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Flashcards in Genitourinary Medicine Deck (13):
1

A women comes into the pharmacy complaining of...
- Painful urination (burning and stinging)
- Needing the toilet but only going a small amount
- Needing to urinate during the night
- Strong smelling urine that is dark
- And lower back pain

What could this be?
What would you ask specifically?

- Could be cystitis

- Rule out any abnormal discharge/smells from vagina (thrush, vaginosis, trichomoniasis)
- Has she had a recent STI check?
- Age - is she post menopausal (more susceptible)
- Systemic infection? Upper UTI? - nausea, vom

2

What are the referral symptoms for cystitis?

- Post menopausal women (low oestrogen and urethra lining thins making more susceptible to infection)
- Under 12 years
- Diabetics
- Had longer than 7 days
- Immuno compromised
- MEN
- FEVER, NAUSEA, VOMITING
- PREGNANCY
- Abnormal vaginal discharge
- Treatment failure
- TAKING BLOOD PRESSURE OR HEART MEDICATION

3

What are the treatment options for thrush?
Lifestyle?

- Canesten Oasis, Cystopurin, Cystemme...
- Aims to make urine alkaline, relieving painful urination
- Use sachets as directed
- If symptoms do not improve after 24hours then see GP

Paracetamol/Ibuprofen for pain relief

- LIFESTYLE:
- Drink plenty of water to dilute urine (help symptoms)
- Avoid intercourse till symptoms resolve
- Avoid perfumed toiletries
- Avoid ignoring the call to urinate
- Maintain good hygiene

4

A women comes into the pharmacy complaining of having curd like discharge. She says there is little or no odour. It developed quite rapidly and is now itchy and sore.

What questions do you ask her and what do you advise?
REFER?
LIFESTYLE?

- Age? (16 to 60)
- Any medical conditions e.g diabetes (glycogen levels)
- Have you been using antibiotics recently?
- Have you been previously diagnosed with thrush?
- How often do you have thrush? (refer if more than 2 cases 6 months or 4 in one year)
- Have you tried anything for it so far?
- Is there any chance that you might be pregnant?
- Any other symptoms?

- If been diagnosed before and none of the above are concerning then advise...
- Clotrimazole cream bd for three days
- Clotrimazole Pessary (night time use)
- Fluconazole capsule (single dose) (may cause GI disturbances)

- Avoid tight clothing, perfumed soaps, advice on how to insert pessaries
- Treat partner if appropriate
- SEE GP IF SYMPTOMS NOT RESOLVED IN 7 DAYS - should start to resolve in 3 days

5

How do you distinguish between thrush, bacterial vaginosis and trichomoniasis?

- Thrush
- Curd like discharge, no smell, white

- BV
- White discharge, strong fishy odour

- Trichomoniasis
- Malodorous, green-yellow in colour

6

What is benign prostate hyperplasia?
Should you refer it?

- Non malignant swelling of prostate
- Cause urgency, small volumes of urine passed
- REFER IF NO DIAGNOSIS INCASE PROSTATE CANCER

7

What can be used to treat BPH?
How does it work?
Lifestyle?

- Tamsulosin 400mcg OTC
- Reduces swelling of the prostate

- Don't drink large volumes at night
- Reduce alcohol and caffeine consumption

8

How long can Tamsulosin be supplied for?

- 2 week initial supply
- If improvement seen then give 28 days supply
- See GP after that

9

What age range can Tamsulosin be supplied to?

- 45 - 75 years
- Must've been suffering for at least 3 months

10

What is menorrhagia?

- Excess bleeding in period
- NOT painful period!

11

What can be used to treat menorrhagia?
How is it taken?
Side effect?

- Refer to GP for COC
- Tranexamic acid reduces blood loss

- 2 tabs tds for 4 days
- Can inc to max of 8 tabs in 24 hours
- Reduce number of tablets when bleeding improved
- DONT USE PROPHYLACTICALLY

- Mild GI disturb
- Visual disturb (see GP)

12

Who can use Tranexamic acid?
Who needs to be referred?

- Woman aged 18-45
- Heavy menstrual loss over several cycles
- Regular cycle of 21 - 35 days

- Outside age range
- History of endometrial cancer in 1st degree rel
- Have PCOS (polycystic ovary syndrome)
- Obese and diabetic
- Breastfeeding
- Used Tranexamic acid without benefit within 3 months
- Anti-coag
- COC
- Renal impairment

13

When should user of Tranexamic acid see GP for advice?

- Change in bleeding pattern
- Sign of blood clot
- Visual disturbances
- Allergic reaction