Pharm - STIs

Question 1

What is the treatment for N.gonorrhoea

Answer 1

Ceftriaxone (injection) - gonorrhoea

Ceftriaxone + doxycycline - multiple infection (gonorrhoea + chlamydia)

Question 2

what is the treatment for chlamydia trachomatis

Answer 2

Doxycycline or Azithromycin - Chlamydia D-K
or Levofloxacin

Ceftriaxone + doxycycline - multiple infection (gonorrhoea + chlamydia)

Question 3

What is the treatment for Mycoplasma genitalium

Answer 3

Doxycycline or Azithromycin

Moxifloxacin (macroplide resistant infections)

Question 4

treatment for syphillis

Answer 4

Penicillin injection

If allergic: doxycycline or azithromycin

Question 5

treatment for HSV-2

Answer 5

Acyclovir

Question 6

Lymphogranuloma venerum (LGW) genital ulcer treatment

Answer 6

Doxycycline
Azithromycin
Erythromycin

Question 7

bacterial vaginosis treatment

Answer 7

Clindamycin
Metronidazole

Question 8

Trichomoniasis (trichomonas vaginalis):
vulvovaginitis treatment

Answer 8

Metronidazole
Tinidazole

Treat both partners

Question 9

candida albicans treatment

Answer 9

Ketoconazole, Itraconazole, fluconazole (oral)
Miconazole, clotrimazole (topical)
Nystatin

Question 10

Sarcoptes scabei (scabies) treatment

Answer 10

Permethrin
Crotamiton
Ivermectin (oral)

Question 11

treatment genital ulcers (caued by HSV-2)

Answer 11

aceteaminophen, ibuprofen

warm water immersion, epsom salts, tea tree

Question 12

differences in anitviral therapies:
acyclovir
famciclovir
valacyclovir

Answer 12

acyclovir - more frequent dosing
famciclovir - greatest bioavailability
valacyclovir - monophosphate form incoorporates into viral DNA - chain termination

Question 13

acyclovir MOA

Answer 13

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)

Question 14

issue of Doxycycline
benefit of Minocycline

Answer 14

D - hepatotoxic - handled by bile (doxy ok for renal insufficiency)
M - less phototoxicity

Question 15

Tetracyclines - MOA & Adverse

Answer 15

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

Question 16

Macrolides - MOA & Adverse

Answer 16

i.e. ‘-mycins’
MOA - bind reversibly to 50S subunit, protein synthesis inhibited, aminoacyl translocation inhibited
Adverse - nausea, vomiting, abdo pain, cardiac arrythmias

Question 17

fluoroquinolones - MOA & Adverse

Answer 17

i.e. ‘-floxacin’
MOA - inhibit bacterial topioisomerase II (DNA gyrase) & topioisomerase IV
(A subunit - nicks & reseals, B subunit - negative supercoils) - interfers with cutting/resealing

Question 18

Penicillin G

Answer 18

MOA - beta lactam

Question 19

treatment acute proctitis, protocolitis, enteritis, epididymitis

Answer 19

ceftriaxone +
doxicycline

Question 20

treatment PID

Answer 20

ceftriaxone + doxycycline + metronidazole
or
cefotetan + doxycycline
or
cefoxitin + doxycycline

Question 21

treatment chancroid - haemophilus ducreyi

Answer 21

azithromycin, ceftriazone, ciprofloxacin, erythromycin

Question 22

condylomata acuminate - genital warts

Answer 22

imiquimod - boosts host immune system, manipulate local inflammation
podofilox - arrests mitosis in metaphase, destabilizes microtubules by binding tubulin, preventing cell division
sinecatechins
cryotherapy, surgery

Question 23

trichomoniasis treatment

Answer 23

metronidazole

Question 24

Metronidazole - MOA, Adverse, Interactions

Answer 24

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

Question 25

Fluconazole - MOA

Answer 25

MOA - inhibitor fungal CYP450 sterol C-14 alpha-demethylation

Question 26

DRUG Ceftriaxone

Answer 26

Use - gonorrhoea, PID MOA - inhibits bacterial cell wall synthesis Adverse - diarrhoea, allergic reaction Interactions - calcium IV solutions -->precipitation, bleeding with anticoagulants

Question 27

DRUG Penicillin G

Answer 27

Use - syphilis, chlamydia, gram (+) infections MOA - inhibits bacterial cell wall synthesis Adverse - hypersensitivity Rx Interactions - decrease effectiveness oral contraceptives

Question 28

DRUG Azithromycin

Answer 28

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

Question 29

DRUG Doxycycline

Answer 29

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

Question 30

DRUG Gemifloxacin

Answer 30

Fluoroquinolone Use - atypical pathogens in pelvic infections MOA - inhibit bacterial DNA gyrase & topoisomerase IV Adverse - nausea, diarrhoea, headache, QT prolongation

Question 31

DRUG Acyclovir, Ganciclovir

Answer 31

Antiviral Use - HSV MOA - inhibits viral DNA polymerase, chain termination Adverse - nausea, vomiting, headache, nephrotoxicity (ganciclovir) Interactions - probenecid can increase acyclovir levels

Question 32

DRUG Foscarnet

Answer 32

Antiviral Use - resistant HSV MOA - inhibits viral DNA polymerase & HIV reverse transcriptase Adverse - nephrotoxicity, electrolyte disturbances, seizures CI - renal impairment

Question 33

DRUG Metronidazole

Answer 33

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

Question 34

DRUG Fluconazole

Answer 34

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

Question 35

DRUG Imiquimod

Answer 35

Use - genital arts, cervical dysplasia MOA - stimulates innate immune response, toll-like receptor 7 agonist Adverse - local skin reaction, flu symptoms

Question 36

DRUG Acetaminophen

Answer 36

Analgesic Use - pain relief from genital ulcers MOA - inhibits prostaglandin synthesis in CNS Adverse - hepatotoxicity Interactions - increase anticoagulant effect of warfarin

Question 37

DRUG Ibuprofen

Answer 37

NSAID Use - pain relief from genital ulcers MOA - nonselective COX inhibitor Adverse - GIT bleed, renal impairment Interactions - decrease efficacy antihypertensive drugs

Question 38

DRUG Moxifloxacin

Answer 38

Quinolone antibiotic Use - PID MOA - inhibits bacterial DNA gyrase & topoisomerase IV Adverse - nausea, diarrhoea, QT prolongation