PHARM-STDs Flashcards by Kenneth Kennedy

name the 3 antivirals used to treat HSV?

acyclovir, famciclovir, valacyclovir

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how does acyclovir work?

prevents further chain elongation (lacks the 3’OH group, and the viral polymerase-associated exonuclease cant remove the acyclovir moiety)

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how does famciclovir work?

metabolized (de-acetylated) to penciclovir

-doesn’t cause chain termination

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you are treating with acyclovir, famciclovir, or valacclovir, what would you need to do with a pt who has renal dysfunction?

adjust the dose

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which of the antivirals has adverse effects that include neurotoxicity including seizures?

acyclovir (also valacyclovir)

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which antiviral used to treat HSV can penetrate the CSF?

acyclovir

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what is the name of the prodrug for acyclovir?

valacyclovir

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what is the benefit of using valacyclovir?

better oral bioavailability

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what happens to acyclovir oral bioavailability as the dose increases?

the bioavailability decreases as the dose increases

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how can you keep the pt from having crystalline nephropathy or neurotoxicity while being treated with antivirals for HSV?

keep the pt well hydrated

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how does penicillin work?

binds PBPs causing cell lysis

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why do we treat syphilis with benzathine Penicillin G?

IM admin produces a drug depot that frees drug over 2 wks

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how is benzathine penicillin G IM eliminated?

renal tubular excretion (huge delay in pts w/ renal dysfunction)

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can benzathine penicillin G penetrate the CSF?

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how do you treat early latent syphilis?

benzathine Pen G IM

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what is the Jarisch-Herxheimer Reaction?

seen after treating pts with secondary syphilis after first injection of penicillin

release of syphilitic antigens w/ subsequent host reaction
chills, fever, headache, myalgias, arthralgias

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what happens to the syphilitic cutaneous lesions during a Jarisch-Herxheimer reaction?

may become more prominent, edematous, and brilliant in color

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how long will a Jarisch-herxheimer rxn last?

persists for a few hours; begins to fade within 48 hrs and does not re-occur

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what provides symptomatic relief to the Jarisch-Herxheimer reaction?

aspirin

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do you stop penicillin therapy if you have a pt have a Jarisch-Herxheimer Reaction?

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Which drugs can you use to treat chlamydia?

azithromycin Or doxycycline

Alternates: erythromycin, levofloxacin, ofloxacin

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how are the antibiotics against chlamydia administered?

oral

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which 2 drugs used to treat chlamydia have long half lives with extensive tissue uptake and slow release?

azithromycin

doxycycline

which 2 drugs used to treat chlamydia undergo little metabolism and mostly eliminated in urine, some in stool?

levofloxacin, ofloxacin

describe the elimination of azithromycin and doxycycline?

little metabolism, most elimination in stool with some elimination in urine

what are the adverse effects of azithromycin?

GI upset, vaginitis

name the anti-chlamydial drug: | AE: GI upset, hepatic damage in high dose esp. in pregnancy; photosensitivity w/ sunlight or tanning bed

doxycycline

which antichlamydial drug causes taste disturbance?

levofloxacin

name the 2 antichlamydial drugs that have these adverse effects: BBW of increased risk of tendonitis & rupture BBW exacerbation of muscle weakness-avoid w/ myasthenia gravis

levofloxacin | ofloxacin

which 4 drugs would you use to treat chancroid?

azithromycin or ceftriaxone or ciprofloxacin or erythromycin base (ACCE got Chanked!)

all the antibiotics used to treat chancroid are oral except ceftriaxone which is ___________-

ceftriaxone MOA

bactericidal beta-lactam; binds PBPs causing cell lysis

how is ceftriaxone eliminated?

eliminated in urine mainly by GF, w/ lesser amounts in stool

which antibiotics are used to treat uncomplicated gonococcal infections of the cervix, urethra, and rectum?

Ceftriaxone (IM) or cefixime Plus Azithromycin or Doxycycline (po) (COCADO)

which antibiotics are used to treat uncomplicated GC infections of the pharynx?

ceftriaxone (IM) or azithromycin (oral) or doxycycline (oral)

which abx treat urethritis-cervicitis?

azithromycin or doxycycline | -alternatively (erythromycin base or levo- or ofloxacin)

which drugs do you use for recurrent treatment of urethritis-cervicitis?

metronidazole or tidazole plus azithromycin (if not used for original episode)

how do you treat trichomonas?

metronidazole or tinidazole

metronidazole/tinidazole MOA

amebeicidal, bactericidal, trichomonacidal - unionized drug taken up by anaerobic organisms & cells where it is reduced to its active form which disrupts DNA's helical structure, thereby inhibiting bacterial nucleic acid synthesis. - equally effective vs. dividing and non-dividing cells

describe the elimination of metronidazole

extensive hepatic metabolism w/ elimination in urine (DISCOLORATION) & stool

metronidazole inhibits which CYP enzyme?

CYP2C9

what are some of the adverse effects of metronidazole and tinidazole?

- avoid in pregnancy & breastfeeding - candidiasis - DISULFURAM-like effect (don't drink EtOH) - secondary malignancies in animal model

what drugs do you use to treat bacterial vaginosis?

metronidazole (oral) or clindamycin (gel) or tinidazole (oral) or clindamycin (oral)

clindamycin MOA

binds to 50s ribosomal subunit to inhibit protein synthesis; bacteriostatic

describe the elimination of clindamycin

short half-life - extensive metabolism w/ elimination of products in urine and stool - 30% of vaginally instilled drug becomes systematized

the CDC recommends intravaginal use of clindamycin only during what time period of pregnancy?

only in 1st trimester (low birth wt, pre-term delivery)

local delivery of what drug is also rarely associated w/ contact toxicity like vaginal erythema, vulvovaginal pruritus, vaginal discharge, vaginal swelling, vaginal bleeding and vaginal pain

clindamycin

what are the OTC options for treating candidiasis?

butoconazole or clotrimazole or miconazole or tioconazole

what are the prescription options for treating candidiasis?

butoconazole or terconazole or fluconazole

how do the conazoles work?

blocks ergosterol synth. through interacting w/ 14-alpha demethylase, a CYP necessary conversion of lanosterol to ergosterol; essential membrane comonent

how the azoles mostly eliminated?

in stool

high systemic doses of azoles produce what adverse effects in fetus and mom?

abdominal wall defects & cleft palate in fetus & maternal stress -avoid in 1st trimester

the oil-based topical products of what class of drugs can weaken latex condoms or diaphragms?

conazoles

what is the major antigenic protein that is in Gardasil and cervarix vaccine?

L1 protein

Gardasil covers which HPV viruses?

6, 11, 16, 18

Cervarix covers which HPV viruses?

16, 18