UTI DRUGS - sweatman Flashcards
T or F: UTIs are the most common infection in women of all ages.
True, on top of this 30-40% of women will have another infection within six months of the initial infection
Who do we typically see uncomplicated UTIs with?
Women, Children, and elderly patients that are otherwise healthy
What is the most common reason for someone to have a complicated UTI?
• how does this happen?
• 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
What is the “Balancing act” of our immune system in UTIs?
- Tight epithelial barrier must be present to prevent infection spread
- 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
T or F: voiding eliminated 99.9% of bacteria that enter tha bladder
True, people with neurogenic bladder are at a much higher risk of getting a UTI
“Voiding Manages the bacterial load”
What is a common ADME feature of ALL abx. given to treat UTIs?
Elimination occurs either extensively or exclusively through the urine
What are your top drug choices for Acute Uncomplicated Cystitis in a non-pregnant pt?
- TMX-SMX
- Nitrofurantoin
- Fosfomycin - single dose
What are your top drug choices for Acute Uncomplicated PYELOnephritis in a non-pregnant pt?
- Ciprofloxacin
- Levofloxacin
- TMX-SMX
- Ceftriaxone IV followed by 7-14 days of oral abx
What are your top drugs of choice for Complicated UTIs in OUTPATIENTS?
- Ciprofloxacin or Levofloxacin
- TMX-SMX
- Amoxicillin-Clavulanate
What are your top drugs of choice for Complicated UTIs in HOSPITALIZED pts?
- Cefepime
- Ceftriaxone
- Levofloxacin
- Tircarcillin-Clavulanate
What are the primary drugs of choice in acute prostatitis?
- Ciprofloxacin
- Levofloxacin
- TMX-SMX
What are the primary drugs of choice to treat SEVERE prostatitis?
- Fluroquinolone
2. Ceftriaxone and Ceftazidime
What are the most commonly used drugs for RECURRENT UTIs?
- Nitrofurantoin
- TMX-SMX
*sometime 2nd generation cephalosporins or TMX by itself are used
What are the most commonly used drugs for Candiduria?
- Fluconazole
2. Flucytosine
What abx. could you not give to a patient with G6PD deficiency?
TMX-SMX
Nitrofurantoin
Trimethoprim-Sulfamethoxazole •Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
What might happen to the fetus if you gave the mother TMX-SMX during the 3rd trimester?
Kemicterus
• Brain Damage and Hearing Damage
Nitrofurantoin • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
In these cards note will be taken only on those drugs that do NOT undergo renal elimination
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Fosfomycin • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
Quinolones • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
Ceftriaxone • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
How long do you need to treat with? • TMX-SMX •Nitrofurantoin • Fosfomycin • Fluoroquinolones •Ceftriaxone
TMX-SMX: 3 days Nitrofurantoin: 5 days Fosfomycine: Single Dose Fluroquinolones: 7 days for cipro, 5 days for levo Ceftriaxone: Single IV dose
Amoxicillin-Clavulanate • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
What is the relationship of antibiotics and candiduria?
• More Abx. = less microflora = more candidia in the GI and GU tract
Fluconazole • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
Flucytosine • Administration • MOA • Resistance? • Adverse effects. • Pts. who shouldn't get it?
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
Amphotericin B • Administration • MOA • Adverse effects. • Pts. who shouldn't get it?
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?
What are some good ways for Women to avoid UTIs?
- 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
What treatment may be necesssary in recurrent intercourse associated UTIs?
Post-Coidal Abx. Prophylaxis, take the abx. within 2 HOURS of intercourse
T or F: both oral lactobacilli and intravaginal estrogen reduce incidence of UTI
True
Note: we don’t really know if cranberry juice works for UTIs
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