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Reproduction Pharmacology > Treatment of STDs > Flashcards

Treatment of STDs Flashcards

1
Q

ANTIVIRALS

A

Acyclovir
Famciclovir
Valacyclovir

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2
Q

ANTIMICROBIALS

A 
Amoxicillin
Azithromycin 
Cefixime
Ceftriaxone
Clindamycin 
Doxycycline  
Erythromycin 
Levofloxacin 
Metronidazole 
Ofloxacin 
Penicillin G 
Tinidazole
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3
Q

ANTIFUNGALS

A 
Butoconazole 
Clotrimazole 
Fluconazole 
Miconazole 
Terconazole 
Tioconazole
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4
Q

HPV Rx

A 
Cervarix  
Gardisil 
Podofilox 
Imiquimod 
Sinecatechins
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5
Q

HSV: Treatment

A

Acyclovir
Famciclovir
Valacyclovir

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6
Q

MECHANISM OF ACTION: Acyclovir & Valacyclovir

A

Competitively inhibits viral DNA polymerase; competes with deoxyguanosine triphosphate for incorporation into viral DNA.

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7
Q

MECHANISM OF ACTION: Famciclovir

A

Famciclovir is metabolized (de-acetylated) to penciclovir. Does not cause chain termination

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8
Q

Metab/Elim: Acyclovir & Valacyclovir

A

Little metabolism; renal elimination; dose adjust in renal dysfunction or failure may occur.

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9
Q

Toxicity: Acyclovir & Valacyclovir

A

Neurotoxicity incl seizures

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10
Q

Patients taking Acyclovir & Valacyclovir?

A

Needs to be well hydrated to avoid crystalline nephropathy or neurotoxicity.

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11
Q

Syphilis: Treponema palladium treatment?

A

Benzathine Penicillin G, IM

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12
Q

MECHANISM OF ACTION: Benzathine Penicillin G

A

Bactericidal beta-lactam: binds PBPs causing cell lysis

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13
Q

Benzathine Penicillin G administration:

A

Produces a drug depot that liberates drug over 2 weeks following 1.2 x106.

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14
Q

Benzathine Penicillin G has poor

A

Penetration of CSF - Not good for neurosyphilis

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15
Q

Benzathine Penicillin G eliminated & hypersensitivity?

A

Rapidly eliminated via renal tubular excretion.
Significantly delayed in patients with decreased renal function.
Hypersensitivity or skin rashes may be problematic.

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16
Q

Latent Syphilis Sero-reactivity w/o other evidence of disease treatment?

A
  • Not sexually transmitted – treatment to prevent complications
  • Early Latent: Benzathine Pen G 2.4 x 106 units IM dose
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17
Q

Congenital Syphilis treatment

A

Aqueous crystalline Penicillin G

Procaine Penicillin G

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18
Q

Jarisch-Herxheimer Reaction?

A

70-90% with secondary syphilis several hours after first injection of penicillin.
Chills, fever, headache, myalgias, and arthralgias
Syphilitic cutaneous lesions may become more
prominent, edematous, and brilliant in color
Few hours; begins to fade within 48 hr and does not re-occur.

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19
Q

Jarisch-Herxheimer Reaction mechanism & treatment?

A

Release of spirochetal antigens with subsequent host reactions to the products
Aspirin gives symptomatic relief
Do NOT discontinue penicillin therapy

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20
Q

Chlamydia is?

A

The most common STD in the US

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21
Q

Chlamydia treatment

A 
Azithromycin
Doxycycline
Erythromycin base
Levofloxacin 
Ofloxacin
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22
Q

Azithromycin DRUG MECHANISM:

A

Binds 50S ribosomal subunit: bacteriostatic

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23
Q

Doxycycline DRUG MECHANISM:

A

Binds 30S ribosomal subunit: bacteriostatic

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24
Q

Erythromycin base DRUG MECHANISM:

A

Binds 50S ribosomal subunit: bacteriostatic

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25
Q

Levofloxacin DRUG MECHANISM:

A

Inhibits DNA gyrase (topo II) in gram-negative:
bactericidal
Inhibits topo IV in gram-positive: bactericidal

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26
Q

Ofloxacin DRUG MECHANISM:

A

Inhibits DNA gyrase (topo II) in gram-negative:
bactericidal
Inhibits topo IV in gram-positive: bactericidal

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27
Q

Amoxicillin DRUG MECHANISM:

A

Bactericidal beta-lactam: binds PBPs causing cell lysis.

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28
Q

Erythromycin base elimination:

A

P-gp & CYP3A4 substrate & inhibitor; minimal elim in urine most in stool.

29
Q

Azithromycin Side effects:

A

GI upset; vaginitis

30
Q

Doxycycline Side effects:

A

GI upset; hepatic damage in high dose esp in pregnancy; photosensitivty with sunlight or tanning bed

31
Q

Erythromycin base Side effects:

A

GI upset; increases toxicity of CYP3A4 substrates; estolate preparations may cause cholestatic jaundice; risk of sudden cardiac death with CYP3A4 inhibitors

32
Q

Levofloxacin & Ofloxacin Side effects:

A

Taste disturbance (levo); GI upset; BBW of increase risk of tendonitis & rupture; BBW of exacerbation of muscle weakness – avoid with myasthenia gravis.

33
Q

Chancroid is

A

Painful necrotizing genital ulcers

34
Q

Chancroid treatment

A

Azithromycin
Ceftriaxone
Ciprofloxacin
Erythromycin base

35
Q

Chancroid Successful treatment:

A

Cures infection & resolves symptoms; advanced cases may suffer permanent scarring.

36
Q

Ceftriaxone DRUG MECHANISM:

A

Bactericidal beta-lactam: binds PBPs causing cell lysis.

37
Q

Ciprofloxacin DRUG MECHANISM:

A

Inhibits DNA gyrase (topo II) in gram-negative: bactericidal

Inhibits topo IV in gram-positive: bactericidal

38
Q

Ciprofloxacin Distributes into

A

Breast milk and crosses placenta. No pattern of adverse events recognized but from abundance of caution drug not recommended in these situations

39
Q

Uncomplicated Gonococcal Infections
cervix, urethra, rectum
TREATMENT:

A

Ceftriaxone
Cefixime
Plus
Azithromycin or Doxycycline

40
Q

Uncomplicated Gonococcal Infections
pharynx
TREATMENT:

A

Ceftriaxone
Plus
Azithromycin or Doxycycline

41
Q

Cefixime DRUG MECHANISM:

A

Bactericidal beta-lactam: binds PBPs causing cell lysis

42
Q

Cefixime ELIMINATION

A

Penetrates urine, prostatic and blister fluids; eliminated unchanged primarily in urine by GF and RTS

43
Q

Cefixime Side effects:

A

Diarrhea & GI upset. Rarely may é clotting time.

False positive for urinary glucose in diabetic patients

44
Q

Urethritis - Cervicitis TREATMENT:

A 
Azithromycin
Doxycycline
Erythromycin base
Levofloxacin
Ofloxacin
45
Q

Recurrent Treatment

Urethritis - Cervicitis

A

Metronidazole or Tinidazole
Plus
Azithromycin

46
Q

Trichomoniasis TREATMENT:

A

Metronidazole

Tinidazole

47
Q

Metronidazole & Tinidazole DRUG MECHANISM:

A

Amebicidal, bactericidal, and trichomonacidal
Unionized drug taken up by anaerobic organisms and cells where it is reduced to its active form which disrupts DNA’s helical structure, thereby inhibiting bacterial nucleic acid synthesis. Equally effective vs. dividing and non-dividing cells.

48
Q

Metronidazole & Tinidazole elimination:

A

Elimination primarily in urine (discoloration) and stool.

49
Q

Metronidazole & Tinidazole side effects & CI:

A

Avoid in pregnancy and breastfeeding; GI upset; candidiasis; disulfiram-like effect (avoid alcohol for 24 hr (M) or 72 hr (T). Tinidazole AFTER completing therapy; 2° malignancies in animal model.

50
Q

Bacterial Vaginosis TREATMENT:

A

Metronidazole
Clindamycin
Tinidazole
Clindamycin

51
Q

Clindamycin DRUG MECHANISM:

A

Binds 50s ribosomal subunit to inhibit protein synthesis; bacteriostatic

52
Q

Clindamycin ISSUES:

A

CDC recommends intravaginal use only in 1st trimester due to an increase in adverse events, such as low birthweight, pre-term delivery, premature rupture of the membranes, and neonatal infections if used after 16 weeks.Excreted in breast milk – AAP sees no issues but manufacturer advises caution. GI upset most commonly with systemic drug BUT also reported with intravaginal application. Local delivery also rarely associated with contact toxicity like vaginal erythema, vulvovaginal pruritus, vaginal discharge, vaginal swelling, vaginal bleeding and vaginal pain.

53
Q

Candidiasis TREATMENT:

A 
Butoconazole
Clotrimazole
Miconazole
Tioconazole
PRESCRIPTION
Butoconazole
Terconazole
Fluconazole
54
Q

Conazoles Mechanism:

A

Blocks ergosterol synthesis through interacting with 14-alpha demethylase, a CYP necessary conversion of lanosterol to ergosterol; essential membrane component.

55
Q

Fluconazole distrubted & eliminated:

A

Widely distributed in tissues and fluids; renal elimination – predominantly unchanged.

56
Q

High systemic doses of azoles produce?

A

Abdominal wall defects & cleft palate in fetus & maternal stress.
Recommended avoid in 1st trimester

57
Q

Oil-based topical Conazoles products:

A

Can weaken latex condoms or diaphragms.

58
Q

HPV: Prevention

A

Human Papillomavirus vaccine [Gardasil & Cervarix]

59
Q

Gardasil & Cervarix Mechanism:

A

Both contain recombinant L1 protein, the major antigenic protein of the capsid of HPV

60
Q

Gardasil: Types?

A

Types 6, 11, 16, & 18 (quadrivalent)

61
Q

Cervarix: Types?

A

Types 16 & 18 (bivalent)

62
Q

HPV: Prevention Recommended for?

A

Recommended girls & boys, men & women <26 y/o and receive 3 doses at 0, 2 & 6 months

63
Q

Genital Warts caused by?

A

90% caused by HPV 6 & 11

64
Q

Genital Warts symptoms & infection

A

Usually asymptomatic but can be painful and pruritic

Available treatments likely reduce but probably don’t erradicate HPV infectivity

65
Q

Genital Warts TREATMENTS:

A

Podofilox
Imiquimod
Sinecatechins

66
Q

Podofilox Mechanism & administration:

A

A plant-derived mitotic spindle inhibitor blocking microtubular activity in keratinocytes
Topical gel: little if any drug systematization

67
Q

Imiquimod Mechanism, administration & elimination:

A

An immune response modifier
Topical gel: absorption = surface area&raquo_space; amount applied
Eliminated in urine

68
Q

Sinecatechins Mechanism & side effect:

A

Agreen tea extract antioxidant

Pain and discomfort at application site

Reproduction Pharmacology (9 decks)

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