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Chpt 88 - Pharmacology for Nursing Care
Sulfonamides and Trimethoprim
21
Nursing
Undergraduate 1
12/02/2012

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Cards

Term
 Which antibiotics were the first available for systemic treatment of bacterial infections?
Definition
Sulfonamides
Term
What is the primary use for sulfonamides?
Definition
Urinary tract infections
Term
What substance are sulfonamides the structural analogs of?
Definition
para-aminobenzoic acid (PABA)
Term
How do sulfonamides work?
Definition
They inhibit synthesis of folic acid, which is a compound required by all cells to make DNA, RNA and protein.
Term
Are sulfonamides bacteriostatic or bactericidal?
Definition
Usually bacteriostatic
Term
Why is use of sulfonamides so limited?
Definition

1. There are now bactericidal antibiotics that are less toxic than sulfonomides

2. Development of sulfonomide resistance

Term
Which sulfonamide is usually favored for use with urinary tract infections?  Why?
Definition

sulfamethoxazole

 

It has good solubility in urine and achieves effective concentrations within the urinary tract.

Term
What are the adverse effects of sulfonamides?
Definition

Hypersensitivity reactions

blood dyscrasias and kernicterus in newborns

renal damage from crystalluria with older sulfonamides

Hemolytic anemia

Term
Why shouldn't sulfonamides be administered to infants less than two months of age?
Definition
Because of the risk of kernicterus, the deposition of bilirubin in the brain, which causes severe neurologic deficits and death.
Term
Which drugs can sulfonamides intensify the effects of?
Definition
warfarin, phenytoin and sulfonylurea-type oral hypoglycemics like glipizide and glyburide.
Term
Which drugs can be cross-sensitive to sulfonamides?
Definition
thiazide diuretics, loop diuretics, sulfonylurea-type oral hypoglycemics
Term
What are the two major categories of sulfonamides?
Definition

1. systemic sulfonamides

2. topical sulfonamides

Term
NCLEX:  Should patients with a demonstrated allergy to a sulfonamide ever take any other sulfonamide-type drug?
Definition
No.  This is not always true, but for NCLEX purposes, it is the correct answer
Term
What are the two remaining groups of systemic sulfonamides?
Definition

1. short acting

2. intermediate acting

Term
What is the only intermediate acting sulfonamide available?
Definition
sulfamethoxazole
Term
How does Trimethoprim act against microbes?
Definition
It inhibits dihydrofolate reductase, the enzyme that converts dihydrofolic acid to its active form: tetrahydrofolic acid and thus suppresses bacterial synthesis of DNA, RNA and proteins.
Term
What are the adverse effects of Trimethoprim?
Definition
Hyperkalemia, megoblastic anemia, thrombocytopenia, neutropenia.  Large doses have been shown to cause fetal malformations in animals, but have not been observed in humans.  Nevertheless, it readily crosses the placenta and should be avoided during pregnancy and closely monitored in lactating women.
Term
What are the trade names of Trimethosprim/Sulfamethoxazole combination preparations?
Definition
Bactrim and Septra
Term
Which diseases are Bactrim and Septra most often used for?
Definition
Urinary tract infection,  otitis media, bronchitis, shigellosis, and pneumonia caused by P. jirovechi
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