Sulfonamides (Nursing)

by Rhonda Lawes, PhD, RN

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      Slides 03-06 Aminoglycosides Sulfonamides Trimethoprim.pdf
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    00:01 Okay, these are the sulfonamides.

    00:04 These are some pretty old-school drugs. In fact, they were the first antibiotics available to treat bacterial infections, which, you know, we are so spoiled, we just think everybody has access to antibiotics.

    00:15 But as early as the 1930s, this was a huge deal that we had antibiotics become available. This saved lives.

    00:24 So this drug is bacteriostatic.

    00:27 Remember the difference? When we talked about aminoglycosides, they were bactericidal, they were killers.

    00:33 Sulfonamides are bacteriostatic.

    00:36 That means they stop the bacteria from reproducing and proliferating, but they don't actually kill them.

    00:43 That's the term bacteriostatic.

    00:46 So, sadly, because they've been around for so long and we've used them and likely overused them, because we are so excited to have them, it has widespread bacterial resistance, okay? So, the bugs really know how to fight off or resist sulfonamides.

    01:02 So, we used to use it for lots of things.

    01:05 Now we've kind of really narrowed it down.

    01:07 We primarily used sulfonamides for UTIs, so urinary tract infections.

    01:13 Remember, that's going to be an infection anywhere between your kidneys and it drops into th bladder. So you're going to have inflammation, infection, you won't be able to see it obviously externally, but your patient is going to experience – it's gonna be very painful for them.

    01:29 Also, watch your elderly clients when they develop a UTI.

    01:32 They may not show you the normal signs of infection, but they will show you some really changed neural status signs.

    01:39 So they might show you confusion, but really, what they have is a UTI.

    01:43 So, there's some special things about sulfonamides.

    01:46 We don't give them to infants less than 2 months old.

    01:49 They're at risk for kernicterus. Now, that is a very strange-sounding word.

    01:54 But what it means is, kernicterus is when the child less than 2 months of age will have an elevated bilirubin level.

    02:03 The worst-case scenario for an elevated bilirubin level is brain damage.

    02:08 So you know, often neonates and infants develop hyperbilirubinemia.

    02:14 Now, that's when their little livers are not really quite ready to deal with things, and sometimes, we really see that with premature infants.

    02:20 But, hyper, elevated, bilirubin; emia, in the blood. That's biggest risk is brain damage to the baby.

    02:29 So whatever causes hyperbilirubinemia is a problem.

    02:34 So, with sulfonamides, it doesn't happen anymore because we don't give them to infants less than 2 months of age.

    02:39 But you'll know in your other classes when you study hyperbilirubinemia, that's the biggest risk; brain damage to the infant.

    02:48 Okay, now we'll talk about adults.

    02:50 Sulfonamides can also make these weird crystalline aggregates in the renal system.

    02:55 That's not good.

    02:56 So anytime a patient is on a sulfonamide and really, anytime a patient is taking any antibiotic, you want them to increase their amount of fluids because we want to minimize the risk. We want to flush those antibiotics out after the body has used them, but particularly, with sulfonamides.

    03:14 They will have a bigger problem with those crystals if they don't drink lots and lots of water.

    03:20 You obviously would want to be careful if the patient had some other issues with fluid-volume balance, but for the general population, if we're giving them a sulfonamide for a UTI, you want to encourage them to drink lots and lots of extra water.

    03:35 Now, we talked about Stevens-Johnson syndrome in the Adverse Reaction video, so you may want to go back and review that, but I'm going to hit the highlights for you again here.

    03:44 With sulfonamides, this is a hypersensitivity reaction.

    03:48 So you want to watch them for any signs of rash or fever.

    03:52 Stevens-Johnson syndrome is rare, but it's a very serious disorder if it happens.

    03:57 Remember, they start to have those erosions on their skin.

    04:00 First they start with those flu-like symptoms, and then they get these painful red or purple rashes or erosions.

    04:08 And it's really uncomfortable for your patient because these erosions are almost like being burned from a severe hot water burn.

    04:17 So, they first start feeling kind of like flu symptoms.

    04:19 Well, if someone's getting a sulfonamide, they probably are already not feeling really well because they have an infection, so they may not recognize the difference when they're just start feeling like the flu.

    04:31 ut when these red spots start popping up, these red purplish skin problems start popping up, and they're painful, that is a huge alert sign for the patient and for you.

    04:42 Anytime a patient is on an antibiotic and starts having a rash or itching, that's a danger sign, and the health care provider needs to be contacted right away.

    04:52 With sulfonamides, it's even more serious than that, because if Stevens-Johnson syndrome is developing, they need to be treated immediately.

    05:00 Because Stevens-Johnson syndrome hits all the mucous membranes, in the throat, the airway could be a problem, swallowing, breathing.

    05:07 This can be a life-threatening event.

    05:09 So, for any antibiotic, you want to be very careful, teach your patients if they have any type of skin rash or itching, they need to notify you right away.

    05:20 With sulfonamides, you particularly want to teach the patient not unnecessarily scare them, but you do want to teach them, "Hey, let us know.

    05:28 If you see anything change in your skin, give us a call right away so we can follow up on it." Now, another serious sulfonamide side effect is you can end up -- If you have a G6PD deficiency.

    05:40 Now, that's not very common, but if a patient does have this special deficiency, then you're going to watch them closely for fever, jaundice, and pale skin because they can end up with hemolytic anemia.

    05:54 Okay, so, hemo means blood, lytic means -- to blow it up.

    05:59 Anemia means less blood, so hemolytic anemia because the cells are just lysed or blown up.

    06:06 Now, I want to be very careful for you to understand that sulfonamides have this effect on people that have a G6PD deficiency.

    06:15 This isn't the general population, but this can happen.

    06:18 But if you have a patient on a sulfonamide, they may not know that they have that deficiency yet.

    06:23 And if they start developing jaundice and pale skin, that should be another alarm signal for you.

    06:28 Now other patients can develop an agranulocytosis.

    06:31 That means -- A means without, and we're talking about the cells of the blood.

    06:35 It's a severe and dangerously low white blood cell count or leukopenia.

    06:41 So I know we're throwing lots of medical terms in here, but I want to make sure that we take the time to explain these to you so you know what you're looking for.

    06:48 So, obviously, lab work might be something if the patient starts to show you symptoms, can be really important that you review.

    06:55 So we've talked about hemolytic anemia, agranulocytosis, and thrombocytopenia.

    07:03 So that means low platelet count, which puts your patient at a risk for bleeding.

    07:08 If you've got agranulocytosis or a low white cell count, you're really going to have a hard time fighting off infection, which is not a good idea for someone who already giving sulfonamides to because they have an infection.

    07:21 So while these don't happen very often, you always want to be on the lookout for any signs that these might be occurring.

    07:28 The last one is aplastic anemia. It's very rare, but you end up with a super low red blood cell count.

    07:35 So when I'm thinking about sulfonamides, you want to keep in mind that there's lab work that needs to be done with this group of medications, too, and we want to watch all the different cells in the blood.

    07:45 All right. Well, that wraps up sulfonamides, and we primarily use those for UTIs.

    07:50 We've talked about kind of the risk factors for that one.

    07:53 Now we're going to move on to the next type of medication.

    About the Lecture

    The lecture Sulfonamides (Nursing) by Rhonda Lawes, PhD, RN is from the course Anti-Infective Drugs in Nursing.

    Included Quiz Questions

    1. An elderly client
    2. A school-aged client
    3. A pregnant client
    4. An adolescent client
    1. An infant client
    2. A hypertensive client
    3. A geriatric client
    4. A client with heart failure
    1. To prevent crystalline aggregates in the kidney
    2. To reduce the levels of bilirubin in the body
    3. To prevent orthostatic hypotension
    4. To reduce the risk of drug-induced dehydration
    1. Agranulocytosis
    2. Thrombocytopenia
    3. Aplastic anemia
    4. Erythrocytosis
    5. Neutrophilia

    Author of lecture Sulfonamides (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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