Pharmacology Ch 89 - Drug therapy for UTIs

nitrofurantoin

AKA Macrobid, Macrodantin, Furadantin Urinary tract antiseptic - becomes concentrated in urine - first choice drug for UNCOMPLICATED CYSTITIS - May be associated with birth defects - do not use if pregnant

relapse, reinfection

Recurrent UTIs can result from: 1. _______: is caused by recolonization with the same organism responsible for the initial infection or 2. ________: is caused by colonization with a NEW organism

E. coli

The majority of uncomplicated, community acquired UTIs are caused by ________

1, 3, 4 (Under acidic conditions, methenamine makes formaldehyde, which causes bacterial cell death. Formaldehyde requires an acid urine to be released. To prevent the dose from being converted to formaldehyde in an acidic stomach, an enteric-coated formula may be used. Ingestion of large volumes of fluid dilutes methenamine and raises the urinary pH. Hepatotoxicity is not associated with methenamine [Mandelamine].)

Which outcomes should a nurse establish when planning care for a patient taking methenamine [Mandelamine]? (Select all that apply.) 1 Maintains a urine pH of 5.5 or lower 2 Consumes 3000 mL of liquid daily 3 Uses an enteric-coated formulation 4 Avoids sulfonamide medications 5 No elevation in liver enzymes

4 (Except for pyelonephritis, most UTIs can be treated with oral therapy at home.)

With the exception of pyelonephritis, the nurse is aware that most urinary tract infections are treated by which method? 1 IV antibiotics at the hospital 2 IV antibiotics in the urgent care setting 3 IM antibiotics at the primary physicians office 4 Oral antibiotics in the home setting

mild moderate severe

____ to ______ infection can be treated at home with oral antibiotics _______ infection requires hospitalization and IV antibiotics

methenamine

A urinary tract antiseptic that decomposes into ammonia and formaldehyde to denature bacterial proteins AKA Hiprex

2, 3, 5 (Complicated UTIs occur in males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.)

A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) 1 Female gender, child-bearing age 2 Indwelling catheter 3 Prostate hypertrophy 4 Fair skin tone 5 Urinary tract stones

2 (Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions. Hyperpigmentation of the palms, gum irritation with bleeding, and scalp tenderness and thinning hair are not side effects associated with nitrofurantoin.)

A patient is taking nitrofurantoin [Macrodantin]. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? 1 Hyperpigmentation of the palms 2 Dyspnea with chills 3 Gum irritation with bleeding 4 Scalp tenderness and thinning hair

4 (Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible)

A patient is to begin taking nitrofurantoin [Macrodantin]. The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? 1 Headache and drowsiness 2 Brown-colored urine 3 Nausea and vomiting 4 Muscle weakness and tingling

2 (Flank pain may indicate continued infection or pyelonephritis. When acute cystitis is treated with a traditional agent of choice, such as trimethoprim/sulfamethoxazole, manifestations of dysuria, urinary urgency and frequency, suprapubic discomfort, and bacteriuria improve. Incontinence, 3+ pedal edema, and hyperactive bowel sounds are unrelated to acute cystitis.)

A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole. Which manifestation should indicate to a nurse that the patient's condition is worsening? 1 Incontinence 2 Flank pain 3 3+ pedal edema 4 Hyperactive bowel sounds

community acquired

For ________ - ________ infections - 3 types of PO therapy may be used: 1. single dose 2. short course (3 days) 3. conventional therapy (7 days)

80

More than ___ % of recurrent UTIs in female patients are due to reinfection - usually involve lower urinary tract and may be related to sexual intercourse or use of contraceptive diaphragm

2 (Most cases of uncomplicated, community-acquired UTI are caused by E. coli. In rare cases, other gram-negative bacilli (eg, K. pneumoniae, Enterobacter spp., and Pseudomonas spp.) are the cause.)

Most cases (more than 80%) of uncomplicated, community-acquired urinary tract infection (UTI) are caused by which bacteria? 1 Klebsiella pneumoniae 2 Escherichia coli 3 Enterobacter spp. 4 Pseudomonas spp.

1, 3, 5 (Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection. The other three statements are true.)

The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) 1 Reinfections are considered frequent if the individual has three or more a year. 2 Prophylactic therapy should continue for at least 2 months. 3 If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. 4 Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. 5 If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.

3 (Acute cystitis is a lower urinary tract infection that occurs most often in women of child-bearing age.)

The nurse is aware that acute cystitis occurs most often in which patient population? 1 Older-adult male patients 2 Children younger than 12 years 3 Women of child-bearing age 4 Women older than 50 years

1 (When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.)

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? 1 Fosfomycin 2 Amoxicillin 3 Cephalexin 4 Trimethoprim

3

When reinfections are frequent ( ___ or more per year) - long term prophylaxis may be necessary and should continue for at least 6 months

acute cystitis

______ ______ is a lower UTI that occurs most often in women of child bearing age. Clinical manifestations: dysuria, urinary urgency, urinary frequency, suprapubic discomfort, pyuria, bacteriuria. - Many women (30% or more) with Sx of acute cystitis also have asymptomatic upper UTI (subclinical pylonephritis)

Acute uncomplicated pyelonephritis

______ ________ _________ is an infection of the kidneys. - common in young children, older adults, and women of child bearing age Clinical manifestations include: fever, chills, severe flank pain, dysuria, urinary frequency, urinary urgency, pyuria, bacteriuria.

acute bacterial prostatitis

_______ _______ _______ is defined as inflammation of the prostate caused by local bacterial infection - responds well to antimicrobial therapy Clinical manifestations include: - high fever, chills, malaise, myalgia, localized pain, and various urinary tract symptoms In most cases: E. coli is the causative agent

UTIs

_______ are the most common infections encountered today. - 25-35% of Sexually active young women develop at least 1 per year - older women in nursing homes (30-50%) develop bacteriuria at any given time

UTIs, cystitis, urethritis, pyelonephritis

_______ may be limited to bacterial colonization of urine or may invade tissues of urinary tract - Either lower urinary tract: ___________ or ________ or upper urinary tract: _____________ - May be complicated or Uncomplicated

complicated

________ UTIs - - Occur in both males an females - associated with predisposing factor - calculi, prostate hypertrophy, indwelling catheter, or impediment to flow of urine

complicated UTIs

________ ________ occur in male and female patients who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection. - Sx can range from moderate to severe - some develop systemic illness, manifesting as fever, bacteremia, and septic shock. - Identity and drug sensitivity must be determined in order to treat - urine sample must be collected BEFORE antibiotic started.

hospital

________-acquired UTIs are frequently caused by: - Klebsiella, Proteus, Enterobacter, and Pseudomonas specie, staphylococci, enterococci, E. coli is responsible for less than 50%

uncomplicated

_________ UTIs - - occur primarily in women of child bearing age and are not associated with any particular predisposing factor