Capsule cases 2

Question 1

Oral contraceptive pill - contraindications and reason for cessation ?

*Womb cancer

Answer 1

Pre - existing liver disease - contraindicated

red-flag symptoms do require urgent cessation
0 elevated blood pressure,
0 new onset headache or
neurological symptoms,
0 acute chest-pain / shortness of
breath.

• women who have taken the oral contraceptive pill have a lower risk of endometrial cancer (cancer of the womb /uterus- begins in the endometrium - lining of womb)
  - bcc womb cancer linked to high oestrogen levels and contraceptives control hormone levels.
• uterine sarcoma - is a type of womb cancer that start in the muscle wall - not endometrial cancer.
• womb cancer - hysterectomy most common treatment. (fallopian tube and ovaries also usually removed)
  Progesterone - used if not in menopause and still want children
  chemotherapy /radiotherapy

Question 2

What drugs increase chance of pregnancy when given in combination with with combined oral contraceptive pill ?

Answer 2

Rifampicin / Rifampin - (antibiotic )
Carbamazepine - anti - convulsant
Phenytoin - anti- convulsant

Increase metabolism of oral contraceptive pill.

Question 3

Warfarin and Corticosteroids ?

Oral contraceptives + warfarin + Steroid ?

Answer 3

Interact - steroids increase action of warfarin - increase blood thinning - INR closely monitored.

Oestrogens antagonise the effects of coumarins (warfarin) and also increase plasma levels of steroids.

Question 4

primigravida - meaning ?

Cardiotocograph - meaning ?

Answer 4

Women pregnant for the first time

electronic fetal heart monitor or cardiotocograph (CTG), ultrasound, is placed over the woman’s abdomen near the fetus’s heart

Question 5

Oxytocin and Syntocinon ?

Answer 5

Oxytocin - hormone produced by posterior pituitary gland

Route - IV infusion , intramuscularly

SIDE EFFECT
0 Water intoxication / retention - causing
hyponatraemia
* Oxytocin - similar structure to Vasopressin /antidiuertic hormone (insert water channels into renal tubules cause water reabsorption.

  0 Uterine Hyperstimulation - complication of labour induction - uterus contracts too frequently - single contraction lasting for 2 mins or 5 or more contractions within 10 min period. 
         * During contractions - blood flow 
           to placenta stops/ slows down 
           (placenta recharges btw 
           contraction. Hyperstimulation can 
           lead to FETAL HYPOXIA . FETAL 
           HEART RATE ABNORMALITIES , 
           FETAL DAMAGE. 
        - Uterine activity monitored for 
          hyperstimulation

Syntocinion - synthetic form of oxytocin Indication - induce and augment (add to labour once labours have been raptured) labour.

Question 6

Use of indomethacin ?

Answer 6

close the ductus arteriosus in premature babies.

Question 7

What drug can correct uterine hyperstimulation ?

Answer 7

Terbutaline- beta adrenoceptor agonist

*This group of drugs suppress myometrial activity and hence are also called tocolytics

Question 8

What is Hormone replacement therapy

Beneifts & risk ?

Answer 8

• Replace hormones which are present in low level during menopause

Benefits 
      0 relieve menopausal symptoms.
      0 Prevent osteoporosis ( which is 
         common after menopause) -  
         oestrogen deficiency linked 
         osteoporosis.  

Risk
0 increased risk of :
- endometrial cancer
- Breast cancer
* women with family history of this -
HRT may not be suitable (risk/ benefit
ratio)

        - Blood clots (with HRT tablets not 
          gel or patch ) -venous 
          thromboembolism 0- blood clot in 
          deep vein ( lower leg, thigh ,groin 
          - usually )

Question 9

Contraindications of HRT therapy ?

Answer 9

• undiagnosed vaginal bleeding,
• severe liver disease,
• pregnancy, ( those on HRT should use contraception)
• venous thrombosis,
• personal history of breast cancer.(family history not an absolute contraindication)
• Well differentiated and early endometrial cancer - when treatment for malignancy is complete - no longer absolute contraindication.

Question 10

What is PSA ?

Answer 10

prostate specific antigen - produced by normal and malignant cells of the prostate gland.

Elevated PSA - possible prostate cancer.

• could also be prostatitis (inflammation of prostate or benign prostatic hyperplasia (BPH) (enlargement of the prostate), post-biopsy of prostate or urinary catheterisation.

BUT ABOVE 100 mg / L - could be nothing really other than metastatic prostate cancer.

RECTAL EXAMINATION IS IMPORTANT IN PROSTATIC ASSESSMENT TO ASSESS FOR LOW LYING RECTAL LESIONS.

Question 11

What is Serum Protein Electrophoresis (SPEP) ?

Answer 11

Measures specific protein in your blood to identify certain disease.

Uses electrical field to separate protein as proteins can have negative or positive charge. Will seperate into shaoe, size , charge.

Some forms of cancer.
Problems with the kidneys or liver.
Problems with the immune system.
Conditions that lead to poor nutrition.

High albumin: Dehydration

High alpha-1 globulin: Infection; inflammation - acute phase.

High alpha-2 globulin: Inflammation -
; kidney disease ( rises in nephritis syndrome)

High beta globulin: Very high cholesterol; low iron (iron-deficiency anemia) - do with transferrin - seriously elevated in iron deficiency.

High gamma globulin: Inflammation; infection; liver disease; some forms of cancer

Low values
Low values may be caused by many conditions. Some of the most common are shown here.

Low albumin: Poor nutrition; inflammation; liver disease; kidney disease

Low alpha-1 globulin: Severe inflammation; liver disease

Low alpha-2 globulin: Thyroid problems; liver disease

Low beta globulin: Poor nutrition
Low gamma globulin: Problems with the immune system

Question 12

What are some of the causes of osteosclerosis ?

Answer 12

• osteosclerosis - increase in bone density
• Metastatic prostatic carcinoma
• Metastatic breast cancer
• Sickle cell disease
  *Sickle cell disease is associated with
  an increase in bone density, due to
  marrow hyperplasia(increase in
  Hemopoietic stem cells in bone
  marrow) and bone
  infarction.( ischemic death of the cellular elements of the bone and marrow.)

Question 13

How do you treat prostate cancer ?

Answer 13

Hormone therapy - gonadotropin releasing hormone antagonists - prevent release of androgens (medical/chemical castration - not removing testes / gonads but are basically inactivating them )

• will lack sex drive.

Androgens - sex hormones - in males Testosterone etc.

• Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells

early stage of prostate cancer development need high levels of Androgens. Called castration sensitive

After while the cancer may become castration resistant after being treated with drug/ surgery that blocks androgens - NO LONGER NEED ANDROGEN TO GROW. MAY RESPOND TO NEWER ANTIANDROGEN DRUGS.