A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug? Select all that apply.

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Sulfasalazine (Azulfidine) is a sulfonamide (salicylate and sulfa antibiotic) and nonbiologic disease-modifying antirheumatic drug (DMARD) used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and inflammatory bowel disease (eg, ulcerative colitis). It inhibits the production of prostaglandin, a mediator in the body's inflammatory response. Most "sulfa" medications (eg, trimethoprim, sulfamethoxazole) share common side effects, including: Crystalluria causing kidney injury - client should drink 8 glasses of water daily to maintain adequate urine output (eg, 1200-1500 mL/day) Photosensitivity and risk for sunburn - client should avoid sun exposure and apply sunscreen Folic acid deficiency (megaloblastic anemia and stomatitis) - client should eat folate-rich foods and take 1 mg/day folic acid supplement Rarely life-threatening agranulocytosis (leukopenia) - client should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately Stevens-Johnson syndrome - client should stop the medicine if rash develops (Option B) Ulcerative colitis is characterized by bloody diarrhea, and the medication is taken to reduce this effect. (Option C) Urine and skin can turn an orange-yellow color but will return to normal when the drug is discontinued. This is an expected finding. Educational objective: Sulfasalazine (Azulfidine) is used for mild to moderate chronic inflammatory RA and inflammatory bowel disease. Important adverse effects include crystalluria with kidney injury, yellow-orange skin and urine discoloration, folic acid deficiency, and photosensitivity.

A Client with Ulcerative Colitis Is Prescribed the Drug Sulfasalazine