Cotrimoxazole

Mechanism of action:
• Contrimoxazole is a combined drug of trimethoprim and sulfamethoxazole in
the ratio 1:5.
• Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by
competing with PABA.
• Trimethoprim blocks production of tetrahydrofolic acid by inhibiting the
enzyme dihydrofolate reductase.
• This combination clocks 2 consecutive steps is bacterial biosynthesis of
essential nucleic acids and proteins and is usually bactericidal.
 Indication:

• Pneumocystic pneumonia (PCP) infection and prohyylaxis

• Stenotrophomonas and other multidrug resistant infection (e.g. MRSA skin
infections)
• Nocardia
• Toxolasmosis
• Gram positive cocci
• Gram negative bacilli (pseudomonas, xanthomonas)
 Dose
• Adult
• Oral: 480 to 960mg twice a day. It can be given upto 1.44gm in very severe
infections.
• Paediatric Patient
• 120 mg (Infrant below 6 months)
• 240 mg every 12 hours (6 months to 5 years)
• 480 mg every 12 hours (children uptoo 12 years)
 Contraindication
• Hypersensitivity
• Blood dyscrasias
• Marked renal or hepatic impairment
• Megaloblastic bone marrow
 Adverse reactions:

• CNS:
Headache, aseptic meningitis, convulsions, peripheral neutris, ataxia, vertigo, dizziness, tremor,
lethargy, paresthesia, tinnitus
• Respiratory:
Cough, dyspnea, lung infilatration, shortness of breath, wheezing, epistaxis
• CVS:
Thrombophlebitis, polyarteristisnodosa, syncope, ventricular tachycardia
• Hepatic:
Jaundice, hepatitis, disturbance in liver enzymes, levated serum transaminases, elevated bilibrum.
 Adverse reactions:

• Dermatologic:
Skin rash, urticarial, photosensitivity, exfoliative dermatitis, fixed drug eruption, erythema, multiforme, erythema
nodosum, Stevens-Johnson Syndrome, toxic epidermalnercrolysis, bullous dermatitis, purpura, angioedema,
Pruritus.
• GI:
Diarrhea, nausea, vomiting, anorexia, constipation, glossitis, stomatitis, pseudomembranous colitis, pancreatitis,
abdominal pain.
• Hematologic:
Leucopenia, neutropenia, thrombocytopenia, pancytopenia, bone marrrowdepression, agranulocytosis,
aplasticanemia, hemolytic anemia, eosinophilia, purpura, hemolysis, megaloblastic anemia, methemoglobinemia,
hypoprothrombinemia, granulocytopenia
 Nursing Consideration:

• For IV infusion, must dilute in 75 or 125ml of D5W only. Administer each

dose over 60 to 90 min. Flush IV line after infusion. Do not use IV
solution if cloudly or precipitates are noted.
• If local irritation or inflammation because of extravascular infiltration
occurs, discontinue infusion and restart at another site.
• Avoid rapid or direct IV injection. Do not Inject IM.
 Urinary
antispasmodic
Flavoxate hydrochloride
 Mechanism of action:

It exerts spasmolytic (papaverine-like) action on smooth muscle. It also

demonstrates local anesthetic and analgesic action. It has antispasmotic
action on the urinary bladder.
 Indication:
• Symptomatic relief of dysuria, frequency, urgency, nocturia, incontinence,
and suprapubic pain associated with various urologic disorders.
 Dose
• Dysuria, Nocturia, Incontience Adult: PO 100-200mg TID or Q.i.d.
• Contraindications:
• Pyloric or duodenal obstruction,
• Obstructive intestinal lessions,
• Illeus,
• Achalasia,
• GI hemorrhage
• Obstructiveuropathiesof lower urinary tract.
 Adverse Reaction
• CNS:
Headache, vertigo, drowsiness, mental confusion (especially in older adults).
• CVS:
Palpitation, tachycardia.
• Special Senses:
Blurred vision, increased intraocular tension, disturbance of eye accommodation.
• GI:
Nausea, vomiting, dry mouth (and throat), constipation (with high doses).
• Skin:
Dermatosis, urticarial.
• Other: Dysuria, Hyperpyrexia, eosinophilia, leukopenia
(rare).
 Nursing Considerations:
• Monitor heart rate. Take apical pulse for 1 full minute. Report tachycardia.
• Lab tests: obtain periodic evaluation of blod counts during therapy.
• Do not drive or engage in potentially hazardous activitied until response
to drug is known.
• Report adverse reactions to physician as well as clinical improvement or
the lack of a favorable response.
THANK YOU