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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
Q

true or false: sexual partners of a patient with BV also need to be treated

A

false - not recommended

26
Q

how should a reoccurence of BV be treated

A

first recurrence: retrial of same regimen

or

trial of different regimen

27
Q

true or false: BV is only treated in symptomatic patients

A

true

only treat asymptomatic if
- prior to IUD insertion
- prior to gynecologic surgery
- prior to therapeutic abortion
- high risk pregnancy

28
Q

what is an option for supressive therapy for BV

A

metronidazole 0.75% PV weekly x 4-6 months

29
Q

which diagnostic test is suggested to be used for diagnosing trichmoniasis

A

NAAT

30
Q

when should a patient who had trichomoniasis be tested for reinfection after tx

A

2 weeks up to 3 months

31
Q

what is the 2 options for initial tx for trichomoniasis

A
  1. metronidazole 2g PO as a single dose
  2. metronidazole 500mg PO BID x 7/7 (rec regimen for females)
32
Q

what is a tx option for trichmoniasis in pregnancy

A

metronidazole 2g as a single dose

33
Q

true or false: 2g dose of metronidazole is safe in BF

A

false - should withhold BF for 24-48 hours

34
Q

true or false: sexual partners of a patient with trichomoniasis need to be treated

A

true + no sex until both partners are sx free

35
Q

what are some a/e of oral metronidazole

A
  • 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
Q

what are some a/e of topical metronidazole

A
  • vaginal discharge
  • yeast infection
  • irritation
  • pain and discomfort
  • avoid tampons during tx
37
Q

topical clindamycin contains this ingredient which may decrease effectiveness of condoms for up to 5 days after use

A

mineral oil

38
Q

what types are cells are present in vulvovaginal candidiasis

A
  • budding yeast
  • pseudohyphae
  • hyphae
39
Q

what are sone risk factors to getting a yeast infection (vulvovaginal candidiasis)

A
  • recent Abx use
  • pregnancy
  • uncontrolled DM
  • aids
  • immunosuppression
  • corticosteroid use
40
Q

true or false: pharmacists can prescribe for BV, trichmoniasis and vulvovaginal candidiasis

A

false - only vulvovaginal candidiasis

41
Q

whar are some red flags where patients would need to be referred for furhter investigation

A
  • 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
Q

what are the 3 options for intial treatment of vulvovaginal candidiasis

A
  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
Q

what option is used as tx for vulvovaginal candidiasis in pregnancy

A

topical azole PV x 7-14 days
* NO FLUCONAZOLE * - risk of spontaneous abortion

44
Q

what are the 2 treatment options for recurrent vulvovaginal candidasis

A
  1. topical azole therapy x 7-14 days
  2. fluconazole 150mg q 3 days for 3 doses (9 days total)
45
Q

true or false: sexual partners of a patient with vulvovaginal candidiasis need to be treated

A

false - only if partner has sxs

46
Q

what are some a/e of PO fluconazole

A
  • nausea
  • abdominal discomfort
  • h/a
47
Q

what is the treatment options for complicated or recurrent VVC

A
  • 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
Q

what are some possible maintenance treatments for complicated VVC in patients with high reoccurence of yeast infections

A
  • 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
Q

true or false: boric acid is safe to use in pregnancy

A

false

50
Q

what is the most common treatment option in complicated yeast infections that are not caused by c albicans

A

boric acid 300mg PV x 14 days

51
Q

how are the non-infectiois causes of vaginitis usually treated

A

generally directed at the underlying cause (hormonal therapies, lubricants/moisturizers) <- require referral

Pharmacotherapy 4271 (29 decks)

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