Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (280 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(naf-sill′in)
Func. class.:
Antiinfective, broad-spectrum
Chem. class.:
Penicillinase-resistant penicillin
Bacteriocidal, interferes with cell wall replication of susceptible organisms; cell lysis mediated by cell wall autolytic enzymes
Effective for gram-positive cocci
(Staphylococcus aureus, Streptococcus viridans, Streptococcus pneumoniae)
, infections caused by penicillinase-producing
Staphylococcus
Hypersensitivity to penicillins or corn
Precautions:
Pregnancy (B), breastfeeding, neonates; hypersensitivity to cephalosporins or carbapenems; GI disease, asthma
Calculator
• Adult:
IV
500-2000 mg q4hr
• Child and infant >1 mo:
IV
50-200 mg/kg/day in divided doses q4-6hr
• Neonates >7 days (weight >2000 g):
IV
25 mg/kg q6hr
• Neonates ≤7 days (weight <2000 g):
IV
25 mg/kg q8hr
• Adult:
IV
100-200 mg/kg/day in divided doses q4-6hr, max 12 g/day
• Neonates >7 days (weight >2000 g):
IV
50 mg/kg q6hr
• Neonates ≤7 days (weight <2000 g):
IV
50 mg/kg q12hr
Available forms:
Powder for inj 1, 2 g, premixed or Add-Vantage vials
•
Product after C&S has been drawn, begin therapy while waiting for results
•
Reconstitute vials: add 1.7 (1.8 nafcil), 3, 4, or 6.4 ml (6.6 ml NaCl) (sterile water for inj, 0.9% NaCl, bacteriostatic water for inj with benzyl alcohol or parabens) to vials with 1 g, 2 g of nafcillin, respectively (250 mg/ml)
•
No further dilution needed; after reconstitution, inject in deep muscle mass
•
Reconstitute vials: add 1.7 (1.8 nafcil), 3, 4, or 6.4 ml (6.6 ml NaCl) sterile water for inj, 0.9% NaCl, bacteriostatic water for inj with benzyl alcohol or parabens) to vials with 1 g, 2 g of nafcillin, respectively (250 mg/ml)
•
Nallpen piggyback units:
reconstitute 1 or 2 g with 50-100 ml or 99 ml, respectively, of sterile water for inj, 0.45% NaCl, 0.9% NaCl
•
Unipen piggyback units:
reconstitute according to manufacturer
•
Further dilute reconstituted sol in 15-30 ml sterile water inj, 0.45% NaCl, 0.9% NaCl; inj slowly over 5-10 min into tubing of free-flowing compatible IV solution
•
Vials, further dilute reconstituted sol to 2-40 mg/ml for peripheral vein inf ≤20 mg/ml (preferred); piggyback unit, no further dilution needed; infuse ≥30-60 min, make sure entire dose is given before ≥10% of sol is inactivated
Y-site compatibilities:
Acyclovir, atropine, cyclophosphamide, diazepam, enalaprilat, esmolol, famotidine, fentaNYL, fluconazole, foscarnet, heparin, HYDROmorphone, magnesium sulfate, morphine, perphenazine, propofol, theophylline, zidovudine
CNS:
Lethargy, hallucinations, anxiety, depression, twitching,
coma, seizures
GI:
Nausea, vomiting, diarrhea
, increased AST, ALT, abdominal pain, glossitis,
pseudomembranous colitis
GU:
Oliguria,
proteinuria, hematuria,
vaginitis, moniliasis,
glomerulonephritis, interstitial nephritis
HEMA:
Anemia, increased bleeding time,
bone marrow depression, neutropenia
INTEG:
Tissue necrosis, extravasation injury at inj site
SYST:
Anaphylaxis, serum sickness, Stevens-Johnson syndrome
Half-life 1 hr; metabolized by liver; excreted in bile, urine 90% protein bound
•
Avoid use with tetracyclines
Increase:
nafcillin concentrations—probenecid
Decrease:
effect of cycloSPORINE—warfarin
Decrease:
nafcillin effect—chloramphenicol, macrolides, sulfonamides, tetracyclines, aminoglycosides
Decrease:
absorption—food, carbonated drinks, citrus fruit juices
Decrease:
Hgb/HcT, neutrophils
False positive:
urine glucose, urine protein
•
I&O ratio; report hematuria, oliguria, high doses are nephrotoxic
•
Pseudomembranous colitis:
assess for diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC, low serum albumin; stop product; usually either vancomycin or IV metroNIDAZOLE given
•
Hepatic studies: AST, ALT
•
Blood studies: CBC with differential bleeding time
Renal studies: urinalysis, BUN, creatinine; abnormal urinalysis may indicate nephrotoxicity
•
C&S before product therapy; product may be given as soon as culture is taken
•
Respiratory status: rate, character, wheezing, tightness in chest
Allergies before initiation of treatment; monitor for anaphylaxis, dyspnea, rash, laryngeal edema; stop product; keep emergency equipment nearby; skin eruptions after administration of penicillin to 1 wk after discontinuing product; cross-sensitivity with cephalosporins may occur
•
Differential WBC 2 × per wk in patients receiving long-term therapy
•
IV site: for redness, swelling, pain at site
•
Extravasation management with cold packs, hyaluronidase
•
Therapeutic response: absence of fever, draining wounds
To report sore throat, fever, fatigue (may indicate superinfection); CNS reactions; pseudomembraneous colitis (diarrhea, fever, abdominal pain, fatigue)
•
To wear or carry emergency ID if allergic to penicillins
Withdraw product; maintain airway; administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert