Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (84 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
See
cephalosporins—2nd generation
(sef-tar′oh-leen)
Teflaro
Func. class.:
Cephalosporin action: Inhibits cell wall synthesis through binding to essential penicillin-binding protein (PBPs)
Acute bacterial skin/skin structure infections (ABSSI), bacterial community-acquired pneumonia
Cephalosporin hypersensitivity
Precautions:
Child/infant/neonate, breastfeeding, elderly patients, antimicrobial resistance, carbapenem/penicillin hypersensitivity, coagulopathy, colitis, dialysis, diarrhea, GI disease, hypoprothrombinemia, IBS, pregnancy (B), pseudomembranous colitis, renal disease, ulcerative colitis, viral infection, vit K deficiency
Calculator
• Adult:
IV
600 mg q12hr × 5-14 days (skin/skin-structure infections) or × 5-7 days (bacterial community-acquired pneumonia)
• Adult:
IV
CCr >30-≤50 ml/min, 400 mg q12hr; CCr ≥15-≤30 ml/min, 300 mg q12hr, CCr ≤15 ml/min, 200 mg q12hr
Available forms:
Powder for inj 400 mg, 600 mg
•
Obtain C&S before use
•
Visually inspect for particulate matter, discoloration if sol or container permits
•
Reconstitute:
add 20 ml of sterile water to 400- or 600-mg vial (20 ml/ml for 400 mg; 30 mg/ml for 600 mg), mix gently until dissolved;
dilute
in 250 ml of 0.9% NaCl, 0.45% NaCl, LR, D
5
, D2.5,
give
over 1 hr, do not admix, use within 6 hr at room temp or 24 hr refrigerated
CV:
Phlebitis
ENDO:
Hypokalemia
GI:
Diarrhea, nausea, vomiting, constipation, abdominal pain,
pseudomembranous colitis (rare)
INTEG:
Rash,
anaphylaxis
Protein binding 20%; excreted in urine 88%, feces 6%; half-life 2.66 hr; not hepatically metabolized
Increase:
prothrombin time risk—anticoagulants
Increase:
LFTs
Decrease:
potassium, eosinophils
•
Infection:
vital signs, sputum, WBC before, during therapy
•
Hypersensitivity:
before use, obtain a history of hypersensitivity reactions to cephalosporins, carbapenems, penicillins; cross-sensitivity may occur
•
Anaphylaxis (rare):
rash, pruritus, laryngeal edema, dyspnea, wheezing; discontinue product, notify health care provider immediately, keep emergency equipment nearby
•
Pseudomembranous colitis:
diarrhea, abdominal pain, fever, bloody stools; report immediately if these occur; may occur several weeks after terminating therapy
•
Monitor BUN, creatinine baseline, periodically; elderly and those with renal disease are at greater risk of renal dysfunction
•
Therapeutic response: negative C&S, resolution of symptoms of infection
•
About the reason for treatment and expected result
•
To immediately report rash, itching, difficulty breathing, bloody diarrhea, fever, abdominal pain
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
HIGH ALERTcelecoxib (Rx)
(sel-eh-cox′ib)
CeleBREX
Func. class.:
Nonsteroidal antiinflammatory, antirheumatic
Chem. class.:
COX-2 inhibitor
Do not confuse:
CeleBREX
/CeleXA/Cerebra/Cerebyx
Inhibits prostaglandin synthesis by selectively inhibiting cyclooxygenase-2 (COX-2), an enzyme needed for biosynthesis
Acute, chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, ankylosing spondylitis, juvenile rheumatoid arthritis (JRA)
Unlabeled uses:
Colorectal adenoma prophylaxis
Pregnancy (D) 3rd trimester; hypersensitivity to salicylates, iodides, other NSAIDs, sulfonamides
Black Box Warning:
CABG
Precautions:
Pregnancy (C) 1st/2nd trimesters, breastfeeding, children <18 yr, geriatric patients, bleeding, GI/renal/hepatic/cardiac disorders, PVD, hypertension, severe dehydration, asthma
Black Box Warning:
GI bleeding/perforation, peptic ulcer disease, MI, stroke
Calculator
Do not exceed recommended dose; deaths have occurred
• Adult:
PO
400 mg initially, then 200 mg if needed on 1st day, then 200 mg bid prn on subsequent days; start with 1/2 dose for poor CYP2C9 metabolizers
• Adult:
PO
200 mg/day as a single dose or 100 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers
• Geriatric:
PO
use lowest possible dose
• Adult:
PO
100-200 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers
• Adult:
PO
200 mg/day or in divided doses (bid); start with 1/2 dose for poor CYP2C9 metabolizers
• Adolescent and child ≥2 yr (>25 kg):
PO
100 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers
• Child ≥2 yr (10-25 kg):
PO
50 mg bid; start with 1/2 dose for poor CYP2C9 metabolizers
• Adult:
PO
(Child-Pugh B) reduce dose by 50%
• Adult:
PO
400 mg bid × 6 mo
Available forms:
Caps 50, 100, 200, 400 mg
•
Do not break, crush, chew, or dissolve caps with a full glass of water to enhance absorption; caps may be opened into applesauce or soft food, ingest immediately with water
•
With food, milk to decrease gastric symptoms (with higher doses [400 mg bid]); do not increase dose
CNS:
Fatigue, anxiety, depression, nervousness, paresthesia
, dizziness, insomnia
CV:
Stroke, MI, tachycardia, CHF,
angina, palpitations, dysrhythmias, hypertension, fluid retention
EENT:
Tinnitus, hearing loss, blurred vision, glaucoma, cataract, conjunctivitis, eye pain
GI:
Nausea, anorexia, vomiting, constipation, dry mouth, diverticulitis, gastritis,
gastroenteritis, hemorrhoids, hiatal hernia, stomatitis,
GI bleeding/ulceration
GU:
Nephrotoxicity:
dysuria
,
hematuria, oliguria, azotemia,
cystitis, UTI,
renal papillary necrosis
HEMA:
Blood dyscrasias,
epistaxis, bruising, anemia,
platelet aggregation
INTEG:
Serious (sometimes fatal) Stevens-Johnson syndrome, toxic epidermal necrolysis,
purpura, rash, pruritus, sweating, erythema, petechiae, photosensitivity, alopecia
RESP:
Pharyngitis, SOB, pneumonia, coughing
Well absorbed, crosses placenta, bound to plasma proteins, metabolized by CYP2C9 in liver, very little excreted by kidneys/in feces, peak 3 hr, half-life 11 hr, protein binding ∼97%
Increase:
bleeding risk—anticoagulants, SSRIs, antiplatelets, thrombolytics, salicylates, alcohol
Increase:
adverse reactions—glucocorticoids, NSAIDs, aspirin
Increase:
toxicity—lithium, antineoplastics, bisphosphonates
Increase:
celecoxib blood level—fluconazole
Decrease:
effect of aspirin, ACE inhibitors, thiazide diuretics, furosemide
Decrease:
effect of feverfew
Increase:
bleeding risk—garlic, ginger, ginkgo
Increase:
ALT, AST, BUN, cholesterol, glucose, potassium, sodium
Decrease:
glucose, sodium, WBC, platelets
•
Pain
of rheumatoid arthritis, osteoarthritis; check ROM, inflammation of joints, characteristics of pain
Black Box Warning:
For cardiac disease that may be worse after taking product; MI, stroke; do not use with coronary artery bypass graft (CABG)
•
CBC during therapy; watch for decreasing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; LFTs, serum creatinine/BUN, stool guaiac
Black Box Warning:
For blood dyscrasias (thrombocytopenia): bruising, fatigue, bleeding, poor healing
•
GI toxicity:
black, tarry stools; abdominal pain
Serious skin disorders:
Stevens-Johnson syndrome, toxic epidermal necrolysis; may be fatal
•
Therapeutic response: decreased pain, inflammation in arthritic conditions; decreased number of polyps
Black Box Warning:
Not to exceed recommended dose; to notify prescriber immediately of chest pain, skin eruptions; to stop product if these occur
•
To check with prescriber to determine when product should be discontinued prior to surgery
•
That product must be continued for prescribed time to be effective; to avoid other NSAIDs, aspirin, sulfonamides
Black Box Warning:
To notify prescriber of GI symptoms: black, tarry stools; cramping or rash; edema of extremities; weight gain
Black Box Warning:
To report bleeding, bruising, fatigue, malaise because blood abnormalities do occur
•
To report possible respiratory infection: fever, SOB, coughing, painful swallowing
•
To report if pregnancy is planned or suspected, pregnancy (C) before 3 wk, (D) after 30 wk
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
1ST GENERATION
cefadroxil (Rx)
(sef-a-drox′ill)
Apo-Cefadroxil
(sef-a′zoe-lin)
(sef-a-lex′in)
Keflex, Panixine
Func. class.:
Antiinfective
Chem. class.:
Cephalosporin (1st generation)
Do not confuse:
cephalexin
/cefaclor
Inhibits bacterial cell wall synthesis; renders cell wall osmotically unstable, leads to cell death; lysis mediated by cell wall autolytic enzymes
cefadroxil:
Gram-negative bacilli:
Escherichia coli, Proteus mirabilis, Klebsiella
(UTI only); gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin infections; otitis media; tonsillitis; UTIs
ceFAZolin:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin infections; bone, joint, biliary, genital infections; endocarditis, surgical prophylaxis, septicemia
cephalexin:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
upper, lower respiratory tract, urinary tract, skin, bone infections; otitis media
Hypersensitivity to cephalosporins, infants <1 mo
Precautions:
Pregnancy (B), breastfeeding, hypersensitivity to penicillins, renal disease
Calculator
• Adult:
PO
1-2 g/day or divided q12hr; loading dose of 1 g initially
• Child:
PO
30 mg/kg/day in divided doses bid, max 2 g/day
• Adult:
PO
CCr 25-50 ml/min, 500 mg q12hr; CCr 10-24 ml/min, 500 mg q24hr; CCr <10 ml/min, 500 mg q36hr
Available forms:
Caps 500 mg; tabs 1 g; oral susp 250, 500 mg/5 ml
• Adult:
IM/IV
1-2 g q6-8hr; max 12 g/day
• Child >1 mo:
IM/IV
75-100 mg/kg in 3-4 divided doses; max 6 g/day
• Adult:
IM/IV
250 mg-1 g q8hr, max 12 g/day
• Child >1 mo:
IM/IV
25-50 mg/kg in 3-4 equal doses, max 6 g/day, or 2 g as a single dose
• Adult:
IM/IV
after loading dose, CCr 35-54 ml/min, dose q8hr; CCr 10-34 ml/min, 50% of dose q12hr; CCr <10 ml/min, 50% of dose q18-24hr
• Child:
IM/IV
CCr >70 ml/min, no dosage adjustment; CCr 40-70 ml/min after loading dose, reduce dose to 7.5-30 mg/kg q12hr; CCr 20-39 ml/min, give 3.125-12.5 mg/kg after loading dose q12hr; CCr 5-19 ml/min, 2.5-10 mg/kg after loading dose q24hr
Available forms:
Inj 250, 500 mg, 1, 5, 10, 20 g; inf 500 mg, 1 g/50-ml vial
• Adult:
PO
250-500 mg q6hr, max 4 g/day
• Child:
PO
25-50 mg/kg/day in 4 equal doses, max 4 g/day
• Adult:
PO
500 mg q12hr
•
2 g 1 hr before procedure
• Adult:
PO
500 mg-1 g q6hr
• Child:
PO
50-100 mg/kg/day in 4 equal doses, max 4 g/day
• Adult:
PO
CCr 10-40 ml/min, 250-500 mg then 250-500 mg q8-12hr; CCr <10 ml/min, 250-500 mg then 250-500 mg q12-24hr
Available forms:
Caps 250, 500 mg; tabs 250, 500 mg, 1 g; oral susp 125 mg, 250 mg/5 ml
•
For 10-14 days to ensure organism death, prevent superinfection
•
With food if needed for GI symptoms
•
Shake susp, refrigerate, discard after 2 wk
•
After C&S completed
•
Check for irritation, extravasation often; dilute in 10 ml sterile water for inj, run over 3-5 min; may be further diluted with 50-100 ml of NS, D
5
W sol, run over 1/2-1 hr by
Y
-tube or 3-way stopcock
•
For 10-14 days to ensure organism death, prevent superinfection
•
After C&S completed
Syringe compatibilities:
DimenhyDRINATE, heparin, vit B complex
Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, alprostadil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B liposome, anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, cefamandole, cefmetazole, cefonicid, cefoperazone, cefoTEtan, cefOXitin, cefpirome, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, DOCEtaxel, doxacurium, doxapram, DOXOrubicin liposomal, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, esmolol, etoposide, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid (as sodium salt), foscarnet, furosemide, gallium, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoproterenol, ketorolac, lidocaine, linezolid, LORazepam, LR’s injection, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, penicillin G potassium/sodium, peritoneal dialysis solution, perphenazine, PHENobarbital, phenylephrine, phytonadione, piperacillin, Plasma-Lyte M in dextrose 5%, polymyxin B, potassium chloride, procainamide, propofol, propranolol, ranitidine, remifentanil, Ringer’s injection, ritodrine, riTUXimab, sargramostim, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil,
tacrolimus, teniposide, tenoxicam, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tolazoline, trastuzumab, trimetaphan, urokinase, vasopressin, vecuronium, verapamil, vinCRIStine, vitamin B complex with C, voriconazole, warfarin
•
Shake susp, refrigerate, discard after 2 wk
•
For 10-14 days to ensure organism death, prevent superinfection
•
With food if needed for GI symptoms
•
After C&S
CNS:
Headache, dizziness, weakness, paresthesia, fever, chills,
seizures
(with high doses)
GI:
Nausea, vomiting,
diarrhea, anorexia
, pain, glossitis, bleeding; increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain,
pseudomembranous colitis
GU:
Proteinuria, vaginitis, pruritus, candidiasis, increased BUN,
nephrotoxicity, renal failure
HEMA:
Leukopenia, thrombocytopenia, agranulocytosis,
anemia,
neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia
INTEG:
Rash, urticaria, dermatitis
RESP:
Dyspnea
SYST:
Anaphylaxis, serum sickness,
superinfection,
Stevens-Johnson syndrome
cefadroxil:
Peak 1-1½ hr, duration 12-24 hr, half-life 1-2 hr, 20% bound by plasma proteins, crosses placenta, excreted in breast milk
IM:
Peak 1/2-2 hr, duration 6-12 hr, half-life 1½-2¼ hr
IM:
Peak 10 min, duration 6-12 hr, eliminated unchanged in urine, 75%-85% protein bound
cephalexin:
Peak 1 hr, duration 6-12 hr, half-life 30-72 min, 5%-15% bound by plasma proteins, 80%-100% eliminated unchanged in urine, crosses placenta, excreted in breast milk
Increase:
prothrombin time—anticoagulants; use cautiously
Increase:
toxicity—aminoglycosides, loop diuretics, probenecid
Increase:
AST, ALT, alk phos, LDH, BUN, creatinine, bilirubin
False positive:
urinary protein, direct Coombs’ test, urine glucose
Interference:
cross-matching
•
Sensitivity to penicillin and other cephalosporins
Nephrotoxicity
: increased BUN, creatinine; urine output: if decreasing, notify prescriber
•
I&O daily
•
Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos, Coombs’ test monthly if patient is on long-term therapy
•
Electrolytes: potassium, sodium, chlorine monthly if patient is on long-term therapy
•
Pseudomembranous colitis:
bowel pattern daily; if severe diarrhea occurs, product should be discontinued
Anaphylaxis:
rash, urticaria, pruritus, chills, fever, joint pain; angioedema; may occur a few days after therapy begins; discontinue product, notify prescriber immediately, keep emergency equipment nearby
•
Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily
Overgrowth of infection:
perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough, sputum
•
Therapeutic response: decreased symptoms of infection, negative C&S
•
To use yogurt or buttermilk to maintain intestinal flora, decrease diarrhea
•
To take all medication prescribed for length of time ordered
To report sore throat, bruising, bleeding, joint pain (may indicate
blood dyscrasias
[rare]); diarrhea with mucus, blood (may indicate
pseudomembranous colitis
)
