Drugs for UTIs Flashcards
What does TMP-SMX stand for?
Trimethoprim - Sulfamethoxazole
MOA for TMP?
(-) bacterial dihydrofolate reductase needed to make tetrahydrofolic acid for DNA replication
MOA for SMX?
Competes with PABA binding to dihydropteroate synthetase needed to make tetrahydrofolic acid for DNA replication
TMP-SMX is active against?
MRSA and pathogens seen in immunocompromised patients
What are possible adverse effects of TMP-SMX?
N/V, rash, pruritus, resistance has developed
MOA for Fosfomycin?
Inactivates Pyruvyl Transferase to (-) cell wall synthesis
When is Fosfomycin used and what kind of resistance does it have?
Acute uncomplicated cystitis
- Low resistance
MOA for Nitrofurantoin?
Becomes reactive intermediates that alter bacterial ribosomal proteins
When is Nitrofurantoin used?
Acute uncomplicated cystitis
What are the possible side effects of Nitrofurantoin?
C. Difficile superinfection
Pulmonary and liver toxicity
Sensorimotor polyneuropathy
MOA for Ciprofloxacin/Levofloxacin?
(-) DNA gyrase and/or Topoisomerase IV
Adverse effects of Ciprofloxacin, but mostly Levofloxacin?
Tendonitis/Tendon rupture
– Peripheral neuropathy, CNS issues, myasthenia gravis exacerbation
What is the most common side effect with Cephalosporins?
Allergic reactions
What generations of Cephalosporins are usually used with UTIs?
Gen 1 and 3
What Gen 1 Cephalosporins are used with uncomplicated UTIs?
Cephalexin
Cefadroxil
What Gen 1 Cephalosporins are used with Uncomplicated UTIs?
Cephalexin
Cefadroxil
What Gen 3 Cephalosporins are used with UTIs?
Ceftriaxone
Cefpodoxime
Cefdinir
Which Gen 3 Cephalosporin is used for Complicated UTIs and what is a possible side effect?
Ceftriaxone
– Bleeding
What is special about Ceftriaxone?
It is eliminated by both the kidney and liver so one of those organ dysfunctions does not mean the drug needs a dosage alteration
Which Gen 3 Cephalosporins are used for Uncomplicated UTIs?
Cefpodoxime
Cefdinir
Piperacillin + Tazobactam are active against?
Gram (+) and (-) and Pseudomonas Aeruginosa
Piperacillin + Tazobactam are used when?
Complicated UTI
What is Vancomycin active against?
MRSA
MOA for Linezolid?
(-) protein synthesis initiation
What is linezolid active against and what is a con about it?
Gram (+) and VRE
– (-) MAO which causes drug interactions
What is Imipenem active against?
Many multiresistant strains
MOA for Daptomycin?
Cyclic lipopeptide that binds cell membrane to cause depolarization
=> (-) synthesis of DNA, RNA, proteins
What is Daptomycin active against and what is weird about its usage?
Gram (+) only
- Lacks approval for VRE but still a 1st line agent for UTI even due to VRE
What are some side effects of Daptomycin?
Bloating, swelling, weight gain
MOA for Chloramphenicol?
(-) 50s subunit to prevent growing peptide chains
When is Chloramphenicol used?
When less toxic agents are ineffective/contraindicated
Possible adverse effects with Chloramphenicol?
Blood diseases: - Aplastic/hypoplastic anemia - Thrombocytopenia - Granulocytopenia Grey baby syndrome
MOA for Gentamicin?
(-) 30s subunit to prevent growing peptide chains
What are the adverse effects associated with Gentamicin?
Neurotoxicity, Nephrotoxicity, Ototoxicity
If acute cystitis is due to MDR gram (-), what 2 agent should be considered?
Nitrofurantoin
Fosfomycin
Otherwise for acute cystitis, what are 3 1st line agents?
Nitrofurantoin
TMP-SMX
Fosfomycin
Otherwise for acute cystitis, what are the 2nd and 3rd line agents?
- Cephalosporins gen 3 or 1
- Fluoroquinolones
For uncomplicated pyelonephritis, what are first line agents?
Fluoroquinolones – ciprofloxacin/levofloxacin
With uncomplicated pyelonephritis, if resistance is > 10% what should be added?
Initial dose of ceftriaxone or 24 hour dose of aminoglycoside
For uncomplicated pyelonephritis, what is a second line agent?
TMP-SMX
