Tx for LUT infections and STI's Flashcards Preview

Repro II: Test 2 > Tx for LUT infections and STI's > Flashcards

Flashcards in Tx for LUT infections and STI's Deck (39):
1

Penicillin G

Beta lactamase inhibitor
staph and some gram positive

- ADR: allergic reaction, anaphylaxis

2

Ampicillin

-Beta lactamase inhibitor
- some gram negative some gram positive

AE: allergies, anaphylaxis

3

Ceftriaxone

- Third generation cephalosporin, inhibits cell wall synthesis

NO ALCOHOL

4

Ampicillin-Sublactam

-Beta-lactamase inhibitor

MOA: inhbits transpeptidation reaction

5

Ciproloxacin/Levofloxacin

-Fluoroquinolones

MOA: targets bacterial DNA gyrase and topoisomerase IV (unable to undo supercoil of DNA)

ADR: GI, CNS, rash, achilles tendon rupture

6

Azithromycin

- MOA: bacteriostatic, binds reversibly to 50S ribosomal subunit

ADR: NAUSEA!!! (most common), GI, hepatotoxicity, QT prolongation

7

Metronidazole

Flagyl

ADR: h/a, nausea, dry mouth, neurotoxic

8

Sulfamethaxoazole/ trimethoprim

Bactrim

MOA: bacteriostatic : inhibits folic acid synthesis in bacteria (thus inhibiting DNA synthesis)

ADR: allergic skin rash, nausea, vomiting, photosensitivity

DDIs: inhibits CYP metaoblism --> potentiated effect of warfarin!

9

Methenamine

- MOA: acidification of urine

ADR: GI distress, painful/ frequent micturition

10

Nitrofurantoin

- MOA: reactive intermediates which damage DNA

ADRs: nausea, vomiting, diarrhea

CI: pregnant women, impaired renal fn.

11

Fosfomycin

- MOA: bactericidal - inhibits early stage of cell wall synthesis - decredased formation of N-acetylmuramic acid

ADR: diarrhea, nausea, ab pain

12

Fluconazole

= antifungal
- `AE: drug interactions and warfarin potentiation

13

uncomplicated infection tx?

infection in individuals who lack structural or functional abnormalities of the urinary tract. Occurs in pre-menopausal females of childbearing age (15-45 years) who are otherwise healthy.

usually E. coli and staph saprophyticus

tx:
1. Trimethoprim /sulfamethoxazole
2. Nitrofurantoin
3. Fosfomycin

14

male infection

not considered uncomplicated because these infections are rare and most often a result of a structural or neurological abnormality.

15

complicated infection

likely the result of a predisposing lesion (congenital abnormality or distortion), a stone, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses.
i) Occurs in both genders. Frequently involves upper and lower urinary tracts.

more varied microorganisms and often more resistant

16

recurrent UTI

in healthy, non-pregnant women; two or more UTIs within 6 months or three or more within one year.
i) Reinfection – different microorganism than what was originally isolated (accounts for the majority of recurrent UTIs).
ii) Relapse – same initial organism; usually indicates a persistent infectious source.

17

lower UTI presentation

dysuria, urgency, frequency, nocturia, suprapubic heaviness.

18

upper UTI presentation

flank pain, fever, nausea, vomiting, malaise.

19

elderly UTI presentation

do not usually experience specific urinary symptoms but will present with altered mental status, change in eating habits, or gastrointestinal symptoms.

20

3 DOC for uncomplicated cystitis

1**Trimethoprim/sulfamethoxazole (TMP/SMX) x3 days
(a) In areas with > 20% resistance of E. coli to TMP/SMX → use nitrofurantoin or fosfomycin.

2**Nitrofurantoin x5 days

3** Fosfomycin single-dose


NOTE: Fluoroquinolones (ciprofloxacin or levofloxacin) reserved for suspected or possible pyelonephritis due to risk of collateral damage (i.e. development of resistance).-- there is increased resistance of E. Coli here (only used in second choice)

21

DOC for acute pyelonephritis

(a) Ciprofloxacin or levofloxacin preferred 1st line for 7-10 days
(b) TMP/SMX x14 days

(c) If amoxicillin/clavulanate or oral cephalosporin used, give ceftriaxone first then continue with oral agent to complete 10-14 day course.
(d) If gram-positive cocci identified on Gram stain, consider E. faecalis, direct treatment towards this potential pathogen (ampicillin).

22

tx for gonorrhea

ceftriaxone

Co-existing chlamydial infection documented in up to 50% of women and 20% of men with gonorrhea. Thus, all patients treated for gonorrhea should be treated with concomitant azithromycin or doxycycline for chlamydia

23

tx for chlamydia

Azithromycin as single, one-time dose.

Doxycycline twice daily for 7 days.

Fluoroquinolones do not offer an advantage over other 1st line agents.
In pregnancy: azithromycin and amoxicillin drugs of choice.

More frequently asymptomatic compared to gonorrhea.

If post-treatment cultures positive, usually represents noncompliance, failure to treat sexual partners, or lab error rather than inadequate therapy or resistance.
Abstain from intercourse x7 days following initiation of treatment.

24

tx for thricomoniasis

Metronidazole or tinidazole

Metronidazole contraindicated in first trimester. Metronidazole excreted in breast milk; interrupt breast feeding for 12-24 hours after maternal ingestion.

Males have high spontaneous cure rate even in the absence of treatment. High, one-time doses may cause GI complaints (anorexia, nausea, vomiting, diarrhea) and some patients may be unable to tolerate → use multi-dose regimen x5-7 days.

25

tx for syphilis

Penicillin G (has long duration of effect!)

highly contagious if not treated

Jarisch-Herxheimer reaction: benign, self-limiting reaction, characterized by flu-like illness (transient headache, fever, chills, malaise, myalgia, tachypnea), peripheral vasodilation, and aggravation of syphilitic lesions. Occurs independent of drug or dose used. Begins within 2-4 hours of initiating therapy, peaks at 8 hours, and is complete in 12-24 hours.

26

tx for sexually aqd epididymitis

ceftriaxone + doxyccline

27

tx for gram - epididymitis

ceftriaxone + levofloxacin

28

PID tx

Cefotetan or cefoxitin PLUS doxycycline; clindamycin PLUS aminoglycoside; single IM dose of ceftriaxone PLUS doxycycline +/- metronidazole.

29

bacterial vaginosis tx

Oral metronidazole or vaginal metronidazole or clindamycin.

30

candidiasis tx

: intravaginal butoconazole, clotrimazole, miconazole, terconazole, or tioconazole. OR single dose of oral fluconazole*.

31

chancroid tx

Single oral dose of azithromycin or IM dose of ceftriaxone.

Treat sex partners if there was sexual contact with infected individual within 10 days of symptom onset.

32

most common organism in uncomplicated UTI?

E. Coli and Staph saprophyticus

** all treated with TMP-SMX

33

what is amoxicillin most approriate for?

enterococcus faecalis

34

which uncomplicated UTI organisms do TMP-SMX cover?

E. Coli
Staph Saprophyticus
Klebsiella pneumonia
proteus mirbalis

35

which Ab is most likely prescirbed that can caused increased INR (interaction w/ warfarin)?

Trimethoprim /sulfamethoxazole (bactrim)

36

risk factors of MDR?

- Hospitalization in last 6 months
- Urinary catheter
- Nursing home resident

worry about pseudomonas and enterococci

37

empiric tx for pyelonephritis?

#1 = Fluoroquinolone (Ciprofloxacin or Levofloxacin)

- TMP-SMX
- Ceftriaxone IV followed by Beta lactam

38

if has syphilis and allergic to penicillin?

tx with doxycycline

39

if pregnant and has penicillin allergy and need tx of syphilis?

need to desensitize (can't use doxycycline with pregnant women) to penicillin