Women's Health: Cystitis & Dysmenorrhea
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Questions and Answers

Which of the following alkalinizing agents is included in OTC treatments for urinary symptoms?

  • Sodium Acetate
  • Potassium Citrate (correct)
  • Sodium Chloride
  • Calcium Carbonate

Why should potassium citrate be diluted with water?

  • To increase absorption
  • To decrease side effects
  • To make the taste more palatable (correct)
  • To enhance its effectiveness

Who is NOT recommended to take potassium citrate?

  • Patients with renal issues
  • Pregnant women (correct)
  • Women under 25
  • Athletes

What is the main distinction between primary dysmenorrhea and secondary dysmenorrhea?

<p>Presence of organic pathology (D)</p> Signup and view all the answers

At what age does the peak incidence of primary dysmenorrhea typically occur?

<p>17 to 25 years (D)</p> Signup and view all the answers

In women, secondary dysmenorrhea is most commonly seen after which age?

<p>30 years (A)</p> Signup and view all the answers

What should be advised for pain relief in dysmenorrhea for up to 2 days?

<p>Both B and C (D)</p> Signup and view all the answers

What phenomenon is often not associated with the start of dysmenorrhea?

<p>Menarche (D)</p> Signup and view all the answers

What percentage of women reported vomiting as a side effect of Ulipristal?

<p>1% (D)</p> Signup and view all the answers

Which of the following is NOT a common side effect of Ulipristal?

<p>Severe hepatic dysfunction (B)</p> Signup and view all the answers

If a woman vomits within how many hours of taking an emergency contraceptive tablet should she take another tablet?

<p>3 hours (A)</p> Signup and view all the answers

Which condition disallows a woman from taking emergency contraceptive pills?

<p>Severe hepatic dysfunction (C)</p> Signup and view all the answers

What is the primary symptom of heavy menstrual bleeding (HMB)?

<p>Excessive menstrual blood loss (C)</p> Signup and view all the answers

Which medication is known to alter menstrual bleeding patterns?

<p>Cimetidine (B)</p> Signup and view all the answers

Irregular bleeding between periods could suggest what kind of condition?

<p>Structural or pathological abnormality (A)</p> Signup and view all the answers

A pharmacist should contact a doctor when a patient presents with which symptom?

<p>Abnormal vaginal discharge (D)</p> Signup and view all the answers

Which treatment is recommended for the symptomatic relief of dysmenorrhea?

<p>Warm bath or heat application (D)</p> Signup and view all the answers

What is the primary action of NSAIDs in the treatment of dysmenorrhea?

<p>Inhibit prostaglandin production (D)</p> Signup and view all the answers

What is the maximum daily dose of Ibuprofen recommended for dysmenorrhea?

<p>1200mg (B)</p> Signup and view all the answers

Which analgesic is considered less effective than NSAIDs for managing dysmenorrhea?

<p>Aspirin (B)</p> Signup and view all the answers

What is a recommended dose for Paracetamol in the treatment of dysmenorrhea?

<p>500-1000mg every 4-6 hours (B)</p> Signup and view all the answers

Which side effect is commonly associated with Hyoscine butyl bromide?

<p>Dry mouth (B)</p> Signup and view all the answers

For which condition is Hyoscine butyl bromide contraindicated?

<p>Narrow-angle glaucoma (C)</p> Signup and view all the answers

What is the advantage of caffeine in relation to analgesics?

<p>It may enhance the analgesic effect. (A)</p> Signup and view all the answers

Which treatment is preferred for menstrual pain when menorrhagia coincides with dysmenorrhoea?

<p>NSAIDs (D)</p> Signup and view all the answers

What is the maximum daily dose of tranexamic acid for very heavy menstrual bleeding?

<p>8 g (D)</p> Signup and view all the answers

How do NSAIDs affect ovulatory bleeding in women with menorrhagia?

<p>Decrease it by approximately 30-40% (B)</p> Signup and view all the answers

Which of the following is a common cause of vaginal discharge?

<p>Bacterial vaginosis (B)</p> Signup and view all the answers

What is the mechanism of action of tranexamic acid?

<p>Stopping the conversion of plasminogen to plasmin (C)</p> Signup and view all the answers

What should be done if there is no improvement in symptoms after using NSAIDs or tranexamic acid for three menstrual cycles?

<p>Stop the treatment (C)</p> Signup and view all the answers

Which of the following is a reported side effect of tranexamic acid?

<p>Mild nausea (A)</p> Signup and view all the answers

Which population should avoid taking tranexamic acid?

<p>Patients on anticoagulants (A)</p> Signup and view all the answers

What is the most likely cause of vaginal discharge based on its incidence in community pharmacy?

<p>Bacterial vaginosis (A)</p> Signup and view all the answers

Which of the following statements about the symptoms of vaginal thrush is true?

<p>Vaginal thrush commonly presents with vulvar pruritus. (A)</p> Signup and view all the answers

When assessing a patient with vaginal thrush, which age group should always be referred for further evaluation?

<p>Women under 16 and over 60 (D)</p> Signup and view all the answers

Which condition is least likely to be the cause of vaginal discharge?

<p>Urinary tract infection (C)</p> Signup and view all the answers

What should be considered if a patient has recurrent vaginal thrush attacks exceeding two in the past six months?

<p>An underlying cause such as diabetes (D)</p> Signup and view all the answers

How does oestrogen affect the vaginal environment in women of childbearing age?

<p>It promotes the production of glycogen. (B)</p> Signup and view all the answers

Which symptom may suggest the presence of a urinary tract infection in relation to vaginal thrush?

<p>Dysuria (pain on urination) (B)</p> Signup and view all the answers

What is a potential reason for increased episodes of vaginal candidiasis during pregnancy?

<p>Alteration of the vaginal environment due to hormonal changes (C)</p> Signup and view all the answers

What is the recommended administration time for internal preparations of topical imidazoles?

<p>At night (B)</p> Signup and view all the answers

Which of the following drugs does oral fluconazole interact with?

<p>Anticoagulants (D)</p> Signup and view all the answers

Which of these is true about the safety of topical antifungals during pregnancy?

<p>They are safe and effective. (D)</p> Signup and view all the answers

What should be done if a patient has vaginal symptoms during their menstrual period?

<p>The treatment should continue without interruption. (B)</p> Signup and view all the answers

How long should sexual intercourse be avoided after treatment for vaginal thrush?

<p>Until the cure is complete (C)</p> Signup and view all the answers

What is a common side effect experienced by up to 10% of patients taking fluconazole?

<p>GIT disturbances (D)</p> Signup and view all the answers

What is recommended for the treatment of an asymptomatic husband when the wife has vaginal thrush?

<p>He needs topical azoles for 6 days. (C)</p> Signup and view all the answers

Which formulation of topical imidazoles is NOT typically available?

<p>Oral capsules (C)</p> Signup and view all the answers

Flashcards

Non-pharmacological pain relief for menstrual cramps

Using methods like warm baths or heat to reduce discomfort.

Exercise and menstrual cramps

Exercise can lessen menstrual cramps by releasing endorphins.

Analgesic treatment for dysmenorrhea

Using pain relievers to manage menstrual cramps.

NSAIDs for menstrual cramps

NSAIDs (ibuprofen, naproxen) are a common treatment option, reducing prostaglandin production that causes uterine contractions.

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Ibuprofen dosage for dysmenorrhea

200-400 mg three times daily.

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Maximum daily dose of Naproxen

750 mg

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Aspirin's effectiveness in dysmenorrhea

Less effective compared to ibuprofen in treating menstrual cramps, and irritating to the stomach.

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Caffeine's effect on menstrual pain

May potentially enhance analgesic effects of pain relievers.

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OTC treatment limitations

Over-the-counter (OTC) treatments are restricted to products containing alkalinizing agents like sodium citrate, sodium bicarbonate, and potassium citrate.

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Potassium Citrate use caution

Potassium citrate is not suitable for individuals with home hyperkalemia, hypertension, heart conditions, or pregnancy - it may result in hyperkalemia.

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Pain relief alternatives

For pain relief, offer over-the-counter options like paracetamol or ibuprofen for up to 2 days.

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Primary dysmenorrhea

Menstrual pain without underlying disease. Often, no physical cause can be found for the pain.

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Secondary dysmenorrhea

Menstrual pain caused by a specific condition or disease, like endometriosis.

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Dysmenorrhea Peak Age (Primary)

Primary dysmenorrhea occurs most often between the ages of 17 and 25.

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Dysmenorrhea Peak Age (Secondary)

Secondary dysmenorrhea is more common in women over 30 years old and rare under 25.

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Menstrual Cycle Length

The average menstrual cycle length is 28 days, but can vary between 21 and 45, and menstruation can last between 3 and 7 days.

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EHC Vomiting

If vomiting occurs within 3 hours of taking emergency contraceptive pills, another tablet should be taken.

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EHC Contraindications

EHC should not be taken by pregnant women, those with severe liver problems, or severe malabsorption issues.

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Heavy Menstrual Bleeding (HMB)

Excessive menstrual bleeding disrupting a woman's life.

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Abnormal Bleeding Timing

Menstrual bleeding outside expected period, like irregular bleeding between periods or after sex.

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Medications Affecting Menstrual Bleeding

Certain drugs can change menstrual bleeding patterns.

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Referral for Abnormal Discharge

Abnormal vaginal discharge warrants a referral for evaluation.

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Referral for Intermenstrual Bleeding

Intermenstrual or post-coital bleeding requires a referral.

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Abnormal Bleeding Symptoms

Abnormal bleeding or discharge may indicate serious conditions like cancer.

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Vaginal Discharge Causes

Bacterial vaginosis is the most likely cause of vaginal discharge; thrush and trichomoniasis are also possible, while atrophic vaginitis and cystitis are less likely.

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Thrush Symptoms

Vaginal thrush is typically characterized by a white, curd-like discharge and intense vulvar pruritus (itching).

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Vaginal Discharge Odors

Strong-smelling vaginal discharge suggests bacterial vaginosis or trichomoniasis, requiring referral.

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Referral Criteria: Age

Women under 16 or over 60 with vaginal thrush symptoms should be referred.

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Referral Criteria: Recurrence

Recurrent vaginal thrush (more than two episodes in six months) may indicate an underlying cause (e.g., diabetes) needing referral.

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Referral Criteria: Pregnancy

Any pregnant woman with vaginal thrush should be referred.

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Referral Criteria: Blood Staining

Blood-tinged vaginal discharge signals a potential underlying issue needing referral.

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Vaginal Itch and its Implications

Vaginal itching (pruritus) is often the most prominent symptom in thrush, while it's less likely in bacterial or trichomoniasis.

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Menorrhagia/HMB with dysmenorrhoea

Heavy menstrual bleeding (menorrhagia/HMB) occurring alongside menstrual cramps (dysmenorrhoea).

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Tranexamic acid use

A medicine that decreases menstrual blood loss by preventing clot breakdown.

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Tranexamic acid dosage

Start with 2 tablets 3 times daily, for 4 days, potentially increasing to 2 tablets 4 times daily for heavier bleeding if needed. Maximum dosage is 8 tablets daily (4g).

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Tranexamic acid side effects

Mild nausea, vomiting, and diarrhea, affecting about 1-10% of patients.

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Tranexamic acid contraindications

Not recommended for use with anticoagulant medications, combined oral contraceptives, unopposed estrogen, or tamoxifen.

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NSAID use for menstrual pain

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to decrease ovulatory bleeding.

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Timeframe for symptom improvement

If a patient does not see improvement in their symptoms after three menstrual cycles, NSAIDs and tranexamic acid might need to be stopped.

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Common vaginal discharge causes

Bacterial vaginosis, vulvovaginal candidiasis (yeast infection), and trichomoniasis (a protozoan infection).

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Oral Fluconazole Absorption

Fluconazole is well absorbed when taken by mouth, and symptoms usually improve 12-24 hours after administration.

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Fluconazole Side Effects (GIT)

Up to 10% of patients experience gastrointestinal (GIT) disturbances like nausea, vomiting, diarrhea, and flatulence when taking oral fluconazole.

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Fluconazole Drug Interactions

Oral fluconazole interacts with some medications like anticoagulants, oral sulfonylureas, ciclosporin (cyclosporin), phenytoin, rifampicin, and theophylline.

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Fluconazole Pregnancy/Breastfeeding

Fluconazole is not recommended during pregnancy or breastfeeding.

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Topical Imidazole Formulations

Topical imidazoles like clotrimazole, econazole, miconazole, butoconazole, and tioconazole come in various forms including vaginal tablets, creams, and pessaries.

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Topical Application Timing

Topical vaginal treatments are often administered at night to allow for absorption and minimize accidental loss.

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Menstrual Period and Vaginal Antifungal

Vaginal antifungal treatment can be used during menstruation. It's okay to wait until after the period if desired, but don't interrupt a course of therapy because of menstruation.

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Sexual Intercourse and Treatment

Sexual intercourse should be avoided until the infection is completely cured to prevent reinfection of both partners.

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Study Notes

Women's Health - 1-Cystitis

  • Cystitis is inflammation of the bladder, common in women, less common in men due to differences in urethra length
  • Bacteria from gastrointestinal tract often cause cystitis, E. coli being the most common
  • Symptoms include urinary frequency, urgency, burning pain during urination, and lower abdominal pain; mild cases can be treated with OTC products
  • About half of cystitis cases clear up within 3 days without treatment

Women's Health - 2-Dysmenorrhea (Period Pain)

  • Menstrual cycle typically lasts 21-45 days, with menstruation lasting 3-7 days
  • Primary dysmenorrhea (PD) is menstrual pain without an underlying organic condition. Secondary dysmenorrhea (SD) is pain associated with a specific condition (e.g. endometriosis)
  • Women aged 17-25 are most likely to experience PD, while SD is more common in women over 30
  • Symptoms can include cramping lower abdominal pain starting before or within 24 hours of menstruation, which typically resolves by the end of the first day
  • Any patient presenting with severe lower abdominal pain should be referred.

Women's Health - 3-Premenstrual Syndrome (PMS)

  • PMS is a collection of physical and emotional symptoms linked to the menstrual cycle. They generally begin 2-14 days before menstruation
  • The cause of PMS is unknown but associated with ovulation and potentially progesterone levels.
  • Symptoms include bloating, weight gain, swelling in ankles and fingers, breast tenderness, headaches, irritability, tension, depression, difficulty concentrating, and fatigue.
  • The recommended treatment is pyridoxine (B6), limited to 100 mg daily

Women's Health - 4-Emergency Hormonal Contraception (EHC)

  • EHC can be used for preventing pregnancy after unprotected sex or contraceptive failure.
  • Levonorgestrel should be taken within 72 hours of unprotected sex, while ulipristal can be taken within 120 hours (5 days) of unprotected intercourse
  • Women under 16 years should be referred to a doctor
  • Existing medical conditions like pregnancy or hypersensitivity to particular drug classes may require a doctor's referral.

Women's Health - 5-Menorrhagia (Heavy Menstrual Bleeding)

  • Menorrhagia is heavy menstrual bleeding.
  • Key symptom is bleeding perceived as greater than normal
  • Other symptoms that may signal underlying issues are bleeding between periods or bleeding after sex

Women's Health - 6-Vaginal Discharge

  • Vaginal discharge is common and has various causes including bacterial vaginosis, vaginal candidiasis (thrush), and trichomoniasis
  • Thrush is the only common vaginal discharge cause that is treatable OTC.
  • Vaginal discharge that has a strong odour, is not white and curd-like, should be referred because it suggests different underlying causes

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Women's Health Lecture 7, 8 PDF

Description

Explore the common issues of cystitis and dysmenorrhea affecting women's health. Learn about the causes, symptoms, and treatments for bladder inflammation and menstrual pain. This quiz covers essential knowledge for understanding these conditions.

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