Pharmacology and practice lecture

Question 1

healthy vaginal ph is approximately?
what leads to or maintains this ph

a healthy vagina is a happy vagina

Answer 1

4.5

the release of lactic acid by lactobacillus

Question 2

bacterial vaginosis is caused by?

what happens to vaginal ph in BV

most common symptom of BV

Answer 2

Caused by an overgrowth of anaerobic bacteria in the vagina e.g., Gardnerella vaginalis

can increase and go up to 6.0

a fishy smelling vaginal discharge

Approximately 50% of women with BV are asymptomatic

Question 3

gandnerella, one of the bacteria that causes BV, can cause what in men?

Answer 3

balanitis and fishy odour

Question 4

is there any sourness or itching in BV

Answer 4

no

Question 5

is BV an STI?

Answer 5

Not a sexually transmitted infection (STI) but it is associated with being sexually active

Question 6

some contributing factors to bacterial vaginosis

Answer 6

Recent change in sexual partner
* Bubble baths
* Vaginal douching
* Use of a copper IUD
* Menstruation (as it causes a change in vaginal pH)
* Tobacco smoking

Question 7

what causes genital thrush

Answer 7

Candida albicans

in GT the fungal infection which results in inflammation of the genital
area

note that during reproductive or fertile years, approx 20% of women have C.albicans naturally present in their vagina, there are usually no symtpoms, but if changes to vaginal ph or hormone levels occur, then it can cause overgrowth of the fungi and symptoms can result from that

Question 8

is genital thrush an STI

Answer 8

Not an STI, but can be associated with being sexually active

Question 9

other contributing factors to genital thrush apart from being sexually active

Answer 9

Oestrogen levels
* Poorly controlled diabetes mellitus
* Being immunocompromised
* Antibiotic treatment
* Local irritation e.g. feminine hygiene products, tightly fitting clothes

Question 10

some Genital thrush symptoms (generally in women)

Answer 10

Vulval itching
* Vulval soreness and irritation
* Vaginal discharge – usually creamy coloured, no smell, curd-like
appearance
* Superficial dyspareunia
* Dysuria

in men there may be;
Redness of the glans penis(the rounded tip of the penis)
Occasionally white, curd-like patches

Question 11

pelvin inflammatory disease

Answer 11

.it is a general term for infection of the upper genital tract in women, and is commonly but not exclusively caused by STIs

not an STI itself but caused by them

Question 12

the two main pathogens(bacteria ) than cause PID

Answer 12

Chlamydia trachomatis
Neisseria gonorrhoeae

these two are the pathogens that cause of chalmydia and gonorrhea

Question 13

the STI that is the most common cause of PID

Answer 13

chlamydia

gonorrhea is another major cause of PID

Question 14

pelvin inflammatory disease symptoms

Answer 14

Pelvic or lower abdominal pain
* Deep dyspareunia
* Dysmenorrhoea
* Abnormal vaginal bleeding
* Increased vaginal discharge
* Fever

Dysmenorrhea, also known as period pain, is cramping or aching pain in the lower abdomen that occurs during menstruation.

note that If acute PID isn’t managed, then it can present as subfertility
many years later. Subfertility is a condition where a couple is having difficulty conceiving, but pregnancy is still possible without medical intervention

Question 15

first line treatment for BV and the usual oral doses

Answer 15

First line treatment is
metronidazole

400mg BD for seven days
2g immediately

note that the seven day course results in fewer relapses

metronidazole can be given orally or vaginally

Question 16

the recommended vaginal dose for BV

Answer 16

5g of vaginal gel every night for seven nights

both oral and vaginal routes for metronidazole deemed equally effective

Question 17

drug treatments for genital thrush and the usual doses

Answer 17

azole antifungals, i.e clotrimazole(imidazole type) or fluclonazole (triazole type)

clotrimazole pessaries, vaginal creams or topical creams

For an uncomplicated infection
* 500mg pessary ON as a single dose
* 5g of 10% vaginal cream ON as a single dose
* Topical cream can be used externally for vulval irritation two or three
times a day
* Topical cream can also be used for male genital symptoms

fluclonazole is systemic, but clotrimazole can be used topically

Question 18

metronidazole mechanism of action

Answer 18

Metronidazole works on anaerobic bacteria only. The lack of oxygen within the bacterial cell forces conversion
to the active form of the drug (reduces the nitro group). The active form then attacks the bacterial DNA, causing strand breakage

The active metabolite of metronidazole is hydroxy-metronidazole

Question 19

azoles mechanism of action

Answer 19

Azoles work by inhibiting synthesis of the sterol components of the fungal cell membrane. This leads to reduced levels of ergosterol and reduced membrane integrity. Toxic sterols also build up within the cell. The cell begins to leak, and then bursts

Question 20

for uncomplicated infection of genital thrush, the usual dose of fluclonazole is? how does fluconazole work

Answer 20

150mg as a single dose

• Fluconazole inhibits cytochrome P450 (CYP2C9 and CYP3A4) enzymes, and so has a lot of drug interactions

Can generally be ignored for single dose treatment – but we should refer rather than managing in the pharmacy

CYP 450 enzymes are a family of proteins that help the body metabolize drugs and other compounds

Question 21

first line treatment for pelvic inflammtory disease and the usual doses

Answer 21

First line treatment is ceftriaxone injection, plus metronidazole and doxycycline in combination

Ceftriaxone 1000mg or 1g Intramuscularly immediately
Metronidazole 400mg BD for 14 days
Doxycycline 100mg BD for 14 days

Question 22

ceftriaxone mechanism of action

doxycycline mechanism of action

Answer 22

iss a beta−lactam type antibiotic – a cephalosporin

Cephalosporins interfere withsynthesis of peptidoglycans in bacterial cell walls

Doxycycline is a tetracycline. Tetracyclines inhibit bacterial protein synthesis and hence cell growth – bacteriostatic

Question 23

second line treatment for PID and usual doses

Answer 23

ofloxacin and
metronidazole in combination

Metronidazole 400mg BD for 14 days
Ofloxacin 400mg BD for 14 days

second line only used where it’s unlikely to be a gonococcal infection causing the PID

Question 24

ofloxacin mechanism of action

Answer 24

Ofloxacin is a fluoroquinolone antibiotic. It works by preventing bacterial DNA from unwinding in order to replicate itself.

fluoroquinolones must only be prescribed when other commonly
recommended antibiotics are inappropriate

Question 25

what are some counselling points for metronidazole

Answer 25

Very important to avoid alcohol – this still applies with the vaginal dosage form because of systemic absorption

The tablets should be taken after food, and swallowed whole with a full glass of water

If a course has been prescribed, the full course must be
completed

If treating PID, the woman and her partner should abstain from sex until the course of antibiotics is completed

Question 26

counselling points for clotrimazole

remember it is mainly used topically

Answer 26

The pessary or vaginal cream should be inserted high into the vagina at night, so it stays in place for longer

The use of a panty liner could be advised, as there may be some residue from the pessary

Vaginal treatments can damage latex condoms, so abstinence would be needed for at least five days after treatment

The topical cream is just for external use, and if it is the sole treatment, should be used for two weeks

Question 27

couselling points for doxycycline

Answer 27

Can’t be taken at the same time as indigestion remedies, iron, or zinc – they reduce absorption of the doxycycline

Swallowed whole with plenty of fluid while sitting or standing – want to get the dose straight down to the stomach

Makes the skin more sensitive to the sun – phototoxicity can result, so sunscreen should be worn, and sunbeds avoided

Important to complete the course

Question 28

couselling points for ofloxacin

Answer 28

Can’t be taken at the same time as indigestion remedies, iron, or zinc – they reduce absorption of the ofloxacin

Ofloxacin – like all the fluoroquinolones – can cause tendonitis, and possible tendon rupture, so patients should be aware

Ofloxacin can make the skin more sensitive to the sun, so sunscreen should be worn and sunbeds avoided

Important to complete the whole course