Nursing Implications of Trimethoprim Primsol

Trimethoprim (trye-meth′oh-prim)

Primsol

Classification: URINARY TRACT ANTI-INFECTIVE

Therapeutic: URINARY TRACT ANTI-INFECTIVE

Pregnancy Category: C

AVAILABILITY

Tablet; liquid

ACTION & THERAPEUTIC EFFECT

Anti-infective and folic acid antagonist with slow bactericidal action. Binds and interferes with bacterial cell growth. Effective against most common UTI pathogens. Most pathogens causing UTI are in normal vaginal and fecal flora. Effective in treatment of acute otitis media.

USES

Initial episodes of acute uncomplicated UTIs, acute otitis media in children.

UNLABELED USES

Treatment and prophylaxis of chronic and recurrent UTI in both men and women; treatment in conjunction with dapsone of initial episodes of Pneumocystis carinii pneumonia; treatment of travelers’ diarrhea.

CONTRAINDICATIONS

Megaloblastic anemia secondary to folate deficiency; creatinine clearance less than 15 mL/min, impaired kidney or liver function; possible folate deficiency; children with fragile X chromosome associated with mental retardation.

CAUTIOUS USE

Renal disease; mild or moderate renal impairment; pregnancy (category C), lactation; children younger than 6 mo.

ROUTE & DOSAGE

Urinary Tract Infection

Adult: PO 100 mg b.i.d. or 200 mg once/day

Child: PO 2–3 mg/kg q12h × 10 days

Acute Otitis Media

Child (6 mo or older): PO 10 mg/ kg divided q12h × 10 days

Travelers’ Diarrhea

Adult: PO 200 mg b.i.d.

Nursing Implications of Trimethoprim Primsol

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ADMINISTRATION

Oral

• Give with 240 mL (8 oz) of fluid if not contraindicated.
• Store at 15°–30° C (59°–86° F) in dry, light-protected place.

ADVERSE EFFECTS (≥1%)

GI: Epigastric discomfort, nausea, vomiting, glossitis, abnormal taste sensation. Hematologic: Neutropenia, megaloblastic anemia, methemoglobinemia, leukopenia, thrombocytopenia (rare). Skin: Rash, pruritus, exfoliative dermatitis, photosensitivity. Body as a Whole: Fever. Metabolic: Increased serum transaminases (ALT, AST), bilirubin, creatinine, BUN.

DIAGNOSTIC TEST INTERFERENCE

Interferes with serum methotrexate assays that use a competitive binding protein technique with a bacterial dihydrofolate reductase as the binding protein. May cause

falsely elevated creatinine values when Jaffe reaction is used.

INTERACTIONS

Drug: May inhibit phenytoin metabolism causing increased levels.

PHARMACOKINETICS

Absorption: Almost completely absorbed from GI tract. Peak: 1–4 h. Distribution: Widely distributed, including lung, saliva, middle ear fluid, bile, bone, CSF; crosses placenta; appears in breast milk. Metabolism: In liver. Elimination: 80% in urine unchanged. Half-Life: 8–11 h.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Reinforce necessity to adhere to established drug regimen. Recurrent infection after terminating prophylactic treatment of UTI may occur even after 6 mo of therapy.
• Assess urinary pattern during treatment. Altered pattern (frequency, urgency, nocturia, retention, polyuria) may reflect emerging drug resistance, necessitating change of drug regimen. Periodically check for bladder distention.
• Be alert for toxic effects on bone marrow, particularly in older adults, malnourished, alcoholic, pregnant, or debilitated patients. Recognize and report signs of infection or anemia.
• Drug-induced rash, a common adverse effect, is usually maculopapular, pruritic, or morbilliform and appears 7–14 days after start of therapy with daily doses of 200 mg or less.
• Monitor lab tests: C&S tests before trimethoprim therapy is initiated. Periodic urine cultures, BUN, creatinine clearance, CBC, Hgb and Hct.

Patient & Family Education

• Drink fluids liberally (2000–3000 mL/day, if not contraindicated) to help flush out urinary bacteria.
• Report pain and hematuria to prescriber immediately.
• Do not postpone voiding even though increases in fluid intake may cause more frequent urination.
• Do not use douches or sprays during treatment periods; practice careful perineal hygiene to prevent reinfection.
• Report to prescriber promptly any symptoms of a blood disorder (fever, sore throat, pallor, purpura, ecchymosis).
• Consult prescriber if severe traveler’s diarrhea does not respond to 3–5 days therapy (i.e., persistence of symptoms of severe nausea, abdominal pain, diarrhea with mucus or blood, and dehydration).
• Drug-induced rash, a common adverse effect, may appear 7–14 days after start of therapy. Report rash to prescriber for evaluation.

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Ditulis oleh Unknown pada tanggal Monday, September 7, 2015