Flashcards in Genito-urinary tract system Deck (40)
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:
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 severe chest pain
Severe stomach pain
Signs of liver disorders (jaundice)
Serious neurological effects: vision/ hearing/ seizures/ headaches
When should oestrogen containing contraceptives be stopped before major surgery?
What about progestogen only?
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?
No- most effective emergency is copper IUD
How long after sexual activity can you use copper IUD for emergency contraception?
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?
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?
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
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