Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (39 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Unasyn
Func. class.:
Antiinfective—broad-spectrum
Chem. class.:
Aminopenicillin with β-lactamase inhibitor
Interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic pressure; lysis due to cell wall autolytic enzymes; combination extends spectrum of activity by β-lactamase inhibition
Skin infections, intraabdominal infections, pneumonia
(Staphylococcus aureus, Escherichia coli, Klebsiella, Proteus mirabilis, Bacteroides fragilis, Haemophilus influenzae, Enterobacter, Acinetobacter calcoaceticus)
, intraabdominal infections
(Enterobacter, Klebsiella, Bacteroides, E. coli)
, gynecologic infections
(E. coli, Bacteroides)
, meningitis, septicemia
Unlabeled uses:
Aspiration pneumonia, bone/joint infections, gonorrhea, infectious arthritis, lower respiratory infections, osteomyelitis, PID, UTI
Hypersensitivity to penicillins, ampicillin, sulbactam
Precautions:
Pregnancy (B), breastfeeding, neonates, hypersensitivity to cephalosporins/carbapenems, renal disease, mononucleosis, viral infections, syphilis
Calculator
• Adult/adolescent/child
≥
40 kg:
IM/IV
1.5-3 g q6hr, max 4 g/day sulbactam
• Child
≤
40 kg:
IV
150-300 mg/kg/day divided q6hr, max 4 g/day
• Adult
≥
40 kg:
IM/IV
CCr 15-30 ml/min dose q12hr; CCr 5-15 ml/min dose q24hr
Available forms:
Powder for inj 1.5 g (1 g ampicillin, 0.5 g sulbactam), 3 g (2 g ampicillin, 1 g sulbactam), 10 g (10 g ampicillin, 5 g sulbactam)
•
Reconstitute by adding 3.2 ml sterile water/1.5-g vial; 6.4 ml/3-g vial, give deep in large muscle, aspirate
•
Do not use IM in child
•
After diluting 1.5 g/3.2 ml sterile water for inj or 3 g/6.4 ml (250 mg ampicillin/125 mg sulbactam), allow to stand until foaming stops; may give over 15 min
•
Dilute further in 50 ml or more of D
5
W, NaCl; administer within 1 hr after reconstitution; give over 15-30 min, separate doses from aminoglycosides by ≥1 hr
Y-site compatibilities:
Amifostine, aminocaproic acid, anidulafungin, atenolol, bivalirudin, bleomycin, CARBOplatin, cefepime, CISplatin, codeine, cyclophosphamide, cytarabine, DAPTOmycin, dexmedetomidine, docetaxel, doxacurium, eptifibatide, etoposide, fenoldopam, filgrastim, fludarabine, fluorouracil, gallium, gatifloxacin, gemcitabine, graniset-ron, hetastarch, irinotecan, levofloxacin, linezolid, methotrexate, metroNIDAZOLE, octreotide, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, remifentanil, riTUXimab, rocuronium, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, TNA, TPN, trastuzumab, vencuronium, vinCRIStine, voriconazole
CNS:
Lethargy, hallucinations, anxiety, depression, twitching,
coma, seizures
GI:
Nausea, vomiting, diarrhea
, increased AST/ALT, abdominal pain, glos
sitis, colitis,
pseudomembranous colitis, hepatic necrosis/failure
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis
,
glomerulonephritis,
dysuria
HEMA:
Anemia, increased bleeding time,
bone marrow depression, granulocytopenia, leukopenia, eosinophilia, hemolysis
INTEG:
Injection site reactions, rash, edema, urticaria
MISC:
Anaphylaxis, serum sickness, toxic epidermal necrolysis, Stevens-Johnson syndrome
IV:
Peak 5 min, half-life 50-110 min, little metabolized in liver, 75%-85% of both products excreted in urine, diffuses to breast milk, crosses placenta
Increase:
bleeding risk—oral anticoagulants; check, INR, PT
Increase:
ampicillin-induced skin rash—allopurinol, check for rash
Increase:
ampicillin level—probenecid
Increase:
methotrexate level—methotrexate
False positive:
urine glucose, urine protein
•
Infection:
characteristics of wound, sputum; take temperature, WBC count; C&S before product therapy, product may be given as soon as culture is taken
•
Bowel pattern before, during treatment
•
I&O ratio; report hematuria, oliguria because penicillin in high doses is nephrotoxic
Any patient with compromised renal system, because product excreted slowly with poor renal system function; toxicity may occur rapidly
•
Hepatic studies: AST, ALT if on long-term therapy
•
Blood studies: WBC, RBC, Hct, Hgb, bleeding time
•
Renal studies: urinalysis, protein, blood, BUN, creatinine
Anaphylaxis:
skin eruptions after administration of ampicillin to 1 wk after discontinuing product
•
Allergies before treatment; reaction to each medication; report allergies
•
Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product choice
•
Storage in tight container, out of light
•
Therapeutic response: absence of fever, draining wounds; negative C&S
•
To report superinfection: vaginal itching; loose, foul-smelling stools; black furry tongue
Pseudomembranous colitis:
fever, diarrhea with pus, blood, mucus; may occur up to 4 wk after treatment; report immediately to health care provider
•
To wear or carry emergency ID if allergic to penicillin products
Withdraw product, maintain airway; administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert