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Renal II Quizam #2 > Lecture 1: Pharm of Renal Infections > Flashcards

Lecture 1: Pharm of Renal Infections Flashcards

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1
Q

What type of UTI is most likely in a nonpregnant women without anatomic abnormalities or instrumentation of the urinary tract?

A

Uncomplicated UTI

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2
Q

What are some of the predisposing factors which would make a UTI be considered complicated?

A
  • Urinary obstruction
  • Urinary retention caused by neuro disease
  • Immunosuppression
  • Renal failure or Renal Transplantation
  • Pregnancy
  • Foreign bodies: Calculi or Indwelling Catheters
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3
Q

UPEC relies on what adhesive organelle to form a biofilm?

A

Type 1 pili, antigen 43, curli

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4
Q

How is P. mirabilis able to form a biofilm for inhabiting the urinary tract?

What are the components of this biofilm?

A
  • Produce urease
  • Calcium crystals + magnesium ammonium phosphate precipitates
  • Crystalline biofims
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5
Q

How is P. aeruginosa able to form a biofilm for inhabiting the urinary tract?

What are the components of this biofilm?

A
  • Changes hydrophobicity of its surface
  • Uses lectins, rhamnolipids
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6
Q

What does E. faecalis use to form a biofilm?

A

Fibrinogen

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7
Q

A young, non-pregnant female presents with dysuria, frequency, urgency, nocturia, and some suprapubic discomfort. On PE you notice some gross hematuria.

What type of UTI does this fit the criteria of?

A

Uncomplicated Cystitis

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8
Q

What are the 3 first line agents for Uncomplicated Cystitis?

A
  1. Nitrofurantoin
  2. Trimethoprim-Sulfamethoxazole (TMP-SMX)
  3. Fosfomycin
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9
Q

What class of agents is used as a second line treatment for Uncomplicated Cystitis?

List 4 drugs in this class.

A
  • Oral beta lactams
  • Amoxicillin, Cefpodoxime, Cefdinir, Cefadroxil
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10
Q

Which class is of Abx is uses as the third line for treatment of Uncomplicated Cystitis?

List 3 drugs in this class

A
  • Fluoroquinolones
  • Ciprofloxacin, Levofloxaxin, Ofloxacin
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11
Q

The first line agents for cystitis, Fosfomycin and Nitrofurantoin, target which gram-type of bacteria?

A

Gram positive and gram negative

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12
Q

What is the MOA of Nitrofurantoin?

A
  • Converted into highly reactive intermediate
  • Disrupts synthesis of proteins, RNA, and DNA
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13
Q

Nitrofurantoin antagonizes what other drug?

Contraindicated in which pts?

A
  • Antagonizes nalidixic acid (synthetic quinolone Abx)
  • Contraindicated in pts w/ G6P dehydrogenase deficiency
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14
Q

What is the MOA of Fosfomycin?

A
  • Cell wall synthesis inhibitor
  • Inhibits cytoplasmic enzyme enolpyruvate transferase
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15
Q

By which method may a bacteria become resistant to Fosfomycin?

A

Inadequate transport of drug into cell

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16
Q

Which first line agent for cystitis come in an oral form and is safe to use in pregnancy?

A

Fosfomycin

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17
Q

Nitrofurantoin and Fosfomycin should not be taken in pts when there is suspicion of?

A
  • Early pyelonephritis
  • Does NOT achieve adequate renal tissue levels
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18
Q

What are the two 3rd gen Cephalosporins used as a second line to treat cystitis?

Target which gram-type of bacteria?

A
  • Cefpodoxime
  • Cefdinir

*Target gram negatives

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19
Q

What is the 1st generation cephalosporin used as a second line tx for Cystitis?

Targets which gram-type of bacteria?

A
  • Cefadroxil
  • Targets gram positive and gram negatives
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20
Q

Which adverse effects exist for Fluoroquinolones and is why the FDA states that disabling and potentially irreversible effects of these drugs outweight their benefits in treating uncomplicated cystitis?

A
  • Tendinitis and tendon rupture
  • Peripheral neuropathy
  • CNS effects
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21
Q

Which 2 drugs should not be used to emperically treat uncomplicated cystitis due to possibility of resistance?

A
  1. Ampicillin
  2. Amoxicillin
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22
Q

If resistance is identified in someone with uncomplicated cystitis, which drug/class can be used?

This drug is insufficiently active against what bacteria?

A
  • Ertapenem (a carbapenem)
  • Insufficient against P. aeruginosa
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23
Q

To determine what drugs to use, what are the major signs/sx’s of someone with Pyelonephritis?

A
  • Unilateral back or flank pain
  • Fever (can be high or low grade) w/ N?V
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24
Q

Which antibiotic class is the first line for Pyelonephritis?

List the 2 drugs that are used?

A
  • Fluoroquinolones
  • Ciprofloxacin or Levofloxacin
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25
If severe pyelonephritis or risk factors for resistance, fluoroquinolones should be adminstered with what parenteral broad spectrum antibiotics until susceptibility data is available?
- **Ceftriaxone (3rd gen.)** **OR** - **Aminoglycosides**: Gentamicin or Tobramycin
26
Aminoglycosides (i.e., Tobramycin or Gentamicin) are active against which gram-type and specific bacteria?
**Aerobic** gram **negatives** + *P. aeruginosa*
27
What is the MOA of aminoglycosides?
Irreversible **protein synthesis inhibitor**, binds **30S ribosomal subunit**
28
What are 3 AE's associated w/ Aminoglycosides? \*Hint: Sheehy gave us a way to remember using the name.
- **CN VIII toxicity**: vertigo and **hearing loss** - **Renal toxicity** - Neuromusclar blockade \*"A-Mean-Guy will punch you in the ear, then the kidney, and finally knock you out"
29
What are the 3 second-line agents which can be used for pyelonephritis in a pt who is hypersensitive to fluoroquinolones or there is resistance?
- TMP-SMX - Oral beta lactams --\> Amoxicillin, Cefpodoxime, Cefdinir, Cefadroxil - Aztreonam
30
If a pt w/ pyelonephritis cannot tolerate TMP-SMX or oral beta lactams, what do you give them?
Aztreonam
31
What is the structure of Aztreoname that allows it be used in penicillin hypersensitive patients?
Monobactam, monocyclic beta-lactam ring
32
Aztreonam has activity against which type of bacteria? \*Way to remember from CMMRS\*
**Aerobic gram-negatives** (*P. aeruginosa)* ## Footnote \*"Tree falls on house = **negative** experience and will probably let air in (**aerobes**)
33
What is the MOA of Aztreonam?
- **Cell wall synthesis inhibitor** - **Transpeptidase** inhibitor
34
Which 2nd line agent for Pyelonephritis comes in IV form?
Aztreonam
35
What are the AE's seen in children associated with Aztreonam?
- Neutropenia (3-11%) - Pain at injection site (12%)
36
What is the clinical presentation of Complicated UTI and is often due to what?
- **Severe** dysuria (**painful urination**) - Often due to an **indwelling catheter**
37
What are the 2 first line agents for **complicated cystitis**?
**Ciprofloxacin** or **Levofloxacin** = Fluoroquinolones
38
Fluoroquinolones are used for complicated cystitis due to their coverage of which bacteria?
*P. aeruginosa* ## Footnote \*Ciprofloxacin or Levofloxacin
39
In complicated cystitis, the presence of gram-positive cocci on gram stains suggests what type of organism causing the UTI? Can use what 2 antibiotics?
- **Enterococcal UTI** (i.e., *E. faecalis* or *E. faecium)* - **Ampicillin** or **Amoxicillin**
40
Which urinary analgesic can be used for pain relief in complicated cystitis? Common finding/AE of this drug?
- Phenazopyridine - Colors urine **orange/red**
41
What are the 3 first line agents used in **mild** complicated pyelonephritis? When is each used (i.e., bacteria and hypersensitivities)?
1) **Ceftriaxone** 2. **Ciprofloxacin** or **Levofloxacin** --\> covers ***P. aeruginosa*** 3) **Aztreoname** --\> alt. in setting of **beta lactam allergy**
42
The beta-lactamase inhibitors: tazobactam and avibactam are available in combinations with beta lactam drugs and can be used for **severe** complicated pyelonephritis, what 3 combos exist?
1. Piperacillin + Tazobactam 2. Ceftolozane (5th gen.) +Tazobactam 3. Ceftazidime (3rd gen.) + Avibactam
43
The **beta-lactamase inhibitors** used in combo for **severe** complicated pyelonephritis are **good inhibitors** of which type of beta-lactamases? Produced by which 2 bacteria which can cause UTI's?
- Ambler **class A** β-lactamase - ***E. coli*** and ***K. pneumoniae***
44
The **beta-lactamase inhibitors** used in combo for severe complicated pyelonephritis are **poor inhibitors** of which type of beta-lactamases? Produced by which 2 bacteria which can cause UTI's?
- Class C β-lactamases - Produced by ***Enterobacter spp.*** and ***P. aeruginosa***
45
Which 3 Carbapenems can be used as first line therapy for **severe** complicated pyelonephritis? Effective against which types of bacteria?
- **Imipenem**, **Doripenem**, and **Meropenem** - **Wide spectrum** = good activity against **gram negatives** (including *P. aeruginosa)* + **gram positives** and **anaerobes**
46
Carbapenems are resistant to?
Beta-lactamases
47
What is the MOA of carbapenems?
**Inhibit transpeptidase**
48
What is significant about the pharmacokinetics of Doripenem, Meropenem, and Ertapenem?
**NOT** metabolized by dihydropeptidase
49
Which carbapenem is most commonly used, but is associated w/ seizures so should be avoided in pts with a history or risk of seizure?
Imipenem
50
Which β-lactam can be used as a first line monotherapy for treating severe complicated pyelonephritis?
**Cefepime** (4th gen Ceph)
51
Which β-lactamase inhibitor + β-lactam combo can be given at a **higher dose** as a first line treatment for severe complicated pyelonephritis if *P. aeruginosa* is suspected?
- Piperacillin + tazobactam
52
Which **carbapenem** can be given at a **higher dose** as a first line treatment for severe complicated pyelonephritis if *P. aeruginosa* is suspected?
Meropenem
53
Which 2 carbapenems have slightly **greater** activity against gram negatives and slightly less against gram positives?
**Doripenem** and **Meropenem**
54
What is the MOA of the β-lactams?
Cell wall synthesis inhibitors, **bind/inhibit transpeptidase**
55
Prostatitis is most often caused by what bacteria?
*E. coli*
56
What are the 3 agents which can be used to treat Prostatitis?
1. TMP-SMX 2. Ciprofloxacin 3. Levofloxacin
57
What is the MOA of fluoroquinolones?
- Inhibit transcription and replication of bacterial DNA - Through inhibition of **topoisomerase II (DNA gyrase)** and **topoisomerase IV**
58
Describe the 3 different mechanisms by which bacteria can develop resistance to fluoroquinolones
- **Mutation** to quinolone binding region on either **DNA gyrase** or **topoisomerase IV** - Active drug efflux - Upregulation of proteins that protect and shield both DNA gyase and topoisomerase IV
59
Prolonged treatment with trimethoprim part of TMP/SMX can cause what AE's?
- Anemia - Leukopenia - Granulocytopenia
60
PSGN is caused by prior infection with what bacteria and what is it's gram stain?
- Group A β-hemolytic streptococcus - Gram positive
61
Which drug can be given IM for patient with recurrent group A β-hemolytic streptococcus infection especially if adherence to previous antibiotic uncertain?
Penicillin G
62
When giving β-lactams such as piperacillin and cephalosporins, what AE/contraindication must you be aware of?
β-lactam hypersensitivity --\> **Anaphylaxis**
63
Repeat treatment for group A beta-hemolytic streptococcus infection should be given with an agent with greater what?
β-lactamase stability
64
For tx of recurrent group A β-hemolytic strep infection focused on using agents with greater β-lactamase stability describe which drugs/class can be used in order of greater β-lactamase stability?
- Penicillin G (given IM) - 1st gen. cephalosporins --\> **Cephalexin** or **Cefadroxil** - 3rd gen. cephalosporins --\> **Cefpodoxime** or **Cefdinir** - **Amoxicillin (aminopenicillin)** or **C****lindamycin** = greatest β-lactamase stability
65
Clindamycin, used for recurrent PSGN, is very effective against bacteria which grow under what kind of conditions?
Anaerobes
66
What is the MOA of clindamycin?
Protein synthesis inhibitor, binds to the 50S ribosomal subunit
67
What is a major AE associated w/ Clindamycin use?
*C. difficile* induced diarrhea and colitis

Renal II Quizam #2 (12 decks)

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