Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (85 page)
EPINEPHrine, antihistamines; resuscitate if needed
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
2ND GENERATION
cefaclor (Rx)
(sef′a-klor)
Ceclor, Raniclor
(sef′oh-tee-tan)
Cefotan
(se-fox′i-tin)
Mefoxin
(sef-proe′zill)
Cefzil
(sef-yoor-ox′eem)
Ceftin, Zinacef
Func. class.:
Antiinfective
Chem. class.:
Cephalosporin (2nd generation)
Do not confuse:
cefaclor
/cephalexin
Cefotan
/Ceftin
cefprozil
/ceFAZolin/cefuroxime
Cefzil
/Ceftin
Inhibits bacterial cell wall synthesis, renders cell wall osmotically unstable, leads to cell death by binding to cell wall membrane
cefaclor:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
respiratory tract, urinary tract, skin, bone, joint infections; otitis media
cefoTEtan:
Gram-negative organisms:
Haemophilus influenzae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis, Klebsiella, Citrobacter, Salmonella, Shigella, Acinetobacter, Bacteroides fragilis, Neisseria, Serratia;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
upper and lower, serious respiratory tract, urinary tract, skin, bone, joint, gynecologic, gonococcal, intraabdominal infections
cefOXitin:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Proteus, Klebsiella, Bacteroides fragilis, Neisseria gonorrhoeae;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
anaerobes including
Clostridium;
lower respiratory tract, urinary tract, skin, bone, gynecologic, gonococcal infections; septicemia, peritonitis
cefprozil:
Pharyngitis/tonsillitis; otitis media; secondary bacterial infection of acute bronchitis; acute bacterial exacerbation of chronic bronchitis; uncomplicated skin and skin-structure infections; acute sinusitis
cefuroxime:
Gram-negative bacilli:
Haemophilus influenzae, Escherichia coli, Neisseria, Proteus mirabilis, Klebsiella;
gram-positive organisms:
Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus;
serious lower respiratory tract, urinary tract, skin, bone, joint, gonococcal infections; septicemia, meningitis
Hypersensitivity to cephalosporins or related antibiotics; seizures
Precautions:
Pregnancy (B), breastfeeding, children, GI/renal disease
Calculator
• Adult:
PO
250-500 mg q8hr, max 4 g/day
• Child >1 mo:
PO
20-40 mg/kg/day in divided doses q8hr or total daily dose may be divided and given q12hr, max 1 g/day
Available forms:
Caps 250, 500 mg; oral susp 125, 187, 250, 375 mg/5 ml; chew tabs (Raniclor) 250, 375 mg
• Adult:
IM/IV
1-2 g q12hr × 5-10 days
• Adult:
IM/IV
CCr 10-30 ml/min, give dose q24hr or 1/2 dose q12hr; CCr <10 ml/min, give dose q48hr or 1/2 dose q24hr
• Adult:
IV
1-2 g 1/2-1 hr before surgery
Available forms:
Inj 1, 2, 10 g
• Adult:
IM/IV
1-2 g q6-8hr
• Adult:
IM/IV
after loading dose, CCr 30-50 ml/min, 1-2 g q8-12hr; CCr 10-29 ml/min, 1-2 g q12-24hr; CCr <10 ml/min, 0.5-1 g q12-24hr
• Adult/adolescent/child ≥45 kg:
IM
2 g as single dose with 1 g
PO
probenecid at same time
• Adult:
IM/IV
2 g q4hr
• Child ≥3 mo:
IM/IV
80-160 mg/kg/day divided q4-6hr; max 12 g/day
Available forms:
Powder for inj 1, 2, 10 g
•
CCr <30 ml/min, 50% of dose
• Adult:
PO
500 mg q24hr × 10 days
• Child 6 mo-12 yr:
PO
15 mg/kg q12hr × 10 days
• Adult:
PO
500 mg q12hr × 10 days
• Adult:
PO
250-500 mg q12hr × 10 days
Available forms:
Tabs 250, 500 mg; susp 125, 250 mg/5 ml
• Adult and child:
PO
250 mg q12hr; may increase to 500 mg q12hr for serious infections
• Adult:
IM/IV
750 mg-1.5 g q8hr for 5-10 days
• Adult:
PO
125 mg q12hr; may increase to 250 mg q12hr if needed
• Child <2 yr:
PO
125 mg bid
• Child >2 yr:
PO
250 mg bid
• Adult:
IV
1.5 g 1/2-1 hr before surgery
• Adult:
IM/IV
1.5 g q6hr; may give up to 3 g q8hr for bacterial meningitis
• Child >3 mo:
IM/IV
50-100 mg/kg/day or IM in divided doses q6-8hr
• Adult:
IM
1.5 g as single dose in 2 separate sites with oral probenecid
•
Dosage reduction indicated with severe renal impairment (CCr <20 ml/min)
Available forms:
Tabs 125, 250, 500 mg; inj 150, 750 mg, 1.5, 7.5 g; inj 750 mg; 1.5 g powder; susp 125, 250 mg/5 ml
•
Do not break, crush, or chew ext rel tabs or caps
•
On an empty stomach 1 hr before or 2 hr after a meal
•
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 completed
•
IV direct after diluting 1 g/10 ml sterile water for inj, give over 3-5 min; may be diluted further with 50-100 ml NS or D
5
W; shake; run over 1/2-1 hr by
Y
-tube or 3-way stopcock; discontinue primary inf during administration
•
May be stored 96 hr refrigerated or 24 hr at room temp
Y-site compatibilities:
Allopurinol, amifostine, aztreonam, diltiazem, famotidine, filgrastim, fluconazole, fludarabine, heparin, insulin (regular), melphalan, meperidine, morphine, PACLitaxel, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa
•
After diluting 1 g or less/10 ml or more D
5
W, NS and give over 3-5 min; may be diluted further with 50-100 ml NS or D
5
W; run over 1/2-1 hr by
Y
-tube or 3-way stopcock; discontinue primary inf during administration; give by cont inf at prescribed rate; may store 96 hr refrigerated or 24 hr at room temp
•
For 10-14 days to ensure organism death, prevent superinfection
•
After C&S completed
Syringe compatibilities:
Heparin, insulin
Y-site compatibilities:
Acyclovir, amifostine, amphotericin B cholesteryl sulfate complex, aztreonam, cyclophosphamide, diltiazem, DOXOrubicin liposome, famotidine, fluconazole, foscarnet, HYDROmorphone, magnesium sulfate, meperidine, morphine, ondansetron, perphenazine, remifentanil, teniposide, thiotepa
•
For 10-14 days to ensure organism death, prevent superinfection
•
After C&S
•
Refrigerate/shake susp before use
•
For 10-14 days to ensure organism death, prevent superinfection
•
With food if needed for GI symptoms
•
After C&S obtained
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, atracurium, aztreonam, cyclophosphamide, diltiazem, famotidine, fludarabine, foscarnet, HYDROmorphone, melphalan, meperidine, morphine, ondansetron, pancuronium, perphenazine, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, vecuronium
CNS:
Dizziness, headache, fatigue, paresthesia, fever, chills, confusion
GI:
Diarrhea
, nausea, vomiting, anorexia, dysgeusia, glossitis, bleeding; increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain, loose stools, flatulence, heartburn, stomach cramps, colitis, jaundice,
pseudomembranous colitis
GU:
Vaginitis, pruritus, candidiasis, increased BUN,
nephrotoxicity, renal failure,
pyuria, dysuria, reversible interstitial nephritis
HEMA:
Leukopenia, thrombocytopenia, agranulocytosis,
anemia,
neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia, leukocytosis, granulocytopenia
INTEG:
Rash, urticaria, dermatitis,
Stevens-Johnson syndrome
RESP:
Dyspnea
SYST:
Anaphylaxis,
serum sickness,
superinfection
PO:
Peak 1/2-1 hr, half-life 36-54 min, 25% bound by plasma proteins, 60%-85% eliminated unchanged in urine in 8 hr, crosses placenta, excreted in breast milk (low concentrations)
IM/IV:
Peak 1½-3 hr, half-life 3-5 hr, 75%-90% bound by plasma proteins, 50%-80% eliminated unchanged in urine, crosses placenta, excreted in breast milk
Half-life 0.75-1 hr; 65%-80% bound by plasma proteins; 90%-100% eliminated
unchanged in urine; crosses placenta, blood-brain barrier; eliminated in breast milk; not metabolize
IM:
Peak 15-60 min
IV:
Peak 3 min
PO:
Peak 1.5 hr, protein binding 36%, elimination half-life 1.3 hr (normal renal function), 2 hr (hepatic disease), 5½-6 hr (end-stage renal disease), extensively metabolized to an active metabolite, eliminated in urine 60%
Peak PO 2 hr, IM 45 min, IV 2-3 min, 66% excreted unchanged in urine, half-life 1-2 hr in normal renal functio
Increase:
effect/toxicity—aminoglycosides, furosemide, probenecid
Increase:
bleeding risk (cefotetan)—anticoagulants, thrombolytics, NSAIDs, antiplatelets, plicamycin, valproic acid
Decrease:
absorption of cephalosporin —antacids
Decrease:
effect of cephalosporin—H
2
-blockers
False increase:
creatinine (serum urine), urinary 17-KS
False positive:
urinary protein, direct Coombs’ test, urine glucose testing (Clinitest)
Interference:
cross-matching
Nephrotoxicity:
increased BUN, creatinine
•
I&O ratio
•
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
•
Bowel pattern daily; if severe diarrhea occurs, product should be discontinued; may indicate pseudomembranous colitis
•
Urine output; if decreasing, notify prescriber (may indicate nephrotoxicity)
Anaphylaxis:
rash, flushing, urticaria, pruritus, dyspnea; discontinue product, notify prescriber, have emergency equipment available
•
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: negative C&S
•
If diabetic, to use blood glucose testing
•
To complete full course of product therapy; to report persistent diarrhea
•
To use yogurt, buttermilk to maintain intestinal flora, decrease diarrhea
•
To notify prescriber if breastfeeding or of any side effects
To report sore throat, bruising, bleeding, joint pain (may indicate blood dyscrasias [rare]); diarrhea with mucus, blood (pseudomembranous colitis)
