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PMP 103 Practice of Pharmacy > Symptoms in pharmacy Women's Health > Flashcards

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
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2
Q

Cystitis

Upper Urinary Tract Infection
(UTI)

A
  • Infections of kidney and infection or inflammation of ureter
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3
Q

Lower Urinary Tract Infection
(UTI)

A
  • Infection/ inflammation of
    bladder
  • Urethritis
  • Infection/inflammation of
    urethra
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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
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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
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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
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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
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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
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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
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10
Q

Home remidies for UTI

A
  • 300mL every day has a bacteriostatic effect Cramberry juice
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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)
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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
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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
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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
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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
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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
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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
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18
Q

Vaginal thrush management

A
  • Topical vaginal cream
  • Pessary
  • Oral capsule
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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
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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
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21
Q

Internal cream for vaginal cream

A
  • Clotrimazole 10% cream Canesten
  • intravaginally using the applicator supplied
    *One-off treatment, best administered at night
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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
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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
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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
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25
Q

Oral capsule canestan for vaginal thrush

A

Fluconazole 150mg oral capsule - oral capsule
- One-off dose, to be swallowed whole
- May take 12-24 hours for symptoms to improve

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26
Q

Drug interactions with Fluconazole

A
  • Warfarin
  • Statins,
  • Phenytoin
  • Rifampicin
  • Ciclosporin
  • Cheophylline
  • Single dose may not affect drug levels too much
27
Q

Thrush symptoms for males

A
  • 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
Q

Treatment for male thrush

A
  • Azole external cream BD for 6 days or oral fluconazole STAT
29
Q

Refer to the GP for thrush

A
  • 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
Q

Primary Dysmenorrhoea

A
  • Pain without underlying causes
  • Manage in community pharmacy
  • 1 in 2 women suffer peaking at 17-25 years of age

Period pains

31
Q

Secondary Dysmenorrhoea

A
  • Pain with underlying disease, e.g.
    endometriosis or pelvic inflammatory disease
  • Older women refer to the GP >30
32
Q

Symptoms of Primary Dysmenorrhoea

A
  • 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
Q

Mittelschmerz

A

Ovulation pain. This pain is mid-cycle at the time of ovulation. It usually lasts a few hours, some report some bleeding too

34
Q

non-drug

Management of Primary Dysmenorrhoea

A
  • 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
Q

Drug management

Management of Primary Dysmenorrhoea

A
  • Simple analgesia (NSAIDs best)
  • Hyoscine butylbromide (antispasmodic)– evidence is patchy
  • Caffeine (enhance analgesic effect)
36
Q

Dysmenorrhoea- NSAIDs

A
  • 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
Q

Menorrhagia

A
  • 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
Q

Treatment for Menorrhagia

A
  • 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
Q

When do you refer to the GP vaginal bleeding

A
  • 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
Q

Oral Contraception

Oral Contraception

A
  • 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
Q

Oral Contraception contraindications

A
  • Blood clots, cancer, peanut allergy as Lovima contains soya bean oil
  • Refer anyone with clinically relevant interaction such as antiepileptics
42
Q

How should the contraceptive pill be taken

A
  • 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
Q

Side effects of oral contraception

A
  • Irregular periods, altered mood, headaches, nausea, weight changes
  • If vomits within 3-4 hours, follow missed pill rules
44
Q

Regulations when supplying oral contraceptives

A
  • 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
Q

Emergency Hormonal
Contraception

A
  • 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
Q

Why?

Sale and supply of EHC

A
  • Failure of barrier contraceptive method
  • Missed contraceptive pills
  • Unprotected sex
47
Q

When?

Questioned asked before supply of EHC

A
  • 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
Q

Ulipristal Acetate

A
  • 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
Q

Levonorgestrel

A
  • 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
Q

Long-term contraception and sexual health

A
  • 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
Q

Perimenopause

A

Woman has irregular cycles of ovulation and menstruation leading up to menopause, continues for 12 months after final period

52
Q

Menopause

A

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
Q

Symptoms of menopause

A
  • Hot flushes, sweats
  • Joint and muscle pain
  • Vaginal dryness, urinary frequency, UTIs
  • Low mood, reduced libido
54
Q

Menopause

Self management from hot flushes

A
  • light clothing, cool showers, using fans
  • Keep bedroom cool at night
  • Avoid triggers- caffeine, spicy food, smoking, alcohol
  • Exercise & lose weight if overweight
55
Q

Menopause

Management of Weak bones

A
  • 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
Q

OTC meds for Vasomotor symptoms of menopause

A
  • Black cohosh - some evidence but not robust and interactions with meds
  • Isoflavones
  • St John’s Wort
57
Q

OTC meds for Urogenital Symptoms of menopause

A
  • Vaginal dryness- OTC vaginal moisturisers and lubricants
58
Q

Estradiol tablets

A

Local vaginal HRT to treat post-menopausal vaginal atrophy caused by low oestrogen

59
Q

Symptoms of vaginal atrophy

A

Vaginal dryness, soreness, itching, burning, irritation, painful sexual intercourse

60
Q

Menopause tablet

Gina

A
  • 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
Q

Selling Estradiol OTC

A
  • Treatment of vaginal atrophy
  • Aged 50 and over who havent had a period for a year
62
Q

Contraindications Estradiol

A
  • Liver disease, current
  • recent heart attack or ischaemic
  • stoke
  • breast/ovarian/vaginal infection
63
Q

Counselling Points for menopause meds

A
  • 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
Q

Ongoing supply of meopause meds

A
  • 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

PMP 103 Practice of Pharmacy (41 decks)

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