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Please write two discussion replies. 250 words each in APA format with at least two peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)All replies must be constructive and use literature where possible. attached you will the discussion replies
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KeShawna
Describe urinary tract infection, causes, symptoms, and treatment
Urinary tract infection (UTI) is a general term used to describe inflammation of the urethra,
bladder, and kidney caused by bacteria, yeast, or chemical irritants. UTIs vary from
asymptomatic bacteriuria to symptomatic and recurrent to sepsis-associated, requiring
hospitalization. Because they have short urethra near the rectum, women acquire UTIs in a 30:1
ratio to men. For men, contributing factors include intercourse with an infected partner,
homosexuality, and an uncircumcised penis. During sexual intercourse, periurethral and urethral
bacteria ascend into the bladder, causing UTI. The bacteria that cause UTIs develop in the fecal
flora, inhabit the vagina and periurethral introitus, and climb to the urethra and bladder.
Escherichia coli is the most causative agent in 85% to 90% of community-acquired UTIs,
followed by Staphylococcus saprophyticus. Pathogens like Pseudomonas, Enterococcus,
Staphylococcus, Serratia, Providencia, and fungi cause complicated UTIs (Arcangelo et al.,
2017). In cases of asymptomatic UTI, the patient presents with no signs or symptoms, and
around 25% to 40% resolve without treatment. In symptomatic UTI, the patient can show
symptoms like urinary urgency or frequency, suprapubic tenderness, acute dysuria, or
costovertebral pain or tenderness. A diagnostic indicator of UTI with or without symptoms is a
urine culture with 105/mL organisms or more. Antibiotic treatment is the standard therapy for all
UTIs.
Discuss treatment for benign prostatic hyperplasia
Treatment for benign prostatic hyperplasia (BPH) falls into three significant categories. One
group is α-adrenergic antagonists or α-blockers (doxazosin, terazosin, tamsulosin, alfuzosin, and
silodosin). Tamsulosin, silodosin, and alfuzosin are selective α1-adrenoreceptor antagonists that
relax the smooth muscle fibers of the prostate and bladder neck, reducing the active features of
prostatic obstruction (Arcangelo et al., 2017). A second group is 5-α-reductase inhibitors
(finasteride and dutasteride). These inhibitors decrease the prostate cell’s intracellular growthstimulatory hormone levels without reducing testosterone levels, leading to a prostatic size
reduction of twenty to thirty percent. The last group is called PDE type 5 inhibitors. Tadalafil
(Cialis) is the only approved drug in this class. PDE5 inhibitors regulate smooth muscle tone in
the human prostate.
Describe overactive bladder, its causes, symptoms, and treatment
The International Continence Society defines overactive bladder as an array of symptoms
that include urinary urgency usually accompanied by frequency (voiding eight or more times per
24 hours) and nocturia (awakening two or more times at night to void), with or without urge
urinary incontinence (UUI) that affects about 34 million people in the United States. The exact
cause of the OAB is multifactorial. Numerous underlying anatomic, physiologic, and
comorbidity-related factors precipitate or exacerbate OAB. Most cases are idiopathic, with the
remainder attributed to myogenic or neurogenic causation. Urgency is the primary symptom of
OAB, followed by frequency, incontinence, and involuntary and inappropriate bladder
contraction. Treatment is contingent upon OAB’s degree of impairment and annoyance.
Treatment of comorbid conditions and referral to a specialist is warranted if empiric or diseasespecific therapy is required (Arcangelo et al., 2017). Behavioral therapy, which consists of
bladder training, pelvic floor muscle exercises, and weight loss, is the first intervention for OAB.
If behavioral therapy does not correct OAB, first-line pharmacologic therapies include
anticholinergic or antimuscarinic drugs oxybutynin, tolterodine, trospium, darifenacin,
solifenacin, and fesoterodine. If tolerability issues prevent the use of anticholinergic drugs,
alternative drugs, imipramine, desmopressin, topical estrogens for females, and alpha-adrenergic
antagonists for males can be used.
Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea
and Syphilis)
Chlamydia’s recommended treatment is 100 mg of oral doxycycline twice daily for seven
days. Alternative regimens include 1 g of azithromycin or 500 mg of levofloxacin once daily for
seven days. The current recommended treatment for gonorrhea consists of 500 mg of
intramuscular ceftriaxone. Azithromycin is no longer an appropriate therapy for gonorrhea due to
increased macrolide resistance. For patients unable to handle cephalosporins, a single dose of
5mg/kg parenteral gentamicin combined with 2 g of oral azithromycin should be prescribed
(Tuddenham et al., 2022). The first-line therapy for syphilis of all stages is parenteral penicillin.
Administering 2.4 million long-acting benzathine penicillin G units as a single intramuscular
dose is optimal for primary, secondary, and early latent syphilis. Late latent syphilis is treated
with 2.4 million units of benzathine penicillin G administered intramuscularly weekly for three
consecutive weeks. Alternate therapy includes 100 mg of oral doxycycline twice daily for 14 to
28 days.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for
Advanced Practice (4th ed.). Wolters Kluwer.
Tuddenham, S., Hamill, M. M., & Ghanem, K. G. (2022). Diagnosis and Treatment of Sexually
Transmitted Infections: A Review. JAMA, 327(2), 161–172.
https://doi.org/10.1001/jama.2021.23487
Anna
1. Describe urinary tract infection, causes, symptoms and treatment
•
Urinary Tract Infections (UTI) can be described as an inflammation caused by bacteria,
yeast or chemical irritants that affect the bladder kidneys, and urethra (Arcangelo et al.,
2017). They often inflict women more often than men due to the anatomical structure of
the urethra and its location in proximity with the rectum (Arcangelo et al., 2017). A
shorter urethra means that pathogens and irritants can more easily transport into and
infect the bladder and kidneys.
•
Urinary tract infections may be attributed to improper cleansing methods and
incontinence, sexual activity, uncircumcised penis, homosexuality, and urinary
retention (Arcangelo et al., 2017). Essentially any prolonged exposure of the urethra
to a pathogen or irritant may lead to a UTI. Escherichia Coli is the leading causative
bacteria related to UTI (Arcangelo et al., 2017). This is likely due to the proximity of
the anus to the urethra and stool being introduced into the urinary tract. Sometimes
UTIs are asymptomatic or do not involve the common symptoms listed above.
•
Some leading symptoms of UTIs include fevers, suprapubic tenderness, new or
increased urinary frequency or urgency, burning and stinging with urination, and
back pain. With upper UTIs patients may experience flank pain nausea and vomiting
(Arcangelo et al., 2017).
•
Regarding treatment options, differentiating chronic from acute, mild from severe,
symptomatic from asymptomatic, and areas and pathogen suspected of infection
source, the treatment can vary. Sometimes hospitalization is required. In the older
population UTI is highly prevalent and often leads to sepsis, so it is important
physicians be keen on identifying symptomatic UTIs to prevent serious complications
(Zeng et al., 2020).
•
Asymptomatic UTIs are often left untreated as they are found to naturally resolve
without treatment and other noncomplicated UTIs in women resolve in at least a
quarter of cases (Arcangelo et al., 2017). Otherwise, all symptomatic UTIs warrant
treatment, and the main drug therapy involves antibiotics to treat the infection, and a
urinary analgesic can be given for discomfort and dysuria (Arcangelo et al., 2017).
Encouraging patients to drink lots of water to encourage flushing out the urinary tract
and using sitz baths may also be beneficial for management. While education on
prevention, like urinating after sex, and proper cleansing methods may aid in
avoiding reoccurrence.
2. Discuss treatment for benign prostatic hyperplasia
•
Benign prostatic hyperplasia (BPH) can require surgical, medical and drug therapy
interventions to effectively treat. It is recommended to first treat less invasively and
prevent progression if the condition allows (Arcangelo et al., 2017). There are 3 drug
classes involved in BPH treatment. These are a-blockers, 5-a-inhibitors, as well as
one PDE type 5 inhibitor (Arcangelo et al., 2017).
3. Describe overactive bladder, causes, symptoms and treatment
•
Overactive bladder (OAB) is a symptom syndrome rather than a discrete diagnosis,
and its symptoms include urinary urgency with frequency and nocturia (Arcangelo et
al., 2017).
•
The causes of OAB are not entirely understood but are considered multifactorial. This
can include anatomical, physiological, and underlying disease factors (Arcangelo et
al., 2017).
•
Treating OAB involves treating underlying conditions that may cause or exacerbate
symptoms. Often a referral to a urologist is warranted. Behavioral therapies are
considered first line treatment, these include pelvic floor exercises, weight loss, and
bladder training (Arcangelo et al., 2017). Drug therapy involves anticholinergic and
antimuscarinic drugs as best solutions. Otherwise, Botox, antidiuretics, tricyclic
antidepressants, desmopressin, topical estrogens, or alpha-adrenergic antagonist can
be considered (Arcangelo et al., 2017).
4. Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea and
Syphilis)
•
Prevention of sexually transmitted infections (STI) is the best recommendation.
Education on prevention methods should always be given to sexually active or at-risk
populations. Abstinence should be encouraged, but otherwise education on the use of
condoms and monogamous sexual relationships, available vaccines, and identification
of STIs, should be given regarding prevention strategies (Workowski et al., 2021).
•
Treatment options vary depending on the STI. However, it is essential that the patient
and their partner are both treated. Treatment options concerning drug therapy include
antimicrobials for all STIs. For Chlamydia a short dose of azithromycin or a
weeklong therapy of doxycycline can be effective. Gonorrhea treatment includes
cefixime, ceftriaxone, azithromycin or doxycycline. Syphilis is typically treated with
penicillin, but a handful of other antibiotics may be utilized due to unusual situations
(Arcangelo et al., 2017).
References
Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics
for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters
Kluwer/Lippincott Williams & Wilkins.
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno,
H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually Transmitted Infections Treatment
Guidelines, 2021. MMWR. Recommendations and reports : Morbidity and mortality weekly
report. Recommendations and reports, 70(4), 1–187. https://doi.org/10.15585/mmwr.rr7004a1
Zeng, G., Zhu, W., Lam, W., & Bayramgil, A. (2020). Treatment of urinary tract infections in
the old and fragile. World journal of urology, 38(11), 2709–2720.
https://doi.org/10.1007/s00345-020-03159-2
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