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Clinical Pharmacology > Lab 5 - UTI, STD, PID > Flashcards

Lab 5 - UTI, STD, PID Flashcards

1
Q

TMP/SMX - MoA

A

Folate antagonist, inhibits DNA synthesis

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2
Q

TMP/SMX - Dose and route

A

160mg TMP, 800mg SMX twice daily PO

Cystitis: for 3 days for women 7 days for men
Pyelonephritis: 7-10 days
Acute bacterial prostatitis: 2-4 weeks
Chronic bacterial prostatitis: 4-6 weeks, recurrence: 12 weeks

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3
Q

TMP/SMX - Adverse effects

A

Stevens-Johnsons syndrome
Crystalluria
Hematuria
Anemia, leukopenia, thrombocytopenia, megaloblastic anemia, hemolytic anemia, GI- reactions

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4
Q

TMP/SMX - Contraindications

A 
Porphyria
Liver and kidney failure
Pregnancy
Infants
G6PD-deficiency
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5
Q

TMP/SMX - Interactions

A
  • Additive folate deficiency with methotrexate

- Increased thiazide-induced thrombocytopenia

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6
Q

Ceftriaxone - MoA

A

Inhibits bacterial cell wall synthesis

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7
Q

Ceftriaxone - Dose and route

A

500 mg IM

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8
Q

Ceftriaxone - Adverse effects

A

Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia
Local irritation: pain after IM injection, thrombophlebitis after IV
Renal toxicity (intersitial nephritis, tubular necrosis)

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9
Q

Ceftriaxone - Contraindications

A

Allergy to cephalosporings and penicillins

Newborns with jaundice or patients with hypoalbuminemia or acidosis

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10
Q

Ceftriaxone - Interactions

A

Probenecid inhibits renal secretion and increases the serum concentration

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11
Q

Doxycycline - MoA

A

Inhibits protein synthesis

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12
Q

Doxycycline - Dose and route

A

100 mg x 2 in 7 days orally

2 week treatment in PID/epididymitis, 3 weeks in LGV

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13
Q

Doxycycline - Adverse effects

A

Nausea
Vomiting
Diarrhea
Photosensitivity
Discoloration of teeth and hypoplasia of the enamel in pregnant women and childer under 8 years
Nephrotoxicity and Hepatotoxicity (increased risk in pregnant women)

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14
Q

Doxycycline - Contraindications

A

Pregnancy and children under 8

Decreased kidney and liver function

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15
Q

Doxycycline - Interactions

A
  • Aminoglycosides potentiate nephrotoxicity

- Calcium and iron reduce bioavailability

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16
Q

Cystitis - Diagnosis

A

Uncomplicated cystitis: based on history; at least one symptom of UTI + absence of vaginal discharge + risk factor present –> no lab evaluation with dipstick or urine culture necessary

Urinary dipstick test: Positive Nitrite (Enterobacteriaceae converts nitrate to nitrite), Positive leukocyte esterase

Urine microscopy: Pyuria (WBC, pus), hematuria
Urine culture: 10^5 bacterial /mL, 10^3 for S. saprophytic

CRP: mild elevation in cystitis, more severe elevation in pyelonephritis

Positive goldflam’s sign in pyelonephritis

Blood culture: in case of complicated pyelonephritis, fever in CAUTI, systemic symptoms in complicated UTI, prostatitis

Men:

  • Culture if symptoms of UTI. Documentation of bacteriuria can differentiate the less common acute/chronic bacterial prostatitis from very common chronic pelvic pain syndrome.
  • Increased levels of prostate-specific antigen + enlarged prostate (CT, ultrasound)
  • Meares-Stamey test (if diagnosis is unclear or UTI is recurrent)
17
Q

Differential diagnosis when women present with dysuria

A

Cervicitis (C. trachomatis, N. gonorrhoeae)
Vaginitis (C. Albicans, Trichomonas vaginalis)
Herpetic urethritis, interstitial cystitis, noninfectious vaginal or vulvar irritation

18
Q

UTI/ASB pregnant women + dose and route

A

Nitrofurantoin: 50 mg 3 times/day for 7 days PO

19
Q

Nitrofurantoin - MoA

A

Inhibits bacterial enzymes, and damages bacterial DNA

20
Q

Nitrofurantoin - Adverse effects

A

GI irritations (nausea, vomiting, diarrhea), pulmonary fibrosis hepatitis, hematologic toxicity

21
Q

Nitrofurantoin - Contraindication

A

Porphyria, renal failure, anuria/oliguria, G6PD –> hemolytic anemia

22
Q

Nitrofurantoin - Interactions

A

Probenecid inh urinary excretion.

Antacids reduce absorption

23
Q

Candiduria - dose and route

A

200 mg/d PO 14 days

24
Q

Prevention of recurrent UTI

A

Continuous, postcoital, patient-initiated therapy; low doses of TMP-SMX, prescribed for 6 months

25
Q

Laboratory Diagnosis of Gonorrhea

A

Nucleic acid amplification test (NAATs) of urine sample: more sensitive than culture
Gram’s staining of urethral/cervical exudates: gram (-) mono or diplococci, PMNs seen in endocervix (presence of inflammatory discharge)
Culture: Thayer-Martin medium. All cases of gonorrhea (urethra, cervix, anus, pharynx) should be cultured.
Blood culture: gonococcal arthritis

26
Q

Uncomplicated gonococcal infection - Treatment

A

500 mg IM Ceftriaxone + Azithromycin 2g PO

27
Q

Azithromycin - MoA

A

Protein synthesis inhibitor

28
Q

Azithromycin - Adverse effects

A

Stomatitis, heart burn, uncoordinated peristalsis, nausea

29
Q

Azithromycin - Interactions

A

Al, Mg, Antacids delay absorption and decrease serum conc.

30
Q

Azithromycin - Contraindication

A

Diarrhea, hypersensitivity to macrolides, hepatic dysfunction

31
Q

Gonococcal meningitis and endocarditis - treatment

A

Ceftriaxone IV 1-2 g every 12-24 h 10-14 days for meningitis, 4 weeks for endocarditis

32
Q

PID- treatment

A

Doxycycline 200 mg/d in 14 days
Ceftriaxone 250 mg IM
Metronidazole 500 mg bid 14 days

33
Q

LGV - characterized by what, and differential diagnosis

A

Acute lymphadenitis and hemorrhagic proctitis

Differential diagnosis- Crohns disease due to giant cell formation and granulomas

34
Q

Chlamydia - Diagnosis

A

NAAT- urine or vaginal swab (cervical swabs from symptomatic women undergoing pelvic exam)
Serology- LGV, neonatal pneumonia. Microimmunofluoresence.
Gram’s staining/culture to exclude gonorrhea
Sigmoidoscopy/biopsy in proctitis

35
Q

Gonorrhea - Pregnant women

Chlamydia- Pregnant women

A

Ceftriaxone 500 mg IM single dose

Amoxicillin 500 mg 3 times daily PO for 7 days

36
Q

Metronidazole - MoA

A

Tissue amebicide. Inhibits pyrovate ferredoxin oxidoreducrase (PFOR) and nucleic acid synthesis.

37
Q

Metronidazole - Adverse effects

A

GI-irritation
Metallic taste
Transient leukopenia
Thrombocytopenia

38
Q

Metronidazole - Contraindication

A

First trimester pregnancy

Alcohol

39
Q

Metronidazole - Interactions

A

Disulfiram-like reaction with ethanol
Increases levels of warfarin
Serum levels affected by drugs inh/inducing cyp3a4.

Clinical Pharmacology (14 decks)

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