21906373
Description
Flashcards by Sam Adeyiga, updated more than 1 year ago
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Created by Sam Adeyiga
about 4 years ago
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| Question | Answer |
| Antimicrobial selection for UTIs depends on factors like....? (1) | 1. the likely infecting microorganism(s). 2. local community resistance prevalence |
| Antimicrobial selection for UTIs depends on factors like....? (2) | classification of UTI 1. cystitis or pyelonephritis 2. complicated or uncomplicated 3. asymptomatic bacteriuria 4. recurrent infection) |
| Antimicrobial selection for UTIs depends on factors like....? (3) | patient’s specific factors 1. allergies 2. renal function 3. compliance |
| Antimicrobial selection for UTIs depends on factors like....? (4) | Rout of elimination 1. no dose adjustment for renal needed means it probably doesn’t achieve adequate concentrations in the urinary tract |
| Antimicrobial selection for UTIs depends on factors like....? (5) | 1. side effect profile, cost 2. minimizing “collateral damage” |
| Which cephalosporin does not require renal insufficient dose adjustment? | ceftriaxone |
| "collateral damage" has been associated with the use of broad-spectrum -----------?. | cephalosporins and fluoroquinolones |
| What are the pathogen suspects of uncomplicated cysttitis? [EKPS or SPEK] | 1. E. coli *** 2. K. pneumoniae 3. P. mirabilis 3. Staph saprophyticus |
| First-line options for the treatment of acute uncomplicated cystitis includes----? | 1. nitrofurantoin 2. SMX/TMP 3. fosfomycin. |
| What are the recommended regimen for [SPEK] ? (1) | Nitrofurantoin monohydrate (Macrobid®) 100 mg PO BID x 5 days |
| What are the recommended regimen for SPEK? (2) | SMX/TMP 800/160 mg (Bactrim DS®) 1 tab PO BID x 3 days |
| What are the recommended regimen for SPEK? (3) | Fosfomycin (Monurol®) 3 grams PO once |
| Nitrofurantoin is contraindicated in patients with a CrCl of ------? | a CrCl < 60mL/min |
| Cockroft-Gault equation | |
| Bactrum should be avoided if resistance is known to be ------- % or if it was used for the treatment of UTI in previous ------months. | a. > 20% b. 3 months |
| 2nd-line options for the treatment of acute uncomplicated cystitis includes----? | 1. Aminopenicillins 2. cephalosporins - 2nd and 3rd gen |
| Alternative options for the treatment of acute uncomplicated cystitis are ----? | Fluoroquinolones (FQ) [it is a broad spectrum] |
| Fluoroquinolones (FQ) serious AEs include | 1. tendinitis 2. tendon rupture 3. CNS effects 4. peripheral neuropathy |
| What are the pathogen suspects of uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable? [EKPG or GPEK] | 1. E. coli *** 2. K. pneumoniae 3. P. mirabilis 4. Gram(+) bacteria |
| What are the recommended regimen for uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable patient? (1) | Cefpodoxime (Vantin®) 100 mg PO BID* - note: any 3rd gen ceph is good ceftriaxone cefotaxime ceftazidime Cefpodoxime * Complicated cystitis = 7 - 10 days * Uncomplicated pyelonephritis = 10-14 days |
| What are the recommended regimen for uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable patient? (2) | Ciprofloxacin 500 mg PO BID x 7 days |
| What are the recommended regimen for uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable patient? (3) | Levofloxacin 750 mg PO daily x 5 days |
| What are the recommended regimen for uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable patient? (4) | SMX/TMP 800/160 mg 1 DS tab PO BID* * complicated cystitis = 7 - 10 days * Uncomplicated pyelonephritis = 10-14 days |
| What are the signs of Hemodynamic instability | 1. Hypotension 2. Hypoxia 3. Tachycardia Tachypnea 4. Shortness of breath 5. Altered mental status 6. Cardiac ischemia 7. Reduced urinary output |
| Which drugs are recommended for treatment of Complicated Cystitis or Uncomplicated Pyelonephritis (Outpatient) | 1. Cefpodoxime (Vantin®) 2. Ciprofloxacin 3. Levofloxacin 4. SMX/TMP |
| What is the 1st line of recommendation for uncomplicated pyelonephritis or complicated cystitis + Hemodynamically stable patient? | FQs [Macrobid is NOT an option here] |
| What are the pathogen suspects of complicated pyelonephritis or complicated cystitis + Hemodynamically unstable? [PEPE or PEPEa] | 1. E. coli 2. K. pneumoniae 3. P. mirabilis 4. P. aeruginosa* 5. Enterococcus faecalis |
| ------------------ should be suspected in MDROs (multi-drug resistant organisms) if hospitalized within the past 6 months, new UTI symptoms after 48 hours of hospitalization, have urinary catheter, or nursing home resident | Pseudomonas aeruginosa. [P. aeruginosa] |
| Which drugs are recommended for treatment of Complicated Cystitis or complicated Pyelonephritis (hospitalization) | Ceftriaxone Ciprofloxacin Levofloxacin |
| What are the recommended regimen for complicated pyelonephritis or complicated cystitis + Hemodynamically unstable patient? (1) | Ceftriaxone 1 gram IV daily x 10-14 days |
| What are the recommended regimen for complicated pyelonephritis or complicated cystitis + Hemodynamically unstable patient? (2) | Ciprofloxacin 400 mg IV BID, then 500 mg PO BID x 10-14 days |
| What are the recommended regimen for complicated pyelonephritis or complicated cystitis + Hemodynamically unstable patient? (3) | Levofloxacin 750 mg IV/PO daily x 5 days or 250 mg IV/PO daily x 10-14 days |
| SMX/TMP requires a -------- days course and levofloxacin 750 mg daily requires only a ------------ course for complicated pyelonephritis or complicated cystitis + Hemodynamically unstable patient | a. 14 day b. 5 day |
| If Enterococcus faecalis is identified, --------- should be started immediately. | vancomycin |
| MDROs should be suspected in patients [1 -4] | 1. hospitalized within the past 6 months 2. those who develop UTI symptoms after 48 hours of hospitalization 3. those who have a urinary catheter 4. those who are a resident of a nursing home. |
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