Ch 48 Flashcards
UTI
The largest number of urinary tract disorders are caused by urinary tract infections (UTI’s). A UTI is a microbial infection of any part of the urinary tract.
can be lower (including cystitis (bladder infection), urethritis, or prostatitis) or upper (also referred to as kidney inf such as pyelonephritis)
Lower UTI including cystitis (bladder inf), urethritis, prostatis
- Cystitis frequently occurs in female patients-short urethra
- Commonly caused by gram neg E. coli, Maybe other gram neg/pos bacteria
- In male patients, lower UTI is most likely prostatitis with symptoms like cystitis
- Urine analysis (UA) and urine culture obtained to diagnose and determine treatment
symps of cystitis
pain and burning on urination, and urinary frequency and urgency
Upper UTI (also referred to as Kidney infection) such as pyelonephritis
- Commonly seen in women of childbearing age, older women and young girls.
- E. coli is most common cause of pyelonephritis
- Urine analysis (UA) and urine culture obtained to diagnose and determine treatment
symptoms of upper UTI / pyelonephritis / kidney infection
chills, high fever, flank pain, pain and burning with urination and urinary frequency and urgency
urinary antiseptics/antiinfectives
nitrofurantoin, methenamine, trimethoprim, ertapenem and the fluoroquinolones.
prevent bacterial growth in kidneys and bladder: tx of UTIs.
c. have bacteriostatic effects (inhibit bacterial growth) when given in lower dosages, and bactericidal (bacteria killing) effects when given in higher doses
e. Drug action occurs in the renal tubule and bladder, reducing bacterial growth
f. Urinalysis and culture & sensitivity (C&S) are performed before antibiotics are started
g. As bactericidal agents, these drugs have potential to cause superinfections
Nitrofurantoin
urinary antiseptic/antiinfective.
a. First prescribed to treat UTI’s in 1953
b. Bacteriostatic or bactericidal depending on the dosage
effective against many gram-positive (including S. aureus, staphylococci) and gram-negative (including E. coli, Neisseria, Klebsiella)
c. Treatment for acute or chronic UTI
d. well absorbed from GI, take w/food for upset
e. normal renally eliminated half-life 20 mins, but will accumulate in serum w/urinary dysfx
f. peak action 30 mins after absorption
g. contact doc for any dyspnea/CP/cough/fever-symps will resolve after d/c. also call for any superinfection symps ie diarrhea or discharge
h. CI: allergy, mod-severe renal, oliguria, anuria, infants <1mo, pregnant/lactate w/ G-6-PD def
i. prec: vit b def, electrolyte imbalance, DM
j. monitor urine output/urine specific gravity for renal dx
ad rxn: C DIFF, peripheral neuropathy, the dyspnea stuff
k. SE: gi, CP, cough, brown urine, diarrhea, rash
no antacids, fluoroquinolones, BC.
know that urinary antiseptics cause false positives in glucose/urine tests.
tell pt to rinse mouth: this med stains teeth.
no driving until know how it affects u.
increase fluids.
methenamine
urinary antiseptic/antiinfective
a. Produces bactericidal effect when urine pH <5.5 by forming ammonia and formaldehyde. Cranberry juice, ascorbic acid, ammonium chloride can be taken to decrease urine pH.
i. Acidic urine is hostile to bacteria
b. Effective against gram+ and gram- (especially gram- E. coli and P. aeruginosa)
c. Should not be taken with sulfonamides: crystalluria
crystalluria
accumulation of crystals in the urine
can lead to kidney stone formation.
Trimethoprim and Trimethoprim-Sulfamethoxazole
a. Trimethoprim (antiinfective) is usually used with Sulfamethoxazole (antibacterial)
b. generic name: TMP-SMZ
c. prevention/treatment of acute and chronic UTIs
d. Especially resistant to S. aureus and methicillin resistant S. aureus
e. May cause GI symptoms, rash, pruritis
f. DO NOT GIVE TO PREGNANT WOMEN/SOMEONE WITH FOLIC DEFICIENCY
Fluoroquinolones (urinary antiseptic/antiinfective)
a. incl ciprofloxacin, levofloxacin
b. lower UTI’s
c. Reserved for patients with no alternative treatment options: increased risk for tendon rupture (either direct or indirect tissue damage, exact mechanism unknown), exacerbate muscle weakness in patients with MG, peripheral neuropathy
d. renal dosing
e. SE Photosensitivity
f. no driving, esp if dizzy w drug.
g. Take with food
h. no antacids
h. Report signs of superinfection or secondary fungal or bacterial infection
Urinary Analgesics
Used for relief of symptoms associated with cystitis including urinary pain, burning, frequency and urgency. Do not have antiseptic/antiinfective properties.
phenazopyridine
urinary analgesic
i. Azo dye combined with dimethyl sulfoxide (DMSO) relieving urinary pain and burning symptomatic of lower UTI’s
ii. Available almost 40 years
iii. se GI, hemolytic anemia, nephrotoxicity, and hepatotoxicity
iv. Urine turns reddish/orange due to dye
v. Glucose of the urine can be affected > serum blood glucose labs
Urinary Stimulants
Used for urinary retention, to stimulate micturition (urination) when bladder function is decreased or lost d/t neurogenic bladder, spinal cord injury or severe head injury
bethanecol (urecholine)
urinary stimulant
i. Direct acting parasympathomimetic
1. Drug action increases tone of the detrusor urinal muscle, producing a contraction strong enough to stimulate urination
