Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
What are the general parameters for an UNCOMPLICATED UTI?
|
Acute -itis
not pregnant (or elderly) no recent instrumentation or ABX no know functional/anatomic abnormalities of the GU tract |
|
|
What G+ organism is not detected by dipstick?
|
S. saprophyticus
|
|
|
What are the 5 general rules for treating UTI's?
|
1. bacterioCIDAL
2. rapid absorption 3. RENAL excretion 4. RENAL distribution (and GU) 5. Efficacy -- empirical |
|
|
What are the 3 key ABX categories for tx of UTI's?
|
Anti-metabolites (TMP-SMX)
fluoroquinolones Misc. (nitrofurantoin) |
|
|
What is a standard course of treatment for uncomplicated lower UTI in women?
|
3-day course of TMP-SMX.... get eradication in 7 days
|
|
|
What is the MOA of anti-folates?
|
SMX inhibits dihydropteroate synthase
TMP inhibits dihydrofalate reductase Both are competitive inhibitors |
|
|
Why use SMX & TMP together?
|
Syngergy! --> bacteriocidal (60x more potent)
|
|
|
What is a potential AE of sulfa drugs (TMP-SMX)?
|
Hypersensitivty --> rash
steven-johnson syndrome |
|
|
What is the MOA of the fluoroquinolones?
|
Disrupt supercoiling of DNA --> inhibit topoisomerase IV and DNA gyrase = DNA rep inhibited
|
|
|
What is the basis of Fluoroquinolone resistance?
|
1. mutation of target enzymes --> DNA gyrase/topoisomerase 4
2. efflux 3. decrease porins |
|
|
What is the basis for resistance to TMP/SMX?
|
SMX: mutate dihydropteroate synthase/ enhanced acquisition of PABA
TMP: mutate/overexpress DHFR |
|
|
Why is moxifloxacin a poor choice of fluoroquinolone for treating UTI's? What would be a better choice?
|
It is primarily hepatically eliminated --> low amt in urine
Use ciprofloxacin (cheap, good e. coli activity) |
|
|
What other drugs/supplements should one avoid taking w/ fluoroquinolones?
|
Antacids, calcium, vitamins/mienerals w/ iron or zinc
|
|
|
What are some important AE's of fluoroquinolones?
|
1. cartilage erosion, arthropathy (pt < 18yo)
2. tendon rupture, tendonitis (climbers) 3. photoxicity in all pt! --> sensitive skin |
|
|
What is a good choice for tx of a >20% resistance to TMP-SMX UTI in women?
|
Select fluoroquinolones for 3 days.... nitrofurantoin in AE's of the fluoros are a problem (7 days)
|
|
|
What is the best approach to tx lower UTI's in children and males?
|
NO SHORT COURSE, 7-14 days
other rules similar but try to narrow spectrum |
|
|
Do you need to tx a patient w/ asymptomatic bacteriuria? What if they are pregnant? What do you use?
|
Not preg... no
Pregnant: YES... risk of pyelonephtritis Tx w/ nitrofurantoin (7-14 d) |
|
|
Why is TMP-SMX contraindicated in pregnanct pt?
|
Fetus AE:
TMP: folate demands not met SMX: displaces bilirubin from albumin --> jaundice, kernicterus |
|
|
What is the first-line tx for asymptomatic bacteruria in preganancy?
|
Nitrofurantoin
MOA: create reactive products --> disrupts protein synth, energy metab, DNA/RNA synth, cell wall synth |
|
|
When is nitrofurantoin contraindicated?
|
renal failure (creatinine clearance < 40 ml/min)
|
|
|
Is Nitrofurantoin useful for pyelonephrtitis?
|
no. only lower UTI's b/c highly excreted in urine... doesn't stay in parenchyma
|
|
|
What are the top two drugs for treating pyelonephritis?
|
ciprofloxacin
ceftriaxone (IV for both) |
|
|
What is a good choice for tx of recurrent UTI's?
|
nitrofurantoin
|
|
|
What are important AE's of nitrofurantoin?
|
pulmonary hypersensitivity (eosinophilia)
pulmonary fibrosis |
