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Therapeutics > Genitourinary Infections > Flashcards

Genitourinary Infections Flashcards

1
Q

What kinds of organisms are common in bacterial vaginosis?

A

Anaerobes:

Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species, Bacteroides species (other than Bacteroides fragilis)

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2
Q

What kinds of organisms are common in VVC?

A

Candida species

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3
Q

The most common pathogen in VVC is…

A

Candida albicans

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4
Q

Risk factors of VVC include:

A 
Impaired immune status
Broad-spectrum abx
Inhibition of normal bacterial flora
30% test + after 2-3 week course of TETRACYCLINE
Post treatment for trichomoniasis or BV
CORTICOSTEROID medications
Pregnancy
Diabetes
Changes in glycogen
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5
Q

Which GU infection has thick and curdy (“cottage cheese-like” discharge?

A

VVC

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6
Q

Which GU infection has normal vaginal pH, a negative “Whiff” test, and the presence of pseudohyphae on wet mounts?

A

VVC

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7
Q

A recurrent VVC is considered ____ or more episodes of symptomatic VVC in

A

3 or more episodes in <1 year

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8
Q

Women with these conditions are considered to have complicated VVCs:

A

Diabetes, Immunocompromising conditions (HIV), underlying immunodeficiency, or immunosuppressive therapy (corticosteroids)

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9
Q

Uncomplicated VVC treatment

A

OTC intravaginal agents:
Clotrimazole 1% or 2% cream, Miconazole 2% or 4$ cream [5g intravaginally daily ranging from 3-14 days], miconazole 100 mg or 200 mg vaginal suppository for 3-7 days

Oral agent:
Fluconazole 150 mg orally in a single dose

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10
Q

What is the treatment for severe vaginitis (complicated)?
Fluconazole 100, 150, or 200 mg PO q___h for ___ doses
OR
Topical antifungal therapy daily for _____ days

A

q72h for 3 doses [3 doses total, 9 days to complete]
OR
topical therapy daily for 7-14 days

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11
Q

What is the treatment for recurrent VVC (complicated) - maybe no longer albicans but a different species of candida?
Induction:
___ days of oral or topical therapy

Maintenance:
Fluconazole 100, 150, 200 mg ______ for _____ months

A

Induction: 7-14 days of oral or topical therapy

Maintenance: weekly for 6 months

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12
Q

Treatment for treatment failure/non-albicans candida vaginitis:
C. glabrata - intravaginal ____ acid _____ mg daily for ____ days
C. krusei - intravaginal ____ acid ____ mg daily for ____ days OR non-fluconazole (oral or topical) azole for _____ days

A

C. glabrata: boric acid 600 mg daily for 21 days

C. krusei: boric acid 600 mg daily for 21 days or non-fluconazole (oral or topical) azole for 7-14 days

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13
Q

New treatment approved for adult and post-menarchal pediatric females with VVC

A

Brexafemme (ibrexafungerp)

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14
Q

Oral VVC drug that is contraindicated during pregnany and a strong CYP3A4 inducer

A

Brexafemme (ibrexafungerp)

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15
Q

Which GU infection has an elevated vaginal pH (~5), a positive “Whiff” test, and thin, white discharge?

A

Bacterial vaginosis

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16
Q

Treatment of sexual partners is usually not needed for bacterial vaginosis: True or False

A

True

17
Q

Recommended regimens for BV:
_______ 500 mg PO BID for 7days OR
_______ gel 0.75% one full applicator (5g) intravaginally once daily for 5 days OR
______ cream 2% one full applicator (5g) intravaginally at bedtime for 7 days

A

Metronidazole, metronidazole, clindamycin

18
Q

Alternative regimen for BV:

_____ 300 mg orally BID for 7 days

A

Clindamycin *but anaerobic coverage has declined from before

19
Q

Clindamycin ovules for BV treatment weaken ___ and ___ products.

A

Latex and rubber products. Patients should abstain from sex until treatment is complete

20
Q

BV treatment in pregnant women:
_____ 500 mg PO ___ for 7 days OR
_____ 250 mg PO ___ for 7 days OR
____ 300 mg PO BID for 7 days

Trichomonas treatment in pregnant women:
Metronidazole ___ g PO _____

A

BV:
Metronidazole 500 mg PO BID for 7 days OR
Metronidazole 250 mg PO TID for 7 days OR
Clindamycin 300 mg PO BID for 7 days

Trichomonas:
Metronidazole 2 g PO ONCE

21
Q

Which GU infection has a pH ~5, a positive “Whiff” test, and white to greenish , frothy discharge?

A

Trichomonas vaginitis

22
Q

The incubation period for Trichomonas vaginitis is short/long?

A

Long, 3-28 days, so can take a while for symptoms to show, if any

23
Q

___% of patients are asymptomatic for trichomonas vaginitis

A

50%

24
Q

Treatment of sexual partners is usually not needed for trichomonas vaginitis: True or False

A

False, you must treat all sexual partners because trichomonas is an STI

25
Q

Distinct findings for trichomonas include ____ spots and ___-shaped flagellate

A

Strawberry spots, pear-shaped flagellate

26
Q

Trichomonas Treatment:
Women - Metronidazole ____ mg BID for __ day(s)
Men - Metronidazole ___ g for ____ day(s)
Alternative - Tinidazole 2 g in a ___ dose

A

Women - Metronidazole 500 mg BID for 7 days
Men - Metronidazole 2 g for 1 days (single dose)
Alternative - Tinidazole 2 g in a single dose

27
Q

A lot of women will not know they have PID until they try to get pregnant (True/False)

A

TRUE

28
Q

BV, VVC, STIs, and parasite infections are all common causes of PID (True/False)

A

True

29
Q

PID treatment:
3 drugs - _____ + doxycycline + metronidazole OR
2 drugs - _____ + doxycycline OR
2 drugs - ____ + doxycycline

A

3 drugs - CEFTRIAXONE (1g IV q24h) + doxycycline (100 mg PO/IV q12h) + metronidazole (500 mg PO/IV q12h) (added for anaerobic coverage)
2 drugs - CEFOTETAN (2g IV q12h) + doxycycline (100 mg PO/IV q12h)
2 drugs - CEFOXITIN (2g IV q6h) + doxycycline (100 mg PO/IV q12h)

cephalosporin + doxycycline partially covers for N. gonorrhea and chlamydia

30
Q

Pregnant women with PID can be treated as an outpatient procedure (True/False)

A

False, pregnancy needs automatic admission

31
Q

For PID, you should generally start with IV and deescalate to PO. (True/False)

A

True

32
Q

Oral therapy for PID after clinical improvement:

Doxycyline 100 BID + Metronidazole 500 mg BID for ___ days

A

14 days!

33
Q

Alternative regimen for PID:
______ + doxycycline OR
______ + gentamicin

A

Ampicillin-sulbactam (3g IV q6h) + Doxycycline (100 mg PO/IV q12h) OR
Clindamycin (900 mg IV q8h) + Gentamicin (loading dose + maintenance dose)

34
Q

If not in an hospital/ER settings for PID, there are IM or oral options for treatment (True/False)

A

True

35
Q

PO Probenacid is given with ____ to increase the half-life but can _____

A

Given with cefoxitin IM to increase its half-life but can also change the half-life of other drugs

36
Q

Ways to prevent PID

A 
Control of STDs
Promotion of condoms
Use of oral contraceptives
Avoidance of vaginal douching
Chlamydia screening
Early diagnosis and completed treatment

Therapeutics (10 decks)

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