  6. Avoid in pts on anticoagulants - as naproxen increases bleeding time and decreases platelet aggregation
31
Q

How to take Naproxen?

A

1st dose - 2 tabs
2nd dose - after 6-8 hours take one more tablet if needed

No more than 3 tabs a day
No more than 3 days use in a month
Swallow whole with water with or after food

32
Q

Side effects of Naproxen?

A 
GI in nature 
Nausea
Vomiting
Diarrhoea
Constipation 
Flatulence 
Dyspepsia
Abdo pain 
Heartburn
Epigastric distress
33
Q

What is the indication of tranexamic acid? Who can use it?

A

Heavy bleeding (Menorrhagia) over several cycles in women aged 18 years and over, with regular 21-35 day cycles and no more than 3 days individual variation in cycle duration

34
Q

Mode of action of Tranexamic acid?

A

Antifibrinolytic which inhibits fibrinolysis - increasing clot formation and reduces blood loss.

35
Q

Contraindication with Tranexamic acid? (8)

A
  1. Mild renal insuffiency
  2. Active thromboembolic disease
  3. Previous thrombolic event and family history
  4. Haematuria
  5. Irregular menstrual bleeding
  6. Pts on warfarin or other anticoags
  7. Pts taking combined oral contraceptives or unopposed oestrogen or tamoxifen
  8. Pregnancy
36
Q

How to take tranexamic acid? Dosage?

When to stop it if not working?

A

Only take it once heavy bleeding has started

2 tablets TDS for as long as needed but max 4 days. Totaly of 4g daily (8 tabs) should not be exceeded.

No improvement within 3 cycles

37
Q

Side effects of Tranexamic acid?

A

Unusual but nausea, vomiting & diarrhoea

Very rare - visual disturbances & thromboembolic events

38
Q

What is LUTS and its symptoms?

A

Lower urinary tract symptoms

Voiding: weak or intermittent urinary stream, hesitancy, terminal dribbling & incomplete emptying

Storage: urgency, frequency, incontinence and nocturia

Post-micturition symptom is post-micturition dribbling

39
Q

What OTC treatment is available for LUTS?

Which age group does it affect?

A

40 years and above especially above 65

Tamsulosin (alpha blocker) can be used for upto 6 weeks with a medical diagnosis required before any further treatment after this time.

40
Q

When should you refer with LUTS

A 
Pain on micturition
Blood in urine
Cloudy urine 
Fever
Incontinence

No improvement/getting worse with treatment after 14 days

41
Q

What is there a risk of when tamsulosin given with other anti-hypertensives ? esp those with significant alpha1-adrenoceptor antagonist activity e.g…..

A

Enhanced hypotensive effect

Doxazosin
Indoramin
Verapamil 
Prazosin 
Terazosin
42
Q

Mild symptoms of LUTS can managed with lifestyle advice such as…?

A
  1. Prudent fluid intake
  2. Balanced diet
  3. Regular exercise
  4. Limiting caffeine and alcohol
43
Q

What is the MOA of Tamsulosin?

A

Alpha 1 blocker - relaxes smooth muscle around the prostate and bladder outlet resulting in increased urinary flow

44
Q

OTC is indicated for which age group?

Directions to take?

A

45-75 years old
400ug cap swallowed whole after the same meal each day

Symptoms should improve within a few days but can take at least a month

45
Q

What are the contraindications for the use of Tamsulosin? (3)

A
  1. Previous prostate surgery
  2. Suffer from dizziness/fainting/postural hypotension
  3. Planned cataract surgery or recent blurred/cloudy vision not seen by GP yet
46
Q

What are the common side effects of Tamsulosin? (7)

A
  1. DIZZINESS (CAUTION as it can reduce blood pressure)
  2. Headache
  3. Palpitations
  4. Postural hypotension
  5. Nausea/vomiting
  6. Constipation/Diarrhoea
  7. Dry mouth
47
Q

Why is Tamsulosin contraindicated in those having cataract surgery?

A

Rare - but can cause intraoperative floppy iris syndrome

48
Q

Are herbal remedies ok to recommend for LUTS?

A

NICE advices against herbal remedies/homeopathy/acupuncture as no evidence for it

49
Q

What is the OTC option for ED?

A

Sildenafil - 18 years and above

50
Q

What are the contraindications for sildenafil? (5)

A 
1. Heart issues:
Heart attack/stroke in last6 months 
Hypotension <90/50
Poor/uncontrolled hypertension 
Unstable angina 
Irregular heat beat/palpitations 
Heart failure
  1. Hepatic disease /cirrhosis of liver
  2. Renal impairment less than <30
  3. Blood disorders - anaemia /leukaemia
  4. Active stomach/gastric ulcers
51
Q

What are the contraindicated medicines with sildenafil?

A
  1. Nitrates (nicorandil, glyceryl trinitrate, isosorbide )
  2. “Poppers” (amyl nitrite) for recreational purposes
  3. CYP3A4 inhibitors - cimetidine, itraconazole, ketoconazole, erythromycin, rifampicin or diltiazem
  4. Alpha-blockers - alfuzosin, doxazosin or tamsulosin
52
Q

What are the main concerns with the use of Sildenafil ? MHRA advice?

A

Safety in those with recent cardiovascular disease events such as heart attack, stroke and its use at the same time as nitrate drugs for angina.

MHRA advice that cardio fitness for sex can be screened by asking pt if they can walk briskly for 20mins or climbs two flights of stairs without getting breathless

53
Q

What class is sildenafil and its MOA?

A

Phosphodiesterase type 5 (PDE5) inhibitor

Prevents the breakdown of cyclic guanosine monophosphate (cGMP)

cGMP relaxes the muscle in penis so that blood can floe and produce an erection. sexual stimulation is still needed to produce erection.

54
Q

How should Sildenafil be taken? & pt advice (5)

A

No more than 1 50mg tablet to be taken per day

with water approx 1 hr before activity (can be taken upto 4 hr before activity)

with or without food

fatty meals can delay absorption

grapefruit and grapefruit juice inhibit the CYP3A4 enzyme and can lead to higher sildenafil levels in blood

55
Q

Side effects of sildenafil? (8)

A

Most SE are mild/moderate and short duration

  1. Headache
  2. Indigestion/dyspepsia
  3. Nausea
  4. Stuffy nose
  5. Dizziness
  6. Facial flushing/hot flush
  7. Colour tinge to vision
  8. Blurred vision/visual disturbance
56
Q

Drug interactions with sildenafil?

A
  1. CYP34A Inhibitors such as ritonavir, ketoconazole, erythromycin, cimetidine
    reduce the clearance of sildenafil.
    Medical advice needed whether to use lower strength 25mg (POM)
    Ritonavir is contraindicated because it has FOUR fold increase in sildenafil concentration.
  2. Alpha blockers - doxazosin, tamsulosin = risk of postural hypotension - medical advice needed
  3. Nitrates - glycerol trinitrate, isosorbide mononitrate
    Sildenafil potentiates the hypotensive effects of nitrates = contraindicated
57
Q

When to refer with ED/Sildenafil?

A
  1. Medical/medicine contraindication

Adverse effects:

  1. Chest pain before, during and after sex. Advise to get into semi sitting position and try to relax. do not use nitrates
  2. Persistent sometimes painful erection lasting longer than 4h
  3. Sudden decrease or loss of vision
  4. Allergic reaction - swelling, sudden wheeziness, difficulty breathing, dizziness
  5. Serious skin reaction - steven johnson syndrome or toxic epidermal necrolysis :
    severe peeling and swelling of skin, blistering of mouth/genitals/eyes
  6. Seizure or fits
58
Q

What is androgenetic alopecia ?

A

Distinctive pattern of hair loss that may occur in genetically predisposed people and thought to be androgen dependent

AKA male pattern boldness

but can affect some women too

59
Q

What is alopecia areata?

A

Hair loss which leads to patchy non-scarring hair loss in the scalp and beard

can occur any age

causes include: hypothyroidism, severe iron deficiency & protein deficiency

60
Q

Androgenetic alopecia can be partially treated by OTC product …. and POM product …?

A

OTC minoxidil - men and women (treatment can take upto 4 months)

POM (private) Finasteride - men ONLY

Neither are available on NHS

61
Q

In which case in terms of size of affected area is minoxidil worth trying?

A

Less than 10cm in diameter in Androgenetic alopecia

62
Q

A woman asks for something for hair loss after giving birth - what would you advise?

A

Hormonal changes occur and is normal. Reassure her the hair will grow back and treatment is not appropriate

63
Q

Which drugs are known for causing hair loss? (11)

A
  1. Cytotoxic drugs
  2. Anticoagulants (coumarins)
  3. Lipid lowering agents (clofibrate)
  4. Vitamin A (overdose)
  5. Allopurinol
  6. Beta-blockers
  7. Bromocriptine
  8. Carbamazepine
  9. Lithium
  10. Sodium valproate
  11. Colchicine
64
Q

How should minoxidil be applied? (3)

A
  1. Applied twice daily to dry scalp and lightly massaged
  2. foam/lotion should be left to dry naturally
  3. hair should not be washed for at least 1 hr after
65
Q

Manufacturers advice against the use of minoxidil in which patients? (5)

A
  1. Hypertension
  2. Angina
  3. Heart disease
  4. Pregnant
  5. Breastfeeding

Need to check with dr

OTC (11 decks)

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