GU and Mens Health pt.2

Question 1

Causes of Epididymitis, Orchitis, Prostatitis and Urethritis?

Answer 1

Mostly bacterial

Viral and fungal possible

Question 2

Urinalysis usually provides answers like?

Answer 2

C&S takes time (24 - 48 hours)

Empirical treatment based o H&P

Question 3

Orchitis follows ________.

Answer 3

epididymitis

Question 4

Epididymitis and Orchitis mostly in men how old?

Answer 4

Men 14 to 35 years old

Question 5

Epididymitis and Orchitis common pathogens?

Answer 5

Neisseria Gonorrhoeae and

Chlamydia trachomatis

Question 6

Epididymitis and Orchitis: older and younger pathogen?

Answer 6

e. coli

especially catheter patients

Question 7

Obtain culture and sensitivity with ?

Answer 7

urethral swab

Question 8

Epididymitis and Orchitis tx?

Suspected GC or Chlamydia infections

Answer 8

Rocephin 250 mg IM single dose and
azithromycin (Zithromax) 1 gram PO

or

Doxycycline (Vibramycin) 100 mg twice daily for 10 days
outpatient

Question 9

If enteric infection suspected? what pathogens?

Answer 9

Escherichia coli

Klebsiella spp.

Enterobacter spp

Question 10

If enteric infection suspected

what is tx?

Answer 10

fluoroquinolones

ofloxacin 300 mg by mouth twice a day for 10 days or

levofloxacin 500 mg by mouth once daily for 10 days

resistance is a big problem with these drugs

Question 11

Urinary Tract Infections specimens ?

Answer 11

Voided clean catch specimens

Question 12

When it affects the lower urinary tract it is known as a____________.

Answer 12

bladder infection(cystitis)

Question 13

When it affects the upper urinary tract it is known as____________.

Answer 13

kidney infection (pyelonephritis)

Question 14

Symptoms from a lower urinary tract infection

Answer 14

pain withurination (dysuria) - H ion on tip of urethra

frequent urination

feeling the need to urinate despite having an empty bladder (urgency)

Question 15

Symptoms of a kidney infection?

Answer 15

feverandflank pain(CVA tenderness) usually in addition to the symptoms of a lower UTI.

Question 16

Urinary Tract Infections

most common cause of infection is ?

Answer 16

Escherichia coli (E-coli)

Question 17

risk factors for UTI?

Answer 17

female anatomy - less complete emptying

sexual intercourse

Incomplete emptying / lack urination

Obesity

catheter

Question 18

Although sexual intercourse is a risk factor, UTIs are not classified as_______.

Answer 18

sexually transmitted infections(STIs)

**STI’s can mimic UTI’s sometimes so be careful **

Question 19

Kidney infection usually follows a bladder infection but may also result from a__________,

Answer 19

bacteremia blood infection

Question 20

UTI tx?

Answer 20

UTIs are treated with a short course ofAbx

Question 21

UTI ABS?

Answer 21

Nitrofurontin

TMP/SMZ

Cephalexin

Resistance high to many of the antibiotics used i.e. Ciprofloxacin

Question 22

complicated cases of UTI tx?

Answer 22

longer course orIVantibiotics

Phenazopyridine (Pyridium) may help with symptoms

GIVES SOME RELIEF with uncomplicated UTI until C&S comes back

Question 23

Pyelonephritis Tx?

Answer 23

Ceftriaxone

Question 24

Pyelonephritis facts?

Answer 24

Out patient longer therapy

Bacteriogram (local resistance patterns)

Urine cultures for complicated, recurrent or bacteremia

dirty urine with stone - treat them aggressively cause it can back up and kill the kidney , dont get lost in a fever, sometimes the fever means nothing when it comes to kidney

Question 25

Ceftriaxone (Rocephin) class?

Answer 25

Cephalosporin, 3rd generation **can use even if PCN allergy cause extremely low cross over **

Question 26

Ceftriaxone (Rocephin) | MOA?

Answer 26

bactericidal; inhibits cell wall mucopeptide synthesis

Question 27

azithromycin (Zithromax) | class?

Answer 27

Macrolides

Question 28

azithromycin (Zithromax) | MOA?

Answer 28

binds to 50S ribosomal subunit, inhibiting protein synthesis

Question 29

azithromycin (Zithromax) | adverse rxn?

Answer 29

Caution QT-prolongation

Question 30

doxycycline (Vibramycin) | class?

Answer 30

Tetracyclines

Question 31

doxycycline (Vibramycin) | MOA?

Answer 31

Mechanism of Action
bacteriostatic; binds to 30S and possibly 50S ribosomal subunit(s), inhibiting protein synthesis

Question 32

doxycycline (Vibramycin) | adverse rxn?

Answer 32

Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.

Question 33

Levofloxacin (Levaquin) | class?

Answer 33

Fluoroquinolones

Question 34

Levofloxacin (Levaquin) | MOA?

Answer 34

bactericidal; inhibits DNA gyrase and topoisomerase

Question 35

Levofloxacin (Levaquin) | BBW?

Answer 35

Tendinitis/Tendon Rupture assoc. w/ incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older pts >60 yo, Avoid in Myasthenia Gravis fluoroquinolones may exacerbate muscle weakness in pts w/ myasthenia gravi

Question 36

Acute prostatitis generally caused by the same organisms that cause ?

Answer 36

UTI

Question 37

Most commonly gram-negative bacteria, especially ?

Answer 37

Enterobacteriaceae (typically Escherichia coli or Proteus species).

Question 38

Sexually transmitted pathogens, such as ___________ and _______________, are possible etiologies in sexually active men, who may have concomitant urethritis or epididymitis

Answer 38

Neisseria gonorrhoeae Chlamydia trachomatis

Question 39

Patients with acute bacterial prostatitis are typically acutely ___.

Answer 39

ill

Question 40

A urine Gram stain and culture should be obtained in all men suspected of _____________ to identify the bacterial etiology

Answer 40

having acute prostatitis

Question 41

Prostatitis then think?

Answer 41

Think HIV, immunocompromised especially in young man with prostatitis

Question 42

Prostatitis tx?

Answer 42

Treatment with trimethoprim-sulfamethoxazole (Bactrim) or a fluoroquinolone (Levaquin), unless drug resistance is suspected. Longer treatment 4 to 12 weeks

Question 43

Prostatitis IV ampicillin therapy if?

Answer 43

sepsis or co-morbidities

Question 44

trimethoprim/ sulfamethoxazole (Bactrim) | class?

Answer 44

Sulfonamides

Question 45

trimethoprim/ sulfamethoxazole (Bactrim) | MOA?

Answer 45

Selectively inhibits dihydrofolate reductase (folate antagonist) and sulfamethoxazole competes with para-aminobenzoic acid (PABA), inhibiting folic acid synthesis

Question 46

trimethoprim/ sulfamethoxazole (Bactrim) | caution if ?

Answer 46

Sulfur allergy methemoglobinemia photosensitivity

Question 47

ampicillin/ sulbactam (Unasyn) class?

Answer 47

Penicillins IV therapy

Question 48

ampicillin/ sulbactam (Unasyn) MOA?

Answer 48

bactericidal; inhibits cell wall mucopeptide synthesis / inhibits beta-lactamases

Question 49

ampicillin/ sulbactam (Unasyn) caution / interaction?

Answer 49

alters GI flora bactericidal activity requires bacterial growth lowers seizure threshold