© Infusion reaction: chills, fever, pain, swelling at site Evaluate: * Therapeutic response: resolution of infection, negative C&S for infecting or- anism, Teach patient/family: © That long-term therapy may be needed to clear infection (2 wk-3 mo, depending on type of infection), that frequent blood draws will be needed * To notify prescriber of bleeding, bruis- ing, or soft-tissue swelling, renal, neuro- logic side effects « Pregnancy/breastfeeding: To notify health care professional if pregnancy is planned or suspected, not to breastfeed el ampicillin (Rx) (am-pi-siltin) Func. class.: Antiinfective— broad-spectrum Chem. class.: Aminopenicilin ACTION: Interferes with cell wall rep- lication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic. pressure; lysis mediated by cell wall autolysins USES: Effective for gram-positive cocci (Staphylococcus aureus, Strep- tococcus pyogenes, Streptococcus faecalis, Streptococcus pneumoniae), ‘gram-negative cocci (Neisseria meningitidis), gram-negative bacilli (Haemophilus influenzae, Proteus mirabilis, Salmonella, Shigella, Liste- ria monocytogenes), gram-positive bacilli, meningitis, G1/GU/respiratory infections, endocarditis, septicemia, otitis media, skin infection, bacterial endocarditis CONTRAINDICATIONS: Hyper. sensitivity to penicillins, antimicrobial resistance Precautions: Pregnancy, breastfeeding, neonates, hypersensitivity to cephalospo- rins, renal disease, mononucleosis ampicillin 79 DOSAGE AND ROUTES Systemic infections © Adult and child =40 kg: PO 250-500 mg q6br; IVIM 2-8 g/day in divided doses q4-6hr * Child <40 kg: PO 50-100 mg/kg/day in divided doses q6-8hr; IVIM 100-150 mg/kg/day in divided doses q6hr Bacterial meningitis * Adult and adolescent: IM/IV 150- 200 mg/kg/day in divided doses q3-4 hr; IDSA dose IV 2 g q4hr * Infant and child: IM/IV 150-200 mg/ kg/day in divided doses q3-4hr; IDSA dose IV 200-400 mg/kg/day in divided doses qohr * Neonate >7 days and >2000 g: IM/IV 200 mg/kg/day in divided doses q6hr; IDSA dose IV 200 mg/kg/day in divided doses q6-8hr Prevention of bacterial endocarditis * Adult: IM/IV 2 g 30 min before pro- cedure © Child: IM/IV 50 mg/kg 30 min before procedure, max 2 g GI/GU infections other than N. gonorrhoeae © Adult and child >20 kg: PO 500 mg qohr, may use larger dose for more seri- ous infections © Child <40 kg: PO 50 mg/kg/day in divided doses q6-8hr Renal disease © Adult and child: CCr 10-50 mL/min extend to q6-12hr; CCr <10 mL/min ex- tend to q12-16hr Available forms: Powder for inj 125, 250, 500 mg, 1, 2, 10 ghial; caps 250, 500 mg; powder for oral susp 125, 250 mg/5 ml. Administer: © Check allergies before using; obtain C&S before using; begin before results are received PO route © Give in even doses around the clock, store caps in tight container, store after reconstituting in refrigerator up to 2 wk, 1 wk room temperature © Tabs may be crushed or caps opened and mixed with water Side effets: italics = common; red = life-threatening80 ampicillin © On empty stomach with plenty of wa- ter for best absorption (1-2 hr before meals or 2-3 hr after meals) * Shake susp well before each dose; store after reconstituting in refrigerator up to 2 wk, 1 wk room temperature IM route * Reconstitute by adding 0.9-1.2 ml/125-mg vial; 0.9-1.9 ml/250-mg vial; 1.2-1.8 mL/500-mg vial; 2.4-7.4 mL/1-g vial; 6.8 mL/2-g vial W route W direct * After diluting with sterile water 0.9-1.2 mI/125-mg product, administer over 3-5 min (up to 500 mg), 10-15 min (>500 mg) Intermittent IV INFUSION route * May be diluted in 50 ml. or more of DW, Ds 0.45% NaCl to a concentration of 30 mg/mL or less; IV sol is stable for 1 hr; give at prescribed rate, do not give in same tubing as aminoglycosides, sepa- rate by =1 hr ¥-site compatibilities: Acyclovir, alem- tuzumab, alprostadil, amifostine, amino- caproic acid, anidulafungin, argatroban, atenolol, azithromycin, bivalirudin, bleo- mycin, CARBOplatin, carmustine, CISpla- tin, clarithromycin, cyclophosphamide, cytarabine, DACTINomycin, DAPTOmy- cin, DAUNOrubicin liposome, dexme- detomidine, dexrazoxane, DOCEtaxel, doxacurium, doxapram, DOXOrubicin liposome, eptifibatide, etoposide, etopo- side phosphate, filgrastim, fludarabine, fluorouracil, foscarnet, gallium, gatiflox- acin, gemcitabine, gemtuzumab, granise- tron, hetastarch, ifosfamide, irinotecan, lepirudin, leucovorin, levoFLOXacin, line- zolid, mannitol, mechlorethamine, mel- phalan, methotrexate, metroNIDAZOLE, milrinone, octreotide, ofloxacin, oxalipla- tin, PACLitaxel, palonosetron, pamidro- nate, pancuronium, —_pantoprazole, PEMEtrexed, penicillin G potassium, per- phenazine, potassium acetate, propofol, remifentanil, riTUXimab, rocuronium, sodium acetate, teniposide, thiotepa, tige- cycline, tirofiban, TNA, trastuzumab, vecuronium, vinBLAStine, vinCRIStine, vit BVC, voriconazole, zoledronic acid SIDE EFFECTS CNS: Seizures (high doses) Gk: Nausea, vomiting, diarrhea, CDAD, stomatitis HEMA: Anemia, bone marrow depres- sion, granulocytopenia, leukopenia, eosinophilia INTEG: Rash, urticaria MISC: Anaphylaxis, serum sickness PHARMACOKINETICS Half-life 50-110 min; excreted in urine, bile, breast milk; crosses placenta; removed by dialysis PO: Peak 2 hr, duration 6-8 hr IM: Peak 1 hr, duration 6-8 hr W: Peak rapid, duration 6-8 hr INTERACTIONS Increase: bleeding—oral anticoagulants, monitor INR/PT Increase: ampicillin concentrations— probenecid, used for this action Increase: ampicillin-induced rash—allopurinol, monitor for rash Decrease: ampicillin level—H, antago- nists, proton pump inhibitors, separate by2hr Drug/Lab Test Increase: eosinophils, ALT, AST Decrease: conjugated estrogens during pregnancy, Hgb, WBC, platelets False positive: urine glucose, direct Coomb’s test Interference: urine glucose (Clinitest, Benedict's reagent, cupric $0,) NURSING CONSIDERATIONS Assess: © Infection: characteristics of wound, sputum; urine, stool, earache, fever WBC baseline, periodically; C&S before product therapy, product may be taken as soon as culture is taken © Hepatic studies: AST, ALT * Blood studies: WBC, RBC, Hgb, Het, bleeding time © CDAD: bowel pattern before/during treatment skin W canada only Oo Genetic warning* Skin eruptions after administration of penicillin to 1 wk after discontinuing product; identify allergies before using * Respiratory status: rate, character, wheezing, tightness in chest ‘+ Anaphylaxis: rash, itching, dyspnea, fa- cial swelling; stop product, notify prescrib- er, have emergency equipment available Evaluate: * Therapeutic response: absence of fe- ver, draining wounds, resolution of infec- tion Teach patient/fami * To take oral ampicillin on empty stomach with full glass of water; to use alternate contraception * All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after com- pleted course of medication * To report sore throat, fever, fatigue, di- arrhea (may indicate superinfection); to report rash, other signs of allergy * That product must be taken in equal intervals around the clock to maintain blood levels * To wear or carry emergency ID if al- Jergic to penicillins + CDAD: diarthea with blood or pus; no- tify prescriber * Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected or if breastfeeding: to use additional contra- ception if using oral contraception, effect may be decreased TREATMENT OF ANAPHY- LAXIS: Withdraw product, maintain airway; administer EPINEPHrine, amino- phylline, 0, IV corticosteroids ampicillin, sulbactam (Rx) Unasyn Func. class.: Antiinfective—broad- spectrum Chem. class: Aminopericilin with B-lactamase inhibitor ampicillin, sulbactam 81 ACTION: Interferes with cell wall rep- lication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic pressure: lysis due to cell wall autolytic enzymes; combination extends spectrum of activity by B-lactamase inhibition USES: Skin infections, intraabdominal infections, cellulitis, diabetic foot ulcer, nosocomial pneumonia, gynecologic infections; Acinetobacter sp., Actinomy- ces sp., Bacillus anthracis, Bacteroides sp., Bifidobacterium sp., Bordetella pertussis, Borrelia burgdorferi, Bru- cella sp., Clostridium sp., Corynebacte- rium diphtheriae/xerosis, Bikenella corrodens, Enterococcus faecalis, Ery- sipelothrix: rhusiopathiae, Escherichia coli, Eubacterium sp., Fusobacterium sp., Gardnerella vaginalis, Haemophi- lus influenzae (beta-lactamase nega- tive/positive), Helicobacter pylori, Klebsiella sp., Lactobacillus sp., Lepto- spira sp., Listeria monocytogenes, Moraxella catarrhalis, Morganella mor- ganii, Neisseria gonorrhoeae, Pas- teurella multocida, Peptococcus sp., Peptostreptococcus sp., Porphyromo- nas sp., Prevotella sp., Propionibacte- rium sp., Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Provi- dencia stuartii, Salmonella sp., Shi- gella sp., Staphylococcus aureus (MSSA)/epidermidis/saprophyticus, Streptococcus agalactiae/dysgalactiae/ pneumoniae/pyogenes, Treponema ‘pallidum, viridans streptococci CONTRAINDICATIONS: Hyper- sensitivity o penicillins, sulbactam Precautions: Pregnancy, breastfeeding, neonates, hypersensitivity to cephalosporins/carbapenems, renal disease, mononucleosis, viral infections, syphilis DOSAGE AND ROUTES * Adult/adolescent/child =40 kg: IM/IV 1.5-3 g qGhr, max 4 g/day sulbactam * Child =40 kg: IV 150-300 mg/kg/day divided q6hr Side effets: italics = common; red = life-threatening82 ampicillin, sulbactam Renal disease © Adult =40 kg: IM/IV CCr 15-30 mL/ min dose q12hr; CCr 5-15 mL/min dose q24hr Available forms: Powder for inj 1.5 g (1g ampicillin, 0.5 g sulbactam), 3 g (2 ampicillin, 1 g sulbactam), 15 g (10 g ampicillin, 5 g sulbactam) Adi ter: IM route * Reconstitute by adding 3.2 mL sterile water/1.5-g vial; 64 ml/3-g vial, give deep in large muscle, aspirate * Do not use IM in child ect IV route © After diluting 1.5 g/3.2 ml sterile wa- ter for inj or 3 9/6.4 mL (250 mg ampi- cillin/125 mg sulbactam), allow to stand. until foaming stops; may give over 15 min, inject slowly Intermittent IV INFUSION route * Dilute further in 50 mL or more of DW, NaCl; administer within 1 hr after reconstitution; give over 15-30 min, separate doses from aminoglycosides by 21 hr ¥-site compatibilities: Alemtuzumab, amifostine, aminocaproic acid, anidula- fungin, argatroban, atenolol, bivalirudin, bleomycin, CARBOplatin, carmustine, cefepime, CISplatin, codeine, cyclophos- phamide, cytarabine, DAPTOmycin, DAU- Norubicin liposome, dexmedetomidine, DOCEtaxel, doxacurium, DOXOrubicin liposomal, eptifibatide, etoposide, fenoldopam, filgrastim, fludarabine, fluo- rouracil, foscarnet, gallium, gatifloxacin, gemcitabine, granisetron, hetastarch, iri- notecan, levoFLOXacin, linezolid, metho- irexate, metroNIDAZOLE, octreotide, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantop: zole, PEMEtrexed, remifentanil, riTUX- imab, rocuronium, tacrolimus, tenipo- side, thiotepa, tigecycline, tirofiban, TNA, TPN, trastuzumab, vecuronium, vinCRI tine, voriconazole, zoledronic acid SIDE EFFECTS. CNS: Coma, seizures (high dose) Gi: Nausea, vomiting, diarrbea, abdom- inal pain, CDAD hepatotoxicity HEMA: Anemia, bone marrow depres sion, granulocytopenia, leukopenia, eosinophilia INTEG: Injection site reactions, rash, urticaria MISC: Anaphylaxis, serum sickness, Stevens-Johnson syndrome. PHARMACOKINETICS W: Peak 5 min, IM 1 hr; halflife 50-110 min (ampicillin) 1-1.4 hr (sulbactam), 10%-50% metabolized in liver, 75%-85% of both products excreted in urine, excreted in breast milk, crosses placenta INTERACTIONS Increase: bleeding risk—oral anticoagu- fants; check INR, PT Increase: ampicillin-induced rash—allopurinol, check for rash Increase: ampicillin level—probenecid Increase: methotrexate level—metho- skin ‘trexate Decrease: contraception effect—oral contraceptives, use additional contraception Drug/Lab Test False positive: urine glucose, urine protein NURSING CONSIDERATIONS Assess: © For previous sensitivity to penicillin or cephalosporins, cross-sensitivity is com- mon © Infection: characteristics of wound, sputum; take temperature, WBC count, check allergies before using; C&S be- fore product therapy, product may be given as soon as culture is taken * CDAD: bowel pattern before, during treatment * Hepatic studies; AST, ALT if on long- term therapy or impaired liver function * Anaphylaxis: skin eruptions after ad- ministration of ampicillin to 1 wk after discontinuing product W canada only Oo Genetic warningEvaluate: + Therapeutic response: absence of fe- ver, draining wounds; negative C&S Teach patient/fat + To report superinfection: vaginal iteh- ing; loose, foul-smelling stools; black furry tongue * GDAD: to report immediately to health care provider symptoms of fever, diarrhea with pus, blood, mucus; may occur up to 4 wk after treatment * To wear or carry emergency ID if al- lergic to penicillin products * Pregnancy/breastfeeding: If preg- nancy is planned or suspected; use addi- tional contraception if using oral contra- ceptives TREATMENT OF ANAPHY- LAXIS: Withdraw product, maintain airway; administer EPINEPHrine, amino- phylline, 0, IV corticosteroids el anakinra (Rx) (an-ah-kin’rah) Kineret Fune. class.: Antirheumatic (DMARD), immunomodulator Chem. class.: Recombinant form of human interleukin-1 receptor antago- nist (L-1Ra) Do not confuse: anakinra/amikacin Kineret/Amikin ACTION: A form of human interleu- kin-1 receptor antagonist (IL-1Ra) pro- duced by DNA technology; blocks activity of IL-1, thereby resulting in decreased inflammation, cartilage degradation, bone resorption USES: Reduction in signs and symp- toms of moderate to severe active rheu- matoid arthritis in patients 218 yr who have not responded to other disease- modifying agents, neonatal-onset multi- system inflammatory disease anakinra 83 CONTRAINDICATIONS: Hyper. sensitivity 10 Escherichia coli—derived proteins, latex; sepsis Precautions: Pregnancy, breastfeed- ing, children, geriatric patients, renal impairment, active infections, immuno- suppression, neoplastic disease, asthma DOSAGE AND ROUTES Rheumatoid arthritis * Adult: SUBCUT 100 mg/day at same time of the day Neonatal-onset multisystem inflammatory disease * Adult/child: SUBCUT 1-2 mg/kg/day, may increase by 0.5-1 mg to max 8 mg/ kp/day Renal dose © Adult: SUBCUT CCr <30 mL/min 100 mg every other day Available form: Inj 100 mg/0.67 ml. prefilled glass syringe Administer: ‘SUBCUT route © Do not use if cloudy, discolored, if particulate is present; protect from light * Do not admix with other sol or medi- cations; do not use filter; give at same time each day * Apply cold compress before, after inj, allow sol to warm to room temperature before use © Use middle thigh, abdomen (outside 2 inches from navel), upper outer buttocks, upper outer area of arm; rotate sites, give inj atleast 1 inch from old site; do not give in skin that is bruised, red, tender, hard; remove needle cover immediately before use, pull gently back on plunger, ifno blood appears, inject entire contents of prefilled syringe; discard any unused portion * Store in refrigerator; do not freeze, shake; protect from light SIDE EFFECTS CNS: Headache, fever EENT: Sinusitis Gk: Abdominal pain, nausea, diarrhea, vomiting HEMA: Neutropenia Side effets: italics = common; red = life-threatening