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Renal and Urinary 3 > Antibiotics for Bacterial Infections of the Bladder and Kidney > Flashcards

Antibiotics for Bacterial Infections of the Bladder and Kidney Flashcards

1
Q

Goals for ABs

A

Cure infection and minimize collateral damage

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2
Q

Example of side effects

A

AIN - penicillins
Lung and neuro - nitrofurantoin
Tnedonitis and seizures - FQs
Skin, especially with sulfa drugs

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3
Q

Normal flora benefits

A

Defend against pathognens

Vit K form E coli

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4
Q

Pathogens associated with decrerased normal flora

A

Clostridium difficile

Vaginal - candida
Fecal bacteria colonize vagina and ascend to bladder - cystitis

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5
Q

Vit K and normal flora

A

Dec in E coli…less Vit K…dec vitamin K —-excessive anticoagulation and increased bleeding risk…warfarin

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6
Q

Empiric tx

A

Start based on clinical scenario and most likely organisim if clinical scenario is very convincing and elay in RX would lead to sginificant problem

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7
Q

If cultre is available and susceptible to more than 1 drug

A

Chose most narrow spectrum, fewest risks and not allergic

If you start empiric, when culture returns, then de-escalate

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8
Q

Tx of cystitis

A

Nitrofuranton
Bactrim
Fosfomycin

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9
Q

Nitrofurantoin

A

Reduced by nitrofuran reductse…reactive intermediate damage DNA

Active against E coli and staph saprophyticus

Gets into urine only, no tissue…good because less vaginits and diarrhea
Bad bc not for pyeloneprhitis

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10
Q

Nitrofurantoin adverse effective

A 
Lung toxicity (fibrosis)
Neurotocic
Hemolyitc anemia if G6PD def
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11
Q

Bactrim

A

Sulfonamide inhibit dihydropteroate syntehtase

Trimeprhotim - dihydrofolate reductase inhibitor

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12
Q

Bactrim clinical

A

2 step inhibito of folate ysnthesis

May be allergic

If not tested and delay in tx not risky, okay to try TMP alo9ne

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13
Q

Bactrim spectrum

A

Strep pneumo
Staph (MRSA)
Gram neg rods except pseudomonoas

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14
Q

SMX main risks

A

Avoid if pregnant…displaces bilirubin from albumin and leads to encephalopathy in newborn

Hemolytic anemia (G6P)

Skin reactons - spearate epidermis from dermis

Fixed drug eruption

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15
Q

Fixed drug eruption

A

Immune mediated and same place each time drug taken

Genitalia or motuh

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16
Q

Separation of epidermis from dermis

A

Delayed HS rxn

Name depends on how much…less than 10% - SJS
Over 30% - toxic epidermal necrolyssi

17
Q

SJS and TEN

A

Warn pts about prodrome

Very dangerous

18
Q

Fosfomycin

A

INhibitor of peptidgolycan syntehsis

Not same that beta-lactams target

Usual specturm - E coli, enterococcus faecalis

19
Q

Fosfomycin clinical use

A

Cystitis only***

SIngle dose into water and drink

Avoid if preg of lactating

20
Q

Beta lactams

A

Inhibits DD-transpeptidase enzymes

21
Q

Aminopenicillins

A

AMoxicillin

NOT okay for empiric cystitis tx but okay to use if culture shows suscetiblity

Covers some gram pos and neg…not stpah or pseudomonas….many E coli are resitant

OKay to use in pregnancy

Cause AIN

22
Q

Bacterial resistance to Blatctams

A

B lactamases

Altered DD-transpeptidades which have less binding (use higher dose) or don;t bind at all (MRSA)

23
Q

Amox+clavulante

A

Clav inhibts beta lactamase

Do NOT combine if it is susceptible to amoxicillin

24
Q

Cephalosporins

A

Very different between generations
MRSA reistant until 5th

OKay to use during preg

25
Q

Ceftriazone

A

Strep, not entero
Staph except MRSA
Gram neg except psuedomonoas
Neisseria honorr

Use for empiric cystitis - alternate
Emperic pyeloneprhotis

26
Q

Drugs NOT routinely use to cystitis

A

Aminopenicillins - many are resistant…can use if susceptibel

FQs - effective but risky

27
Q

Pyelonprhitis only

A

FQs ,
AMinoglycosides
Carbapenems

28
Q

FQs

A

Inhibit bacterial enzymes

Most gram negative rds including pseudomonas but increase reisstance

Some gram+ but variable

29
Q

FQs and UTIs

A

Ciprofloxicin

Good for outatient because good tissue penetration and oral bioavailbality

NOT for uncomplication cystitis unless no other options

30
Q

FQ adverse rxn

A

Tendonitis - achilles rupture

Seizures - displaces GABA…more likely if taking NSAIDs, avoid if epileptic

May cause false+ urine opiate test

31
Q

Aminoglycosides

A

Inhibit ribosomal protein syntehsis

Must give IV

Most gram - including pesuodomonas

Think of these for gram -

32
Q

AG adverse rxns

A

Kidney
Ear
NM blockade (avoid in MG)

33
Q

Carbapenems

A

Must give IV

Reistant to most Beta-lactamses

Very broad

Disadvantages - more change in normal flora nad risk of superbugs

Renal and Urinary 3 (22 decks)

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