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Pharm III > STIs > Flashcards

STIs Flashcards

1
Q

RF for STIs

A

Number of sexual partners
Men who have sex with men
Prostitution
Illicit drug use

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2
Q

Prevention methods for STIs

A

Male condoms
Female condoms
Diaphragm

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3
Q

Male condoms

A

Latex is more effective than lambskin
Discourage lambskin in latex allergies- use polyurethane synthetic instead
Use a water-based lubricant because petroleum and oil-based lubes can degrade integrity of condom

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4
Q

Female condoms

A

Can be inserted up to 8 hrs prior
Discourage male and female condom use at the same time- one of them will break
Polyurethane synthetic, diaphragm-like ring
Limited data on viral protection

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5
Q

Diaphragm

A

Limited protection

Least preferred, good for trich, gonorrhea, chlamydia

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6
Q

Neisserie gonorrhoeae

A

Gram neg diplococcus

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7
Q

GU presentation of gonorrhea

A 
Vaginal d/c
Uterine bleeding 
Dysuria
Urinary frequency
PID
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8
Q

Throat presentation of gonorrhea

A

Pharyngitis

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9
Q

Anorectal presentation of gonorrhea

A

Rectal pain
Pruritis
Mucopurulent d/c
Bleeding

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10
Q

Tx for uncomplicated gonorrhea

A

Ceftriaxone 250 mg IM x1 +
(Azithromycin 1 g PO x 1 OR
Doxycycline 100 mg PO BID x 7 days)

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11
Q

Tx for disseminated gonococcal infection

A

Ceftriaxone 1 g IV/IM q24h for at least seven days or until sx have resolved for 24 hrs + Azithromycin 1 g PO x 1

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12
Q

Tx for infants born to mother with infection

A

Erythromycin 0.5% ophthalmic ointment x 1

Mandated by law

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13
Q

Counselling for gonorrhea

A

Avoid intercourse x 7 days after completing abx

Sex partners should be treated

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14
Q

MOA of ceftriaxone

A

3rd gen cephalosporin

Inhibits cell wall synthesis

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15
Q

AEs of ceftriaxone

A

Injection site reaction
Diarrhea
Pregnancy category B

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16
Q

MOA of azithromycin

A

Macrolide

Inhibits RNA-dependent protein synthesis

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17
Q

AEs of azithromycin

A 
N/V
Diarrhea
Abd pain
SJS (rare)
Avoid if QT prolonged
Pregnancy category B
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18
Q

Syphilis

A

Treponema pallidum
Spirochete
Transmitted via sexual contact with lesion

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19
Q

Incubation period of primary syphilis

A

10-90 days

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20
Q

Presentation of primary syphilis

A

Single, painless lesion

Erodes, ulcerates, heals within 1-8 wks

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21
Q

Sites of primary syphilis infection

A

External genitalia
Perianal region
Mouth
Throat

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22
Q

When does secondary syphilis develop?

A

2-8 wks after initial infection

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23
Q

Site of secondary syphilis infection?

A

Hematogenous

Lymphatic

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24
Q

Presentation of secondary syphilis

A

Pruritic or nonpruritic rash
Mucocutaneous lesions
Flulike sx
Lymphadenopathy

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25
Q

When does secondary syphilis subside?

A

Within 4-10 wks if untreated

Lesions can recur at any time x 4 yrs

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26
Q

When does latent syphilis develop?

A

4-10 wks after secondary stage

Pos serologic test, no other evidence of dz

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27
Q

What are the latency stages of latent syphilis?

A

Early and late latency

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28
Q

Early latency- latent syphilis

A

1 yr from onset of infection

Potentially infectious d/t risk of mucocutaneous relapse

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29
Q

Late latency- latent syphilis

A

Noninfectious

Exception: transmission from mother to infant

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30
Q

When does tertiary syphilis develop?

A

Develops in 30% of untreated pts 10-30 yrs after initial infection

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31
Q

What are the sites of tertiary syphilis infection?

A 
CNS
Heart
Eyes
Bones
Joints
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32
Q

CV presentation of tertiary syphilis

A

Aortitis

Aortic insufficiency

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33
Q

Neurosyphilis presentation of tertiary syphilis

A 
Meningitis
Paresis
Dementia
Blindness
Hearing loss
Tabes dorsalis
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34
Q

Congenital syphilis

A

Transplacental transmission

Greatest risk with primary and secondary infection

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35
Q

Presentation of congenital syphilis

A

Low birth weight
Prematurity
Stillborn
Congenital syphilis

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36
Q

Complications of congenital syphilis

A

Cataracts
Deafness
Seizures
Death

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37
Q

Tx for congenital syphilis

A

Aqueous crystalline PCN G IV

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38
Q

Primary, secondary, early latent syphilis tx

A

Benzathine PCN G 2.4 mil units IM x 1
PCN allergy:
Doxycycline
Tetracycline
F/u at 6 and 12 mos
-Additionally, at 24 mos for early latent dz
Pregnant pts need to go through PCN desensitization

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39
Q

Counselling for primary, secondary, early latent syphilis

A

Avoid intercourse x 7 days for early latent dz

Treat sex partners within 90 days dx

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40
Q

Late latent and tertiary syphilis tx

A 
Benzathin PCN G 2.4 mil units IM once weekly x 3 wks
-If dose >2 days late, must restart tx
PCN allergy:
Doxycyline
Tetracycline
F/u at 6, 12, 24 mos
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41
Q

Neurosyphilis and ocular syphilis tx

A

Aqueous crystalline PCN G 3-4 mil units IV q4h x 10-14 days
Alternative:
-Procaine penicillin 2.4 mil units IM daily PLUS probenecid 500 mg PO QID x 10-14 days
-PCN allergy: desensitize

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42
Q

F/u to neurosyphilis and ocular syphilis tx

A

CSF exam q6 mos until cell count nl

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43
Q

PCNs MOA

A

Beta-lactam

Inhibits cell wall synthesis

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44
Q

AEs of PCNs

A

Injecton site reaction
N/V
Diarrhea
Pregnancy category B

45
Q

MOA of doxycyline

A

A tetracycline

Bind with 30s and 50s ribosomal subunits- inhibit protein synthesis

46
Q

AEs of doxycycline

A

N/V
Diarrhea
Photosensitivity
Pregnancy category D

47
Q

Chlamydia

A

Chlamydia trachomatis
Atypical
Symptom onset 7-21 days

48
Q

GU presentation of chlamydia in men

A

Dysuria
Urinary frequency
Urethral d/c

49
Q

GU presentation of chlamydia in women

A

Vaginal d/c
Uterine bleeding
Dysuria
Urinary frequency

50
Q

Throat presentation of chlamydia

A

Pharyngitis

51
Q

Anorectal presentation of chlamydia

A

Rectal pain
Pruritis
Mucopurulent d/c
Bleeding

52
Q

Complications of chlamydia

A

Epididymitis
Reiter’s syndrome
PID

53
Q

Tx of uncomplicated chlamydia

A

Azithromycin 1 g PO x 1

Alternative: Doxycycline 100 mg PO BID x 7 days

54
Q

Tx of chlamydia in pregnancy

A

Azithromycin 1 g PO x 1

Alternative: Amoxicillin 500 mg PO TID x 7 days

55
Q

Counselling for chlamydia

A

Avoid intercourse x 7 days after completing abx

Sex partners should be treated

56
Q

Genital herpes

A

HSV-1, HSV-2

57
Q

Presentation of genital herpes

A

Multiple painful pustular or ulcerative lesions on external genitalia, flulike sx

58
Q

Lesions at extragenital sites- genital herpes

A

Eye
Rectum
Pharynx
Fingers

59
Q

CNS presentation of genital herpes

A

Meningitis
Transverse myelitis
Sacral radiculopathy syndrome

60
Q

Presentation of 1st episode of genital herpes

A

Multiple painful pustular or ulcerative lesions on external genitalia
-Develop over 7-10 days
-Heal in 2-4 wks
Flulike sx during first few days after appearance of lesions
Pruritis, vaginal or urethral d/c, paresthesias, urinary retention

61
Q

What occurs after a primary genital herpes infection

A

Virus establishes latency in neurons

Viral shedding x 7-12 days

62
Q

Recurrent genital herpes

A 
Prodrome
-50% of pts
--Mild burning, itching, tingling
Compared to primary infections
-Fewer lesions, more localized
-Shorter duration of active infection
-Milder sx
Viral shedding x 4 days
63
Q

Tx for 1st episode of genital herpes

A 
Treat 7-10 days with:
Acyclovir
-400 mg PO TID
-200 mg PO 5x/day
Famciclovir
-250 mg PO TID
Valacyclovir
-1 g PO BID
64
Q

Tx for recurrent genital herpes

A 
Episodic therapy
-Initiated early during recurrence
-Acyclovir, Famciclovir, Valacyclovir
-Treat 1-5 days
Suppressive therapy
-Acyclovir, Famciclovir, Valacyclovir
-Treat daily or twice daily x 1 yr
Severe complicated dz
-Acyclovir IV
65
Q

MOA of acyclovir, famciclovir, valacyclovir

A

Antiviral

Inhibits DNA synthesis and viral replication

66
Q

AEs of acyclovir, famciclovir,, valacyclovir

A 
Malaise
HA
N/V
Diarrhea
Pregnancy category B
67
Q

Trichomoniasis

A

Trichomonas vaginalis
-Pear-shaped, motile, flagellated protozoan parasite
Trichomonads gather in clusters and cause damage to underlying epithelium
Can survive up to 45 mins on moist surfaces
-Transmission via contact with infected bath or toilet articles, communal bathing

68
Q

Presentation of trichomoniasis in men

A

Urethral d/c
Dysuria
Burning
Pruritis

69
Q

Presentation of trichomoniasis in women

A 
Malodorous greyish-yellow vaginal d/c
Dysuria
Pruritis
Painful intercourse
Inflammation/erythema
70
Q

Tx for trichomoniasis

A

Metronidazole 2 g PO x 1
Tinidazole 2 g PO x 1
If sx remain:
Metronidazole 500 mg PO BID x 7 days

71
Q

Counselling for trichomoniasis

A

Avoid intercourse x 7 days after completing abx
Sex partners should be treated
Do not drink alcohol while taking the meds and 24 hrs after last dose of metro, 72 hrs after last dose of tinidazole

72
Q

MOA of metronidazole and tinidazole

A

Antiprotozoal

Penetrates organism, inhibits protein synthesis, produces cell death

73
Q

AEs of metronidazole and tinidazole

A 
N/V
Metallic taste
SJS (rare)
Disulfiram-like rxn
Metro= pregnancy category B
Tinidazole= pregnancy category C
74
Q

HPV

A

Most common viral STD in US
Over 100 types
Papillomaviruses use the skin or mucosal linings to replicate
-Oral, genital, anal or respiratory

75
Q

Prevention of HPV

A

Gardasil quadrivalent vaccine
Gardasil 9 nonavalent vaccine
Indications: females and males 9-26 y/o
-Prevents cervical precancers, cervical cancer, genital warts, anal cancer

76
Q

What strains does Gardasil cover?

A

6
11
16
18

77
Q

What strains does Gardasil 9 cover?

A 
Gardasil quadrivalent in addition to:
31
33
45
52
58
78
Q

What is a bivalent vaccine that helps prevent HPV?

A

Cervarix
Protects against 16 and 18
Indications: Females 9-26 y/o for prevention of cervical precancers and cervical cancer

79
Q

HPV tx- general concepts

A

Symptomatic tx
- No tx of virus available
Pt administered and provider administered therapies
Tx varies based on site of infection

80
Q

What are the options for external tx for genital/perianal warts?

A

Podofilox
Imiquimod
Sinecatechins

81
Q

Podofilox MOA

A

Keratolytic drug

Inhibits cell division, necrosis occurs, tissues erode

82
Q

Dose of Podofilox and instructions

A

0.5% solution or gel

Treat x 3 days, wait 4 days, repeat if sx persist x 4 cycles

83
Q

AE of podofilox

A

Localized burning
Inflammation
Itching
Pregnancy category C

84
Q

Imiquimod MOA

A

Stimulates production of interferon and cytokines

85
Q

Administration of imiquimod

A

5% cream
Wash area 6-10 hrs after application
Treat 3x/wk up to 16 wks

86
Q

AE of imiquimod

A 
Local inflammatory reactions
Ulceration
Vesicles
Hypopigmentation
May degrade integrity of condoms and diaphragms
Pregnancy category C
87
Q

Sinecatechins MOA

A

Antioxidant

88
Q

Sinecatechins dosing and application

A

15% ointment
Apply with finger TID up to 16 wks
Avoid sexual contact while on skin

89
Q

When to avoid sinecatechins

A

HIV +
IC
Pts with genital herpes

90
Q

AE of sinecatechins

A 
Local inflammatory rxns
Burning
Itching
Ulceration
Vesicles
May degrade integrity of condoms and diaphragms
Pregnancy category C
91
Q

What are provider administered external therapies for genital/perianal warts?

A 
Cryotherapy
-Liquid nitrogen or cryoprobe
Podophyllin resin
Trichloroacetic acid (TCA)
Surgical removal
-Not for vaginal or urethral meatus warts
92
Q

Tx protocol for vaginal, urethral meatus, and anal warts

A

Require provider administered therapies

Those therapies are the same as the ones for genital/perianal warts

93
Q

MOA of podophyllin resin

A

Binds to microtubules, induces cell death

94
Q

Directions of podophyllin resin

A

Apply to lesion, cleanse area after tx

  • First administration: leave on for 30-40 mins
  • -Monitor for extreme burning or discomfort
  • Repeat administration: leave on for 1-4 hrs
95
Q

AE of podophyllin resin?

A 
Local rxns
Fever
Leukopenia
Thrombocytopenia
Avoid in pregnancy
96
Q

MOA of trichloroacetic acid (TCA)

A

Destroys proteins of cells

97
Q

Directions for trichloroacetic acid (TCA)

A

Apply to lesion, allow white frost to form, cleanse after tx

98
Q

AE of trichloroacetic acid (TCA)

A

Local reactions

Burning

99
Q

Bacterial vaginosis

A

Polymicrobial
Results from replacement of nl flora with anaerobic bacteria
May affect women who are not sexually active

100
Q

Presentation of bacterial vaginosis

A

Malodorous vaginal d/c or asymptomatic

101
Q

1st line tx for bacterial vaginosis

A

Metronidazole PO
Metronidazole gel intravaginal
Clindamycin cream intravaginal

102
Q

Alternative tx for bacterial vaginosis

A

Tinidazole PO, Clindamycin PO, clindamycin ovules

103
Q

Counselling for bacterial vaginosis

A

Avoid intercourse x 7 days after completing abx

104
Q

Doses for metronidazole PO

A

ER 750 mg PO qd x 7 days

105
Q

Metronidazole intravaginal cream dose and AE

A

1 applicator full daily-BID x 1-5 days
AE: itching, vaginal candidiasis, disulfiram-like rxn
Pregnancy category B

106
Q

MOA of intravaginal clindamycin

A

Lincosamide

Binds to 50s ribosomal subunit, inhibits bacterial protein synthesis

107
Q

Directions of intravaginal clindamycin

A

Insert 1 applicator full or ovule intravaginally once daily x 1-7 day

108
Q

AE of intravaginal clindamycin

A

Skin rxns
Itching
Pregnancy category B

109
Q

Counselling for intravaginal clindamycin

A

Oil based: may degrade integrity of condoms and diaphragms x 5 days after use
Remove foil from ovules, cleanse applicators between uses

Pharm III (8 decks)

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