STI Drugs

Question 1

-cyclovir/ciclovir

Answer 1

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

Question 2

(val)acyclovir

Answer 2

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

Question 3

famciclovir

Answer 3

metabolized to penciclovir
NO chain termination
AE: none significant

Question 4

cervarix

Answer 4

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

Question 5

gardisil

Answer 5

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

Question 6

podofilox

Answer 6

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

Question 7

imiquimod

Answer 7

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

Question 8

sinecatechins

Answer 8

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

Question 9

beta lactams

Answer 9

MOA: binds PBP inducing cell lysis

Question 10

macrolide

Answer 10

MOA: 50s ribosomal inhbitor

Question 11

quinolone

Answer 11

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

Question 12

cephalosporins

Answer 12

MOA: binds PBP inducing cell lysis

Question 13

amoxicillin

Answer 13

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

Question 14

azithromycin

Answer 14

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

Question 15

cefixime

Answer 15

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

Question 16

ciprofloxacin

Answer 16

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

Question 17

ceftriaxone

Answer 17

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

Question 18

clindamycin

Answer 18

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

Question 19

doxycycline

Answer 19

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

Question 20

erythromycin base

Answer 20

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

Question 21

levofloxacin

Answer 21

PO

quinolone

Question 22

metronidazole

Answer 22

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

Question 23

ofloxacin

Answer 23

PO

quinolone

Question 24

penicillin G

1. aqueous crystalline
2. benzathine
3. procaine

Answer 24

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

Question 25

-azoles

Answer 25

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

Question 26

tinidazole

Answer 26

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

Question 27

butoconazole

Answer 27

Rx | gel/cream -azole

Question 28

clotrimazole

Answer 28

OTC | gel/cream -azole

Question 29

fluconazole

Answer 29

Rx PO -azole CYP2C9 inhibitor

Question 30

miconazole

Answer 30

OTC | gel/cream -azole

Question 31

terconazole

Answer 31

Rx | gel/cream -azole

Question 32

ticonazole

Answer 32

OTC | gel/cream -azole

Question 33

Jarisch-Herxheimer Rxn

Answer 33

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

Question 34

HSV Tx

Answer 34

acyclovir, famciclovir, valacyclovir

Question 35

Syphilis Tx

Answer 35

penicillin G

Question 36

Chlamydia Tx

Answer 36

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

Question 37

Chancroid Tx

Answer 37

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

Question 38

uncomplicated gonococcal infection Tx (cervix, urethra, rectum)

Answer 38

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

Question 39

urethritis/cervicitis Tx

Answer 39

azithromycin or doxycycline | ALT: erythromycin base, levofloxacin, ofloxacin

Question 40

recurrent Tx for urethritis/cervicitis

Answer 40

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

Question 41

trichomoniasis Tx

Answer 41

metronidazole or tinidazole

Question 42

bacterial vaginosis

Answer 42

metronidazole or clindamycin | ALT: tinidazole, clindamycin

Question 43

candidiasis Tx

Answer 43

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