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