Genito-Urinary

Question 1

what are the different types of incontinence?

Answer 1

urgency - sudden, immediate need to pass urine
stress - leakage on exertion, coughing, sneezing
mixed - urgency and stress (treat as predominant type)

Question 2

how do you treat urge incontinence?

Answer 2

1st bladder training for 6 weeks
2nd antimuscarinic (oxybutynin/ tolterodine)
3rd mirabegron

Question 3

what are the contraindications to antimuscarinics?

Answer 3

glaucoma
GI obstruction

Question 4

name the antimuscarinics?

Answer 4

oxybutynin, solifenacin, tolterodine, trospium

Question 5

what are side effects to the anti-muscarinics?

Answer 5

constipation, dry mouth, flushing, dizziness, drowsiness, tachycardia

Question 6

how do you manage nocturnal enuresis in children?

Answer 6

1st enuresis alarm
2nd desmopressin (>5)

Question 7

what is the major side effect of desmopressin?

Answer 7

hyponatraemic convuslions

Question 8

what are the counselling points for desmopressin for nocturnal enuresis?

Answer 8

avoid fluid overload (restrict fluid overload 1 hour before food and until 8 hours after desmopressin)
stop desmopressin in V&D

Question 9

what medications can be used for urinary retention?

Answer 9

alpha blockers
5 alpha reductase inhibitors

Question 10

what are the side effects of alpha blockers?

Answer 10

postural hypotension, dizziness, intra-operative floppy iris syndrome

*take first dose before bed

Question 11

what are the side effects of finasteride (5 alpha reductase inhibitor)?

Answer 11

male breast cancer

Question 12

what is the MHRA alert for finasteride?

Answer 12

depression and suicidal thoughts

Question 13

what is the advice regarding finasteride and its teratogenic effect?

Answer 13

women of CB age should not handle crushed/ broken tablets
men should use a condom if partner of CB age

Question 14

what treatment options are available for erectile dysfunction?

Answer 14

phosphodiesterase type-5 inhibitors
prostaglandin analogue (alprostadil)

Question 15

what effect dose food have on the phosphodiesterase type-5 inhibitors?

Answer 15

delayed effect

Question 16

how long before sex should sildenafil be taken?

Answer 16

1 hour

Question 17

how long before sex should tadalafil and avanafil be taken?

Answer 17

30 minutes

tadalafil is long acting, can be used once daily

Question 18

how long before sex should vardenafil be taken?

Answer 18

25-50 minutes

Question 19

what are the side effects of phosphodiesterase type-5 inhibitors?

Answer 19

flushing
dizziness
nasal congestion
migraine
priapism (erection > 4 hours) - medical emergency

Question 20

what medications are used in abortions?

Answer 20

gemeprost
mifepristone
misoprostol

Question 21

what medications are used to induce labour?

Answer 21

dinoprostone
misoprostol
oxytocin

Question 22

what medications are used to prevent and treat bleeding in labour, abortion and miscarriage?

Answer 22

carbetocin
carboprost
ergometrine
misoprostol
oxytocin

Question 23

what medication is used to treat an ectopic pregnancy?

Answer 23

methotrexate

Question 24

what medications are used to treat premature labour?

Answer 24

salbutamol/ terbutaline
atosiban
indometacin
nifedipine

Question 25

what non-hormonal contraceptive treatments are there?

Answer 25

barrier (condom - oil based products can damage latex) IUD (copper coil)

Question 26

what drugs are available in a POP?

Answer 26

levonorgestrel, northisterone, desogestrel

Question 27

will additional contraception be required when starting the POP?

Answer 27

no additional precaution if started in first 5 days of cycle 2 days precaution if started at other point

Question 28

if a dose of the POP is missed, within how many hours is it safe to take the missed dose without needing further contraception?

Answer 28

within 3 hours 12 hours if desogestrel * if longer use condom for 2 days

Question 29

what is the upper age limit for CHC?

Answer 29

50

Question 30

what is the pill free period with CHC?

Answer 30

21 days 7 days pill free

Question 31

will additional contraception be required when starting the CHC?

Answer 31

if started on day 6 of cycle or later, additional contraception for 7 days

Question 32

if 1 pill of CHC has been missed, what should be done?

Answer 32

take ASAP, no further action

Question 33

if 2 or more pills of CHC have been missed, what should be done?

Answer 33

take one pill ASAP + condom for 7 days omit pill free interval EHC - if missed in first 7 days of cycle and sex occurs

Question 34

what is first line for emergency contraception?

Answer 34

IUD, up to 5 days after UPSI

Question 35

what drug options are available for EHC?

Answer 35

levonorgestrel (72 hours) ulipristal (120 hours) - 1 week delay of breastfeeding, can use more than once in each cycle, use barrier for 14 days if on CHC and 9 days if on POP, await 5 days before starting regular contraception