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pharm exam 3 > UTI's > Flashcards

UTI's Flashcards

1
Q

Uncomplicated UTI Symptoms

A

Also called cystitis

dysuria
hematuria
pyuria
frequency
urgency
suprapubic discomfort
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2
Q

Lower UTI (cystitis) First Line Treatment

A
  1. nitrofurantoin
  2. TMP/SMX (sulfa drug)
  3. fosfomycin
    due to effectiveness and low risk for resistance

IF one of these dose not work, try another before going to beta lactam or fluoroquinolone

IF you cannot take these due to allergy, tolerating, or concern for resistance THEN take beta-lactam or fluoroquinolone

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3
Q

Nitrofurantoin

Line
Dosing
Spectrum
Community

S/E
Contraindicated
Notes

A

FIRST LINE FOR UNCOMPLICATED UTI (1)
(or recurrent)

100mg BID x 5 days
> IR: 100mg QID x 5 days

Spectrum: (narrow), ECOLI AND STAPH SAPRO
Community: if local resistance is >20% or if sulfa allergy

S/E
Turns urine dark yellow to brown
N/HA/Flatulence

Contraindicated
elderly with CrCl <30
CrCl <60

Notes
TAKE WITH MEALS (increase absorption + min GI upset)
Doesnt cause vaginitis

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4
Q

TMP/SMX

Line
Dosing
Spectrum
Community

S/E
Serious S/E
Notes

A

FIRST LINE FOR UNCOMPLICATED UTI (2)
(or recurrent)
(has sulfa drug in it)

160/800mg (DS) BID x 3 days

Spectrum: ECOLI, klebsiella, proteus mirabilis
Community: if local resistance is <20%

S/E:
GI Upset: n/v/loss of appetite
Hyperkalemia with ACE and ARB
Hypoglycemia with hypoglycemic
Photosensitivity
Mild skin eruptions

Serious S/E:
Liver damage
Decreased O2 (hemoglobuinuremia)
Sev. Skin disorders (SJS) (toxic necro)

Notes:
TAKE WITH 8OZ of WATER (EACH DOSE)
DONT USE IN PREGGOS

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5
Q

Fosfomycin

Line
Dosing
Spectrum
Community

S/E
Notes

A

FIRST LINE FOR UNCOMPLICATED UTI (3)
(or recurrent)

3000mg (3g) powder x 1 dose

Spectrum: VRE, ESBL, ECOLI (+)
Community: if local resistance is >20% or if sulfa allergy

S/E:
N/D
Vaginitis
AVOID IN PYELONEPHRITIS

Notes:
MIX WITH 3-4oz of WATER

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6
Q

Recurrent UTI Outline

A

2 or more infections in 6 months
OR
3 or more infections in 1 year

With recurrent: each episode has resolution to symptoms
Recurrence is caused by same bacterium

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7
Q

Collateral Damage

A
  • Ecological A/E of antibiotic Therapy

ie CDIFF

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8
Q

2ND LINE for Recurrent UTI or Alternative Needed

A
  • Cannot tolerate due to allergy or s/e of first liners
  • Women whose urine culture shows resistance to preferred antibiotics
  • beta lactams and fluoroquinolones have higher risk of collateral damage
Beta-Lactams (5-7 days)
PCN
-Amoxicillin-Clavulanate 500mg BID 
Cephalosporins
-Cefadroxil 500mg BID
-Cefdinir 300mg BID
-Cefpodoxime 100mg BID
  • Amoxicillin or Ampicillin should NOT be used due to limited effectiveness and resistance concerns*
  • Less efficacy and more side effects than first liners*

Fluoroquinolones

  • ciprofloxacin 250mg BID
  • ciprofloxacin ER 500mg daily
  • levofloxacin 250mg daily
  • ofloxacin 200mg daily
  • Fluoroquinolones reserved for more complicated UTI’s*
  • Concern with A/E: seizures, QT prolong, tendonitis, tendon rupture, peripheral neuropathy, aortic rupture, CDIFF
  • moxifloxacin is not used bc lower concentration in urine*
  • More effective than beta lactams but higher risk of resistance and greater risk of collateral damage*
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9
Q

Complicated UTI’s

A

Any of the following features:

  • fever over 99.9
  • signs of systemic (chills, rigors, significant fatigue, malaise beyond baseline)
  • Flank Pain/ CVA pain
  • Pelvic or Perineal Pain (men can suggest prostatitis)

Treatment: Fluoroquinolones

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10
Q

Acute Pyelonephritis

A
  • Common in kids, older adults and women of child bearing ages
  • Fever, chills, flank pain, dysuria, frequency, urgency, pyuria, usually bacturia
  • EColi 90% of infections
    > mild-mod: treat with abx at home
    > severe: hospital IV abx
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11
Q

Treatment of Acute Pyelonephritis

A

Hospitalization: s/s sepsis, critically ill, persistant high fevers over 101, cant maintain hydration or take meds

Ciprofloxacin 500mg BID x 7 days
Ciprofloxacin ER 1000mg Daily x 7 days
Ofloxacin 400mg BID x 7 days
Levofloxacin 750mg Daily x 5 days

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12
Q

Phenozopyridine

A

OTC: pyridium, uristat, AZO

  • No more than 2 days
  • Can mask symptoms
  • Not replacement of Abx or Medical Treatment
S/E: 
orange/red urine
staining of contacts orange/red 
HA
Dizziness
Rash
Fever
Itching
Serious S/E are usually dose dependent (over dose, using too long)
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13
Q

Non Pharm UTI Prevention

A 
Good Hygiene
- wiping
- pre/post coital voiding
- avoiding tampons, hottubs, douching 
Cranberry Juice
Increase water intake
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14
Q

Pharm UTI Prevention

A 
- Highly effective against reoccurrence 
    > usually with colonization
- Collateral damage high risk 
    > Cdiff, resistance 
- Continuous 6-12 mo
- Intermittment pre post coital 
- Treatment could be for years
- Only effective while taking the abx
     > UTI frequency resumes after stopping abx
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pharm exam 3 (14 decks)

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