Chapter 7- GU System Flashcards by Melissa Steve

What treatment is available for urinary incontinence

Pelvic floor exercise is used

Drug treatments includes:
Duloxetine for stress associated incontinence

Antimuscarinic (Oxybutinin, solifenacin) and selective B3 receptor stimulation (mirabegron)

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Side effects of Antimuscarinic used in urinary incontinence

Constipation
Dry mouth
Sweating
Dilation of pupils

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What’s used for bedtime wetting (enuresis) in children

Observe fluid intake
Set alarms
Desmopressin if alarm not effective
Imipramine (in children)

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How is acute urinary retention managed

Catheterisation used to relieve symptoms 
Alpha blocker (doxazosin, tamsulosin) given for atleast 2 days to manage the acute urinary retention

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Treatment for chronic urinary retention

Alpha blocker (doxazosin, tamsulosin)

5- alpha reductase inhibitor (finesteride, dutasteride) especially if enlarged prostate

(Or both)

Then surgery

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What’s the most common cause of urinary retention in men?

Benign prostatic hyperplasia

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Side effects of alpha blockers

Depression 
Dry mouth 
GI disturbances 
Dizziness (may cause hypotension on first dose so take sitting) 
Impair motor skilled tasks (driving)
Floppy iris syndrome

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Why should cataracts be cautioned in orients having cataract surgery

It can give floppy iris syndrome risk

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What must you counsel for 5-alpha reductase inhibitors

Women of child bearing age should avoid handling crushed or broken tablets/ leaking caps

Excreted in semen so use of condom is recommended

Chance of male developing breast cancer so changes in breast tissue should be reported immediately

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What’s the most effective form of contraception

Hormonal

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When can hormonal contraceptives be used

Women who have started their menstrual cycle

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What’s does the combined hormonal contraceptives contain

Oestrogen and progesterone

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Advantages of the CHC

Reliable and reversible
Reduced dysmenorrhea (pain) and menorrhagia (heavy bleeding)
Less ovarian cysts
Less benign breast disease
Less risk of ovarian and endometrial cancer
Reduced risk of pelvic inflammatory disease

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What’s monophasic and phasic COC pill

Monophasic= contains the same amount of eostrogen and progesterone

Phasic= contains varying amount

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How long before major elective surgery, leg surgery or surgery that results in immobilisation should oestrogen containing contraception be stopped

4 weeks

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When should CHC be stopped immediately

Sudden sever chest pain 
Sudden breathlessness 
Unexplained swelling or pain in calf 
Severe stomach pain 
BP above 160/95mmHg
Serious neurological effects 
Hapatitis/ jaundice

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What should be given if oestrogen containing contraceptives are not indicated

Progesterone only contraceptives

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When can emergency contraception be offered to a person

After unprotected sex taken place:

On any day of their cycle

21 days after childbirths

5 days after abortion, miscarriage

Regular contraception been compromised

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What are the emergency hormonal contraception and how long they effective for

Copper IUD first line- 5 days

Levonorgestrel- 3 days LEVONELLE

Ulipristal- 5 days (if obese) ELLAONE

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How long should women wait after taking ulipristal before starting regular hormonal contraception

5 days

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When is the risk of VTE greater when patients on hormonal contraception

Family history of VTE under 45
Obese 
Immobilised
Age over 35, avoid if over 50
Smoker 
History of superficial thrombophlebitis

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What is considered a missed pill with hormonal contraception combined pill

More that 24 hours late

Worse at the beginning or end of the cycle

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What’s another method of emergency contraception

Intra uterine device

Can be inserted upto 5 days after unprotected sex and acts as contraception after

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What’s the risk of intra- uterine device

Risk of infection in the first 20 days after insertion and a carriage of STI

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Can you breastfeed after taking emergency hormonal pill

Levonorgestrel = yes Ulipristal = wait 1 week

What are the 3 types of progesterone only pill and when is it considered a missed pill

Levonorgestrel -3hrs late Desogestrel- 12hrs late Norethisterone -3 hours late

What’s a missed contraceptive pill counselling

Take one as soon as you remember, may mean taking 2 in 24hours Use barrier method for the next 24hours

What are the different types of hormonal contraception, what do they contain and how long do they last

COC pill (oestrogen and progesterone) take one daily with 7 day free period Contraceptive patch (oestrogen and progesterone) last one week Contraceptive injection (progesterone) last 2-3 months Contraceptive implant (progesterone) lasts upto 3 years Intra-uterine device (progesterone)

What medicines do EHC interact with

Enzyme inducing drugs: | Rifampicin, anti-epileptic, St. John’s wort, ritonavir, griseofulvin

What can you do to the levonorgestrel 1.5mg EHC if the patient is on an enzyme inducing drug or is obese

Give double (3mg) unlicensed Or a non hormonal emergency contraceptive (copper IUD)

When is progesterone only pill more suitable than the combined one

``` Patients with VTE Older women Heavy smokers Hypertension Diabetes Heart disease Migraines from COC ```

What can be a cause of erectile dysfunction

``` Psychogenic Vascular Neurogenic Endocrine abnormalities And drugs (antihypertensives, antidepressants, antipsychotics) ```

What can be given for erectile dysfunction

Phosphodiestrase inhibitors (drugs that increase blood flow to the penis) are first line Sildenafil Tadalafil Vardenafil

What’s licenced for the treatment of pre-ejaculation

Dapoxetine | A short acting SSRI

When is phosphodiestrase inhibitors contraindicated

Patient receiving nitrates Recent stroke Angina attacks MI

How are prostaglandins and oxytocics used in obstetrics

They are used to induce abortion, induce labour and to minimise blood loss from the placenta site By causing uterine contractions

Examples of obstetrics

Oxytocin Carbetoxin Ergometrine Prostaglandin

What can be given for vagina atrophy

Oestrogen containing creams (small amount for shortest period of time) minimise s/e of endometrial hyperplasia and carcinoma

How are the different fungal vulval and vaginal infections treated

Candidal vulvitis- treated locally with cream (Imidazole) Vaginal candidiasis- treated with antifungal cream of pessary inserted high into the vagina (Imidazole) or if oral route Triazole given

How are fungal vaginal infections treated in pregnancy And how in persistent infections

Topical imodazole May need longer course Oral avoided Treatment extended to 6 months in recurrent infections

How are non fungal vaginal infections usually treated?

metronidazole gel

What obstetrics is given for abortion

Gemeprost Mifespristone Misoprostol

What obstetrics is given to induce labour

Dinoprostone Misoprostol Oxytocin

What obstetrics is given to prevent or treat bleeding from labour, abortion or miscarriage

``` Carbetocin Carboprost Ergometrine Misoprostol OxyContin ```

What obstetrics is given for ectopic pregnancy

Methotrexate

What obstetrics is given for premature labour

SABA Atosiban Indometacin Nifedipine

What other use does finesteride have other that urinary incontinence

Treat hair loss

Adverse affect of finesteride that may cause men might stop taking it

Gynaecomastia

What other use does alpha blocker have except urinary retention

Resistant hypertension

Side effect of finesteride

Male breast cancer | Depression and suicidal thoughts

What forms does the combined contraceptive come in

Oral Transdermal patch Vaginal ring

What does does the progestogen come in

Oral Parenteral Intrauterine device

When is the risk increased of arterial thromboembolism for patients on hormonal contraceptives

Diabetes Hypertension Migraine without aura

How long after major surgery can COC be restarted

2 weeks after being mobilised

What’s common with progestogen only pill

Menstrual irregularities, heavy or light periods

When should you get EHC for POP and COC when missed a pill

POP missed on pill and had unprotected sex within 2 days COC missed 2 pills and had unprotected sex within 7 days

Which EHC can you give if a patient is on medication that interact (eg epileptic meds)

Copper IUD 3mg levonorgestrel Ulipristal

What’s the risk of the hormonal implant?

MHRA alert of the implant reaching the lungs

Cancer side effect of COC and POP

COC increased risk of cervical and breast cancer POP increased risk of breast cancer

How long should you use addiction barrier protection when you take Ulipristal when on other contraception

``` COC= 14 days POP= 9 days pill, 14 days parenteral ```

Which contraceptives are not effected by enzyme inducing drugs

Parenteral POP | IUD

What conditions can Antimuscarinic a worsen

``` Hyperthyroidism Coronary artery disease Congestive heart failure Hypertension Prostatic hyperplasia Arrhythmia Tachycardia ```

Is COC suitable in breast feeding

Advantages of parenteral POP

Protects against ectopic pregnancy | Not affected by enzyme inducing drugs

Disadvantages of parenteral POP

Delayed return of fertility | Irregular cycles

Advantages and disadvantages or implant POP

Advantages: highly effective and long lasting (3 years) Disadvantage: affected by enzyme inducers

Why are long journeys while on COC risky

DVT risk with travels > 3 hours

According to frasers guidelines when can you provide contraception without parental consent to under 16?

She understands the doctors advice She cannot be persuaded to inform her parents She’s likely to have sex again If her mental of physical health will suffer It’s in her best interest

What bp should contraception be stopped

Above 160/95mmHg

What age can thrush treatment be sold otc

Between 16-60

When should progesterone pill be taken

On day 1 of the cycle | If started after day 5, additional precaution is required

What’s the main risk of giving phosphodiesterase type 5 inhibitors with cvd drugs

Hypotension

When should you advice patients to take sildenafil

1 hour before sex and before food

What’s the criteria to supply tamsulosin otc

Symptoms for 3 months Men aged 45- Initially 2 week supply Of improvement further 4 weeks can be given then must have seen gp

What medication can cause cystitis

Tioprofenic acid

Which EHC can be taken again in the same cycle

Levonorgestrel