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Pharm Sulfa UTI
Pharm Hodges Ch. 51 Sulfa/UTI
| Question | Answer |
|---|---|
| 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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