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Flashcards in STI Drugs Deck (43):
1

-cyclovir/ciclovir

PO: 7-10 days (2-5x daily)
antiviral: inhibits DNA pol
activation: viral thymidine kinase
dose adjust in renal disease
Tx: HSV
HYDRATION (avoid crystalline nephropathy/neuro), cross hyper-sensitivity

2

(val)acyclovir

chain termination
AE: neurotoxicity, seizures (penetrates CNS)
val: prodrug with better oral bioavailability

3

famciclovir

metabolized to penciclovir
NO chain termination
AE: none significant

4

cervarix

recombinant L1 protein
IM: IgG neutralizing Ab
bivalent HPV vaccine: 16, 18
AE: hypersensitivity

5

gardisil

ages 9-26 yrs
recombinant L1 protein
IM: IgG neutralizing Ab
quadrivalent HPV vaccine: 6, 11, 16, 18
AE: hypersensitivity
grown in YEAST

6

podofilox

topical
MOA: mitotic spindle inhibitor
Tx: HPV genital warts
AE: pruritus
not recommended in pregnancy

7

imiquimod

topical
MOA: antiviral toll-like receptor activator (immune modifier): stimulates IFN and cytokine production
Tx: HPV genital warts
AE: pruritus
not recommended in pregnancy

8

sinecatechins

topical
MOA: keratolytic: antioxidant
AE: pruritus
Tx: HPV genital (warts?)

9

beta lactams

MOA: binds PBP inducing cell lysis

10

macrolide

MOA: 50s ribosomal inhbitor

11

quinolone

MOA: DNA gyrase inhibitor (topo II) in G-; inhibit topo IV in G+
Tx: chlamydia ALT, cervicitis ALT
AE: TENDONITIS/RUPTURE

12

cephalosporins

MOA: binds PBP inducing cell lysis

13

amoxicillin

PO
beta lactam
CAN be used in pregnancy
adjust dose in renal disease

14

azithromycin

PO
long T1/2
macrolide
AE: GI
Tx: chlamydia 1st, urethritis ALT, cervicitis ALT

15

cefixime

PO
cephalosporin
false pos. urinary glucose test
Tx: chancroid ALT, gonococcal ALT + azithromycin

16

ciprofloxacin

PO
quinolone
CYP1A2 inhibitor
CI: pregnancy, lactation
Tx: chancroid ALT (not chlamydia/cervicitis)

17

ceftriaxone

IM
cephalosporin
AE: GI
Tx: chancroid ALT, gonococcal ALT + azithromycin

18

clindamycin

PO/gel
MOA: 50s ribosomal inhibitor
AE: GI, C. DIFF infection
gel AE: discontinue after 1st trimester (pre-term, low birth weight, ruptured membranes), contact irritation
Tx: vaginosis ALT

19

doxycycline

PO
long T1/2
MOA: 30s ribosomal inhibitor
AE: HEPATIC (esp. in pregnancy), PHOTOSENSITIVE
Tx: chlamydia 1st, urethritis ALT, cervicitis ALT

20

erythromycin base

PO
short T1/2
macrolide
CYP3A4 INHIBITOR
substrate: P-gp, CYP3A4
AE: HYPERTROPHIC PYLORIC STENOSIS in neonates
Tx: chlamydia ALT, chancroid choice, cervicitis ALT

21

levofloxacin

PO
quinolone

22

metronidazole

MOA: disrupts DNA structure
resistance: decreased activation, increase free radical scavenging, increased DNA repair
inhibit: CYP2C9
CI: pregnancy/breastfeeding
AE: DISULFIRAM
Tx: trichmoniasis ALT, vaginosis ALT

23

ofloxacin

PO
quinolone

24

penicillin G
1. aqueous crystalline
2. benzathine
3. procaine

beta lactam
1. IV: congenital syphilis (10 days)
2. IM: syphilis 1st (not good for neurosyphilis: no BBB penetration)
3. IM: congenital syphilis (10 days)
AE: HYPERSENSITIVITY (if pregnant, desensitize and Tx), Garish-Herxheimer Rxn

25

-azoles

MOA: ergosterol syn. inhibitors (14alpha demethylation of lanosterol)
gel/cream: limited systemic absorption/residual activity for days; oil based weaken condoms
resistance: decreased drug, target mutation/up-regulation, bypass pathways
Tx: candidiasis ALT
avoid in 1st trimester: systemic dose causes abdominal wall defects, cleft palate

26

tinidazole

OTC
gel/cream -azole; disrupt DNA structure (oral) inhibiting nucleic acid syn.
metabolism: CYP3A4
Tx: trichomoniasis ALT, vaginosis 2nd ALT
CI: pregnancy, breastfeeding
AE: DISULFIRAM

27

butoconazole

Rx
gel/cream -azole

28

clotrimazole

OTC
gel/cream -azole

29

fluconazole

Rx
PO -azole
CYP2C9 inhibitor

30

miconazole

OTC
gel/cream -azole

31

terconazole

Rx
gel/cream -azole

32

ticonazole

OTC
gel/cream -azole

33

Jarisch-Herxheimer Rxn

release of spirochetes (syphilis) antigens with host rxn to products: chill, fever, headache, myalgia, arthralgia, more prominent syphilitic cutaneous lesions (fade within 48 hrs)
do NOT discontinue penicillin

34

HSV Tx

acyclovir, famciclovir, valacyclovir

35

Syphilis Tx

penicillin G

36

Chlamydia Tx

azithromycin (1 day) or doxycycline
ALT: erythromycin, levofloxacin, ofloxacin
everything else: 1 week
ALT in PREGNANCY: amoxicillin

37

Chancroid Tx

azithromycin (oral, 1 dose) or ceftriaxone (IM, one dose) or ciprofloxacin or erythromycin base

38

uncomplicated gonococcal infection Tx (cervix, urethra, rectum)

ceftriaxone or cefixime plus azithromycin (preferred due to tetracycline resistance) or doxycycline
pharynx infection: same but don't use cefixime

39

urethritis/cervicitis Tx

azithromycin or doxycycline
ALT: erythromycin base, levofloxacin, ofloxacin

40

recurrent Tx for urethritis/cervicitis

metronidazole or tinidazole plus azithromycin (if NOT used in original Tx)

41

trichomoniasis Tx

metronidazole or tinidazole

42

bacterial vaginosis

metronidazole or clindamycin
ALT: tinidazole, clindamycin

43

candidiasis Tx

OTC: butoconazole, clotrimazole, miconazole, ticonazole
Rx: butoconazole, terconazole, fluconazole (only oral)