Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (213 page)
(i-me-pen′em sye-la-stat′in)
Primaxin IM, Primaxin IV
Func. class.:
Antiinfective—miscellaneous
Chem. class.:
Carbapenem
Do not confuse:
imipenem
/Omnipen
Primaxin
/Premarin
Interferes with cell-wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure; addition of cilastatin prevents renal inactivation that occurs with high urinary concentrations of imipenem
Serious infections caused by gram-positive
Streptococcus pneumoniae
, group A β-hemolytic streptococci,
Staphylococcus aureus
, enterococcus; gram-negative
Klebsiella, Proteus, Escherichia coli, Acinetobacter, Serratia, Pseudomonas aeruginosa, Salmonella, Shigella, Haemophilus influenzae, Listeria
sp.
Hypersensitivity to this product or amide local anesthetics, or carbapenems; AV block, shock (IM)
Precautions:
Pregnancy (C), breastfeeding, children, geriatric patients, seizure disorders, renal disease, head trauma; hypersensitivity to cephalosporins, penicillins; pseudomembranous colitis, ulcerative colitis
Calculator
• Adult ≥70 kg: IV
250 mg every 6 hr (mild infections); 500 mg every 6–8 hr (moderate infections); 500 mg every 6 hr (severe life-threatening infections)
• Adult 60 kg: IV
250 mg IV every 8 hr (mild infections); 250 mg every 6 hr (moderate or severe life-threatening infections)
• Adult 50 kg: IV
125 mg every 6 hr (mild infections) 250 mg every 6 hr (moderate or severe life-threatening infections)
• Adult 40 kg: IV
125 mg every 6 hr (mild infections); 250 mg every 6–8 hr (moderate infections); 250 mg every 6 hr (severe life-threatening infections)
• Adult 30 kg: IV
125 mg every 8 hr (mild infections); 125 mg every 6 hr or 250 mg every 8 hr (moderate infections); 250 mg every 8 hr (severe life-threatening infections)
• Adolescent/child/infant ≥3 mo: IV
15–25 mg/kg every 6 hr
• Infant 1–3 mo and ≥1500 g: IV
25 mg/kg every 6 hr
• Neonate 1–4 wk and ≥1500 g: IV
25 mg/kg every 8 hr
• Neonate <7 days and ≥1500 g: IV
25 mg/kg every 12 hr
P. aeruginosa
• Adult ≥70 kg: IV
500 mg every 6 hr (mild infections); 500 mg every 6 hr or 1 g every 8 hr (moderate infections); 1 g every 6–8 hr (life-threatening infections)
• Adult 60 kg: IV
500 mg every 8 hr (mild infections); 500 mg every 8 hr or 750 mg every 8 hr (moderate infections); 0.75–1 g every 8 hr (life-threatening infections)
• Adult 50 kg: IV
250 mg every 6 hr (mild infections); 250–500 mg every 6 hr (moderate infections); 500 mg every 6 hr or 750 mg every 8 hr (life-threatening infections)
• Adult 40 kg: IV
250 mg every 6 hr (mild infections); 250 mg every 6 hr or 500 mg every 8 hr (moderate infections); 500 mg every 6–8 hr (life-threatening infections)
• Adult 30 kg: IV
250 mg every 8 hr (mild infections); 250 mg every 6–8 hr; 250 mg every 6 hr or 500 mg every 8 hr (life-threatening infections)
• Adolescent/child/infant ≥3 mo: IV
15–25 mg/kg every 6 hr
• Infant 1–3 mo weighing ≥1500 g: IV
25 mg/kg every 6 hr
• Neonate 1–4 wk weighing ≥1500 g: IV
25 mg/kg every 8 hr
• Neonate <7 days weighing ≥1500 g: IV
25 mg/kg every 12 hr
• Adult/adolescent/child ≥12 yr: IM
500 or 750 mg every 12 hr, max 1.5 g/day
• Adult/adolescent/child ≥12 yr: IM
750 mg every 12 hr, max 1.5 g/day
Pseudomonas
infection
•
Imipenem; cilastatin in combination with ciprofloxacin or an aminoglycoside plus a respiratory fluoroquinolone or an advanced macrolide
• Adult ≥70 kg: IV
500 mg every 6–8 hr
• Adult 60 kg: IV
250 mg every 6 hr
• Adult 50 kg: IV
250 mg every 6 hr
• Adult 40 kg: IV
250 mg every 6–8 hr
• Adult 30 kg: IV
125 mg every 6 hr or 250 mg every 8 hr
• Adult: IV
500–1000 mg every 6 hr × 10 days
•
Adult ≥70 kg (reduce normal dose of 1 g/day to): IV
CCr 41-70 ml/min, 250 mg q8hr; CCr 6-40 ml/min, 250 mg q12hr;
(reduce normal dose of 1.5 g/day to):
CCr 41-70 ml/min, 250 mg q6hr; CCr 21-40 ml/min, q8hr; CCr 6-20 ml/min, 250 mg q12hr;
(reduce normal dose of 2 g/day to):
CCr 41-70 ml/min, 500 mg q8hr; CCr 21-40 ml/min, 250 mg q6hr; CCr 6-20 ml/min, 250 mg q12hr
Available forms:
Powder for sol inj 250, 500 mg; powder for susp 500 mg
•
After C&S is taken
•
Reconstitute 500 mg/2 ml lidocaine without EPINEPHrine; shake
•
Inject deeply in large muscle, aspirate, product for IM is not for IV use
•
After reconstitution of 250 or 500 mg with 10 ml of diluent and shake; add to ≥100 ml of same inf sol
•
250-500 mg over 20-30 min; ≥750 mg over 40-60 min; give through
Y
-tube or 3-way stopcock; do not give by IV bolus or if cloudy
Y-site compatibilities:
Acyclovir, amifostine, aztreonam, cefepime, cisatracurium, diltiazem, famotidine, fludarabine, foscarnet, granisetron, IDArubicin, insulin (regular), melphalan, methotrexate,
ondansetron, propofol, remifentanil, tacrolimus, teniposide, thiotepa, vinorelbine, zidovudine
CNS:
Fever, somnolence,
seizures,
confusion, dizziness, weakness, myoclonus
CV:
Hypotension, palpitations, tachycardia
GI:
Diarrhea, nausea, vomiting
,
pseudomembranous colitis, hepatitis,
glossitis
GU:
Renal toxicity/failure
HEMA:
Eosinophilia, neutropenia,
decreased Hgb, Hct
INTEG:
Rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site
RESP:
Chest discomfort, dyspnea, hyperventilation
SYST:
Anaphylaxis, Stevens-Johnson syndrome
IV:
Onset immediate, peak 1/2-1 hr, half-life 1 hr, 70%-80% excreted unchanged in urine
Increase:
imipenem plasma levels—probenecid
Increase:
antagonistic effect—β-lactam antibiotics
Increase:
seizure risk—ganciclovir, theophylline, aminophylline, cycloSPORINE
Decrease:
effect of valproic acid
Increase:
AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine
False positive:
direct Coombs’ test
•
Renal studies: creatinine/BUN
•
Infection:
increased temp, WBC, characteristics of wounds, sputum, urine or stool culture
•
Sensitivity to penicillin—may have sensitivity to this product
•
Renal disease: lower dose may be required
•
Bowel pattern daily; if severe diarrhea occurs, product should be discontinued; may indicate pseudomembranous colitis
Allergic reactions, anaphylaxis:
rash, urticaria, pruritus, wheezing, laryngeal edema; may occur a few days after therapy begins; have epinephrine, antihistamine, emergency equipment available
•
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
•
Therapeutic response: negative C&S; absence of signs and symptoms of infection
To report severe diarrhea; may indicate pseudomembranous colitis
To report sore throat, bruising, bleeding, joint pain; may indicate blood dyscrasias (rare)
EPINEPHrine, antihistamines; resuscitate if needed
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert