12.29 Anti-Infective – Sulfonamides

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Included In This Lesson



  1.        Overview

A.    Bacteriostatic agents

B.    Gram + / – organisms

C.     Types

1.     Sulfonamides

2.     Sulfisoxazole

3.     Sulfamethizole

4.     Sulfasalazine

5.     Trimethoprim / Sulfamethoxazole (TMP/SMX)

6.     Sulfadoxine / Pyrimethamine

7.     Silver Sulfadiazine

8.     Sulfanilamide

9.     Sulfacetamide

     II.         II. Mechanism of Action

A.    Preventing bacterial synthesis of folic acid

   III.         III. Indications

A.    Plasmodium and Toxoplasma spp

B.    Inflammatory bowel disease 

C.     Nocardiosis

D.    Urinary tract infections

E.     Malaria

F.     Burns

G.    Vaginitis

H.    Ocular infections

   IV.         IV. Contraindications

A.    Drug allergy

B.    Porphyria

C.     Pregnant women 

D.    Infants

    V.         V. Interactions

A.    Sulfonylureas

B.    Phenytoin

C.     Warfarin

D.    Cyclosporine

   VI.         VI. Side Effects

A.    Hematological

1.     Agranulocytosis

2.     Aplastic anemia

3.     Hemolytic anemia

4.     Thrombocytopenia

B.    Gastrointestinal

1.     Nausea

2.     Vomiting

3.     Diarrhea

4.     Pancreatitis

C.     Integumentary

1.     Epidermal necrolysis

2.     Exfoliative dermatitis

3.     Stevens-Johnson syndrome

4.     Photosensitivity

D.    Other

1.     Convulsions

2.     Crystalluria

3.     Toxic nephrosis

4.     Headache

5.     Peripheral neuritis

6.     Urticaria

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Hey there, and today’s we are going to discuss sulfonamides, which are a certain type of antibiotic class.

Alright, quick overview. sulfonamides are bacteriostatic, meaning they stop bacteria from reproducing, while not necessarily killing them. The mechanism of action that causes these antibiotics to work is related to their ability to prevent the synthesis of folic acid – which is needed for cell growth. Sulfonamides are used to treat gram +/- organisms.

Sulfonamides all begin with SULF-, which is an easy way to remember this drug class.

Sulfonamides indications can be remembered as PINUMOBV, plasmodium / toxoplasma (parasites), IBD, nocardosis, UTI, malaria, ocular infections, burns and vaginitis.

Sulfonamides contraindications can be remembered by DIPP – drug allergy, infants (hyperbilirubinemia in neonates may cause kernicterus, porphyria – abnormalities in the chemical steps that lead to heme production), and pregnant women (as these drugs can cause birth defects).

Sulfonamides interactions include sulfonylurea, phenytoin, warfarin and cyclosporine. Interactions with warfarin cause increase in warfarin effects (SPWC).

Sulfonamides side effects are broken into four categories. The first one is hematologic and include – agranulocytosis, aplastic anemia, hemolytic anemia and thrombocytopenia.

The second category is GI and include N/V/D and pancreatitis.

The third category is integumentary and includes epidermal necrolysis (which is widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis), exfoliative dermatitis, Stevens-Johnson syndrome (severe skin reaction) and photosensitivity.

The fourth and final category is other and includes – Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis and urticaria.

Priority nursing concepts for sulfonamides include pharmacology and infection control.

Alright, let’s review, sulfonamides being with SULF-. Indications include plasmodium / toxoplasma (parasites), IBD, nocardosis, UTI, malaria, ocular infections, burns and vaginitis (PINUMOBV). Contraindications include drug allergy, infants, porphyria (POUR-FEAR-IA) and pregnant women (DIPP). Interactions include sulfonylurea, phenytoin, warfarin and cyclosporine (SPWC). Side effects are broken down into four categories – heme (agranulocytosis, aplastic anemia, hemolytic anemia and thrombocytopenia) / GI (and include N/V/D and pancreatitis) / integumentary (epidermal necrolysis, exfoliative dermatitis, Stevens-Johnson syndrome and photosensitivity / other (convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis and urticaria).

You know now the important details regarding sulfonamides. Now, go out and be your best self today and as always, Happy Nursing!

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