Ch 46 UTIs Flashcards
Sulfonamides and trimethoprim
Prototype drug;
Sulfamethoxazole- trimethoprim ( SMZ- TMP, Bactrim, Sentra, Co-trim)
Sulfadiazine
Trimethoprim
What’s the pharmalogical action of sulfonamide and trimethoprim
Inhibit bacterial growth by preventing the synthesis of folic acid which is essential for the production of DNA RNA and proteins
What are therapeutic uses of SMZ-TPM
Urinary tract infections
Otitis media
Bronchitis
Shigella sis and pneumocystis jiroveci pmeumonia
What are adverse effects of sulfonamides and trimethoprim
Hypersensitivity including Stevens Johnson syndrome
Blood dyscrasias
Crystalluria
Kernicturis ( jaundice, increased bilirubin levels which is neurotoxic to infants)
Photosensitivity
Sulfonamides can increase the effect of warfarin, phenytoin, sulfonylurea oral hypoglycemic and tolbutamide.
What are contraindications and precautions of sulfonamides and trimethoprim
SMZ-TMP is contraindicated in clients who have folate acid deficiency because it increase the risk of. Megoblastic anemia.
Clients who have renal disfunction
Clients older than 65 who take ACE inhibitors because it can cause hyperkalemia.
What are urinary tract symptoms
Decrease frequency burning and during urination negative culture urines.
What are urinary tract antiseptics
They treat acute urinary tract infections
Prohhylaxis for recurrent lower urinary tract infections
What is the prototype drug of urinary tract antiseptics
Nitrofurantoin( Furadantin, Novo- Furan,)
Macrocrystals ( Macrodantin, macrobid)
Methenamine( Hiprex, urex)
What is nitrofurantoin
It is a broad spectrum urinary antiseptic with bateriostatic and bacteriocidal action, bacterial injury occurs by damaging DNA
What are adverse effects of urinary tract antiseptics
GI discomfort, anorexia, nausea,vomiting, diarrhea.( take with milk or food, reduce dosage, use macrocrystalline tablets to reduce GI discomfort)
Hypersensitivity reactions with severe pulmonary manifestations such as dyspnea,cough,chest pain,fever, chills and alveolar infiltration
Blood dyscrasia, do baseline CBC and periodic LFT, monitor for easy bruising and epistaxis
Peripheral neuropathy, numbness,tingling of the hand and feet, muscle weakness, not recommended for ppl with kidney failure
Headache drowsiness dizziness
Nitrofurantoin is contraindicated in ppl who
Have renal dysfunction and creatinine clearance of less than 40 ml/ min
What are nursing considerations for a client taking urinary tract antiseptics
Urine will have a brownish color
Take with food if GI symptoms occur
Avoid crushing tab because of possibility of tooth staining
Teratogenic drug
What are fluoroquinolones
Broad spectrum antimicrobial used for a wide variety of micro organisms such as aerobic gram negative bacteria, gram positive bacteria.
Alternative to parenteral antibiotics who have severe infections
Urinary, respiratory, and GI TRACT infection, infections of the bones, joints, skin and soft tissues
Prevention of anthrax in ppl who have inhaled anthrax spores.
Adverse effects of fluoroquinolones
GI discomfort
Achilles rupture
Supra infection ( thrush,vaginal yeast infection)
Phototoxicity( severe sunburn) when exposed to direct or indirect sunlight and sunlamps even when sun screen is applied
Prototype drug of fluoroquinolones
Ciprofloxacin ( Cipro)
ofloxacin ( Floxin)
Moxifloxacin ( Avelox)
Levofloxacin ( Levaquin)
Contraindications of fluoroquinolones
Cipro shouldn’t be given to ppl under 18 due to the risk of Achilles’ tendons rupture unless the child is being treated for E. coli infections of urinary tract or inhalation anthrax
Increases risk for developing CDIFF
Use cautiously in older adults and those who have cardiovascular disorders.
Can affect the CNS
Sulfonamides are contraindicated in who
Clients taking diuretics, Tolbutamide, Lasix
What is nursing education for a client taking sulfamethoxazole- trimethoprim ( Septra)
Take med on a empty stomach with a full glass of water for maximum absorption
What is a discharge teaching for a client taking nitrofurantoin ( Furadantin)
Observe for bruising on the skin
Take with milk or meals
Expect brownish coloration of urine.
A nurse is teaching a client about cipro what should she instruct
Observe for pain and swellingat the Achilles’ tendon
Monitor for vaginal yeast infection
Inspect mouth for cottage cheese like lesions
A nurse is planning to administer cipro via IV to a client who has cystitis what is a appropriate nursing action
Infuse over 60 minmot mimimize irritation of the vein
What meds are used to treat UTIs
Sulfonamides
Trimethoprim
Urinary antiseptics
Other meds include;
Penicillins, aminoglycosides, cephalosporins, and fluoroquinolones
