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Pharmacotherapy 4271 > Vaginitis (Final) > Flashcards

Vaginitis (Final) Flashcards

1
Q

this is any condition with symptoms of abnormal vaginal discharge, odor, irritation or burning

A

vaginitis

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2
Q

what are the 3 infectious causes of vaginitis

A
  • bacterial vaginosis
  • vulvovaginal candidiasis (yest infection)
  • trichomoniasis
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3
Q

what are the 4 noninfectious causes of vaginitis

A
  • atrophic
  • allergic
  • irritant
  • inflammatory
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4
Q

what bacteria is involved at the vaginal level in a normal situation

A

lactobacilli

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5
Q

what is the normal vaginal pH

A

3.5-4.5

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6
Q

in bacterial vaginosis, what bacteria is present, that overrules the normal lactobacilli

A

g. vaginalis

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7
Q

what symptoms are present in someone who has bacterial vaginosis

A
  • fishy odor
  • thin discharge (worsens after sex)
  • may have pelvic discomfort
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8
Q

true or false: inflammation is present in bacterial vaginosis

A

false

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9
Q

what is the vaginal pH in someone with bacterial vaginosis

A

> 4.5

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10
Q

what bacteria is present in someone with vulvovaginal candidiasis

A

candida albicans or other candida species

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11
Q

what are the symptoms associated with vulvovaginal cadidiasis

A
  • white, thick, curdy, discharge
  • itching and burning
  • dyspareunia (genital pain during or after sex)
  • dysuria
  • NO ODOR
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12
Q

true or false: inflammation is present in vulvovaginal candidiasis

A

true

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13
Q

what is vaginal pH in vulvovaginal candidiasis

A

3.5 - 4.5 (normal)

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14
Q

what bacteria is present in trichomoniasis

A

trichomonas vaginalis

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15
Q

what are the symptoms associated with trichmoniasis

A
  • green/yellow frothy discharge
  • foul odor
  • vaginal pain or soreness
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16
Q

true or false: inflammation is present in trichomoniasis

A

true

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17
Q

what is the vaginal pH in trichomoniasis

A

> 4.5

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18
Q

what diagnostic testing can be done for vaginitis

A
  1. microscopy and
  2. vaginal pH and
  3. amine (whiff) test

or

  1. NAAT
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19
Q

what type of cells are present in the normal vaginal environment

A

squamous epithelial cells

parabasal cells (most common in premenarchal and postmenopausal patients)

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20
Q

what type of cells are present and may be indicative of bacterial vaginosis

A

clue cells (squamous epithelial cells studded with many coccobacilli)

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21
Q

what is the Amsel Diagnostic criteria for bacterial vaginosis

A
  1. thin, homogenous discharge
  2. positive whiff test
  3. clue cells present on microscopy
  4. vaginal pH > 4.5

three out of four criteria must be met

22
Q

what are the 3 initial tx options for bacterial vaginosis

A
  1. metronidazole 500mg BID x7/7
  2. metronidazole 0.75 gel PV daily x5/7
  3. clindamycin 2% vaginal cream OV x7/7
23
Q

what is another oral option used to treat BV if metronidazole does not work

A

Clindamycin 300mg PO BID x 7/7

24
Q

what are the 3 treatment options for BV in pregnancy

A
  1. metronidazole 500mg BID x 7/7
  2. metronidazole 250mg TID x 7/7 (if pt cant tolerate 500mg dose)
  3. clindamycin 300mg BID x 7/7
25
true or false: sexual partners of a patient with BV also need to be treated
false - not recommended
26
how should a reoccurence of BV be treated
first recurrence: retrial of same regimen or trial of different regimen
27
true or false: BV is only treated in symptomatic patients
true only treat asymptomatic if - prior to IUD insertion - prior to gynecologic surgery - prior to therapeutic abortion - high risk pregnancy
28
what is an option for supressive therapy for BV
metronidazole 0.75% PV weekly x 4-6 months
29
which diagnostic test is suggested to be used for diagnosing trichmoniasis
NAAT
30
when should a patient who had trichomoniasis be tested for reinfection after tx
2 weeks up to 3 months
31
what is the 2 options for initial tx for trichomoniasis
1. metronidazole 2g PO as a single dose 2. metronidazole 500mg PO BID x 7/7 (rec regimen for females)
32
what is a tx option for trichmoniasis in pregnancy
metronidazole 2g as a single dose
33
true or false: 2g dose of metronidazole is safe in BF
false - should withhold BF for 24-48 hours
34
true or false: sexual partners of a patient with trichomoniasis need to be treated
true + no sex until both partners are sx free
35
what are some a/e of oral metronidazole
- GI upset - metallic taste - dark discoloration of urine - urethral burning + severe interaction with alcohol - do not drink alcohol while taking this medication + 3 days after
36
what are some a/e of topical metronidazole
- vaginal discharge - yeast infection - irritation - pain and discomfort * avoid tampons during tx
37
topical clindamycin contains this ingredient which may decrease effectiveness of condoms for up to 5 days after use
mineral oil
38
what types are cells are present in vulvovaginal candidiasis
- budding yeast - pseudohyphae - hyphae
39
what are sone risk factors to getting a yeast infection (vulvovaginal candidiasis)
- recent Abx use - pregnancy - uncontrolled DM - aids - immunosuppression - corticosteroid use
40
true or false: pharmacists can prescribe for BV, trichmoniasis and vulvovaginal candidiasis
false - only vulvovaginal candidiasis
41
whar are some red flags where patients would need to be referred for furhter investigation
- prepubertal (rare in this pop) - 1st time vaginal sxs - has underlying illness such as DM - pregnant - has a reoccurence of vulvovaginal candidiasis within 2 months of the last episode - is immunosupressed - is at risk of an STI (e.g. hx of unprotected sex, mutliple partners)
42
what are the 3 options for intial treatment of vulvovaginal candidiasis
1. topical azole therapy (e.g. clotrimazole / Canestan) 2. fluconazole 150mg PO as a single dose 3. teraconazole 0.4 or 0.8% vaginal cream hs x 7/7
43
what option is used as tx for vulvovaginal candidiasis in pregnancy
topical azole PV x 7-14 days * NO FLUCONAZOLE * - risk of spontaneous abortion
44
what are the 2 treatment options for recurrent vulvovaginal candidasis
1. topical azole therapy x 7-14 days 2. fluconazole 150mg q 3 days for 3 doses (9 days total)
45
true or false: sexual partners of a patient with vulvovaginal candidiasis need to be treated
false - only if partner has sxs
46
what are some a/e of PO fluconazole
- nausea - abdominal discomfort - h/a
47
what is the treatment options for complicated or recurrent VVC
- Fluconazole 150mg po q 3 days for 3 doses then weekly x 6 months or may use boric acid 300-600mg gel caps PV daily x 14 days
48
what are some possible maintenance treatments for complicated VVC in patients with high reoccurence of yeast infections
- ketoconazole 100mg daily - clotrimazole 500mg PV monthly - boric acid 300mg cap PV 5 days each month beginning the first day of the menstrual cycle
49
true or false: boric acid is safe to use in pregnancy
false
50
what is the most common treatment option in complicated yeast infections that are not caused by c albicans
boric acid 300mg PV x 14 days
51
how are the non-infectiois causes of vaginitis usually treated
generally directed at the underlying cause (hormonal therapies, lubricants/moisturizers) <- require referral

Pharmacotherapy 4271 (29 decks)

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