Pharm - STIs Flashcards
What is the treatment for N.gonorrhoea
Ceftriaxone (injection) - gonorrhoea
Ceftriaxone + doxycycline - multiple infection (gonorrhoea + chlamydia)
what is the treatment for chlamydia trachomatis
Doxycycline or Azithromycin - Chlamydia D-K
or Levofloxacin
Ceftriaxone + doxycycline - multiple infection (gonorrhoea + chlamydia)
What is the treatment for Mycoplasma genitalium
Doxycycline or Azithromycin
Moxifloxacin (macroplide resistant infections)
treatment for syphillis
Penicillin injection
If allergic: doxycycline or azithromycin
treatment for HSV-2
Acyclovir
Lymphogranuloma venerum (LGW) genital ulcer treatment
Doxycycline
Azithromycin
Erythromycin
bacterial vaginosis treatment
Clindamycin
Metronidazole
Trichomoniasis (trichomonas vaginalis):
vulvovaginitis treatment
Metronidazole
Tinidazole
Treat both partners
candida albicans treatment
Ketoconazole, Itraconazole, fluconazole (oral)
Miconazole, clotrimazole (topical)
Nystatin
Sarcoptes scabei (scabies) treatment
Permethrin
Crotamiton
Ivermectin (oral)
treatment genital ulcers (caued by HSV-2)
aceteaminophen, ibuprofen
warm water immersion, epsom salts, tea tree
differences in anitviral therapies:
acyclovir
famciclovir
valacyclovir
acyclovir - more frequent dosing
famciclovir - greatest bioavailability
valacyclovir - monophosphate form incoorporates into viral DNA - chain termination
acyclovir MOA
antiviral
guanosine derivative causing chain termination
activated by viral thymidine kinase –> converted mono–>di–>tri by host enzymes –> inhibits viral DNA polymerase = chain termination (lack of 3’OH group)
issue of Doxycycline
benefit of Minocycline
D - hepatotoxic - handled by bile (doxy ok for renal insufficiency)
M - less phototoxicity
Tetracyclines - MOA & Adverse
i.e. doxycycline
MOA - binds reversibly to 30S subunit, bacteriostatic, block binding aminoacyl-tRNA on m-RNA-ribosome complex
Adverse - phototoxicity, hepatic injury, nephrotoxocity (doxy safe), Fanconi syndrome, stunted growth
Macrolides - MOA & Adverse
i.e. ‘-mycins’
MOA - bind reversibly to 50S subunit, protein synthesis inhibited, aminoacyl translocation inhibited
Adverse - nausea, vomiting, abdo pain, cardiac arrythmias
fluoroquinolones - MOA & Adverse
i.e. ‘-floxacin’
MOA - inhibit bacterial topioisomerase II (DNA gyrase) & topioisomerase IV
(A subunit - nicks & reseals, B subunit - negative supercoils) - interfers with cutting/resealing
Penicillin G
MOA - beta lactam
treatment acute proctitis, protocolitis, enteritis, epididymitis
ceftriaxone +
doxicycline
treatment PID
ceftriaxone + doxycycline + metronidazole
or
cefotetan + doxycycline
or
cefoxitin + doxycycline
treatment chancroid - haemophilus ducreyi
azithromycin, ceftriazone, ciprofloxacin, erythromycin
condylomata acuminate - genital warts
imiquimod - boosts host immune system, manipulate local inflammation
podofilox - arrests mitosis in metaphase, destabilizes microtubules by binding tubulin, preventing cell division
sinecatechins
cryotherapy, surgery
trichomoniasis treatment
metronidazole
Metronidazole - MOA, Adverse, Interactions
MOA - diffuses into the organism, inhibits protein synthesis - loss of helical DNA structure and strand breakage
Adverse - N+V, diarrhoea, abdo pain, glossitis, vertigo
Interactions - ethanol - Disulfram Rx + promotes renal retention lithium - toxicity
Fluconazole - MOA
MOA - inhibitor fungal CYP450 sterol C-14 alpha-demethylation
DRUG
Ceftriaxone
Use - gonorrhoea, PID
MOA - inhibits bacterial cell wall synthesis
Adverse - diarrhoea, allergic reaction
Interactions - calcium IV solutions –>precipitation, bleeding with anticoagulants
DRUG
Penicillin G
Use - syphilis, chlamydia, gram (+) infections
MOA - inhibits bacterial cell wall synthesis
Adverse - hypersensitivity Rx
Interactions - decrease effectiveness oral contraceptives
DRUG
Azithromycin
Macrolide
Use - chlamydia, gonorrhoea, PIDMOA - inhibits bacterial protein synthesis, binding 50S ribosomal subunit
Adverse - nausea, diarrhoea, abdo pain, QT prolongation
Interactions - use with antacids - decrease absorption, other QT prolonging drugs
DRUG
Doxycycline
Use - chlamydia, gonorrhoea, PID
MOA - inhibits bacterial protein synthesis, binding 30S ribosomal subunit
Adverse - nausea, vomiting, photosensitivity, oesophagitis
CI - pregnancy (teratogenic)
Interactions - decrease oral contraceptive use
DRUG
Gemifloxacin
Fluoroquinolone
Use - atypical pathogens in pelvic infections
MOA - inhibit bacterial DNA gyrase & topoisomerase IV
Adverse - nausea, diarrhoea, headache, QT prolongation
DRUG
Acyclovir, Ganciclovir
Antiviral
Use - HSV
MOA - inhibits viral DNA polymerase, chain termination
Adverse - nausea, vomiting, headache, nephrotoxicity (ganciclovir)
Interactions - probenecid can increase acyclovir levels
DRUG
Foscarnet
Antiviral
Use - resistant HSV
MOA - inhibits viral DNA polymerase & HIV reverse transcriptase
Adverse - nephrotoxicity, electrolyte disturbances, seizures
CI - renal impairment
DRUG
Metronidazole
Antimicrobial
Use - bacterial vaginosis, trichomoniasis
MOA - disrupts bacterial DNA, inhibits nucleic acid synthesis
Adverse - metallic taste, nausea, peripheral neuropathy
CI - first trimester pregnancy
Interactions - alcohol consumption - Disulfiram-like reaction, anticoagulant effect
DRUG
Fluconazole
Antifungal
Use - vaginal candidiasis
MOA - inhibit fungal cytochrome P450-dependant enzyme, lanosterol 14-alpha-semethylase
Adverse - nausea, headache, hepatotoxicity
Interactions - drugs metabolised by CYP34A, CYP2C9 can induce toxicity
DRUG
Imiquimod
Use - genital arts, cervical dysplasia
MOA - stimulates innate immune response, toll-like receptor 7 agonist
Adverse - local skin reaction, flu symptoms
DRUG
Acetaminophen
Analgesic
Use - pain relief from genital ulcers
MOA - inhibits prostaglandin synthesis in CNS
Adverse - hepatotoxicity
Interactions - increase anticoagulant effect of warfarin
DRUG
Ibuprofen
NSAID
Use - pain relief from genital ulcers
MOA - nonselective COX inhibitor
Adverse - GIT bleed, renal impairment
Interactions - decrease efficacy antihypertensive drugs
DRUG
Moxifloxacin
Quinolone antibiotic
Use - PID
MOA - inhibits bacterial DNA gyrase & topoisomerase IV
Adverse - nausea, diarrhoea, QT prolongation
