Name of Drug SULFAMETHOXAZOLETRIMETHOPRIM(cotrimoxazole)

Classification Sulfonamide, anti-infective

Action Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid.Trimethoprim inhibits enzymes of folic acid pathways

Contraindications >Hypersensitivity to sulfonamides, trimethoprim, sulfonylureas, thiazides, or loop diuretics >Porphyria >Marked renal or hepatic impairment >Megaloblastic anemia caused by folate deficiency >Pregnancy at term or when premature birth is possible >Infants younger than 2 months

Nursing Responsibility CNS: headache, Patient monitoring depression, >monitor CBC hallucinations, with white insomnia, differential. drowsiness, fatigue, Watch for apathy, anxiety, evidence of blood ataxia, vertigo, dycrasias. polyneuritis, > stay alert for peripheral eryhtema neuropathy, seizures multiforme. CV: allergic Report early signs myocarditis or before condition pericarditis can progress to EENT: periorbital Stevens-Johnsons edema, optic syndrome. neuritis, transient >monitor patient myopia, tinnitus for signs and GI: nausea, symptoms of vomiting, superinfection, abdominal pain, including fever, stomatitis, glossitis, tachycardia, and dry mouth, chills. pancreatitis, >monitor liver anorexia, function tests and pseudomembranous assess for colitis evidence of GU:hematuria, hepatitis. proteinuria, > check kidney crystaluria, toxic function tests

Adverse Effect

nephrosis with oliguria and anuria, renal failure Hematologic: megaloblastic anemia, agranulocytosis, aplastic anemia, thrombocytopenia, leucopenia, hemolytic anemia Hepatic:jaundice, hepatitis, hepatocellular necrosis Respiratory: shortness of breath, pleuritis, allergic pneumonitis, pulmonary infiltrates, fibrosing alveolitis Skin: generalized skin eruption at I.V site, chills, drug, fever, hypersensitivity reactions including anaphylaxis, serum sickness lupus-like syndrome

weekly. Evaluate patients fluid intake, urine output and urinr pH. Report hematuria, oliguria, or anuria right away. > monitor neurological status. Report seizures, hallucinations, or depression. >patient teaching.