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afsha - infections > UTI drugs info > Flashcards

UTI drugs info Flashcards

1
Q

dose of nitrofurantoin for lower UTI for pregnant women - MR and IR preps

& when to avoid in pregnancy

A

100mg BD 7 days (MR prep)
50mg QDS 7 days (IR prep)

avoid at term risk of neonatal haemolysis*

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2
Q

dose of nitrofurantoin for lower UTI for men - MR and IR preps

A

100mg BD for 7 days - MR
50mg QDS for 7 days - IR

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3
Q

dose of nitrofurantoin for non-pregnant women with lower UTI - MR and IR preps

A

50mg QDS for 3 days - IR
100mg BD for 3 days - MR

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4
Q

dose of nitrofurantoin for catheter associated UTIs (IR and MR)

A

50mg QDS 7 days (IR)
100mg BD 7 days (MR)

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5
Q

when would you give immediate release preps over MR preps of nitrofurantoin for UTIs

A

when MR preps are unavailable

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6
Q

nitrofurantoin dose for SEVERE CHRONIC RECURRENT UTI

A

100mg QDS for 7 days (using IR preps, not MR)

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7
Q

dose of nitrofurantoin for prophylaxis of recurrent UTI (using IR preps)

A

50-100mg OD, at night
alternatively 100mg for 1 dose to be taken following exposure to trigger

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8
Q

MHRA nitrofurantoin: pulmonary and hepatic adverse drug reactions

A
  • increase vigilance for acute pulmonary reactions in 1st week of treatment
  • closely monitor pt on long term therapy for new or worsening respiratory symptoms esp in elderly
  • discontinue immediately if new or worsening symptoms of pulmonary damage
  • caution when prescribing to pt with pulmonary disease which may mask signs and symptoms of adverse reactions
  • be vigilant for signs and symptoms of hepatic dysfunction esp with long term therapy
  • caution in pt with HI
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9
Q

nitrofurantoin contraindicated in this age

A

under 3 months

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10
Q

3 contraindications of nitrofurantoin

A

acute porphyrias
G6PD deficiency
less than 3 months

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11
Q

what is the interaction (not severe or anything) between nitrofurantoin and vincristine and similar drugs

amiodarone, taxanes, platins, isoniazid,

amiodarone, taxanes, platins, isoniazid, leflonamide, metronidazole, phenytoin, vinka alkaloids

A

increased risk of peripheral neuropathy

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12
Q

side effects which warrant discontinuation of nitrofurantoin (3)

A
  • unexplained haematological or neurological syndromes (such as peripheral neuropathy) occur
  • hepatitis
  • pulmonary reactions (usually occur within first week of treatment and are reversible with cessation of therapy)
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13
Q

acute pulmonary reactions with nitrofurantoin usually occur within …

A

first week of treatment

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14
Q

can you use nitrofurantoin in BF?

A

avoid
only small amounts present in milk but enough to produce haemolysis in G6PD deficient infants

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15
Q

giving nitrofurantoin to pt with renal impairment increases risk of

A

peripheral neuropathy

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16
Q

avoid nitrofurantoin if eGFR

A

less than 45

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17
Q

monitoring requirements of nitrofurantoin

A
  • on long term therapy, monitor LFTs and monitor for pulmonary symptoms esp in elderly (discontinue if deterioration in lung function)
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18
Q

patient and carer advice for nitrofurantoin - seek immediate medical attention if

A

signs of pulmonary, hepatic, haematological or neurological adverse reactions develop

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19
Q

does nitrofurantoin effect driving and skilled tasks

A

yes
Patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness and drowsiness.

20
Q

do you need to take nitrofurantoin with or without food

A

take with or just after food or a meal

21
Q

nitrofurantoin can colour urine which colour

A

yellow brown

22
Q

use of trimethoprim in pregnancy and BF

A
  • avoid in pregnancy, teratogenic risk in 1st trimester. folate antagonist.
  • short term use in BF not known to be harmful
23
Q

trimethoprim dose adjustments in RI

A
  • caution in RI
  • dose reduction to half normal dose after 3 days if eGFR 15-30
  • dose reduction to half normal dose if eGFR less than 15
24
Q

dose of trimethoprim for prophylaxis of recurrent UTI

A

100mg OD, at night
alternatively 200mg 1 dose to be taken following exposure to trigger

25
Q

dose of trimethoprim for catheter associated UTI

A

200mg BD for 7 days (14 days if upper UTI symptoms e.g. fever and loin pain are present)

26
Q

dose of trimethoprim for lower UTI for female (obvs not pregnant because avoid in pregnancy)

A

200mg BD for 3 days

27
Q

dose of trimethoprim for lower UTI for male

A

200mg BD for 7 days

28
Q

contraindication for trimethoprim (1)

A

blood dyscrasia

29
Q

interactions trimethoprim - MTX

A

avoid
increased risk of haematological SE (sometimes fatal)

30
Q

interactions trimethoprim - warfarin

A

increase AC effect of warfarin

31
Q

interactions digoxin and trimethoprim

A

T increases conc of digoxin
monitor digoxin conc

32
Q

trimethoprim is …. toxic

A

nephrotoxic so increased risk of nephrotoxicity with other drugs e.g. antivirals, aspirin, amphotericin B, cephalosporins, Cs, NSAIDs, lithium, MTX , ACEi etc

33
Q

trimethoprim interaction with ACEi and NSAIDs (2)

A

increased risk of nephrotoxicity
increased risk of HYPERkalaemia (esp notable with ACE or ARB given with spironolactone or eplerenone)
NSAIDs also increase risk of hyperkalameia as above

34
Q

can you take clozapine with trimethoprim

A

no avoid as increased risk of neutropenia

35
Q

monitoring requirements of trimethoprim

A
  • blood counts with long term use and in those with or at risk of folate deficiency
  • serum electrolytes in pt at risk of developing hyperkalaemia (e.g. ACE/ARB/NSAIDs/SEAT) and consider monitoring in other pt esp with long term use
  • renal function esp with long term use
36
Q

trimethoprim can cause the following electrolyte imbalance esp if given with SEAT, ACE, ARB, NSAIDs

A

hyperkalaemia

37
Q

on long term treatment pt and their carers should be told how to recognise signs of blood disorders and are advised to seek immediate medical attention if symptoms e.g.

A

fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

38
Q

choice of abx therapy for UTI in pregnancy
1st and 2nd line

A

Oral first line: Nitrofurantoin.
Oral second line (if no improvement after at least 48 hours, or first line not suitable):
Amoxicillin (only if culture susceptible), or cefalexin

39
Q

prophylaxis of recurrent UTI - cefalexin dose

A

125mg OD, at ngiht
alternatively 500mg for one dose following exposure to a trigger

40
Q

dose of cefalexin for lower UTI + in pregnancy

A

500mg BD for 3 days
pregnancy: 500mg BD for 7 days

41
Q

cefalexin is ….toxic so….

A

nephrotoxic so combination with other nephrotoxic drugs (e.g. vancomycin, ACE, NSAIDs, antivirals, etc) increases risk

42
Q

are blood disorders common SE of cefalexin

A

yes, all cephalosporins

43
Q

what is methanamine hippurate and how does it work

A

urinary antiseptic agent
prevents urine infections as it has an antiseptic effect on urinary system
sterilises urine, stopping growth of certain bacteria

44
Q

what is methanamine indicated for

A

prophylaxis and long term treatment of chronic or recurrent uncomplicated lower UTIs (+ in pt with catheters)

45
Q

methanamine dose for prophylaxis and long term treatment of chronic or recurrent uncomplicated lower UTIs (+ in pt with catheters)

A

without catheter: 1g every 12 hours
with catheter: 1g every 8-12 hours

afsha - infections (57 decks)

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