Question

Chapter 38- Pipercillin/tazabactam (Zosvn) (IV) Antibiotic name Ticarcillin/clavulanate potassium IV// (Timentin) (IV) Drug Class & Cefazolin (IV)/Cephalexin (PO) Ceftriaxone (IM or IV) Cephalosporins Ceftriaxone: Crosses blood brain barrier: can treat meningitis Extended Spectrum Penicillin indications Contraindications Commorn Adverse Effects Major Interactions ex. CYP450 Nurse Considerations: amples: Age renal/hepatic precautions, safety with administration lab monitoring, teaching)

Answer 1

Ans) Extended spectrum penicillin:

Extends antimicrobial spectrum when combined with penicillinase-sensitive antibiotics
-Ampicillin/sulbactam (Unasyn)
-Amoxicillin/clavulanic acid (Augmentin)
-Ticarcillin/clavulanic acid (Timentin)
-Piperacillin/tazobactam (Zosyn)

Contraindications:

- Contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or β-lactamase inhibitors.

Common adverse effects:

1. GI, allergic manifestations - similar to PEN G
2. Bleeding - results from binding of drugs to the ADP receptor on platelets (Ticar > Piperacillin)
3. Neutropenia - Piperacillin
4. Phlebitis - both drugs

Other:

-Prolonged bleeding, platelet dysfunction
-Sodium overload
-Hypokalemia
-Cholestatic jaundice
-Superinfection

Major interactions:

1. broad spectrum penicillins decrease oral contraceptives

2. potassium supplements c potassium penicillins increases serum potassium levels
3. penicillins with aminocglycosides via IV inactivate each other

Nursing consideration:

• They are excreted via the kidneys, we have to monitor BUN/Cr and renal function (elderly clients tend to have some level of renal insufficiency)
• Check culture and sensitivity reports to ensure that this is the drug of choice for this patient.
• Ensure that patient receives full course of aminoglycosides as prescribed, divided around the clock to increase effectiveness and decrease the risk for development of resistant strains of bacteria.
• Monitor infection site and presenting signs and sympoms throughout course of drug therapy because failure of these manifestations to resolve may indicate the need to reculture the site.
• Provide safety measures to protect the patient if CNS effects (e.g. confusion, disorientation, numbness) occur.
• Educate client on drug therapy to promote understanding and compliance.
• Provide the following patient teaching: safety precautions (e.g. changing positions, avoiding hazardous tasks, ec.), drinking lots of fluids and to maintain nutrition even though nausea and vomiting may occur, report difficulty breathing, severe headache, fever, diarrhea, and signs of infection.

Cephalosporins:

Contraindications:

• Ceftriaxone IV must not be coadministered with calcium-containing IV solutions (including continuous calcium-containing infusions such as parenteral nutrition) in neonates ≤ 28 days because precipitation of ceftriaxone-calcium salt is a risk.

• Fatal reactions with ceftriaxone-calcium precipitates in the lungs and kidneys of neonates have been reported.

• Ceftriaxone should not be given to hyperbilirubinemic and preterm neonates because in vitro, ceftriaxone can displace bilirubin from serum albumin, potentially triggering kernicterus.

Common adverse effects:

• Stomach discomfort
• Nausea or vomiting
• Diarrhea
• Thrush (white fungus in the mouth), yeast infection, or other fungal infection
• Blood abnormalities
• Rash or itching

Drug interactions associated with cephalosporins:

1. alcohol exacerbates various side effects of cephalosporins
2. probeneicd decreases urine excretion of the drugs
3. uricosurics increase excretion rate

Nursing consideration:

Assess to prior administration the following:

1. assess for allergy to cephalosporins
2. record VS and urine output
3. take and evaluate baseline lab results (esp. BUN/Cr, ALP, ALT, etc.)

Nursing intervention:

1. monitor for superinfections
2. monitor for allergy, have epinephrine handy
3. advise patient to ingest buttermilk, yogurt, or acidophilus supplemetn to prevent superinfections c long term use of cephalosporin
4. complete the regimen as prescribed
5. infuse all IV cephalosporins over 30 minutes or as ordered to prevent pain and irritation
6. warn clients to report any SE from oral cephalosporin drugs (anorexia, vomiting, nausea, HA, dizziness, itching, and rash)
7. advice to take with food if gastric irritation
8. encourage adequate amount of fluids to avoid dehydration from diarrhea.