Gynecologic and Pregnancy Related Infections Part 1 Flashcards
What is the Amsel Criteria? What is it for?
- Helps diagnose bacterial vaginosis –> need 3 out of 4
- Homogenous, thin, grayish-white discharge
- Vaginal pH >4.5
- Pos Whiff test
- Clue cells on saline wet mount
What is bacterial vaginosis associated with?
- Increased sexual activity
- STIs
- Douching
- Smoking
What is the most important bacterial that causing bacterial vaginosis? What is special about it?
- Gardnerella vaginalis
- Creates a biofilm that allows other bacterial to grow and thrive
What are the common drugs used for Gardnerella vaginosis?
- Metronidazole
- Tinidazole
- Clindamycin
What is the MOA of metronidazole?
- Gets activated by reduction of nitro group
- Causes a loss of helical DNA structure and strand breakage
What organisms does metronidazole affect?
- Obligate anaerobes and Protozoans (like Trichomonas)
What is an undesirable side effect of nitroimidazoles?
- Disulfuram-like reaction with alcohol –> flushing, HA, and vomiting
What is clindamycin used for?
- Alternative to penicillin
- Effective against beta-lactamase bacteria (GAS)
- TSS
- PID
What is the MOA of clindamycin?
- Binds 50S subunit of ribosome
What is the coverage of clindamycin?
- Gram pos
- Most anaerobes
What is an important side effect of clindamycin?
- C diff
What are some risk factors for vaginal candidiasis?
- DM
- Immunosuppression
- Increased estrogen states
- Broad spectrum antibiotic use
What are some drugs used for candidiasis?
- Clotrimazole
- Miconazole
- Tioconazole
- Terconazole
- Butoconazole
- Oral fluconazole
What is the MOA for ‘Azoles’?
- Inhibits conversion of lanosterol to ergosterol by CYP450 system
What is a warning with fluconazole?
- Potential for fetal harm –> cause serious and specific birth defects
- Could prolong QT interval (Torsades)
- When combined with erythromycin, could increased cardiotoxicity
