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Pharmacology
Urinary Antiseptic
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What are the main urinary antiseptics mentioned in the study material?
Nitrofurantoin
Nalidixic
acid
Methanamine
Fluoroquinolones
Sulfonamides
Cotrimoxazole
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What is an antimicrobial agent?
A chemical
substance
that
inhibits
or
kills
microorganisms
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How does an antibiotic differ from an antimicrobial agent?
An antibiotic is produced by
microorganisms
to
inhibit
or
kill
other microorganisms
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What is the primary function of an antiseptic?
To inhibit
bacterial
growth in
vitro
and in
vivo
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What is the role of a disinfectant?
To
kill microorganisms
in a
non-living
environment
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In which populations are UTIs most prevalent?
Women of
child-bearing
age and the
elderly
population
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What is the most common pathogen causing uncomplicated UTIs?
E. coli
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What is the function of urinary antiseptics?
To suppress
bacteriuria
in the urine
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Why are urinary antiseptics often administered with acidifying agents?
Because
low pH
is an
independent
inhibitor of
bacterial growth
in urine
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Which urinary antiseptic is active against many urinary tract pathogens but not Proteus or Pseudomonas?
Nitrofurantoin
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What enhances the activity of Nitrofurantoin?
Acidification
of the urine
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What are the adverse effects of Nitrofurantoin?
Gastrointestinal
intolerance, hypersensitivity, peripheral neuritis,
hematologic
disorders,
liver
damage, and
pulmonary
reactions
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In which conditions is Nitrofurantoin contraindicated?
Renal
impairment,
pregnancy
, and
neonates
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What do methenamine mandelate and methenamine hippurate release at pH levels lower than 5.5?
Formaldehyde
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Why are methenamine drugs not usually active against Proteus?
Because
Proteus
organisms
alkalinize
the urine
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What is the first quinolone drug used clinically?
Nalidixic acid
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What are the toxic effects of Nalidixic acid?
Gastrointestinal
irritation,
glycosuria
,
skin rashes
,
phototoxicity
,
visual disturbances
, and
CNS
stimulation
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What is the mechanism of action of fluoroquinolones?
They inhibit
topoisomerase
II (
DNA-gyrase
) and
topoisomerase IV
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How do fluoroquinolones differ from first-generation quinolones?
Fluoroquinolones have
substitutions
that
increase
antibacterial activity and tissue
penetration
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What are the generations of fluoroquinolones and their characteristics?
1st Generation:
Nalidixic
acid
G-ve
activity, except
Pseudomonas
Uncomplicated
UTI
2nd Generation:
Norfloxacin
,
Lomefloxacin
,
Ofloxacin
,
Ciprofloxacin
G-ve
+
Pseudomonas
, some
G+ve
Indications
: UTI, respiratory infections, STDs, pyelonephritis
3rd Generation:
Levofloxacin, Sparfloxacin, Gatifloxacin, Moxifloxacin, Grepafloxacin
Same as
2nd
+ ↑
G-ve
and
pen-sensitive Strep. pneumoniae
Indications
:
exacerbated acute chronic bronchitis
,
community-acquired
pneumonia
4th Generation:
Trovafloxacin
Same
as
3rd
+ ↑
anaerobic coverage
Indications:
intra-abdominal
infections,
PID
,
nosocomial
pneumonia
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What are the side effects of fluoroquinolones?
Arthropathy
,
Achilles tendonitis
,
crystalluria
,
gastrointestinal
disturbances, and
photosensitivity
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What rare but dangerous side effects are associated with fluoroquinolones?
Cardiac
issues like QT prolongation,
CNS
effects,
hepatotoxicity
, and
hematuria
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What drug interactions should be avoided with fluoroquinolones?
Antacids
and
milk
products containing
Al
++,
Mg
,
Fe
,
Zn
,
Ca
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What are some species of Haemophilus mentioned in the study material?
Haemophilus
spp.
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Which bacteria are associated with pneumococcal pneumonia?
Streptococcus pneumoniae
and
Streptococcus fecalis
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What is the significance of the 3rd and 4th generation in pneumococcal pneumonia?
They are particularly
effective
against pneumococcal pneumonia.
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What class of antibiotics do fluoroquinolones belong to?
Fluoroquinolones
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What is a common side effect of fluoroquinolones related to joints?
Arthropathy
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Why are fluoroquinolones not recommended for pregnant women and nursing mothers?
Due to potential
risks
to the developing
fetus
and nursing
infant.
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What serious condition can fluoroquinolones cause in geriatric patients?
Achilles tendonitis
leading to
tendon rupture.
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What is crystalluria and which fluoroquinolones are exceptions?
Crystalluria is the
presence
of crystals in urine; exceptions are
levofloxacin
,
gatifloxacin
,
moxifloxacin
, and trovafloxacin.
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What gastrointestinal disturbances can fluoroquinolones cause?
GIT
disturbances such as
nausea
and
diarrhea.
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What is a rare but dangerous cardiac side effect of fluoroquinolones?
QT prolongation
leading to
Torsades de pointes.
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Which fluoroquinolone was withdrawn due to safety concerns?
Grepafloxacin
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What CNS side effects can occur with fluoroquinolones?
Insomnia
,
dizziness
,
anxiety
, and
seizures.
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Which fluoroquinolone is particularly associated with hepatotoxicity?
Trovafloxacin
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What is hematuria and in which patients is it a concern with fluoroquinolones?
Hematuria is the presence of
blood
in urine, especially in
G-6-PD
deficient patients.
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What can decrease the absorption of fluoroquinolones?
Antacids
and
milk
products containing
Al
++,
Mg
,
Fe
,
Zn
,
Ca.
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What interaction occurs between fluoroquinolones and NSAIDs?
They can cause
CNS
disturbances due to displacement of
GABA
from its receptors.
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What is the effect of fluoroquinolones on theophylline levels?
They can
increase
theophylline levels, leading to
toxicity.
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