Nitrofurantoin Flashcards

1
Q

Nitrofurantoin is a

A

nitrated heterocyclic compound

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2
Q

Nitrofurantoin is FDA approved for

A

cysitis

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3
Q

Originally nitrofurantoin was developed as _____ but was poorly _____

A

a microcrystalline product; tolerated (diarrhea, nausea)

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4
Q

Primary product (Nitrofurantoin)

A

macrocrystalline (Macrobid)

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5
Q

How does Macrobid differ from the microcrystalline version?

A

delayed absorption with improved tolerability

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6
Q

Nitrofurantoin MOA

A

activated by bacterial flavoproteins to reactive intermediates

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7
Q

How do activated intermediates damage bacteria?

A

damage ribosomal proteins, DNA, and other macromolecules involved in metabolism and cell wall synthesis

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8
Q

How is nitrofurantoin selective for bacterial cells?

A

bacteria reduce it more rapidly than mammalian cells

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9
Q

Nitrofurantoin oral absorption

A

90%; good

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10
Q

Nitrofurantoin 1/2 life

A

short

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11
Q

Nitrofurantoin elimination

A

40% unchanged in urine

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12
Q

Nitrofurantoin urine elimination take place

A

in glomerular filtration, tubular secretion, and tubular reabsorption

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13
Q

Alkalinized urine may ___ antimicrobial activity

A

reduce

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14
Q

Clinical response is dependent on ____ therefore, impaired renal function ___ the utility of nitrofurantoin

A

urine concentrations; limits

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15
Q

Nitrofurantoin tissue penetration

A

does not penetrate well into tissues, including kidney parenchyma, CSF, eye, prostate, or abiotic fluid

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16
Q

Nitrofurantoin should/should not be taken with food

A

should to improve tolerability and enhance absorption

17
Q

Nitrofurantoin ___ renal adjustment

18
Q

Nitrofurantoin is contraindicated in people with

A

CrCl < 60 ml/min

19
Q

Emerging data suggests that nitrofurantoin is safe and effective if used for short duration in patients with

A

CrCl 30-60 ml/min

20
Q

Decision to use Nitrofurantoin in patients with CrCl 30-60ml/min will depend on

A

alternative regimen, duration of treatment, and physical f/u

21
Q

Nitrofurantoin spectrum coverage

A

dark purple: MSSA, MRSA, E. faecium, E. faecalis

dark red: E. coli, citrobacter

light red: klebsiella, enterobacter, p. aeruginosa

22
Q

Nitrofurantoin adverse effects

A
GI
rare neurologic, hepatotoxicity, pulmonary toxicity, fibrosis, hemolytic anemia in patients with G6PD deficiency
urine discoloration (brown)
false negative glucosuria test
23
Q

Nitrofurantoin is contraindicated in

A

pregnancy >38 weeks and neonates <1 month

24
Q

Nitrofurantoin drug interactions

A

magnesium based antacids (reduced nitro absorption), probenecid (increases nitro serum concentrations)

25
Nitrofurantoin indications
only indicated for cystitis since it has insufficient concentrations in tissues to treat pyelonephritis and in serum to treat anything else
26
Nitrofurantoin duration of therapy
5 days typically for uncomplicated
27
Nitrofurantoin primary adverse effects for uncomplicated disease
GI