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PHCY 310 > L 34 > Flashcards

L 34 Flashcards

1
Q

Risk factors for UTIs

A

Female sex, age, dehydration, diabetes, pregnancy, kidney stones, UT obstruction

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2
Q

What are the Signs and symptoms of complicated UTIs (e.g pyelonephritis)

A

Systemic signs/symptoms e.g fever, chills, flank pain, nausea, vomiting, elevated WBC count

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3
Q

What are the Signs and symptoms for uncomplicated UTIs

A

Urinary frequency, urinary urgency, dysuria, suprapubic pain, nocturia (waking up at night to pee)

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4
Q

Do older patients present with the same UTI symptoms? Why/why not?

A

No, they have a naturally impaired immune system, so may present with altered mental status, poor appetite, incontinence etc

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5
Q

What is the diagnosis of UTIs based on?

A

Based on signs, symptoms and urine culture if necessary.

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6
Q

What are the Goals of UTI therapy (x4)?

A
  1. Eradicate causative pathogen
  2. Prevent or treat consequences of infection
  3. Administer appropriate empiric antimicrobial therapy or target therapy based on culture results
  4. Prevent recurrence of infection
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7
Q

What is the main pathogen of uncomplicated 80% uTIS and complicated 50% UTIs?

A

E.Coli

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8
Q

Where do they often come from?

A

Most often: E.coli (gram -ve)
Less common gram -ves: klebsiella pneumonia, proteus
Less common gram +ves: Staph and enterococcus
Pathogens often originate from the perirectal area

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9
Q

What are some examples of 2 resistant bacteria that can cause UTIs?

A

Enterobacter and pseudomonas aeruginosa species

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10
Q

What does the evidence look like for non-pharmacological/alternative UTI treatments? What
are some examples of these treatments?

A

Though the Evidence is patchy/uncertain.

e.g cranberry juice, alkalinisers, Hiprex

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11
Q

Pharmacological treatments for UTIs

Do you want a narrow or wide therapeutic index?

A

Antimicrobial therapy.

Wide therapeutic index

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12
Q

Name 3 general approaches that might be used to determine what dose to prescribe for a patient?

A
  1. Population method: Give everyone the same dose
  2. Covariate-based dosing: Base the dose on patient characteristics (e.g weight, renal function, sex etc)
  3. Dose-individualisation/response based: Dose based on response (adjusted for effect)
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13
Q

Name 6 common oral pharmacological treatment options (class + example) for UTIs. which is first line?
Which doesn’t reach adequate concentrations in renal impairment patients?

A
  1. Penicillins (e.g amoxicillin)
  2. Cephalosporins (e.g cefalexin)
  3. Fluoroquinolones (e.g norfloxacin)
  4. Nitrofurantoin
  5. Trimethoprim-sulfamethoaxazole
  6. Trimethoprim
    First line: Trimethoprim
    Nitrofurantoin doesn’t reach adequate concentration in the urine in renal impairment patients.
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14
Q

Name 5 common intravenous pharmacological treatment options for UTIs (class + example)
Which is first line?

A
  1. Penicillins (e.g amoxicillin)
  2. Aminoglycosides (e.g gentamicin)
  3. Cephalosporins (e.g cefuroxime)
  4. Fluoroqiunolones (.g ciprofloxacin)
  5. Carbapenems (e.g meropenem)
    First line = gentamicin, narrow Tx window, dosed 24 hourly
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15
Q

Which tissues have the highest concentrations?

What is t1/2, how are metabolites cleared?

A
  • Inhibits bacterial dihydrofolate reductase
  • Gram +ve and -ve bacteria
  • Yes, emerging resistance
  • Urine, CNS, sputum, bile have highest concs.
  • t1/2 = 11 hours, metabolites cleared renally
    Uncomplicated UTI dosing of trimethoprim.
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16
Q

When is trimethoprim contraindicated?

A

300mg nocte 3/7 (men = 7 days)

Contraindicated if CLcr <10mL/min (V. LOW)

17
Q

What medications/natural products have interactions with trimethoprim?

A

Warfarin, phenytoin, digoxin, creatinine

18
Q

What medication is trimethoprim often combined with?

A

Trimethoprim + sulfamethoxazole
Common side effects of trimethoprim
Hyperkalaemia, GI disturbances

19
Q

What are the indications for aminoglycosides?

A

Serious infections due to aerobic gram-negative bacilli

20
Q

What are the General gentamicin dose?How is Gentamicin delivereD?

A

5-7mg/kg (kg = IBW), given OD

IV infusion over 30 mins

21
Q

How is gentamicin cleared and eliminated?

Is it metabolized?

A 
Cleared renally (NOT METABOLISED)
Eliminated into urine
22
Q

Peak serum concentration of gentamicin occurs at…

A

Peak serum concentration of gentamicin occurs at the end of the infusion

23
Q

Serum concentrations of gentamicin at the end of the dos interval (… hours) are ….?

A

Serum concentrations of gentamicin at the end of the dos interval (24 hours) are almost unmeasurable

24
Q

Is gentamicin a time-dependent or concentration-dependent drug?

A

Therefore what is important?
Concentration-dependent killer.
Dose is important

25
Q

For gentamicin, a higher …. means a …. bacterial kill and a …. bacterial kill?

A

For gentamicin, a higher Cmax means a greater bacterial kill and a faster bacterial kill

26
Q

Name three factors that might be expected to predict variability in dose requirements between patients (x5)?

A
  1. ADHERENCE
  2. Drug interactions
  3. Weight differences
  4. Renal function differences
  5. Genetic differences
27
Q

Gentamicin has a … therapeutic window. What does this mean?

A

Gentamicin has a narrow therapeutic window. This means that there is a small concentration range here the drug has a high probability of being effective and a low probability of producing side effects.

28
Q

Potential side effects of gentamicin?

A

Ototoxicity and nephrotoxicity

29
Q

Give 2 examples of B lactams?
Do they have a wide or narrow therapeutic range?
Is dose adjustment therefore required between patients?

A

B lactam examples: penicillins, cephalosporins.
B lactams have a wide therapeutic range.
Dose requirements are less variable between patients but dose adjustment can still be required (e.g renal failure, obesity etc)

30
Q

What is the first dose of gentamicin based on?

What about the subsequent doses?

A

1st dose: based on IBW
Subsequent doses are adjusted based on target exposure and renal function (dose-response based therapy for optimized efficacy and safety)

PHCY 310 (65 decks)

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