Pharm Of Renal Infections Flashcards
What are the top 3 populations of patients who get UTIs?
- Females
- Infant boys
- Old men
UTIs can lead to what other 3 infections?
Cystitis, pyelonephritis, and prostatitis
Top 3 pathogens for Uncomplicated UTI?
E. Coli, Klebsiella, and Staph Saprophyticus
Top 4 Pathogens for Complicated UTI?
- E. Coli.
- Enterococcus
- Klebsiella
- Candida
Most important element of the biofilm for E Coli?
Type 1 pili
Most important element of the biofilm for proteus?
Urease leading to calcium and magnesium phosphate crystals
What is the most important element to the P aeruginosa biofilm?
Lectins and rhamnoliids. Essentially, they change the PA to be lipophilic and connect.
Most important element of the biofilm for enterococcus faecalis?
Fibrinogen
Patient presents with no symptoms, is having a urine screen for a drug test for work, but has bacteria in the urine, what is the diagnosis?
Asymptomatic Bacteriuria
Clinical symptom triad of Cystitis?
Frequency dysuria, and pain
What are the three drugs for first line treatment of Cystitis?
Nitrofur, Fosfomycin, and TMP-SMX
What is second line treatment against Cystitis?
Oral Beta Lactams
What is the third line treatment for Cystitis and why is it third?
Fluoros because they have the most adverse effects.
What bacteria can we use nitro on and what two are a no go?
Gram positive and gram negative. No for PA and strains of proteus.
What is important to say about the pharmacokinetics of nitro and what are 2 adverse effects of Nitro?
It is metabolized and excreted very quickly so no systemic action. Nassau and vomiting.
Nitro is contraindicated in high patient population?
Glucose 6 phosphate dehydrogenase.
What is the MAO for fosfomycin?
Cell wall synthesis inhibitor
When should we not use nitro and fosfomycin for cystitis and why?
We should not use it if we think Pyelonephritis is also going on because they are not effective against renal tissue.
When do we not use TMP-SMX?
When resistance is known to be greater than 20%
Which fluoro is not recommended to use and why?
Moxifloxacin and it attains much lower urinary levels.
FDA states to not use fluoros for what and why?
Uncomplicated UTIs because of adverse effects, tendinitis and tendon rupture being the worst.
What two drugs do we not use for treatment of uncomplicated cystitis?
Ampicillin and amoxicillin
Two clinical presenting symptoms for pyelonephritis and which one is different than cystitis?
Unilateral back pain and fever. Cystitis doesn’t not present with fever.
What is first line treatment and second line treamtment for pyelonephritis?
- Fluoro.
2. TMP-SMX, oral beta lactam, aztreonam
What do we add to the treatment regimen if it is a severe pyelonephritis with Fluoro?
Ceftriazone or aminoglycoside.
What are the two aminoglycosides used for the severe pyelonephritis?
Gentamicin and tobramycin
What bacteria are the aminoglycosides effective against?
Aerobic gram negative plus PA.
What is the MAO for the aminoglycosides?
Protein synthesis inhibitor. Binds to 30s ribosomal subunit.
3 adverse effects of aminoglycosides?
8th cranial nerve toxicity, renal toxicity, and neuromuscular blockade.
When do we use aztreonam for pyelonephritis?
Second line treatment if the patient does not tolerate the TMP or beta lactams first.
What bacteria is aztreonam effective against?
Aerobic gram negative
MAO of Aztreonam?
Cell wall synthesis inhibitor
