Flashcards in RTS- women's health Deck (43)
treatments for dysmenorrhoea (periods pain)
(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
what is the limit on naproxen for dysmenorrhoea
max 3 days use, 750mg daily
brand names for ibuprofen and naproxen for period pain
ibuprofen - feminax, neurofen
naproxen - feminax ultra, boots period pain relief
red flags for dysmenorrhoea
pain and bleeding between periods, after sex or urination
sudden severe pain
post menopausal women
painkillers used for 3-4 cycles and not worked
what is menorrhagia?
heavy period - excessive menstrual blood loss which interferes with women physical, emotional and social quality of life.
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)
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
red flags for menorrhagia
increase blood loss
pain in sex
tranexamic acid tabs oTC not suitable
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
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
What is thrush?
common opportunistic infection with yeast like fungus Candida albicans - vaginal area
precipitating factors of thrush
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
what is treatment for thrush?
Topical imidazole antifungals
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
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
Can clotromazole be used in pregnancy?
Yes under the physician supervision - the pessary must be inserted without an applicator
red flags for thrush
>2 in 6 months
under 16 or over 60
discharge is yellow/green
lower abdominal pain
pain in sex or urination
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
what bacteria causes cystitis?
symptoms of cystitis
pain during urine
pain in blader
strong smelling urine and cloudy
red flags of cystitis
first time occurring
very dark or cloudy urine (indicates haematuria)
fever is 38 degrees or above
3 or more occurrences in a year
lasting longer than2 days
men and children
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
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,
what are sodium and potassium bicarbonate contra-indicated in in cystitis?
(sodium in hypertension)
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
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
Time frame for levonelle one step?
within 72 hours of intercourse - 3 days
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
Time frame for EllaOne?
120 hours- 5 days