Question

lor bile PN 200 Fundamentals of Nursing II UTI – trimethoprim-sulfamethoxazole RM, a 46-year-old woman, has a severe urinary tract infection. She takes trimethoprim- sulfamethoxazole (Bactrim) 160mg/800mg every 6 hours. 1. Is the dose within the recommended drug dose and dosing interval? What is the nurse's responsibility? 2. What are the similarities and differences between trimethoprim-sulfamethoxazole and sulfadiazine? 3. What are the signs of thrombocytopenia, hemolytic anemia, and agranulocytosis for patients who take high doses of sulfonamides? 4. Explain the assessment and nursing interventions regarding these severe adverse reactions to sulfonamides. 5. Patient teaching is an important part of nursing interventions. Explain the nurse's role regarding patient teaching concerning the following: A what is the required amount of daily fluid intake? В What are the cross-sensitive effects if a patient is allergic to other sulfonamides preparations? What allergic reactions may occur? What time of the day should sulfonamides be taken? Why should bruising and bleeding be reported? E What protective measures should be taken to prevent a possible photosensitivity? RM takes the anticoagulant Coumadin 7.5mg daily 6. What effect does Bactrim have on warfarin (Coumadin)? 7. Should RM's coumadin dosage be increased or decreased? Explain you answer. Reviewed 9/18

Answer 1

Urinary tract infection

An infection that affects the part of urinary tract is called Urinary tract infection( UTI).

1. Sulfamethaxazole- trymethoprim ( Cotrimaxazole) is a combination of sulfamethaxazole and trymethoprim in the ratio of 1:5. The trade names are Bactrim, Cotrim, Septra.

The dose of the drug (160mg/800mg) for Urinary tract infection is within the recommended dose. But the dosing interval is not within the recommended limit

The recommended interval for the dose is 12 hours, but the patient follows 6 hour interval.

Nurses responsiblity:

-Assess for side effects of the drug

- Check the prescription for the drug and inform the patient about the proper interval for taking the drugs.

- Monitor regular blood count assessment

- Nurses should ensure that they complete the entire course.

2. Similarities and differences between Sulfamethaxazole and trymethoprim and Sulfadiazine:

Sulfamethaxazole and trymethoprim and Sulfadiazine are antibiotics that inhibit or stop the growth of the bacteria.These drugs are used to treat a variety of infections. But these three antibiotics are not used in viral infections.

Sulfamethaxazole and Sulfadiazine are sulfonamides and the mechanism of action of is inhibiting the folate synthesis, that is essential for bacterial growth, by inhibiting PABA( para amino benzoic acid). There by inhibiting bacterial growth. Pharmacokinetics are different for Sulfadiazine and Sulfamethaxazole. Metabolism and excretion of Sulfadiazine is lesser extent than Sulfamethaxazole. urinary , bile and Cerebrospinal fluid concentration is high for Sulfadiazine.

Mechanism of action of Trymethoprim is to inhibit the conversion of dihydro folic acid to tetrahydro folic acid( essential for bacterial DNA synthesis). There by inhibiting the bacterial growth.

Sulfamethaxazole and trymethoprim are usually used in combination to treat infections as they have a combined action to inhibit the bacterial growth. It may reduce bacterial resistance also.

3. High doses of Sulfonamides may cause severe side effects in patients. The signs of allergy to sulfa drugs are rash, hives, swelling in the throat , pale or red colour of the face, Itching in eyes. The side effects of long term of therapy includes agranulocytosis, thrombocytopenia and hemolytic anaemia. The signs of these side effects are fever, chills, headaches, low BP and sores in the mouth and throat( agragranulocytosis).

easy bruising, prolonged bleeding from cuts, gum bleeding, blood in urine( thrombocytopenia)

pale skin, dark coloured urine, jaundice, fever, weekness and confusion( hemolytic anaemia)

4. Assessment and nursing interventions

* Assess for the side effects of sulfonamides and its severity

* Assess the history of the patient: any drug allergy

* Assess regular blood counts

* Identify high risk patients( contraindicated during pregnancy and lactation)

* Assess the history of any renal disease

* Instruct the patient to stop the drug if there is any sign of hypersensitivity( allergic rashes)

* Observe the patient for the signs of thrombocytopenia( easily bruising and bleeding) or hemolytic anaemia( palor, jaundice, fever)

* Instruct the patient to take 8- 10 glass of water per day

* Instruct the to avoid exposure to sunlight and to wear protective clothing while going out.