Dosage & Contraindica Nursing

Drug Name Action Indication Adverse Effects

Route tion Responsibility

Systemic Fixed Skin: Mild to

TRIMETHOPRIM- Infections combination moderate rashes
Pneumocystis Hypersensitivit NURSING
SULFAMETHOXAZOL Adult: PO of (including fixed
carinii y to TMP, IMPLICATION
E (TMP-SMZ) 160 mg sulfamethoxaz drug eruptions),
pneumonitis, SMZ, S
(tri-meth'o-prim-sul-fa- TMP/800 ole (SMZ), an toxic epidermal
Shigellosis sulfonamides,
meth'ox-a-zole) mg SMZ (1 intermediate necrolysis. GI:
enteritis, and or bisulfites; Assessment &
double acting Nausea, vomiting,
severe group A beta- Drug Effects
Bactrim, Co- strength antiinfective diarrhea,
complicated hemolytic
Trimoxazole, Septra [DS] tablet) sulfonamide, anorexia,
UTIs due to streptococcal
q12h IV 8– and hepatitis,  Be aware
most strains of pharyngitis;
Classifications: 10 mg/kg/d trimethoprim pseudomembrano that IV
the megaloblastic
antiinfective; urinary TMP (TMP), a us enterocolitis, Septra
Enterobacteriac anemia due to
tract agent; divided q6– synthetic stomatitis, contains
eae. Also folate
sulfonamide 12h infused antiinfective. glossitis, sodium
children with deficiency;
over 60–90 Both abdominal pain. metabisulfi
acute otitis creatinine
min components Urogenital: te, which
media due to clearance <15
Child: PO of the Kidney failure, produces
susceptible mL/min;
>2 mo & combination oliguria, anuria, allergic-
strains of pregnancy
<40 kg, 4 are synthetic crystalluria. type
Haemophilus (category C),
mg/kg/d folate Hematologic: reactions
influenzae, and lactation. Not
TMP q12h; antagonist Agranulocytosis in
acute episodes recommended
>40 kg, antiinfectives. (rare), aplastic susceptible
of chronic for infants <2
160 mg Mechanism of anemia (rare), patients:
bronchitis in mo.
TMP/800 action is megaloblastic Hives,
adults.
mg SMZ (1 principally anemia, itching,
DS tablet) enzyme hypoprothrombine wheezing,
q12h IV >2 inhibition, mia, anaphylaxi
mo, 8–10 which thrombocytopenia s.
mg/kg/d prevents (rare). Body as a Susceptibili
TMP bacterial Whole: ty (low in
divided q6– synthesis of Weakness, general
12h infused essential arthralgia, population)
over 60–90 nucleic acids myalgia, is seen
min and proteins. photosensitivity, most
allergic frequently
Pneumoc myocarditis. in
ystis asthmatics
carinii or atopic
Pneumonia nonasthma
Adult: IV tic persons.
20 mg/kg/d  Lab tests:
TMP Baseline
divided q6h and
infused followup
over 60–90 urinalysis;
min CBC with
differential,
Prophylax platelet
is for count, BUN
Pneumoc and
ystis creatinine
carinii clearance
Pneumoni with
a prolonged
Adult: PO therapy.
160 mg  Monitor
TMP/800 coagulation
mg SMZ tests and
q24h prothrombi
Child: PO n times in
150 mg/m2 patient
TMP/750 also
mg/m2 SMZ receiving
b.i.d. 3 warfarin.
consecutive Change in
d/wk (max: warfarin
320 mg dosage
TMP/d) may be
indicated.
Renal  Monitor
Impairme I&O
nt volume
Clcr 10–30 and
mL/min: pattern.
reduce Report
dose by significant
50%; <10 changes to
mL/min: forestall
reduce renal
dose by calculi
75% formation.
Also report
failure of
treatment
(i.e.,
continued
UTI
symptoms)
.
 Older adult
patients
are at risk
for severe
adverse
reactions,
especially
if liver or
kidney
function is
compromis
ed or if
certain
other
drugs are
given. Most
frequently
observed:
Thrombocy
topenia
(with
concurrent
thiazide
diuretics);
severe
decrease in
platelets
(with or
without
purpura);
bone
marrow
suppressio
n; severe
skin
reactions.
 Be alert for
overdose
symptoms
(no
extensive
experience
has been
reported):
Nausea,
vomiting,
anorexia,
headache,
dizziness,
mental
depression,
confusion,
and bone
marrow
depression.