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What is the main treatment target for uncomplicated cystitis and pyelonephritis?
E. coli
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What are symptoms of acute uncomplicated cystitis?
- Absence of fever, flank pain
- Tolerating PO
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What are the antimicrobial used to treat acute uncomplicated cystitis?
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole
- Fosfomycin
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True/false: if pyelonephritis suspected, nitrofuramntoin should not be used as treatment
True
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True/false: if pyelonephritis suspected, Fosfomycin should not be used as treatment
True
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True/false: if pyelonephritis suspected, trimethoprim-sulfamethoxazole should not be used as treatment
False; TMP-SMX is okay to use even if pyelonephritis is suspected
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If local E coli resistance to TMP-SMX is <20%, what is the treatment regimen for acute uncomplicated cystitis?
- TMP-SMX-DS 1 tab bid for 3 days (if no allergy)
- And/or Pyridium 200 mg pot id x 2 days
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If local E coli resistance to TMP-SMX is >20%, or if patient is allergic to sulfa, what is the treatment regimen for acute uncomplicated cystitis?
- Nitrofurantoin 100 mg po bid for 5 days
- Fosfomycin 3 gm po for one dose
- And/or Pyridium 200 mg pot id for 2 days
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Pyridium turns your urine ______
Red-orange to brown color
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What is Pyridium?
- Bladder topical anesthetic
- Decreases symptoms of cystitis
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What is the MOA for fosomycin?
- Inhibits bacterial cell wall synthesis
- Prevent production of N-acetylmuramic acid
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What is the recommended dosage and route of administration for Fosfomycin as treatment for acute uncomplicated cystitis?
Single dose PO
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True/false: in the US, Fosfomycin is available in IV form
False; US only oral, Europe has it in IV
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What is trimethoprim-sulfamethoxazole?
A combination antibacterial drug with 5:1 ratio of sulfa to trimethoprim
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What is the MOA of Trim-sulfa
Inhibition of bacterial metabolism by inhibiting folic acid metabolism
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Which UTI drug’s MOA is to inhibit folic acid metabolism?
Trim-sulfa
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Which UTI drug’s MOA is to interfering bacterial cell wall synthesis?
Fosfomycin
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Which enzyme does sulfa inhibit?
dihydropteroate synthase
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Which enzyme does trimethoprim inhibit?
Dihydrofolate reductase
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What is the active form of folic acid called?
Tetrahydrofolate
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Which enzyme is immediately upstream of tetrahydrofolate formation (active form of folic acid)?
Dihydrofolate reductase
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True/false: bacteria can use exogenous folate
False; bacterial must synthesize folate from PABA
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Sulfa is structurally analogous to which compound that is essential to bacterial folic acid synthesis?
PABA
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Trimethoprim and sulfamethoxazole work in _____ manner
Synergistic
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True/false: trim-sulfa is a non-FDA approved use to treat MRSA
True
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What are adverse affects of sulfonamide?
- Crystalluria
- Hypersensitivity
- Hemolytic anemia
- Kernicterus – bilirubin in brain
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Which drug crystalizes in urine and can cause acute urinary obstruction?
Sulfonamide
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True/False: patients are advised to drink plenty of water when taking sulfonamide to avoid crystallization from occurring
True
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Which drug used to treat UTI can cause hemolytic anemia?
Sulfonamide
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True/false: sulfonamide can cause elevated bilirubin brain injury
True
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True/false: sensitivity to sulfa antibiotics means you are sensitive to sulfonamide diuretics like furosemide
False; allergic to sulfa antibiotics would still be okay to be on furosemide
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True/false: there is no cross-allergenicity between sulfa antibiotics and other drugs containing sulfonamide functional groups
True
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What is nitrofurantoin MOA?
Nitrofurantoin is reduced by flavoproteins to active intermediates that may damage ribosomal proteins and DNA and RNA
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True/false: nitrofurantoin is given intravenously
False; it is given orally only
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Under what condition can nitrofurantoin no longer achieve its therapeutic urine levels and must not be used to treat acute cystitis?
CrCl < 50 ml/min
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True/false: nitrofurantoin should be taken with plenty of fluid to avoid crystallization from occurring
False; that is for sulfa drugs.
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True/false: nitrofurantoin should be taken with food to have better GI absorption
True
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What are adverse side effects of nitrofurantoin?
- Nausea
- Vomiting
- Allergic pneumonitis
- Pulmonary fibrosis with long term use
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Which UTI drug causes GI symptoms like nausea/vomiting?
Nitrofurantoin
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Which drug can cause pulmonary symptoms hours to weeks after drug exposure?
Nitrofurantoin
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True/false: nitrofurantoin’s side effect can be allergic pneumonitis and that is usually associated with eosinophilia
True
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