Sulfonamides

Sulfonamides are a group of compounds consisting of amides of sulfanilic

acid. They’re known for their bacteriostatic effects; they interfere with the
functioning of the enzyme necessary for bacteria metabolism, growth, and
multiplication. Zonisamide, a sulfonamide, is approved for the adjunctive
treatment of partial seizures in adults.

Pharmacokinetics
Peak concentrations of zonisamide occur within 2 to 6 hours of
administration. The drug is widely distributed and is extensively bound to
erythrocytes. Zonisamide is metabolized by the CYP3A4 enzyme in the
liver and is excreted in urine, primarily as the parent drug and the
glucuronide metabolite. Low doses should be initiated in elderly patients
because of the possibility of renal impairment.

Pharmacodynamics
The precise mechanism of zonisamide is unknown, but it’s believed to
involve stabilization of neuronal membranes and suppression of neuronal
hypersensitivity.

Pharmacotherapeutics
Zonisamide is approved only as adjunctive therapy for partial seizures in
adults. Despite its limited indication, it has demonstrated usefulness in
other types of seizure activity (infantile spasms and myoclonic,
generalized, and atypical absence seizures).

Drug interactions
Drugs that induce liver enzymes (such as phenytoin, carbamazepine, or
phenobarbital) increase the metabolism and decrease the half-life of
zonisamide. Concurrent use of zonisamide with drugs that inhibit or
induce CYP3A4 can be expected to increase or decrease the serum
concentration of zonisamide. Zonisamide isn’t an inducer of CYP3A4, so
it’s unlikely to affect other drugs metabolized by the CYP3A4 system.

Adverse reactions
Common adverse reactions to zonisamide include:
• somnolence
• dizziness
• confusion
• anorexia
• nausea
• diarrhea
• weight loss
• rash.
Slow titration of the dosage and administration with meals may
decrease the incidence of adverse reactions.
More serious adverse reactions that have been associated with
zonisamide include:
• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• psychosis
• aplastic anemia
 • agranulocytosis
• oligohidrosis, hyperthermia, and heatstroke (in children).
Zonisamide is contraindicated in patients with allergies to
sulfonamides. Zonisamide is in category C for pregnancy, and its
disposition in breast milk is unknown. The safety and effectiveness
of the drug in children younger than age 16 hasn’t been established.
The use of zonisamide in patients with renal clearances of less than 50
mL/minute isn’t recommended.

Nursing process
Assessment
• Obtain a history of the patient’s underlying condition before therapy
and reassess it regularly thereafter.
• Monitor the patient’s body temperature, especially during the
summer, because decreased sweating may occur (especially in
children ages 17 and younger), resulting in heatstroke and
dehydration.
• Monitor the patient’s renal function periodically.
• Monitor the patient’s serum levels and response to the prescribed
drug as indicated.
• Monitor the patient for hypersensitivity or adverse reactions.
• Assess the patient’s compliance with therapy at each follow-up visit.

Key nursing diagnoses

• Risk for injury related to adverse reactions
• Impaired physical mobility related to sedation
• Noncompliance related to long-term therapy
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Planning outcome goals
• Risk to the patient will be minimized.
• The patient will be able to perform ADLs.
• The patient will exhibit behavior that complies with drug therapy.

Implementation
• The drug may be taken with or without food. Tell the patient not to
bite or break the capsule.
• Use cautiously in the patient with hepatic or renal disease; he may
need slower adjustments and more frequent monitoring. If the
patient’s glomerular filtration rate is less than 50 mL/minute, don’t
use the drug.
• Reduce the dosage or discontinue the drug gradually; abrupt
withrawal of the drug may cause increased frequency of seizures or
status epilepticus.
• Increase the patient’s fluid intake to help increase urine output and
help prevent renal calculi, especially if he has predisposing factors.
• Expect to adjust the drug dosage according to the patient’s response.
• Administer safety precautions if the patient has adverse CNS
reactions.
Evaluation
• Patient sustains no injury from adverse reactions.
• Patient maintains physical mobility.
• Patient complies with therapy and has no seizures.