Prim
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trimethoprim (TMP) (trye meth' oh prim) Primsol, Proloprim, Trimpex Pregnancy Category C Drug class
Antibacterial Therapeutic actions
Inhibits the synthesis of nucleic acids and proteins in susceptible bacteria; the bacterial enzyme involved in this reaction is more readily inhibited than the mammalian enzyme. Indications
• •
Uncomplicated urinary tract infections caused by susceptible strains of E. coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species, and coagulasenegative Staphylococcus species, including Staphylococcus saprophyticus Treatment of acute otitis media due to susceptible strains of S. pneumoniae and H. influenza in children
Contraindications and cautions
• •
Contraindicated with allergy to trimethoprim, pregnancy (teratogenic in preclinical studies), megaloblastic anemia due to folate deficiency. Use cautiously with hepatic or renal dysfunction, lactation.
Available forms
Tablets—100, 200 mg; solution—50 mg/5 mL Dosages ADULTS
100 mg PO q 12 hr or 200 mg q 24 hr for 10 days. PEDIATRIC PATIENTS
•
Otitis media: 10 mg/kg/day in divided doses q 12 hr for 10 days.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT
For creatinine clearance of 15–30 mL/min, 50 mg PO q 12 hr; creatinine clearance of < 15 mL/min, not recommended. Pharmacokinetics Route Oral
Onset Varies
Peak 1–4 hr
Metabolism: Hepatic; T1/2: 8–10 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects
•
Dermatologic: Rash, pruritus, exfoliative dermatitis
• • •
GI: Epigastric distress, nausea, vomiting, glossitis Hematologic: Thrombocytopenia, leukopenia, neutropenia, megaloblastic anemia, methemoglobinemia, elevated serum transaminase and bilirubin, increased BUN and serum creatinine levels Other: Fever
Nursing considerations Assessment
• •
History: Allergy to trimethoprim, megaloblastic anemia due to folate deficiency, renal or hepatic dysfunction, pregnancy, lactation Physical: Skin color, lesions; T; status of mucous membranes; CBC; liver and renal function tests
Interventions
• • • •
Perform culture and sensitivity tests before beginning drug therapy. Protect the 200-mg tablets from exposure to light. Arrange for regular, periodic blood counts during therapy. Discontinue drug, consult with physician if any significant reduction in any formed blood element occurs.
Teaching points
• • • •
Take the full course of the drug; take all the tablets prescribed. Have periodic medical checkups, including blood tests. These side effects may occur: Epigastric distress, nausea, vomiting (eat frequent small meals); rash (consult with your health care provider for appropriate skin care). Report fever, sore throat, unusual bleeding or bruising, dizziness, headaches, rash.
Adverse effects in Italic are most common; those in Bold are life-threatening.
Antibacterial Therapeutic actions
Inhibits the synthesis of nucleic acids and proteins in susceptible bacteria; the bacterial enzyme involved in this reaction is more readily inhibited than the mammalian enzyme. Indications
• •
Uncomplicated urinary tract infections caused by susceptible strains of E. coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species, and coagulasenegative Staphylococcus species, including Staphylococcus saprophyticus Treatment of acute otitis media due to susceptible strains of S. pneumoniae and H. influenza in children
Contraindications and cautions
• •
Contraindicated with allergy to trimethoprim, pregnancy (teratogenic in preclinical studies), megaloblastic anemia due to folate deficiency. Use cautiously with hepatic or renal dysfunction, lactation.
Available forms
Tablets—100, 200 mg; solution—50 mg/5 mL Dosages ADULTS
100 mg PO q 12 hr or 200 mg q 24 hr for 10 days. PEDIATRIC PATIENTS
•
Otitis media: 10 mg/kg/day in divided doses q 12 hr for 10 days.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT
For creatinine clearance of 15–30 mL/min, 50 mg PO q 12 hr; creatinine clearance of < 15 mL/min, not recommended. Pharmacokinetics Route Oral
Onset Varies
Peak 1–4 hr
Metabolism: Hepatic; T1/2: 8–10 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects
•
Dermatologic: Rash, pruritus, exfoliative dermatitis
• • •
GI: Epigastric distress, nausea, vomiting, glossitis Hematologic: Thrombocytopenia, leukopenia, neutropenia, megaloblastic anemia, methemoglobinemia, elevated serum transaminase and bilirubin, increased BUN and serum creatinine levels Other: Fever
Nursing considerations Assessment
• •
History: Allergy to trimethoprim, megaloblastic anemia due to folate deficiency, renal or hepatic dysfunction, pregnancy, lactation Physical: Skin color, lesions; T; status of mucous membranes; CBC; liver and renal function tests
Interventions
• • • •
Perform culture and sensitivity tests before beginning drug therapy. Protect the 200-mg tablets from exposure to light. Arrange for regular, periodic blood counts during therapy. Discontinue drug, consult with physician if any significant reduction in any formed blood element occurs.
Teaching points
• • • •
Take the full course of the drug; take all the tablets prescribed. Have periodic medical checkups, including blood tests. These side effects may occur: Epigastric distress, nausea, vomiting (eat frequent small meals); rash (consult with your health care provider for appropriate skin care). Report fever, sore throat, unusual bleeding or bruising, dizziness, headaches, rash.
Adverse effects in Italic are most common; those in Bold are life-threatening.
