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PHAR 253 - Therapeutics (2) > STIs / Contraception > Flashcards

STIs / Contraception Flashcards

1
Q

What are some resources for STIs?

A

PHAC
CDC manual
CPS
RX
SK Prevention
Government of Sask
Saskatoon sex health
Sex life sask

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2
Q

What is important when providing care on STI

A

safe private area
confidentiality
build rapport
plain inclusive language

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3
Q

What are the three groups of STI’s

A

viral= ie) HPV, HIV
bacterial= ie) syphilis, gonorrhoea
Parasitic- trichomoniasis

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4
Q

Risk factors for STIs

A

Multiple partners, no barrier, previous STI, substance use,

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5
Q

What can we do to help STI prevention?

A

assess and discuss risk
educate about signs
vaccine
treat and follow up

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6
Q

What things should we ask to assess risk?

A

sexually active?
any sx?
contraception?
avoiding STI?
Concerns?
last period?
Pap test?
share sex toys?

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7
Q

True or False: Most STI’s are asymptomatic

A

True

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8
Q

Who should be screened regularly

A

sexually active

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9
Q

Which STI’s don’t have to be reported?

A

HPV
herpes

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10
Q

What options do we have of barrier protection?

A

external condom, internal condom, dental dams

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11
Q

What is the issue with barrier protection?

A

syphylis, HPV, HSV= shedding or external lesions= lower protection

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11
Q

What type of a condom is not recommended?

A

spermicidal lube condom containing nonoxynol-9

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12
Q

What are some goals of therapy for STI?

A

Treat infection
remove sx
lower spread
decrease vertical transmission to newborns
lower complications

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13
Q

True or false STIs can spread through breast feeding?

A

true

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14
Q

How does vertical transmission of chlamydia affect baby?

A

preterm birth, conjunctivitis, pneumonia

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15
Q

How does vertical transmission of Gonorrhea affect baby?

A

systemic infection, ophthalmia neonatorum

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16
Q

How does vertical transmission of Syphilis affect baby?

A

systemic sx, fetal loss

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17
Q

What are some STI-associated syndromes

A

cervicitis, epididymitis, proctitis, vaginitis, anogenital ulcer, PID

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18
Q

How do we know if it is yeast vaginitis?

A

curdy white and itchy

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19
Q

How do we know if it is trichomonas vaginitis?

A

yellow frothy

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20
Q

How do we know if bacterial vaginitis?

A

fishy odour, grey discharge

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21
Q

What can cause anogenital ulcers?

A

HSV, syphilis

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22
Q

What HPV causes warts?

A

6+11

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23
Q

What STI’s affect pregnancy?

A

HPV, HSV,

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24
Q

True or false syphilis can make you infertile?

A

true

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25
Q

What is the most commonly reported STI in Canada?

A

Chlamydia

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26
Q

Most common sx in chlamydia

A

dysuria, urethritis, cervicitis, proctitis, conjunctivitis

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27
Q

Chlamydia complications

A

PID, Infertility, Reiter syndrome,

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28
Q

Treatment of Chlamydia

A

Preferred= Doxy 100 BID for 7 days
or Azithro 1 g once= pregnant or amoxicillin 500 TID for 7 days

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29
Q

Counselling points on doxycycline

A

with food and no iron or calcium within 3 hours photosensitivity

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30
Q

When can you start sex again during chlamydia treatment?

A

7 days after azithro dose or end of regimen and no sx

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31
Q

When should you follow up on chlamydia treatment?

A

Test of cure= 3-4 weeks following positive repeat 6 months after

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32
Q

What is LGV?

A

L1,2,3 genotype of chlamydia and is more invasive
rare and affects lymph primarily

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33
Q

What is primary LGV?

A

3-30 days= small painless papules

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34
Q

What is secondary LGV/

A

2-6 weeks after primary
swell of lymph, fever, fatigue, ocular inflammation disease

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35
Q

What is tertiary LGV?

A

chronic inflam lesions= scars
lymph obstruction= genital elephantiasis
destruction of genitalia

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36
Q

What is treatment for LGV/

A

Doxy 100 BID for 21 days
azithro 1 gm weekly for 3 weeks

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37
Q

True or false, gonorrhoea is curable if treated quickly

A

True

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38
Q

What other STI is concomitant with gonorrhoea?

A

chlamydia

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39
Q

What are sx of gonorrhoea?

A

vag discharge, ab pain, dysuria, bartholinitis, painful sex, itch, testical pain

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40
Q

What are the complications of gonorrhoea

A

PID
Infertility
ectopic pregnancy, DGI, arthritis, meningitis

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41
Q

What is treatment for gonorrhoea?

A

Ceftriaxone 250mg IM once AND azithro 1 gm once
OR
cefixime 800mg once and azithro 1 gm once

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42
Q

What are some points for gonorrhoea counselling?

A

adherence= resistance is a concern
take with food for azithro
same no sex as chlamydia

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43
Q

What is the follow up for gonorrhoea

A

TOC 4-5 days following treat, NAAT no but if needed 4 weeks after positive. repeat after 6 months

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44
Q

What STI is highest rate in Canada

A

syphilis

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45
Q

What is primary syphilis

A

painless lesions for 3 weeks

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46
Q

What is secondary syphilis?

A

rash, fever, headache, meningitis fro 2-12 weeks

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47
Q

What is early latent syphilis?

A

asymptomatic for less than a year of infection

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48
Q

What is late latent syphilis?

A

asymptomatic for more than a year of infection

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49
Q

What is cardiovascular syphilis?

A

aortic aneurysm, stenosis= 10-20 years

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50
Q

What is gumma?

A

tissue destruction of any organ from syphilis= 1-46 years

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51
Q

What is neurosyphilis/ocular?

A

can be asymptomatic, or headaches, vertigo, dementia can be early or late (1-20)

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52
Q

What is the symptoms of early congenital syphilis?

A

<2 years old 2/3 asymptomatic can be anemia, neurosyph, rhinitis, osteochondritis

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53
Q

What is the symptoms of early congenital syphilis?

A

> 2 years old 2/3 asymptomatic can be anemia, neurosyph, osteochondritis, hutchinson

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54
Q

What is the treatment of syphilis?

A

benzathine pen G 2.4 mill U IM once for primary, secondary and early
for late= same but weekly for 3 doses

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55
Q

What us follow up for syphilis

A

No TOC
titre change= four fold after 6 months

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56
Q

What is jarisch-herxheimer rxn?

A

acute febrile reaction
occurs within first 24 hours of therapy
NOTa allergic reaction
manage with NSAIDS
may induce labour

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57
Q

What is the most common STI in the world

A

HPV

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58
Q

What are the high risk HPV types

A

16,18

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59
Q

What complications from HPV

A

cervical cancer, cancer

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60
Q

What are symptoms of HPV

A

asymptomatic
itch, discomfort, bleeding, warts
cancer= need Pap test

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61
Q

What treatment for HPV

A

Imiquimod cream 3.75% daily and wash off after 8 hours
OR 5% cream 3x a week and remove after 6-10 hours
OR
Sinecatechins 10% (green tea leaves) apply strand TID
OR CRYO, lazer, surgery, podophyllin 25%

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62
Q

What can we give for pain of HPV lesions?

A

lidocaine

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63
Q

When can you have sex again after HPV breakout?

A

avoid while treating lesions= until they are gone

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64
Q

What vaccine can we give for HPV

A

Gardasil 9
Cervarix

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65
Q

When do you get the vaccine for HPV?

A

grade 6

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66
Q

At what point is Gardasil not free?

A

over the age of 26 years

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67
Q

How effective is Gardasil?

A

97%

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68
Q

What is s/e of Gardasil?

A

headache, fever, dizzy

69
Q

What is the difference between HSV1 and HSV2

A

1= oral infection but can cause genital
2= genital

70
Q

Which gender has more HSV

A

Women

71
Q

What are sx of HSV

A

prodromal, then ulcers for 9-11 days

72
Q

Which lasts longer the primary infection or non for HSV

A

Primary

73
Q

Treatment of HSV genital?

A

Acyclovir 200 five x/day for 5-10 days
OR
famciclovir 250 TID for 5 days
OR
Valalcyclovir 1000 BID for 10 days

74
Q

What is treatment for pregnant HSV2

A

acyclovir regimen

75
Q

What is treatment for recurrent HSV 2

A

Acyclovir 200 five x/day for 5-10 days
OR
famciclovir 125 BID for 5 days
OR
Valalcyclovir 500 BID for 10 days OR 1g OD for 3 days

76
Q

What is treatment for suppressive HSV 2

A

Acyclovir 200 five x/day
OR
famciclovir 250 BID for
OR
Valalcyclovir 500 BID(if >9 recurrences) or 500 if <9

77
Q

What happens if neonatal herpes occurs

A

60% of death
systemic infection in organs

78
Q

Treatment of Neonatal herpes?

A

acyclovir 45-60mg/kg/day IV in q8 for 14-21 days

79
Q

Counselling on HSV

A

use as early until healed
no sex during episodes
shedding can occur during asymptomatic stage
lifelong

80
Q

What is monkey pox?

A

viral disease
spread in direct contact of lesions, fluids, mucosal surfaces

81
Q

What is sx of Mpox?

A

rash on face and extremities, fever, fatigue

82
Q

What is treatment for Mpox?

A

vaccine (smallpox)
POP
PrEP
or just own body after 2-4 weeks

83
Q

What percentages of pregnancies are unplanned and how many end up in abortion?

A

40-60%
abortion= 50%

84
Q

What is the role of each hormone in the menstrual cycle?

A

GnRH= release FSH,LH
FSH= maturation of follicle
Estrogen= thickens endometrium, inhibit FSH and stim LH
LH= trigger ovulation
progesterone= for implantation, stop FSH and LH

85
Q

How long is the average cycle?

A

28 days

86
Q

What happens I the follicular phase?

A

increase FSH and one follicle becomes dominant and produces estrogen
this estrogen limits FSH and causes surges of LH

87
Q

How long does it take to ovulate after LH surge ?

A

28-32 hours= day 14

88
Q

What happens in the luteal phase?

A

release of ovum
follicle becomes corpus luteum, if implant= continue progesterone for endometrium, if no implant progesterone stops

89
Q

What is the plant version of estrogen?

A

esterol

90
Q

General MOA of hormonal contraceptives?

A

estrogen to stop release of FSH
progestin suppress LH and FSH and thicken cervical mucus and stop implantation

91
Q

What is the history of the pill?

A

Margaret Sanger made titbit was at a really high dose= clots

92
Q

Why is there a break period for contraception?

A

period= not pregnant, can’t tell if on it (good for church)

93
Q

What is the difference between mono,bi,triphase OC?

A

mon= fixed levels of both
Bi= fixed EE and more progestin in 2nd phase
Tri= fixed or variable EE and high progestin in all three phases

94
Q

True or false Multiphase products are better at preventing pregnancy?

A

No they are the same in all respects

95
Q

If we are doing continuous dosing what product should we probably give?

A

monophaseic <50mcg of EE

96
Q

Why do people want to do continuous dosing of OC?

A

less chance of ovulation, less period, more forgiving if missing dose

97
Q

Do periods build up if you skip them?

A

fuck no

98
Q

What day should the pill be started?

A

most effective on day 1 of period BUT start anytime just use other contraception for 7 days

99
Q

Why do you need to use back up contraception if not starting on day one of period?

A

takes 7 full days of EE to prevent ovulation

100
Q

What is the percent failure of combined OC use?

A

perfect use= <0.3%
Typical=3-8%

101
Q

What to do if missed dose?

A

Take immediately then continue as usual, if in week 2-3 skip hormone free interval

102
Q

What are the side effect of combined OC and when do they typical stop?

A

first 3 months
bleed=adherence up estrogen
breast tender= lower estrogen
nausea= take with food
weight gain is minimal
headache
depression
acne= initial worse then improve

103
Q

What are the benefits of OC other than stop pregnancy?

A

less frequent period and lower pain, endometriosis, osteoporosis, acne

104
Q

What risk are there with OC?

A

VTE, MI and stoke
Cancer of breast and cervical= could be due to sex tho

105
Q

What factors put you at risk of CVD events with OC?

A

smoke >35, hTN, >50mcg of EE

106
Q

What are some DI with combined OC?

A

some antibiotics reduce enterohepatic circulation= not an issue though
CYP 3A4- anticonvulsants (lamotrigine)= use higher EE or alt method

107
Q

What are contraindication of OC?

A

VTE, HTN, stroke, breast cancer, migraine with aura, post partum, smoke

108
Q

When can we start combined OC after pregnancy?

A

3-6 weeks after

109
Q

True or false OC and transdermal have same efficacy?

A

True

110
Q

What are the components in transdermal contraception?

A

0.6 EE and 6mg of norelgestromin

111
Q

How do you use transdermal patch?

A

1 patch weekly for 3 weeks to arm, butt, ab,

112
Q

What happens if you forget a patch?

A

take it immediately and skip HFI if in week 2 or 3

113
Q

When are transdermal contraception less effective

A

> 90kg

114
Q

What does the ring do for contraception?

A

EE ring that sits in vagina

115
Q
A
116
Q
A
117
Q
A
118
Q

What is a missed dose for the ring?

A

out for longer than 3 hours

118
Q

How long is the ring stable at room temperature?

A

4 months

119
Q

POP has two types of progestin what are they?

A

norethindrone 35mcg
drospirenone 4mg

119
Q

True or false you need to take the ring out for sex?

A

false

120
Q

Of the two POP’s how does each stop pregnancy?

A

norethindrone=alters mucus and endometrium MAY cause no ovulation
drospirenone=stop ovulation

121
Q

How long is the HFI for both POP’s

A

norethindrone= NONE
drospirenone= 4 days

122
Q

How long is a missed dose for POP?

A

3 hours
but drospirenone is more forgiving

123
Q

What is an issue with POP in post partum?

A

for norethindrone hard to take at same time with new baby

124
Q

What drug could be an issue when on drospirenone?

A

rampril or other diuretics

125
Q

What is the injectable contraception?

A

150 mg of medroxyprogesterone

126
Q

How does the injectable contraception work?

A

stop ovulation increases mucus, alter endometrium

127
Q

How often do you need the depo shot?

A

q12 weeks

128
Q

What is something that MUST be counselled on if administering depo shot?

A

delayed fertility for 9 months after and BONE LOSS

129
Q

How long does copper IUD last for?

A

3-10 years

130
Q

How does copper IUD work?

A

copper is toxic to sperm and stops implantation

131
Q

What is in hormonal IUD and how does it work?

A

levonorgestrel
thicken mucus, change endometrium, may suppress ovulation

132
Q

How long does hormonal IUD last?

A

5 years

133
Q

Contraindication of IUD

A

pregnancy-duh
cancer of women
STI or pelvic infection last 3 months

134
Q

What is in the implantable contraception and how does it work?

A

progestin only= etonogestrel
stop ovulate and change mucus

135
Q

How long does implantable BC last?

A

3 years

136
Q

What is failure rate of condoms?

A

97% or 86%

137
Q

What other barrier methods?

A

diaphragms = cap overs cervix
sponges= spermicidal
cervical cap
spermicides-nonoxynol-9

138
Q

What are permanent contraceptive methods?

A

tubal ligation
vasectomy

139
Q

What is the fail rate of pull out method?

A

22%

140
Q

How do you do natural family planning?

A

take temp in morning
if temp increase of at least 0.2 degrees= ovulate
3 days of higher temp= fertility period over
OR look at mucus

141
Q

How do you do the calendar method of family planning?

A

subtract 21 from shortest cycle= fertility begins
subtract 10 from longest cycle= fertility ends

142
Q

True or false, if you breast feed you don’t ovulate.

A

True

143
Q

When does implantation occur?

A

6-14 days after fertilization

144
Q

What are the three EC options?

A

LNG
UPA
cu IUD

145
Q

For the three EC how long are the good for?

A

LNG- up to 72hrs
UPA= 120hrs
Cu-IUD= 7 days

146
Q

Could IUS be an option for EC?

A

not inferior but pricey and need a physician

147
Q

How does UPA work?

A

prevents ovulation

148
Q

How does LNG work?

A

delay ovulation and inhibit sperm and ovum travel

149
Q

What are some side effects of EC?

A

nausea, vomit, cramps, fatigue, headache, breast tenderness

150
Q

What causes nausea in EC and OC?

A

estrogen

151
Q

What happens if you ovulate and take EC?

A

may still get pregnant

152
Q

Benefit of UPA over LNG

A

UPA can be taken if longer than 3 days and can be right up to peak of LH
in heavier women

153
Q

Why would we want LNG over UPA?

A

LNG won’t interact with BC
UPA can interact with progestin and it not work

154
Q

How long do we have to wait before restarting BC after using UPA?

A

5 days

155
Q

I have a BMI of 34 what EC do I need?

A

copper iud

156
Q

I have a BMI of 27 what EC do I need?

A

UPA

157
Q

True or false UPA and LNG work if unprotected sex after it was taken?

A

False

158
Q

How long is an egg viable for?

A

1 day

159
Q

What are the only contraindications of oral EC?

A

pregnancy and allergy

160
Q

What medication terminates pregnancy?

A

mifepristone

161
Q

What does misoprostal do?

A

cause contractions

162
Q

Why are people not using the abortion drugs?

A

pharmacy does not stock cause ti is expensive

163
Q

What is age of consent?

A

16 years

164
Q

Can we give BC to kids without parental approval? And if the parent asks if they have it can we tell them?

A

NOOOO

165
Q

When must we report by law a sexual assault?

A

if it is on a minor

166
Q

What is conscientious objection and what must pharmacists do?

A

object due to moral reasons

don’t say why just object and provide referral BUT HAVE to in emergencies

167
Q
A
168
Q
A

PHAR 253 - Therapeutics (2) (8 decks)

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