UTI

Question 1

2 most common pathogens in uncomplicated UTIs

Answer 1

e coli
staph saprophyticus

Question 2

most common pathogen causing UTIs in diabetics

Answer 2

klebsiella

Question 3

most common pathogen causing UTIs in people with indwelling catheters

Answer 3

pseudomonas

Question 4

4 findings in clean catch UA, diagnostic for UTIs

Answer 4

• leukocytes esterase– indicates pyuria
• Nitrite
• hematuria
• bacteriuria

cultures NOT needed in uncomplicated UTIs

Question 5

what test must be done if pt fails tx?

Answer 5

urine culture

Question 6

if a pt has sx of UTI and gets a negative urine dipstick, what does this mean?

Answer 6

does not r/o infection! treat them anyway

Question 7

what are the 3 first line meds used in uncomplicated

Answer 7

TMP-SMX DS 1 PO BID x 3 days
NTF 100 mg PO BID x 5 days
Fosfomycin 3g PO x 1 dose

Question 8

what 3 meds should you avoid in pregnant people? which two are preferred

Answer 8

avoid: bactrim, cipro & NTF
preferred: amox of keflex

Question 9

which medication causes pulm toxicity in elderly

Answer 9

NTF

Question 10

2 major SE of quinolones

Answer 10

tendonitis or tendon rupture
hyperglycemia

Question 11

which med should be taken with food

Answer 11

NTF

Question 12

medication that causes discolored urine, hemolytic anemia, GI sx, rash, HA? (include dosing details)

Answer 12

Phenazopyridine (pyridium) 200mg PO TID PRN x 2 days dysuria

used to tx SYMPTOMS not the bacteria

Question 13

med that causes anticholenergic sx, urinary retention w/ BPH

Answer 13

methenamine 2 tabs PO QID PRN x 2 days

Question 14

deficiency of what hormone contributes to increased risk of UTIs in geriatric patients

Answer 14

estrogen

Question 15

differentiate macrobid vs macrodantin

Answer 15

• macrobid 100mg BID x 5-7days; less GI ADR
• macrodantin 50-100mg PO QID x 5-7 days; more GI ADR; can be used prophylactically after intercourse of QHS

Question 16

which medication should be avoided in pyelonephritis d/t negligible tissue penetration

Answer 16

NTF– also avoid in renal dysfunction

Question 17

primary reason why NTF is on beers list

Answer 17

inadequate concentration in urine when CrCl is below 60ml/min
increased ADR– peripheral neuropathy, hepatotoxicity, pulmonary fibrosis and interstitial pneumonitis

Question 18

rod shaped E. coli on swollen epithelial cells of bladder; epithelial surface secreted thick mucus filaments

Answer 18

bladder infection/cystitis

Question 19

how are complicated UTIs treated?

Answer 19

same as uncomplicated UTI but for longer

Question 20

when do you test for cure 3 wks later to confirm clearence

Answer 20

complicated or recurrent UTIs

Question 21

these are risk factors for what?

• intercourse w/in 1 month
• maternal h.o UTI
• new sex partner in past yr
• spermicide use in past yr
• age of 1st UTI under 15 yo

Answer 21

recurrent UTI

Question 22

how are recurrent UTIs treated

Answer 22

same as regulat but longer (1-2 wks) & do NOT use same abx as last time
also do culture!

Question 23

what is the condition?

• evidence of UTI, fever, chills, flank pain, N/V, CVAT
• elderly & immunocompromised have atypical sxs (GI or pulm)
• misdiagnosis -> urosepsis, chronic pyelo, renal abscess, renal failure, HTN

Answer 23

acute pyelonephritis

Question 24

what is the admission criteria for acute pyelonephritis (5)

Answer 24

• persistent vomiting
• suspected sepsis
• uncertain diagnosis
• urinary tract obstruction
• over 60, immunocompromised, poor social support, pregnant

Question 25

acute pyelonephritis dx requires UA and confirmatory urine cultures. what are 2 expected findings??

Answer 25

- + leukocyte esterase & +/- nitrite - WBC (kidney inflammation) - gram stain for abx therapy +/- blood cultures

Question 26

4 first line tx of acute pyelonephritis

Answer 26

- cipro 500mg PO BID x 7 days +/- initial IV cipro 400 or ceftriaxone 1g - cipro 1000mg ER PO Q day for 7 days - Levo 750mg PO Q day x 5 days - TMP-SMZ 1 PO BID x 14 days

Question 27

tx for acute pyelo in pregnant patient

Answer 27

Augmentin 500/125mg PO TID x 10-14 days; can add Ceftriaxone 1g IV x 1 dose

Question 28

what medication is not effective in pyelonephritis? how long should immunosuppressive pts be treated?

Answer 28

- never use NTF - tx immunosuppressive pt for 21 days

Question 29

how are UTIs in males treated?

Answer 29

Bactrim DS 1 (or fluoroquinolone) PO BID x 7-10 days | if its from STD, tx accordingly

Question 30

- irritative voiding sx w/ negative urine culture in typically 30 to 70 yrs - disrupts work, social relationships and sexual activity - urgency/frequency, suprapubic pain, dysparunia, chronic pelvic pain - sleep deprivation, depression, suicidal ideation - sx worse in wk before menses; dietary association

Answer 30

interstitial cystitis dx confirmed by cystoscopy findings (glomerulations or ulcers)

Question 31

pinpoint hemorrhages seen w/ hydrodistention (can cause period of symptomatic relief)

Answer 31

glomerulations

Question 32

results in bladder wall scarring & decreased capacity

Answer 32

hunner's ulcers

Question 33

- over 100K CFU/mL in asymp. pt in about 40% of elderly men and women

Answer 33

asymptomatic bacteruria

Question 34

who benefits from treatment in asymptomatic bacteriuria (3)

Answer 34

- pregnant ppl - renal transplant pt - pt that undergo GU procedures

Question 35

2 ways to tx urethral syndrome

Answer 35

doxycyline 100mg PO BID x 14 days azithromycin 1g PO x 1 dose

Question 36

which abx should be avoided in those taking warfarin? why?

Answer 36

bactrim-- increases the INR!!