Podcast
Questions and Answers
What patient condition may indicate the need for referral due to treatment failure?
What patient condition may indicate the need for referral due to treatment failure?
- Symptoms that resolve with over-the-counter medication
- No improvement within 7 days of treatment (correct)
- Patient experiencing only mild discomfort
- Symptoms persisting for more than 5 days
Which of the following treatments for vaginal thrush is affected by drug interactions?
Which of the following treatments for vaginal thrush is affected by drug interactions?
- Antibiotics
- Oral corticosteroids
- Systemic fluconazole (correct)
- Topical imidazoles
What is a possible side effect of oral fluconazole?
What is a possible side effect of oral fluconazole?
- Headaches
- Increased energy levels
- Weight gain
- Gastrointestinal disturbances (correct)
In which scenario might the prescriber consider contacting for alternative therapy?
In which scenario might the prescriber consider contacting for alternative therapy?
What is the dose for oral fluconazole when treating vaginal thrush?
What is the dose for oral fluconazole when treating vaginal thrush?
What is the maximum time frame in which ulipristal can be taken after unprotected intercourse for it to be effective?
What is the maximum time frame in which ulipristal can be taken after unprotected intercourse for it to be effective?
Which medication should be referred for further evaluation if a woman has taken any in the last 4 weeks?
Which medication should be referred for further evaluation if a woman has taken any in the last 4 weeks?
What is the main method through which levonorgestrel is believed to work before ovulation?
What is the main method through which levonorgestrel is believed to work before ovulation?
What should a pharmacist suggest if a woman suspects she might already be pregnant?
What should a pharmacist suggest if a woman suspects she might already be pregnant?
Which statement regarding the effectiveness of ulipristal and levonorgestrel is true?
Which statement regarding the effectiveness of ulipristal and levonorgestrel is true?
What should be done if hormonal emergency contraception is deemed unsuitable for the woman?
What should be done if hormonal emergency contraception is deemed unsuitable for the woman?
Which scenario does NOT indicate the need for emergency hormonal contraception?
Which scenario does NOT indicate the need for emergency hormonal contraception?
What is the primary mechanism by which Ulipristal acts?
What is the primary mechanism by which Ulipristal acts?
Which adverse effect is most frequently reported by women taking emergency hormonal contraception?
Which adverse effect is most frequently reported by women taking emergency hormonal contraception?
What should a woman do if she vomits within 3 hours after taking the emergency hormonal contraception tablet?
What should a woman do if she vomits within 3 hours after taking the emergency hormonal contraception tablet?
Which condition should prevent a woman from taking Levonorgestrel?
Which condition should prevent a woman from taking Levonorgestrel?
What is defined as heavy menstrual bleeding (HMB)?
What is defined as heavy menstrual bleeding (HMB)?
Which symptom is most indicative of a potential pre-cancerous condition or cervical cancer?
Which symptom is most indicative of a potential pre-cancerous condition or cervical cancer?
Which of the following is not a contraindication for taking emergency hormonal contraception?
Which of the following is not a contraindication for taking emergency hormonal contraception?
Which medication is mentioned to alter menstrual bleeding but is not specified as causing heavy menstrual bleeding?
Which medication is mentioned to alter menstrual bleeding but is not specified as causing heavy menstrual bleeding?
In postmenopausal women, abnormal vaginal bleeding is particularly significant because it may indicate which condition?
In postmenopausal women, abnormal vaginal bleeding is particularly significant because it may indicate which condition?
What should be done if a woman presents with any blood staining in her vaginal discharge?
What should be done if a woman presents with any blood staining in her vaginal discharge?
Which condition is associated with the most prominent vaginal itching?
Which condition is associated with the most prominent vaginal itching?
What is a possible consequence of using products containing local anesthetics for vaginal symptoms?
What is a possible consequence of using products containing local anesthetics for vaginal symptoms?
Which group of women requires referral upon first occurrence of vaginal symptoms?
Which group of women requires referral upon first occurrence of vaginal symptoms?
What indication may suggest a urinary tract infection when associated with vaginal thrush?
What indication may suggest a urinary tract infection when associated with vaginal thrush?
What should a pharmacist inquire about to assess the cause of vaginal itching?
What should a pharmacist inquire about to assess the cause of vaginal itching?
During pregnancy, what hormonal change is associated with an increased incidence of vaginal candidiasis?
During pregnancy, what hormonal change is associated with an increased incidence of vaginal candidiasis?
In what cases should diabetic women with thrush be referred?
In what cases should diabetic women with thrush be referred?
Which scenario suggests a referral due to sexually transmitted diseases (STDs)?
Which scenario suggests a referral due to sexually transmitted diseases (STDs)?
What is a potential complication if thrush remains untreated in diabetic patients?
What is a potential complication if thrush remains untreated in diabetic patients?
Which condition is characterized by a profuse, frothy, greenish-yellow discharge?
Which condition is characterized by a profuse, frothy, greenish-yellow discharge?
What is the most likely cause of vaginal discharge?
What is the most likely cause of vaginal discharge?
Which demographic should be referred if presenting symptoms of vaginal thrush?
Which demographic should be referred if presenting symptoms of vaginal thrush?
What type of discharge is typically associated with bacterial vaginosis?
What type of discharge is typically associated with bacterial vaginosis?
Which infection is commonly treated with over-the-counter medications?
Which infection is commonly treated with over-the-counter medications?
What is a common symptom of vulvovaginal candidiasis?
What is a common symptom of vulvovaginal candidiasis?
Which condition has a strong likelihood of being asymptomatic in up to 50% of patients?
Which condition has a strong likelihood of being asymptomatic in up to 50% of patients?
What is the effect of oestrogen on vaginal flora?
What is the effect of oestrogen on vaginal flora?
Which of the following infections is the least likely cause of vaginal discharge?
Which of the following infections is the least likely cause of vaginal discharge?
What is the key characteristic of discharge indicating a potential referral?
What is the key characteristic of discharge indicating a potential referral?
Flashcards
Oral Fluconazole Dose
Oral Fluconazole Dose
A single dose of 150mg taken at any time of the day is the standard treatment for vaginal thrush.
Fluconazole Absorption and Relief
Fluconazole Absorption and Relief
Fluconazole is quickly absorbed when taken orally, and symptoms usually improve within 12-24 hours after administration.
Fluconazole Side Effects
Fluconazole Side Effects
Common side effects include gastrointestinal disturbances like nausea, vomiting, diarrhea, and flatulence. These occur in up to 10% of patients.
Fluconazole Drug Interactions
Fluconazole Drug Interactions
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Fluconazole and Prothrombin Time
Fluconazole and Prothrombin Time
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Emergency Hormonal Contraception (EHC)
Emergency Hormonal Contraception (EHC)
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EHC Time Limits
EHC Time Limits
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EHC Effectiveness
EHC Effectiveness
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EHC Types
EHC Types
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EHC Effectiveness: Ulipristal vs. Levonorgestrel
EHC Effectiveness: Ulipristal vs. Levonorgestrel
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EHC: When to Refer to a Doctor
EHC: When to Refer to a Doctor
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EHC: How it Works (Levonorgestrel)
EHC: How it Works (Levonorgestrel)
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Ulipristal
Ulipristal
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Levonorgestrel
Levonorgestrel
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EHC Side Effects
EHC Side Effects
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Who Should Avoid EHC?
Who Should Avoid EHC?
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Menorrhagia
Menorrhagia
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Clinical Feature of Menorrhagia
Clinical Feature of Menorrhagia
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Abnormal Bleeding Pattern
Abnormal Bleeding Pattern
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Irregular Bleeding and Pre-cancer
Irregular Bleeding and Pre-cancer
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Vaginal Discharge: Common Causes
Vaginal Discharge: Common Causes
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Bacterial Vaginosis
Bacterial Vaginosis
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Trichomoniasis
Trichomoniasis
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Vulvovaginal Candidiasis (Thrush)
Vulvovaginal Candidiasis (Thrush)
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Thrush: OTC Treatment
Thrush: OTC Treatment
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Vaginal Flora and pH
Vaginal Flora and pH
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Age and Vaginal Infections
Age and Vaginal Infections
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Referrals for Vaginal Discharge
Referrals for Vaginal Discharge
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Discharge: Identifying Cause
Discharge: Identifying Cause
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Atrophic Vaginitis
Atrophic Vaginitis
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Vaginal Itch (Pruritus)
Vaginal Itch (Pruritus)
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Vaginal Itch: Causes
Vaginal Itch: Causes
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When to Refer for Vaginal Itch
When to Refer for Vaginal Itch
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Dysuria with Thrush
Dysuria with Thrush
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First Occurrence of Vaginal Thrush
First Occurrence of Vaginal Thrush
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Recurrent Vaginal Thrush
Recurrent Vaginal Thrush
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Vaginal Thrush in Pregnancy
Vaginal Thrush in Pregnancy
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Vaginal Thrush in Diabetes
Vaginal Thrush in Diabetes
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First Occurrence of STDs
First Occurrence of STDs
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Previous History of STDs
Previous History of STDs
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Study Notes
Emergency Hormonal Contraception (EHC)
- EHC is available over-the-counter (OTC) for women aged 16 and over in the UK.
- For women under 16, the pharmacist should refer them to a doctor.
- Common reasons for requesting EHC include contraceptive method failure (e.g., condom breakage), missed pills, and unprotected sexual intercourse (UPSI).
Timing of EHC Use
- Ulipristal should be taken within 120 hours (5 days) of unprotected sex.
- Levonorgestrel should be taken within 72 hours (3 days) of unprotected sex.
- Earlier use increases efficacy.
- Copper intrauterine devices (Cu-IUDs) can be used for emergency contraception within 120 hours of unprotected sex, if hormonal methods are unsuitable.
Pregnancy Considerations
- If pregnancy is suspected (e.g., irregular or delayed period), a pregnancy test should be suggested.
- EHC will not work if the woman is pregnant.
- There is no evidence that EHC is harmful to pregnancy.
Interactions with Medications
- Women taking certain medications (e.g., carbamazepine, rifampicin, griseofulvin) within the previous four weeks should be referred.
Treatment Timescale
- Ulipristal should be started within 120 hours of unprotected intercourse.
- Levonorgestrel should be started within 72 hours of unprotected intercourse.
Treatment
- Levonorgestrel (1.5 mg tablet) and Ulipristal (30 mg tablet) are taken as a single tablet as soon as possible after unprotected sex.
- Ulipristal is more effective than levonorgestrel for emergency contraception.
Mode of Action (EHC)
- Levonorgestrel may act by delaying or inhibiting ovulation, affecting the fallopian tubes, or altering the endometrium after ovulation to inhibit implantation.
- Ulipristal inhibits or delays ovulation via luteinizing hormone suppression.
Side Effects (EHC)
- Common side effects include headache and nausea (affecting around 1 in 5 and 1 in 8 women, respectively.)
- If vomiting occurs within 3 hours of taking the tablet, another tablet should be taken..
Contraindications (EHC)
- EHC should not be taken if pregnant.
- EHC should not be taken by those with severe liver problems.
- Levonorgestrel should not be taken by those with severe malabsorption issues.
Heavy Menstrual Bleeding (HMB)
- The key symptom is excessive blood loss perceived as greater than normal.
- Irregular bleeding outside of menstrual periods (e.g., post-coital bleeding) may indicate a structural problem (e.g., cervical cancer).
- Several months of heavy bleeding may indicate iron deficiency anemia.
- Medications can alter menstrual bleeding (e.g., anticoagulants, thyroid hormones).
Management and Treatment for HMB
- For HMB coexisting with dysmenorrhea, NSAIDs are typically preferred over tranexamic acid.
- If no improvement occurs within 3 menstrual cycles, discontinue NSAIDs, or tranexamic acid.
- NSAIDs in sufficient doses can reduce ovulatory bleeding by approximately 30-40%.
Vaginal Discharge
- Common causes include bacterial vaginosis, vulvovaginal candidiasis (thrush), and trichomoniasis.
- Thrush is the only OTC treatable vaginal discharge.
- Bacterial vaginosis is characterized by a thin white discharge with a fishy odor.
Vaginal Thrush
- Women under 16 or over 60 with suspected thrush should be referred.
- Vaginal itching and burning are common; discharge may be thick, white, and clumpy.
- Refer pregnant women with vaginal thrush, those with a history of STIs or repeated occurrences, or those who do not respond to treatment.
Treatment of Vaginal Thrush
- Topical imidazoles (e.g., clotrimazole, miconazole) and oral fluconazole are available OTC.
- Fluconazole is usually given as a single dose (150 mg).
- Potential side effects of oral fluconazole include gastrointestinal issues (nausea, vomiting, diarrhea) in up to 10% of cases.
- Topical medications provide vaginal relief and treatment.
Prevention of Vaginal Thrush
- Practices to maintain dryness are suggested (e.g. Avoiding douching, warm environment, cotton undergarments, good hygiene).
Treatment of Partner
- Men with balanitis may benefit from similar topical azole treatment for up to 7 days.
- Treating without symptoms is contentious.
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Description
This quiz covers important aspects of Emergency Hormonal Contraception (EHC), including its availability, timing of use, and considerations regarding pregnancy. It also discusses interactions with other medications and common reasons for requesting EHC. Test your knowledge on this vital topic in reproductive health.
