Womens Health OTC Flashcards
When is EHC used?
Unprotected sex
Contraceptive failure
Advanced supply
When is a referral needed for EHC?
> 5 days unprotected sex
Changes to period
Severe liver dysfunction
Interacting medicines - enzyme inducers, phenytoin, carbamazepine, rifampicin, rifabutin, ritonavir, St. John’s wort, griseofulvin
When is levonelle used?
16+
Within 72 hours
Can take more than once in same cycle
Avoid in severe liver impairment, ectopic pregnancy risk, Crohn’s disease
OK in breastfeeding
Doesn’t reduce efficacy of regular contraception
Significantly interacts with ciclosporin
When is Ella one used?
Women of child bearing age, can be used under 16
Within 120 hours
Can’t take more than once in same cycle
Avoid in severe liver impairment, asthma, steroids
Not recommended in breastfeeding for 1 week
Use condos until next period
What is the advice for EHC?
Take ASAP Second dose if vomiting within 3 hours Use barrier method until next period Ella one reduces contraceptive effectiveness Abnormal bleeding at period see GP Delayed period see Gp Severe abdominal pain see GP
What are the symptoms of cystitis?
Dysuria
Urinary frequency and urgency
Incomplete bladder emptying
Dark, cloudy, strong smelling urine
When do you refer cystitis?
Women under 60, over 70 Men and children Recurrent attacks > 2 episodes in last 6 months Symptoms > 48 hours Severe symptoms Flank pain Systemic symptoms Haematuria Abnormal vaginal discharge Medication ADR
What patient groups are predisposed to ADRs?
Diabetic
Immunocompromised
Pregnant
What is used OTC for cystitis?
Mild symptoms present for < 48 hours for two days only
Potassium citrate (cystopurin) Sodium citrate (cymalon, canesoasis)
When is potassium citrate contraindicated?
Hyperkalaemia
Interacts with ACEi, spironolactone, potassium sparing diuretics
When is sodium citrate contraindicated?
Hypertension Heart disease Pregnancy Kidney disease Self restricted diet
Interacts with lithium
What is the advice for cystitis?
Cranberry juice
Large quantities of water
Urinate after sex
Front to back
Wait 20 seconds to strain out residual urine by leaning backwards
Avoid spermicides, perfumed soaps, douches
Wear cotton underwear and avoid tight jeans and trousers
What are the symptoms of menorrhagia?
Heavy menstrual bleeding
When is menorrhagia referred?
Intermenstrual bleeding Postcoital bleeding or pain < 18 or over 45 OTC failure Renal failure Medication ADR Familial endometrial cancer Active VTE Pregnancy Obesity Diabetes COC PCOS
What is used otc for menorrhagia?
Tranexamic acid
18-45
Once heavy bleeding starts take two 500mg tabs TDS max four days
What are the side effects of tranexamic acid?
Nausea
Vomiting
Diarrhoea
Rarely thromboembolic effects
What are the contraindications of tranexamic acid?
Hypersensitivity
Haematuria
Renal failure
What is the advice for menorrhagia?
Change towel every 6 hrs
Change tampon every 2 hrs
What are the symptoms of dysmenorrhea?
Lower abdominal cramps Back pain Nausea Vomiting Diarrhoea Fatigue
What are the referral criteria for period pain?
Secondary dysmenorrhea Pain increases on onset of menses Women > 30 years with new or worsening symptoms Vaginal bleeding post menopause Oral contraceptives Intermenstrual pain and bleeding Pain with late bleeding Presence of fever
What is used for dysmenorrhea?
Ibuprofen 12+
Naproxen 15-50
500mg then 250mg 6-8 hrs later if needed
Max 3/day max 3 days/month
What are the cautions for NSAIDs?
Asthma GI events Heart failure Stroke Anticoagulants NSAID hypersensitivity Pregnancy
What are the other drugs used in period pain?
Antimuscarinics 6+ hyoscine hydrobromide
Antispasmodics 12+ alverine
What is the advice for dysmenorrhea?
Hot water bottle Exercise Acupuncture Dietary supplements Tens machine
What are the symptoms of vaginal thrush?
Itching and soreness
Cottage cheese discharge
Pain during sex
Stinging of skin when urinating
When do you refer thrush?
Under 16 or over 60 OTC failure > 7 days First episode Recurrent attacks > 2 episodes in last 6 months Abnormal discharge - grey/fishy = BV, yellow/green = trichomoniasis Spotting, pain, dysuria Sores, ulcers, blisters STI Abnormal bleeding Medication ADR
What patient groups are predisposed to thrush?
Pregnancy
Diabetic
Immunocompromised
What is used to treat vaginal thrush?
Clotrimazole pessary/internal cream
Oral fluconazole
16-60 years
Men can have oral fluconazole
What is the advice for vaginal thrush?
Cotton underwear, loose clothing
Avoid perfumed soap
Front to back
