Pharmacotherapy II - Sexually Transmitted Infections

azithromycin

To what drug do the following CIs belong?:

- hypersensitivity

- hepatic dysfunction

- long QT syndrome

increases warfarin effect

What are potential DIs of azithromycin?

False

True or false:

- Ceftriaxone must be renally adjusted.

IM and IV

NOT oral

Routes of administration of ceftriaxone?

SJS

Main ADE of clindamycin?

increases warfarin effect

What are potential DIs of clindamycin?

- anorexia

- dental discoloration

- diarrhea

- HA

- hepatotoxemia

- photosensitivity

- interacts w/ cations

PREGNANCY D CATEGORY (may be used in pregnancy in severe cases)

ADEs of doxycycline?

doxycycline

What ABX may decrease effectiveness of other ABX (ampicillin, amoxicillin, PCN VK)?

metronidazole

What ABX may cause a disulfiram-like rxn?

SJS

Main ADE of metronidazole?

- use in 1st trimester of pregnancy

- use of EtOH during tx

CIs for metronidazole?

IM and IV

Routes of administration for PCN G procaine?

IM injection only!

Route of administration for benzathine PCN G?

PCN G Procaine

To what drug do the following CIs belong?:

- caution in renal impairment

- C. diff associated with diarrhea

- doxycycline

- minocycline

- TCN

What drugs may decrease the effectiveness of PCN G Procaine?

- metronidazole 500mg PO x7d

- metronidazole gel 0.75% one applicatorful (5g) intravaginally daily x5d

- clindamycin 2% cream one 5g applicatorful intravaginally at bedtime x7d

1st line tx for BV?

True

*If not, adverse pregnancy outcomes may occur (premature ROM, preterm birth).

True or false:

- All symptomatic pregnant women w/ BV should be treated.

- azithromycin 1g single dose OR

- doxycycline 100 mg BID x7d

- alternative: levofloxacin 500mg daily x7d

1st line tx for chlamydia (in a non-pregnant pt)

- azithromycin 1g single dose

- alternative: amoxicillin 500mg TID x7d

Recommended tx for chlamydia in a pregnant pt?

valacyclovir 1g BID x7-10d

What meds would you give to a pt w/ his/her first episode of HSV (genital herpes)?

valacyclovir 500mg 1x/d every day

What meds would you give to a pt w/ 6(+) episodes of HSV (genital herpes) per year as suppressive therapy?

valacyclovir 1g one daily x5d

valacyclovir 500mg BID x3d

What meds would you give a pt w/ episodic HSV?

- 3 days, 4 days

- a max of 4 wks

- anus, vagina, pregnancy

- bichloracetic, trichloroacetic

Genital Warts: HPV

Patient Applied - Podofilox 0.5% solution or

- BID for _________ and then _________ no tx

- Continue cycle until no visible warts for _________

- NOT recommended for _________, _________, _________

Can also give them imiquimod or sinecatechins to apply on their own

Provider Applied - _________ and _________ acids

- apply small amount, dry, apply weekly if necessary

gardasil

_________ HPV Vaccine

- recommended ages 9-26

- only 2 doses needed if 1st dose was before 15th bday

gonorrhea - single ceftriaxone 500g IM dose (>150kg (300lb) single 1g (1000mg) IM dose)

chlamydia - doxycycline 100mg BID x7d

Gonorrhea and chlamydia tx?

True

True or false:

- Always treat gonorrhea and chlamydia together.

C. trachomatis

N. gonorrhoeae

Pelvic inflammatory dz (PID) is often caused by...?

ceftriaxone IM + doxy x14d + metronidazole

alternative:

- cefotetan IV + doxy q12h

- ampicillin/sulbactam 3g IV q6h + doxy 100mg BID

Recommended tx for PID?

IM benzathine PCN G* 2.4 million units IM in a single dose

1st line for syphilis?

doxy 100mg 2x/d for 2 wks

Alternative tx (besides PCN) for syphilis?

f/u and reexamine pt and draw titers at 6, 12, and 24 months post-tx

For a pt w/ either 1° or 2° syphilis, PCN G should be given IM as a single dose. What do you do after that?

order LP and HIV test

- HIV (+): ID consult

- HIV (-) but LP (+) for neurosyphilis: tx for neurosyphilis

- HIV (+) and LP (+): PCN G 2.4 million units IM once weekly for 3 wks

Your asymptomatic pt w/ 1° or 2° syphilis returns for f/u and has a 4x increase in his titers. What do you do?

order LP and HIV test

Your symptomatic pt w/ 1° or 2° syphilis returns for f/u. What do you do?

early: 2.4 million units IM single dose

late and 3°: 2.4 million units IM every week for 3 doses

then f/u for reexamination and titer draw @6, 12, 24 months post-tx

Your patient has latent or 3° syphilis. What dose/duration of PCN G should you give?

aqueous crystalline PCN G 18-24 million units IV q4h or continuous infusion x10-14 d

How should you treat neurosyphilis?

- reexamine pt and CSF q6months until WBC normalizes

- may need 2nd course of tx if does not decline or completely normalize after 2 yrs

What f/u should you do for neurosyphilis?

metronidazole 500mg twice daily x7d

AVOID CONSUMPTION OF ALCOHOL DURING AND FOR UP TO 24 HRS AFTER LAST DOSE

How do you treat trichomonas vaginalis in women?

metronidazole 2g PO single dose

AVOID CONSUMPTION OF ALCOHOL DURING AND FOR UP TO 24 HRS AFTER LAST DOSE

How do you treat trichomonas vaginalis in men?

a) ceftriaxone

Which of the following meds is NOT available orally?

a) ceftriaxone

b) clindamycin

b) azithromycin

Which may cause QT prolongation?

a) doxycycline

b) azithromycin

c) metronidazole

c) doxycycline

Which may decrease the effectiveness of other antibiotics?

a) azithromycin

b) PCN G procaine

c) doxycycline

2021

When were the STI guidelines last updated?

b) ocular prophylaxis in neonates

What situation would NOT receive ceftriaxone treatment for gonococcal infections?

a) ophthalmia in neonates and infants

b) ocular prophylaxis in neonates

c) pregnancy

genital warts (HPV)

What STI does imiquimod cream treat?

1g IM single dose

What is the dose of ceftriaxone for a gonococcal infection for a patient weighing >150 kg?

a) ganciclovir

Which of the following is NOT used for Genital Herpes Simplex?

a) ganciclovir

b) valacyclovir

c) acyclovir

d) famciclovir

b) PCN G

Which is NOT used for treatment of cervicitis?

a) doxycycline

b) PCN G

c) azithromycin

benzathine PCN G 2.4 million units IM as a single dose

Which is the preferred treatment for primary, secondary, and early latent adult syphilis?

pelvic inflammatory dz

ceftriaxone 500mg IM as a single dose PLUS doycycline 100mg PO BID x 14 days WITH metronidazole 500mg PO BID x 14 days is the treatment for what?

valacyclovir 1g PO once daily

Which is a correct treatment for Genital Herpes Simplex for suppressive therapy for recurrent genital herpes?

permethrin

Which can be used to treat both Pediculosis Pubis and Scabies? *different doses