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Renal Week 3 > UTI DRUGS - sweatman > Flashcards

UTI DRUGS - sweatman Flashcards

1
Q

T or F: UTIs are the most common infection in women of all ages.

A

True, on top of this 30-40% of women will have another infection within six months of the initial infection

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2
Q

Who do we typically see uncomplicated UTIs with?

A

Women, Children, and elderly patients that are otherwise healthy

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3
Q

What is the most common reason for someone to have a complicated UTI?
• how does this happen?

A

• In dwelling catheters = common cause of uncomplicated UTIs

HOW:
• Fibrinogen collects on the catheter and provides a breeding ground for the bacteria

• Bacteria may breed and produce toxins that damage the bladder or they can spread readily to the kidney

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4
Q

What is the “Balancing act” of our immune system in UTIs?

A
  1. Tight epithelial barrier must be present to prevent infection spread
  2. Inflammatory response kills the infection but also causes endothelial damage

We must balance the need to fight the bacteria and save the epithelium to control spread of infection

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5
Q

T or F: voiding eliminated 99.9% of bacteria that enter tha bladder

A

True, people with neurogenic bladder are at a much higher risk of getting a UTI

“Voiding Manages the bacterial load”

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6
Q

What is a common ADME feature of ALL abx. given to treat UTIs?

A

Elimination occurs either extensively or exclusively through the urine

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7
Q

What are your top drug choices for Acute Uncomplicated Cystitis in a non-pregnant pt?

A
  1. TMX-SMX
  2. Nitrofurantoin
  3. Fosfomycin - single dose
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8
Q

What are your top drug choices for Acute Uncomplicated PYELOnephritis in a non-pregnant pt?

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. TMX-SMX
  4. Ceftriaxone IV followed by 7-14 days of oral abx
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9
Q

What are your top drugs of choice for Complicated UTIs in OUTPATIENTS?

A
  1. Ciprofloxacin or Levofloxacin
  2. TMX-SMX
  3. Amoxicillin-Clavulanate
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10
Q

What are your top drugs of choice for Complicated UTIs in HOSPITALIZED pts?

A
  1. Cefepime
  2. Ceftriaxone
  3. Levofloxacin
  4. Tircarcillin-Clavulanate
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11
Q

What are the primary drugs of choice in acute prostatitis?

A
  1. Ciprofloxacin
  2. Levofloxacin
  3. TMX-SMX
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12
Q

What are the primary drugs of choice to treat SEVERE prostatitis?

A
  1. Fluroquinolone

2. Ceftriaxone and Ceftazidime

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13
Q

What are the most commonly used drugs for RECURRENT UTIs?

A
  1. Nitrofurantoin
  2. TMX-SMX

*sometime 2nd generation cephalosporins or TMX by itself are used

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14
Q

What are the most commonly used drugs for Candiduria?

A
  1. Fluconazole

2. Flucytosine

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15
Q

What abx. could you not give to a patient with G6PD deficiency?

A

TMX-SMX

Nitrofurantoin

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16
Q 
Trimethoprim-Sulfamethoxazole
•Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• IV or PO

MOA:
• Synergistically inhibits back to back steps in the Folate synthesis pathway

Resistance:
• Arises through DECREASED drug penetration and efflux pumps

Adverse effects:
• Blood Dyscrasia and other less specific symptoms

Who Should Not get this:
• Any Woman in Trimester 1 or 3. Trimester 2 is fine and breastfeeding it fine
• People with Folate Deficiency
• People with G6PD defeciency

17
Q

What might happen to the fetus if you gave the mother TMX-SMX during the 3rd trimester?

A

Kemicterus

• Brain Damage and Hearing Damage

18
Q 
Nitrofurantoin
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• PO

MOA:
• METABOLICALLY ACTIVATED by bacterial FLAVOPROTEINS
• Inactivate or Alters Bacterial Ribosomes

Resistance:
• VERY UNLIKELY - would require many simultaneous mutations

Adverse Effects:
• Blood Dyscrasia and Reduced Appetite
• Colors Urine BROWN

People who shouldn’t get it:
•People with G6PD deficiency

THIS DRUG IS SAFE FOR USE IN PREGNANCY and Breatfeeding

19
Q

In these cards note will be taken only on those drugs that do NOT undergo renal elimination

A

adfsa

20
Q 
Fosfomycin
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
PO

MOA:
• Antimetabolite inhibitor of Bacterial ENOLPYRUVATE TRANSFERASE
• Blocks N-acetylmuramic Production (decreases the amt. of peptidoglycan production)

Resistance:
• Conferred QUICKLY through enolpyruvate transferase mutation

Adverse Effects:
• PERIPHERAL NEUROPATHY, renal, pulmonary, and hepatic toxicity with long term use

Don’t give it to:
• Breastfeeding moms

21
Q 
Quinolones 
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Ciprofloxacin and Levofloxacin

Administration:
• IV or PO

MOA:
• Bacterial Topoisomerase inhibitors

Resistance:
• Mutation in Topo (aka DNA gyrase) or efflux

Adverse Effects:
• Tendon Rupture and Tendonitis

Don’t Give to:
• Pregant women or Children but is FINE IN BREASTFEEDING

22
Q 
Ceftriaxone
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• IV or IM

MOA:
• Inhibits Penicillin Bindings proteins needed for bacterial cell wall synthesis

Resistance:
•Penicillinase, PBP muts, or efflux

Adverse Effects:
•Steven Johnson Syndrome, Anaphylaxis, Renal Failure

Don’t Give to:
• SAFE for women who are pregnant OR breastfeeding

23
Q 
How long do you need to treat with? 
• TMX-SMX
•Nitrofurantoin
• Fosfomycin
• Fluoroquinolones 
•Ceftriaxone
A 
TMX-SMX: 3 days 
Nitrofurantoin: 5 days
Fosfomycine: Single Dose
Fluroquinolones: 7 days for cipro, 5 days for levo
Ceftriaxone: Single IV dose
24
Q 
Amoxicillin-Clavulanate
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• PO

MOA:
• Broad Spectrum ß-lactam (acts on PBPs)

Resistance:
• ß-lactamase muts, PBPs muts, drug efflux

Adverse Effects:
• Steven Johnson Syndrome, Anaphylaxis, Hepatotoxicity

Don’t Give to:
• SAFE for women who are pregnant OR breastfeeding

25
Q

What is the relationship of antibiotics and candiduria?

A

• More Abx. = less microflora = more candidia in the GI and GU tract

26
Q 
Fluconazole 
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• PO

MOA:
• Inhibits 14-alpha-Sterol demethylase disrupting Ergosterol Synthesis leading to fungal cell membrane damage

Resistance:
• mutation in demethylase or increase efflux pump

Adverse effects:
POTENTIAL CYP based interactions
• very rare fatal hepatotoxicity

Don’t Give to:
• DO NOT give to Pregnant woment, fine if they’re breastfeeding

27
Q 
Flucytosine
• Administration 
• MOA
• Resistance?
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
• PO

MOA:
• Converted by Fungi to 5-Fluorouricil

Resistance:
• RAPID EMERGENCE OF RESISTANCE WHEN USED ALONE

Adverse effects:
• HALLUCINATIONS and CONFUSION
• MYELOSUPPRESSION in long term treatment

Don’t Give to:
• Pregnancy Category C, not sure about breastfeeding

28
Q 
Amphotericin B
• Administration 
• MOA
• Adverse effects. 
• Pts. who shouldn't get it?
A

Administration:
•ITRAVESICLE IRRIGATION VIA a CATHETER

MOA:
• Drills holes in lipid (ergosterol) membrane of fungi

Adverse Effects:
• Severely Nephrotoxic

Don’t give to:
• Pregnant women?

29
Q

What are some good ways for Women to avoid UTIs?

A
  • Urinate Before and After Sex
  • Do not use Spermicides
  • If you have undergone menopause consider taking OTC cranberry pills and ask dr. about using Perscription Vaginal Estrogen Cream
30
Q

What treatment may be necesssary in recurrent intercourse associated UTIs?

A

Post-Coidal Abx. Prophylaxis, take the abx. within 2 HOURS of intercourse

31
Q

T or F: both oral lactobacilli and intravaginal estrogen reduce incidence of UTI

A

True

32
Q

Note: we don’t really know if cranberry juice works for UTIs

A

aasdf

Renal Week 3 (16 decks)

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