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UTI, Adverse Effects, Adverse Reactions, Adverse Effects, Special…

- - - - Nitrofurantoin
        
        Dosing- 100mg PO BID for 5 days (7 days for males)
        
        PK
        
        Renally excreted, contraindicated in CrCl < 60
        
        Well absorbed
        
        Half-life: 20-60 minutes, prolonged with renal impairment
        
        Protein binding: 60-90%
        
        Bioavailability: increased with food by 40%
        
        MOA
        
        Reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules
        
        increased serum phosphate, flatulence, nausea, headache, C. diff, DILI, peripheral neuropathy, pulmonary toxicity
        
        Special Populations
        
        Pediatric: contraindicated in children < 1 month of age (increased risk of hemolytic anemia)
        
        Elderly: avoid use in geriatric patients
        
        Patient Counseling
        
        Drug may cause brown-color urine.
        
        Drug may cause loss of appetite, nausea, vomiting, or hemolytic anemia.
        
        Tell patients on therapy for 6 months or longer to report signs of adverse pulmonary effects such as malaise, dyspnea on exertion, cough, or signs of diffuse interstitial pneumonitis or fibrosis.
        
        Patient should take drug with food.
        
        Instruct patient to report signs/symptoms of hepatic dysfunction, or neuropathy.
      - Sulfamethoxazole-Trimethoprim
        
        Dosing- 800/160 mg PO BID for 3 days (7 days for males)
        
        PK
        
        Rapid, completely absorbed
        
        Half-life: 6-11 hours (TMP), 9-12 hours (SMX)
        
        Renally excreted as metabolites and unchanged drug, dosage adjustment necessary
        
        Metabolized via CYP2C9 (SMX)
        
        MOA
        
        Interferes with bacterial folic acid synthesis and growth via inhibition of dihydrofolic acid formation as well as inhibit dihydrofolic acid reduction to tetrahydrofolate, resulting in further inhibition of the folic acid pathway
        
        hypersensitivity reactions, dermatitis, skin photosensitivity, skin rash, hyperkalemia diarrhea, nausea, stomatitis, vomiting
        
        Drug causes sun sensitivity. Pt should use sunscreen, cover skin with clothing and a hat, and avoid the sun/tanning beds.
        Pt should maintain adequate hydration during therapy to prevent crystalluria and renal stone formation.
        Patient should also report signs/symptoms of a severe skin reaction such as Stevens-Johnson syndrome (flu-like symptoms, spreading red rash, or skin/mucous membrane blistering) or toxic epidermal necrolysis (widespread peeling/blistering of skin).
        Advise patient to immediately report signs/symptoms of fulminant hepatic necrosis (somnolence, confusion, jaundice, abdominal pain), blood dyscrasia, severe diarrhea, or shortness of breath.
        
        Special Populations
        
        Elderly: Use with caution, greater risk for more severe side effects
        
        Use with caution in people with potential for folate deficiency
        
        Contraindicated in people with sulfa allergy
      - Fosfomycin
        
        Dosing- 3 grams of powder mixed in water as a single oral dose
        
        PK:
        
        Rapidly absorbed
        
        Half- life: 3-8 hours, 50 hours in CrCl < 54 ml/min, 40 hours in CKD Stage 5
        
        Renal excretion decreases to 11% with CrCl < 54ml/min
        
        Excreted in urine (38% as unchanged) and feces (18% as unchanged)
        
        Bioavailability: 37% [30% with food]
        
        MOA
        
        Inhibits bacterial wall synthesis by inactivating pyruvyl transferase, which is critical in the synthesis of cell walls by bacteria
        
        headache, pain, dizziness, skin rash, diarrhea, nausea, dyspepsia, rhinitis
        
        Renal Impairment: Dose adjustment required in patients with renal impairment
        
        Patient Counseling
        
        Immediately report s/sx of Clostridium difficile associated diarrhea (severe, watery, or bloody diarrhea)
        
        Mix drug with 3-4 oz water (not hot) before ingesting. Do not ingest dry powder form of the drug, it must be dissolved in water first.
  - - - Fluoroquinolones (Ciprofloxacin or Levofloxacin)
      - Sulfamethoxazole-Trimethoprim
    - - IV fluoroquinolone
      - IV aminoglycoside with or without ampicillin
      - IV extended-spectrum cephalosporins with or without an aminoglycoside