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PHRM 865: Theraputics V > Lecture 17.1: Genitourinary Infections > Flashcards

Lecture 17.1: Genitourinary Infections Flashcards

1
Q

What are some of the common Genitourinary System Infections?

A
  • Pyelonephritis: Kidney Infections
  • Cystitis: Bladder Infection
  • Urethritis: Urethra Infection
  • Prostatitis: Prostate Infection [Males]
  • Epidiymitis: Epididymis Infection [Males]
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2
Q

What are the Classifications of UTIs?

A
  • Asymptomatic Bacteriuria [DO NOT TREAT]
  • Uncomplicated
  • Complicated
  • Pyelonephritis
  • Catheter-Associated

ASB - ONLY treat if pregnant or urologic procedure

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3
Q

What are some of the complicated UTI patient characterisitics?

A
  • Funtional/anatomical abnormal urinary tract
  • Indwelling catheter
  • Instrumentation
  • Pregnant
  • Men
  • Elderly
  • DM
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4
Q

What is the most common pathogen that causes UTIs?

A
  • E. Coli

~30% are resistant to FQs, SMX-TMP

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5
Q

What are some of the risk facotrs for UTIs

Female? Males?

A
  • Pregnancy [Female]
  • Sex [Female]
  • Diaphragm/Spermicide use [Female]
  • No Circumcision [Male]
  • Large Prostate [Male]
  • Condom Catheter [Male]
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6
Q

What are some of the important things that we look at during a Urinalysis?

Components?

A
  • Bacteria > 10^5
  • WBC > 10
  • Leukocyte Esterase indicates WBCs
  • Nitrite Test: Are nitrates to Nitrites

Want a Midstream catch
Looking at Infection SYMPTOMS

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7
Q

What is the clinical presentation of Cystitis?

A
  • NEW dysuria, urgency, frequency
  • Suprapubic “heaviness” or lower back pain

Maybe foul smelling urine or Hematuria

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8
Q

What are some of the clinical presentation of Pyelonephritis?

A
  • Fever +/- Chills, Rigor, Nausea, Vomiting, Diarrhea
  • FLANK PAIN
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9
Q

What is the most common Genitourinary infection in Males?

A
  • Prostatitis
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10
Q

What is the difference between Acute and Chronic Prostatitis?

A
  • Acute: Fever, Chills, Malaise, cloudy urine, Swollen/Tender Prostate
  • Chronic: Frequencym Urgency, Pelvic/Back Pain, Normal Prostate
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11
Q

What are some of the pathogens that causes Prostatits in Males?

A
  • Gram (-): E. Coli, Proteus, P. Aeruginosa
  • Gram (+): Enterococcus, S. Aureus
  • Maybe: N. Gonorrhea, Chlamydia
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12
Q

What are the common antibiotics that are used to treat Genitourinary infectinos?

A
  • Nitrofurantoin [Macrobid]
  • SMX/TMP
  • Fosfomycin
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13
Q

What is the mechanism of action for Nitrofurantoin?

A
  • Disrupts cell wall formation by inhibiting acetyl-coenzyme-A
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14
Q

What is the Spectrum of Activity for Nirtofurantoin?

A
  • Gram (-): E. Coli, Citrobacter, Salmonella, Shigella
  • Gram (+): E. Faecalis, E. Faecium

Twice daily [MacroBID]: 100mg PO q12h

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15
Q

What are the imporant pharmacokinetics for Nirtofurantoin?

ADME?

A
  • Absorption: Readily Absorbed
  • Distribution: NOT to other areas
  • Metabolism: Minimal Hepatic
  • Elimination: Renal; Half Life ~20mins

Bacteriostatic or cidal

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16
Q

What are some of the adverse effects for Nirtofurantoin?

A
  • GI: Nausea, Farting [little vomiting, diarrhea, stomach pain]
  • Neuro: Headache [little dizziness, drowsiness, vertigo]
  • Rare [Hemolytic Anemia (G6PD)…]
17
Q

What are some important precautions for Nitrofurantoin?

A
  • Contraindicated if CrCl < 30
  • Old people might give false positives
  • Its ok to use during pregnancy [ be cautious tho]
18
Q

What is the mechanism of action for SMX-TMP?

A
  • SMX: Inhibits Dihydrofolic Acid
  • TMP: Inhibits Dihydrofloate Reductase
19
Q

What is the Spectrum of activity for SMX/TMP?

A
  • Gram (+): MRSA, Listeria
  • Gram (-): E. Coli, K. Pneumonia, Enterbacter… [Stenotrophomnas is 1st line]
  • Other: Jirovecii [Carinii]

Dosing: 5:1 - SMX:TMP ratio
DS Tab = 800/160mg
UTI: 1 DS BID

20
Q

What are the important pharmacokinetics’ for SMX/TMP?

A
  • Absorption: Excellent Orally
  • Distribution: Widely Distributed
  • Metabolism: Hepatic
  • Elimination: Renal; Half Life ~ 11h

Bacteriostatic Alone; Bactericidal Together

21
Q

What are some of the side effects for SMX/TMP?

A
  • GI: Nausea, Abdonimal Pain, Vomiting, Diarrhea
  • Rash
  • Interstital Nephritis
  • Hyperkalemia, Hyponatremia
22
Q

What are some of the precautions for SMX/TMP?

A
  • AVOID in pregnancy [Cat C]
  • Drug interations –> WARFARIN
23
Q

What is the mechanism of action for Fosfomycin?

A
  • Inhibits cell wall synthesis
24
Q

What is the spectrum of activity for Fosfomycin?

A
  • E. Coli, Entercoccus sp.
  • Resistant Organisms [ESBL, CRE, VRE]
25
Q

What are the important pharmacokinetics for Fosfomycin?

ADME?

A
  • Absorption: Prodrug; require dissolution
  • Distribution: to kidneys, bladder, prostate, seminal vesicles
  • Metabolism: NO
  • Elimination: Urine/Feces; Half Life 5.5h

Bactericidial in Urine

26
Q

What are some of the side effects for Fosfomycin?

A
  • Diarrhea, Nausea, Headache, Dizziness
  • C. Difficile, Vaginitis

PREGNANCY CAT B - OK TO USE

27
Q

What is the mechanism of action for the Fluoroquinolones?

A
  • Inhibits DNA replication by affecting DNA Gyrase & Topo IV
28
Q

What is the specturm of activity for Fluoroquinolones?

A
  • Gram (-): C > L >M
  • Gram (+): M > L >C

Gram (-) Includes P. Aeruginosa
Gram (+) includes S. Pneumonia
Moxi for anaerobes

29
Q

What are some important pharmacokinetics for the Fluoroquinolone?

A
  • Absorption: Excellent orally
  • Distribution: Widely NOT CNS
  • Metabolism: Hepatic EXCEPT Levo
  • Elimination: Renally EXCEPT Moxi
30
Q

What are some of the Side Effects for the Fluoroquinolones?

A
  • GI: Nausea, Vomiting, Diarrhea
  • CNS: Dizziness, Headache
  • C. DIFF
  • Tendon Rupture
  • QTc Prolongation
  • Aortic Dissection [BLACK BOX]
31
Q

What are some of the precautions for the Fluoroquinolones?

A
  • Drug Interactions: Divalent & Trivalent Cations [ZICAM = decreased oral]
  • WARFARIN
  • AVOID in pregnancy [Cat C]
32
Q

What is the treatment recommendation for Asymtomactic Bateriuria?

A
  • DO NOT TREAT
  • Except: during Pregnancy or Urologic Procedure or Renal Transplant
33
Q

What is the treatment recommendation for Uncomplicated Cystitis?

A
  • 1st Line: Macrobid, SMX/TMP, Fosfomycin
  • 2nd Line: FQs
  • 3rd Line: B-lactams

REMINDERS

Macrobid: AVOID in pyelo
SMX/TMP: AVOID if >20% or used for UTI in past 3m
Fosfomycin: AVOID in pyelo
FQs: MORE collateral damages
B-lactams: LESS efficacy than other agents

34
Q

What is the recommended treatment for Pyelonephritis?

A
  • Non-Hospitalized: Cipro, Levo, SMX/TMP, B-lactam [all 7d duration]
  • Hospitalised: IV FQs, IV extended Cephalo +/- AGs [Ceftriaxone or Cefazlion], IV Carbapenem
35
Q

What is the recommended treatment for Acute Prostatitis?

A
  • DO NOT massage prostate
  • SMX/TMP, FQs, B-lactams

2-4 week duration

36
Q

What is the recommended treatment for Chonic Prostatitis?

A
  • Hard to treat
  • FQs, Trimethoprim Alone [SMX does NOT penetrate well]

6-12 week duration
SURGERY??

PHRM 865: Theraputics V (42 decks)

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