STD antibiotics

Question 1

How do you treat Syphilis?

Answer 1

Penicillin G

Question 2

Sero-reactivity without other evidence of disease is known as what kind of syphilis?

Answer 2

Latent syphilis (not sexually transmitted); Late latent syphilis gets 3 weekly treatments instead of just 1

Question 3

What do you do with a pregnant patient or allergic patient with syphilis?

Answer 3

Desensitize and treat. No alternative drugs recommended

Question 4

MOA of penicillin G?

Answer 4

Bacteriocidal beta lactam; binds Peptidoglycan binding protein & causes cell lysis

Question 5

Administration of Pen G in syphilis?

Answer 5

Single dose IM

Question 6

Elim of Pen G?

Answer 6

Renal; caution in renal failure

Question 7

Does Pen G penetrate CSF?

Answer 7

No! Won’t treat neurosyphilis

Question 8

How do you treat congenital syphilis?

Answer 8

10 day course of Procaine Pen G. If >1 day missed, start over. Given IV instead of IM

Question 9

Describe the Jarisch-Herxheimer reaction

Answer 9

Very common in pts being treated for secondary syphilis. Hours after first injection of Pcn –> chills, fever, headache, myalgia, syphilitic lesion becomes “brilliant in color”. This persists for a few hours then goes away by 48 hrs

Question 10

What do you do if a patient has the Jarisch-Herxheimer rxn?

Answer 10

You can give them aspirin for relief but DO NOT discontinue therapy

Question 11

Dosage of Benzathine Pcn G?

Answer 11

2.4 x 10^6 units of IM dose

Question 12

Dosage of Procaine Pcn G?

Answer 12

50K units/kg/dose IM daily for 10 days

Question 13

How do you treat primary syphilis?

Answer 13

Benzathine Pcn G

Question 14

First line of tx for Chlamydia?

Answer 14

Azithromycin

Question 15

First line tx for Gonorrhea?

Answer 15

Ceftriaxone

Question 16

First line tx for Urethritis/Cervicitis?

Answer 16

Azithromycin

Question 17

First line tx for recurrent urethritis/cervicitis?

Answer 17

Metronidazole

Question 18

First line tx for Trichomoniasis?

Answer 18

Metronidazole

Question 19

First line tx for bacterial vaginosis?

Answer 19

Metronidazole

Question 20

Ceftriaxone MOA?

Answer 20

Bacteriocidal beta lactam

Question 21

Ceftriaxone treats?

Answer 21

Chancroid; uncomplicated GC

Question 22

So.. grouping.. what are the cell wall synthesis inhibitors for this block?

Answer 22

1. Pcn G
2. Amoxicillin
3. Ceftriaxone
4. Cefixime
   * *Last 2 are both cephalosporins

Question 23

Name the protein synthesis inhibitors for this block. (there are 4)

Answer 23

1. Doxycycline (a tetracycline)
2. Clindamycin (a lincosamide)
3. Azithromycin (a macrolide)
4. Erythromycin (a macrolide)

Question 24

Doxy MOA?

Answer 24

Binds 30S ribosomal subunit; bacteriostatic

Question 25

Doxy ADE (4)?

Answer 25

1. GI upset
2. Hepatic damage in high dose (esp in pregnancy)
3. Photosensitivity
4. Category D teratogen (bad for baby bones)

Question 26

Doxy treats? (3 things)

Answer 26

1. Chlamydia
2. GC
3. Urethritis/Cervicitis

Question 27

Clindamycin MOA?

Answer 27

Binds 50S ribosomal subunit; bacteriostatic

Question 28

AE’s of Clindamycin? (3 things)

Answer 28

1. When used for vaginosis, this is a topical drug. If you use it intravaginally after the first trimester, it has AE’s on the fetus!
2. Excreted in breast milk. There are no issues officially, but still be careful when breast-feeding
3. Rarely, contact toxicity like vaginal erythema, pruritis, discharge, swelling, bleeding, pain
   * *bonus: topical gels can disrupt integrity of condoms

Question 29

Clindamycin is used to treat?

Answer 29

Topical ointment for bacterial vaginosis

Question 30

Macrolides (Azithromycin & Erythromycin) MOA?

Answer 30

Binds 50S ribosomal subunit; bacteriostatic

Question 31

Azithromyicin AE’s? (2)

Answer 31

1. GI upset

2. Vaginitis

Question 32

Azithromycin treats?

Answer 32

1. Chlamydia (first line)
2. Chancroid (first line)
3. Uncomplicated GC
4. Urethritis/Cervicitis (first line)

Question 33

Dosage of Azithromycin?

Answer 33

1g orally; single dose (really easy to take)

Question 34

What are the DNA/RNA synthesis inhibitors for this block? (5)

Answer 34

The FQ's
1. Ciprofloxacin
2. Levofloxacin
3. Ofloxacin
Others:
4. Metronidazole
5. Tinidazole

Question 35

Fluoroquinolone MOA?

Answer 35

Inhibit DNA gyrase (topo 2) in gram - organisms

Inhibit topo 4 in gram + organisms

Question 36

Levofloxacin AE’s? (3)

Answer 36

1. GI upset & bad taste
2. BBW: increased risk for tendinitis & tendon rupture
3. BBW: Exacerbation of muscle weakness (contra’d in myasthenia gravis)
   * Also, pregnancy category C

Question 37

Levofloxacin treats? (2)

Answer 37

1. Chlamydia

2. Urethritis/Cervicitis

Question 38

Whats unique about the distribution of Levofloxacin?

Answer 38

Widely distributed. Gets into CSF, prostate, gynecologic tissues, breast milk

Question 39

AE’s of Ofloxacin?

Answer 39

Same as levofloxacin. GI, tendonitis, muscle weakness

Question 40

Ofloxacin treats?

Answer 40

Same as levofloxacin (chlamydia, urethritis/cervicitis)

Question 41

Metronidazole & Tinidazole MOA?

Answer 41

These are the trifecta! They are amebicidal, bactericidal, & trichomonacidal. It disrupts DNA’s helical structure –> inhibits bacterial nucleic acid synthesis. **Equally effective in dividing & non-dividing cells
**Remember Pcn & other beta lactams are only effective in dividing cells

Question 42

The Metronidazole/Tinidazole AE’s? (4)

Answer 42

1. GI upset
2. Candidiasis
3. Cant drink alcohol while on these drugs (yes, that is an adverse effect!)
4. Secondary malignancies seen in animal models
   * *Remember to take the animal model thing with a grain of salt cuz they stuff the rats full of the drug

Question 43

Metronidazole/Tinidazole treat?

Answer 43

1. Bacterial vaginosis (first line)
2. Recurrent urethritis/cervicitis (first line)
3. Trichomoniasis (first line)

Question 44

Weird, Sweatmany side effect of Metronidazole/Tinidazole?

Answer 44

Urine discoloration