Mosby's 2014 Nursing Drug Reference (38 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(am-pi-sill′in)
Func. class.:
Antiinfective—broad-spectrum
Chem. class.:
Aminopenicillin
Do not confuse:
Omnipen
/imipenem
Interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic pressure; lysis mediated by cell wall autolysins
Effective for gram-positive cocci
(Staphylococcus aureus, Streptococcus pyogenes, Streptococcus faecalis, Streptococcus pneumoniae)
, gram-negative cocci
(Neisseria meningitidis)
, gram-negative bacilli
(Haemophilus influenzae, Proteus mirabilis, Salmonella, Shigella, Listeria monocytogenes)
, gram-positive bacilli; meningitis, GI/GU/respiratory infections, endocarditis, septicemia, otitis media
Unlabeled uses:
Biliary tract infection, shigellosis, typhoid fever, PID, OB/GYN infections, leptospirosis
Hypersensitivity to penicillins, antimicrobial resistance
Precautions:
Pregnancy (B), breastfeeding, neonates, hypersensitivity to cephalosporins, renal disease, mononucleosis
Calculator
• Adult and child ≥40 kg:
PO
250-500 mg q6hr;
IV/IM
2-8 g/day in divided doses q4-6hr
• Child <40 kg:
PO
50-100 mg/kg/day in divided doses q6-8hr;
IV/IM
100-200 mg/kg/day in divided doses q6-8hr
• Adult and adolescent:
IM/IV
150-200 mg/kg/day in divided doses q3-4hr; IDSA dose IV 12 g in divided doses q4hr
• Infant and child:
IM/IV
150-200 mg/kg/day in divided doses q3-4hr; IDSA dose IV 300 mg/kg/day in divided doses q6hr
• Neonates >7 days and >2000 g:
IM/IV
200 mg/kg/day in divided doses q6hr; IDSA dose IV 200 mg/kg/day in divided doses q6-8hr
• Adult and child
≥
45 kg:
PO
3.5 g given with 1 g probenecid as a single dose (not recommended by CDC)
• Adult:IM/IV
2 g 30 min before procedure
• Child:
IM/IV
50 mg/kg 30 min before procedure, max 2 g
N. gonorrhoeae
• Adult and child
>
20 kg:
PO
250-500 mg q6hr, may use larger dose for more serious infections
• Child
≤
20 kg:
PO
50-100 mg/kg/day in divided doses q6hr
• Adult and child:
CCr 10-50 ml/min extend to q6-12hr; CCr <10 ml/min extend to q12-16hr
• Adult: PO
500 mg qid × 5 days (not recommended by CDC)
• Adult/adolescent/child:
IV
100 mg/kg/day in divided doses q6hr × 14 days or more
Available forms:
Powder for inj 125, 250, 500 mg, 1, 2, 10 g; IV inj 500 mg, 1, 2 g; caps 250, 500 mg; powder for oral susp 125, 250/5 ml
•
On empty stomach with plenty of water for best absorption (1-2 hr before meals or 2-3 hr after meals)
•
Shake susp well before each dose
•
Reconstitute
by adding 0.9-1.2 ml/125-mg vial; 0.9-1.9 ml/250-mg vial; 1.2-1.8 ml/500-mg vial; 2.4-7.4 ml/1-g vial; 6.8 ml/2-g vial
•
IV direct:
after diluting with sterile water 0.9-1.2 ml/125 mg product, administer over 3-5 min (up to 500 mg), 10-15 min (>500 mg)
•
May be diluted in 50 ml or more of D
5
W, D
5
0.45% NaCl to a conc of 30 mg/ml or less; IV sol is stable for 1 hr; give at prescribed rate, do not give in same tubing as aminoglycosides, separate by ≥1 hr
Y-site compatibilities:
Acyclovir, alprostadil, amifostine, aminocaproic acid, anidulafungin, atenolol, bivalirudin, bleomycin, CARBOplatin, CISplatin, clarithromycin, cyclophosphamide, DACTINomycin, DAPTOmycin, dexmede-tomidine, docetaxel, doxacurium, DOXOrubicin liposome, eptifibatide, etoposide, filgrastim, fludarabine, fluorouracil, foscarnet, gatafloxacin, gemcitabine, granisetron, hetastarch, ifosfamide, irinotecan, levofloxacin, linezolid, mechlorethamine, methotrexate, metroNIDAZOLE, octreotide, ofloxacin, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, perphenazine, propofol, remifentanil, riTUXimab, rocuronium, sodium acetate, teniposide, thiotepa, tigecycline, tirofiban, TNA, trastuzumab, vinCRIStine, vit B/C, voriconazole
CNS:
Lethargy, hallucinations, anxiety, depression, twitching,
coma, seizures
GI:
Nausea, vomiting, diarrhea
,
pseudomembranous colitis,
stomatitis
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis
,
glomerulonephritis
HEMA:
Anemia, increased bleeding time,
bone marrow depression, granulocytopenia,
leukopenia, eosinophilia,
hemolysis
INTEG:
Rash, urticaria
, erythema multiforme
MISC:
Anaphylaxis, serum sickness, Stevens-Johnson syndrome, toxic epidermal necrolysis
Half-life 50-110 min; metabolized in liver; excreted in urine, bile, breast milk; crosses placenta; removed by dialysis
PO:
Peak 2 hr, duration 6-8 hr
IM:
Peak 1 hr
IV:
Peak 5 min
Increase:
bleeding, oral anticoagulants, monitor INR/PIJ
Increase:
ampicillin concentrations—probenecid
Increase:
ampicillin-induced skin rash—allopurinol, monitor for rash
Increase:
AST, ALT
Decrease:
conjugated estrone during pregnancy, conjugated estriol
False positive:
urine glucose
•
Infection:
characteristics of wound, sputum, WBC; baseline, periodically; C&S before product therapy, product may be taken as soon as culture is taken
Nephrotoxicity:
I&O ratio; report hematuria, oliguria; renal studies: urinalysis, protein, blood, BUN, creatinine
•
Hepatic studies: AST, ALT
•
Blood studies: WBC, RBC, Hgb, Hct, bleeding time
•
Bowel pattern before, during treatment
•
Skin eruptions after administration of penicillin to 1 wk after discontinuing product; identify allergies before using
•
Respiratory status: rate, character, wheezing, tightness in chest
Anaphylaxis:
rash, itching, dyspnea, facial swelling; stop product, notify prescriber, have emergency equipment available
•
Adequate intake of fluids (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 tight container; after reconstituting, oral suspension refrigerated for 2 wk or stored at room temp for 1 wk
•
Therapeutic response: absence of fever, draining wounds, other symptoms of infection
•
That tabs may be crushed; caps may be opened, mixed with water
•
To take oral ampicillin on empty stomach with full glass of water
•
All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after completed course of medication
To report sore throat, fever, fatigue, diarrhea (may indicate
superinfection
); to report rash, other signs of allergy
•
That product must be taken in equal intervals around the clock to maintain blood levels
•
To wear or carry emergency ID if allergic to penicillins
•
Pseudomembranous colitis:
diarrhea with blood or pus; notify prescriber
Withdraw product, maintain airway; administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids