NUR 210 EXAM 4 NOTES
Sulfonamides
Sulfonamides-Trimethoprim-Sulfamethoxazole Uses ➢ Synergistic effect ➢ Both drugs together in one compound cause bacterial resistance to develop much more slowly.➢ Seeing it used for MRSA ➢ Urinary infections (also in chapter 48) ➢ Alternative therapy for patients allergic to penicillin Route ➢ Oral, IV, topical, ophthalmic
Side effects/adverse reactions ➢ GI distress, stomatitis ➢ Photosensitivity ➢ Hypoglycemia ➢ Blood dyscrasias-RBC’s, WBC’s, platelets ➢ Crystalluria can lead to Renal failure ➢ Stevens-Johnson syndrome
Contraindications ➢ Renal or liver disease ➢ Anemia Caution ➢ Older adults ➢ Diabetes ➢ Interactions ➢ Increase bleeding with warfarin ➢ Increases effect of hypoglycemic ➢ Increases digoxin level
➢ Assessment ➢ Vital signs ➢ Renal function – Urine output/labs as available ➢ Medical history/medication history ➢ Allergies ➢ CBC (baseline)
➢ Nursing Interventions ➢ Obtain C & S ➢ Administer with full glass of water ➢ Increase fluid intake to at least 2000 mL/day. 1 / 2
➢ Monitor I & O ➢ Monitor VS ➢ Monitor for bleeding, CBC, and renal function.➢ Monitor for rash, superinfection.➢ Avoid during third trimester.➢ Best given on an empty stomach ➢ Teaching ➢ Increase fluids to several quarts a day ➢ Do not take antacids with med ➢ Warn patient if allergic to other sulfa drugs may be allergic to this one (oral hypoglycemics – sulfonylureas) ➢ Teach to side effects and how to minimize them ➢ Teach to adverse reactions to report such as bruising or bleeding ➢ Wear sunglasses and sunblock when outdoors
Topical and Ophthalmic Sulfonamides Topical use of sulfonamides can cause hypersensitivity reactions; they are infrequently used.Silver sulfadiazine (Silvadene): Used in the treatment of burns and sometimes skin ulcers
Antifungals and Metronidazole Antifungals • Fungal infections ➢ Superficial infections • Oral candidiasis (thrush) • Vaginal candidiasis (yeast infection) • Tinea pedis (athlete’s foot) ➢ Systemic infections • Lungs, CNS, abdomen • Severe ➢ Opportunistic fungal infection • Immunocomprised patient • Patients taking antibiotics (superinfection) • Steriods • Chemotherapy • Other immunosuppressive • Antifungal drugs • Nystatin – local - lotions • Fluconazole – systemic – oral tablet
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