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Pharm Sulfa UTI

Pharm Hodges Ch. 51 Sulfa/UTI

QuestionAnswer
UTIs account for ______ office visits per year and _____ hospitalizations. 8 milllion/ 100,000. They are the MOST common type of bacterial infection.
The urinary tract consists of the ____ Kidneys, ureters, bladder, and urethra.
Why do woman have more UTIs than men? Anatomical differences. Shorter urethra and no scrotum to act as a barrier to the anus ( and e.coli)
Retrograde infections AKA ascending. Infections that travel from urethra upward.
Uropathogens Increase their success rate by use of "sticky" secretions to ascend
How can you tell urethritis from cystitis in presentation? Less voiding urgency and slower onset of symptoms. Cystitis is fast and furious.
UA will reveal what signs of infection? bacteriuria, pyuria (urine w/pus), hematuria, changes in urine pH, nitrites, or proteins.
In males, cystitis is likely to follow ____________ anal intercourse and accompanied by prostatitis.
pyelonephritis inflammation of the kidney, pelvis, and other renal cells. F/Chills/ N/V/ back pain and flank tenderness
UTIs can be classed as ______ or ____ Uncomplicated or Complicated. Refers to the absence or presence of collateral morbidities
Acute Uncomplicated Cystitis AUC. NO other serious health d/o., usually W of reproductive age, 18-24. Factors - spermicide, diaphragm, estrogen deficiency.
Dx of AUC can be done on S/S and Hx alone with no labs. AUC = Acute Uncomplicated Cystitis
Most common causative agent E. coli
Asymptomatic Bacteriuria In as much as 60% of W > 60. Rarely progresses, does not NEED to be treated. Must Tx pregnant, immunosuppressed, or someone w/ other urological procedures.
Traditional choice for AUC is ___ TMP-SMZ (The pain of the cystitis is TeMPorary so SMilZ! If you have one yoursulf, take a sulfonamide)
TMP-SMZ Prototype drug for Sulfonamides. Fixed dose combo. 3 Day. Many resistant strains limit its use as a first line agent.
Alternate therapy for AUC (D/T resistance to TMP-SMZ) fluoroquinolone (ciprofloxacin - Cipro 1x/daily is available) Norfloxacin, ofloxacin, levofloxacin.[Cystitis is the Honeymooners diseases. That ALTERNATE to the bride is the FLOWER (fluor) Girl.Flox of people at the wedding]
TMP-SMZ resistance > 20% in the community Try a urinary antiseptic such as nitrofurantoin, or a single dose of fosfomycin.
Fosfomycin Urinary antiseptic. Single dose, dissolved in H20, blocks cell wall synthesis and is only indicated for UTI.
Complicated UTI Underlying comorbidites that increase the risk of treatment failure. More aggressive Tx needed.
Comorbidities that complicate UTIs structural problems/ indwelling catheters/ elderly ill/ recurring UTI / resistant uropathogens/ poor hygiene/ ALL UTIs in men
C-UTIs are caused by ___________ a broader spectrum of pathogens. When treating, a culture must be obtained to identify specific microbes.Tx with broad, results obtained, narrow spectrum. F/U cultures performed weeks later.
Modifications to UTI pharm needed for which groups? infants, pregnant, older, recurring.
Infants and children can have UTIs? True or false True. Problem is scarring of kidneys which produces problems later in life. Mostly e. coli. Can treat with TMP-SMZ but not with fluoroquinolones
UTIs and pregnant women Most be treated. Risk for premature birth and low birth weight. Pyelonephritis is one of most freq. reasons to hospitalize pregnant women. UA routine at 16 weeks. HI Bact - Tx even if asympt.
Continued asymptomatic bacteriuria is predictive of ___________ symptomatic UTI later in pregnancy. Continue Tx until cultures are negative.
Pregnant women - drugs are limited to those that are in Pregnancy Class what? B. Unless the patient is gravely ill. Fluoroquinolones contraindicated d/t growth inhibition in fetus.
Drugs for pregnant women with UTI cephalosporins, ampicillin, nitrofurantoin. Rocephin is sometimes a drug of choice.
Geriatric considerations High incidence, especially in LTC. Factors include BPH, retention and incontinence. SYMPTOMS MAY INCLUDE altered mental status in elderly, sudden incontinence, N/V.
If immunosuppressed, an ABx may be prescribed for prophy against pneumonia, UTIs, and skin and soft tissue infections. Always TEST elderly for specific strain/ ABx
Recurring 1 in 5 will have another within 6 months.
relapse second infection within 2 weeks
re occurrence second infection within 6 months. 2 or more within 6 months or 3 or more w/i a year - candidate for PROPHY.
Prophy meds for UTI low doses daily, 3 x a wk, give women pills on standby to self administer at first symptom.
Sulfonamides - Bacteriostatic. Binds to enzyme, folic acid synthesis stops and bacterial growth slows. traditional drugs of choice for UTI. Resistance is limiting their ability to be first line. Gram + and Gram -. Broad spectrum. Staph, strep, H. influenza, Chlamydia, pneumonia, Shigella, test d/t resistance problems.
Sulfonamides MOA inhibit the synthesis of folic acid or folate. Folic acid is a water soluble vitamin that is critical in the synthesis or RNA and DNA. BACTERIOSTATIC
decline in prescription of sulfonamides dev. of penicillin, ecphalosporins, macrolides. Approval of TMP-SMZ marked resurgence.Decades of use has brought about resistance.
Sulfonamides are classed by their ___ and ___ absorption and excretion. Subclasses include: Oral readily absorbed, Oral NOT readily absorbed (sulfasalazine), topical
Oral PO readily absorbed means they go through all tissues. Converted into inactive metabolites and excreted rapidly by kidney. Sulfisoxazole, sulfadiazine, and TMP-SMZ.
Sulfadoxine exception - long 1/2 life of 5-7 days. Malarial prophylaxis. [Sitting on the DOCKS for a long time and got Malaria]
Oral agents that are not readily absorbed One drug - Sulfasalazine. Remains unabsorbed so as to Tx intestinal infections and colitis. Careful of systemic toxicity.
Topical sulfonamides Silver sulfadiazine - prophy and Tx of topical infections from wounds or burns. Absorbed across skin - watch for significant plasma drug levels.
Sulfonamides - Adverse effects. Generally safe but... Adverse FX on the urinary tract, hypersensitivity reactions, N/V/anorexia. HYPERKALEMIA.
Sulfonamides have a ______ which may cause _________ low solubility / crystalluria. Drink up to 3000 mL a day to achieve UO or 1500 mL in 24 hours.
Baseline tests and periodic values should be taken to check for __________ aplastic anemia, agranulocytosis, bone marrow depression (Pt w/ preexisting myelosuppression)
Hypersensitivy to Sulfa drugs well-documented. Photosensitivity, dermatitis, hives, Fever, malaise.
Cross sensitivity for sulfa drugs exists with ______. diuretics, thiazides, sulfonylurea diabetic agents. Avoid these in Pt with sensitivity to sulfonamides to avoid Stevens-Johnson sydrome.
Stevens-Johnson syndrome. necrotic tissue rash. Report RASH immediately. Fever, chills, rash on torso. Skin comes off in sheets.
Sulfonamides are contraindicated in pregnancy and while breast feeding and in infants less than 2 months (bilirubin and jaundice issues)
TMP - SMZ Antibacterial, folic acid inhibitor, sulfonamide. UTI prophy. Pneumonia, shigella, acute/chronic bronchitis.
TMP - SMZ Adverse effects Hypersensitivity is common. Rash, itching, fever. Crystalluria, Stevens Johnson
TMP - SMZ Contraindications hypersensitivity to sulfites, sulfonamides, or chem. cousins like thiazide diuretics. NOT with folate deficient anemia or severe renal impairment. Enhances oral anticoagulants.
If overdose on TMP-SMZ as evidenced by bone marrow depression, give leucovorin
Nursing implications LOTS OF FLUIDS, monitor older patients on diuretics, look for severe skin reactions.
Drugs similar to TMZ-SMP Sulfadiazine, sulfisoxazole, sulfadoxine-pyrimethamine (used only for malaria)
Sulfadiazine short acting, oral, broad spectrum, MORE CRYSTALLURIA than others, silver sulf is a topical medication. Pregnancy Cat C.
Sulfisoxazole short acting, oral, UTI, ear infections, H influ, nocardiosis and malaria. LESS crystalluria. Opthalmic form for chlamydial conjunctivitis. Preg Cat C
TMP can stand alone. Uncomplicated UTI, otitis media, travelers diarrhea. pheumonia. Rash and itch common s/e.
Sulfasalazine is best taken ____ after meals to prolong time in the intestines.
Urinary Antiseptics anti-infective drugs used exclusively for UTI. Small class where urinary system is not the "excretor" but the target tissue. Hi concen in ur. tract essential.
Advantage of Urinary Antiseptics able to treat local infections in the urinary tract w/o reaching high levels in the blood. Not first choice but important role.
Nitrofurantoin and nitrofurantoin macrocrystals Prototype drug for Urinary tract antiseptics. Ther. class - antibacterial. Older, used for uncomplic. acute cystitis
Nitrofurantoin and nitrofurantoin macrocrystals most commonly used for prophy of recurrent UTI. active against E.coli and many other Gram +/- aerobes. NOT indicated for pyelonephritis.
Nitrofurantoin and nitrofurantoin macrocrystals MOA broad based. This has made it more difficult for bacteria to create resistant strains. Would necessitate multiple mutations.
MOA for nitrofurantoin drug intermediates attack bacterial ribosomal proteins, inhibit protein synthesis, energy metab., DNA RNA synthesis.
Nitrofurantoin and nitrofurantoin macrocrystals BACTERICIDAL at therapeutic doses, onset 30 minutes, 1/2 life 20 minutes
Nitrofurantoin Adverse effects Acute and chronic pulmonary toxicity is a serious adverse effect. Look for lung involvement, months or years later.
Nitro Contras severe renal impairment (creat. clearance < 60, oliguria or anuria (can't get high amounts in urine), pregnant, infants < 1 month
Nitro Cautions Be careful when using with pt with pulmonary disease. Also with preexisting hepatic disease. Do liver function tests and D/C immed. if changes are noted. Not with antacids with magnesium. Give WITH FOOD or milk.
Nursing Assessments Do not crush d/t teeth staining. Watch for pulmonary reaction within first week (flulike)Watch for muscle weakness. Neuropathy can NOT be reversed
Nitrofurontoin MANY give harmless BROWN color to the urine. Brown like a fur coat in the night.
Other urinary antiseptics fosfomycin, methenamine, nalidixic acid.
Fosfomycin cell wall inhibitor, bladder antiseptic. SINGLE dose PO. Preg B
Methemamine 2 salts. Breaks down into formaldehyde, a byproduct toxic to microorg. Only for prophy tx of recurrent UTI, usually with neurogenic bladder. Broad spectrum. Urease positive Proteus resistent d/t ammonia in urine (blocks formaldehyde) Preg C
Nalidixic acid (NegGram) 1st quinolone anti-infective marketed. Inhibit DNA/RNA synthesis. Limited to UTI. Absorbed in GI, concentrated in urine.
Nalidixic adverse effects GI distress, high doses may make you drowsy, fatigue, headaches, visual disturbances like blurred vision.
Nalidixic Contras Infants <3 months d/t ICP. Monitor labs for hemolytic anemia and thrombocytenia in pt. Reduce doses for those on anticoagulants. PregC . Rapid resistance develops during therapy.
AUC Tx cascade 1. TMP-SMZ (sulfonamide) 2. Cipro (fluorquinolones) 3. nitrofurantoin Furadantin, Macrobid). (I am FURious that ANTOINe was not ANTISEPTIC that NIghT)
C - UTI start with a broad spectrum anti-infective and adjust based on D&S. Can be treated with same drugs as AUC, normally 14 days
fluoroquinolones contraindicated in children under 18, Affects cartilage development. Also contra for pregnancy. Kids can be FLOWER GIRLS but they can't take FLUOROQ.
Pregnant women can take which 4 drugs for UTIs? Cephalosporins, ampicillin, nitrofurantoin, Rocephin. (AMP it up, use your CEPHALO and take your ROCEPHIN at NIghT)
Sulfasalazine PO oral drug, Sulfonamides not readily absorbed. Used to treat intestinal infections and mild colitis [Sally is not allowed in the clique - not absorbed]
Sulfadiazine - adverse? Most crystalluria
Sulfisoxazole (Gantrisin) Sometimes preferred d/t less crystalluria. [More GANtle on your stomach, less crystals in your SOX]
TMP-SMZ can enhance anticoagulants, potassium sparing effect.
Created by: TCC2013
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