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Flashcards in RTS- women's health Deck (43)
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1

treatments for dysmenorrhoea (periods pain)

1. NSAIDS
(a) ibuprofen 200-400mg TDS - neurofen, feminax
(b) Naproxen 250mg tabs- day 1 2 tabs to start then 1 every 6-8 hours. day 2&3 - 1 tab every 6-8 hours. MAX 3 DAYS USE - and 750mg nail. only licensed for dysmenorrhea.

If NSAIDS contra indicated -
(a) paracetamol - 500-1000mg up to QDS
(b) codeine with ibuprofen or para - co-codamol 8/500mg, solpadeine = 200/12.8g

(c) dihydrocodeine - 7.46g with paracetamol 500mg - paramol

(d) hycosine butylbromide - 10mg tabs- buscopan cramps

2

what is the limit on naproxen for dysmenorrhoea

max 3 days use, 750mg daily

3

brand names for ibuprofen and naproxen for period pain

ibuprofen - feminax, neurofen
naproxen - feminax ultra, boots period pain relief

4

red flags for dysmenorrhoea

pain and bleeding between periods, after sex or urination
sudden severe pain
amenorrhoea/menorrhagia
post menopausal women
unpleasant discharge
IUD
painkillers used for 3-4 cycles and not worked

5

what is menorrhagia?

heavy period - excessive menstrual blood loss which interferes with women physical, emotional and social quality of life.

6

treatment for menorrhagia?

tranexamic acid tablets - OTC (switched from POM to P in 2011)
2 x 500mg tablets TDS - for a max 4 days
Up to 4g daily (8 tabs)

7

Mechanism & indication of tranexamic acid tablets

anti-fibrinolytic competitive inhibitor of activation of plasminogen to plasmin
Indication - to reduce menstrual bleeding for ages 18-45 years with regular 21-35 day cycles

8

red flags for menorrhagia

irregular bleeding
increase blood loss
pain in sex
discharge
pelvic pain
tranexamic acid tabs oTC not suitable

9

physical & psychological symptoms of pre menstrual syndrome

physical - bloated, pain, headache, sleep issues weight gain (1kg)
Psychological - mood swings, irritable, anxiety, forgetfulness, tired, restless, loss of libido

10

how is PMS treated?

(a) symptom specific - NSAIDS, paracetamol, buscopan
(b) holistic - changes to diet e.g reduction in caffeine, evening primrose oil, calcium ,magnesium,
Herbal - vitex agnus -castus

11

What is thrush?

vulvovaginal candida
common opportunistic infection with yeast like fungus Candida albicans - vaginal area

12

precipitating factors of thrush

ages 20-30
pregnancy
antibiotics
immunocompromised
diabetes mellitus

13

symptoms of thrush

vaginal - itchy, burn, sore, discharge or creamy and curd like or thin and watery - odourless
Dysuria- pain / sting on urination
dyspareunia - pain in sex

14

what is treatment for thrush?
Topical imidazole antifungals

1. Clotrimazole:
canesten pessary 500mg alone or with +2% thrush cream
canesten 10% vaginal cream, +2% thrush cream
canesten 200mg pessary x3
canesten 100mg pessary x6

2. Miconazole cream 2% for vulval use

15

Treatment for thrush - oral triazole antifungals

fluconazole - capsule 150mg single dose (canesten oral or generic)
- Also marketed as canesten duo (fluconazole capsule and clotrimazole cream)
- LOTS of contra indications e.g. preg/BF, under 16, >60

fluconazole 150mg / clotrimazole 2% cream is licensed for balanitis

16

Can clotromazole be used in pregnancy?

Yes under the physician supervision - the pessary must be inserted without an applicator

17

red flags for thrush

first occurrence
>2 in 6 months
under 16 or over 60
pregnancy
discharge is yellow/green
blisters
abnormal bleeding
lower abdominal pain
pain in sex or urination
treatment fail

18

what is cystitis?

inflammation of the bladder - usually caused by bacterial infection - caused by e.g not emptying the bladder properly, bacteria transferred from anus to urethra (common as urethra shorter), soaps, chemicals, medication

19

what bacteria causes cystitis?

E.coli
staphylococcus saprophyticus

20

symptoms of cystitis

frequency/urgency
pain during urine
pain in blader
strong smelling urine and cloudy

21

red flags of cystitis

first time occurring
very dark or cloudy urine (indicates haematuria)
fever is 38 degrees or above
vomiting
discharge
3 or more occurrences in a year
lasting longer than2 days
pregnancy
men and children

22

cystitis treatment

plenty of water
avoid alcohol, caffeine, tea juices
avoid sex until clear
paracetamol and ibuprofen
alkalinising agents e.g - sodium citrate/bicarbonate, potassium citrate/bicarbonate

23

what are the medication interactions with the alkalinising agents sodium and potassium citrate/bicarbonate?

sodium - lithium
Potassium - ACE inhibitors (e.g ramipril),
K+ sparing diuretics e.g amiloride,
aldosterone antagonists

24

what are sodium and potassium bicarbonate contra-indicated in in cystitis?

heart disease
renal disease
pregnancy
men
children
(sodium in hypertension)

25

Name 2 types of emergency hormonal contraception
Do they interrupt existing pregnancies?

1. levonelle one step (levonorgestrel 1500mcg, 1.5 mg)

2. EllaOne - ulipristal acetate 30mg

Neither EHC interrupt existing pregnancies

26

describe levonelle one step EHC?

prevents ovulation & fertilisation if the intercourse is in the preovulatory phase, when the likelihood is the highest
- ineffective once implantation has begun
License - >16 years

27

Time frame for levonelle one step?

within 72 hours of intercourse - 3 days

28

describe EllaOne EHC?

inhibits/postpones ovulation via binding to the progesterone receptor and suppress LH surge.
LICENSE- any woman of child bearing age including adolescents

29

Time frame for EllaOne?

120 hours- 5 days

30

side effects of EHC?

nausea, abdominal pain, headache, dizziness, fatigue, menstrual cycle disruption
NOTE: must repeat dose if vomit within 3 hours of taking.
- Must wear a barrier method e.g condoms until the next period and continue with oral contraception as usual