Therapeutics ID Butler – Flashcards
Unlock all answers in this set
Unlock answersDefinition/Classification of Cystitis |
Bladder infection
Lower Tract Infection |
Definition/Classification of Urethritis |
Infection of urethra
Lower Tract Infection |
Definition/Classification of Prostatitis |
Infection of prostate
Lower Tract Infection |
Definition/Classification of Epididymitis |
Infection of epididymis
Lower Tract Infection |
Definition/Classification of Pyelonephritis |
Infection of Kidney
Upper Tract Infection
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Routes of Infection |
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In the urine, the defense mechanisms are: |
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In the bladder, the defense mechanisms are: |
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Uncomplicated UTI |
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Complicated UTI |
-Obstructions -Neurologic deficit -Can affect both genders |
Predisposing Risk Factors for UTIs |
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Clinical Presentation of UTIs: Adults |
Lower Tract
Upper Tract
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Clinical Presentation of UTIs: Elderly |
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Diagnostic Criteria for Significant Bacteriuria: Symptomatic Female |
> 102 CFU coliforms/ml or > 105 CFU non-coliforms/ml |
Diagnostic Criteria for Significant Bacteriuria: Symptomatic Male |
> 103 CFU bacteria/ml |
Diagnostic Criteria for Significant Bacteriuria: Symptomatic Individual on Two Consecutive Specimens |
> 105 CFU bacteria/ml |
Diagnostic Criteria for Significant Bacteriuria: Catheterized Specimens |
> 102 CFU bacteria/ml |
Pathogens for Acute Uncomplicated Cystitis |
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Empiric Therapy for Acute Uncomplicated Cystitis |
If there is an allergy to TMP/SMX, patient was hospitalized in past 6 months, or P. aeruginosa is suspected:
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Follow Up for Acute Uncomplicated Cystitis |
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Pathogens for Symptomatic Abacteriuria |
Chlamydia trachomatis Escherichia coli Gardeneralla vaginalis Ureaplasma urealyticum Neisseria gonorrhoeae Staphylococcus spp. |
Empirical Treatment for Symptomatic Abacteriuria |
OR
If STD suspected:
Azithromycin 1 g PO single dose + TMP/SMX DS OR Doxycycline 100 mg PO BID x 7 days + TMP/SMX DS |
Diagnosis of Asymptomatic Bacteriuria |
Elderly Females Pregnant
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Pathogens of Asymptomatic Bacteriuria |
Klebsiella pneumoniae Escherichia coli Enterococcus faecalis Proteus mirabilis Staphylcoccus saprophyticus |
For Asymptomatic Bacteriuria, who do you want to treat? |
Pediatrics Prego
Do not treat adult female if not pregnant |
Symptoms for Acute Pyelonephritis |
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Pathogens for Acute Pyelonephritis |
Klebsiella pneumoniae Proteus mirabilis Enterococcus faecalis Pseudomonas aeruginosa Escherichia coli |
Treatment for Acute Pyelonephritis |
Trimethoprim/Sulfamethoxazole DS 1 PO BID x 14 days OR Levofloxacin 500 mg PO daily x 14 days OR Ampicillin 2 g IV q 6 hrs + Gentamicin 1mg/kg/dose IV x 14 days
Once they are stable and afebrile, can switch to PO |
Follow Up for Acute Pyelonephritis |
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Nosocomial UTI |
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Pathogens of Nosocomial UTI |
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UTI in Males: Complications and Duration of Treatment |
Complicated Catheterization, obstruction of urinary tract, renal and urinary stones, bladder outlet obstruction
Uncomplicated Rare Prolonged Treatment 10-14 days Follow up with culture and sensitivity at 4-6 weeks after completion of treatment |
Causes of UTI in Pregnancy |
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Common Pathogen of UTI in Pregnancy |
Escherichia coli |
Treatment of UTI in Pregnancy |
DOC --> Nitrofurantoin 100 mg BID x 7 days
Alt:
Amoxicillin/Clavulanate q 12 hrs x 7 days
OR
Cephalexin 500 mg q 12 hrs x 7 days
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Follow Up for UTI in Pregnancy |
Urine collection 1-2 weeks after therapy and then monthly |
Recurrent UTIs More Common In: |
Females
20% with cystitis Sexual intercourse Contraceptives |
Recurrent UTIs: 3 or less per year |
Treat as separate infection |
Recurrent UTIs: > 3 per year |
Treat conventionally then prophylaxis for 6 months
Trimethoprim/Sulfamethoxazole 1/2 single strength tab PO daily
OR
Trimethoprim 100 mg PO daily
OR
Nitrofurantoin 50 mg PO daily
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Recurrent UTIs: Re-Infection Prevention |
Post-Coital Void after intercourse Single dose TMP/SMX following intercourse (not common) Postmenopausal Topical estrogen cream - use vaginally |
Risk Reduction for UTIs |
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Urinary Tract Irritants |
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Non-Pharmacological Therapy for UTIs
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Non-Specific Therapy for UTIs |
Urinary Analgesics, Antispasmodics, Antispectics
Helps with painful urination and urgency Should not be used for > 2 days b/c they mask the true UTI symptoms |
Why is Trimethoprim a Category C drug in terms of pregnancy? |
It decreases folic acid which is needed for nucleotide biosynthesis |
Trimethoprim should not be used in newborns because: |
it causes hyperbilirubin which increases risk for developing jaundice |
Why is levofloxacin considered category C in terms of pregnancy risk? |
It causes bone/joint deformities |
What is a counseling point for patients when taking levofloxacin? |
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Possible Routes for Prostatitis |
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Pathogens of Prostatitis |
G- Enterics Escherichia coli (most common in chronic prostatitis) Klebsiella pneumoniae Proteus mirabilis
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Clinical Presentation of Prostatitis: Signs/Symptoms |
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Clinical Presentation of Prostatitis: Physical Examination |
Acute: swollen, tender, or indurated gland Chronic: indurated, enlarged gland |
Clinical Presentation of Prostatitis: Labs |
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Treatment of Prostatitis: First line, duration of chronic prostatitis treatment, and suppressive therapy |
FIRST LINE: Trimethoprim/Sulfamethoxazole DS 1 tab PO BID x 4 weeks OR Ciprofloxacin 500 mg PO BID x 4 weeks OR Levofloxacin 750 mg PO QD x 4 weeks
Treat Chronic Prostatitis for 6-12 weeks
Suppressive Therapy: Ciprofloxacin 500 PO 3x q week OR TMP/SMX SS 1 tab PO QD OR Nitrofurantoin 100 mg PO QD
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