Which conditions are adverse effects of sulfonamide antibiotics select all that apply

Open Resources for Nursing (Open RN)

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Critical Thinking Activity 3.9a
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Which conditions are adverse effects of sulfonamide antibiotics?
Which symptoms may develop as adverse reactions to sulfonamides select all that apply?
Which adverse effect is most common with sulfonamides?
What are the undesirable effects of sulfonamides and what can result from these effects?

Sulfonamides are one of the oldest broad-spectrum antimicrobial agents that work by competitively inhibiting bacterial metabolic enzymes needed for bacterial function.

Indications: Sulfonamides are used to treat urinary tract infections, otitis media, acute exacerbations of chronic bronchitis, and travelers’ diarrhea.

Mechanism of Action: This mechanism of action provides bacteriostatic inhibition of growth against a wide spectrum of gram-positive and gram-negative pathogens.

Specific Administration Considerations: Allergic reactions to sulfonamide medications are common and, therefore, patients should be monitored carefully for adverse effects including delayed hypersensitivity reactions. Sulfonamide medications increase the risk of crystalluria that can cause kidney stones or decreased kidney function; therefore, patients should increase their water intake while taking these medications.[1]

Patient Teaching & Education: The patient should receive education to complete the full prescribed dose of medications and take measures to not skip doses. If a dose is missed, the patient should take the missed dose as soon as possible unless it is near the next dosing time. The medication can cause increased photosensitivity, and patients should be educated to use sunscreen and protective clothing with sun exposure. The patient should also report any rash, sore throat, fever, or mouth sores that might occur. Unusual bleeding or bruising should also be reported to the provider. If patients are receiving prolonged therapy, they may require platelet count monitoring.[2]

Now let’s take a closer look at the medication grid for trimethoprim-sulfamethoxazole in Table 3.9.[3]

Table 3.9 Sulfonamides Medication Grid

Class/Subclass

Prototype/Generic

Administration Considerations

Therapeutic Effects

Side/Adverse Effects

Sulfonamides

trimethoprim – sulfamethoxazole

Check for allergies

Dose adjustment for renal impairment

Administer PO with 8 oz of water

Monitor urine output and for cloudiness or crystals

Do not administer IM

Use cautiously with cardiac antidysrhythmics

Use cautiously with oral antidiabetics; may increase hypoglycemic effects. Monitor glucose level carefully

Use cautiously with anticoagulant medications such as warfarin; may increase risk of bleeding. Monitor INR and patient for signs of bleeding

Monitor for systemic signs of infection:

-WBCs

-Fever

Monitor actual site of infection

Monitor culture results, if obtained

SAFETY:

Sulfonamides, including sulfonamide-containing products such as sulfamethoxaole /trimethoprim, should be discontinued at the first appearance of skin rash of any sign of adverse reaction

Critical Thinking Activity 3.9a

Using the above grid information, consider the following clinical scenario question:

A nurse is caring for an elderly diabetic patient who has been prescribed trimethoprim-sulfamethoxazole for a urinary tract infection. What nursing interventions will be implemented prior to medication administration?

Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.

Pharm Chapter 6-10 study guide questions

1.After teaching a group of nursing students about sulfonamides, the instructor determines that the teaching was

successful when the students identify which of the following as an example of a sulfonamide antibiotic? Select all that apply.

C)Sulfamethoxazole/trimethoprim (Bactrim)

E)Silver sulfadiazine (Silvadene)

Feedback:

Silver sulfadiazine (Silvadene) and sulfamethoxazole/trimethoprim (Bactrim) are sulfonamide antibiotics. Amoxicillin

is an aminopenicillin. Ciprofloxacin is classified as a fluoroquinolone. Clarithromycin is a macrolide.

2.A group of nursing students are reviewing information about sulfonamides. Which of the following if stated by the

students indicate understanding of this drug class? Select all that apply.

A)Sulfonamides are well absorbed when given orally.

E)Sulfonamides are excreted by the kidneys.

Feedback:

Sulfonamides are well absorbed by the GI tract and are excreted by the kidneys. Sulfonamides treat both gram-positive

and gram-negative infections.

3.When reviewing the medical records of several clients who are prescribed sulfonamide therapy, the nurse would expect

laboratory findings related to which bacteria? Select all that apply.

B)Escherichia coli

C)Klebsiella pneumoniae

E)Staphylococcus aureus

Feedback:

Sulfonamides are often used to control infections caused by both gram-negative and gram-positive bacteria, such as

Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Typically, sulfonamides are not used to treat infections

caused by Pseudomonas aeruginosa or Streptococcus pyogenes.

4.Sulfonamides are commonly used to treat which of the following types of infections?

Select all that apply.

A)Ulcerative colitis

B)Urinary tract infection

C)Acute otitis media

Feedback:

Sulfonamides are often used to treat ulcerative colitis, urinary tract infection, and acute otitis media.

5.A client is taking trimethoprim and sulfamethoxazole (Bactrim DS) one tablet twice daily for 14 days. Which of the

following would the nurse include when teaching the client about possible adverse reactions? Select all that apply.

C)Anorexia

D)Crystalluria

E)Photosensitivity

Feedback:

Teaching should address potential adverse reactions that can occur while taking a sulfonamide. These adverse reactions

include nausea, vomiting, anorexia, stomatitis, chills, fever, crystalluria, and photosensitivity.

6.The nurse suspects that a client who is taking a sulfonamide has leukopenia. Which assessment findings would support

this suspicion? Select all that apply.

A)Sore throat

B)Cough

Feedback:

Antibiotics including sulfonamides can lead to leukopenia, which would be manifested by fever, sore throat, or cough.

Thrombocytopenia is also possible and would be manifested by easy bruising or unusual bleeding from minor to moderate

trauma. Nausea and photosensitivity are adverse reactions to sulfonamides.

7.A nurse is reviewing the laboratory test results of a client receiving sulfasalazine therapy for ulcerative colitis. Which of

the following would the nurse anticipate finding? Select all that apply.

B)Leukopenia

C)Thrombocytopenia

D)Aplastic anemia

Feedback:

Leukopenia, thrombocytopenia, and aplastic anemia are hematologic changes that may occur during prolonged

sulfonamide therapy, such as during ulcerative colitis treatment with sulfasalazine.