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genito urinary Flashcards

(88 cards)

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1
Q

first line urinary incontinence

A

antimuscs:

oxybutinin = direct relaxant
tolterodine
fesoterodine
darifenacin
solifenacin
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2
Q

second line urinary incontinence

A

beta3agonists

mirabegron

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3
Q

caution with mirabegron

A

QT prolongation

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4
Q

CI with mirabegron

A

severe uncontrolled hypertension

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5
Q

moderate-severe stress incontinence

A

duloxetine

women only

don’t withdraw abruptly

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6
Q

first line in child nocturnal enuresis

A

enuresis alarms - continue until 2 weeks uninterrupted dry nights

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7
Q

second line in child nocturnal enuresis

A

SL/PO desmopression in 5+

IN route shouldn’t be used in NE due to increased SEs

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8
Q

desmopressin side effects

A

hyponatramic convolusions

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9
Q

desmopressin counselling

A

avoid fluid overload - restrict fluid 1 hour before and 8 hours after

stop desmopressin in vomiting/diarhoea until normal

avoid concomitant drugs that increase vasopressin secretion e.g. TCADs

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10
Q

alpha blockers MOA

A

relaxes prostatic smooth muscle

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11
Q

alpha blockers

A 
doxazosin
tamsulosin
alfuzosin
indoramin
terazosin
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12
Q

alpha blockers side effects

A

postural hypotension

intra-operative floppy iris syndrome

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13
Q

alpha blockers counselling

A

take first dose at bed

driving can be impaired

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14
Q

finasteride MOA

A

5Alpha Reductase inhibitor

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15
Q

finasteride & dutasteride counselling

A

report breast symptoms e.g. lumps/pain/nipple discharge

use condoms - excreted in semen

women of child-bearing age should avoid handelling

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16
Q

finasteride MHRA alert

A

report signs of depression and suicidal thoughts

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17
Q

fraser guidelines when prescribing contraception to under 16s without parental consent

A
  • patient understands advice
  • cannot be persuaded to inform parents
  • likely to continue having sex
  • in patient’s best interest to provide treatment
  • if her physical or mental health will deteriorate without contraception
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18
Q

COC moa

A

inhibits ovulation

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19
Q

age CI for COC

A

> 50 yo

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20
Q

when to start COC

A

any time of cycle but if started day 6+, use protection for 7 days

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21
Q

increased risk of VTE

A
  • BMI>30
  • smoker
  • primary relative under 45 with VTE
  • superficial thrombophlebitis
  • Long term immobilisation
  • age>50
  • desogestrel/gestodene/drosperinone
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22
Q

increased risk of arterial thromboembolism

A
  • DM
  • hypertension
  • migraine without aura
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23
Q

when to stop COC for elective surgery

A

4 weeks before

prog-only as alternative

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24
Q

when to restart COC after surgery

A

on first menses at least 2 weeks after full mobilisation

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25
what to do in emergency surgery if patient takes COC
thromboprophylaxis
26
what to do in journeys longer than 3 hours when patient takes COC
compression stockings and leg exercises
27
signs of VTE when on COC
PE: - sudden chest pain - sudden breathlessness - sudden cough - blood-stained sputum DVT -unexplained swelling or pain in one calf
28
signs of stroke when on COC
sudden neuro effects: - sudden headache - sudden visual/auditory disturbances - dysphasia - collapse - first seizure - motor disturbances - unilateral numbness
29
other reasons to stop COC
- liver dysfunction - BP > 160/95 - prolonged immobility after surgery(DVT risk)
30
POP moa
thickens cervical mucus
31
menstrual irregularities are associated with what pill
POP
32
how to take POP
if started on day 5 of cycle, additional precaution is required for 2 days
33
COC cancer SEs
breast | cervival
34
POP cancer SEs
breast
35
COC cancer benefits
endometrial | ovarian
36
other COC benefits
reduces: dysmenorrhea and menorrhagia PMT PID BBC fibroids/cysts
37
COC missed pill
>24hrs
38
COC missed pill exceptions
Zoely/Qlaira >12hrs
39
1 missed COC pill
take 1 pill asap + next one at normal time even if it means 2 together no extra precautions
40
2 missed COC pills
take one pill asap + condom for 7 days (9 days with zoely/qlaira)
41
if COC pill missed in last 7 days
omit pill-free interval
42
if COC pill missed in first 7 days
EHC
43
missed POP
> 3hours
44
missed POP exception
desogestrel >12 hours
45
missed POP rules
take asap + condom for 2 days
46
when EHC is needed in POP
if UPS happens before 2 correct pills are taken
47
vomiting and diarrhoea COC
vomit <2hrs = take another asap >24 severe - protection until 7 days after recovery and pill resumed. (9 days if qlaira) in last 7 days - omit pill free interval
48
vomiting and diarrhoea POP
vomit<2hrs = take another asap severe or pill not taken within. hrs (12hrs desogestrel) = protection until 2 days after recovery and pill resumed
49
patch cycle
3 patch weeks and 1 week patch free
50
patch detached for >24hrs or delayed application at start of cycle
apply new one ASAP and start new day 1 + condom for 7 days
51
delayed application of patch on week 2 or week 3
<48hrs = apply new patch and continue as normal >48 hours = start new day 1 + condom for 7 days
52
what to do if patient is on an enzyme inducing drug
copper iud PO injection use until 4 weeks after stopping
53
EHC in patients on enzyme inducers
``` copper iud 3mg levonorgestrel (UL) ```
54
what is ulipristal efficacy affected by
antacids H2RAg PPIs
55
EHC first line
copper iud - most effective
56
copper iud
<120 hrs after ups or up to 5 days after earliest calculated ovulation
57
second line EHC
hormonal levonorgestrel 1500mg < 72hrs ulipristal 30mg <120hrs
58
EHC in BMI>26 or >70kg
uliptristal or levonorgestrel double dose
59
vomiting after levonelle and ellaone
<3 hours = replace dose
60
cautions with levonelle
crohns - malabsorption past ectopic pregnancy ciclosporin
61
cautions with ellaone
severe asthma w/ oral corticosteroids sever liver impairment
62
ellaone CI
>1 dose in same cycle
63
ulipristals effect on regular contraceptives
reduces effectiveness use barrier for COC - 14 days (16 if qlaira) POP - 9 days (14 if parenteral) wait 5 days before restarting hormonal contraception
64
hormonal contraception counselling
next period could be early/late use barrier til next period report lower ab pain to gp take a pregnancy test > weeks post ups if periods are abnormal
65
what age is IUD nCI
<25 PID
66
which iud has reduced risk of pid
levonorgestrel releasing
67
iud brands
mirena - 5 years levosert - 3 years jaydess - 3 years
68
mirena indications
contraception oestrogen-opposition in HRT menorrhagia
69
levosert indications
contraception | menorrhagia
70
jaydess indications
contraception
71
IUD MHRA advice
uterine perforation so report pelvic pain change in periods pain on sex increased bleeding for a few weeks
72
removal of iud
dont remove midcycle unless additional contraceptive is used for 7 days if removal is essential and ups occurs, give ehc pregnant - remove in 1 TM
73
parenteral contraception
norethisterone - 8 weeks medroxyprogesterone - 2 years etonorgestrel (nexplanon) - 3 years
74
MHRA advice of nexplanon
implants may reach lung via pulmonary artery must be able to feel it otherwise locate and remove use chest imaging if unable to locate in arm
75
pd5i
sildenafil - 1 hr before sex & food tadalafil - 30 mins before vardenafil - 25-60 mins before avanafil - 30 mins before
76
PGA
alprostadil (not PO) report erection > 4hrs = priapism
77
PD5i moa
increased blood flow to penis
78
PD5i vasodilating side effects
``` flushing hypotension headache/migraine dyspepsia nasal congestion palpitations tachycardia ```
79
PD5i CI
reduced blood perfusion: ``` MI unstable angina recent stroke nitrates systolic <90 ```
80
PD5i
nitrates alpha blockers CCB nicorandil
81
abortion drugs
PGA: gemeprost misoprotol Anti prog: mifespristone
82
labour inducing drugs
DOM dinoprostone (natural PG) misoprostol oxytocin (natural hormone)
83
prevent bleeding during labour/miscarriage/abortion
``` carbetocin carboprost ergometrine misoprostol oxytocin ```
84
ectopic pregnancy
MTX
85
premature labour
salbutamol/terbutaline atosiban (oxytocin antag) indometacin (COXi stops PG synth) nifedipine NISA
86
treating BV/VT
metronidazole 2g single dose
87
thrush in pregnancy
topical imidazole for 7 days
88
recurrent thrush
6 month treatment

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