Chapter 7 BNF (Genito-Urinary System)

Question 1

What Drugs are First Line in Urge Urinary Incontinence?

Answer 1

Oxybutynin
Tolterodine 
Darifenacin
Solifenacin
Trospium
Fesoterodine 
Flavoxate
Propiverine

Question 2

What is second line in urge urinary incontinence?

Answer 2

Mirabegron (QT)

Question 3

Whats first line in Stress incontinence in women?

Answer 3

Duloxetine

Question 4

What is first line treatment in Nocturnal Enuresis?

Answer 4

Enuresis Alarms (lower refractory rate)

Question 5

What is second line in Nocturnal Enuresis?

Answer 5

Desmopressin in over 5 years old?

Question 6

What are the counselling points with nocturnal enuresis?

Answer 6

restrict fluid intake 1 hr before and 8 hours after

stop in vomiting/diarrhoea

Question 7

What is the first line in acute urinary retention?

Answer 7

Cathetarisation

Question 8

What are the side effects of alpha blockers?

Answer 8

hypotension

intra-operative floppy iris syndrome

Question 9

What are the counselling points with alpha blockers?

Answer 9

Take first dose at bedtime to avoid first dose postural hypotension

Question 10

What are the side effects of Finestaride?

Answer 10

Male breast cancer

depression and suicidal thoughts (MHRA Alert)

Question 11

What is the advice on finestaride regarding contraception and pregnancy?

Answer 11

wear condom if partner is pregnant or likely to become pregnant

women of child bearing age avoid handling finasteride tablets (and Dulasteride caps)

Question 12

What are the fraser guidelines when prescribing to under 16 years.

Can provide contraception without parental consent if:

Answer 12

she understands the advice
cannot be persuaded to tell parents
likely to continue having sex
mental and physical health at risk

Question 13

which progestogens can be offered to females suffering from acne, breast symptoms, breakthrough bleeding with other progestogens?

Answer 13

Norgestimate
Desogestrel
Drosperinone
Gestodene

Question 14

What Progestogens are available in POP?

Answer 14

Desogestrel
Norethisterone
Levonogestrel

Question 15

When should the combined oral contraceptive be started

Answer 15

any time during cycle

if day 6 or later, use protection for 7 days

Question 16

What patients should be offered Phasic preparations?

Answer 16

Women without withdrawal bleeding and women with breakthrough bleeding on monophasic

Question 17

What is considered low strength oestrogen?

Answer 17

20mg ethinylestradiol

Question 18

What are the risk factors for VTE? how many does the patient need for oestrogens to be avoided?

Answer 18

Type of progestogen: Deso, Gesto, Drospe 
BMI >30
Smoking 
Primary relative under 45 with VTE 
Long-term immobilisation 
Age >35 years

Question 19

What are the risk factors for ATE? how many does the patient need for oestrogens to be avoided?

Answer 19

Diabetes
Hypertension
Migraine without aura

Question 20

How is the POP taken?

Answer 20

once daily on a continuous basis, starting on day one of the cycle

if started day 5 or later, use protection for 2 days

Question 21

Cancer side effects of COC and POP?

Answer 21

COC - Cervical and Breast

POP - Breast

Question 22

Cancer benefits of COC?

Answer 22

Reduce Ovarian and Endometrial Cancer

Question 23

COC: What to do when 1 pill missed?

Answer 23

Take one asap and next one at normal time

Question 24

COC: What to do when 2 pills missed?

Answer 24

Take one asap, condom for 7 days (Zoely/Qlaira 9 days)

Omit pill free interval if missed in last 7 days

EHC if missed in first 7 days and unprotected sex occurs

Question 25

What time interval is the COC considered a ‘missed pill’

Answer 25

24hours (Zoely/ Qlaira 12 hrs)

Question 26

After how long is the POP consider a ‘missed pill’

Answer 26

3 hours (desogestrel 12 hours)

Question 27

POP: What to do when 1 pill

Answer 27

Take ASAP, condom for 2 days

EHC if unprotected sex happens before 2 pills are taken

Question 28

Whats the course of action for Evra patches detached for over 24hours or delayed application at beginning of cycle?

Answer 28

Apply new patch ASAP

Start a ‘new day 1 cycle’ + condom 7 days

Question 29

Whats the course of action for delayed application of Evra Patches mid cycle?

Answer 29

<48 hours - apply new patch and continoue

> 48hours - start new day 1 cycle and condom for 7 days

Question 30

What regular contraception can be used with patients taking and enzyme inducer?

Answer 30

Copper IUD
Progestogen on injections

until 4 weeks after drug

Question 31

What EHC can be used for patients taking and enzyme inducer?

Answer 31

Copper IUD

3mg levonorgestrel

Question 32

which contraception is affected by drugs that raise pH?

Answer 32

Ulipristal

Question 33

Whats first line EHC?

Answer 33

Copper IUD
5 days after unprotected intercourse

5 days after earlist calculated ovulation

Question 34

What BMI and weight should be offered Ulipristal or 3mg levonogesterel

Answer 34

70kg or 26kg/m2

Question 35

When is levonorgestrel cautioned?

Answer 35

Crohns disease
past ectopic pregnancy
ciclosporin

Question 36

When Ulipristal cautioned?

Answer 36

severe asthma

severe liver impairment

Question 37

How long must precaution be taken with hormonal contraception after Ulipristal?

Answer 37

COC: 14 DAYS (16 Qlaira)

POP: 9 AYS ( 14 parenteral)

Question 38

How long should patients wait before starting regular Hormonal contraception?

Answer 38

5 days

Question 39

What do home pregnancy tests test for?

Answer 39

Human chorionic gonadotropin