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PHAR 153 > Vaginitis > Flashcards

Vaginitis Flashcards

1
Q

Describe the presentation of normal vaginal secretions.

A

-Generally odorless
-Clear / slight white color with egg white consistency
-1-4mL secreted daily
-Acidic pH (3.8 to 4.2)
-Lactobacillus bacteria predominant

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2
Q

Pronounced white vaginal discharge may be indicative of what?

A

Yeast Infection

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3
Q

Yellow’ey-Green vaginal discharge may be indicative of what?

A

STI

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4
Q

Gray vaginal discharge may be indicative of what?

A

Bacterial Vaginosis (BV)

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5
Q

Pink vaginal discharge may be indicative of what?

A

Vaginal Irritation, Implantation Bleeding, Cervical Bleeding

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6
Q

Red vaginal discharge may be indicative of what?

A

Cervical Polyp, Endometrial / Cervical Cancer, Menstruation, Cervical Infection

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7
Q

Fungal infection of the exterior pubic region of a female might be referred to as what condition?

A

Vulvovaginal Candidiasis (VVC)

-Vulva = Outside, Vaginal = Inside… Important distinction.

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8
Q

Do Genital Warts & Herpes present as Vaginitis?

A

-Nope… Generally, presents as open sores & bleeding / pain.

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9
Q

Non-Infectious Vaginitis causes?

A

-Postmenopausal / Menopausal Atrophy
-Changes to bacterial flora of the vagina
-Foreign body retention (ie. Tampon)
-Allergies

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10
Q

Order the following Infectious Vaginitis-causing conditions by increasing pH:

Vulvovaginal Candidiasis
Atrophy
Trichomoniasis
Bacterial Vaginosis

A

1) Vulvovaginal Candidiasis: pH is < 4.5
2) Bacterial Vaginosis: pH is 5-6
3) Trichomoniasis: pH is > or = 6
4) Atrophy: pH is 7

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11
Q

A fishy odor & creamy, gray discharge may be indicative of what infectious Vaginitis-causing condition?

A

Bacterial Vaginosis

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12
Q

Frothy & wet discharge with a fowl scent & potential pruritis may be indicative of what infectious Vaginitis-causing condition?

A

Trichomoniasis

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13
Q

“Cottage Cheese-like discharge”, odorless, & localized stinging / burning in & around the vagina may be indicative of what infectious Vaginitis-causing condition?

A

Vulvovaginal Candidiasis

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14
Q

What distinguishing factor does VVC present that other Vaginitis conditions usually don’t?

A

Severe Pruritis

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15
Q

What sorts of things may alter normal vaginal flora?

A

-Puberty
-Menstruation
-Estrogen / OCP Therapy
-Pregnancy
-Post-Menopause
-Antibiotics
-Vaginal Surgery (ie. Hysterectomy / Abortion)

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16
Q

What might be some risk factors that leave a woman susceptible to vaginal infection?

A

-Uncontrolled Diabetes
-Broad Spectrum Antibiotics
-Immunosuppression
-Medications (Chemo, Corticosteroids, Contraception)
-Diet
-Stress
-Pregnancy
-Menses
-Chemical Irritants
-Synthetic / Non-Breathable Undergarments & Clothing

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17
Q

When is a woman most susceptive to VVC infection (at what age range)?

A

30-40yrs… Rare before puberty.

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18
Q

What other patient symptoms are indicative of VVC infection (Hint: Two “dys” symptoms)?

A

Dysuria - Painful urination
Dyspareunia - Painful intercourse

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19
Q

When do we need to refer for VVC?

A

-1st time experiencing symptoms
-If discharge presents an odor (potentially indicative of another type of infection… bacterial?)
-Pregnant
-Pre-Puberty
-Underlying chronic illness or immunocompromised
-Recurrence within 2 months
-Presence of other symptoms (Fever / Pelvic or Abdominal Pain / Rashes / Sores)
-Heightened risk of STI (Unprotected Sex & multiple sexual partners)

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20
Q

Jane (35yrs old) comes into your Pharmacy presenting VVC-like symptoms. You do a screen & identify that her vaginal discharge is odorless, this is not her first time experiencing VVC-like symptoms, & she isn’t pregnant. She’s had intercourse with one partner over the past year & has come in for the same thing about 6 weeks ago. There’s no indication she’s immunocompromised & she’s otherwise healthy. What’s the most appropriate course of action?

A

Referral… There’s recurrence of potential VVC within two months (6 weeks falls within the 8 week cut off).

21
Q

Are there any long-term consequences of VVC in terms of a woman’s fertility?

A

Nope… None in terms of vaginal scarring either.

22
Q

Why are we much quicker to jump the gun on referring Bacterial Vaginosis in comparison to Vulvovaginal Candidiasis?

A

-Increased risk of obtaining / passing on STI’s… STI’s can lead to severe complications such as infertility & permanent organ damage, as well as increase the risk of HIV infection.

23
Q

Antifungal agents we use to treat Uncomplicated VVC?

A

Clotrimazole
Miconazole
Terconazole
Nystatin

24
Q

Clotrimazole dosing regimens (for vaginal tablets)?

A

500mg vaginal tab x 1 dose
200mg vaginal tab x 3 night-time doses

25
Q

Clotrimazole dosing regimens (for vaginal cream application)?

A

1%: 1 applicator of cream PV HS x 7 days
2%: 1 applicator of cream PV HS x 3 days
10%: 1 applicator of cream PV HS x 1 day

-For Vulva irritation & itchiness, external application BID or prn until subsides.

26
Q

Miconazole dosing regimens (for vaginal ovules)?

A

100mg HS x 7 days
400mg HS x 3 days
1200mg HS x 1 dose

27
Q

Miconazole dosing regimens (for vaginal cream application)?

A

2%: 1 applicator of cream PV HS x 7 days
4%: 1 applicator of cream PV HS x 3 days

-For Vulva irritation & itchiness, external application BID or prn until subsides.

28
Q

What benefit does 1-3 day treatment have over 7 day treatment? Does the shorter treatment duration mean vaginal infections will clear up quicker?

A

-Increased compliance on shorter treatment plan…
-Resolution still takes ~3 to 7 days.

29
Q

Oral Fluconazole dosing regimen?

A

1 dose of a 150mg oral capsule… Enough to maintain concentrations within vaginal secretions for 72hrs or potentially longer.

30
Q

Who is it unsuitable to give Oral Fluconazole to?

A

Girls < 12yrs (pre-Puberty)

31
Q

What capsular Antifungal product is potentially fatal if taken po?

A

-Boric Acid… Poisonous agent (only use PV).

32
Q

When is Boric Acid a suitable AF agent?

A

-If patient has an allergy or is resistant to azoles.

33
Q

When do we expect some improvement in a VVC patient taking OTC products? Full resolution?

A

Improvements: ~3 days
Resolved: ~7 days

-Seek Physician if it persists beyond a week (could be indicative of a different infection)!

34
Q

Are Oral / Topical Azole products relatively well-tolerated?

A

-Absolutely… Some may have allergies or intolerances to them, but they are very safe to use (potential for some local irritation, but that’s about it).

35
Q

Continue treatment of a vaginal yeast infection even if symptoms disappear? Do I use it during menstrual cycle? Can I have sex during usage of oral / topical products?

A

i) Yes… Stick course of treatment out even if symptoms go away.

ii) Yes… And avoid tampon usage during this time.

iii) Not recommended… During treatment + 3 days (~10 days no sex), as sex can be uncomfortable, reduce contraceptive effectiveness & increases possibility of transmission to partner.

36
Q

Meena comes into your Pharmacy asking if yogurt can be used to clear up her friend’s vaginal yeast infection… What advice would you give her?

A

-Probably minimal effectiveness but worth a try if they want an alternative to drug treatments… However, use unsweetened yogurt & avoid adding honey to the fray (as sugars could fuel bacteria if it isn’t Candidiasis).

37
Q

Prescribed agents for resistant yeast infections?

A

Terconazole 0.4% cream
Topical Nystatin 100 000 Units

38
Q

Dosing regimen of Terconazole 0.4% cream?

A

Applicator PV HS x 7 days

39
Q

Dosing regimen of Topical Nystatin?

A

Applicator PV HS x 2 weeks

40
Q

Is Terconazole safe in pregnancy? Topical Nystatin?

A

Terconazole: Avoid 1st Trimester… Can be used 2nd / 3rd if benefits outweigh risks.

Topical Nystatin: Very safe agent for pregnant women to use.

41
Q

Two other products to avoid giving to pregnant women with yeast infections?

A

-Oral Fluconazole & PV Boric Acid Tabs… Increased miscarriage & birth defect risk.

-Consider giving Topical Azoles or Topical Nystatin instead.

42
Q

Is vaginal douching necessary to prevent infection?

A

-Absolutely not (and can actually be harmful)… Disrupts normal bacterial flora, potentially acts as an irritant & can increase risk of ascending infection.

43
Q

Gwenyth comes into your Pharmacy complaining of vaginal irritation. She’s post-menopausal & complains of vaginal dryness. What OTC product might you give her?

A

Vagisil or other vaginal lubricants

44
Q

Jane comes into your Pharmacy complaining of hot flashes & vaginal irritation / itchiness. She is also post-menopausal. What potential prescriptive option is available to treat her co-morbid symptoms?

A

Hormone Replacement Therapy (used when hot flashes & itchiness are demonstrated together)

45
Q

What Azole product is often used in the treatment of Bacterial Vaginosis?

A

Metronidazole

46
Q

Dosing regimen for Metronidazole in BV treatment?

A

Oral: 500mg tab x 7 days; 2g tab x 1 dose

0.75% Gel: Applicator (5g) PV OD x 5 days

47
Q

What other common prescription grade treatment is used to treat BV?

A

2% Clindamycin Cream… Applicator (5g) PV OD x 7 days.

48
Q

CanesBalance Gel is another prescription grade product used to treat BV. What unusual allergy demonstrated by a patient would make this product unsuitable to use?

A

Shellfish

49
Q

A Dr. has faxed in a prescription to your Pharmacy. Identify the problem with this drug choice…

Drug: 0.75% Metronidazole Gel (for treatment of Trichomoniasis infection).

SIG: Insert 1 applicator (5g) PV OD x 5 days

A

-Intravaginal Metro Gel is NOT effective!!! Treatment must be oral & systemic (swap for either 2g one time treatment or 500mg BID x 7d).

PHAR 153 (10 decks)

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