Ch 46 UTIs

Question 1

Sulfonamides and trimethoprim

Answer 1

Prototype drug;
Sulfamethoxazole- trimethoprim ( SMZ- TMP, Bactrim, Sentra, Co-trim)
Sulfadiazine
Trimethoprim

Question 2

What’s the pharmalogical action of sulfonamide and trimethoprim

Answer 2

Inhibit bacterial growth by preventing the synthesis of folic acid which is essential for the production of DNA RNA and proteins

Question 3

What are therapeutic uses of SMZ-TPM

Answer 3

Urinary tract infections
Otitis media
Bronchitis
Shigella sis and pneumocystis jiroveci pmeumonia

Question 4

What are adverse effects of sulfonamides and trimethoprim

Answer 4

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.

Question 5

What are contraindications and precautions of sulfonamides and trimethoprim

Answer 5

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.

Question 6

What are urinary tract symptoms

Answer 6

Decrease frequency burning and during urination negative culture urines.

Question 7

What are urinary tract antiseptics

Answer 7

They treat acute urinary tract infections

Prohhylaxis for recurrent lower urinary tract infections

Question 8

What is the prototype drug of urinary tract antiseptics

Answer 8

Nitrofurantoin( Furadantin, Novo- Furan,)
Macrocrystals ( Macrodantin, macrobid)
Methenamine( Hiprex, urex)

Question 9

What is nitrofurantoin

Answer 9

It is a broad spectrum urinary antiseptic with bateriostatic and bacteriocidal action, bacterial injury occurs by damaging DNA

Question 10

What are adverse effects of urinary tract antiseptics

Answer 10

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

Question 11

Nitrofurantoin is contraindicated in ppl who

Answer 11

Have renal dysfunction and creatinine clearance of less than 40 ml/ min

Question 12

What are nursing considerations for a client taking urinary tract antiseptics

Answer 12

Urine will have a brownish color
Take with food if GI symptoms occur
Avoid crushing tab because of possibility of tooth staining
Teratogenic drug

Question 13

What are fluoroquinolones

Answer 13

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.

Question 14

Adverse effects of fluoroquinolones

Answer 14

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

Question 15

Prototype drug of fluoroquinolones

Answer 15

Ciprofloxacin ( Cipro)
ofloxacin ( Floxin)
Moxifloxacin ( Avelox)
Levofloxacin ( Levaquin)

Question 16

Contraindications of fluoroquinolones

Answer 16

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

Question 17

Sulfonamides are contraindicated in who

Answer 17

Clients taking diuretics, Tolbutamide, Lasix

Question 18

What is nursing education for a client taking sulfamethoxazole- trimethoprim ( Septra)

Answer 18

Take med on a empty stomach with a full glass of water for maximum absorption

Question 19

What is a discharge teaching for a client taking nitrofurantoin ( Furadantin)

Answer 19

Observe for bruising on the skin
Take with milk or meals
Expect brownish coloration of urine.

Question 20

A nurse is teaching a client about cipro what should she instruct

Answer 20

Observe for pain and swellingat the Achilles’ tendon
Monitor for vaginal yeast infection
Inspect mouth for cottage cheese like lesions

Question 21

A nurse is planning to administer cipro via IV to a client who has cystitis what is a appropriate nursing action

Answer 21

Infuse over 60 minmot mimimize irritation of the vein

Question 22

What meds are used to treat UTIs

Answer 22

Sulfonamides
Trimethoprim
Urinary antiseptics

Other meds include;
Penicillins, aminoglycosides, cephalosporins, and fluoroquinolones