Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (321 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(pip′er-ah-sill′in/ta-zoe-bak′tam)
Zosyn
Func. class.:
Antiinfective, broad spectrum
Chem. class.:
Extended-spectrum penicillin, β-lactamase inhibitor
Interferes with cell-wall replication of susceptible organisms; osmotically unstable cell wall swells and bursts from osmotic pressure; tazobactam is a β-lactamase inhibitor that protects piperacillin from enzymatic degradation
Moderate to severe infections: piperacillin-resistant, β-lactamase–producing strains causing infections in respiratory, skin, urinary tract, bone, gonorrhea, pneumonia; effective for resistant
Staphylococcus aureus
, resistant
Escherichia coli, Bacteroides fragilis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides vulgatus, Haemophilus influenzae
Hypersensitivity to penicillins; neonates; carbapenem allergy
Precautions:
Pregnancy (B), breastfeeding, renal insufficiency in children, hypersensitivity to cephalosporins, CHF, seizures, GI disease, electrolyte imbalances
Calculator
• Adult:
IV
4.5 g q6hr or 3.375 g q4hr with an aminoglycoside or antipseudomonal fluoroquinolone × 1-2 wk; continue aminoglycoside only if
Pseudomonas aeruginosa
is isolated
• Adult:
IV INF
6-12 g/day given 2.25 g q8hr to 3.375 g q6hr over 30 min × 7-10 days
• Child ≥40 kg (88 lb):
IV
3.375 g q6hr × 7-10 days
• Child ≥9 mo and <40 kg:
IV
100 mg/kg (piperacillin)/kg q8hr × 7-10 days
• Infant 2 mo to <9 mo:
IV
80 mg (piperacillin) q8hr × 7-10 days
• Adult:
IV
CCr 20-40 ml/min, give 3.375 g q6hr (nosocomial pneumonia); give 2.25 g q6hr (all other indications); CCr <20 ml/min, give 2.25 g q6hr (nosocomial pneumonia), give 2.25 g q8hr (all other indications)
Available forms:
Powder for inj 2 g piperacillin/0.25 g tazobactam, 3 g piperacillin/0.375 g tazobactam, 4 g piperacillin/0.5 g tazobactam, 36 g piperacillin/4.5 g tazobactam
• Separate aminoglycoside from piperacillin to avoid inactivation
•
Product after C&S is complete
•
Reconstitute each 1 g of product/5 ml 0.9% NaCl for inj or sterile water for inj, dextrose 5%; shake well; further dilute in ≥50 ml compatible IV sol, run as int inf over ≥30 min
Y-site compatibilities:
Alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, atenolol, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate/chloride/gluconate, CARBOplatin, carmustine, cefepime, chloramphenicol, cimetidine, clindamycin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexrazoxane, diazepam, digoxin, diphenhydrAMINE, DOCEtaxel, DOPamine, doxacurium, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, erythromycin, esmolol, etoposide, fenoldopam, fentaNYL, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, isoproterenol, ketorolac, lansoprazole, leucovorin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, milrinone, morphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, PENTobarbital, PHENobarbital, phenylephrine, plicamycin, potassium chloride/phosphates, procainamide, ranitidine, remifentanil, riTUXimab, sargramostim, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiotepa, tigecycline, tirofiban, trimethobenzamide, vasopressin, vinBLAStine, vinCRIStine, voriconazole, zidovudine, zoledronic acid
CNS:
Lethargy, hallucinations, anxiety, depression, twitching, insomnia, headache, fever, dizziness,
seizures,
vertigo
CV:
Cardiac toxicity
GI:
Nausea, vomiting, diarrhea;
increased AST, ALT; abdominal pain, glossitis,
pseudomembranous colitis,
constipation
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis
,
glomerulonephritis, renal failure
HEMA:
Anemia, increased bleeding time,
bone marrow depression, agranulocytosis, hemolytic anemia
INTEG:
Rash, pruritus,
exfoliative dermatitis
META:
Hypokalemia, hypernatremia
SYST:
Serum sickness, anaphylaxis, Stevens-Johnson syndrome
Half-life 0.7-1.2 hr; excreted in urine, bile, breast milk; crosses placenta; 33% bound to plasma proteins
IV:
Peak completion of IV
Increase:
effect of neuromuscular blockers, oral anticoagulants, methotrexate
Increase:
piperacillin concentrations—aspirin, probenecid
Decrease:
antimicrobial effect of piperacillin—tetracyclines, aminoglycosides IV
Increase:
platelet count, eosinophilia, neutropenia, leukopenia, serum creati
nine, PTT, AST, ALT, alk phos, bilirubin, BUN, electrolytes
Decrease:
Hct, Hgb, electrolytes
False positive:
urine glucose, urine protein, Coombs’ test
•
Infection:
temp, stools, urine, sputum, wounds
•
I&O ratio; report hematuria, oliguria because penicillin in high doses is nephrotoxic; maintain hydration unless contraindicated
•
Hepatic studies: AST, ALT before treatment and periodically thereafter
•
Blood studies: WBC, RBC, Hct, Hgb, bleeding time before treatment and periodically thereafter; serum potassium
•
Renal studies: urinalysis, protein, blood, BUN, creatinine before treatment and periodically thereafter
•
C&S before product therapy; product may be given as soon as culture is taken
• Pseudomembranous colitis:
diarrhea, bloody stools, fever, abdominal cramps; may occur ≤2 mo after treatment; bowel pattern before and during treatment
•
Skin eruptions after administration of penicillin to 1 wk after discontinuing product
•
Respiratory status: rate, character, wheezing, tightness in chest
• Anaphylaxis:
wheezing, laryngeal edema, rash, itching; discontinue product, have emergency equipment nearby
•
Adequate intake of fluids (2 L) during diarrhea episodes
•
Discard after 24 hr if stored at room temp or after 48 hr if refrigerated; use single-dose vials immediately after reconstitution; stable in ambulatory IV pump for 12 hr
•
Therapeutic response: absence of fever, purulent drainage, redness, inflammation; culture shows decreased organisms
•
That culture may be taken after completed course of medication
• To report sore throat, fever, fatigue (superinfection); CNS effects (anxiety, depression, hallucinations, seizures);
pseudomembranous colitis:
fever, diarrhea with blood, pus, mucous
•
To wear or carry emergency ID if allergic to penicillins
•
To notify nurse of diarrhea
Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids for anaphylaxis
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(peer-byoo′ter-ole)
Maxair
Func. class.:
Bronchodilator
Chem. class.:
β-Adrenergic agonist
Causes bronchodilation with little effect on heart rate by action on β-receptors, causing increased cAMP and relaxation of smooth muscle
Reversible bronchospasm (prevention, treatment) including asthma; may be given with theophylline or steroids
Hypersensitivity to sympathomimetics, tachycardia
Precautions:
Pregnancy (C), breast-feeding, cardiac disorders, hyperthyroidism, hypertension, diabetes mellitus, prostatic hypertrophy
Calculator
• Adult and child
>
12 yr:
INH 1-2 puffs (0.4 mg) q4-6hr; max 12 INH/day
Available forms:
Aerosol delivery 0.2 mg pirbuterol/actuation
•
After shaking; exhale; place mouthpiece in mouth; inhale slowly; hold breath; remove; exhale slowly
•
Gum, sips of water for dry mouth
CNS:
Tremors, anxiety, insomnia, headache, dizziness, stimulation, restlessness, hallucinations, drowsiness, irritability
CV:
Palpitations, tachycardia, hypertension, angina, hypotension, dysrhythmias
EENT:
Dry nose and mouth, irritation of nose, throat
GI:
Gastritis, nausea, vomiting, anorexia
MS:
Muscle cramps
RESP:
Paradoxical bronchospasm,
dyspnea, coughing
INH:
Onset 3 min, peak ½-1 hr, duration 5 hr, terminal half-life 2 hr
Hypertensive crisis: MAOIs
Increase:
action of other aerosol bronchodilators
Increase:
pirbuterol action—tricyclics, antihistamines, levothyroxine
Decrease:
pirbuterol action—β-blockers
Increase:
action of both—cola nut, guarana, yerba maté
Increase:
effect—green tea (large amounts), guarana
•
Respiratory function: vital capacity, forced expiratory volume, ABGs, B/P, lung sounds, pulse, characteristics of sputum
Paradoxical bronchospasm, that can occur rapidly, hold product, notify prescribeer
•
Storage in light-resistant container; do not expose to temperatures over 86° F (30° C)
•
Fluid intake >2 L/day to liquefy thick secretions
•
Therapeutic response: absence of dyspnea, wheezing over 1 hr
•
Not to use OTC medications; extra stimulation may occur
•
Use of inhaler; review package insert with patient
•
To avoid getting aerosol in eyes
•
Actuator is for Maxair autoinhaler; do not use with other inhaler canister
•
About all aspects of product; avoid smoking, smoke-filled rooms, persons with respiratory infections
•
To keep fluid intake >2 L/day to liquefy thick secretions
Administer a β-adrenergic blocker