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Clinical Pharmacy > Vaginal Conditions > Flashcards

Vaginal Conditions Flashcards

1
Q

At puberty, due to estrogen, the vaginal lining changes to ___________, which contains glycogen

A

stratified squamous epithelium

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2
Q

_______ uses the glycogen of the vagina to form lactic acid. This creates an acidic pH between 3.5 - 5.5

A

Lactobacillus bacteria

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3
Q

What is the purpose of the acidic environment in the vagina?

A
  • the acidity helps maintain the normal vaginal flora and inhibitors the growth of pathogenic organisms
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4
Q

What changes to the environment of the vagina after menopause?

A
  • thinning of the vaginal lining occurs, lactobacilli decline and the pH rises
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5
Q

What are the factors that influence the vaginal flora, pH and glycogen concentration include what?

A
  • aging
  • menstrual cycle hormonal fluctuations
  • certain diseases- diabetes mellitus (increase of sugar peeing out)
  • various medications (antibiotics)
  • douching
  • number of sexual parters (increases exposure to additional organisms)
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6
Q

What should be done to clean the vagina?

A
  • vagina is self-cleaning through secretions and has protective substances (NO concern about vaginal cleanliness)
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7
Q

What are the adverse effects associated with douching?

A
  • disruption of normal vaginal flora, increased risk of irritation or infection
  • risk of genital tract infections, ectopic pregnancy, potential cervical cancer risk
  • may prevent detection of infection
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8
Q

Douching is associated with what in pregnancy?

A
  • preterm births, low birth weight infants and decreased fertility
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9
Q

What should douching be avoided in?

A
  • avoid in pregnancy, use as a contraceptive or as a self treatment of vaginal infections, 24-48 prior to gynecologic exams and at least 3 days after last dose of a vaginal anti fungal medication
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10
Q

Genital towelettes may contain what?

A
  • may contain perfumes, astringents, emollients and anti-invectives which may lead to irritation or allergic reactions
  • occasionally can use, but daily cleansing with mild soap and water preferred
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11
Q

What are the risks of using a feminine deodorant spray?

A
  • meant to decrease genital odour
  • risk of masking an infection, causing irritation and allergic reactions
  • do not apply to the inside of the vagina
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12
Q

What are some of the non-pharms to prevent vaginal irritation?

A
  • wear cotton underwear only
  • avoid tight fitting clothing and synthetic materials
  • change pads and tampons regularly (at least every 4-8 hours), use only unscented products
  • avoid vaginal sprays and deodorants
  • change out of damp swimwear and sports clothing
  • avoid long exposure to conditions that are hot and cause sweating
  • wipe front to back after using the toilet
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13
Q

What is bacterial vaginosis?

A
  • imbalance in the normal vaginal flora

- increased growth in organisms (aerobic bacteria) normal found in the genital tract and a decrease in lactobacilli

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14
Q

What are the complications associated with bacterial vaginosis and pregnancy?

A
  • 2nd trimester miscarriage
  • pre-term birth
  • pelvic inflammatory disease
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15
Q

What are the risk factors associated with bacterial vaginosis?

A
  • more common if sexually active
  • new sexual partner
  • IUD
  • douching
    (this is NOT sexually transmitted however)
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16
Q

What are the signs of bacterial vaginosis?

A
  • thin, off-white/yellow or grey discoloured discharge

- vaginal pH of 5-6

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17
Q

What are the symptoms of bacterial vaginosis?

A
  • fishy odour (can be stronger after sex)
  • can be asymptomatic
  • minimal itching
  • LACK of inflammation- therefore there is no experience of dysuria or painful intercourse
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18
Q

Is bacterial vaginosis a referral?

A

YES

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19
Q

What is the treatment for asymptomatic BV?

A
  • treatment is not required unless
  • high risk pregnancy
  • prior to IUD insertion or gynecological procedures
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20
Q

What is the treatment for symptomatic BV?

A
  • requires rx treatment

- can use oral metronidazole, oral clindamycin, clindamycin 2% vaginal cream, or metronidazole 0.75% gel

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21
Q

What is the efficacy of yoghurt or L. acidophilus in treating bacterial vaginosis?

A
  • lack of evidence for efficacy
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22
Q

Does the male partner require a treatment for BV?

A
  • no
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23
Q

What is considered a recurrent vaginal infection?

A
  • infection is considered recurrent if it occurs within 1-3 months of previous treatment, occurs in 15-30% of patients
  • diagnosis must be reconfirmed by a physician (for BV)
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24
Q

What is the recommended treatment options for a recurrent BV infection?

A
  • metronidazole 500 mg po bid for 10-14 days
  • metronidazole gel 0.75%, one applicator once a day intra-vaginally for 10 days, followed by suppressive therapy of metronidazole gel bid for 4-6 months
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25
Q

What is the treatment of BV in pregnancy?

A
  • oral treatment is preferred
  • metronidazole 500 mg bid for 7 days
  • clindamycin 300 mg po bid for 7 days
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26
Q

What is a trichomoniasis infection?

A
  • STI caused by trichomonad vaginalis (a protozoa)
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27
Q

What are the risk factors of a trich infection?

A

multiple sexual partners, nonuse of barrier contraception, presence of other STI’s

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28
Q

What are the complications associated with a trich infection?

A
  • low birth weight infants

- tubal infertility

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29
Q

What are the signs associated with a trich infection?

A
  • large amounts of white or yawl frothy discharge (can also be green)
  • redness of the vulva and the cervix
  • vaginal pH > 6
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30
Q

What are the symptoms associated with a trich infection?

A
  • no odour
  • itching
  • vaginal discharge (may or may not have green or yellow discharge)
  • may be asymptomatic
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31
Q

What is the first line treatment for trich infections?

A
  • oral metronidazole
  • 2 Gm single dose
  • 500 mg bid for 7 days
  • cure rate is 90-95%
32
Q

Should sexual partners be treated for trich infections as well?

A

yes (especially important because most men with rich infections are asymptomatic)

33
Q

What is the treatment option available for trich infections in pregnancy?

A
  • metronidazole oral: 2 g as a single dose is preferred, but can also use 500 mg bid for 7 days
34
Q

What is vulvovaginal candidiasis (VC)?

A
  • generally caused by candida albicans (80-90% of cases)

- the normal flora of the vagina can become pathogenic when there is a change in the sexual environment

35
Q

Is vulvovaginal candidiasis sexually transmitted?

A

no

36
Q

What are the signs associated with VC?

A
  • white, clumpy curd-like discharge
  • inflammation and redness in the vaginal area
  • vaginal pH <4.5
37
Q

What are the symptoms associated with VC?

A
  • itching (severe)
  • pain during sex
  • no odor
  • stinging/burning
  • may be asymptomatic
38
Q

What are the risk factors associated with VC?

A
  • medications (antibiotics, hormone ingestion and chemotherapy)
  • menses (rare prior to menses and post menopausal)
  • pregnancy
  • stress
  • immunocompromised
  • diabetes (poorly controlled)
  • clothing (tight fitted and synthetic fabrics)
  • irritants (scented products, douches)
39
Q

What are the goals of treatment in treating vaginal infections?

A
  • relieving signs and symptoms of the infection
  • eradicate the infection
  • prevent recurrence
  • prevent misdiagnosis and therefore a delay in treatment
40
Q

What are the guidelines for a patient to self-treat VVC?

A
  • uncomplicated (not recurrent)
  • previously diagnosed with VVC
  • mild to moderate symptoms
  • NOT pregnant
  • over 12 years old
  • has had less than 3 episodes in the past year, with no signs and symptoms within the last 2 months
41
Q

What are the red flags for referral in a VVC infection?

A
  • first episode
  • less than 12 years of age
  • pregnancy
  • symptoms of fever, pain in lower abdomen, back or shoulder
  • many corticosteroid or immunosuppressive drug use
  • diabetes or an HIV infection
  • recurrent infection (less than 2 months, 4 infections within a 12 month period)
42
Q

What are some of the non-pharms that should be recommended to treat a VVC infection?

A
  • keep tissue healthy and free for irritation by using good genital hygiene
  • avoid vaginal deodorants, douching, harsh soaps and perfumed products
  • avoid tight clothing and synthetic underwear. Recommend cotton underwear and loose fitting undergarments and pants
  • NO evidence that eating yogurt will treat the infection
43
Q

Imidazoles are all ________ in treating VVC? Which ones can you use?

A
  • equally effective (80-90% effectiveness)
  • clotrimazole (canesten)
  • miconazole (monistat)
  • butoconazole (rx)
  • terconazole (rx)
44
Q

What are the different OTC options for clotrimazole?

A
  • intravaginal and topical OTC options
45
Q

What is clotrimazole used for?

A
  • used for mild to moderate fungal infections
46
Q

What are the side effects of clotrimazole?

A
  • itching, burning, bloating and irritation
47
Q

What is the difference in efficacy between the 1 day, 3 day or 6 day treatments for anti-fungals?

A
  • regardless if you use a 1 day, 3 day or 6 day treatment, then your symptoms will all resolve in 7 days
    • THERE IS NO DIFFERENCE
  • with the one day, you have a greater risk of side effects and no faster resolution, so typically do not recommend this
48
Q

What are the side effects mostly seen with miconazole?

A
  • itching, burning, headaches, allergic contact dermatitis, skin rashes
49
Q

OTC antifungals should be used once daily at ______

A

bedtime

50
Q

In what timeframe should patients experience some relief?

A
  • 24-48 hours (may take a week for complete relief)
51
Q

Should tampons or douching be used while on these OTC treatments?

A
  • no! not to be used for 3 days after treatment
52
Q

Should condoms of diaphragms be used while on OTC treatments for vaginal infections?

A
  • not to be used during or for 3 days after treatment

- oil based and may cause either to fail

53
Q

What is the dose of fluconazole?

A
  • single dose oral medication available OTC

- clinical cure 97% within 5-16 days

54
Q

Can fluconazole be used in pregnancy?

A

no, its contraindicated in pregnancy

55
Q

Fluconazole is not recommended for females under the age of ____, unless under the advice of a physician

A

12 y/o

56
Q

What are the side effects of fluconazole?

A
  • headache, nausea, abdominal pain, dyspepsia, dizziness
57
Q

Can butoconazole 2% be used in pregnancy?

A

only to be used in 2nd or 3rd trimester - category C (studies are lacking)

58
Q

What are the side effects associated with butoconazole 2%?

A
  • vaginal irritation, burning, itching

- contains mineral oil

59
Q

Can terconazole be used in pregnancy?

A
  • avoid during 1st trimester (possibility of absorption)
60
Q

What are the side effects of terconazole?

A
  • headache, abdominal pain, vaginal burning or itching, fever, chills
61
Q

Is terconazole a prescription product or an OTC product?

A

rx

62
Q

What is the expected timeframe of improvement of symptoms?

A

within 48-72 hours

63
Q

What is the expected timeframe of symptom resolution?

A

resolution of symptoms is in 7 days

64
Q

After how may days should a person be referred?

A

if symptoms do not resolve in 7 days

65
Q

Should be a referral if there is a recurrence of symptoms within _____

A

2 months

66
Q

Should we be recommending products with benzocaine in it?

A
  • NO! They are said to relieve itching but can cause local reactions, therefore they are generally not recommended
67
Q

Recurrent candidiasis is wen there is more than ___ episodes in one year

A

4

68
Q

Recurrent candidiasis is more likely in women with what conditions?

A
  • uncontrolled diabetes
  • immunosuppression
  • pregnancy
69
Q

What is typically the initial treatment of a recurrent candidiasis infection?

A
  • fluconazole 150 mg every 72 hours (3 doses)
  • topical azoles for 10-14 days
  • boric acid intravaginally for 14 days
70
Q

What is typically used as maintenance for recurrent candidiasis infections?

A
  • minimum of 6 month treatment- relapse rate is high
  • fluconazole 150 weekly
  • ketoconazole 100mg OD
  • clotrimazole 500mg once a month
  • boric acid 300mg intravaginally for 5 days each month beginning on first day of menstrual cycle
71
Q

You can self medicate for uncomplicated VVC only when the patient has _______

A

been diagnosed by a physician

72
Q

What is toxic shock syndrome?

A
  • an acute illness caused by a toxin producing Staphylococcus aureus (commonly found pathogen in the vulvar tissue)
73
Q

Who is at risk for TSS?

A
  • menstruating women using tampons, women using contraceptive spouse, diaphragm, cervical cap
  • anyone with a surgical wound infection
74
Q

What are the symptoms associated with TSS?

A
  • sudden high fever, diarrhea, vomiting, disease, weakness, muscle aches, fainting or near fainting, sunburn-like rash in the palms of the hand and the soles of the feet
75
Q

Does someone that exhibits signs of TSS need to be referred to the doctor?

A
  • yes, they do

Clinical Pharmacy (24 decks)

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