STI Drugs Flashcards
-cyclovir/ciclovir
PO: 7-10 days (2-5x daily) antiviral: inhibits DNA pol activation: viral thymidine kinase dose adjust in renal disease Tx: HSV HYDRATION (avoid crystalline nephropathy/neuro), cross hyper-sensitivity
(val)acyclovir
chain termination
AE: neurotoxicity, seizures (penetrates CNS)
val: prodrug with better oral bioavailability
famciclovir
metabolized to penciclovir
NO chain termination
AE: none significant
cervarix
recombinant L1 protein
IM: IgG neutralizing Ab
bivalent HPV vaccine: 16, 18
AE: hypersensitivity
gardisil
ages 9-26 yrs recombinant L1 protein IM: IgG neutralizing Ab quadrivalent HPV vaccine: 6, 11, 16, 18 AE: hypersensitivity grown in YEAST
podofilox
topical MOA: mitotic spindle inhibitor Tx: HPV genital warts AE: pruritus not recommended in pregnancy
imiquimod
topical MOA: antiviral toll-like receptor activator (immune modifier): stimulates IFN and cytokine production Tx: HPV genital warts AE: pruritus not recommended in pregnancy
sinecatechins
topical
MOA: keratolytic: antioxidant
AE: pruritus
Tx: HPV genital (warts?)
beta lactams
MOA: binds PBP inducing cell lysis
macrolide
MOA: 50s ribosomal inhbitor
quinolone
MOA: DNA gyrase inhibitor (topo II) in G-; inhibit topo IV in G+
Tx: chlamydia ALT, cervicitis ALT
AE: TENDONITIS/RUPTURE
cephalosporins
MOA: binds PBP inducing cell lysis
amoxicillin
PO
beta lactam
CAN be used in pregnancy
adjust dose in renal disease
azithromycin
PO long T1/2 macrolide AE: GI Tx: chlamydia 1st, urethritis ALT, cervicitis ALT
cefixime
PO
cephalosporin
false pos. urinary glucose test
Tx: chancroid ALT, gonococcal ALT + azithromycin
ciprofloxacin
PO quinolone CYP1A2 inhibitor CI: pregnancy, lactation Tx: chancroid ALT (not chlamydia/cervicitis)
ceftriaxone
IM
cephalosporin
AE: GI
Tx: chancroid ALT, gonococcal ALT + azithromycin
clindamycin
PO/gel MOA: 50s ribosomal inhibitor AE: GI, C. DIFF infection gel AE: discontinue after 1st trimester (pre-term, low birth weight, ruptured membranes), contact irritation Tx: vaginosis ALT
doxycycline
PO
long T1/2
MOA: 30s ribosomal inhibitor
AE: HEPATIC (esp. in pregnancy), PHOTOSENSITIVE
Tx: chlamydia 1st, urethritis ALT, cervicitis ALT
erythromycin base
PO
short T1/2
macrolide
CYP3A4 INHIBITOR
substrate: P-gp, CYP3A4
AE: HYPERTROPHIC PYLORIC STENOSIS in neonates
Tx: chlamydia ALT, chancroid choice, cervicitis ALT
levofloxacin
PO
quinolone
metronidazole
MOA: disrupts DNA structure resistance: decreased activation, increase free radical scavenging, increased DNA repair inhibit: CYP2C9 CI: pregnancy/breastfeeding AE: DISULFIRAM Tx: trichmoniasis ALT, vaginosis ALT
ofloxacin
PO
quinolone
penicillin G
- aqueous crystalline
- benzathine
- procaine
beta lactam
1. IV: congenital syphilis (10 days)
2. IM: syphilis 1st (not good for neurosyphilis: no BBB penetration)
3. IM: congenital syphilis (10 days)
AE: HYPERSENSITIVITY (if pregnant, desensitize and Tx), Garish-Herxheimer Rxn
-azoles
MOA: ergosterol syn. inhibitors (14alpha demethylation of lanosterol)
gel/cream: limited systemic absorption/residual activity for days; oil based weaken condoms
resistance: decreased drug, target mutation/up-regulation, bypass pathways
Tx: candidiasis ALT
avoid in 1st trimester: systemic dose causes abdominal wall defects, cleft palate
tinidazole
OTC
gel/cream -azole; disrupt DNA structure (oral) inhibiting nucleic acid syn.
metabolism: CYP3A4
Tx: trichomoniasis ALT, vaginosis 2nd ALT
CI: pregnancy, breastfeeding
AE: DISULFIRAM
butoconazole
Rx
gel/cream -azole
clotrimazole
OTC
gel/cream -azole
fluconazole
Rx
PO -azole
CYP2C9 inhibitor
miconazole
OTC
gel/cream -azole
terconazole
Rx
gel/cream -azole
ticonazole
OTC
gel/cream -azole
Jarisch-Herxheimer Rxn
release of spirochetes (syphilis) antigens with host rxn to products: chill, fever, headache, myalgia, arthralgia, more prominent syphilitic cutaneous lesions (fade within 48 hrs)
do NOT discontinue penicillin
HSV Tx
acyclovir, famciclovir, valacyclovir
Syphilis Tx
penicillin G
Chlamydia Tx
azithromycin (1 day) or doxycycline
ALT: erythromycin, levofloxacin, ofloxacin
everything else: 1 week
ALT in PREGNANCY: amoxicillin
Chancroid Tx
azithromycin (oral, 1 dose) or ceftriaxone (IM, one dose) or ciprofloxacin or erythromycin base
uncomplicated gonococcal infection Tx (cervix, urethra, rectum)
ceftriaxone or cefixime plus azithromycin (preferred due to tetracycline resistance) or doxycycline
pharynx infection: same but don’t use cefixime
urethritis/cervicitis Tx
azithromycin or doxycycline
ALT: erythromycin base, levofloxacin, ofloxacin
recurrent Tx for urethritis/cervicitis
metronidazole or tinidazole plus azithromycin (if NOT used in original Tx)
trichomoniasis Tx
metronidazole or tinidazole
bacterial vaginosis
metronidazole or clindamycin
ALT: tinidazole, clindamycin
candidiasis Tx
OTC: butoconazole, clotrimazole, miconazole, ticonazole
Rx: butoconazole, terconazole, fluconazole (only oral)
