Genito-urinary system Flashcards by Rachel Westhead

Which antidepressant can be used to manage stress incontinence in women?

Duloxetine 40mg BD

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What bladder symptoms are manages with anti-muscarinic drugs?

Urge incontinence

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Name some anti-muscarinic drugs used to manage urge incontinence?

Oxybutynin, tolterodine, solifenacin, fesoterodine, dairfenacin, flavoxate, propantheline bromide

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Antimuscarinic side effects?

Constipation, dry mouth, dizziness, tachycardia

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Some contra-indications for antimuscarinics in urge incontinence?

Myasthenia gravis, urinary retention, GI obstruction, severe UC

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Safety concerns with mirabegron?

Can cause QT prolongation

Contra-indicated in severe uncontrolled hypertension, monitor blood pressure during treatment

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What drug can be used for nocturnal enuresis in children and what is the main side effect?

Desmopressin

Risk of hyponatraemic convulsions - avoid fluid overload

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What is the most common cause of urinary retention?

Benign prostatic hyperplasia

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What is 1st line treatment for urinary retention in BPH?

Alpha-adrenoreceptor blockers

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How do alpha-adrenoreceptor blockers work?

Relax prostatic smooth muscle causing an increased urinary flow rate + improvement in obstructive symptoms

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Name some alpha-adrenoreceptor blockers

Tamsulosin, alfuzosin, doxasozin, terazosin, indoramin

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Side effects of alpha-adrenoreceptor blockers such as tamsulosin?

Hypotension

Intra-operative floppy iris syndrome

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‘Alfuzosin is contra-indicated in postural hypotension’

True or false?

True

All alpha-adrenoreceptor blockers are

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What counselline should be given to a patient starting an alpha-adrenoreceptor blocker such as tamsulosin?

Take the first dose at bedtime as there is a risk of hypotension
Driving may be impaired

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When can tamsulosin be sold OTC?

Men aged 45-75
Over 3 months symptoms of BPH
400mcg daily

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How much tamsulosin can be supplied to a patient OTC?

Initially a 2 weeks supply
If no improvement of symptoms in 2 weeks then refer to GP
If improvement in symptoms can supply a further 4 weeks, after 6 weeks must see GP for confirmation that they can continue to take

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What is second line treatment for urinary retention in BPH?

5-alpha reductase inhibitor AND alpha-adrenoreceptor blocker

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Name some 5-alpha reductase inhibitors?

Finasteride + dutasteride

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What doses of finasteride are given for BPH?

5mg OD

Male baldness - 1mg OD

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MHRA safety warning associated with finasteride?

Reports of depression and suicidal thoughts

Stop treatment and inform healthcare professional if depression develops

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Safety concerns with finasteride + dutasteride?

Risk of male breast cancer, report any changes to breast tissue
Can be excreted in semen, use a condom if risk of pregnancy. Broken/crushed tablets should not be handled by women of child-bearing potential

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What are the Fraser guidelines for prescribing contraception for under 16s?

Can provide if:

They understand the drs advice
Can’t be persuaded to tell parents
Very likely to continue to have sex
Without contraception physical or mental health will suffer
It is in the patient’s best interest

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What are the advantages of combined hormonal contraceptives?

Reliable and reversible
Reduced dysmennorhoea + menorrhagia
Reduced PMT
Less benign breast disease
Reduced pelvic inflammatory disease
Reduced risk of ovarian/endometrial Ca

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When can COC be started?

Any time in the menstrual period

If after day 6 in cycle use protection for 7 days

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What are phasic preparations and when should they be offered?

Contain varying amounts of oestrogen + progestogen | Reserved for women with no withdrawal bleeding or breakthrough bleeding

Name some contraceptive oestrogen components?

Ethinylestradiol, estradiol, mestranol

Name some contraceptive progestogen components?

Desogestrel, drospirenone, gestodene, levonornogestrel

Which progestogen is a derivative of spironolactone?

Drosperinone - monitor for hyperkalaemia

When should COC be stopped prior to surgery?

Any oestrogen-containing contraceptives should be stopped 4 weeks before surgery

When can COC be restarted after surgery?

On first menses, should be 2 weeks after full mobilisation

What advice about travelling should be given to patients on COC?

On journeys over 3 hours risk of DVT can be reduced by wearing compression stockings and doing leg exercises

Which of these is NOT a reason to stop oestrogen-containing contraception/HRT? - Unexplained swelling in calf of one leg - Sudden breathlessness - Sudden partial loss of vision - Pregnancy - Blood pressure reading of 160/95 mmHG

Pregnancy

Which of these is NOT a contra-indication for oestrogen? - Smoking over 40 cigs a day - Age over 50 - BMI >35 - Sedentary lifestyle - Complicated diabetes

Sedentary lifestyle

How do progestogen-only contraceptives work?

Alter cervical mucus to prevent sperm penetration | May inhibit ovulation in some women

'Menstrual irregularities are common with use of progestogen-only pills' True or false?

True

Can POPs be used prior to surgery?

Yes, may be an alternative to combined contraceptives

When can POPs be restarted after pregnancy?

Up to day 21 post-partum, if >21 days then additional protection should be used for 2 days

What is classed as a 'missed pill' with progestogen-only contraceptives?

One that is over 3 hours late (desogestrel is over 12 hours) Take the pill ASAP and use protection for 2 days Seek EHC if unprotected sex BEFORE 2 pills are taken correctly

What advice should be given for vomiting after taking a POP?

If if was less than 2 hours after taking then take another pill If persistent/severe D+V then use protection for 2 days after it ends

When can EHC be offered after childbirth?

21 days

When can EHC be offered after abortion or miscarriage?

5 days

What should be offered first line for emergency contraception?

Copper IUD | Most effective form of contraception + provides ongoing protection

When can a copper IUD be inserted for emergency contraception?

120 hours after unprotected intercourse

'EHC offered after ovulation is ineffective' | True or false?

True

At what point in the menstrual cycle does ovulation occur?

Around day 12-15 | Cycle starts day 1 on the first day of menses

What type of EHC should be offered to obese patients/ patients who weigh >70kg?

- Ulipristal | - Double dose of levornogestrel

How long after EHC can oral contraceptives be started?

Levornogestrel - can start immediately | Ulipristal - wait for 5 days as can reduce effectiveness of regular contraceptives

Can EHC be used more than once in the same cycle?

- Levornogestrel should not be used more than once in the same cycle due to the risks of side effects - Ulipristal may be used more than once - Levornogestrel should not be used within 5 days of ulipristal as can reduce the contraceptive effect

Why would you be cautious supplying EllaOne to a young woman with asthma?

Ulipristal is not recommended in severe asthma treated with ICS as it can have an anti-glucocorticoid effect

Which migraine symptoms should women on COCs report?

- Increase in headache frequency or onset of focal symptoms - Stop if serious neurological effects occur - Should be avoided in migraine with aura

What are the cancer risks associated with COC?

Can increase the risk of breast and cervical cancer, potentially due to earlier diagnosis Risk should be gone after stopping treatment for 10 years Can reduce the risk of ovarian and endometrial Ca

Why should COC be avoided in liver disease?

Risk of hepatic impairment | Stop if severe stomach pain, jaundice, hepatitis or liver enlargement

When can COC be started after abortion or miscarriage?

On the same day

What is classed as a missed pill with COC?

Over 24 hours late | Take when you remember, can take 2 together

When should additional protection be used for missed combined contraceptive pills?

If 2 or more pills are missed Especially out of the 1st 7 pills in the packet Additonal protection for 7 days, if this includes the break then omit pill-free interval

Which two brands of COC class a missed pill as over 12 hours late?

Qlaira + zoely

What advice should be given to women taking COC with severe D+V?

Use protection for 7 days from recovery For 9 days if qlaira If this occurs in the last 7 days of the packet then omit pill free interval

What is classed as a 'missed patch'?

Patch that has been detached for over 24 hours or if there is delayed application at the start of the cycle

What counselling should be given to patients who are taking EHC?

- Next period may be early or late - Use a barrier method of contraception until next period - See GP if any lower abdo pain, risk of ectopic pregnancy - If periods are abnormal then take a pregnancy test (must be 3 weeks after unprotected sex)

Why are IUD less suitable in under 25s?

Risk of pelvic inflammatory disease

What advice should be offered if a patient with an IUD becomes pregnant?

Should be removed in the first trimester

What risks are associated with medroxyprogesterone parenteral contraception?

- Can cause menstrual disturbance and potential to delay return to full fertility - Risk of osteoporosis

'Erectile dysfunction is associated with an increased risk of cardiovascular disease?' True or false?

True

Which drugs are used first line for erectile dysfunction?

Phosphodiesterase type-5 inhibitors | Sildenafil, vardenafil, avanafil, tadalafil

Which phosphodiesterase type-5 inhibitor is long-acting?

Tadalafil - can be used for spontaneous sexual activity

How soon before intercourse should sildenafil be taken?

1 hour

What is second line treatment for erectile dysfunction + the associated risk?

Alprostadil | Risk of priapism, seek medical advice if erection >4 hours

What are the side effects of phosphodiesterase type-5 inhibitors such as sildenafil?

Hypotension | Flushing, tachycardia, palpitations, nasal congestion, dyspepsia

Contra-indications for phosphodiesterase type-5 inhibitors?

- MI/unstable angina - Hypotension (systolic BP <90) - Use of nitrates (risk of hypotension)

When can sildenafil be sold OTC?

- 18 + males - 50mg dose taken 1 hour before sex - Max 100mg per dose, max one dose per day - If taken with food then onset may be delayed - See GP in 6 months for clincal review of potential underlying conditions