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Therapeutics IV > UTI - Block 2 > Flashcards

UTI - Block 2 Flashcards

1
Q

What are the dosage forms of Nitrofurantoin?

A

Macrocrystals: Macrodantin
Monohydrate: MicroBid

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2
Q

ADRs of Nitrofurantoin?

A

Urine discoloration, N/V, pulmonary fibrosis, eosinophilia

CI: CrCl <30

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3
Q

ADRs of Bactrim? CI?

A
  1. Drug-induced thrombocytopenia
  2. Hyperkalemia

CI: Dofetilide, warfarin, sulf allergy

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4
Q

BBW of FQs?

A
  1. Tendon rupture, peripheral neuropathy, CNS effects
  2. Muscle weakness
  3. QT prolongation
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5
Q

What are the most common pathogens that cause UTIs?

A

Klebsiella
E. coli
Entercoccus
Proteus
Staph. saprophyticus

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6
Q

Antibotic resistant organisms that may cause UTIs?

A
  1. VRE
  2. ESBL producing E. coli
  3. AmpC and carbapenemase production of E coli
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7
Q

Infection of the bladder?

A

Cystitis

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8
Q

Infection of the kidneys?

A

Pyelonephritis

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9
Q

Presence of microbes in the urinary tract?

A

Bacteriuria

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10
Q

Bacteriuria w/o sx of infection

A

Asymptomatic bacteriuria (ASB): ≥10^5 CFU/mL w/o sx

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11
Q

Acute infection of the prostate

A

Prostatitis

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12
Q

Inflammation, swelling and irritation of the urethra

A

Urethritis

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13
Q

Sign of infection, positive leukocyte esterase?

A

Pyuria

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14
Q

Pain and burning upon urination?

A

Dysuria

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15
Q

Organelles of adhesion allowing bacteria to colonize environmental surfaces or cells and resist flushing?

A

Bacterial fimbriae/pili

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16
Q

Urine is forced up ureters into kidneys

A

Vesicoureteral reflux

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17
Q

What are the host defense mechanism used to prevent UTIs?

A
  1. Length of urethat tract (males have longer)
  2. Low urinary pH
  3. High urea concentration
  4. Prostatic secretion
  5. Voiding expels bacteria that colonize in the urethra
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18
Q

What is the difference between upper and lower UTI?

A

Upper: Pyelonephritis infects the kidneys
Lower: Cystitis doesn’t involve the kidney (e.g. urethra, bladder)

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19
Q

What are the characterisitcs for uncomplicated UTI?

A
  1. Acute, sporadic, recurrent infection
  2. Premenopausal femals
  3. No anatomical/functional abnormalities
  4. Normal, healthy
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20
Q

What is considered a complicated UTI?

A
  1. Men
  2. Pregnancy
  3. Obstrution of urinary tract
  4. Foreign body
  5. Incomplete voiding
  6. Diabetes
  7. Vesicoureteral refulx
  8. Immunosupression
  9. Hx of instrumentation
  10. Health care associated infection
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21
Q

What are the RF of UTIs?

A
  1. Females
  2. Pregancy
  3. Diabetes
  4. Seniors
  5. Dysfunctional lower UT
  6. Urinary incontinence
  7. Obesity
  8. Neurologic conditions
  9. Poor pesonal hygiene
  10. Males with BPH
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22
Q

Presentations of cystitis?

A
  1. Urinary urgency
  2. Urinary frequency
  3. Dysuria
  4. Nocturia
  5. Suprapubic pain
  6. Hematuria
23
Q

Presentations of pyelonephritis?

A
  1. Fever
  2. Flank pain
  3. Chills
  4. N/V
  5. Costovertebral angle tenderness
24
Q

What is the difference between urine analysis and cultrue?

A

Culture: looks for microbes
Analysis: used for uncomplicated cystitis outpatient

25
Q

What are the lab results of UTIs?

A
  1. Urine culture (Gold standard)
  2. Pyuria
  3. Hematuria
  4. Bacteriuria
  5. Leukocyte esterase +
  6. Nitrite + (w/ nitrite reducers)
26
Q

How is uncomplicated cystitis normally diagnosed?

A

Hx and s/s of infection

27
Q

How do we diagnose complicated/recurrent infection?

A

Culture/sensitivity

28
Q

Should urine cultures be used for uncomplicated cystitis?

A

No, but can use urinalysis

29
Q

OTC product used for UTI? Counseling

A

Phenazopyridine HCl (urinary analgesic)
1. Treats the sx not the infection
2. Only used for 1-2 days with ABX
3. Red-orange discoloration that may stain contacts and urine

30
Q

Non-pharm for UTI?

A
  1. Increase fluid intake
  2. Complete voiding
  3. Cranberry products
31
Q

Which of the following organisms is most likely responsible for a UTI in a novel, uncomplicated infection?

A

E. coli

32
Q

Who are more susceptible to MDR G- UTI?

A
  1. MDR G- or FQ resistant-PA isolates
  2. Inpatient
  3. Use of FQ, Bactrim, of broad-spec b-lactam
  4. Travel to high prevalence areas
33
Q

UTIs are best treated after categorizing the infection, assign MOA of infection with corresponding ABX?

A

Filtration depends on size and PPB: Sulfonamides, Nitrofurantoin, AG
Actively secreted into urine: b-lactams and FQ

34
Q

What is the first line for acute uncomplicated cystitis?

A
  1. Nitrofurantoin 100 mg BID x 5days
  2. Bactrim DS (avoided IF resistance exceeds 20%) 1 tabl BID for 3 days
  3. Fosfomycin 3 g once
35
Q

Alt tx for acute uncomplicated cystitis?

A
  1. FQ (Cipro and Levo) -> more serious infection and resistant strains -> Don’t use mox or gemi
  2. Augmentin -> Don’t use amoxicillin or ampicillin empirically
36
Q

What is the first line tx for outpatient complicated UTI including mild/moderate pyelonephritis?

A

Cipro and Levo

37
Q

What is tx for outpatient complicated UTI including mild/moderate pyelonephritis is patient has FQ resistance >10% from E. coli?

A

Ceftriaxone, ertapenem, gent/tobra -> followed by FQ

38
Q

What is the tx for outpatient complicated UTI including mild/moderate pyelonephritis in patients with FQ allergy?

A

Cetriaxone, ertapenen, gent/tobra -> followed by Bactrim or Augmentin

39
Q

What is the tx for outpatient complicated UTI including mild/moderate pyelonephritis in patients with MDR?

A

Ertabenem

40
Q

What is the first line tx for inpatient complicated UTI (severe)?

A

Ceftriaxone IV
Alt: Cipro or Levo IV

41
Q

What is the tx for inpatient complicated UTI (severe) in patient with MDR risk??

A
  1. Cefepime (anti-pseudomonal)
  2. Piperacillin/tazobactam (anti-pseudomonal)
  3. Meropenem (if recent ESBL isolate)
  4. Imipenem (if recent ESBL isolate)
42
Q

Tx for UTIs in pregnancy? Alt?

A

First-line: amoxicillin, Augmentin, cephalexin
Alt: Nitrofurantoin and Sulfonamides (avoid in 1st and 3rd trimester)

Treatment for 5-7 days

43
Q

ABX avoided in pregnancy?

A
  1. Tetracycline
  2. FQ
44
Q

Presentations of UTIs in elderly?

A
  1. Altered mental status
  2. Change in eating habits
  3. GI sx
45
Q

Modifiable RF for UTI in catherized patients?

A
  1. Method and duration of catheterization
  2. Catheter system
  3. Care of system
  4. Technique of HC personnel inserting the catheter
46
Q

What patient populations do you screen for aysmptomatic bacteriuria?

A
  1. Pregnancy
  2. Patients undergoing urological procedures:
    * Cytoscopy
    * Ureteroscopy
    * Nephroscopy
    * Urethrethroscopy
    * Removal of tissue, tumors, and stones
47
Q

What is the pharm tx for ASB?

A

Non unless pregnant for 5-7 days:
1. Amoxicillin
2. Cephalexin

48
Q

What are the common pathogens associated with prostatitis?

A
  1. Chlamydia trachomatis
  2. Ureaplasma urealyticum
  3. Mycoplasma hominis
49
Q

What is the time cut-off for acute prostatitis?

A

> 3 months

50
Q

What are RF for bacterial prostatitis?

A
  1. Prolonged urinary catheterization
  2. BPH
51
Q

What are the sx of prostatitis?

A
  1. Fever
  2. Malaise
  3. Dysuria
  4. Urinary frequency/hesitancy
  5. Pelvic pain
52
Q

Physical exam of prostatitis?

A

Enlarged prostate and tender to palpitation

53
Q

Tx for actute prostatitis?

A
  1. Bactrim
  2. Cipro
  3. Levo

For 2-4 wks

54
Q

Tx for chronic bacterial prostatitis?

A

FQ (Cipro and Levo) for 4-6 wks

Therapeutics IV (39 decks)

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