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My Edits > Urinary Pharmacology > Flashcards

Urinary Pharmacology Flashcards

1
Q

Management of acute bacterial prostatitis

A
  • Hospital admission for systemically unwell or septic patients (for bloods, blood cultures and IV antibiotics)
  • Oral antibiotics
  • Analgesia (paracetamol or NSAIDs)
  • Laxatives for pain during bowel movements
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2
Q

Antibiotics for acute bacterial prostatitis

A

Oral antibiotics, typically for 2-4 weeks (e.g., ciprofloxacin, ofloxacin or trimethoprim)

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3
Q

Management of chronic prostatitis

A
  • Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
  • Analgesia (paracetamol or NSAIDs)
  • Psychological treatment, where indicated (e.g., cognitive behavioural therapy and / or antidepressants)
  • Antibiotics if less than 6 months of symptoms or a history of infection
  • Laxatives for pain during bowel movements
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4
Q

Antibiotics for chronic prostatitis

A
  • Antibiotics if less than 6 months of symptoms or a history of infection
  • e.g. trimethoprim or doxycycline for 4-6 weeks
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5
Q

Management of Epididymo-orchitis is low risk of STD

A

Ofloxacin (usually first-line) for 14 days

Alternatives:

  • Levofloxacin / ciprofloxacin
  • Doxycycline
  • Co-amoxiclav
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6
Q

Quinolone antibiotics such as ofloxacin, levofloxacin and ciprofloxacin are powerful broad-spectrum antibiotics, often used for urinary tract infections, pyelonephritis, epididymo-orchitis and prostatitis.

They give excellent gram-negative cover. It is worth remembering two critical side effects, as these may be tested in exams and are essential to inform patients about:

A
  • Tendon damage and tendon rupture, notably in the Achilles tendon
  • Lower seizure threshold (caution in patients with epilepsy)
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7
Q

Antibiotics choice for LUTI

A

Trimethoprim (often associated with high rates of bacterial resistance)

Nitrofurantoin (avoided in patients with an eGFR <45)

Alternatives:

  • Pivmecillinam
  • Amoxicillin
  • Cefalexin
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8
Q

Duration of Antibiotics for LUTI for

  • simple infection
  • immunosuppressed women
  • abnormal anatomy
  • impaired kidney function
  • men
  • pregnant women
  • catheter-related UTIs
A
  • 3 days of antibiotics for simple lower urinary tract infections in women
  • 5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
  • 7 days of antibiotics for men, pregnant women or catheter-related UTIs
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9
Q

Management of LUTI in Pregnancy

A

The antibiotic options are:

  • Nitrofurantoin (avoid in the third trimester)
  • Amoxicillin (only after sensitivities are known)
  • Cefalexin

Nitrofurantoin needs to be avoided in the third trimester as there is a risk of neonatal haemolysis

Trimethoprim needs to be avoided in the first trimester as it works as a folate antagonist.

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10
Q

Management of Pyelonephritis in community

A

First-line antibiotics for 7-10 days when treating pyelonephritis in the community:

  • Cefalexin
  • Co-amoxiclav (if culture results are available)
  • Trimethoprim (if culture results are available)
  • Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
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11
Q

Analgesia in kidney stones

A
  • NSAIDs are the most effective type of analgesia, for example, intramuscular or rectal diclofenac
  • IV paracetamol is an alternative, where NSAIDs are not suitable
  • Opiates are not very helpful for pain management and are not routinely used
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12
Q

What medication can be used to help aid the spontaneous passage of stones?

A

Tamsulosin (an alpha-blocker)

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13
Q

Patients will require life-long immunosuppression to reduce the risk of kideny transplant rejection. The usual regime is:

A
  • Tacrolimus
  • Mycophenolate
  • Prednisolone
  • Cyclosporine
  • Sirolimus
  • Azathioprine
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14
Q

Most types of glomerulonephritis are treated with:

A
  • Immunosuppression (e.g. steroids)
  • Blood pressure control by blocking the renin-angiotensin system (i.e. ACE inhibitors or angiotensin-II receptor blockers)
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15
Q

Management of diabetic nephropathy

A
  • Treatment is by optimising blood sugar levels and blood pressure.
  • ACE inhibitors (suffix pril) are the treatment of choice in diabetics for blood pressure control. They should be started in patients with diabetic nephropathy even if they have a normal blood pressure
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16
Q

Treatment for :

  • Type 1 Renal Tubular Acidosis
  • Type 2 Renal Tubular Acidosis
  • Type 4 Renal Tubular Acidosis
A

Type 1&2: oral bicarbonate

Type 4:

  • fludrocortisone
  • sodium bicarbonate and treatment of the hyperkalaemia may also be required
17
Q

Management of Rhabdomyolysis

A
  • IV fluids are the mainstay of treatment
  • Consider IV sodium bicarbonate (evidence on this is not clear)
  • Consider IV mannitol. Hypovolaemia should be corrected before giving mannitol (evidence on this is not clear)
  • Treat complications, particularly hyperkalaemia
18
Q

Criteria for when to treat hyperkalaemia

A
  • Patients with a potassium ≤ 6 mmol/L with otherwise stable renal function don’t need urgent treatment
  • Patients with a potassium ≥ 6 mmol/L and ECG changes need urgent treatment
  • Patients with a potassium ≥ 6.5 mmol/L regardless of the ECG need urgent treatment
19
Q

Treatment of hyperkalaemia

A
  • Insulin (e.g. actrapid 10 units) and dextrose (e.g. 50mls of 50%) drives carbohydrates into cells and takes potassium with it, reducing the blood potassium
  • Calcium gluconate stabilises the cardiac muscle cells and reduces the risk of arrhythmias
20
Q

Other options for lowering the serum potassium (x5):

A
  • Nebulised salbutamol temporarily drives potassium into cells.
  • IV fluids can be used to increase urine output, which encourages potassium loss from the kidneys (but don’t fluid overload patients with renal failure).
  • Oral calcium resonium draws potassium out of the gut and into the stools. It works slowly and is suitable for milder cases of hyperkalaemia.
  • Sodium bicarbonate (IV or oral) may be considered on the advice of a renal specialist in acidotic patients with renal failure. It drives potassium into cells as the acidosis is corrected.
  • Dialysis may be required in severe or persistent cases associated with renal failure
21
Q

What medication can slow the development of cysts and the progression of renal failure in autosomal dominant polycystic kidney disease?

A

Tolvaptan (a vasopressin receptor antagonist)

My Edits (23 decks)

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