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PHA332 > UTI > Flashcards

UTI Flashcards

1
Q

Name the 4 places in the urinary system where a UTI can occur

A

Kidneys, ureter(s), bladder or urethra

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2
Q

What is the typical bacteria that causes a UTI?

A

E.Coli

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3
Q

Give 3 symptoms of a lower UTI in the bladder

A
  1. Polyuria
  2. Dysuria
  3. Lower abdominal discomfort
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4
Q

What are possible symptoms of a UTI in the urethra?

A
  1. Burning on urination
  2. Discharge
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5
Q

How can an STI cause a UTI?

A

Due to the proximity of urethra to vagina

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6
Q

Why are UTIs more common in women?

A

Women have a shorter urethra so easier for bacteria to travel through and there is less distance between the urethra and the anus (compared to men) hence easier for bacteria to get trapped here.

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7
Q

Name 3 risk factors of UTIs

A
  1. Sex (woman)
  2. Post menopausal women
  3. Antibiotic use (disrupts flora)
  4. indwelling catheters
  5. Sex (urinate after)
  6. Pregnancy
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8
Q

Who would you refer if you suspected a UTI?

A

Pregnant woman
Men
Under 16s
Symptoms of pyelonephritis
Signs of sepsis
Non response to antibiotics

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9
Q

What is pyelonephritis and what are the symptoms?

A

Kidney infection
Fever, back pain, flu-like illness, nausea/ vomiting & cold/ shivering

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10
Q

What are the signs of sepsis?

A

Altered mental state, increased HR, low BP, anuria (lack of urine), ashen rash, cyanosis, non-blanching rash

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11
Q

Would you perform a urine dipstick test on an over 65? Explain your answer.

A

No- as asymptomatic bacteria is common and could result in unnecessary antibiotics

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12
Q

What would you do to confirm a UTI in an over 65?

A

Send urine culture- most uncomplicated infections will resolve in that time as you do not get results back straight away

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13
Q

What is the exception of prescribing antibiotics for a UTI is there is no symptoms?

A

If they are pregnant

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14
Q

What are the key signs of complex UTI?

A

Pain on urination
Night time waking to urinate
Cloudy urine

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15
Q

What does the urine dipstick test for?

A

Leukocytes, RBCs and nitrites
(positive= UTI)

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16
Q

What would you do if a dipstick result came back positive for leukocytes but negative for nitrites?

A

Send urine culture as could be UTI

17
Q

What is the drug used for a UTI in pregnant women in the first trimester?

A

Nitrofurantoin (7 day course)

18
Q

Name 3 increased risk groups of antibiotic resistance

A

Care home resident
Recurrent UTI
Unresolving symptoms
Hospitalisation >7 days in 6 month
Recent travel with increased resistance
Previous UTI resistance

19
Q

If the patient is at risk of AB resistance what should you do?

A

Send urine culture

20
Q

How can we help reduce antibiotic resistance?

A

Use LESS of the 3Cs
ciprofloxacin
cephalosporins
co-amoxiclav

21
Q

Which antibiotic used to treat UTI has a narrow spectrum?

A

Trimethoprim

22
Q

What is the most common drug for UTI and why?

A

Nitrofurantoin because although it has a broad spectrum, it is concentrated in the urine and there is a lower risk of resistance compared to trimethoprim

23
Q

What is the dose & duration of nitrofurantoin for UTI?

A

100mg MR twice a day for 3 days

24
Q

When would trimethoprim be prescribed to treat a UTI and what is the dose and duration?

A

If there was a low risk of resistance
200mg twice daily for 3 days

25
Q

Why modified release?

A

Easier regime to follow (taking twice a day is better than taking 4x a day)

26
Q

When can you not prescribe nitrofurantoin?

A
  1. If eGFR is less than 45ml/min
    - it requires good kidney function to flush it into urinary tract & out (not effective otherwise)
  2. G6PD deficiency
  3. Acute porphyria
  4. Infants under 3 month
27
Q

What can be used as a second line drug for UTI?

A

Nitrofurantoin if trimethoprim is first choice
Pivmecillinam- 400mg initial dose then 200mg 3x a day for 3 days
Fosfomycin- 3g single dose sachet

28
Q

What is the MOA of nitrofurantoin?

A

It is concentrated in the urine and kills bacteria, it is reduced by bacterial flavoproteins to reactive intermediates which inactive/ alter bacterial ribosomal proteins

29
Q

How should you take nitrofurantoin?

A

With food -to increase bioavailability

30
Q

Name 3 side effects of nitrofurantoin

A

Nausea/ vomiting
Dizzy/ tired
Itchy rash
Peripheral neuropathy
Pulmonary rxns- STOP

31
Q

What would you recommend if a patient was taking nitrofurantoin and presented with an itchy rash/ allergic reaction or swollen salivary glands?

A

Discontinue!
Try a different drug if ongoing issues

32
Q

When should you discontinue nitrofurantoin?

A

Itchy rash/ allergic rxn/ swollen salivary glands
Pulmonary issues
Liver issues
Blood issues
Neurological issues

33
Q

What is the MOA of trimethoprim?

A

It inhibits DHFR therefore blocks reduction of dihydrofolate to tetrahydrofolate by susceptible organisms

34
Q

What is the active form of folic acid?

A

Tetrahydrofolate

35
Q

What does trimethoprim interact with and what happens if this interaction was to occur?

A

Methotrexate- Both antifolates so decreases this which is used to make new DNA

Warfarin- causes hyperkalemia which increases risk of HA

36
Q

When should trimethoprim not be prescribed ever?

A

Blood dyscrasias
Pregnancy first trimester (need folate)

37
Q

What are the side effects of trimethoprim?

A

Mild GI issues nausea/ vomiting
Skin rash & pruritis (3-7% patients)
Blood disorders (if used long term)
*Top 2 reversible when trimethoprim is stopped)

38
Q

What advice would you give to a patient who has a UTI?

A

Stay compliant with medication
Consult GP if and concerns
Keep hydrated to flush bacteria out
Paracetamol for pain
Hygiene (front to back)
Empty bladder after sex
Birth control

PHA332 (8 decks)

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