ch. 75

Question 1

are sulfonamides bacteriocidal or bacteriostatic

Answer 1

bacteriostatic

Question 2

MOA solfonamides

Answer 2

Sulfonamides are structural analogs of PABA (component of folate) - suppress bacterial growth by inhibiting synthesis of tetrahydrofolate (derivative of folate). On the absence of folate the bacteria cant synthesize DNA, RNA, proteins

Question 3

Sulfonamides are preferred drugs for

Answer 3

Acute UTIs - Bactrim

Question 4

how do we make folate?

Answer 4

we dont, get it from our diet. Bacteria makes its own

Question 5

Treat chlamydia

Answer 5

Azithromycin

doxycycline

Question 6

used to treat ulcerative collitis

Answer 6

Sulfasalazine

Question 7

Sulfonamides with rash of any sort or any reaction

Answer 7

stop immediately - high risk SJS

Question 8

adverse effects of Sulfonamides in newborns

Answer 8

kernicterus

Question 9

adverse effects of Sulfonamides

Answer 9

blood dyscrasias
hypersensitivity
photosensitivity
avoid prolonged exposure to sunlight - sunburn
crystalluria

Question 10

pt ed on how to take oral sulfonamides

Answer 10

drink 8-10 glasses of water or other non caffeinated fluids per day to decrease risk for crystalluria - can still have caffeine

report rash or tingling in mouth

Question 11

hematologic effects of sulfonamides

Answer 11

G6PD def for blacks and people of mediterranean orgin. Red cell lysis can produce fever, pallor, jaundice (hemolytic anemia)

can cause agranulocytosis, leukopenia, thrombocytopenia and very rare aplastic anemia

Question 12

kernicterus

Answer 12

disorder in newborns caused by deposition of bili in the brain. - neurotoxic and can cause severe neurologic deficits and even death.

Question 13

Sulfonamides should not be given to infants younger than ___and not to pregnant pat after ___ weeks gestation

Answer 13

2 mos

32 weeks gestation

Question 14

sulfonamides and breastfeeding

Answer 14

no

Question 15

to minimize the risk for renal damage, adults should maintain a daily urine output of at least ____ mL

Answer 15

1200 (8-10 glasses of water a day)

crystalluria

Question 16

sulfonamides are contraindicated for pt with creatinine clearance of

Answer 16

severe kidney disease

50% of dose if GFR is 15-30mL/min

Question 17

Drug interactions and sulfonamides

Answer 17

intensify effects of warfarin, phenytoin and sulfonylurea-type oral hypoglycemics (glipizide, glyburide)

Question 18

what food can you not take with Sulfadiazine

Answer 18

Vic C or acidifying drinks such as cranberry juice increase risk of crystalluria

Question 19

which med is for topical derm disorders

Answer 19

Topical Sulfacetamide

Question 20

sulfonamides and older adults

Answer 20

more likely to experience adverse effects - neutropenia, SJS/ TEN

Question 21

which is more likely to cause crystalluria

Answer 21

Sulfadiazine

Question 22

sulfacetamide should not be used by pt with history of severe hypersensitivity to

Answer 22

sulfonamides
sulfonylureas
thiazide or loop diuretics

Question 23

Trimethoprim inhibits

Answer 23

dihydrofolate reductase

Question 24

recurrent UTI treated with

Answer 24

Bactrim

Question 25

Pt ed trimethoprim

Answer 25

``` early signs of blood dyscrasias -sore throat -fever -pallor report any of these signs ```

Question 26

adverse effects trimethoprim

Answer 26

``` itching rash epigastric distress nausea vomiting glossitis stomatitis hyperkalemia ```

Question 27

potential effects of trimethoprim only if preexisting folic acid def

Answer 27

because of the pathway that trimethoprim works on megaloblastic anemia thrombocytopenia neutropenia

Question 28

what populations would be ad increased risk for folic acid def

Answer 28

excessive alcohol intake pregnant women debilitated pt

Question 29

A pt on trimethoprim has sore throat, fever, pallor | what do you do

Answer 29

CBC if sig reduction in counts - d/c trimethoprim administer leucovorin - a reduced form of folic acid

Question 30

pt pop at high risk due to hyperkalemia while taking trimethoprim

Answer 30

trimethoprim suppresses renal excretion of k and can promote hyper K Pt at greatest risk are those taking high doses those with renal impairment those taking other drugs that can elevate k - ACE, ARB, Potassium sparing diuretics, aldosterone antagonists, potassium supplements

Question 31

Hyperkalemia typically develops within ___ days of starting Trimethoprim

Answer 31

5

Question 32

Trimethoprim in pregnancy

Answer 32

no - folate- neural tube defects

Question 33

Trimethoprim in breastfeeding

Answer 33

no

Question 34

Bactrim (Trimethoprim/sulfamethoxazole) MOA

Answer 34

SMZ acts to inhibit incorporation of PABA into folate | TMP inhibits dihydrofolate reductase

Question 35

Bactrim used in

Answer 35

``` UTIs otitis media bronchitis shigellosis pneumonia from P.jirovecii ```

Question 36

CNS effects of Bactrim

Answer 36

headache, depression, hallucinations

Question 37

drug interactions for bactrim

Answer 37

warfarin phenytoin sulfonylurea - type oral hypoglycemics intensify bone marrow suppression in pt receiving methotrexate meds that also hyperk

Question 38

med for bordetella pertussis

Answer 38

erythromycin

Question 39

which has less microbial resistance trimethoprim Sulfonamide

Answer 39

trimethoprim