Urinary Pharmacology Flashcards
Management of acute bacterial prostatitis
- 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
Antibiotics for acute bacterial prostatitis
Oral antibiotics, typically for 2-4 weeks (e.g., ciprofloxacin, ofloxacin or trimethoprim)
Management of chronic prostatitis
- 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
Antibiotics for chronic prostatitis
- Antibiotics if less than 6 months of symptoms or a history of infection
- e.g. trimethoprim or doxycycline for 4-6 weeks
Management of Epididymo-orchitis is low risk of STD
Ofloxacin (usually first-line) for 14 days
Alternatives:
- Levofloxacin / ciprofloxacin
- Doxycycline
- Co-amoxiclav
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:
- Tendon damage and tendon rupture, notably in the Achilles tendon
- Lower seizure threshold (caution in patients with epilepsy)
Antibiotics choice for LUTI
Trimethoprim (often associated with high rates of bacterial resistance)
Nitrofurantoin (avoided in patients with an eGFR <45)
Alternatives:
- Pivmecillinam
- Amoxicillin
- Cefalexin
Duration of Antibiotics for LUTI for
- simple infection
- immunosuppressed women
- abnormal anatomy
- impaired kidney function
- men
- pregnant women
- catheter-related UTIs
- 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
Management of LUTI in Pregnancy
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.
Management of Pyelonephritis in community
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)
Analgesia in kidney stones
- 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
What medication can be used to help aid the spontaneous passage of stones?
Tamsulosin (an alpha-blocker)
Patients will require life-long immunosuppression to reduce the risk of kideny transplant rejection. The usual regime is:
- Tacrolimus
- Mycophenolate
- Prednisolone
- Cyclosporine
- Sirolimus
- Azathioprine
Most types of glomerulonephritis are treated with:
- Immunosuppression (e.g. steroids)
- Blood pressure control by blocking the renin-angiotensin system (i.e. ACE inhibitors or angiotensin-II receptor blockers)
Management of diabetic nephropathy
- 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
Treatment for :
- Type 1 Renal Tubular Acidosis
- Type 2 Renal Tubular Acidosis
- Type 4 Renal Tubular Acidosis
Type 1&2: oral bicarbonate
Type 4:
- fludrocortisone
- sodium bicarbonate and treatment of the hyperkalaemia may also be required
Management of Rhabdomyolysis
- 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
Criteria for when to treat hyperkalaemia
- 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
Treatment of hyperkalaemia
- 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
Other options for lowering the serum potassium (x5):
- 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
What medication can slow the development of cysts and the progression of renal failure in autosomal dominant polycystic kidney disease?
Tolvaptan (a vasopressin receptor antagonist)
