Pharm Chapter 46

What are some medications used to treat UTIs?
Sulfonamides, trimethoprim, and urinary antiseptics
What is the expected pharm action of Sulfamethoxazole-trimethoprim (SMZ-TMP, Bactrim, Septra, Co-Trim)
Sulfonamides and trimethoprim inhibit bacterial growth by preventing the synthesis of folic acid.
~~Folic acid is essential for the production of DNA, RNA, and proteins~~
What are some therapeutic uses of SMZ-TMP?
used to treat urinary tract infections.
■ Causative agents include Escherichia coli, klebsiella, proteus, enterobacter, and
Neisseria gonorrhoeae.
■ Other infections include otitis media, bronchitis, shigellosis, and Pneumocystis jiroveci pneumonia.
What are some adverse effects of SMZ-TMP?
–hypersensitivity
–Blood dyscrasias
–Crystalluria
–Kernicterus
–Photosensitivity
— Sulfonamides
What can sulfoamides increase the effect of?
Warfarin, phenytoin, sulfonylurea oral hypoglycemics, and tolbutamide
What are some SMZ-TMP contraindications?
–SMZ-TMP is contraindicated in clients who have folate deficiency (increases risk of megaloblastic anemia)
What patients should be careful when taking SMZ-TMP?
–Use cautiously in clients who have renal dysfunction. Reduced dosage of SMZ-TMP is recommended.
— Administer with caution in adults older than age 65 years who take angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blockers (ARB) because of risk for hyperkalemia.
How should SMZ-TMP be taken?
Instruct clients to take SMZ-TMP on an empty stomach with a full glass of water
What are some examples of urinary tract antiseptics?
nitrofurantoin (Furadantin, Novo-Furan) and nitrofurantoin macrocrystals (Macrodantin, Macrobid), methenamine
What is the expected pharm action of urinary tract antiseptics?
–Nitrofurantoin is a broad-spectrum urinary antiseptic with bacteriostatic and bactericidal action.
–Bacterial injury occurs by damaging DNA.
What are some therapeutic uses of Nitrofurantoin?
–Acute urinary tract infections
–Prophylaxis for recurrent lower urinary tract infections
What are some adverse effects of nitrofurantoin?
–GI discomfort
–Hypersensitivity reactions with pulmonary manifestations
–Blood dyscrasias
–peripheral neuropathy
–headache, drowsiness, dizziness
What are some contraindications of nitrofurantoin?
contraindicated in clients who have renal dysfunction and creatinine clearance less than 40 mL/min
What will impaired renal function increase?
the risk of medication toxicity because of inability to excrete nitrofurantoin.
What are some nursing considerations for nitrofurantoin?
–Inform clients that urine will have a brownish discoloration
–Encourage clients to administer with food if GI symptoms occur
What is an example of a fluoroquinolone?
ciprofloxacin
What is the expect pharm action of ciprofloxacin?
Fluoroquinolones are bactericidal as a result of inhibition of the enzyme necessary for
DNA replication.
What are some therapeutic uses of ciprofloxacin?
–Broad-spectrum antimicrobials used for a wide variety of micro-organisms such as aerobic gram-negative bacteria, gram-positive bacteria, klebsiella, and E. coli
–Urinary, respiratory, and GI tract infections; infections of bones, joints, skin, and soft tissues
What is the medication of choice for prevention of anthrax in clients who have inhaled anthrax spore?
Ciprofloxacin (fluoroquinolone)
What are some adverse effects of ciprofloxacin?
–GI discomfort
–Achilles tendon rupture
–Suprainfection (thrush)
–Phototoxicity (sunburn)
Can children under the age of 18 be given ciprofloxacin?
No, only if they are being treated for an E. coli infection
What are some interactions of ciprofloxacin?
Plasma levels of theophylline (Theolair) can › increase with concurrent use of ciprofloxacin
What decreases absorption of ciprofloxacin?
Cationic compounds (aluminum-magnesium › antacids, iron salts, sucralfate, milk and dairy
products)
What can increase plasma levels of warfarin?
Ciprofloxacin
What patients should have decreased levels of ciprofloxacin?
Patients who have renal dysfunction
A nurse is reviewing a client’s medication history and notes an allergy to sulfonamides. Which of the following medications are contraindicated due to this allergy?
Hydrochlorothiazide (Microzide)
Tolbutamide (Orinase)
Furosemide (Lasix)
A nurse is planning discharge teaching for a female client who has a new prescription for sulfamethoxazole-trimethoprim (Septra). Which of the following information should the nurse include in the teaching?
Take the medication on an empty stomach.
A nurse is providing teaching to a client who has a new prescription for nitrofurantoin (Furadantin). Which of the following information should the nurse include in the teaching? (Select all that apply.)
–Observe for bruising on the skin
–Take the medication with milk or meals
–Expect brownish discoloration of urine
A nurse is teaching about ciprofloxacin (Cipro) to a female client who has a severe urinary tract infection. Which of the following information about adverse reactions should the nurse include in the teaching? (Select all that apply.)
–Observe for pain and swelling of the Achilles tendon
–Monitor for a vaginal yeast infection
–Inspect the mouth for cottage cheese-like lesions
A nurse is planning to administer ciprofloxacin (Cipro) IV to a client who has cystitis. Which of the following is an appropriate action by the nurse?
Infuse medication over 60 min.