Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

M201 > W9 UTI > Flashcards

W9 UTI Flashcards

1
Q

Causes of Cystitis (for info)

A

Wiping front to back after bowel motion
Previous infection not clearing
Uncontrolled diabetes
Sexual intercourse
Irritation from chemicals / toiletries
Post-menopausal changes to vaginal lining
Side effect of some medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cystitis vs UTI
Can they be used interchangeably?

A
  • Terms ‘cystitis’ and ‘UTI’ often used interchangeably
  • ‘Cystitis’ is used to describe a collection of urinary symptoms including dysuria (pain on urinating), frequency and urgency

Same symptoms BUT
Main difference: Cystitis can stem from non-infectious causes. A urinary tract infection, by definition, must involve an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the Normal Symptoms of UTI? (6)

A
  • Signs of impending attack: itching or pricking sensation in urethra
  • More frequent desire to pass urine
  • Urgent need to pass urine throughout day and night
  • Can only pass few burning, painful drops of urine (dysuria)
  • Bladder may not feel completely empty after urinating
  • Cloudy and strong-smelling urine: sign of bacterial infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the Symptoms Needing Referral for UTI? (4)

A
  • Haematuria (blood in urine)- may just be severe UTI, but could be kidney stone (blood with pain) or
    potentially bladder/kidney cancer (blood but no pain)
  • Symptoms suggestive of upper UTI- pain in lower back, loin pain and tenderness, systemic symptoms such as fever, nausea and vomiting
  • Abnormal vaginal discharge- local fungal or bacterial infection
  • Cystitis symptoms & alteration in vaginal discharge & lower abdo pain= ? chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cystitis- Who to Refer to GP? (11)

A
  • Children
  • Males
  • Pregnant females
  • Post-menopausal women- could be vaginal atrophy
  • Catheterised patients
  • Upper UTI symptoms
  • Symptoms of systemic infection- fever/nausea/vomiting
  • Haematuria or abnormal vaginal discharge
  • Symptoms lasting longer than 2 days
  • Recurrent cystitis- could be diabetes
  • Failed treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cystitis:
Management- Self and OTC

A
  • Majority of cases are self-limiting and will resolve in 3 days
  • Only antibiotics will treat, rest offers symptomatic relief and prevention of recurrence

Self-management:
* Avoiding vaginal irritants
* Drink plenty of water
* Empty bladder fully
* Wipe front to back after bowel motion
* Urinate after sexual intercourse
* ? Role of cranberry juice in preventing recurrence

OTC OPTIONS
* Simple analgesia
* Alkalysing agents
* Potassium citrate and sodium citrate
* Antibiotics
* Only if scheme running in local area
* Specific inclusion criteria
* Trimethoprim or Nitrofurantoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cystitis- POM Management in Primary Care
What is 1st line?
Duration?

A
  • 1st line: Nitrofurantoin OR Trimethoprim
    Duration
  • Women: 3 days
  • Men: 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Nitrofurantoin

A
  • Type of antibiotic (classed as ‘other’ in BNF)
  • Dose: 100mg BD of the modified-release preparation
    -Immediate release available, at a different dose (mainly used for prophylaxis)
  • Avoid in renal impairment (if eGFR under 45mL/min/1.73m2)
  • Antibacterial effect depends on renal secretion of drug into urinary tract
  • Also INC risk of peripheral neuropathy
  • Can use in eGFR 30-44 mL/min/1.73m2 if benefit outweighs risk
  • Common side effects:
    o Colours urine yellow / brown
    o GI side effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Trimethoprim:
Dose?
Common SE?

A
  • Type of antibiotic (classed as ‘other’ in BNF)
  • Dose: 200mg BD
  • Note: high resistance rates to this drug, so might not work
  • As much as 50% of E.coli UTIs in Hywel Dda HB are resistant
    • Common side effects:
      o Diarrhoea and vomiting
      o Electrolyte imbalance (K+)
      o Headache
      o Skin reactions
  • AVOID in patients with low folate or on a folate antagonist (e.g. methotrexate, some
    antiepileptics and proguanil) (AND PREGNANCY!)
  • Works by blocking production of active form of folic acid in bacteria  can’t synthesise DNA  cell
    death
  • It can reduce the levels of folic acid in humans (can affect same enzyme)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complicated Lower UTIs
What is classed as “complicated”?

A
  • Patient over 65 years
  • More likely to be resistant to UTIs
  • Any other risk factors for resistance:
  • Care home resident
  • Recurrent UTI
  • Recent hospitalisation
  • Unresolving urinary symptoms
  • Recent travel to areas of high antimicrobial resistance
  • Previous resistant UTI
  • Complicated UTI in women
  • Renal impairment
  • Abnormal urinary tract
  • Poorly controlled diabetes
  • Immunosuppression
  • Technically all UTIs in men are complicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

POM management of complicated UTIs:
What is first-line?
What is second-line?

A
  • Treatment is as per local guidelines and sensitivities of recent mid-stream
    urine (MSU) sample results
  • If no MSU available, treat empirically
  • 1st Line: Nitrofurantoin OR Trimethoprim
  • Same dose as uncomplicated, but 7 day duration for men and women
  • 2nd Line: Pivmecillinam OR Fosfomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pivmecillinam

A
  • Pivmecillinam is a type of penicillin antibiotic
  • Not suitable in penicillin-allergic patients
  • Dose: 400mg TDS
  • NB tablets only available as 200mg
  • Duration: 7 days
  • Patient must be over 40kg
  • Risk of oesophageal ulceration
  • Must take with half a glass of water and after a meal while sitting or standing (not
    lying flat)to  risk
  • Common side effects:
    o Nausea / vomiting / diarrhoea
    o Hypersensitivity reactions, including skin rashes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fosfomycin
Dose?
Directions?
SE?

A
  • Type of antibiotic (classed as ‘other’ in BNF)
  • Dose: 3g (one sachet) STAT, then repeat dose 3 days later
  • Risk of missing the dose
  • Dissolve sachet in water and take immediately on an empty stomach
    (2-3 hours before or after meal)
  • Preferably take before bedtime and after emptying bladder
  • Common side effects:
    o Abdominal pain
    o Nausea / vomiting / diarrhoea
    o Headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

UTI treatment in Elderly:
What should be considered?

A
  • Always treat elderly patients (over 65 years) as ‘complicated’
  • Elderly patients get very unwell from UTIs
  • Increased risk of falls
  • Increase in confusion (incl. hallucinations)
  • May be misdiagnosed as something else (always ask for MSU in confused/fallen patients)
  • Once treated, confusion and fall risk will usually resolve/return to baseline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are UTIs treated in Pregnancy?

A
  • Tend to always treat with antibiotics
  • Risk to baby- infection can cause early labour and low birth weight
  • Classed as a ‘complicated’ infection, so treat for 7 days (instead of 3)
  • Need to check that drug is safe in pregnancy
  • Must know the gestation (i.e. how far along is pregnancy)
  • Choice of abx depends on gestation
  • E.g. nitrofurantoin ok in 1st and 2nd trimester, but caution in 3rd trimester(avoid near term) due to risk of neonatal haemolysis
  • Check local guidelines for specifics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UTI treatment in Children:
Is age an issue?
What is first-line?
What is second-line?
Duration?

A
  • Children under 3 months: Refer to secondary care
  • Children over 3 months: Treat
  • 1st Line: Cefalexin OR Nitrofurantoin
  • 2nd Line: Trimethoprim OR Amoxicillin
  • Duration: 3 days
  • Use second line if resistance or if you need a liquid (cheaper)
17
Q

What is an Indwelling Catheter?

A
  • Catheter = flexible tube inserted through the bladder to remove urine
  • Can be temporary or long-term (indwelling)
  • Often, you will get stagnant urine in bag / tubing, which will grow bacteria
  • Doesn’t mean that patient has a UTI
  • ONLY treat if symptomatic
  • Treat as a “complicated” infection
18
Q

Pyelonephritis

A
  • Also referred to as “upper UTI” or “kidney infection”
  • Happens when the bacteria that cause cystitis travels from the bladder up
    to one or both kidneys
  • Classic symptoms:
  • Fever
  • Shivers
  • Nausea
  • Pain in lower back / side
  • Associated with lower UTI symptoms
19
Q

What is Pyelonephritis?

A
  • Potentially serious infection
  • Can damage kidneys
  • Infection can also spread to bloodstream (sepsis)
  • Must treat with antibiotics
  • Might need analgesia too- often painful and uncomfortable
  • Can take up to two weeks to feel completely better afterwards
20
Q

Pyelonephritis Management:
1st line?
2nd line?

A
  • Try to prescribe as per MSU results
  • If not available, prescribe empirically
    MINOR PRESENTATIONS
  • 1st Line: Cefalexin
  • 1g PO TDS 7 – 10 days
  • 2nd Line: Co-trimoxazole OR Ciprofloxacin
  • Co-trimoxazole: 960mg PO BD for 7 – 10 days
  • Ciprofloxacin: 500mg PO BD for 7 day
21
Q

Cefalexin:
Drug class?
Dose?
Common SE?

A
  • Type of cephalosporin antibiotic (1ST generation)
  • Dose: 500mg TDS
  • Note: Some cross-sensitivity in patients with penicillin allergy
  • Incidence of up to 10% of penicillin-allergic patients
  • Do not give if history of immediate sensitivity; otherwise use with caution
  • Common side effects:
    o Diarrhoea and vomiting
    o Headache
    o Abdo pain
    o Skin reactions
  • Safe in pregnancy and breast feeding
22
Q

Co-trimoxazole:
Class of drugs?
What 2 drugs does it contain?
Dose?
What are the common SE?

A
  • Type of antibiotic (classed as ‘Other’ in BNF)
  • Combination of trimethoprim and sulfamethoxazole
  • Sometimes referred to as old brand name of ‘Septrin’
  • Used due to synergistic effects of both antibiotics
  • Dose: 960mg BD PO
  • Note: Tight restrictions around its prescribing from the Committee on Safety of Medicines
  • Want to encourage use of single agents
  • Lower risk of side effects if just using one agent
  • Can only use for some indications- complex UTI being one (usually if sensitivities to it only)
    • Common side effects:
      o See those of constituent drugs
      o Mainly gastro side effects
  • Rare but serious side effects:
    o Blood disorders (leucopenia, thrombocytopenia, megoblastic anaemia etc.)
    o Skin disorders (Stevens-Johnson syndrome, toxic epidermal necrolysis)
  • Similar contraindications to constituent drugs (e.g. NO in pregnancy)
23
Q

Ciprofloxacin

A
  • Type of quinolone antibiotic
  • Dose: 500mg BD
  • Important safety information:
  • Tendon damage
    o Can cause irreversible tendon damage and rupture
    o Usually occurs within 48h of starting treatment; can happen several months after stopping
    o Risk increased in increasing age (over 60s), if using steroids concomitantly, or had tendon issues before
    o STOP treatment if: tendinitis or tendon rupture, muscle pain, muscle weakness, joint pain, joint swelling, peripheral neuropathy, and CNS effects,
  • Convulsions
    o Can induce convulsions in patient with/without history of convulsions
    o Taking NSAIDs at same time can increase the risk
    o Caution in epilepsy
  • Risk of aortic aneurysm and dissection
    o Rare, but avoid in patients with history of these
    o Seek immediate medical attention if sudden onset severe abdo, chest or back pain develops
  • Risk of heart valve regurgitation
    o Small increased risk
    o Use different agent if patient has heart valve or other at-risk disorders (see BNF)
  • Common side effects:
    o Diarrhoea and vomiting
    o QT prolongation
    o Headache
    o Skin reaction
24
Q

Gentamicin

A
  • Type of aminoglycoside antibiotic
  • Dose: Calculated on a patient-by-patient basis
  • Most health boards will have a ‘gentamicin calculator’ to calculate dose based on renal function and BMI. This will ‘band’ the dose
  • Usual initial dose: 3-5mg/kg IV OD for max 5-7 days
  • Note: Drug has a narrow therapeutic index
  • Requires therapeutic drug monitoring to ensure serum levels not toxic
  • Check trough level immediately prior to second dose (wait for level before giving dose)
  • Safe = level under 1mg/L (OK to continue to give at same dose)
  • If level is high: extend dosing interval by another 12-24 hours then check level again
  • Common side effects (these are dose-related)
    o Renal impairment
    o Deafness (can be irreversible)
    o Headache
    o Skin reactions
  • AVOID in patients with poor renal function (CrCL <30mL/min)
  • Drug is renally excreted
  • If can’t remove drug from body, will accumulate = increased risk of ototoxicity and nephrotoxicity
25
Q

Piperacillin with tazobactam (Tazocin®)

Drug classes?
Dose?
Common SE?

A
  • Type of penicillin antibiotic
  • Do not give to patients with penicillin allergy!!
  • Piperacillin is the antibiotic whilst tazobactam* prevent bacterial enzymes from breaking down the beta
    lactam ring (thus overcoming some resistance)
  • Type of broad-spectrum antibiotic
  • Dose: 4.5g IV TDS
  • Reduce in renal impairment
  • Common side effects:
    o Diarrhoea and vomiting
    o Hypersensitivity reactions
    o Thrombocytopenia (low platelets)
    o Skin reactions
  • Only use to treat as per local guidelines
  • As it’s broad-spectrum, some prescribers will use for any sort of infection
  • Poor practice, as increases risk of resistance and rates of C.diff

*Beta-lactamase inhibitor

26
Q

Meropenem

A

Type of carbapenem antibiotic
* Some similarities in structure to penicillins (beta-lactam ring), so risk of cross-sensitivity
* AVOID in severe penicillin allergy
* Caution in mild-moderate allergy - ?alternative, or closely monitor for reaction
* Dose: 0.5-1g IV TDS
* Reduce dose in renal impairment
* Common side effects:
o Diarrhoea and nausea and vomiting
o Abdo pain
o Headache
o Skin reactions
* Use is tightly restricted
* Only use for specific indications, usually under consultant micro advice

27
Q

What is Urosepsis?

A
  • Occurs when bacteria from a UTI move into the bloodstream
  • Very serious condition
  • As person’s body tries to fight the infection, it can cause  heart rate,
    fever, chills and confusion, which can lead to organ failure and death
  • Signs and symptoms
    o  heart rate and  respiratory rate
    o Fever and chills
    o Little to no urine output (oliguria or anuria)
    o Anxiety, impending sense of doom/death
    o Dizziness, inability to focus, loss of consciousness
    o Organ failure and septic shock (low BP, cyanosis, pale extremities)
    o UTI symptoms (recognise these early to prevent progression to sepsis)
28
Q

Urosepsis- Cause

A
  • E. coli (usually) infects bladder causing UTI
  • Multiplies and travels up to kidneys
  • Causes pyelonephritis and continues to multiple
  • As kidneys are always in direct contact with blood when they filter it, the bacteria
    has easy access to the bloodstream
  • Bacteria then spreads to rest of body via bloodstream
29
Q

What are the risk factors for developing UTI?

A

o Female (shorter urethra)
o Faecal incontinence
o Urinary retention / difficulty emptying bladder fully
o Recent urinary tract surgery
o Urinary tract obstruction (stones, BPH or tract scarring)
o Improper catheter insertion

30
Q

Urosepsis Management

A
  • For diagnosis, should send away blood and urine samples for culturing
  • Whilst waiting for the culture results, treat empirically:
  • If CrCL over 30mL/min
  • Gentamicin OD IV for max of 5 days
  • If CrCL under 30mL/min
  • Piperacillin-tazobactam (Tazocin®) 4.5g IV TDS
  • OR Meropenem IV (for non-severe penicillin allergy)
  • OR drug as per micro advice in severe penicillin allergy
31
Q

What are the barriers to managing UTI’s? (4)

A
  1. Resistance
    o High rates of UTI resistance due to mismanagement in past
    o Push to have urine MSU* to ensure appropriate, targeted treatment
  2. Prophylaxis
    o Not a common practice anymore
    o Increases risks of resistance
    o Is common in children, try to avoid in elderly
  3. Commissioning of services
    o UTI service not available in all community pharmacies
    o No equity in service provision across Wales
  4. Misdiagnosis (e.g. confusion and falls)
    o Treating UTI may resolve these issues
    o Quick and easy to rule out UTI

*midstream specimen of urine
-test for infection

32
Q

What can untreated UTIs lead to? (2)

A

Pyelonephritis and Urosepsis

33
Q

What 2 drug classes are the safest in pregnancy treatment of UTI?

A

Penicillins & Cephalosporins

34
Q

What are the issues around pregnancy?

A

Really important to check what stage of pregancy:
Trimethoprim- Avoid in 1st trim, ok in 2nd and 3rd
Nitrofurantoin- Ok in 1st, 2nd trim, avoid in term - Inc risk of haemolysis

M201 (81 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions