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Pharm GU Exam #1
Terms in this set (144)
Should you treat asymptomatic UTIs in the elderly?
In what gender should you obtain a culture before treating a UTI?
Should asymptomatic children under 5 with an asymptomatic UTI be treated?
How long should Ciprofloxacin and Levofloxacin be used to treat a UTI?
How long should SMZ/TMP be used to treat a UTI?
How long should oral cephalosporins be used to treat a UTI?
How long should amoxicillin/clavulanate be used to treat a UTI?
How long should you treat a hospitalized patient for pyelonephritis?
Until pt is afebrile x 24-48 hours and then do 2 week course with oral Abx
What should you do 2 weeks after completing Abx for pyelonephritis?
What causes 85% of uncomplicated UTIs?
Does Trimethoprim/sulfamethoxazole or Amoxicillin have a higher cure rate and lower relapse rate?
What class of Abx should you not use routinely for UTIs due to high E. coli resistance?
What Abx should not be used for a UTI due to low tissue penetration into the GU tract? (2)
What Abx enter the urine via filtration? (3)
What Abx enter the urine by being filtered and actively secreted? (2)
What is the only GU infection penicillins are used to treat?
What Abx is penicillin combined with to treat acute pyelonephritis?
What penicillin may be used to treat a UTI in pregnancy?
What class of drugs is safe to use in pregnancy, but resistance is high for UTIs?
When can fluoroquinolones be used for Tx of a UTI? (2)
Local resistance patterns for E. coli are 10% or less
Pt cannot take sulfa-trimeth
2 cautions for fluoroquinolones
Affects blood sugar readings
When can sulfonamides be used to treat a UTI?
E. coli resistance is less than 20%
What drug is exclusively used both therapeutically and prophylactically for UTIs?
What is important to remember when prescribing MacroBID?
Use brand name
Pregnancy category of MacroBID
Contraindications to MacroBID (5)
Early pyelonephritis suspected
1st trimester of pregnancy
Last week of pregnancy
Why should MacroBID be avoided if early pyelonephritis is suspected?
Serum concentrations do not get high enough to treat systemic infections
Why should MacroBID be avoided the last week of pregnancy?
Hemolytic anemia in the newborn
When is Azithromycin (Zithromax) indicated for a UTI?
Alternative to Doxy in pts with risk factors for Chlamydia
When is doxycycline indicated for a UTI?
Risk factors for STD
Class of Zemdri (plazomicin)
Indication for Zemdri (plazomicin)
Complicated UTIs, including pyelonephritis
Warnings for Zemdri (plazomicin) (2)
What is the most efficacious single dose therapy for a UTI? (2)
What course of Trimeth/Sulfa and quinolones are superior to single dose therapy?
3 day therapy
What is another single dose therapy for UTIs?
How long is Nitrofurantoin (MacroBID) therapy?
How long should a male be treated for a UTI?
How long should Abx be given for uncomplicated UTIs?
How long should Abx be given for complicated UTIs?
How long should a UTI be treated in males with prostate involvement?
6 to 12 weeks
Indication for phenazopyridine (Pyridium)
Symptomatic relief of discomfort and pain before antibacterial therapy becomes effective
How long should phenazopyridine (Pyridium) be administered and why?
No more than 2 days, will mask Sx of inappropriate antibiotic choice
What is the main adverse effect of phenazopyridine (Pyridium)?
Discoloration of urine to reddish orange, will stain contacts
Indications for IV therapy for a UTI (2)
Hospitalized acute and chronic pyelonephritis
When can cranberry juice be used to prevent UTIs?
Only when used continuously
What type of cranberry has no data to support its use?
How long should a UTI be treated in pregnancy?
Abx used to treat UTI in pregnancy (4)
When should trimeth/sulfa be avoided in pregnancy?
1st trimester and 3rd trimester near term
Indication for Fosfomycin (Monurol)
Only indicated for UTI
MOA of Fosfomycin (Monurol)
Broad spectrum bactericidal antibiotic that interrupts cell wall synthesis and reduces bacterial adherence to the uroepithelial cells
Pregnancy category of Fosfomycin (Monurol)
Indication for UTI prophylaxis
Women with 3 or more episodes a year or 2 or more in 6 months
When will UTI prophylaxis be dosed?
At bedtime or after intercourse
Abx used for UTI prophylaxis (4)
Macrodantin (nitrofurantoin)- which is not MacroBID
What can you do for UTI prophylaxis if cost is a concern? (2)
Only take post-coitus
Take at onset of Sx
Indication for pentosan polysulfate sodium (Elmiron)
Pregnancy category of pentosan polysulfate sodium (Elmiron)
What is the most common side effect of pentosan polysulfate sodium (Elmiron)
Hair loss, normally in a single spot
What is the most effective Tx of pentosan polysulfate sodium (Elmiron)?
Dietary approach of avoiding trigger foods
Usual etiology of bacterial prostatis in someone <35 y/o (2)
Treatment of bacterial prostatitis in someone <35 y/o (2)
Ceftriaxone + Doxycycline
Usual etiology of bacterial prostatitis in someone >35 y/o
Treatment of bacterial prostatitis in someone >35 y/o (2)
Usual etiologies of chronic bacterial prostatitis (3)
Treatment of chronic bacterial prostatitis (3)
Meds to avoid with BPH (5)
Drugs with significant anticholinergic effects
Sympathomimetic drugs (2)
What anticholinergic poses little risk to urinary retention in BPH if there is good flow?
MOA of alpha blockers in BPH
Relaxes smooth muscles in the urinary tract and prostate to increase urinary flow with minimal effect on sex drive
Nonselective alpha blockers (3)
What nonselective alpha blocker is not approved for BPH?
Selective alpha blockers (2)
Warning for alpha blockers
Orthostatic hypotension when beginning meds
What class of drugs causes intraoperative floppy iris syndrome?
What is the least likely of the alpha blockers to cause ejaculatory problems?
What alpha blocker is contraindicated with CYP3A4 inhibitors?
What alpha blocker is least likely to cause orthostatic hypotension but is most likely to cause ejaculatory problems?
Class of finasteride (Proscar) and dutasteride (Avodart)
5-alpha reductase inhibitors
MOA of 5-alpha reductase inhibitors
Inhibit the production of dihydrotestosterone
Indication for 5-alpha reductase inhibitors
Pts with large prostates who are not good surgical candidates
Pregnancy category of 5-alpha reductase inhibitors
What class of meds should women of childbearing age not handle the tablets?
5-alpha reductase inhibitors
What 5-alpha reductase inhibitor is indicated for alopecia, not BPH?
What 5-alpha reductase inhibitor works 5 months faster than the other?
What is an herbal supplement for BPH that does not actually work?
MOA of Leuprolide (Lupron)
Inhibits gonadotropin secretion which suppresses testicular steroidogenesis
Indication for Leuprolide (Lupron)
Advanced prostate cancer, palliative Tx
What vitamin increases risk of prostate cancer?
Indication for Bicalutamide (Casodex)
Treatment of advanced prostate carcinoma
Class of Leuprolide (Lupron)
MOA of Bicalutamide (Casodex)
Anti-androgen that prevents testosterone stimulation of cell growth in prostate cancer
MOA of Flutamide (Eulexin)
Competitively blocks dihydrotestosterone binding at androgen receptors which inhibits androgen-dependent DNA synthesis and protein synthesis so tumor cells stop growin
What is a therapeutic vaccine to treat advanced prostate cancer?
MOA of Provenge (Sipuleucel-T)
Stimulates the body's immune response to prostate cancer by injecting pt's own modified white cells into the body
Regimens for testicular cancer (3)
Etoposide and Cisplatin
Bleomcyin, Etopaside, and Cisplatin
Vinblastine, Ifosfamide, Mesna, and Cisplatin
What is a side effect of Cisplatin?
MOA of anticholinergics for overactive bladder
Antagonize muscarinic cholinergic receptors to evoke detrusor contraction
What muscarinic receptor does anticholinergics work on and in what areas of the body is it located?
M3- located in bladder and salivary/excretory glands
Most common anticholinergic for overactive bladder
Anticholinergics for overactive bladder (6)
What anticholinergic is the least M3 selective?
What drug is prodrug of tolterodine (Detrol)?
Topical anticholinergic for bladder control
What class of meds increases the risk of Alzheimer's/cognitive impairment by 50%?
In what pt's should you not use anticholinergics due to Alzheimer's risk? (2)
Hx of stroke
FHx of dementia
Class of Mirabegron (Myrbetriq)
Beta-3 receptor agonist
MOA of Mirabegron (Myrbetriq)
Stimulates beta-3 receptors to relax the detrusor muscle during the storage phase of urinary bladder fill-void cycle
Advantages of Mirabegron (Myrbetriq) (2)
No anticholinergic side effects
No QT prolongation
Treatment of stress urinary incontinence (2)
Estrogen- improves urethral closure
Duloxetine (cymbalta)- not FDA approved
Classes of drugs that cause ED (10)
Drugs with abuse potential
What antidepressant should you use in ED?
Non-pharm options for ED Tx (3)
Penile support sleeve (Rejoyn)
What route of administration should you never use for testosterone and why?
N/V, first-pass metabolism, hepatotoxicity
Drugs that lower testosterone levels (2)
Morphine and other opioids
Testosterone replacement patches(4)
Delatestryl (Testosterone enanthate)
What topical testosterone replacement is applied to the scrotal skin?
Testosterone topical gels (3)
Where should Fortesta be applied?
What labs should you get to monitor testosterone?
Total and free testosterone
MOA of intracavernosal injection
Direct injection of vasoactive prostaglandins onto the corpus cavernosum
How often can intracavernosal injections be used?
Twice a week
MOA of Muse (alprostadil)
Alpostadil is absorbed by the urethral mucosa and transported to the corpus spongiosum and corpus cavernosum to cause vasodilation of vascular beds
Class of Muse (alprostadil)
How is Muse (alprostadil) administered?
Phosphodiesterase type-5 inhibitors (3)
MOA of phosphodiesterase inhibitors
Enhance the effect of nitric oxide by inhibiting phosphodiesterase type 5 to allow blood to flow into the penile tissues to allow for LIFT OFF
What is required for a phosphodiesterase inhibitor to work?
Important warnings for phosphodiesterase inhibitors (2)
Color disturbance (blue/green)
Drug indications (3)
What phosphodiesterase inhibitor should you give to man who cannot plan and wants to take the med continuously without regard to timing of sexual activity?
Cialis (tadalafil) continuous dosing
What phosphodiesterase inhibitor is indicated for pulmonary HTN?
Revatio (sildenafil)- lower dose
What is an herbal supplement for ED that does not work?
MOA of topical anesthetics for premature ejaculation
PO meds for premature ejaculation (4)
Why is Dapoxetine a good option for premature ejaculation?
Enters body quickly and is metabolized quickly which allows for PRN use
What SSRI is superior to Prozac for premature ejaculation?
Why is Tramadol not recommended routinely for premature ejaculation?
Tx of female hypoactive sexual desire disorder (4)
What drug for female hypoactive sexual desire disorder only increases sexual arousal and orgasm, but not desire?
Dosing of flibanserin (Addyi)
Once daily at bedtime in premenopausal women
What should you always consider in female hypoactive sexual desire disorder?
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