Unit 7: GU Flashcards
Most common pathogen for UTI
E coli
Complicated UTIs may be due to
Pseudomonas, enterococcus, staphylococcus, serratia, providencia, fungi
Urine culture for UTI
> 10^5/mL
Urinary analgesics for UTI
Methenamine, phenazopyridine, flavoxate
used to treat urgency, frequency, burning, and discomfort
Should not be used for more than 2 days
First line antibiotics for UTI
Trimethoprim-Sulfametaxazole (Bactrim)
Nitrofurantoin
Fluoroquinolones (Cipro)
Second line antibiotics for UTI
Cipro–usually reserved for complicated UTI and pyelonephritis
Antibiotics safe for UTI in pregnancy
Amoxicillin, cephalexin, nitrofurantoin (only 1st and 2nd trimester)
Prostatitis categories
Acute bacterial
chronic bacterial
chronic nonbacterial and pelvic pain syndrome
asymptomatic inflammatory
Main organism in acute bacterial prostatitis
E coli and pseudomonas
Main organisms in chronic bacterial prostatitis
pseudomonas, E Coli, proteus mirabilis, klebsiella pneumoniae, enterococcus
Most accurate method of prostatitis diagnosis
culture isolation of prostatic urine
1st line therapy for bacterial prostatitis
Fluoroquinolone for 4-6 weeks
Oral
Other antibiotics for bacterial prostatitis
Bactrim, doxycycline, azithromycin, clarithromycin
BPH causes
may be due to higher amounts of estrogen in the gland that increases activity of substances that promote cell growth; or increase in DHT levels
Increased smooth muscle tone in lower urinary tract due to stimulation of alpha 1 receptors
Main class of drugs for BPH
a1 blockers
5-a-reductase inhibitors for BPH
Finasteride + Dutasteride
Decrease levels of intracellular DHT without reducing testosterone levels
Most men achieve 20-40% reduction after 6 months of use
a-adrenergic blockers
-zosin, tamsulosin (flomax)
Relax smooth muscle of prostate and bladder neck without interfering with bladder contractility
May take weeks to months to see effects
May cause hypotension
Erection
Release of NO following PANS stimulation –> causes smooth muscle relaxation that permits inflow of blood
Vasoactive intestinal peptide and prostaglandins E1 + E2 also contribute to vasodilation
Phosphodiesterase 5 inhibitors
Sildenafil (viagra)
Inhibit breakdown of one of messengers required for erection
Reinforce the normal cellular signals that increase cAMP
Phosphodiesterase 5 inhibitors CI in
use of nitrates, unstable angina, systolic BP <90, alpha blockers, recent MI
Overactive bladder
urinary urgency + frequency, nocturia, with or without urge urinary incontinence
SANS stimulates urethral sphincter closure and detrusor relaxation during filling
PANS influences contraction of detrusor and relaxation of sphincter during emptying
Predominant mediator of detrusor contraction
ACh mediated activation of muscarinic receptors–more so M3
Drug target for treatment of OAB
M3 receptor blockage
First line tx of OAB
Anticholinergics/antimuscarinics
Anticholinergics for OAB
Oxybutynin, tolterodine, trospium, solifenacin, fesoterodine
Increase bladder capacity, decrease intensity and frequency of bladder contractions and delay initial urge to void
Beta adrenergic agonists for OAB
Mirabegron
Selective B3 agonist
Increases cAMP which causes smooth muscle relaxation and increased urine storage space
Onabotulinumtoxin A (Botox) for OAB
Reserved for patients who have failed other treatments
Injected into detrusor muscle, inhibits Ca dependent release of ACh, ATP and substance P and desensitizes motor neurons
UTI is a common SE
Alpha adrenergic antagonists for OAB
-Zosin
Decrease sympathetic mediated stricture
Antidiuretic drugs for OAB
Desmopressin
Can cause diuresis without impacting BP
Causative organism for chlamydia
Chlamydia trachomatis
First line therapy for chlamydia
Azithromycin single dose
Doxycycline
Causative organism for gonorrhea
N. Gonorrhoeae
First line treatment for gonorrhea
Single dose ceftriaxone + single dose of azithromycin
Causative organism for syphilis
Spirochete trepenema pallidum
First line treatment for syphilis
Penicilin G
If allergic treat with doxycyline or tetracycline
Antivirals for genital herpes
Acyclovir, famciclovir, valacyclovir
CI in breastfeeding
Most common pathogens for pelvic inflammatory disease
N. Gonorrheoeae and C. Trachomatis
TX for PID
Usually same as gonorrhea or chlamydia
Cefoxitin, doxycycline, clindamycin, ofloxacin, metronidazole, ceftriaxone
Therapy for HPV
Podofilox and Podophyllin Resin–self applied gel
Trichloroacetic acid and bichloroacetic acid–applied by healthcare professional
