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Renal System > UTI Drugs > Flashcards

UTI Drugs Flashcards

1
Q

Antimicrobial agents used for UTIs

A
  1. Trimethoprim-sulfamethoxazole (TMP-SMX)
  2. Fosfomycin
  3. Nitrofurantoin
  4. Cirpofloxacin
  5. Levofloxacin
  6. Ceftriaxone
  7. Amoxicillin-Clavulanate
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2
Q

Antifungals used for UTIs

A
  1. Fluconazole

2. Flucytosine

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3
Q

Tx of Acute uncomplicated cystitis?

  • (In first-line order)
  • (assuming non-pregnant)
A
  1. Trimethoprim-Sulfamethoxazole* (TMP-SMX)
  2. Nitrofurantoin
  3. Fosfomycin (single dose)

*local rates of resistance must be

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4
Q

Tx of Acute uncomplicated pyelonephritis?

  • (In first-line order)
  • (assuming non-pregnant)
A
  1. Ciprofloxacin
  2. Levofloxacin
  3. Trimethoprim-Sulfamethoxazole (TMP-SMX)
  4. Ceftriaxone IV followed by 7-14 days oral antibiotic
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5
Q

Tx of outpatient Complicated UTIs? (In first-line order)

A
  1. Ciprofloxin or Levofloxacin
  2. Trimethoprim-Sulfamethoxazole (TMP-SMX)
  3. Amoxicillin-Clavulanate
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6
Q

Tx of hospitalized Complicated UTIs? (In first-line order)

A
  1. Cefepime (4th gen cephalosporin)
  2. Ceftriaxone (3th gen cephalosporin)
  3. Levofloxacin
  4. Ticaracillin-Clavulanate
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7
Q

Tx of acute prostatitis? (In first-line order)

A
  1. Ciprofloxin
  2. Levofloxin
  3. Trimethoprim-Sulfamethoxazole (TMP-SMX)
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8
Q

Tx of severe prostatitis? (In first-line order)

A

Intravenous (IV):

  1. Fluroquinolone
  2. 3th gen cephalosporins (Ceftriaxone or Ceftazidime)
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9
Q

Tx of Reccurent UTIs?

a. Most commonly used (In first-line order)
b. Occasional first-lines (in order)

A

Most common

  1. Nitrofurantoin
  2. Trimethoprim-Sulfamethoxazole (TMP-SMX)

Ocassionally:

  1. 2nd Gen cephalosporins (Cefector and Cephalexin)
  2. Trimethoprim
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10
Q

Tx of candiduria?

A
  1. Oral Fluconazole

2. Oral Flucytosine

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11
Q

General side effects of oral antimicrobials used to treat UTIs?

A
  1. GI upset
  2. N/V
  3. Rash
  4. Pruritis (itching of skin)
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12
Q

Excretions of drugs used to treat UTIs?

A

All drugs used to treat UTIs are exclusively or extensively excreted in the urine

thereby providing a high drug concentration in the intended site of drug action

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13
Q

MOA of TMP-SMX?

A

Synergistic sequential inhibitors of enzymes involved in bacterial synthesis tetrahydrofolic acid

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14
Q

Contraindications for using TMP-SMX?

A
  1. Patients with folate deficiency

2. Pregnancy (Use okay in 2nd Trimester, but probably should still avoid)

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15
Q

MOA of Nitrofuratoin

A

Metabolically activated by bacterial flavoproteins to active intermediates that inactivate or alter bacterial ribosomal proteins

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16
Q

Additional AEs of Nitrofuratoin?

A
  1. Loss of appetite (inappetence)

2. Colors urine brown

17
Q

Alternative drug used to tx a UTI in a pregnant women?

A

Nitrofuratoin

  • administered for 5 days
  • equally effective as TMP-SMX
18
Q

MOA of Fosfomycin?

A

Antimetabolite inhibitor of bacterial cytosolic enolpyruvate transferase
- decreases peptidogylcan chain formation

19
Q

Resistance to Fosfomycin develops rapidly

- what are these mechanisms?

A
  1. Mutation in drug target

2. Decreased uptake

20
Q

Significant AEs of Fosfomycin?

A
  1. Peripheral Neuropathy
  2. Renal tox
  3. Hepto tox
  4. Pulmonary tox
  • with long-term use
  • monitor function!
21
Q

Can Fosfomycin be used safely in pregnancy?

A

Yes

BUT not with breastfeeding

22
Q

MOA of Fluorquinolones?

A

Inhibit bacterial topoisomerases (DNA gyrase)

23
Q

Serious AEs of Fluoroquinolones?

A
  1. Tendonitis and Tendon Rupture (worse w/ concurrent steroid use)
  2. Chondrogenesis
  3. Increased QT interval (Cipro)
24
Q

Length of drug administration for Cipro- and Levofloxacin?

A
  • Ciprofloxacin (7 days)

- Levofloxacin (5 Days)

25
Q

Contraindication for Fluoroquinolones (ciprofloxacin and levofloxacin)?

A
  1. Pregnancy

2. Children

26
Q

What drugs used to treat UTIs are having issues with resistance?

A

TMP-SMX and Fluoroquinolones

27
Q

Pregnant women with pyelonephritis.

How do you tx?

A

Single IV dose of a 3rd generation Cephalosporin (ceftriaxone)
- in conjunction with short-course oral beta-lactams

28
Q

Serious AEs of Ceftiaxone?

A
  1. Anaphylaxis
  2. SJS (stevens-johnson syndrome)
  3. Renal failure
29
Q

Effectiveness of Amoxicllin-Clavulanate in treating UTIs compared to fluoroquinolones and TMP-SMX?

A

Amoxicllin-Clavulanate Less effective

30
Q

Why is fluconazole, and not other Azoles, useful in treating Candiduria?

A

Only azole to be eliminated renally

- thereby producing high drug concentrations in urinary tract

31
Q

Contraindications of fluconazole?

32
Q

Tx of flucanazole-resistant cases of candiduria?

A

Flucytosine (pro-drug for 5-Flurouracil)

33
Q

Adverse effects of Flucytosine

A

Commonly: Headache, N/V, Hallucinations

  • Bone marrow suppression w/ long term use
34
Q

Contraindications of Flucytosine?

35
Q

UTI drugs with contraindications for pregnancy

A
  1. TMP-SMX
  2. Fluoroquinolones
  3. Flucytosine
36
Q

How would Amphotericin B be given to treat genitourinary fungal infections? Why is this necessary?

A

Intravesically (directly administered into the bladder via a catheter)

  • lipid formulation of Amphotericin B prevents the drug from being renally eliminated (renal toxicity)
37
Q

Methods to prevent recurrent UTIs

A
  1. Urinate before and after sex
  2. Do not use spermicides
  3. Antimicrobial prophylaxis (post-coital use has less AE than daily prohylaxis)
  4. non-microbials (Lactobilli and estrogen cream)
  5. Cranberry extract (maybe)

Renal System (19 decks)

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