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GU2 - Urology > Pharm - UTI > Flashcards

Pharm - UTI Flashcards

1
Q

What are the goals of therapy for UTI?

A
  1. Eradicate invading organism
  2. Prevent/treat systemic consequences of infection
  3. Decrease the potential for collateral damage with too broad of antimicrobial therapy.
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2
Q

What is the most common pathogens for acute cystitis?

A

E. coli

*can also be enterobacteriaceae (proteus mirabilis and K. pneumonia) and staph saprophyticus

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3
Q

What is the most common pathogens for pyelonephritis?

A

E. coli, enterobacteriaceae, and enterococcus.

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4
Q

What are the advantages of prescribing phenazopyridine (pyridium)?

A

It relieves symptoms caused by irritation of the urinary tract such as pain, burning, and feeling of needing to urinate urgently or frequently.

It is basically a painkiller to soothe lining of urinary tract.

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5
Q

What is the role of vaginal estrogen in prevention of cystitis?

A

normalizes vaginal flora, supporta vaginal growth of lactobacillus spp.
Appears to reduce risk of reoccurence.

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6
Q

What is the role of cranberry in prevention of cystitis?

A

Prevents bacterial adherence to uroepithelial cells.

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7
Q

What is the role of lactobacillus in prevention of cystitis?

A

competitive exclusion of usual uropathogens.

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8
Q

MOA of nitrofurantoin (Macrobid)

A

Converted by bacteria to metabolites that inhibit bacterial ribosomes - preventing protein synthesis.

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9
Q

Given patient CrCl > 60 mL/min, is there a contraindication to nitrofurantoin (Macrobid)?

A

No, no adjustments in dosing are needed.

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10
Q

Given patient CrCl < 60 mL/min, is there a contraindication to nitrofurantoin (Macrobid)?

A

The manufacturer suggests not using, but data suggest safe and effective with CrCl down to 30 mL/min.

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11
Q

Given patient CrCl < 30 mL/ in, is there a contraindication to nitrofurantoin (Macrobid)?

A

Yes, avoid drug.

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12
Q

Nitrofurantoin (Macrobid) ADR

A

MC - urine turns brown, nausea, HA, flatulence.

  • can cause hemolytic anemia with G6PD deficiency
  • up to 1% serious ADR is acute or chronic pulmonary reaction including fibrosis and hemorrhage
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13
Q

Acute pulmonary reaction to nitrofurantoin (Macrobid)

A
  • hypersensitivity type I or II
  • appears in days
  • fever, dyspnea, irritating cough, rash, chest pain, cyanosis
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14
Q

Chronic pulmonary reaction to nitrofurantoin (Macrobid)

A
  • either cell-mediated or toxic response
  • develops in several months
  • dyspnea, dry cough, fatigue, less intense than acute
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15
Q

Duration of therapy for nitrofurantoin (Macrobid) for uncomplicated UTI

A

5 days

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16
Q

Duration of therapy for TMP/SMX (Bactrim) for uncomplicated UTI

A

3 days

17
Q

Duration of therapy for fosfomycin for uncomplicated UTI

A

1 day

18
Q

Contraindications to use of TMP/SMX (Bactrim)

A
  • 3rd trimester of pregnancy d/t risk of kernicterus in newborn
  • avoid if prevalence of resistance > 20% or if patient has taken Bactrim for cystitis in the preceding 3 months
19
Q

ADR of TMP/SMX (Bactrim)

A
  • rash
  • allergic reaction
  • GI intolerance
  • bone marrow suppression
20
Q

Indications for fosfomycin

A
  • tx of uncomplicated cystitis
  • may be useful for complicated lower tract infections as well
  • NOT effective for systemic infections
  • lower rates of collateral damage but is expensive
  • covers most pathogens
21
Q

Contraindications to use of fosfomycin

A

Avoid if suspicion for early pyelonephritis

22
Q

ADR d/t fosfomycin

A

Mild GI - diarrhea, nausea

23
Q

What is the role of fluoroquinolone in the treatment of cystitis?

A
  • used for both cystitis and systemic infections
  • levofloxacin (Levaquin) and ciprofloxacin (Cipro)
  • good gram-negative activity, some gram-positive activity (active against pseudomonas)
24
Q

What population do you NOT use fluoroquinolone in?

A

Do NOT use in children or pregnancy.

*limit use with UTI’s as to preserve use for more serious infections

25
Q

What is the collateral damage caused by fluoroquinolone?

A

D/t excellent systemic concentrations and broad-spectrum nature, fluoroquinolone causes A LOT of collateral damage.

26
Q

ADR of fluoroquinolone

A
  • QT prolongation
  • GI intolerance
  • tendon rupture (especially in the elderly)
27
Q

What is the place in therapy for PO beta lactams in tx of cystitis?

A

They are less effective than fluoroquinolone or Bactrim d/t high resistance rates, so they should only be used it the bacteria has known susceptibility.

Examples: augmentin, cefdinir, and cephalexin.

28
Q

Given a patient with uncomplicated, acute cystitis, select the most appropriate antibiotic.

A

1st line agents: nitrofurantoin (Macrobid)*, TMP-SMX (Bactrim), or fosfomycin

29
Q

nitrofurantoin (Macrobid) vs. TMP-SMX (Bactrim)

A

Macrobid is 1st line tx and prophylaxis of uncomplicated cystitis

  • It has equal efficacy as Bactrim with less potential for collateral damage (it concentrates in the urine, so doesn’t have large effects on bacteria elsewhere)
  • low resistance rates
  • inexpensive
30
Q

Choose the best abx therapy for continuous prophylaxis for recurrent UTIs

A
  • patients given daily continuous abx tx for 6 months, then d/x
  • if recurrence does not decrease the therapy will be reinitiated
  • can use Bactrim, TMP-SMX, Macrobid, or Cipro
31
Q

Risk factors for MDR organisms in complicated UTI

A
  • inpatient stay
  • recent use of fluoroquinolone, TMP-SMX, or broad-spectrum beta-lactam
  • international travel to areas with high resistance
32
Q

What is the place in therapy of fluoroquinolone in tx of complicated UTI?

A

It is the drug of choice if no contraindications, h/o allergy, drug interaction that can’t be modified, or h/o fluoroquinolone use in the past 3 months with high risk of resistance.

33
Q

What is the appropriate abx regimen for outpatient treatment of complicated UTI?

A

*drug of choice: fluoroquinolone

34
Q

If there is fluoroquinolone resistance in outpatient tx of complicated UTI, what regimen do you use?

A

use long-acting IV or IM abx

  • ceftriaxone IV/IM + fluoroquinolone PO
  • gentamicin or tobramycin IV/IM + PO fluoroquinolone
  • ertapenem IV one time + PO fluoroquinolone
35
Q

If no MDR gram-negative infection in outpatient tx of complicated UTI…

A
  • treat with standard spectrum abx until C&S is back
  • ceftriaxone, fluoroquinolone
  • tailor the abx when results are available
  • treat IV until patient improves, then oral based on C&S
  • duration: 5-14 days, based on response
36
Q

If risk for MDR gram-negative in outpatient tx of complicated UTI…

A
  • use broad-spectrum abx with ESBL coverage (imipenem or meropenem)
  • if urine gram stain shows gram-positive cocci add one:
  • vancomycin, daptomycin, or linezolid

GU2 - Urology (10 decks)

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