Pharmacology and practice lecture Flashcards
healthy vaginal ph is approximately?
what leads to or maintains this ph
a healthy vagina is a happy vagina
4.5
the release of lactic acid by lactobacillus
bacterial vaginosis is caused by?
what happens to vaginal ph in BV
most common symptom of BV
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
gandnerella, one of the bacteria that causes BV, can cause what in men?
balanitis and fishy odour
is there any sourness or itching in BV
no
is BV an STI?
Not a sexually transmitted infection (STI) but it is associated with being sexually active
some contributing factors to bacterial vaginosis
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
what causes genital thrush
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
is genital thrush an STI
Not an STI, but can be associated with being sexually active
other contributing factors to genital thrush apart from being sexually active
Oestrogen levels
* Poorly controlled diabetes mellitus
* Being immunocompromised
* Antibiotic treatment
* Local irritation e.g. feminine hygiene products, tightly fitting clothes
some Genital thrush symptoms (generally in women)
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
pelvin inflammatory disease
.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
the two main pathogens(bacteria ) than cause PID
Chlamydia trachomatis
Neisseria gonorrhoeae
these two are the pathogens that cause of chalmydia and gonorrhea
the STI that is the most common cause of PID
chlamydia
gonorrhea is another major cause of PID
pelvin inflammatory disease symptoms
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
first line treatment for BV and the usual oral doses
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
the recommended vaginal dose for BV
5g of vaginal gel every night for seven nights
both oral and vaginal routes for metronidazole deemed equally effective
drug treatments for genital thrush and the usual doses
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
metronidazole mechanism of action
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
azoles mechanism of action
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
for uncomplicated infection of genital thrush, the usual dose of fluclonazole is? how does fluconazole work
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
first line treatment for pelvic inflammtory disease and the usual doses
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
ceftriaxone mechanism of action
doxycycline mechanism of action
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
second line treatment for PID and usual doses
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
ofloxacin mechanism of action
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
what are some counselling points for metronidazole
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
counselling points for clotrimazole
remember it is mainly used topically
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
couselling points for doxycycline
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
couselling points for ofloxacin
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
