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PHA332 > UTI In Practice > Flashcards

UTI In Practice Flashcards

1
Q

Where can you contract a urinary tract infection?

A

UPPER:
-kidneys
-ureters

LOWER:

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2
Q

Where does bacteria enter during a UTI and what is the most common bacteria?

A

Enters the urinary tract through the urethra
-Escherichia coil which is gram negative which is usually found in the GI tract.

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3
Q

What are the symptoms of a lower UTI infection?

A

Bladder(cystitis)
-polyuria (this is increased urination)
-dysuria (painful urination)
-lower abdominal discomfort (SHOULDNT BE PAINFUL ON THE BACK IF IT IS THIS IS SOMETHING TO WORRY ABOUIT IT CAN BE STONES)

Urethra(urethritis):
-burning on passing urine
-discharge
STIs can cause this also due to the proximity of urethra to vagina

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4
Q

What are the risk factors of developing a UTI?

A

-more common in females due to shorter urethra and the proximity to the anus,
-post menopausal women, this is due to the decline in oestrogen
-indwelling catheters - these provide a ascending route to bacteria.
-recent antibiotic use as it disrupts the normal bacterial flora.
-sexual intercourse
-pregnancy
-spermicides can cause irritation and they are attachment sites for E.coli.

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5
Q

How is pregnancy a risk factor of developing a UTI?

A

The progesterone mediated smooth muscle relaxation to bladder and the ureters, there is compression of the ureters by the uterus.

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6
Q

When do we not give antibiotics?

A

If there is no visible symptoms, but there is bacteria, do not treat as this could essentially cause antibiotic resistance.

But treat a women that is pregnant if they don’t display any symptoms, with antibiotics.

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7
Q

When do we refer a patient with a UTI?

A

-men
-Younger than 16 years old
-Signs of sepsis( high heart rate, high respiratory rate and lower blood pressure)
-non responsive to first antibiotics
-symptoms of pyelonephritis (spreading tot he kidneys)
Which can be seen as, fever, nausea and vomiting, loin /kidney pain and blood in the urine.

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8
Q

What is a urine dipstick not used to check for a UTI in patients above the age of 65?

A

This is because aysmptomatic bacteruira is common in this group of people and could effectively lead to an unnecessary use of antibiotics.

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9
Q

Why is urine culture not the best way to test for UTI?

A

-not always necessary if the UTI is uncomplicated.
-the results are not immediate they take time
-by the time the results come back the uncomplicated infection would have gone away and been resolved.

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10
Q

How to spot pyelonephritis (pain in kidneys

A

-kidney tenderness in the back under the ribs
-flu like illness
-nausea and vomiting
-Myalgia (muscle aches and pains)
-Pyrexia (fever)

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11
Q

How to spot sepsis?

A

High risk signs include:
-altered mental state and behaviour
-increased respiratory rate
-increased heart rate
-low blood pressure
-cyanosis
-non blanching rash
-Anuria (the kidneys aren’t producing urine)
-mottled/ashen skin

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12
Q

How to diagnosis a UTI?

A

if the following signs and symptoms are present:
-dysuria (painful urination and discomfort)
-cloudy urine
-nocturia (waking up to urinate)

If 2 or 3 of the following signs and symptoms are recognised then it is most likely a UTI and will not require a urine dipstick.
If 1 sign is recognised then a urine dipstick should be preformed.
If no symptoms are present (urgency, visible blood in the urine, frequency and tenderness), if there is these signs preform a urine dipstick, if not it is unlikely to be a UTI and consider other diagnoses.

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13
Q

How to read a urine dipstick in patients under 65 ?

A

-NEGATIVE for nitrates, leukocytes and red blood cells= this means a uti is less likely
-NEGATIVE for nitrates but positive for leukocytes= could be a UTI so consider treatment depending on symptoms severity and send away a urine culture.
-POSITIVE FOR RBC WITH POSITIVE NITRATES AND LEUKOCYTES = likely to be a UTI, treat and keep an eye on it and treat with antibiotics depending on symptoms severity.

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14
Q

How does the diagnosis differ when checking patients over 65 years of age?

A
  • NO URINE DIPSTICK
    -always send a urine culture
    -new onset of dysuria and 2 +new symptoms this indicates a UTI
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15
Q

How would we diagnose a pregnant women with a UTI?

A

-regular urine samples as part of pregnancy care.
-2x culture show bacteria give antibiotics.

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16
Q

How do we treat a pregnant women for a UTI?

A

ANTIBIOTICS -7 DAYS OF NITROFURANTOIN (NOT RECOMMENDED AT TERM)
-if the patient is asymptomatic they still must be given antibiotics
-symptomatic relief with paracetamol
-send the patient for urine culture
-amend the prescription if needed

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17
Q

If a group B streptococcus is isolated what would we give?

A

Prophylactic antibiotics will be offered during labour and delivery

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18
Q

Why are antibiotics still given to females who are pregnant and they are asymptomatic?

A

This is because the is a risk of pyelonephritis and premature delivery risk if not treated correctly

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19
Q

What are the lines of treatments used for pregnant women with a UTI?

A

1ST LINE= nitrofurantoin 100mg modified release twice a day for 7 days (eGFR should be above 45ml/minute)

If first choice isn’t suitable or it has not shown adequate effectiveness within 48 hours then use…..

2ND LINE= amoxicillin 500mg three times a day for 7 days

3RD LINE=. Cefalexin 500mg twice a day for 7 days

20
Q

What medication cannot be used in pregnancy women to treat a UTI and why?

A

Trimethoprim cannot be used within the first trimester (12 weeks) as it is seen to be an anti folate drug meaning that it will decrease the levels of folic acid and this is essential to the babies development.

21
Q

What things should we consider when giving an antibiotic?

A

-how severe are the symptoms?
(Only patients allowed antibiotics if asymptomatic are pregnant women)
-risk of complications
-previous urine culture results
-previous antibiotic use (the more courses of antibiotics means the higher risk of resistance)

22
Q

What risk factors correlate with increased resistance?

A

-care home residents
-recurrent UTI (2 in 6 months or 3 in 12 months)
-unresolving urinary symptoms
-hospitalisation for more than 7 days in the last 6 months
-recent travel to a country with increased resistance
-previous UTI resistance to trimethoprim, cephalosporins and quinolones

23
Q

What advice would we give someone with a UTI?

A

-stay hydrated, drink plenty of water , helps flush bacteria from the urinary tract
-avoid dehydration
-always wipe front to back
-avoid scented products
-empty the bladder frequently
-cranberry juice or tablets (no evidence ) may be helpful
-birth control
-paracetamol for pain, ibuprofen if appropriate and lower UTI

24
Q

if there is a risk of resistance what should be done?

A

ALWATS SAFETY NET
Send urine for culture and susceptibilities

25
Q

What antibiotics should we reduce the use of?

A

-ciprofloxacin
-cephalosporins
-co -amoxiclav

26
Q

What medications/antibiotics do we want to increase the use of in UTIs?

A

-nitrourantoin
-trimethoprim - this is still good for UTIs in children
-pivmecillinam (penicillin)

27
Q

When should co-amoxiclav only be recommended?

A

-pyelonephritis in pregnancy
-facial cellulitis or prophylaxis post dog or human bite
-persistent sinusitis

28
Q

Why is nitrofurantoin used more than trimethoprim in UTI infections?

A

Trimethoprim is narrow spectrum and it’s resistance is common.

Nitrofurantoin is more broad spectrum, its concentrated in the areas of need and its resistance rates are much lower.

29
Q

What are the antibiotics used in non pregnant women for the treatment of a UTI?

A

FIRST LINE= nitrofurantoin 100mg modified release twice a day for 3 days. (EGFR must be above 45)

Trimethoprim-if low risk of resistance, 200mg twice a day for 3 days.

If no improvement within 48 hrs or first choices are not suitable then use….

SECOND LINE= nitrofurantoin 100mg modified release twice a day for 3 days.

Pivmecillinam (penicillin) = 400mg initial dose, then 200mg three times a day for a total of 3 days.

Fosfomycin= 3g single dose sachet

30
Q

What is the mode of action of nitrofurantoin?

A

When taken orally, it gets filtered out of your blood and into your urine. This concentrates the medicine where the bacteria are that are causing the urinary tract infection. It kills the bacteria by entering their cells and damaging their genetic material (alter ribosomal proteins)

31
Q

When do we avoid nitrofurantoin?

A

IF THE PATIENT SUFFERS WITH RENAL IMPAIRMENT:
<45ml/min/1.73m2

Nitrofurantoin is not effective in renal impairment because as antibacterial efficacy depends on renal secretion of drug into urinary tract.

CAN USE IN 30-44ML/MIN IN EXCEPTIONAL CASES IF BENEFITS OUTWEIGH THE RISKS.

32
Q

How to take nitrofurantoin?

A

Take with food to increase bioavailability.

33
Q

What 2 preparation s are there for nitrofurantoin?

A

Standard release: 50MG four times daily

Modified release 100mg twice daily

34
Q

What would you warn the patient who is taking nitrofurantoin?

A

It can darken urine to a yellow brown colour but this is normal and is nothing to be so worried about.

35
Q

When is nitrofurantoin contraindicated?

A

-low eGFR
-infants younger than 3 months
-G6PD deficiency, this is when there isn’t enough glucose 6 phosphate dehydrogenase, that helps the red blood cells function properly.
-acute porphyria this is when there is a deficiency in the enzymes used for the biosynthetic heme pathway

36
Q

What cautions should be recognised before prescribing nitrofurantoin?

A

-liver toxicity
-pregnancy
-pulmonary disease
-anaemia
-low B12
-folate deficiency

37
Q

What adverse effects can be encountered when taking nitrofurantoin?

A

-GI disturbances
Nausea, vomiting, loss of appetite, diarrhoea
TO MINIMISED THIS TAKE WITH FOOD OR MILK

-dizziness
-itchy rash/allergic reaction
-fatigue
-swollen salivary glands -discontinue
-peripheral neuropathy( avoid in diabetic patients) discontinue if signs
-pulmonary problems , discontinue if signs of difficulty breathing etc

38
Q

When to discontinue nitrofurantoin?

A

-unexplained pulmonary,hepatotoxic,haematological or neurological syndrome occurs

39
Q

What is trimethoprims mechanism of action?

A

It inhibits the dihydrofolate receptor, blocking the reduction of dihydrofolate to tetrahydrofolate (active form of folic acid) by susceptible organism.
So essentially this drug kills stops the conversion to active folic acid which the bacteria’s need to live, thus bacteria is killed.

40
Q

What considerations should be made before prescribing trimethoprim?

A

RENAL IMPAIRMENT: dose will be reduced if needed in severe renal impairment patients

41
Q

What interactions occur with trimethoprim?

A

Methotrexate and warfarin
-can cause hyperkalaemia, so caution with drugs that can increase potassium levels e.g. ace inhibitors

42
Q

When is trimethoprim contraindicated?

A

-first trimester of pregnancy
-blood dyscrasias, this is a disease that can affect the bone marrow, lymph nodes and the blood

43
Q

What are the adverse effects of trimethoprim?

A

-mild GI disturbances e.g. nausea and vomiting
-prutitis and skin rashes
-blood disorders (if taken long term)

These side effects are reversible Upon discontinuing trimethoprim

44
Q

What is the pharmacists job in regards to a patient with a UTI?

A

-consider a diagnosis
-recognise when the symptoms are mild and if they would respond well to self care
-advise on appropriate self care
-recognise when to refer
-any long term antibiotics must be reviewed
-

45
Q

What antibiotic can be given as a patient group direction?

A

-trimethoprim, some community pharmacies can give this antibiotic if the pharmacist specially trained.
-GP should be notified of the supply
-make a note in patient PMR

PHA332 (25 decks)

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