Drugs for UTIs

Question 1

What does TMP-SMX stand for?

Answer 1

Trimethoprim - Sulfamethoxazole

Question 2

MOA for TMP?

Answer 2

(-) bacterial dihydrofolate reductase needed to make tetrahydrofolic acid for DNA replication

Question 3

MOA for SMX?

Answer 3

Competes with PABA binding to dihydropteroate synthetase needed to make tetrahydrofolic acid for DNA replication

Question 4

TMP-SMX is active against?

Answer 4

MRSA and pathogens seen in immunocompromised patients

Question 5

What are possible adverse effects of TMP-SMX?

Answer 5

N/V, rash, pruritus, resistance has developed

Question 6

MOA for Fosfomycin?

Answer 6

Inactivates Pyruvyl Transferase to (-) cell wall synthesis

Question 7

When is Fosfomycin used and what kind of resistance does it have?

Answer 7

Acute uncomplicated cystitis

- Low resistance

Question 8

MOA for Nitrofurantoin?

Answer 8

Becomes reactive intermediates that alter bacterial ribosomal proteins

Question 9

When is Nitrofurantoin used?

Answer 9

Acute uncomplicated cystitis

Question 10

What are the possible side effects of Nitrofurantoin?

Answer 10

C. Difficile superinfection
Pulmonary and liver toxicity
Sensorimotor polyneuropathy

Question 11

MOA for Ciprofloxacin/Levofloxacin?

Answer 11

(-) DNA gyrase and/or Topoisomerase IV

Question 12

Adverse effects of Ciprofloxacin, but mostly Levofloxacin?

Answer 12

Tendonitis/Tendon rupture

– Peripheral neuropathy, CNS issues, myasthenia gravis exacerbation

Question 13

What is the most common side effect with Cephalosporins?

Answer 13

Allergic reactions

Question 14

What generations of Cephalosporins are usually used with UTIs?

Answer 14

Gen 1 and 3

Question 15

What Gen 1 Cephalosporins are used with uncomplicated UTIs?

Answer 15

Cephalexin

Cefadroxil

Question 16

What Gen 1 Cephalosporins are used with Uncomplicated UTIs?

Answer 16

Cephalexin

Cefadroxil

Question 17

What Gen 3 Cephalosporins are used with UTIs?

Answer 17

Ceftriaxone
Cefpodoxime
Cefdinir

Question 18

Which Gen 3 Cephalosporin is used for Complicated UTIs and what is a possible side effect?

Answer 18

Ceftriaxone

– Bleeding

Question 19

What is special about Ceftriaxone?

Answer 19

It is eliminated by both the kidney and liver so one of those organ dysfunctions does not mean the drug needs a dosage alteration

Question 20

Which Gen 3 Cephalosporins are used for Uncomplicated UTIs?

Answer 20

Cefpodoxime

Cefdinir

Question 21

Piperacillin + Tazobactam are active against?

Answer 21

Gram (+) and (-) and Pseudomonas Aeruginosa

Question 22

Piperacillin + Tazobactam are used when?

Answer 22

Complicated UTI

Question 23

What is Vancomycin active against?

Answer 23

MRSA

Question 24

MOA for Linezolid?

Answer 24

(-) protein synthesis initiation

Question 25

What is linezolid active against and what is a con about it?

Answer 25

Gram (+) and VRE | -- (-) MAO which causes drug interactions

Question 26

What is Imipenem active against?

Answer 26

Many multiresistant strains

Question 27

MOA for Daptomycin?

Answer 27

Cyclic lipopeptide that binds cell membrane to cause depolarization => (-) synthesis of DNA, RNA, proteins

Question 28

What is Daptomycin active against and what is weird about its usage?

Answer 28

Gram (+) only | - Lacks approval for VRE but still a 1st line agent for UTI even due to VRE

Question 29

What are some side effects of Daptomycin?

Answer 29

Bloating, swelling, weight gain

Question 30

MOA for Chloramphenicol?

Answer 30

(-) 50s subunit to prevent growing peptide chains

Question 31

When is Chloramphenicol used?

Answer 31

When less toxic agents are ineffective/contraindicated

Question 32

Possible adverse effects with Chloramphenicol?

Answer 32

``` Blood diseases: - Aplastic/hypoplastic anemia - Thrombocytopenia - Granulocytopenia Grey baby syndrome ```

Question 33

MOA for Gentamicin?

Answer 33

(-) 30s subunit to prevent growing peptide chains

Question 34

What are the adverse effects associated with Gentamicin?

Answer 34

Neurotoxicity, Nephrotoxicity, Ototoxicity

Question 35

If acute cystitis is due to MDR gram (-), what 2 agent should be considered?

Answer 35

Nitrofurantoin | Fosfomycin

Question 36

Otherwise for acute cystitis, what are 3 1st line agents?

Answer 36

Nitrofurantoin TMP-SMX Fosfomycin

Question 37

Otherwise for acute cystitis, what are the 2nd and 3rd line agents?

Answer 37

- Cephalosporins gen 3 or 1 | - Fluoroquinolones

Question 38

For uncomplicated pyelonephritis, what are first line agents?

Answer 38

Fluoroquinolones -- ciprofloxacin/levofloxacin

Question 39

With uncomplicated pyelonephritis, if resistance is > 10% what should be added?

Answer 39

Initial dose of ceftriaxone or 24 hour dose of aminoglycoside

Question 40

For uncomplicated pyelonephritis, what is a second line agent?

Answer 40

TMP-SMX