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kyleannkelsey
on FreezingBlue Flashcards.
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What constitutes a “Lower” UTI?
Cystitis (bladder) and urethritis
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What constitutes an “Upper” UTI?
Pyelonephritis (kidney)
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What constitutes a “Simple” UTI?
No structural or functional abnormality
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What constitutes a “Complicated” UTI?
Presence of predisposing condition (congenital, catheter, stone, BPH, etc.)
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Is lower or upper UTI simpler to treat?
Lower (Upper = pyelonephritis)
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What are the risk factors for UTI?
- Age (young and old in men, throughout life in women)
- Sex
- Anatomical abnormalities
- Instrumentation
- Trauma
- Mediations (Diuretics, newer diabetes medications, Anticholinergics)
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What are the common organisms implicated in community acquired UTIs?
- E. coli
- Proteus mirabilis
- Staph saprophyticus
- Klebsiella
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What are the common organisms implicated in Hospital acquired UTIs?
- Klebsiella
- Enterococcus faecalis
- Pseudomonas aeruginosa
- E. coli
- Staphylococcus a.
- Candida
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What drug is a good choice for a nursing home patient with a UTI?
Flouroquinolones (Cipro/Levo, etc.)
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An ESBL E. coli will typically be resistant to what usual UTI treatments?
Cephalosporins, PCNs, flouroquinolones and aminoglycosides
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ESBL producing E. coli will typically be susceptible to what antibiotics?
Meropenem
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What are the clinical manifestations of UTI without pyelonephritis?
- Dysuria
- Polyuria
- Urgency
- Nocturia
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What are the clinical manifestations of UTI with pyelonephritis?
- Flank pain
- Malaise
- Fever
- Abdominal pain
- Mental status changes
- N/V
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How is UTI diagnosed?
- Hx
- PE
- Urinalysis (nitrites, WBCs, WBC esterases)
- Positive culture from urinalysis
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What constitutes uncomplicated UTI?
- Immunocompetent
- No co-morbidities
- No known urologic problems
- Not pregnant
- Premenopausal
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What constitutes a complicated UTI?
- Hx of childhood UTIs
- Immunocomprimised
- Pre-adolescent or Post-menopausal
- Pregnant
- Underlying metabolic disorder
- Urologic abnormality
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What are the indications for a single dose therapy for UTI?
- Acute
- Uncomplicated
- Lower UTI
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What are the CIs for single dose treatment of UTIs?
- Pregneancy
- Male
- Kid
- Resistant/relapsing/reinfection
- Pyelonephritis
- Complicated
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What treatment is offered for Single dose UTI therapy?
Fosfomycin tromethamine (Monurol)
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What is the dosing for Fosfomycin tromethamine (Monurol)?
1 x dose of 3 grams powder packet dissolved in water
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What is the most common SE for fosfomycin tromethamine (Monurol)?
Diarrhea
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What is the brand name for fosfomycin tromethamine?
Monurol
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What is the generic name for Monurol?
Fosfomycin tromethamine
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What is the main disadvantage to Fosfomycin tromethamine (Monurol)?
$70 a dose
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How should you take Fosfomycin tromethamine (Monurol)?
Dissolved in water on an empty stomach
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What are the indications for a 3 day therapy for the treatment of UTI?
- Healthy men ages 20-40
- Girls over 5 years w/symptoms
- Healthy non-pregnant women with first or second episode
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What are the drugs of choice for 3 day treatment of UTI?
- TMP/SMX
- Quinolone (Cipro/Levo)
- Nitrofurantoin macrocrystals
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What is the dose for UTI 3 day treatment with TMP/SMX?
4 mg/kg trimethoprim Q12H x3 days
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What is the dose for UTI 3 day treatment with Ciprofloxacin?
250 mg PO BID x3 days
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What is the dose for UTI 3 day treatment with Levofloxacin?
250 mg PO QD x3 days
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