Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (315 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
Appendix B
penicillin G benzathine (Rx)
(pen-i-sill′in)
Bicillin L-A
Pfizerpen
Apo-Pen-VK
, Penicillin VK
Func. class.:
Broad-spectrum antiinfective
Chem. class.:
Natural penicillin
Interferes with cell-wall replication of susceptible organisms; lysis is mediated by cell-wall autolytic enzymes, results in cell death
Respiratory infections, scarlet fever, erysipelas, otitis media, pneumonia, skin and soft-tissue infections, gonorrhea; effective for gram-positive cocci
(Staphylococcus, Streptococcus pyogenes, S. viridans, S. faecalis, S. bovis, S. pneumoniae)
, gram-negative cocci
(Neisseria gonorrhoeae)
, gram-positive bacilli
(Actinomyces, Bacillus anthracis, Clostridium perfringens, C. tetani, Corynebacterium diphtheriae, Listeria monocytogenes)
, gram-negative bacilli
(Escherichia coli, Proteus mirabilis, Salmonella, Shigella, Enterobacter, Streptobacillus moniliformis)
, spirochetes
(Treponema pallidum)
Hypersensitivity to penicillins, corn
Precautions:
Pregnancy (B), breastfeeding; hypersensitivity to cephalosporins, carbapenem, sulfites; severe renal disease, GI disease, asthma
Calculator
• Adult:
IM
2.4 million units in single dose
• Child
<
2 yr:
IM
50,000 units/kg in single dose, max 2.4 million units as single inj
• Adult:
IM
1.2 million units in single dose
• Child
>
27 kg:
IM
900,000-1.2 million units as single dose
• Child
≤
27 kg:
IM
300,000-600,000 units as single dose
• Adult:
IM
1.2 million units as single dose
• Child
>
27 kg:
IM
900,000-1.2 million units as single dose
• Child
<
27 kg:
IM
300,000-600,000 units as single dose
Available forms:
Inj 600,000 units/ml
• Adult:
IM/IV
5-24 million units in divided doses q4-6hr
• Child
<
12 yr:
IV
150,000-300,000 units/kg/day in 4-6 divided doses; max 24 million units/day
•
CCr <10 ml/min, give full loading dose then 1/2 of loading dose q8-10hr
Available forms:
Powder for inj 1, 5, 20 million units/vial; inj 1, 2, 3 million units/50 ml
• Adult/child:
IM
600,000-1 million units as single dose or divided bid doses/day for 10 days to 2 wk
• Adult/child
>
12 yr:
IM
600,000-1 million units/day × 7-10 days
• Adult/adolescent/child
≥
60 lbs:
IM
600,000-1 million units/day
• Adolescent/child
<
60 lbs:
IM
300,000 units/day
Available forms:
Inj 600,000, 1,200,000 units/unit dose
• Adult/adolescents/child
>
12 yr:
PO
250-500 mg q6hr
• Child
<
12 yr:
PO
25-50 mg/kg/day in divided doses q6-8hr; max 2 g/day
• Adult/adolescent/child
≥
12 yr:
PO
125-250 mg q6-8hr × 10 days
• Child
<
12 yr and
>
27 kg:
PO
500 mg q8 or 12 hr × 10 days
• Child
<
12 yr and
≤
27 kg:
PO
250 mg q8hr or q12hr or 40 mg/kg/day in 3 divided doses × 10 days
• Adult:
PO
125-250 mg bid continuously
• Adult:
PO
250-500 mg q6-8hr
•
Dosage reduction indicated with renal impairment (CCr <50 ml/min) based on clinical response, degree of impairment
Available forms:
Tabs 250, 500 mg; powder for oral sol 125, 250 mg/5 ml
•
No dilution needed, shake well, deep IM inj in large muscle mass; avoid intravascular inj; aspirate; do not give IV
•
Penicillin G sodium or potassium can be given IM or IV, vials containing 10 or 20 million units not for IM use
•
Vials/bulk packages: dilute according to manufacturer’s directions
•
Frozen bags: thaw at room temp, do not force thaw, no reconstitution needed
•
Final conc (100,000-500,000 units/ml—adults; 50,000 units/ml—neonate/infant)
•
Total daily dose divided q4-6hr and given over 1-2 hr (adult), 15 min (infant/neonate)
Y-site compatibilities:
Acyclovir, amiodarone, cyclophosphamide, diltiazem, enalaprilat, esmolol, fluconazole, foscarnet, heparin, HYDROmorphone, labetalol, magnesium sulfate, meperidine, morphine, perphenazine, potassium chloride, tacrolimus, theophylline, verapamil, vit B/C
•
No dilution needed, give deep IM inj; avoid intravascular inj; aspirate; do not give IV
•
Orally on empty stomach for best absorption
•
Oral susp: tap bottle to loosen, add 1/2 total amount of water, shake, add re
maining water, shake; final conc (125 or 250 mg/ml) store in refrigerator after reconstitution, discard after 14 days
CNS:
Lethargy, hallucinations, anxiety, depression, twitching,
coma, seizures,
hyperreflexia
GI:
Nausea, vomiting, diarrhea
, increased AST, ALT, abdominal pain, glossitis, colitis,
pseudomembranous colitis
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis
,
glomerulonephritis, renal tubular damage
HEMA:
Anemia, increased bleeding time,
bone marrow depression, granulocytopenia, hemolytic anemia
META:
Hypo/hyperkalemia, alkalosis, hypernatremia
MISC:
Anaphylaxis, serum sickness, Stevens-Johnson syndrome,
local pain
, tenderness and fever with IM inj
IM:
Very slow absorption; time to peak 12-24 hr; duration 21-28 days; excreted in urine, feces, breast milk; crosses placenta
IV:
Peak immediate
IM:
Peak 1/4-1/2 hr
PO:
Peak 1 hr, duration 6 hr
Excreted in urine unchanged, excreted in breast milk, crosses placenta, half-life 30-60 min
IM:
Peak 1-4 hr, duration 15 hr, excreted in urine
PO:
Peak 30-60 min, half-life 30 min, excreted in urine, breast milk
Increase:
penicillin effect—aspirin, probenecid
Increase:
effect of heparin, methotrexate
Decrease:
effect of oral contraceptives, typhoid vaccine
Decrease:
antimicrobial effect of penicillin—tetracyclines
False positive:
urine glucose, urine protein
•
Infection:
temp; characteristics of sputum; wounds; urine; stools before, during, after treatment; C&S before therapy; product may be given as soon as culture is taken
•
I&O ratio; report hematuria, oliguria because penicillin in high doses is nephrotoxic; renal tests: urinalysis, protein, blood
Any patient with compromised renal system because product is excreted slowly with poor renal system function; toxicity may occur rapidly
•
Hepatic studies: AST, ALT
•
Blood studies: WBC, RBC, Hct, Hgb, bleeding time
Pseudomembranous colitis:
diarrhea, mucus, pus; bowel pattern before, during treatment
•
Respiratory status: rate, character, wheezing, tightness in chest
Allergies before initiation of treatment, reaction of each medication; because of prolonged action, allergic reaction may be prolonged and severe; watch for anaphylaxis: rash, dyspnea, pruritus, laryngeal edema; skin eruptions after administration of penicillin to 1 wk after discontinuing product
•
EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment
•
Adequate fluid intake (2 L) during diarrhea episodes
•
Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
•
Storage in dry, tight container; oral susp refrigerated 2 wk
•
Therapeutic response: resolution of infection
•
To report sore throat, fever, fatigue; may indicate superinfection; CNS effects: depression, hallucinations, seizures
•
To wear or carry emergency ID if allergic to penicillins
•
To report diarrhea, with blood, pus, mucous to prevent dehydration
•
To shake susp well before each dose; to store in refrigerator for up to 2 wk
•
To use all medication prescribed
•
To use additional contraception if using any of these products