310 Endocrine and genito-urinary medicines Flashcards

Question

What is polycystic ovary syndrome (PCOS)?

Answer 1

The main features of PCOS are: * irregular periods * excess androgens * polycystic ovaries - ovaries enlarged & contain many fluid-filled sacs

Answer 2

PCOS is very common and is thought to affect up to **1 in 5** women in the UK.

Answer 3

* irregular/no periods * difficulty getting pregnant * excess hair growth (face/chest/back/buttocks) * weight gain * thin hair/hair loss * oily skin & acne

Answer 4

PCOS is associated with an increased risk of developing health problems later in life such as **type 2 diabetes** and **high cholesterol levels**.

Answer 5

* cause is unknown * often a familial link * associated with high insulin levels (body not as reactive to insulin so produces a lot to overcompensate) * high insulin levels also associated with obesity

Answer 6

* blood tests to check hormone levels * ultrasound scan - will show whether there is a high number of follicles in the ovaries

Answer 7

* cannot be cured, symptoms can be managed * weight loss (if overweight) * medications * irregular periods - contraceptive pill * thin out womb lining - IUD * fertility problems - clomifene/letrozole * reducing insulin levels - metformin * excess hair - some combined contraceptive pills/cyproterone acetate/spironolactone/flutamide/finasteride * surgery - if medications to help stimulate fertility are not effective

Answer 8

**No common** side effects in the BNF, frequency not known, according to patient.info: * hot flushes * nausea * headaches * breast discomfort * painful periods * breakthrough bleeding * abdo pain * pelvic pain * discomfort * bloating * weight gain * eyesight problems - blurred vision, flashes in front of eyes

Answer 9

Clomifene blocks feedback mechanism to the pituitary gland. Pituitary gland releases more gonadotrophin, stimulates ovulation.

Answer 10

* there is a risk of multiple pregnancies * do not take for more than 6 cycles - increased risk of ovarian cancer * may cause birth defects - stop taking if fall pregnant

Answer 11

**_Common_** side effects in the BNF!!

Answer 12

Osteoporosis is a health condition that causes pores in the bones, **weakening** them, making them **fragile** and **more likely to break**.

Answer 13

* broken wrist * broken hip * broken vertebrae

Answer 14

* usually recognised when develop a break * might not even realise - can break when sneeze and may just be living with a long-term pain * might walk with a characteristic stoop * DEXA scan (bone density)

Answer 15

* over 3 million people in the UK * women more commonly (post menopause lose bone density) - particularly if had menopause \<45

Answer 16

* old age * being female, post menopause (particularly menopause \<45) * taking high dose steroids 3 months + * inflammatory conditions, hormone conditions, malabsorption conditions * family history * long-term use of medicines that affect bone density (eg anti-oestrogen tablets) * eating disorders (anorexia/bulimia) * low BMI * not exercising regularly * heavy drinking & smoking * lack of dietary calcium

Answer 17

* exercise regularly * eating well - lots of calcium + vitamin D * 10 microgram vitamin D supplement * lifestyle changes - giving up smoking, reducing alcohol consumption

Answer 18

A group of medicines called *bisphosphonates*. These include **alendronic acid** and **risendronic acid**.

Answer 19

There are **_common side effects_** of alendronic acid in the BNF.

Answer 20

* there are no common side effects in the BNF, just frequency not known * the NHS website says side effects associated with bisphosphonates include: * irritation to the foodpipe * swallowing problems * stomach pain * patient.info states: * indigestion * nausea * stomach ache * diarrhoea * constipation * headache * muscle and joint pain * heartburn * pain or difficulty swallowing

Answer 21

Aledronic acid **binds tightly to bone** & prevents calcium being removed by **osteoclasts** - stops osteoclasts breaking down bone.

Answer 22

* swallow tablet whole. Should be sitting or standing for at least 30 minutes after * Should be taken 30 minutes before breakfast or any other oral medication (empty stomach) * Take on the same day of the week * advised to seek medical advice if experience dysphagia, worsening heartburn, pain swallowing (oesophagal irratation)

Answer 23

**Insulin** and **glucagon** are secreted from the pancreas

Answer 24

Alpha cells secrete **glucagon**.

Answer 25

Beta cells secrete **insulin**.

Answer 26

Glucagon is secreted in a response to a drop in blood glucose levels. Acts to prevent blood glucose levels dropping, converts glycogen to glucose by glyconeogenesis.

Answer 27

Insulin is secreted when there is a **rise in blood glucose** levels. Receptor sites on cell surface membranes bind insulin and lead to changes in the **permeability** and **enzyme action** of the cell which in turn **reduces blood glucose** levels.

Answer 28

* the body's immune system attacks and destroys the beta cells that produce insulin * treatment for life

Answer 29

* In type 2 diabetes the body does not produce enough insulin, or the body's cells do not react to insulin * often a result of obesity

Answer 30

* feeling thirsty * urinating more frequently (particularly at night) * feeling tired * weight loss & loss of muscle bulk * itching around the penis/vagina - frequent episodes of thrush * wounds that heal slowly * blurred vision

Answer 31

* onset within 15 minutes * duration 2-5 hours * (eg insulin aspartate, insulin glulisine, insulin lispro)

Answer 32

Short-acting & rapid-acting insulins should be injected **20 minutes** before meals.

Answer 33

* Onset 30-60 minutes * duration 2-5 hours * (eg humulins)

Answer 34

* onset 1-2 hours * duration 11-24 hours * (eg insulin isophane)

Answer 35

* onset 1-2 hours * duration - up to 36 hours * (eg insulin glargine, insulin detemir)

Answer 36

* hypoglycaemia * local reaction at injection site * fat deposits at injection sites

Answer 37

* bizzare behaviour * faint * irritability * weakness * sweating * nausea

Answer 38

* 10-20g of glucose by mouth - liquid or granulated sugar (lumps) * 10g glucose in 2 heaped teaspoons sugar, 3 lumps * glucogel * glucagon injection (if not able to administer orally)

Answer 39

* gliclazide (sulphonylureas) * metformin (biguanides) * nateglinide (other antidiabetics) * insulin

Answer 40

Actrapid (rapid-acting) & insulin glargine (long-acting)

Answer 41

* oedema * just memorise the ones given in class: * hypoglycaemia * local reaction at injection site * abnormal fat deposits at injection sites

Answer 42

Stimulates peripheral **glucose uptake** primarily by skeletal muscle cells & fat by **inhibiting glucose production & release** by the liver.

Answer 43

* sharps bin + careful with needles * inform doctors taking insulin * if undergoing a hypo/hyper avoid manual tasks * take 30 minutes before food * inject at different sites * how to use * storage temperature/length (most insulins once opened are stored out of the fridge - shortened expiry) * insulin passport

Answer 44

Metformin & gliclazide

Answer 45

There are side effects for metformin in the BNF!

Answer 46

Decreases gluconeogenesis by increasing peripheral utilisation of glucose.

Answer 47

There are common side effects in the **BNF** for the drug group gliclazide belongs to, sulfononylureas!

Answer 48

* gastrointestinal side effects are common * metformin + alcohol --\> avoid excess consumption (lactic acidosis) * hypers/hypos - avoid manual tasks * take before a meal * if you miss a dose do not double up the next one * if m/r - swallow whole, do not crush

Answer 49

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Answer 50

The menopause usually occurs between **45** and **55**, the average age for a woman in the UK to reach the menoapause is **51**.

Answer 51

* hot flushes * night sweats * vaginal dryness + discomfort during sex * difficulty sleeping * low mood + anxiety * reduced sex drive * problems with memory and concentration Symptoms may start a few months or years before your periods stop, known as the *perimenopause*, and on average persist for around **4 years** after your last period.

Answer 52

* combined HRT * estradiol * timbolone

Answer 53

* bloating * breast tenderness/swelling * swelling in other parts of the body * feeling sick * leg cramps * headaches * indigestion * vaginal bleeding These are the side effects according to the NHS website. Also states these side effects will often pass in a few weeks.

Answer 54

There are common side effects in the BNF!!

Answer 55

There are common side effects for timbolone in the BNF

Answer 56

Estradiol is an agonist for the estrogen receptor (possibly both subtypes ER alpha and ER beta), modulating the **gene transcription and expression** in ER-expressing cells which in turn **reduces symptoms** of the menopause.

Answer 57

* go for mammograms and check breasts regularly (all types of HRT increase risk of breast cancer) - however radiological detection more difficult? * reducing risk of blood clots: maintain healthy weight, no (quit) smoking, regular movement * if prescribed cream/patch then how to administer/apply * may take a couple of weeks to work

Answer 58

Endometriosis is a condition where tissue similar to the **lining of the womb** starts to grow in other places such as the **ovaries** and **fallopian tubes**.

Answer 59

* pain in lower tummy (pelvic pain) - worse during period * period pain that stops you doing normal activities * pain during or after sex * pain when peeing or pooing during your period * feeling sick, constipation, diarrhoea, or blood in your urine during your period * difficulty getting pregnant

Answer 60

* painkillers * ibuprofen + paracetamol * hormone medications/contraceptives * combined pill, contraceptive patch, intrauterine system, GnRH analogues * surgery to cut away patches of endometriosis tissue * operation to remove some or all of the organs affected. - eg hysterectomy to remove the womb

Answer 61

* genetics - tends to run in families * retrograde mestruation - womb lining flows up the fallopian tubes and embeds itself instead of leaving the body as a period * immune system problem * endometrium cells spreading through the body in the bloodstream or lymphatic system * not certain how or why, probably a combination of

Answer 62

Paracetamol (to relieve pain) & the combined oral contraceptive pill.

Answer 63

No common, use frequency not known? Rarely causes side effects, and if it does could be a sign of overdose.

Answer 64

There are some in the BNF (+common knowledge the pill is crap)

Answer 65

* suppresses ovulation * decreases secretion of FSH & LH * hormones in the pill cause the uterus lining to become thinner resulting in periods that are shorter and lighter, reducing endometriosis symptoms

Answer 66

* take at the same time everyday * increased risk of DVT (maintain healthy weight, quit/no smoking, move regularly) * if have an epiode of diarrhoea or vomiting, may need to take extra precautions during ex (if using as a contraceptive too)

Answer 67

Pelvic inflammatory disease is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries.

Answer 68

PID mainly affects sexually active women agen 15-24.

Answer 69

Usually the symptoms of PID are mild, which makes it difficult to diagnose, and may include: * pain around the pelvis or lower abdomen * discomfort or pain puring sex that is felt deep inside the pelvis * pain when urinating * bleeding between periods or after sex * heavy periods * painful periods * unusual discharge, especially yellow or green a few women will become very ill with: * severe abdomenal pain * high temperature * feeling and being sick

Answer 70

* most cases caused by a bacterial infection * caused by STI - such as chlamydia or gonorrhoea * could be caused by bacteria that usually live in the vagina

Answer 71

usually be treated with 14 day abx course if caught early

Answer 72

Doxycycline & metronidazole

Answer 73

There are common side effects for doxycycline in the BNF!

Answer 74

There are common side effects associated with metronidazole in the BNF!

Answer 75

* broad spectrum antibiotic * inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing tRNA binding * stops replication of bacteria * bacteriostatic

Answer 76

* doxycycline taken for PID/chlamydia * need to speak to sexual partners so that they can get checked (GUM clinics can do this anonymously for you) * decrease risk of PID by using condoms + getting new partners to have a sexual health check * take any antacids 2-3 hours after dose (BNF) * swallow whole with plenty of water (BNF) * should be taken with meals (BNF) * complete the course (BNF) * photosensitivity - sunlight/lamps should be avoided (BNF)

Answer 77

Dysmenorrhoea is **painful cramping**, usually in the lower abdomen occuring shortly **before or after menstruation**, or both. May occur with or without **pelvic pathology** (pathologies = fibroids/endometriosis, PID, endometrial polyps) Primary = without pathologies Secondary = with pathologies

Answer 78

* usually starts 6-12 months after menarche * pain usually starts shortly before onset of menstruation and lasts for up to 72 hours, improving as menses progresses * may also experience nausea, vomiting and migraine

Answer 79

* can start after several years of painless periods * pain can be present throughout menstrual cycle (not just during menses) - often exacerbated by menses * other gynaecological symptoms present

Answer 80

* cramping in the abdomen * pain in the back * bloating * vomiting

Answer 81

* not sure why some women get them worse than others * cramps are a contraction of the uterus in an attempt to shed its lining

Answer 82

Paracetamol & naproxen

Answer 83

No common side effects but a list of side effects in the BNF. The NHS website said: * confusion * headaches * ringing in the ears * changes in vision * tiredness and feeling sleepy * dizziness * rashes

Answer 84

* not fully understood * thought to reduce production of prostaglandins in the brain and spinal cord, which reduces pain

Answer 85

* no more than 8 in 24 hours * do not take with any other paracetamol containing products * no more than 2 at any one time

Answer 86

Amenorrhoea is when a woman doesn't start her periods or misses periods. When a woman misses **3 or more** menstrual periods she has amenorrhoea or if a girl doesn't start her periods by the age of **15**.

Answer 87

Primary amenorrhoea is the failure of menses to occur by the age **16 years** in the presence of normal growth and secondary sexual characteristics.

Answer 88

Secondary amenorrhoea is defined as the cessation of regular menses for **3 months** or cessation of irregular menses for **6 months**. - Many cases attributed to PCOS or medical reason.

Answer 89

* pregnancy * stress * sudden weight loss * being overweight * over-exercising * taking the contraceptive pill * menopause * PCOS

Answer 90

* cessation of menstruation * other symtoms are related to the cause of amenorrhoea (ie milky nipple discharge if pregnant)

Answer 91

Clomifene, combined oral contraceptive pill & medroxyprogesterone

Answer 92

There are common side effects for medroxyprogesterone in the BNF!

Answer 93

Medroxyprogesterone inhibits the production of gondadotropin, preventing follicular maturation and ovulation and causes endometrial thinning.

Answer 94

* likelihood of menstrual disturbance (BNF) * delay in return to fertility and irregular cycles may occur after discontinuation of treatment

Answer 95

Bacterial vaginosis (BV) is a **common** cause of **unusual vaginal discharge**. It is not a STI, but can increase your risk of getting an STI. It is when the acidic environment of the vagina, which favours good bacteria, becomes **less acidic** allowing the **overgrowth of anaerobic organisms** that replace the normallactobilli.

Answer 96

A change to the pH of the vagina which can be caused by: * using perfumed soaps and bubble baths * vaginal deodorants, washes or douches * strong detergents in underwear Increased risk if: * sexually active * change in partner * have an IUD * used perfumed products in or around your vagina

Answer 97

* 50% of women will not present with symptoms * unusual vaginal discharge, strong fishy smell * strong fishy smell particularly after sex * discharge that is white/grey * discharge that is thin/watery Doesn't usually cause soreness or itching

Answer 98

The condition is **not** usually serious. It is important to seek treatment if you're **pregnant** as there's a small chance that BV **can cause complications** with pregnancy.

Answer 99

Clindamycin 2% cream & metronidazole 0.74% cream.

Answer 100

There is only one side effect associated with clindamycin 2% cream in the BNF which is **skin reactions**.

Answer 101

There are common side effects associated with metronidazole in the BNF!

Answer 102

Clindamycin **inhibits the bacterial protein synthesis** - prevents bacteria from producing proteins - essential for growth, which **clears up infection**.

Answer 103

* damages latex condoms and diaphragms so use alternative contraception (BNF) * avoid sex during infection * wash hands before/after use * administer at night (BNF) * how to use the applicator

Answer 104

Gonorrhoea is a sextually transmitted infection called by a bacteria called *Neisseria gonorrhoeae gonococcus*.

Answer 105

* unprotected sex (vaginal or anal) * sharing sex toys that have not been washed/covered with condom * passed from pregnant woman to baby

Answer 106

* thick yellow/green discharge from the vagina/penis * pain when urinating * bleeding between periods (women) * 1 in 10 men and half of women do not experience symptoms

Answer 107

Oral ciprofloxacin or azithromycin. (as a single dose after a ceftriaxone injection)

Answer 108

In the BNF the only common side effect is arthropathy (in children). Which will not be relevant for Gonorrhoea. Cipro is taken as a stat dose for gonorrhoea, so side effects will probably not occur. According to the NHS website, common side effects for ciprofloxacin are: * feeling sick * diarrhoea

Answer 109

In the BNF there is only arthralgia as a common side effect. Azithromycin will be taken as a single dose so there likely will not be common side effects. According to the NHS website: * feeling sick * diarrhoea * losing your appetite * headaches * feeling dizzy or tired * changes to your sense of taste

Answer 110

Ciprofloxacin has actions which prevent DNA replication. Prevents DNA replication by targeting the alpha subunits of DNA gyrase which prevents he bacterial DNA from supercoiling.

Answer 111

* avoid sex until infection has cleared (2 week follow up appointment to retest) * ensure using condoms when having sex * do not share sex toys * ciprofloxacin may affect performance of skilled tasks, this may be exacerbated by alcohol

Answer 112

Chlamydia is the most common sexually transmitted infection in the UK. It is caused by the bacterium *Chlamydia trachomatis*.

Answer 113

Most people do not experience symptoms with chlamydia infection. If you do develop symptoms they may include: * pain when urinating * unusual discharge from the vagina, penis or bottom * for women, pain in the tummy, bleeding after sex and bleeding between periods * in men, pain and swelling in the testicles

Answer 114

Chlamydia infection can be serious if not treated early on. It can lead to PID, epdidymo-orchitis & infertility.

Answer 115

doxycycline or ofloxacin

Answer 116

There are no common side effects in the BNF, only frequency not known. According to patient.info: * diarrhoea * headache * feeling dizzy * problems sleeping * eye irritation * cough * skin itchiness

Answer 117

Candidiasis is thrush. A fungal infection of the vagina, or penis.

Answer 118

* watery white discharge

Answer 119

* painful urination * white discharge (cottage cheese) * unpleasant smell * inflamed foreskin, difficult to retract * irritation, burning and redness around the head of the penis and under the foreskin

Answer 120

clotrimazole pessaries/creams & fluconazole

Answer 121

There are **no common side effects** of clotrimazole in the BNF. According to the NHS website you may experience: * red, irritated skin * pain or a burning or stinging sensation

Answer 122

There are **common** side effects for fluconazole in the BNF!!

Answer 123

Clotrimazole alters permeability of the fungal cell wall. Inhibits production of components of the fungal cell membrane. This kills fungi and clears up infection.

Answer 124

* how to use pessary/applicator * be careful if using condoms/diaphragms as can reduce efficacy - use alternative contraceptive methods * do not use applicator if pregnant * wash hands before and after use

Answer 125

Benign prostatic hyperplasia (BPH), or benign prostate enlargement (BPE) is the medical term to describe an **enlarged prostate**, a condition that can affect how you **pass urine**.

Answer 126

BPH is common in **men over 50**.

Answer 127

* lifestyle changes - drink less alcohol/caffeine/fizzy drinks; exercise more; avoid sweeteners; drink less in the evenings * medicines * surgery (severe cases)

Answer 128

alfuzosin & finasteride

Answer 129

There are common side effects for alfuzosin in the BNF!

Answer 130

There is only 1 common side effect in the BNF, however there are frequency not known. Patient.info only reports sexual dysfunction (same as BNF). Netdoctor is more specific: * decreased ejaculate volume * decreased sex drive * difficulty maintaining (or getting) an erection

Answer 131

Alfuzosin is an alpha-adrenergic blocking agent that **selectivity inhibits** the alpha-adrenergic receptors in the **lower urinary tract**. Inhibition of these receptors leads to the **relaxation of smooth muscle** in the **bladder neck** and **prostate**, resulting in the improvement in urine flow and a reduction in symptoms in benign prostate hyperplasia.

Answer 132

* first dose effect (take at bedtime, lay down) * can affect performance of skilled taks * take with or just after food * swallow whole * (all counselling points are in BNF)

Answer 133

Urinary retention happens when someone **can’t completely empty their bladder**. Instead of all the urine (wee) being passed out through the urethra, some remains in the bladder.

Answer 134

* urge to urinate frequently * inability to urinate * still feeling need to urinate after finishing

Answer 135

Urinary retention affects **more men** than women, and is more common as you get **older**.

Answer 136

* structural problems with urethra eg - narrowing (stricture) or blockage * structural problems with bladder neck, sometimes following treatment for a congenital (present at birth) condition, such as posterior urethral valves or bladder exstrophy * weak bladder and pelvic floor muscles * problems with nerve messages travelling between the bladder and brain * side effects of some medications, including anaesthesia * surgery to the urinary system * constipation when the bowel is full of poo and presses on the bladder and urethra

Answer 137

Alfuzosin and finasteride

Answer 138

Erectile dysfunction is the failure to maintain a satisfactory erection.

Answer 139

* drinking too much * stress/anxiety * medication * tiredness * if it happens more regularly it may be caused by a physical/emotional problem

Answer 140

Sildenafil & alprostadil

Answer 141

There are **common side effects** for sildenafil in the BNF 76!

Answer 142

There are **common side effects** for all the different ways of using alprostadil in the BNF.

Answer 143

* It usually takes 30 to 60 minutes for sildenafil to work for erectile dysfunction. You can take it up to 4 hours before you want to have sex. * You will also need to be aroused for it to work * can be sold OTC, so check not taking any other nitrate medications (can cause dangerous drop in blood pressure), already have low blood pressure, a history of heart or liver proble,s * do not take more than one dose in a day * best taken on an empty stomach, may take longer to work if taken with food * see your doctor if you experience chest pain or painful erections that last for 4 hours or more or loss of vision

Answer 144

* Influx of nitric oxide into the corpus cavernosum is required for an erection * Sildenafil enhances effects of nitric oxide on the corpus cavernosum * Nitric oxide (NO) in the corpus cavernosum of the penis binds to guanylate cyclase receptors, which results in increased levels of cGMP * Sildenafil protects cyclic guanosine monophosphate (cGMP) from degradation by cGMP-specific phosphodiesterase type 5 (PDE5) in the corpus cavernosum.

Answer 145

1. type of dialysis 2. dialysis equipment used 3. molecular weight of drug 4. water solubility of drug 5. protein binding 6. affective volume of distribution 7. usual route of clearance 8. body weight

Answer 146

1. molecular weight of the drug 2. water solubility of the drug 3. protein binding of the drug 4. volume of distribution 5. method of clearance

310 Endocrine and genito-urinary medicines Flashcards

(173 cards)