Pharmacology SULFONAMIDES

Contraindications (sulfonamide)

Children under 2 yrs, near the end of pregnancy

Urticaria

Hives

Herbal Considerations & UTIs

The use of cranberries juice and antibiotics is recommended by physicians for long-term suppression of UTIs

Other Reactions of Sulfonamides:

chills, fever, crystalluria (crystals in urine), photosensitivity

Persons taking sulfonamides

need to increase fluid to 2000 mL to prevent genitourinary problems caused by the drug

Sulfonamides Usage:

UTI, Otitis, Ulcerative colitis, treatment of infections in second and third degree burns

Stevens Johnson Syndrome (SJS)

Be alert for lesions on skin, mucous membranes, eyes, and other organs. The lesions appear as red wheals or blisters, often starting on the face, in mouth, or on lips, neck and extremites. Fever, cough, muscular aches, pain, and headaches

Common reactions of Sulfonamides:

Anorexia, nausea, vomiting, diarrhea, abdominal pain, chills, fever, stomatitis Crystalluria: Increase fluid intake Photosensitivity: Wear protective clothing or sunscreen

Ongoing Assessment (sulfasalazine)

Ask patient to report to health care provider any changes in stool

When diabetic patients are prescribed sulfonamides:

Assess for possible hypoglycemic reaction (blood sugar below 70 mg/dL)

Sulfonamides - Bacteriostatic

Antibacterial agents, control infections caused by gram-positive and gram-negative bacteria

Sulfonamides care:

Care is taken to prevent trauma when moving patient. Inspect the skin daily for bruising and evidence of exacerbation of existing ecchymotic areas. Have patient use a soft-bristled tooth-brush to prevent trauma to mucous membranes of the oral cavities

Chronic Care and Health Supplement Alert

Diabetic patients: Assess for hypoglycemic reaction Cranberries/cranberry juice: Prevents and relieves symptoms of UTIs Combination of cranberries with antibiotics: Long-term suppression of UTIs Extremely large doses of cranberries: Produce gastrointestinal disturbances

Contraindications and Precautions

During lactation; near end of pregnancy; Children under 2 yrs Infections caused by group A beta-hemolytic streptococci Use cautiously for renal impairment, hepatic impairment, and bronchial asthma

Adverse effect of sulfonamide drug: Altered elimination patterns

Help patient maintain adequate fluid intake and output: Prevent crystalluria and stone (calculi) formation in GI tract. Measure and record intake and output every 8 hours Notify primary health care provider: Urinary output decreases or the patient fails to increase his or her oral intake

Leukopenia

Low WBCs - fever, sore throat, and cough

Impaired Skin Integrity:

Photosensitivity - the skin become more sensitive to sunlight during sulfonamide therapy. Patients should be cautioned to wear protective clothing and sun-screen when outside. The skin should be inspected each shift for signs of sores or blisters. The skin and mucous membranes should be inspected for up to 14 days after the end of therapy

Sulfonamides Mild Adverse Reactions

anorexia (loss of appetite)

Impaired Skin Integrity: Photosensitivity

Skin is more sensitive to sunlight when taking sulfonamides. Sunscreens recommended but should not be used in place of protective clothing. Inspect skin and mucous membranes for sores or blisters. Inspect for up to 14 days

Which category of antimicrobial agents is used chiefly because of low cost and effectiveness in treating common bacterial infections?

Sulfonamides: Although the sulfa drugs are very effective, newer and more effective antibiotics with fewer side effects and faster rates of action are replacing them

Nursing Alert:

TEN and SJS are serious and sometimes fatal hypersensitivity reactions. Sloughing of skin and mucous membranes can occur. Internal organ involvement can cause death

Bacteriostatic:

The ability to inhibit the activity of folic acid in bacterial cell metabolism. They slow or or retard the multiplication of bacteria.

The patient who has been on long-term sulfonamide therapy begins to bruise easily and have some bleeding from the mucous membranes. These symptoms reflect which of the following complications attributed to sulfonamide therapy?

Thrombocytopenia: easy bruising and unusual bleeding after trauma to the skin or mucous membranes

silver sulfadiazine (Silvadene)

Usage: topical, treatment and prevention of infections in second and third degree burns Adverse Reactions: Skin discoloration, burning sensation, Leukopenia

trimethroprim and silver sulfadiazine (Silvadene)

Usage: traveler's diarrhea due to E. coli, acute media, UTI Adverse Reactions: Stevens Johnson Syndrome, hematologic changes, anorexia, glossitis

sulfadiazine

Uses: UTIs, acute otitis, influenzae, menigitis Adverse Reacations: Crystalluria, Stevens Johnson Syndrome, Hematologic changes

sulfamthoxazole (same as sulfadiazine)

Uses: UTIs, acute otitis, influenzae, menigitis Adverse Reacations: Crystalluria, Stevens Johnson Syndrome, Hematologic changes

The most frequent Adverse Reaction with topical appliciation of a sulfonamidies includes:

burning sensation or pain when applied to the skin

Thrombocytopenia:

easy bruising and unusual bleeding after moderate to slight trauma to the skin or mucous membranes. The extremities of patient with thrombocytopenia are handled with care to prevent bruising

Administration of sulfonamides:

give on an empty stomach or 1 hour before or 2 hours after meals

Impaired Urinary Elimination:

increase fluid intake to 2000 mL or more to prevent crystalluria and stones (calculi) forming in the GI tract. Measure ant record the patient's intake and output every 8 hrs & notify health care provider if the urinary output decreases or the patient fails to increase his or her oral intake

Sulfonamides and methotrexate (immunosuppression & chemotherapy drug)

increased bone marrow suppression

Sulfonamides and hydantoins (anticonvulsants)

increased serum hydantoin level

Sulfonamide and oral anticoagulants

increases action of the anticoagulants

Photosensitivity

is an adverse reaction of sulfonamides; people taking these drugs should lessen outdoor activities

Hypersensitivity reactions during Sulfonamide therapy

urticaria (hives), pruritus (itching), generalized skin eruptions, Toxic Epidermal Necrolysis (TEN) or Stevens Johnson Syndrome (SJS)