Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (36 page)
(a-mox-i-sill′in)
Amoclan, Apo-Amoxi Clav
, Augmentin, Augmentin XR, Clavulin
Func. class.:
Broad-spectrum antiinfective
Chem. class.:
Aminopenicillin β-lactamase inhibitor
Do not confuse:
Augmentin
/amoxicillin
Bacteriocidal, interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure; lysis mediated by bacterial cell wall autolytic enzymes, combination increases spectrum of activity against β-lactamase–resistant organisms
Lower respiratory tract infections, sinus infections, pneumonia, otitis media, skin infection, UTI; effective for strains of
Escherichia coli, Proteus mirabilis, Haemophilus influenzae, Streptococcus faecalis, Streptococcus pneumoniae
, and some β-lactamase–producing organisms
Unlabeled uses:
Actinomycotic mycetoma, chancroid, dental infections, dentoalveolar infection, melioidosis, pericoronitis, SARS
Hypersensitivity to penicillins, severe renal disease, dialysis, jaundice
Precautions:
Pregnancy (B), breastfeeding, neonates, children, hypersensitivity to cephalosporins; renal/GI disease, asthma, colitis, diabetes, eczema, leukemia, mononucleosis, viral infections, phenylketonuria
Calculator
• Adult: PO
250-500 mg q8hr or 500-875 mg q12hr, depending on severity of infection
• Child ≤40 kg:
PO
20-90 mg/kg/day in divided doses q8-12hr
• Adult: PO
CCr 10-30 ml/min dose q12hr; CCr <10 ml/min dose q24hr; do not use 875-mg strength or ext rel if CCr <30 ml/min; Augmentin XR is contraindicated with renal disease
Available forms:
Tabs 250, 500, 875 mg/125 mg clavulanate; chew tabs 200/28.5, 400/57 mg; powder for oral susp 250/28.5, 200/28.5, 400/57, 600/42.9 mg/5 ml; ext rel tabs (XR) 1000 mg amoxicillin, 62.5 mg clavulanate; powder for oral susp (ES) 600 mg amoxicillin, 42.9 mg clavulanate
•
Do not break, crush, chew XR (ext rel) product
Only as directed; two 250-mg tabs not equivalent to one 500-mg tab due to strength of clavulanate
•
Shake susp well before each dose; may be used alone, mixed in drinks; use im
mediately, discard unused portion of susp after 14 days, store in refrigerator
•
Give around the clock
•
Give with light meal for increased absorption
CNS:
Headache, fever,
seizures,
agitation, insomnia
GI:
Nausea, diarrhea, vomiting
, increased AST/ALT, abdominal pain, glossitis, colitis, black tongue,
pseudomembranous colitis
GU:
Oliguria, proteinuria, hematuria,
vaginitis, moniliasis
,
glomerulonephritis
HEMA:
Anemia,
bone marrow depression, granulocytopenia, leukopenia, eosinophilia,
thrombocytopenic purpura
INTEG:
Rash
, urticaria, dermatitis,
toxic epidermal necrolysis
META:
Hypo/hyperkalemia, alkalosis, hypernatremia
SYST:
Anaphylaxis, respiratory distress, serum sickness, superinfection, Stevens-Johnson syndrome,
candidiasis
PO:
Peak 2 hr, duration 6-8 hr, half-life 1-1⅓ hr, metabolized in liver, excreted in urine, crosses placenta, excreted in breast milk, removed by hemodialysis
Increase:
amoxicillin levels—probenecid
Increase:
anticoagulant effect—warfarin
Increase:
skin rash—allopurinol
Decrease:
action of oral contraceptives
Decrease:
absorption by a high-fat meal
Increase:
AST/ALT, alk phos, LDH
False positive:
direct Coombs’s test
Nephrotoxicity at high doses: I&O ratio; report hematuria, oliguria
•
Hepatic studies: AST, ALT
•
Blood studies: WBC, RBC, Hgb, Hct, bleeding time
•
Renal studies: urinalysis, protein, blood, BUN, creatinine; if urine output decreases, long-acting products should not be used
•
C&S before product therapy; product may be given as soon as culture is taken
Pseudomembranous colitis:
bowel pattern before, during treatment; diarrhea, cramping, blood in stools; report to prescriber
Anaphylaxis:
rash, itching, dyspnea, facial/laryngeal edema; skin eruptions after administration of penicillin to 1 wk after discontinuing product
•
Adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit
•
Adequate intake of fluids (2 L) during diarrhea episodes
•
Scratch test to assess allergy after securing order from prescriber; usually done when penicillin is only product of choice
•
Storage in refrigerator for 10 days
•
Therapeutic response: absence of infection
•
To take as prescribed, not to double dose
•
All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after completed course of medication
To report sore throat, fever, fatigue
(superinfection or agranulocytosis);
diarrhea, cramping, blood in stools
(pseudomembranous colitis)
•
That product must be taken in equal intervals around the clock to maintain blood levels
•
To wear or carry emergency ID if allergic to penicillins
Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O
2
, IV corticosteroids for anaphylaxis
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert