Pharm Wk 10 Flashcards
STIs are often ? making screening important in their detection
asymptomatic
to differentiate the various STIs: it’s characterized into 3 categories
- infections characterized by vaginal discharge
- infections characterized by urethritis and cervicitis
- infections characterized by genital ulcers
what are the 3 infections most frequently associated with vaginal discharge?
- vulvovaginal candidiasis
- trichomoniasis
- bacterial vaginosis
vulvovaginal candidiasis commonly caused by ?
Candida albicans
Trichomoniasis caused by ?
trichomonas vaginalis
Bacterial vaginosis caused by ?
a replacement of the normal vaginal flora by an overgrowth of anaerobic microorganisms, Mycoplasma and Gardnerella vaginalis
what is recommended for patients with Trichomoniasis?
Metronidazole
what are the adverse effects of metronidazole?
GI upset, metallic taste, urethral burning, dark or reddish-brown discoloration of urine
for pregnant women with trichomoniasis, what is the preferred treatment?
oral metronidazole
What are the treatments for bacterial vaginosis?
oral or topical metronidazole or topical clindamycin
for clindamycin, which one is preferred? oral or topical?
topical
what are the adverse effects of clindamycin?
When used topically, it may cause vulvovaginitis, when used orally can cause GI upset, C. difficile colitis, diarrhea
Uncomplicated vulvovaginal candidiasis can be treated by?
intravaginal axoles or oral fluconazole
Is treatment necessary in asymptomatic cases of vulvaginal candidiasis?
no, unnecessary
What is the mechanism of action of azole antifungals (includes fluconazole)
work by inhibiting an enzyme necessary for the synthesis of ergosterol which is necessary for fungal membrane function, depletion of ergosterol leads to increased membrane permeability and possibly interferes with membrane-bound enzyme systems
what are the adverse effects of azole antifungals?
- oral fluconazole is associated with headache, nausea, abdominal pain, diarrhea, dyspepsia, dizziness
- topical azole antifungals are usually only associated with local hypersensitivity
What are the 2 main causes of urethritis and cervicitis?
- gonorrhea
- chlamydia
Gonorrhea is caused by?
Neisseria gonorrhoeae
Chlamydia is caused by?
Chlamydia trachomatis
What is the preferred treatment for chlamydia?
azithromycin or doxycycline
What is the preferred treatment regimen for anogenital gonococcal infections ?
a combination of a third-generation cephalosporin (ceftriaxone or cefixime) with azithromycin
What is the preferred
treatment for patients with cephalosporin-resistant gonorrhea or a history of anaphylactic reaction to penicillin or allergy to cephalosporins
combination of gentamicin with azithromycin, or gentamicin with doxycycline
What is the mechanism of action for azithromycin?
bacteriostatic activity by interfering with protein synthesis
What is the mechanism of action of doxycycline?
antibiotics that interfere with protein synthesis by binding to the 30S ribosomal subunity and blocks the binding of tRNA to the A site
What generation of cephalsporins are ceftriaxone?
third generation
Gentamicin belongs to what class of antibiotics?
aminoglycoside
What is the mechanism of action for gentamicin?
they bind to polysomes and cause misreading and premature termination of mRNA translation
what is the preferred antibiotic for pregnant women with chlamydial infections?
axithromycin
what is the preferred antibiotic for pregnant women with gonococcal infections?
Ceftriaxone
the 2 most common STIs associated with genital ulcers in North America are ?
genital herpes and syphilis
What is the preferred treatment for syphilis?
benzathine penicillin G
What can be used as an alternative for those who are allergic to penicillin and have syphilis?
doxycycline
What is the adverse effects of benzathine penicillin G
jarisch-herxheimer reaction: fever, chills, rigors, sweating
Which herpes simplex virus (HSV) type is primarily associated with orolabial infections?
HSV-1, though HSV-2 can also infect the orolabial area.
Which HSV type is primarily associated with genital infections?
HSV-2, but HSV-1 can also cause genital herpes.
What percentage of the North American population carries HSV-1?
Approximately 50%.
What percentage of the North American population carries HSV-2?
Approximately 12–14%.
What type of drugs are used to treat symptomatic herpes infections?
Synthetic nucleoside analogues.
How do nucleoside analogues work against HSV?
They resemble nucleoside bases, get phosphorylated by viral kinases, and halt DNA synthesis.
How long are oral antivirals typically used for treating recurrent orolabial herpes?
1–5 days.
What is the benefit of initiating oral acyclovir within 1 hour of symptom onset?
It may reduce the duration of pain by about 1 day.
How effective is valacyclovir for cold sores?
A 1-day treatment started within 2 hours of symptoms can reduce episode duration by 1 day.
How does famciclovir affect cold sore healing?
It shortens the median time to normal skin from 6.2 days (placebo) to 4–4.4 days.
What are the symptoms of genital herpes?
Papules, vesicles, and painful ulcers in the genital and surrounding areas.
When is suppressive therapy recommended for recurrent genital herpes?
When recurrences happen 4 or more times per year.
Does suppressive therapy completely prevent HSV transmission?
No, but it reduces recurrences and transmission risk.
Why is valacyclovir often preferred over acyclovir for suppressive therapy?
It can be taken once per day.
What is the strategy for deprescribing suppressive therapy?
Interrupt every 3–6 months and reassess based on recurrence frequency.
Why is genital herpes a concern in pregnancy?
It can cause neonatal herpes, which can be fatal.
How can acyclovir help pregnant women with genital herpes?
Daily use from 36 weeks reduces recurrences, shedding, and C-section risk.
