Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (410 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(trye-meth′oh-prim–sul-fa-meth-ox′a-zole)
Bacter-Aid DS, Bactrim DS, Novo-Trimel
, Nu-Cotrimox, Septra, Septra DS, Sultrex, SMZ/TMP
Func. class.:
Antiinfective
Chem. class.:
Sulfonamide—miscellaneous
Sulfamethoxazole (SMZ) interferes with the bacterial biosynthesis of proteins by competitive antagonism of PABA when adequate levels are maintained; trimethoprim (TMP) blocks the synthesis of tetrahydrofolic acid; the combination blocks 2 consecutive steps in the bacterial synthesis of essential nucleic acids and protein
UTI, otitis media, acute and chronic prostatitis, shigellosis,
Pneumocystis jiroveci
pneumonitis, chronic bronchitis, chancroid, traveler’s diarrhea
Breastfeeding, infants <2 mo; hypersensitivity to trimethoprim or sulfonamides; pregnancy at term, megaloblastic anemia, CCr <15 ml/min, porphyria, hyperkalemia
Precautions:
Pregnancy (C), geriatric patients, infants, renal disease, G6PD deficiency, impaired hepatic/renal function, possible folate deficiency, severe allergy, bronchial asthma, UV exposure
Calculator
Based on TMP content
• Adult:
PO
160 mg TMP q12hr × 10-14 days
• Child:
PO
8 mg/kg TMP/day in 2 divided doses q12hr (Treatment): 2 mg/kg/day (prophylaxis)
• Child:
PO
8 mg/kg TMP/day in 2 divided doses q12hr × 10 days
• Adult:
PO
160 mg TMP q12hr × 10-14 days
pneumonitis
• Adult and child:
PO
15-20 mg/kg TMP daily in 4 divided doses q6hr × 14-21 days;
IV
15-20 mg/kg/day (based on TMP) in 3-4 divided doses for ≤14 days
•
Dosage reduction necessary in moderate to severe renal impairment (CCr <30 ml/min)
Available forms:
Tabs 80 mg trimethoprim/400 mg sulfamethoxazole, 160 mg trimethoprim/800 mg sulfamethoxazole; susp 40 mg/200 mg/5 ml; IV 16 mg/80 mg/ml
•
Medication after C&S; repeat C&S after full course of medication
•
With resuscitative equipment, EPINEPHrine available; severe allergic reactions may occur
•
On an empty stomach 1 hr before or 2 hr after meals
•
With full glass of water to maintain adequate hydration; increase fluids to 2 L/day to decrease crystallization in kidneys
•
After diluting 5 ml of product/125 ml D
5
W, run over 1-1½ hr
Y-site compatibilities:
Acyclovir, aldesleukin, allopurinol, amifostine, amphotericin B cholesteryl, atracurium, aztreonam, cefepime, cyclophosphamide, diltiazem, DOXOrubicin liposome, enalaprilat, esmolol, filgrastim, fludarabine, gallium, granisetron, HYDROmorphone, labetalol, LORazepam, magnesium sulfate, melphalan, meperidine, morphine, pancuronium, perphenazine, piperacillin/tazobactam, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, vecuronium, zidovudine
CNS:
Headache, insomnia, hallucinations, depression, vertigo, fatigue, anxiety,
seizures, product fever,
chills,
aseptic meningitis
CV:
Allergic myocarditis
EENT:
Tinnitus
GI:
Nausea, vomiting, abdominal pain
, stomatitis,
hepatitis,
glossitis, pancreatitis, diarrhea,
enterocolitis,
anorexia,
pseudomembranous colitis
GU:
Renal failure, toxic nephrosis;
increased BUN, creatinine; crystalluria
HEMA:
Leukopenia, neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia, hypoprothrombinemia, Henoch-Schönlein purpura, methemoglobinemia, eosinophilia I
INTEG:
Rash, dermatitis, urticaria,
Stevens-Johnson syndrome,
erythema, photosensitivity, pain, inflammation at inj site,
toxic epidermal necrolysis, erythema multiforme
RESP:
Cough, SOB
SYST:
Anaphylaxis, SLE
PO:
Rapidly absorbed; peak 1-4 hr; half-life 8-13 hr; excreted in urine (metabolites and unchanged), breast milk; crosses placenta; 68% bound to plasma proteins; TMP achieves high levels in prostatic tissue and fluid
Increase:
thrombocytopenia—thiazide diuretics
Increase:
potassium levels—potassium-sparing diuretics, potassium supplements
Increase:
hypoglycemic response—sulfonylurea agents
Increase:
anticoagulant effects—oral anticoagulants
Increase:
levels of dofetilide
Increase:
crystalluria—methenamine
Increase:
bone marrow depressant effects—methotrexate
Decrease:
hepatic clearance of phenytoin, CYP2C9, CYP3A4 inducers
Decrease:
response—cycloSPORINE
Increase:
alk phos, creatinine, bilirubin, AST, ALT
•
I&O ratio; note color, character, pH of urine if product administered for UTI; output should be 800 ml less than intake; if urine is highly acidic, alkalization may be needed
•
Renal studies: BUN, creatinine, urinalysis with long-term therapy
•
Type of infection; obtain C&S before starting therapy
•
Blood dyscrasias, skin rash, fever, sore throat, bruising, bleeding, fatigue, joint pain
•
Allergic reaction:
rash, dermatitis, urticaria, pruritus, dyspnea, bronchospasm; product should be discontinued at 1st sign of rash; AIDS patients more susceptible
•
Storage in tight, light-resistant container at room temp
•
Therapeutic response: absence of pain, fever; C&S negative
•
To take each oral dose with full glass of water to prevent crystalluria; to drink 8-10 glasses of water/day; to take product on an empty stomach 1 hr before meals, 2 hr after meals
•
To complete full course of treatment to prevent superinfection
•
To avoid sunlight; to use sunscreen to prevent burns
•
To avoid OTC medications (aspirin, vit C) unless directed by prescriber
•
To use alternative contraceptive measures; that decreased effectiveness of oral contraceptives may occur
•
To notify prescriber if skin rash, sore throat, fever, mouth sores, unusual bruising, bleeding occur; to notify prescriber of CNS effects: anxiety, depression, hallucinations, seizures
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
See
Appendix B