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Flashcards in Genito-urinary tract system Deck (40)
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Which drug is of benefit in stress incontinence in women (second line to surgery) ?



When should oxybutynin be avoided and why?

Avoid in frail elderly women due to risks of chronic confusion, acute delirium, impairment of daily functioning.


When is mirabegron contraindicated?

Severe uncontrolled HTN ≥ 180/110


What age are children expected to be dry?

How is nocturnal enuresis managed?

Expected to be dry by 5 years old
Consider treatment only when child reaches 7

1st line: enuresis alarm (+ reward system)
2nd line: desmopressin
3rd line: Antimuscarinics (e.g oxybutynin) or TCAs (e.g imipramine)


What should be done before a catheter is removed?

Give an alpha blocker for at least 2 days.


How is chronic urinary retention managed?

Alpha blockers (e.g tamsulosin)
Review after 4-6 weeks then every 6-12 months


How is BPH managed?

1st line: alpha blocker

2nd line: 5a-reductase inhibitor (e.g finasteride) if prostate is enlarged

3rd line:combo of both/ surgery


When should indoramin be avoided?

Parkinsons- exacerbates it


What are the side effects of alpha blockers?

When should they be avoided?

First dose hypotension (give at night)
-cause sexual dysfunction
-caution if pt on antihypertensives/ patients with HF

-AVOID if cataract surgery- risk of floppy iris syndrome


What is the MHRA alert associated with 5a-reductase inhibitors (e.g finasteride + dutasteride) ?

rare reports of depression and suicidal thoughts- discontinue.


What are the precautions surrounding use of finasteride and dutasteride?

Tablets- not handled by women of childbearing age.
Excreted in semen- men should use a condom
Can cause male breast cancer!!
Can hide markers of prostate cancer- evaluate regularly for prostate cancer.


How is pain relieved in cystitis?

What are the referral criteria?

Alkalinisation of urine with:
potassium citrate
sodium bicarb

Refer if: symptoms >3 days, renal/ cardiac issues (due to treatment with sodium + potassium)


Which are the progestogens?
How do they work?

Desogestrel, levonorgestrel, norethisterone.
They alter cervical mucus to prevent sperm penetration


When should combined contraceptives or HRT be stopped immediately?

BP systolic >160 or diastolic >95
Unexplained leg swelling (DVT signs)
Sudden breathlessness
Sudden severe chest pain
Severe stomach pain
Signs of liver disorders (jaundice)
Prolonged immobility
Serious neurological effects: vision/ hearing/ seizures/ headaches


When should oestrogen containing contraceptives be stopped before major surgery?

What about progestogen only?

4 weeks

Progestogen only can be continued


When are copper IUDs less appropriate?

Women <25 due to higher risk of pelvic inflammatory disease


Which progestogen can inhibit ovulation (no periods)?



How long after childbirth can you have EHC?

What about after abortion/ miscarriage?

21 days after childbirth

5 days aft abortion/ miscarriage


What is the most effective contraception?

Is it also the most effective emergency contraceptive?

Hormonal contraceptives

No- most effective emergency is copper IUD


How long after sexual activity can you use copper IUD for emergency contraception?

5 days


Which EHC can be used more than once in the same cycle?

Levonorgesterel has more side effects when used more than once in a cycle.


How soon after using ulipristal for EHC can you restart your ongoing contraception?

5 days


When should ulipristal be avoided?

Severe asthma treated with oral steroids


Which medicines reduce effectiveness of hormonal contraception?

What should be done if a woman needs to go on this type of medicine?

Enzyme inducers:

Remember: CRAP GPS induce me to madness..

Switch her to copper IUD/ parenteral progestogen.


What are the side effects of combined oral contraceptives?

Breast cancer risk
Cervical cancer risk
Liver disorders
VTE risk
Neurological symptoms such as migraine, vision, hearing problems, seizures- discontinue if severe


What should be done if doses of combined oral contraceptive are missed?

Which pills does this not apply too?

If ONE pill missed (24 hours+) take the missed pill then continue taking the rest as normal, no additional contraception is needed

If TWO pills missed (48 hours+) take the latest missed pill then continue taking the rest as normal, use extra contraception for the next 7 days.
If pill is missed in the first week, not protected- EHC may be needed if sex occurred.
If pill is missed in third week (pills 15-21) omit the pill free interval. start new pack right after.

Doesnt apply to :
Zoely, Eloine (not protected after 24hrs missed dose)
Qlaira (not protected after 12hrs of missed dose)


What is the MHRA alert associated with the copper IUD?

Risk of uterine perforation especially up to 36 weeks postpartum or if breastfeeding.


What should be done if doses of progestogen only (minipill) contraceptive are missed?

If less than 3 hours late (12 hours for desogestrel):
take the missed pill asap. take the next pill at the usual time. You are protected- no extra precautions.

If more than 3 hours late (12 hours for desogestrel):
take one pill as soon as you remember, take next pill at usual time. You are not protected for the next 2 days (48 hours) use condoms and EHC needed if sex occurs.


How is erectile dysfunction managed?

Phosphodiesterase type-5 inhibitors:
Sildenafil, avanafil, vardenafil- PRN
Tadalafil- long acting can be used OD for regular sex.
Six doses at max strength= non responder (refer)

2nd line: alprostadil (under medical supervision)
Via: intracavernosal, intraurethral, topical


What is priapism? How is it treated?

Erection >4 hours
Erection > 6 hours should be treated without delay.

Penile aspiration/ lavage (blood drawn from penis)
Penile injection of a sympathomimetic (e.g adrenaline/ metaraminol/ phenylephrine