Clindamycin (Rx)

Used to treat Bacterial Vaginosis

2% insert 1 supp vag nightly x7d

300mg BID x7d

    Metronidazole (Rx)

Used to treat Bacterial Vaginosis

0.75% gel, insert 5g vag BID x5d

2 gm dose po once

500mg BID x7d

Povodine/iodine (Rx for compounding)

used to treat BV

Reduce TOTAL vaginal flora

Insert 1 (5 gm) suppository BID x 14-28 days

NO pregnancy or breastfeeding (systemic absorption)

Metronidazole (Rx)

Used to treat Trichomoniasis

500mg BID x7d

Tinidazole (Rx, resistant infections)

used to treat Trichomoniasis

2g as single dose

Lactobacillus acidophilus

Used to as prevention of Vulvovaginal Candidiasis

Butoconazole 2%

Used to treat Vulvovaginal Candidiasis

3 day intravag cream

Clotrimazole 1% or 2%

Used to treat Vulvovaginal Candidiasis

3-7 day intravag cream

Miconazole 2% or 4%

Used to treat Vulvovaginal Candidiasis

1, 3, 7 day intravag cream OR sup

Ticonazole 6.5%

Used to treat Vulvovaginal Candidiasis

1 day intravag ointment

Lactobacillus acidophilus

Used To re-establish normal flora in the vagina

8oz. po yogurt, potentially prevent recurrent VVC

Vaginal antibacterial/antifungal

used as vaginal suppositories, 200mg vag sup qhs x6 nights

risk allergic dermatitis

Gentian violet

Use with 1 tampon soaked and inserted vag for several hours or overnight x1-5 days

Risk staining fabrics/skin

Boric acid

600mg QD-BID x14d

Risk toxic, teratogenic

top cause of vaginal symptom, increases vaginal pH, smells fishy and can itch.

Can cause UTI, pretem labor and low birth rate. Increases HIV transmission. Is in 12% of virginal adolescents.

Treated with clindamycin, metronidazole, and povodine/iodine (all of these are vaginal suppository)

- 2^nd top cause of vaginal symptoms.

 Caused by fungi, does not change pH, cause thick “cottage cheese” liquid with no odor.

Increases transmission of infections.

Treated with butoconazole, clotrimazole, miconazole and ticonazole.

3^rd top cause of vaginal symptoms.

Caused by protozoan. Increases pH, causes a yellow-green liquid with a malodorous odor.

 In 50% of women no symptoms at first, then can cause pruritus, erythema.

Is treated by metronidazole and tinidazole.

inflammation of vagina, and can decrease estrogen levels.

Can cause dyspareunia (painful sex)

is painful sex.

Can be caused by diaphragm not fitting correctly, menopause, hemorrhoids, herpes, genital warts and other STDs, menopause, anti-estrogen medication and transient state of estrogen deficiency (such as breast-feeding and childbirth)

Astroglide, KY, Durgel, Vagisil Intimate Moisturizer

glycerinl; propylene glycol.

 Used for atrophic vaginitis and dyspateunia

Hydrocypropyl methlcellulose.

Used for atrophic vaginitis and dyspateunia

glycerin; hydroxyethylcellulose.

Used for atrophic vaginitis and dyspateunia

vitamin E; propylene glycol gel.

Used for atrophic vaginitis and dyspateunia

propylene glycol; glycerin; acacia honey type O. U

sed for atrophic vaginitis and dyspateunia

glycerin; mineral oil.

Used for atrophic vaginitis and dyspateunia

Black cohosh

Cimicifuga Racemosa

Used for PMS, dysmenorrhea, menopausal symptoms

Suppresses LH levels, binds to estrogen receptors and contains small levels of salicylic acid.

 Cant interact with oral contraceptives and estrogen therapy. Take 20mg BID

Do not use with Oral contraceptives, or Estrogen replacement therapy, and may cause hepatotoxicity

Cranberry

Used to prevent UTIs by Inhibiting E. coli adherence

Active ingredient: hipurric acid

Do not take with Warfarin or trace amounts of salicylic acid in juice

300mg-400mg BID or 8-16oz daily

may cause kidney stones

Dong quai

Used for PMS, dysmenorrhea, menopausal symptoms

It enhances endogenous estrogen production and serotonergic activity

Do not take with Warfarin

4.5gm powdered rood QD. It is safe for up to 24 wks.

Fenugreek

Used to promote lactation, control glucose, decrease appetite, and as flavoring agent (maple)

The MOA is unknown, but it does reduce after-meal glucose levels

Do not take with antidiabetics or antiplatelets

2300mg BID-TID, May give breast milk mild maple smell, May decrease blood sugar levels

Panax ginseng

Used for male fertility, impotence, premature ejaculation. Also for coping with stress

Can help with hyper/hypotension and is a CNS stimulant and used for depression. Also enhances synthesis of NO

Do not use with ethanol, anticoagulants, antidiabetics, and caffeine

900mg po TID or topically applied 1hr prior to intercourse. Can be safe for use up to 3 months

Used to improve lower urinary tract symptoms due to BPH (benign prostatic hyperplasia)

May inhibit 5-alpha-reductase and have local antiestrogenic/anti-inflam effects

Do not take with tamsulosin, alpha-adrenergic blocker, avodart or proscar

160mg BID or 320mg QD, recommended for up to 1yr of use

Used for psychologic or organic erectile dysfunction. Increases sexual vitality

Is used as an Alpha-2 antag (central and peripheral), a CNS stimulant and increases nerve impulses to genital tissue

Do not take with antihypertensive( other alpha-2 antagonist), MAOIs, and caffeine

15-30mg QD, generally considered UNSAFE for OTC, due to risk of hyper/hypotension and may have synergistic effect with L-arginine

Women use to help prevent pregnancy

Different sponges are today, protectaid pharmatex. All which have some sort of spermacide

Levonogestrel 1.5mg (progestin only tablet)

Uses: within 72 hrs after unprotected sex, method failure, sexual assault

may cause abdominal pain may indicate ectopic pregnancy

Pyridoxine (vitamin B6)

Used to treat PMS

Take 100 mg a day

Used to treat PMS symptoms

Take 400 IU for mastalgia

Calcium & Vitamin D

Used to treat PMS symptoms

1200mg/400 IU daily to prevent PMS mood/physical symptoms

Primary treatment. Is effective. Decrease sx by ~50%

Used to treat PMS

take 360mg D for 7 days prior to period

Used to treat PMS symptoms

Start 1 week prior and during 1^st few days of menses

Is usually effective. Decreases physical and mood sx

VITEX (chasteberry)

Treats physical and mood sx

20-40mg daily for progressive improvement of PMS over several cycles

Cautions: pregnancy, but typically well tolerated

Likely effective

Gingko

Primary mastalgia and fluid retention treated

80mg BID on days 16-day 5

Caution: antiplatelets, antidepressants, omeprazole

Likely effective

Black cohosh

Treats physical and mood sx

40-80mg BID

No cautions

Possibly effective

Treats mood (MAOI)

300mg QD

Caution with xanthines

Possibly effective

Evening Primrose Oil

o   INEFFECTIVE

Caffeine

Increases PMS irritability

Xanthine class: DO NOT TAKE if history of peptic ulcer disease or taking MAOIs

Increase gastric pH by neutralizing gastric acid

Also stops pepsin at pH > 5

Work better for duodenal ulcers (from H. pylori)

Obsolete

May cause hypernatremia, systemic alkalosis, belching, feedback stim of gastric acid secretion from CO2 formation

Do NOT give for an antacid

Calcium-induced feedback stim of gastric acid secretion

Magnesium salts

Mg-hydroxide, carbonate, or silicate are effective and well tolerated

May cause diarrhea

Milk of magnesia: pure magnesium hydroxide

Al-hydroxide, silicate are effective and well tolerated

May cause constipation

Very little absorption of aluminum in GI (<1% of dose)

Optimal antacid: mixture of Mg and Al oxides/silicates

Neutralize HCl, form gel-like structure which absorbs pepsin, will not interfere w/ GI motility

***watch for kidney impairment (renal elim of surplus Mg)***

Al + Mg hydroxide examples

Riopan, Gelusil, Kudrox, Maalox liquid

High calcium carbonate content

Maalox quick dissolve tabs, Rolaids, Tums-ex

Analog of PGE1, is like PGE2: prevent/counteract inhib of PG formation (NSAIDS)

Increases gastric blood flow (vasodilation), Increases mucus and bicarb secretion, and inhibits gastric acid production

May induces painful ab cramps, Diarrhea, and Contractions of uterus ***MUST NOT BE GIVEN TO PREGNANT WOMEN***

Sucralfate (Carafate)

is a mucusal protectant that uses Sulfate sucrose + aluminum hydroxide

acquires neg charge, binds/inactivates, May stimulate protective factors (mucus, PG formation)

Can absorbs several other drugs and should be taken before meals

Bismuth salts

Colloidal bismuth subcitrate

Cause the formation of mucosal protectant and inhibits growth of H. pylori

Histamine H2 receptor antagonists

Blocks stim effects of histamine and gastrin on gastric acid production and partially antagonizes effect of vagal stim

Examples- Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid), Nizatidine (Axid)

Proton pump inhibitors

Irreversibly inactivates H+/K+ ATPase and Reduces both basal and stimulated acid release

Prolonged use favors bacteria growth in stomach, B12 absorption.

Recommended use 8 weeks, will inhibit CYP and interact with warfarrin

First PPI, standard drug

Is a prodrug, absorbed in small intestine, reaches parietal cell via circulation

Weak base, accumulates in acidic environment of canaliculi

Acid catalysis converts into reactive sulfonamide => readily reacts with electrophiles

Covalent binding inactivates pump irreversibly

Is an S-isomer of omeprazole

Only advantage: higher and more reproducible bioavailability (>70%)

More expensive than omeprazole

Proton Pump inhibitor that is Available as IV prep

Rabeprazole (Aciphex)

Antihistamines

OTC meds of choice for PREVENTION of N/V related to motion sickness (NOT TREATMENT)

Primary side effect: drowsiness and anticholinergic effects (worse with diphenhydramine and dimenhydrinate)

Adult dose:         25-50mg every 4-6hrs

Age 6-12:             12.5-25mg every 6-8hrs

Age 2-6:               6.25mg every 4-6hrs

Dimenhydrinate

Is an antihistamine

Adult dose:         50-100mg every 4-6hrs

Age 6-12:             25-50mg every 6-8hrs

Age 2-6:               12.5-25mg every 6-8hrs

is an antihistamine

Adult dose:         50mg 1hr before travel, then 60mg every 4-6hrs

Age 6-12:             25mg every 6-8hrs

Age 2-6:               DO NOT USE

is an antihistamine

Adult dose:         25-50mg 1hr before travel

Age 6-12:             DO NOT USE

Age 2-6:               DO NOT USE

is a pregnancy category A used for nausea and vomiting

12.5mg 3-4 times daily

is a pregnancy category A used for nausea and vomiting

10-25mg 3-4 time daily

Usual dose: 1000mg daily in divided doses

Side effect: increased bleeding

reversibly block sensory nerve tranmission

example- benzocain 5-20% and pramoxine 1%

Temporarily relives pain, itching, burning

Systemic absorption minimal

structurally similar to epi/NE and stimulates alpha-adrenergic receptors causing vasoconstriction

temporarily relieves pain, itching, burning

Protectants

Forms protective barrier on skin, preventing water loss and irritation

Glycerin, lanolin, mineral oil, white petrolatum, zinc oxide, cocoa butter

Use up to 6 times a day, or after each bowel movement

Astringents

Cause coagulation of skin cells, protecting underlying tissue

examples- witch hazel, zinc oxide

Use up to 6 times a day, or after bowel movements

Keratolytics

Used to treat anorectal disorders 

May cause sloughing of epidermal cells and may expose underlying tissue for applying other meds

examples- resorcinol and alcloxa

Use up to 6 times a day, external only, but is not recommended for treatment

Analgesics/anesthetics/antipruritics

Relive pain, itching, and discomfort when applied externally

examples- camphor and menthol

Use up to 6 times a day, external only

Can be used for anorectal disorders

Can cause vasoconstriction and relieve itching

examples- hydrocortisone 1%

Use only 3-4 times a day

Methylcellulose (Citrucel), Psyllium (Metamucil), Polycarbophil calcium (Fibercon)

Bulk Laxatives

Dissolve or swell in intestinal lumen, and inreases stool mass and softens consistency

Do not take with digoxin, warfarin, tetracyclines, nitrofurantoin, Ca and Fe

Docusate calcium (Surfak), and Docusate sodium (Colace, Dulcolax)

Emollient Stool softeners

Surface active agents allow water to penetrate stool mass and intestinal lumen

Saline Laxatives

Magnesium hydroxide (milk of magnesia), Magnesium citrate, and Sodium phosphate (Fleet enema)

non-absorbable ions that draw water into rectum to stimulate bowel movement

Hyperosmotic laxatives

Examples- Glycerin suppositories (Fleet), Polyethylene glycol (MiraLax)

Poorly absorbed molecules that cause osmotic effect and draws water into rectum, stimulating bowel movement

Increase intestinal motility by irritation of mucosa and stimulate water secretion into intestinal lumen

examples- Bisacodyl (Dulcolax, Correctol), Senna (Senokot, Ex-lax), Castor oil

Cascara sagrada

Herbal Remedy for constipation

not approved by the FDA

do not use if pregnant or breastfeeding

herbal remedy for constipation

not approved by FDA

do not use is pregnant or breastfeeding

Helps maintain normal flora and aid in digestion

May be useful to increase frequency and consistency of stools

Binds to mu receptors in intestine, slows motility, does not usually cause CNS side effects and allows for absorption of fluid and electrolytes, decreases GI secretion

4mg initially, followed by 2mg after each loose stool

Reacts with HCl in stomach to form bismuch oxychloride/salicylic acid

examples- Pepto bismol, Kaopectate

Take 2 tablets every hours up to 16 tablets per day

do not take if under 12, pregnant, AIDS or ASA allergy. Also can decrease antibiotic absorption

Saccharomyces boulardii

Herbal remedy for diarrhea

Evidence shows it is good for reducing occurrence of antibiotic-assoc diarrhea when given with the antibiotic and continued after for at least 1 week

May reduce severity/duration in children who are malnourished

Only studied in children with low zinc levels

Avoid in renal disease, pregnancy, breastfeeding

Avoid zinc chloride salt

Studies suggest infants/young children <3y/o may have fewer bowel movements/less diarrhea

inflammation of the stomach lining

type A- autoimmune destruction of acid-secreting mucosa of the stomach

type B- caused by H pylori, which causes antral mucosa to be inflammed