Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (157 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(er-tah-pen′em)
Invanz
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Carbapenem
Do not confuse:
INVanz
/AVINza
Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure; bactericidal
Adult patients with moderate to severe infections caused by the following organisms: intraabdominal infections—
Escherichia coli, Clostridium clostridioforme, Eubacterium lentum, Peptostreptococcus
sp.,
Bacteroides fragilis, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides uniformis;
complicated skin/skin-structure infections—
Staphylococcus aureus
(methicillin-susceptible),
Streptococcus pyogenes, E. coli, Peptostreptococcus
sp.; community-acquired pneumonia—
Streptococcus pneumoniae
(penicillin-susceptible),
Haemophilus influenzae
(β-lactamase–negative),
Moraxella catarrhalis;
complicated UTI—
E. coli, Klebsiella pneumoniae;
acute pelvic infections—
Streptococcus agalactiae, E. coli, B. fragilis, Porphyromonas asaccharolytica, Peptostreptococcus
sp.,
Prevotella bivia
, infection prophylaxis prior to elective colorectal surgery
Hypersensitivity to this product, its components, amide-type local anesthetics (IM only); anaphylactic reactions to β-lactams
Precautions:
Pregnancy (B), breastfeeding, children, geriatric patients, GI/renal/hepatic disease
Calculator
• Adult/adolescent:
IM/IV
1 g/day × 5-14 days
• Infant ≥3 mo/child:
IM/IV
15 mg/kg bid (max 1 g/day) × 5-14 days
• Adult:
IM/IV
1 g/day × 7-14 days
• Child 3 mo-12 yr:
IM/IV
15 mg/kg bid × 7-14 days
• Adult:
IM/IV
1 g/day × 10-14 days
• Child 3 mo-12 yr:
IM/IV
15 mg/kg bid × 10-14 days
• Adult:
IM/IV
1 g/day × 10-14 days
• Child 3 mo-12 yr:
IM/IV
15 mg/kg bid × 10-14 days
• Adult:
IM/IV
1 g/day × 3-10 days
• Child 3 mo-12 yr:
IM/IV
15 mg/kg bid 3-10 days
• Adult:
IV
1 g as a single dose 1 hr prior to surgical incision
Available form:
Powder, lyophilized, 1 g
•
Reconstitute the 1 g vial of ertapenem with 3.2 ml of 1% lidocaine HCl injection (without EPINEPHrine) (280 mg/ml), agitate well to form a solution; the IM reconstituted formulation is not for IV use
•
IM administration may be used as an alternative to IV administration in the treatment of infections where IM therapy is appropriate; only give via IM injection × 7 days
•
For a 1 g dose:
immediately withdraw the contents of the vial and inject deeply into a large muscle, aspirate before injection to avoid injection into a blood vessel
•
For a dose
<1 g (i.e., for pediatric patients 3 mo–12 yr): immediately withdraw a volume equal to 15 mg/kg (max 1 g/day) and inject deeply into a large muscle, aspirate before injection to avoid injecting into a blood vessel; use the reconstituted IM sol within 1 hr after preparation
•
Visually inspect for particulate matter and discoloration before use, may be colorless to pale yellow; do not mix with other products; dextrose sols are not compatible
•
1 g vial:
For each gram reconstitute with 10 ml of either NS injection, sterile water for injection, or bacteriostatic water for injection to 100 mg/ml, shake
•
1 g dose
: immediately transfer contents of the reconstituted vial to 50 ml of NS injection; for a dose <1 g (pediatric patients 3 mo–12 yr): from the reconstituted vial, immediately withdraw a volume equal to 15 mg/kg of body weight (max 1 g/day) and dilute in NS injection to a concentration of 20 mg/ml or less
•
Complete the inf within 6 hr of reconstitution, infuse over 30 min; do not co-infuse with other medications
•
The reconstituted IV sol may be stored at room temperature if used within 6 hr, or store under refrigeration for 24 hr and use within 4 hours after removal from refrigeration; do not freeze
Y-site compatibilities:
Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, argatroban, arsenic trioxide, atenolol, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cyclophosphamide, cycloSPORINE, cytarabine, dacarbazine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, dolasetron, DOPamine, doxacurium, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, ifosfamide, inamrinone, insulin (regular), irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate,
methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, milrinone, mitoMYcin, mivacurium, morphine, moxifloxacin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, PACLitaxel, pamidronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, polymyxin B, potassium acetate/chloride/phosphates, procainamide, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, trimethobenzamide, vancomycin, vasopressin, vecuronium, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Insomnia,
seizures,
dizziness,
headache
CV:
Tachycardia
GI:
Diarrhea, nausea, vomiting
,
pseudomembranous colitis
GU:
Vaginitis
INTEG:
Rash
, urticaria,
pruritus
, pain at inj site,
infused vein complication, phlebitis/thrombophlebitis
, erythema at inj site
RESP:
Dyspnea, cough, pharyngitis, crackles, respiratory distress
SYST:
Anaphylaxis
IV:
Onset immediate; peak dose dependent; half-life 4 hr; metabolized by liver; excreted in urine, feces, breast milk
Increase:
ertapenem levels—probenecid; do not coadminister
Decrease:
effect of valproic acid
Increase:
hepatic enzymes
•
Renal disease: lower dose may be required
•
Pseudomembranous colitis:
bowel pattern daily: if severe diarrhea occurs, product should be discontinued
•
For infection: temp, sputum, characteristics of wound before, during, after treatment
Allergic reactions, anaphylaxis;
rash, urticaria, pruritus; may occur a few days after therapy begins; sensitivity to carbapenem antibiotics, other β-lactam antibiotics, penicillins
•
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough or sputum
•
Therapeutic response: negative C&S; absence of signs, symptoms of infection
•
To report severe diarrhea (may indicate
pseudomembranous colitis
), CNS side effects
•
To report overgrowth of infection: black, furry tongue; vaginal itching; foul-smelling stools
•
To avoid breastfeeding; product is excreted in breast milk
EPINEPHrine, antihistamines; resuscitate if needed (anaphylaxis)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert