Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro 2 Pharm > LUT infect & STI > Flashcards

LUT infect & STI Flashcards

1
Q

Penicillins (admin)

A

Penicillin G (IV,IM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aminopenicillins (admin)

A

Ampicillin (PO,IV,IM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cephalosporins (admin)

A

Ceftriaxone 3rd Gen. [Rocephin] (IV, IM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

B-Lactamase Inhibitors (admin)

A

Ampicillin-sulbactam [Unasyn] (IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fluoroquinolones (admin)

A

Ciprofloxacin [Cipro] (PO, IV, topical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Macrolides/Ketolides (admin)

A

Azithromycin [Zithromax, Z-pak] (PO, IV, topical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Metronidazole (admin)

A

Metronidazole [Flagyl] (PO, IV, topical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sulfonamides/Trimethoprim (admin)

A

Sulfamethoxazole/trimethoprim [Bactrim] (PO, IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Urinary Tract Antiseptics (admin)

A

1) Methenamine (PO)

2) Nitrofurantoin (PO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Azole Antifungals

A

Fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Trimethoprim/sulfamethoxazole (TMP/SMX) MOA

A

Sulfonamide=bacteriostatic, competitive inhibition of dihydropteroate synthase

Trimethoprim= synergistic, inhibits dihydrofolate reductase

Together inhibits sequential steps in Folic acid pathway & inhibits bacterial use of PABA for folic acid synthesis, Inhibits final reduction step.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Trimethoprim/sulfamethoxazole (TMP/SMX) PK

A

SMX t1/2= 10 H
TMP t1/2= 11 H
Dose adjust for prolonged renal impairment

Hepatic Metabolism: SMX 25-50% excreted in urine24H
TMP 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Trimethoprim/sulfamethoxazole (TMP/SMX) ADR

A 
allergic skin rashes
nausea
vomiting
CNS (headache, depression)
photosensitivity
renal dysfunction
Stevens-Johnson syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Trimethoprim/sulfamethoxazole (TMP/SMX) DDi

A

Inhibits CYP metabolism:
potentiates Warfarin!
inc. serum conc. Digoxin, Phenytoin
Enhance HyperK effects of ACEIs, ARBs, Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nitrofurantoin MOA

A

Highly reactive intermediates damage DNA:

Bacteria reduce drug more rapidly= more selective activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nitrofurantoin PK

A

Macro-crystalline formula absorbed/excreted slowly.
Antibacterial Conc. not found in plasma due to rapid elimination (t1/2 0.3-1 H)

Excretion rate related to CrCl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Nitrofurantoin ADRs

A

Nausea, vomiting, diarrhea
Macro-crystalline formula better tolerated

Not exceed 14 day therapy –> repeated course needs rest period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nitrofurantoin Ci

A

Pregnant women
impaired REnal Fxn (40 mL/min)
children <1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Methenamine

A

Not primary UTI durg. Used for chronic suppressive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Methenamine MOA

A

Decomposes to formaldehyde in h2o
Acidification of urine promotes formaldehyde formation
3 hours to complete = slow process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Methenamine PK

A

10-30% decomposition in gastric juice unless enteric coating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Methenamine ADRs

A 
GI distress
painful/frequent micturition 
hematuria
rash
low systemic toxicity at usual doses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Methenamine Ci

A

Hepatic insufficiency due to Ammonia production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fosfomycin MOA

A

bactericidal; Inhibits early stage cell wall synthesis.

Inactivates pyruvyl transferase leading to dec. formation of N-acetylmuramic acid–> only found in bacterial cell walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Fosfomycin PK

A

rapidly absorbed: Oral only ins U.S. (IV elsewhere)

renal elimination; t1/2 4H, if CrCl<54 mL/min t1/2 50H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Fosfomycin ADRs

A

diarrhea
nausea
abdominal pain
HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Fluoroquinolones MOA

A

Conc. dependent killing: Targets DNA Gyrase and Topoisomerase IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Fluoroquinolones PK

A

Well absorbed: divalent/trivalent cations impair absorption

Renal Clearance, Dose adjust in renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Fluoroquinolones ADRs

A

GI 3-17% most common (mild nausea, vomiting, abdominal discomfort)
CNS 0.9-11% (mild HA, dizziness, delirium, rare hallucinations)
rash
photosensitivity
Achilles tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

B- Lactams MOA

A

inhibits Transpeptidation rxn: last step in peptidoglycan synthesis. D-Ala-D-Ala: B-lactams covalently bind PBPd preventing cross linking= cell lysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Penicillin G benzathine PK

A

IM injection; Abs slowly Avg. duration of antimicrobial activity ~26 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Penicillin G benzathine ADRs

A 
Allergic Rxns 0.7-10%
Anaphylaxis 0.004-0.04%
interstitial nephritis ( rare) 
pseudomembranous colitis
Jarisch-Herxheimer rxn
33
Q

Ampicillin

A

Drug of choice for susceptible enterococci!

34
Q

Ceftriaxone PK

A

IV or IM t1/2=8H

35
Q

Ceftriaxone ADRs

A

1% risk of cross reactivity to Penicillins
injection site rxn
diarrhea

36
Q

Azithromycin MOA

A

Bacteriostatic: Binds irreversibly to 50s subunit
inhibits translocation of newly synthesized peptidyl tRNA molecule from acceptor site on ribosome to peptidyl donor site

37
Q

Azithromycin PK

A

rapidly abs: Al and Mg hydroxide antacids reduce abs.
high intracellular conc.
hepatic metabolism= inactive metabolites
Primary biliary excretion major route t1/2= 40-60H

38
Q

Azithromycin ADs

A

GI (epigastric distress)
hepatotoxicity
arrhythmia
prolonged QT

39
Q

Macrolide DDi

A

CYP3A4 inhibition: prolongs effects of Digoxin,valproate warfarin & others
Azithromycin; structure differs so less likely to produce DDIs but still use caution

40
Q

Metronidazole MOA

A

prodrug; requires reductive activation of nitro groups,
Single e- transfer in anaerobic bacteria forms highly reactive Nitro radical anions:
Radical Mechs target DNA
inc O2 inhibits Metronidazole as O2 competes for e-

41
Q

Metronidazole PK

A

Abs rapidly/completely PO. t1/2=8Hrs
Penetrates well into body tissues and fluids, vaginal secretions
Hepatic Metabolism: >50% of systemic Cl; 75% eliminated in urine as metabolites

42
Q

Metronidazole ADRs

A

HA
Nausea
dry mouth
metallic taste
Occasionally: Vomiting, Diarrhea, Abdominal distress
Neurotoxic: dizziness, Vertigo, Encephalopathy (very rarely)
Disulfiram effect–> Abdominal distress, vomiting, flushing, HA if EtOH consumed within 3 days of drug

43
Q

Metronidazole DDIs

A

induce metabolism of phenobarbital, prednisone, & rifampin.

prolongs prothrombin time in Warfarin users

44
Q

UTI

A

Microorganisms in urinary tract: NOT due to contamination
Potential to invade tissues: Cystitis= bladder lower tract
Pyelonephritis= kidney upper tract

45
Q

Uncomplicated UTI

A

UTI with normal Structure and Fxn

pre-menopausal Females 15-45yo otherwise healthy

46
Q

Male UTI

A

Rare: most commonly due to structural or neurological abnormality
NOT considered uncomplicated

47
Q

Complicated UTI

A

Usually predisposing lesion ( congenital abnormality or lesion), stone. indwelling catheter, prostatic hypertrophy, obstruction or neurological deficit interfering w/ norm. flow of urine.

Both genders: Freqently UUT & LUT

48
Q

Recurrent UTI

A

2 or more UTI is 6 months
3 or more in a year
Healthy and not pregnant

49
Q

Reinfection (UTI)

A

Different microorganism than 1st isolated ( majority of recurrent UTIs)

50
Q

Relapse (UTI)

A

same as initially isolated= indicates persistent infectious source

51
Q

Etiology UTI

A

Usually from bowel Flora
Virtually every Organism associated w/UTI
some predominate

52
Q

Uncomplicated UTI ( Etiology)

A

1) E. Coli ( 80-90% of community acquired infections)
2. Stap. Saprophyticus
also
3)K. pneumoniae
4)Proteus spp.
5)P. aeruginosa
6) Enterococcus spp.

53
Q

Complicated UTI (etiology)

A

More varied and often more resistant

1) E. Coli (< 50% of infections)
2) Enterococci
a. #2 most isolated in Hosp. Pts (DT 3rd gen Ceph)
b. Vanco Res. E. Faecalis an VRE increasing ( Only Tx: linezolid)
3) Proteus spp.
4) K. pneumoniae
5) Enterobacter spp.
6) P. aeruginosa
7) Staph spp.
a. S. aureus from urinary tract; more commonly DT bacteremia producing metastatic abscesses in the kidney
8) Candida spp.
a. Critically ill and chronically chaterized

54
Q

LUT UTI(clinical presentation)

A 
dysuria
urgency
frequency 
nocturia
suprapubic heaviness
55
Q

UUT UTI(clinical presentation)

A 
Flank pain
Fever
Nausea 
Vomiting
Malaise
56
Q

Elderly UTI(clinical presentation)

A 
Usually no urinary symptoms! 
Present with;
Altered mental status 
Chg in eating habits 
GI symptoms
57
Q

Indwelling Catheters/ neuro disorders UTI(clinical presentation)

A

Flank pain

Fevers

58
Q

Labs UTI

A

Bacteriuria
pyuria WBCs >10/mm3 (5-10/mm3 upper limit normal)
Nitrate positive
leukocyte esterase positive

59
Q

UTI Treatment goals

A

Eradicate organism
Prevent a /treat systemic consequences
Prevent recurrence
Dec. potential collateral damage ( Resistance DT broad antimicrobial coverage )

60
Q

N. gonorrhoeae Tx

A

Ceftriaxone IM injection

Penicillin allergic: Azithromycin

61
Q

N. gonorrhoeae Concerns & Comments

A

Many undiagnosed and under-reported
50% F coexisting Chlamydial infection 20% M
Everyone Tx for both ( Zpak or Doxy)

62
Q

Chlamydia trachomatis Tx

A

Zpak single 1 time dose
Doxycycline BID 7 days
Fluoroquinolones not better than 1st lines
Pregnant= azithromycin and amoxicillin DOC

63
Q

Chlamydia trachomatis C & C

A

Frequently asymptomatic compare the gonorrhea
Post Tx cultures + represents noncompliance/ failure to Tx partners or lab error
No sex 7 Days following initial Tx

64
Q

Syphilis (T pallidum) Tx

A

Parenteral Pen. G Tx of choice all stages
Pen. G benzathine IM injection
Pen Allergic: only document allergy Doxy
Preg & allergy: Skin test if + desensitize
Neurosyphilis: Pen G IV every 4hrs 10-14 days

65
Q

Syphilis C &C

A

Highly contagious: Fatal/ seriously disabling in un Tx

66
Q

Jarish-Herxheimer rxn: syphilis Tx

A

Flu like illness( bening & self limiting) peripheral vasodilation, aggravation of lesions. Independent of drug dose happens 2-4 hrs after TX peaks at 8 hours and complete by 12-24Hrs

67
Q

Trichomoniasis ( T. vaginalis) Tx

A

Metronidazole or tinidazole

68
Q

Trichomoniasis C & C

A

Metronidazole Ci is 1st Trimester and excreted in Breast Milk: Don’t feed 12-24hrs after Tx
Men high spontaneous cure rate w/o Tx
High 1 time dose GI issues( N/V/D and anorexia) –> multi dose x5-7 days

69
Q

Epididymitis ( chlamydia / gonorrhea) Tx

A

Sexually acquired: Ceftriaxone & Doxycycline
Enteric Gram - Bacteria: Ceftriaxone and Levofloxacin
(seen in: Older men, Urinary tract instrumentation, surgery, obstruction or immunosuppressed)

70
Q

PID ( chlamydia / gonorrhea) Tx

A

Cefotetan or cefoxitin PLUS doxy or:
Clindamycin PLUS aminoglycoside or:
Ceftriaxone PLUS Doxy +/- metronidazole
IV therapy until 24hrs after clinical improvement, then Doxy PO for 14 days

71
Q

PID concerns

A

Myco.genitalium, M. Hominis, & various anaerobics may be involved Tx Must cover all.

72
Q

Chancroid ( H. ducreyi) Tx

A

1 dose azithromycin PO or IM Ceftriaxone

Tx partenrs if sex contact within 10 days of symptom onset.

73
Q

Bacterial Vaginosis ( organisms)

A 
Anaerobic bacteria
Gardnerella vaginalis
Ureaplasma spp.
Mobiluncus curtisii
Mycoplsma spp.
74
Q

Bacterial Vaginosis Tx

A

PO metronidazole or:
Vaginal metronidazole or clindamycin.
Suppressive: 2x weekly metronidazole gel
Preg: metronidazole or Clindamycin

75
Q

Bacterial Vaginosis Concerns

A

Recurrence common: Retreatment with same or alt Tx effective in short term

76
Q

Vulvovaginal Candidiasis (C albicans ) Tx uncomp

A

intravagianl: butoconazole, clotrimazole, miconazole, terconazole, tioconazole: or 1 dose fluconazole PO

77
Q

Vulvovaginal Candidiasis (C albicans ) Tx reccur

A

weekly Fluconazole for 6 months may reduce recurrences

78
Q

Vulvovaginal Candidiasis Concerns

A

Complicated azole resistant C. glabrata or non albicans spp. seen in immunosuppressed , poorly controlled DM or preg. require more aggressive Tx

79
Q

Vulvovaginal Candidiasis Comments

A

Not STI but common in women Tx for STI

1 dose PO fluconazole as effective as 7 days intra vaginal azole Tx: …many pts prefer

Repro 2 Pharm (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions