GU Flashcards
What 3 organisms most commonly cause UTI’s?
E coli, proteus, klebsiella
What 3 organisms often cause UTI’s in nursing homes?
enterococci, staph, and fungus
If an elderly person has asymptomatic bacteruria, how do we treat?
YOU DON’T!
What is 1st line treatment for and uncomplicated UTI?
TMP-SMZ, cephalexin, ampicillin
What if a pt has a UTI and a sulfa allergy, what do you prescribe?
Amoxicillin-Clavulanate
If a pt has a UTI + a sulfa allergy and there is known resistance in the area?
Floroquinolone
What are 3 main variables of SIRS?
Temp >100.9; HR >90; Tachypnea >20/min
What are the Inflammatory variables of SIRS?
WBC >12 (leukocytosis) or WBC <4 (leukopenia)
> 10% immature forms on normal WBC count
What is Sepsis?
2 or more SIRS + infection (UTI, cellulitis, pneumonia, influ, shingles, meningitis, fungal)
What is severe sepsis?
2 or more SIRS + Infection + End Organ Damage
What are some examples of end organ damage?
Hypotension <65 or <90 at any on check
Renal failure (Cr >2)
Shock Liver (Bili >2)
Elevated Lactic Acid (>2)
Respiratory Failure
How do we treat Sepsis?
give O2, goal directed (fluids), tx infection
Urine storage is under what type of control?
Sympathetic
Voiding is under what type of control?
Parasympathetic
Urge incontinence is caused by what?
Detrusor over activity
Stress incontinence is caused by what?
Weak pelvic floor & sphincter failure
What are some red flag sxs with incontinence?
abrupt onset, pelvic pain, and hematuria
What are some lifestyle Tx for incontinence?
weight loss, correct meds, avoid caffeine/alcohol, stop smoking!
Kegle’s + Bladder training
Prompted/scheduled voiding
What pharm options are available for incontinence?
Oxybutynin
What are some S/E’s of oxybutynin?
tooth decay & anticholinergic effects!!
Increased frequency of urination, nocturia, hesitancy, and weak stream are all sxs of what?
BPH
What kind of work-up should you do for BPH?
PE of urinary tract, abdomen, DRE, UA & culture
What are some age related renal changes?
- Decreased bladder contractility
- Increased inhibited bladder contractions
- Urine output shifted to later in the day
- Sphincter striated muscle attenuated
- Decreased bladder capacity
- (Modest) increased PVR
- Decreased urethral closure pressure and vaginal mucosal atrophy
- BPH and prostate hypertrophy
There are 6 major causes of sexual dysfunction, what are they?
- Vascular
- Neuropathic
- Drug Induced
- Psychogenic
- Hypogonadism
- Thyroid or Renal
What should you always ask if a pt has when they are concerned about sexual dysfunction?
Are you able to masturbate & morning or sleep associated erections
- If able, most likely psychogenic causes
If a pt has femoral bruits & poor pedal pulses and they lack morning erections, diagnosis?
Vascular
If a pt has a hx of pelvic surgery, irradiation, spinal injury or parkinson’s dz and they lack morning erections, diagnosis?
Neuropathic
What PE finding would you see with neuropathic sexual dysfunction?
Loss of bulbocavernosus reflex
What medications can induce sexual dysfunction?
SSRI’s
MAOI’s
antipsychotics antihypertensives (spironolactone, clonidine)
statins (lovastatin, simvastatin, atorvastatin)
alcohol
opioids
acid-suppression drugs (ranitidine)
