Tuberculosis Latent- no s/sActive- leads to destruction of lung tissue-can be fatalHow is it transmitted? Person to person by aerosolized sputum Treatment for Latent TB:Name Spectrum Resistance Uses ADRs DDIs OtherIsoniazid Bacteriocidalto mycobacteriaReduce risk by multiple drug therapyPrimary agent for tx and prophylaxis and active TBHepatotoxicity, peripheral neuropathy (reverse with pyridoxine B6)Alcohol, rifampin, pyrazinamide all increases risk of liver injuryRifampin Broad (as above)As above TB, leprosy, meningococcal carriersDiscoloration of body fluids (red-orange body fluids), liver toxicityOral contraceptives (gets inactivated), Coumadin (decreases effect-> clot) Tell pts about the discoloration-stain clothes, contacts… Pyrazinamide As above Active TB in combination with Rif, Ison, ethambutolLiver toxicity UTIsPregnant Women: always treat pregnant women with UTIs even if they are asymptomaticClassified by Location:1. Lower UTI: bladder (cystitis), urethra (urethritis)2. Upper UTI: kidney (pyelonephritis)Complicated v Uncomplicated: Uncomplicated: young femalesComplicated: kidney stones, male, catheter, BPH, hx of surgery or obstruction Lower UTIWho gets it? Women of child bearing ageSymptoms: frequency, dysuria, urgency, suprapubic pain Cause: E-coliDrugs: Primsol, Bactrim, Septra, Macrobid, CiproTreatment: 3-5 days, less-not effective, more-less compliant Urinary Tract AntisepticsAntibiotics that are ONLY used to treat UTIsDrugs become concentrated in the urine, but do not achieve adequate levels in tissue or blood-don’t give them for other infections Examples: A) Nitrofurantoin (Macrobid)a. Good for: i. Uncomplicated lower UTIs- not good for upper UTIsii. Prophylaxis for UTIb. ADRs:i. Dose adjustment in renal impairment (want to decrease it)- can lead to peripheral neuropathyii. GI-N/V eat with food!B) Methanemine (Urex)a. Requires what? An acidic environment- forms formaldehyde if not Urinary Tract Analgesics (numbs the pain, must take antibiotic with it)A) Phenazopyridine (Pyridium-AZO)a. MAO: has topical analgesic effectb. Uses: control s/s of dysuria, frequency, urgency (numbs all down there), only for first 24-48 hrs!c. ADRs: discolors urine-reddish orange (warn the pt)d. IMPORTANT: does not kill bacteria Acute Pyelonephritis Cause: E-ColiSigns and Symptoms: flank pain, fever, chills (systemic s/s), dysuria, frequency, urgencyA) Treatment for Mild to Moderate Infections:a. Length of tx: 2 weeks (longer than bladder infections)b. Drugs: cipro, sulfonamides, PCNsc. Important: urinary antiseptics will not
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