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Pharm Exam 3 > ch 76 > Flashcards

ch 76 Flashcards

1
Q

What are the characteristic inflammatory syndromes that result from bacteria invading tissues of the urinary tract

A

Urethritis
Cystitis
pyelonephritis
prostatitis

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2
Q

Cystitis and urethritis are considered ______ tract infections

A

lower

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3
Q

pyelonephritis is considered an __________ tract infection

A

upper

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4
Q

A UTI associated with a predisposing factor such as calculi, prostatic hypertrophy, indwelling catheter or urinary obstruction are considered (men or women)

A

complicated

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5
Q

Uncomplicated UTIs occur primarily in who?

A

women of childbearing age and are not associated with any predisposing factors

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6
Q

antibiotic classes to treat UTIs

A 
sulfonamides
tirmethoprim
prnicillins
aminoglycosides
carbapenems
cephalosporins
fluoroquinolones
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7
Q

2 urinary tract antiseptics

A

nitrofurantoin

methenamine

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8
Q

More than 80% of uncomplicated UTIs are caused by what bacteria

A

E.coli

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9
Q

what are other potential UTI causes that are gram neg bacilli

A 
Klebsiella pneumoniae
Enterobacter
Proteus
Providencia
Pseudomonas species
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10
Q

What is one gram positive cocci that account for 10-15% of community associated infections

A

stapylococcus saprophyticus

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11
Q

Hospital associated UTIS are frequently caused by

A 
Klebsiella
proteus
enterbacter 
pseudomonas species
staphylococci
enterococci
E.coli is is responsible for less than 50% of HA UTIS
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12
Q

clinical manifestations of acute cystitis

A 
dysuria
urgency
frequency
suprapubic discomfort
pyuria
bacteriuria
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13
Q

for community associated acute cystitis, what 3 types of oral therapy can be employed?

A

1) single dose therapy
2) short-course therapy (3 days)
3) conventional therapy (7 days)

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14
Q

what treatment therapy is recommended for uncomplicated, community associated infections in women that are not pregnant and whose symptoms began less than 7 days before starting treatment?

A

single-dose and short course - short course is preferred because it is more effective

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15
Q

conventional therapy is indicated for all patients who do not meet the criteria for short-course therapy who include

A

males
children
pregnant women
women with suspected Upper tract involvement

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16
Q

for uncomplicated cystitis what are your drugs of choice

A

trimethoprim/sulfamethoxazole

Nitrofurantoin

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17
Q

In communities where resistance to the drugs of choice (>20%) what is your next line of treatment for uncomplicated cystitis?

A

fluoroquinolones (ciprofloxacin)

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18
Q

what is the one dose treatment for Uncomplicated cystitis when compliance is a concern?

A

fosfomycin

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19
Q

acute uncomplicated pyelonephritis is an infection of the

A

kidneys

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20
Q

clinical manifestations of acute uncomplicated pyelonephritis

A 
fever
chills
severe flank pain
dysuria
frequency
urgency
pyuria
bacteriuria
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21
Q

treatment of mild to moderate uncomplicated pyelonephritis

A

treated at home with oral abx
fluroquinolones
trimethoprim/sulfamethoxazole

22
Q

treatment of severe pyelonephritis

A 
hospitalization
IV ABX
options include
ciprofloxacin
ceftriaxone
ceftazidime
ampicillin plus gentamycin
ampicillin/subactam

after you have gained control with IV abx
switch to oral abx within 24 -48 hours

23
Q

complicated UTIs occur in

A

males and females who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection

24
Q

duration of treatment for a complicated UTI

A 
7 days (cystitis)
14 days (pyelonephritis or with systemic involvement)
25
Q

what is caused by recolonization with the same organism responsible for the initial infection

A

relapse

26
Q

what is caused by recolonization with a new organism

A

reinfection

27
Q

more than 80% of recurrent UTIs in female are due to

A

reinfection

28
Q

when reinfections are frequent (3+ per year) long term _______may be indicated

A

prophylaxis

29
Q

what meds are used for prophylaxis

A

trimethoprim (100mg)
nitrofurantoin (50 or 100 mg)
trimethoprim/sulfamethoxazole (40mg/200mg)

30
Q

prophylaxis should continue for at least

A

6 months

31
Q

what can you do if reinfection is r/t intercourse

A

void after intercourse

single dose prophylaxis of trimethoprim/sulfamethoxazole 80mg/400mg) taken after intercourse

32
Q

acute bacterial prostatitis

A

inflammation of the prostate caused by local bacterial infection

33
Q

clinical manifestations of acute bacterial prostatitis

A 
high fever
chills
malaise
myalgia
localized pain
various urinary tract symptoms
34
Q

for severe infection of acute bacterial prostatitis with E coli causing acute bacterial prostatitis

A

start with an iv agent (a fluoroquinalone (ie)ciprofloxacine)
followed by 2-4 weeks with an oral agent (either doxycycline or a fluoroquinolone)

35
Q

treatment for severe infection of acute bacterial prostatitis with vancomycin - sensitive E faecalis

A

start with iv ampicillin/sulbactam

followed by 2-4 weeks with oral amoxicillin, levofloxacin or doxycycline

36
Q

what is the first choice drug for uncomplicated cystitis?

A

Nitrofurantoin

37
Q

what are the trade names for Nitrofurantoin

A

Furandantin
Macrodantin
Macrobid

38
Q

Nitrofurantoin (Macrobid) is active against a large number of what type of bacteria

A

gram-positive
gram negative

staphylococci
streptococci
Neisseria
Bacteroides 
strains of E coli
39
Q

what organisms are frequently resistant to Macrobid

A

Proteus
Pseudomonas
enterobacter
klebsiella

40
Q

therapeutic use for Nitrofurantoin (Macrobid)

A

infections of the lower urinary tract

prophylaxis of recurrent lower UTI
not recommended for infections of upper UTI

41
Q

adverse effects of Macrobid

A

anorexia
n/v/d

dyspnea
chest pain
chills 
fever
cough

leukopenia
hemolytic anemia - gpd6 and in newborns

demyelination and nerve degeneration
muscle weakness
tingling

severe liver injury - manifests as
hepatitic necrosis
cholestatic jaundice

42
Q

how do you minimize GI upset with macrobid

A

take with food or milk

43
Q

macrobid and newborns

A

contraindicated

44
Q

macrobid in preganant women

A

contraindicated

45
Q

antimicrobial spectrum of methenamine (Hiprex, Urex)

A

virtually all bacteria are susceptible to this med, virtually no resistance

46
Q

Methenamine (Hiprex, Urex) is used for

A

chronic infection of the Lower urinary tract

47
Q

Uncomplicated acute cystitis
allergic to sulfa or nitro or renal dysfunction
allergic to beta lactam antibiotics or known resistance

A

Fluoroquinolone

Ciprofloxacin or Levofloxacin

48
Q

Uncomplicated acute cystitis
allergic to sulfa or nitro or renal dysfunction
No allergy to beta lactam abx or known resistance

A

Augmentin
Cephalexin

seeing community resistance now

49
Q

what do you treat infants with uti

A

ampicillin and gentamycin

50
Q

can you give nitrofurantoin in infants

A

not less than 1 month

Pharm Exam 3 (19 decks)

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