GU extra Flashcards
(15 cards)
You are reviewing a 52-year-old male patient with benign prostatic hyperplasia (BPH) who has been on an alpha-blocker for the past 2 years. His symptoms have worsened over the last 2 months, with increased nocturia and urgency. He has no signs of infection or blood in his urine, and his blood pressure is 134/82 mmHg. Which of the following patients would NOT typically require a 5-alpha reductase inhibitor?
Choose only ONE best answer.
A
Elderly
B
Enlarged prostate
C
High risk of progression
D
Recurrent pyelonephritis
E
Raised prostate-specific antigen concentration
D
A 17-year-old female approaches you in the pharmacy and requests a private consultation. She confides that she had unprotected sexual intercourse 4 days ago and did not use any form of contraception. She is not on any regular contraception and is not taking any other medication. She mentions that this is the second time this month that this has happened—the first being around 2 weeks ago when another pharmacy provided her with levonorgestrel. What is the most appropriate course of action in this case?
Choose only ONE best answer.
A
Provide the patient with levonorgestrel and advise her to take one tablet immediately
B
Provide the patient with levonorgestrel and advise her to take two tablets immediately
C
Provide the patient with ulipristal acetate and advise her to take one tablet immediately
D
Refer her to a GP, as it is too late after unprotected intercourse for treatment to be effective
E
Refuse treatment, as emergency hormonal contraception (EHC) cannot be used twice in one cycle
CONFIRM
C – Emergency hormonal contraception (EHC) can be used more than once in the same menstrual cycle. However, if levonorgestrel has been used first, ulipristal acetate should be avoided for the next 7 days, and if ulipristal acetate has been used first, levonorgestrel should be avoided for the next 5 days. In this case, the patient took levonorgestrel 2 weeks ago and is now 4 days after unprotected intercourse. Since levonorgestrel is effective only within 72 hours (3 days) after unprotected sex, and she is now outside that window, ulipristal acetate is the safest and most effective option as it can be used up to 120 hours (5 days) after unprotected intercourse.
During your annual medication review with Mrs. Lynne Cyclin, she shares that she has been having increasing difficulty in delaying urination during the day, often experiencing a sudden and urgent need to go. She is concerned as she has always been healthy and is unsure why this is occurring. Which of the following are risk factors for incontinence?
Choose only ONE best answer.
A
Significant weight loss
B
Smoking cessation
C
Diarrhoea
D
Pregnancy and vaginal delivery
E
First-generation antihistamines
Risk factors for incontinence include old age, pregnancy and vaginal delivery, obesity, smoking, constipation, a family history of incontinence, and the use of certain medications such as diuretics, alcohol, and caffeine.
25-year-old Jane, who has never used contraception before, is considering starting combined hormonal contraception (CHC). She has relied on barrier methods in the past and is concerned about potential side effects. You reassure her that side effects are generally rare and highlight the health benefits associated with CHC. Which of the following is NOT a health benefit associated with combined hormonal contraception?
Choose only ONE best answer.
A
Improves acne
B
Reduces bone density in peri-menopausal females
C
Reduces dysmenorrhea and menorrhagia
D
Reduces menopausal symptoms
E
Aligns bleeding patterns
B – Combined hormonal contraception (CHC) provides several health benefits, including improving acne, reducing dysmenorrhea (painful periods) and menorrhagia (heavy periods), aligning bleeding patterns, and reducing menopausal symptoms. It also helps maintain bone density in peri-menopausal females under 50. However, it does not reduce bone density; in fact, it is generally associated with maintaining bone density rather than decreasing it.
You are working on a Saturday morning at a local community pharmacy when you receive a call from a patient seeking advice on contraception. She recently returned from a two-week trip to Italy and has been feeling unwell since coming back. She wants to know if her symptoms could be related to her Microgynon (ethinylestradiol with levonorgestrel) tablets. Which of the following presenting signs would NOT prompt you to advise this patient to stop her tablets immediately?
Choose only ONE best answer.
A
Calf pain, swelling, and redness
B
Chest pain and breathlessness
C
Severe stomach pain
D
Severe vomiting and diarrhoea
E
Visual changes and limb weakness
Persistent vomiting and diarrhoea (option D) are common side effects that could reduce the effectiveness of the pill but do not necessarily require immediate cessation of the medication. The other symptoms listed could indicate serious conditions such as deep vein thrombosis, pulmonary embolism, or stroke, which would warrant immediate discontinuation of the contraceptive pill.
Mr. Begron has been admitted to the geriatric ward due to a fall. You review his medication chart and note that he is taking the following:
Amlodipine 10mg tablets
Ramipril 10mg tablets
Tamsulosin 400mcg tablets
Finasteride 5mg tablets
Amitriptyline 10mg tablets
Naproxen 250mg GR tablets
As you go through his list of medications, Mr. Begron asks you about finasteride. He is concerned because he has read that it can cause serious side effects. Which of the following is NOT a side effect of finasteride?
Choose only ONE best answer.
A
Sexual dysfunction
B
Decreased libido
C
Gynecomastia
D
Hair loss
E
Depression
Hair loss is not a side effect of finasteride; in fact, finasteride is often used to treat male pattern baldness. Common side effects include sexual dysfunction, decreased libido, gynecomastia, and depression.
While shadowing a GP and discussing various patient cohorts, you decide to ask about the use of enuresis alarms for treating nocturnal enuresis. You’ve encountered several young patients whose parents have been advised to use an enuresis alarm. Why is an enuresis alarm preferred over drug treatment?
Choose only ONE best answer.
A
Alarms are easier for young patients to use
B
Adherence to alarms has been shown to be higher
C
Alarms have a lower relapse rate compared to drug treatments when discontinued
D
Choice if often cost-related
E
Pharmacological treatments are often unavailable
nuresis alarms are preferred over drug treatments because they have a lower relapse rate when discontinued. This means that once treatment with an enuresis alarm is stopped, the patient is less likely to experience a return of symptoms compared to those who discontinue pharmacological treatments.
68-year-old, has just had a hypertension review at the practice. His clinic and home blood pressure readings are above target, and you discuss starting an additional medication to help control his blood pressure. He has a history of prostatic hyperplasia and continues to be symptomatic despite current treatment. You decide to prescribe a medication that can address both issues and advise him to take the first dose at bedtime due to the risk of postural hypotension. Which of the following medications is this advice likely applicable to?
Choose only ONE best answer.
A
Dutasteride
B
Terazosin
C
Mirabegron
D
Finasteride
E
Propantheline
The advice to take the first dose at bedtime due to the risk of postural hypotension is likely applicable to terazosin. Terazosin is an alpha-blocker used to treat both hypertension and prostatic hyperplasia, and it can cause postural hypotension, which is why taking the first dose at bedtime can help minimize this risk.
she mentions that she’s been struggling more and more to delay urination during the day and has been experiencing accidents when outside her home. She has already tried exercise-based treatments without success and now wishes to consult with a GP about medication options. Currently, she is on furosemide 40mg twice daily for leg oedema and ramipril 10mg once daily for hypertension. What is the most appropriate treatment option that the GP is likely to offer?
Choose only ONE best answer.
A
Propantheline
B
Oxybutynin
C
Flavoxate
D
Duloxetine
E
Imipramine
First-line treatment for urgency incontinence is bladder training for at least 6 weeks. If this is not effective, the second-line treatment typically involves an antimuscarinic medication, such as oxybutynin or tolterodine.
Mrs. Z, an 81-year-old, has been experiencing urinary issues with difficulty fully emptying her bladder. The GP has recommended a review of her medication regimen. She is currently taking amitriptyline 10mg for neuropathic pain, a terbutaline 100mcg inhaler, sertraline 50mg for anxiety, ibuprofen 200mg occasionally for headaches, and loratadine 10mg for hay fever. Her blood pressure is normal, and she does not take any other medications. Which of the following medications is likely causing her urinary symptoms?
Choose only ONE best answer.
A
Amitriptyline
B
Terbutaline
C
Sertraline
D
Loratadine
E
Ibuprofen
A – Amitriptyline is likely the cause of her urinary symptoms. As a tricyclic antidepressant, amitriptyline can have anticholinergic effects, which may contribute to difficulty in completely emptying the bladder.
was diagnosed with urgency incontinence three weeks ago after experiencing sudden urges to pass urine for a while. He mentions that the symptoms are still ongoing, making it challenging for him to manage, especially when he needs to travel far from home. Knowing that there are various treatment options for urgency incontinence, you inquire about the treatment he has been offered. What is the first-line treatment option for urgency incontinence?
Choose only ONE best answer.
A
Bladder training for at least 4 weeks
B
Bladder training for at least 6 weeks
C
Bladder training for at least 3 months
D
Pelvic floor muscle training for 3 months
E
Pelvic floor muscle training for 6 months
Bladder training for 6 weeks
You are calling a 78-year-old male patient as part of your new medicine service to check on his progress with Tolterodine for managing urinary symptoms. He mentions that the only side effect he’s experienced is a dry mouth. You advise trying saliva replacement sprays and contacting his GP if the problem persists. After the call, you realize you forgot to mention a crucial point and decide to call him back. What is the most important counselling point to offer to this patient?
Choose only ONE best answer.
A
Report any signs of diarrhoea as this needs to be addressed urgently
B
A referral to the GP is needed as a dry mouth can be a sign of oral cancer
C
Report any signs of excessive sweating as this needs to be addressed urgently
D
Be aware of drowsiness as the medication can affect the performance of skilled tasks like driving
E
Report any signs of depression as this should be reviewed by your GP
D – Tolterodine, an antimuscarinic medication, can cause drowsiness, which may impair the ability to perform tasks that require alertness, such as driving. It is important for the patient to be aware of this side effect and take appropriate precautions
You receive a call from a patient you saw earlier in the pharmacy. She obtained levonorgestrel for emergency contraception from another local pharmacy after having unprotected sexual intercourse yesterday. She has a 4-month-old baby and forgot to ask the other pharmacist whether levonorgestrel is safe to take while breastfeeding and if she needs to delay breastfeeding. How soon after taking levonorgestrel can she resume breastfeeding?
Choose only ONE best answer.
A
No delay
B
Wait 4 hour before breastfeeding
C
Wait 24 hours before breastfeeding
D
Wait 5 days before breastfeeding
E
Wait 7 days before breastfeeding
No delay
You are reviewing Miss Eleanor, a 24-year-old female known to your practice. She was recently started on Noriday (norethisterone) 350 mcg tablets for contraception but has been experiencing irregular spotting since beginning the medication. This side effect has been disruptive to her lifestyle, and she has decided she can no longer tolerate it. She asks to be switched back to a combined oral contraceptive. You decide to prescribe Gedarel (ethinylestradiol and desogestrel) 30/150 tablets and advise her on the need for additional precautions when she starts Gedarel. How long will she need to use additional precautions when switching from Noriday to Gedarel?
Choose only ONE best answer.
A
Patient will be protected straight away, therefore precautions are not needed
B
Patient will need additional precautions for 2 days after switching
C
Patient will need additional precautions for 7 days after switching
D
Patient will need additional precautions for 12 days after switching
E
The patient will need to abstain from sex completely
C
– When switching from a progestogen-only pill like Noriday to a combined oral contraceptive like Gedarel, additional precautions are needed for the first 7 days of the new medication to ensure full contraceptive protection.
A 32-year-old male presents at the pharmacy requesting to buy Viagra Connect (sildenafil) 50 mg tablets. He is informed that this medication can only be sold by a pharmacist after a consultation to ensure its safety. The patient agrees to fill out a questionnaire to rule out potential contraindications.In which of the following scenarios would sildenafil be appropriate for Mr. B?
Choose only ONE best answer.
A
Patients prescribed isosorbide mononitrate
B
Patient with premature ejaculation
C
Patients taking doxazosin for high blood pressure
D
Patient with a past history of myocardial infarction, 1 year ago
E
Patients taking Entresto (sacubitril and valsartan) for chronic heart failure
D – We would be able to supply Viagra Connect to Mr. B because if he had had a heart attack more than 6 months ago (but not earlier) and he was not taking any contraindicated medications. Sildenafil is contraindicated in patients taking nitrates or certain alpha-blockers, such as doxazosin, and it should not be sold to those on sacubitril and valsartan due to licensing restrictions.
