Symptoms in the Pharmacy - Women’s Health Flashcards

Question

Management- Topical vaginal cream EXTERNAL cream

Answer 1

Clotrimazole 2% cream (Canesten®) - immediate symptomatic relief of itch - apply thinly to VULVA and surrounding area BD-TDS until symptoms disappear

Answer 2

Itching/burning sensation can damage latex contraceptives - use alternative precautions for at least 5 days after using product

Answer 3

Clotrimazole 10% cream (Canesten®) Administer intravaginally using the applicator supplied One-off treatment, best administered at night

Answer 4

Itching/burning sensation Uncomfortable (formulation) damage latex contraceptives- use alternative precautions for at least 5 days after using product Not to be used during periods- may wash out

Answer 5

Clotrimazole 500mg, 200mg or 100mg (Canesten®)

Answer 6

Administer intravaginally as high as possible using the applicator supplied

Answer 7

500mg pessary: One-off treatment at night, can be repeated in 7 days if infection returns (only this is available via Common Ailments Scheme) 200mg pessary: One pessary daily at night for 3 days 100mg pessary: Two pessaries daily at night for 3 days OR one pessary daily at night for 6 days

Answer 8

Itching/burning sensation Uncomfortable If using longer course = need motivation Not to be used during periods- may wash out Do not use tampons/intravaginal douches/spermicides etc during treatment

Answer 9

Fluconazole 150mg oral capsule (Canesten®) One-off dose, to be swallowed whole May take 12-24 hours for symptoms to improve

Answer 10

warfarin, statins, phenytoin, rifampicin, ciclosporin and theophylline Single dose may not affect drug levels too much, but will need to refer to GP

Answer 11

mild and transient; include nausea, abdo discomfort, flatulence and diarrhoea. Convenient and acceptable formulation

Answer 12

Male may catch infection from a female partner May be asymptomatic

Answer 13

Irritation, burning and redness around the head of the penis and under the foreskin White/cream-coloured discharge, thick in consistency like cottage cheese Discharge which may or may not have an unpleasant smell Difficulty pulling back the foreskin

Answer 14

Azole external cream BD for 6 days or oral fluconazole STAT

Answer 15

First occurrence of symptoms- to confirm diagnosis Allergic to antifungals Pregnant or breast feeding Immunocompromised More than 2 thrush attacks in previous 6 months Previous exposure to STI or partner with STI Women aged under 16 or over 60 Abnormal/irregular vaginal bleeding Blood-stained vaginal discharge // Foul smelling discharge Vulval or vaginal sores/blisters/ulcers Associated lower abdo pain or dysuria Adverse effects related to treatment (redness/irritation/swelling) No improvement within 7 days of treatment OTC licensing of candidiasis products reflect these referral criteria

Answer 16

period pains

Answer 17

Pain without underlying causes Manage in community pharmacy 1 in 2 women suffer, while 1 in 10 have severe symptoms, requiring time off work or school Peak incidence: 17-25 years of age

Answer 18

Pain with underlying disease, e.g. endometriosis or pelvic inflammatory disease

Answer 19

- cramping lower ab pain - begins before start bleed - pain eases after menstruation - gone by end of first day of bleeding - Not associated with the start of menstruation (menarche) because ovulation doesn’t happen within the first few months/years of menstruation [ Women often state that period pain begins several months/years after pain-free menstruation [Women often state that period pain begins several months/years after pain-free menstruation]

Answer 20

Mittelschmerz = ovulation pain. This pain is mid-cycle at the time of ovulation. It usually lasts a few hours, some report some bleeding too Therefore important to identify timing of pain to differentiate

Answer 21

Exercise (endorphins help) TENS machine (alters ability to receive/perceive pain signals) Acupuncture Locally applied low-level heat (heat pads or even warm bath) Supplements like fish oil or vitamin B- evidence is patchy

Answer 22

Simple analgesia (NSAIDs best) Hyoscine butylbromide (antispasmodic)– evidence is patchy Caffeine (enhance analgesic effect)

Answer 23

Pain of dysmenorrhoea linked to increased prostaglandin activity NSAIDs block synthesis of prostaglandins, which is why they are effective in treating period pains

Answer 24

Ibuprofen: 200-400mg TDS with food Naproxen: 500mg initially then 250mg 6-8 hours later if needed. Max 3 days treatment can be supplied OTC. NSAIDs not appropriate if allergy (incl. aspirin), asthma or GI bleeds. Could offer these patients paracetamol- doesn’t work on prostaglandins but may have some benefit Take painkillers regularly for 2-3 days each period, not just PRN

Answer 25

Heavy menstrual bleeding Excessive blood loss interferes with a woman’s physical, social, emotional and material quality of life

Answer 26

30-40mL per cycle Menorrhagia: 60-80mL or more per cycle

Answer 27

Tranexamic acid

Answer 28

antifibrinolytic Inhibits fibrinolysis > increased clot formation > reduced blood loss

Answer 29

Only take once heavy bleeding has started (not before) Two x 500mg tablets TDS until symptoms alleviated, for a maximum of 4 days OTC If bleeding very heavily, can increased to a maximum of eight tablets a day (4g daily) Can repeat for each menstrual cycle

Answer 30

Women under 18 or over 45 years of age Tried tranexamic acid for three menstrual cycles without a reduction in bleeding Breastfeeding women Obese or diabetic patients (could be PCOS) If tranexamic acid contraindicated or cautioned- e.g. in history of convulsions, taking warfarin, taking oral contraceptives Signs of iron-deficient anaemia: tiredness, paleness Irregular bleeding/abnormal bleeding/bleeding between periods/prolonged periods – may be endometrial cancer Bleeding between periods/pain during sex/ bleeding after sex/ bleeding after menopause – may be cervical cancer History of clotting- e.g. PE, DVT

Answer 31

P med: desogestrel 75mg tablets (Lovima® and Hana®) Type of progesterone-only pill (POP) Can be 99% effective in preventing pregnancy Must only sell: As a form of contraception (i.e. no other indication) To women of childbearing age (under 18s to be supplied based on clinical judgement as no info on safety or efficacy in SPC) Dose: 1 tablet daily (no break between packs)

Answer 32

Blood clots, cancer, soya/peanut allergy (Lovima® contains soya bean oil, so avoid in both allergy types)

Answer 33

Refer anyone with clinically relevant interaction (e.g. antiepileptics)

Answer 34

Take on Day 1 of period, otherwise will need additional barrier contraception if starting on days 2-5. RPS has guidance on when to start in other situation, e.g. after EHC, after childbirth, after miscarriage, if switching between contraceptives

Answer 35

Under 12 hours: Take ASAP and continue as normal Over 12 hours: Protection lost, take ASAP and use barrier methods for 7 days. May need EHC.

Answer 36

Common: irregular periods, altered mood, headaches, nausea, weight changes If vomits within 3-4 hours, follow missed pill rules

Answer 37

First supply- up to 3 months can be supplied Repeat supply- up to 12 months can be supplied Women under 18- up to 3 months can be supplied Only OK to supply if: Not pregnant No bleeding between period/after sex No health conditions No allergies Not taking other meds otherwise, refer

Answer 38

2 products licensed OTC: Levonorgestrel 1500 microgram tablet (Levonelle®) Ulipristal acetate 30mg tablet (Ella One®) Next period may be sooner, later or on time. If lighter, shorter or 3 days later than usual, need to take pregnancy test.

Answer 39

16+ Some areas have PGDs where it can be supplied for free under locally agreed protocol (usually from 13 years)

Answer 40

what happened? - failure of barrier contraceptive (condom splits) - missed contraceptive pill -unprotected sex when> - explain why asking - EHC most effective the sooner its taken after unprotected sex - answer will influence already pregnant? - last period normal/lughter/later? - Any other episodes of unprotected sex during this cycle?

Answer 41

Supply to a patient representative Moral beliefs Advance supply of EHC Long-term contraception and sexual health

Answer 42

Cannot sell to under 16s, but they may fall under local PGD Should be aware of issues such as non-consensual intercourse, child protection issues, vulnerable adults, consent and confidentiality RPS and Dept of Health have guides with practical advice on managing vulnerable adults, e.g. if domestic violence suspected Children under 13 are deemed too young to consent, so cases should be reported to social services Sexual activity with children under 16 is an offence, but may be consensual. Law will not prosecute mutually agreed sex between young people of a similar age, unless it’s abuse or exploitation Can provide contraception and sexual health advice to children under 16 and patient confidentiality applies- do not need parent consent. Should obtain consent to share information; this does not apply if it’s in the child’s best interest to share (e.g. to prevent harm or to protect the child). Can seek advice from experts without disclosing identifiable details, however.

Answer 43

Perimenopause Menopause

Answer 44

Woman has irregular cycles of ovulation and menstruation leading up to menopause, continues for 12 months after final period

Answer 45

Biological state having occurred when a woman has not had her period for 12 consecutive months. The ovaries stop maturing eggs and secreting oestrogen + progesterone, menstruation stops and she can no longer conceive

Answer 46

Vasomotor symptoms: hot flushes, sweats Musculoskeletal symptoms: joint and muscle pain Urogenital symptoms: vaginal dryness, urinary frequency, UTIs Other symptoms: low mood, reduced libido

Answer 47

Hot flushes & night sweats Keeping cool- light clothing, cool showers, using fans Keep bedroom cool at night Avoid triggers- caffeine, spicy food, smoking, alcohol Exercise & lose weight if overweight Mood changes Plenty of rest, take exercise, relaxing activities such as yoga Weak bones (> oestrogen = > risk osteoporosis) Regular weight-bearing and resistance exercise, healthy diet with sources of calcium, getting some sunlight Stop smoking, less alcohol & calcium/vit D supplements

Answer 48

Vasomotor symptoms Black cohosh Isoflavones St John’s Wort used for depression) Urogenital Symptoms Vaginal dryness- OTC vaginal moisturisers and lubricants (Vagisil®,Vagisan®)

Answer 49

Despite NICE guidelines suggesting black cohosh or isoflavones may help with vasomotor symptoms, they state that the following should be explained: Some evidence for it, but not robust Multiple preparations are available and their safety is uncertain Different preparations may vary Interactions with other medicines have been reported

Answer 50

Contraindications to treatment Experienced side effects Symptoms don’t sound like vaginal atrophy Hx of endometriosis Already on systemic HRT / using a different local HRT Anyone who doesn’t fit selling criteria (e.g. women under 50, last period was less than 1 year ago etc) If symptoms worsen/don’t improve after 7 weeks Tx Red flag symptoms: Vaginal – undiagnosed bleeding, smelly/unusual discharge, severe itching Vulva – changes to look/texture/colour, soreness, rashes, lumps, swelling Pain – pelvic, when passing urine Lower abdominal – pain, bloating, swelling

Symptoms in the Pharmacy - Women’s Health Flashcards

(75 cards)