Trimethoprim/Sulfamethoxazole (Nursing)

00:01 Welcome to this mouthful right here. This is an official tongue twister, trimethoprim/sulfamethoxazole. Whoa, I didn't even do it there, did I? Trimethoprim/sulfamethoxazole.

00:14 There we go, I made it.

00:16 I think that's going to be the last time I say it, so we can make it through this video together.

00:21 You'll see it up there on the top.

00:23 This is a fixed combination of 2 medications, right? You got sulfamethoxazole and trimethoprim.

00:29 So that's why you see the 2 names and the little hash mark in between.

00:33 So we use these drugs together.

00:36 We use it to treat UTI. Oh, hey, wait a minute.

00:39 What other medication have we talked about to treat UTI? Yeah, just the one before right.

00:46 See if you can jot the name of that medication in the margin of your notes.

00:50 Now, we also use it to treat pneumocystis pneumonia, or PCP.

00:54 It's an opportunistic fungi. A pneumonia is an infection in the lung.

01:01 And, really, people that have to be severely immunocompromised, like someone who's on chemotherapy for cancer, someone who is an AIDS patient, someone who's a transplant patient who's on medications that we use to suppress their immune system so they don't reject their organ.

01:17 Those are the groups of people who are at risk for PCP.

01:20 It's an opportunistic fungi that if your immune system is functioning well, usually we can fight it off. But if you were immunocompromised, you're at risk for this specific bug.

01:31 So, for this magic combination, we use it to treat UTIs, which is relatively minor.

01:37 Then we use it to treat PCP, which is a really big deal, because these patients are already severely immunocompromised.

01:45 So, the most common side effects with trimethoprim/sulfamethoxazole would be GI distress.

01:51 Now, that's kind of a good one for you to file away because, really, any oral medication can upset someone's stomach.

01:58 But I know personally, I have found that antibiotics are kind of the worst case scenario for having an upset stomach for me.

02:05 So anytime I have to take an antibiotic, I pretty much know that there's going to be some GI distress that goes along with it.

02:12 Now the adverse effects for this combination -- remember, it's 2 separate drugs that are given together -- the adverse effects are like if I gave you trimethoprim by itself, or sulfamethoxazole by itself.

02:24 So, what I want to focus on next is the worst side effect from trimethoprim.

02:29 So you'll see that red box down there at the bottom.

02:32 One of the biggest risks for trimethoprim is hyperkalemia.

02:36 Now, let's break that word down. You may already know what it is, so just enjoy how smart you are.

02:41 But for the rest of us mere mortals, let's look at hyperkalemia.

02:46 Anytime you see "hyper," that means elevated or extra.

02:49 Kalemia refers to potassium in the blood, so hyperkalemia means a high potassium blood level.

02:59 So, this medication, particularly the trimethoprim part of it, can cause an elevated potassium.

03:05 That's really a big concern because elevated potassium can start messing with your cardiac rhythms, so we want to be really careful about that and monitor that in our patients.

03:16 Also, if your patients have any other medical problems that cause them to already have an elevated potassium level, we're going to be very cautious with this drug combination.

03:26 Now, the second side effect is birth defects.

03:29 So you would not want to give trimethoprim to a patient who is pregnant.

03:34 Okay, so even though we have these drugs together, we give them as a combination.

03:38 We talked about the side effects, they're just the same as if we gave each one of these drugs separately.

03:43 We focused on trimethoprim adverse effects being hyperkalemia, the elevated potassium, and birth defects.

03:51 And the side effects for sulfamethoxazole are what we've already covered.