Drug Cards: Penicillins

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All of these drugs should be administered at least 1 hour before or two hours after a meal.

Generic Name: penicillin G (aqueous)
Trade Name: Pfizerpen

Drug Classification: Penicillins
Therapeutic Use: infections due to susceptible microorganisms; syphilis, gonorrhea
Contraindication: contraindicated in patients with hypersensitivity to penicillins or solutions containing dextrose may be contraindicated in patients with a known allergy to corn or corn products.
Therapeutic Blood serum level:≤0.1 µg/mL
Adverse effects: glossitis, stomatitis, gastritis, furry tongue, nausea, vomiting, diarrhea,rash,fever, pain at injection site, hypersensitivity reactions, hematopoietc changes.
Usual dose: up to 20-30 million Units/day IV or IM; dosage may also be based on weight.
Nursing Implications: should be used cautiously in patients with a history of hypersensitivity to penicillin or the cephalosporins. Penicillin should be used cautiously in patients with renal disease, asthma, bleeding disorders, gastrointestinal disease, pregnancy or lactation, and history of allergies.
Patient/ family teaching: The nurse should observe the patient closely for a hypersensitivity reaction, which may occur any time during therapy with the penicillin. Notify the health provider immediately if one or more of the following should occur: skin rash; hives (urticaria); severe diarrhea; vaginal or anal itching; black,furry tongue; sores in the mouth; swelling around the mouth or eyes; breathing difficulty; or gastrointestinal disturbances such as nausea, vomiting, and diarrhea.

Generic Name: penicillin G benzathine
Trade Name: Bicillin C-R, Bicillin L-A, Permapen

Drug Classification: Penicillins
Therapeutic Use: infections due to susceptible microorganisms, syphilis; prophylaxis of rheumatic fever or chorea.
Contraindication: contraindicated in patients with known history of mono, kidney disease, or severe bloody diarrhea from Antibiotics.
Therapeutic Blood serum level: >0.02ph/mL.
Adverse effects: same as penicillin G
Usual Dose: Up to 2.4 million Units/day IM
Nursing Implications: should be used cautiously in patients with a history of or suspected allergy (eczema, hives, hay fever, asthma).
Patient/family teaching: The nurse should advise the patient to not breast feed while taking this drug and take the drug at least 1 hour before or two hours after a meal. Contact the health care provider if there are any signs of an allergic reaction.

Generic Name: penicillin G procaine
Trade Name: Pfizerpen-AS, Wycillin

Drug Classification: Penicillins
Therapeutic Use: infections due to susceptible organisms.
Contraindications: Mono, Kidney Disease, Severe Bloody Diarrhea from Antibiotics.
Therapeutic Blood serum level: 5.0-7.5.
Adverse effects: same as penicillin G
Usual Dose: 600,000-2.4 million Units/day IM
Nursing Implications: Penicillin G procaine should be used with caution in individuals with histories of significant allergies and/or asthma.
Patient/ family teaching: The nurse should advise that without regular intake of the medication, gout attacks may occur. Also, the nurse should instruct the patient and family to notify the health care provider at once should the patient experience any adverse reactions or signs and symptoms of infection.

Generic Name: penicillin V
Trade Name: Veetids

Drug Classification: penicillins
Therapeutic Use: infections due to susceptible organsims
Contraindication: contraindicated in patients with known bloody diarrhea, mono, or kidney disease.
Therapeutic Blood serum levels: 125-500 mg q6h
Adverse effects: same as penicillin G
Usual Dose: 125-500 mg orally q6h or q8h.
Nursing Implications:should be used cautiously in patients with a history of or suspected allergy (eczema, hives, hay fever, asthma).
Patient/family teaching:Discontinue medication and promptly report to physician the onset of hypersensitivity reactions and superinfections if they occur. Use specially marked measuring device to ensure accurate doses of oral liquid preparation.

Generic Name: dicloxacillin sodium
Trade Name: Dynapen

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: A history of a hypersensitivity (anaphylactic) reaction to any penicillin is a contraindication.
Therapeutic Blood serum level: 14.4 mcg/mL
Adverse effects: sameas penicillin G
Usual Dose: 125-250 mg orally q6h.
Nursing Implications:should be used cautiously with a history of sensitivity of penicillin.
Patient/family teaching: the nurse should advise the patient that antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Generic Name: nafcillin
Trade Name: Generic only. No brands.

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: A history of a hypersensitivity (anaphylactic) reaction to any penicillin is a contraindication.Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.
Therapeutic Blood serum level: 8-40 µg/mL.
Adverse effects: same as penicillin G.
Usual Dose: 500 mg IV q4.
Nursing Implications: Nafcillin should generally not be administered to patients with a history of sensitivity to any penicillin.Penicillin should be used with caution in individuals with histories of significant allergies and/or asthma.
Patient/family teaching: Caution should be exercised when patients with concomitant hepatic insufficiency and renal dysfunction are treated with nafcillin and the drug should be administered an hour before or 2 hours after a meal.

Generic Name: oxacillin sodium
Trade Name: Bactocill

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma, kidney disease, liver disease.
Therapeutic Blood serum level: 43 µg/mL
Adverse effects:same as penicillin G
Usual Dose: 500 mg-1g orally q4-6h; 250 mg-1 g q4-6h IM, IV
Nursing Implications: should be used cautiously since this medication contains sodium. This could affect you if you are on a salt-restricted diet or if you have a condition which could be worsened with an increase in salt intake (e.g., congestive heart failure). Consult your doctor or pharmacist for more information.
Patient/family teaching: The nurse can explain that,if the diet permits, yogurt, buttermilk, or Acidophilus capsules may be taken to reduce the risk of fungal superinfection. If any stool is bloody, contact the health care provider.

Generic Name: amoxicillin
Trade Name: Amoxil, Trimox

Drug Classification:penicillins
Therapeutic Use: same as penicillin G
Contraindication: AMOXIL is contraindicated in patients who have experienced a serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to AMOXIL or to other β-lactam antibiotics (e.g., penicillins and cephalosporins).
Therapeutic Blood serum level: 1.5 mcg/mL to 3.0 mcg/m
Adverse effects: same as penicillin G
Usual Dose: 500-875 mg orally q12h or 250 mg orally q8h
Nursing Implications: Report onset of generalized, erythematous, maculopapular rash (ampicillin rash) to physician. Ampicillin rash is not due to hypersensitivity; however, hypersensitivity should be ruled out.
Patient/family teaching: Report onset of diarrhea and other possible symptoms of superinfection to physician.Do not breast feed while taking this drug without consulting physician.

Generic Name: ampicillin oral
Trade Name: Prinipen, Totacillin

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: Mono, Kidney Disease, Severe Bloody Diarrhea from Antibiotics
Therapeutic Blood serum level:(15.9 ,ug/ml)
Adverse effects: same as penicillin G
Usual dose: 250-500 mg orally q6h.
Nursing Implications: Use cautiously with renal disorders.
Patient/ family teaching: The nurse should advise the patient to report chills, wheezing, pruritus (itching), respiratory distress, or palpitations to physician immediately.Do not breast feed while taking this drug without consulting physician.

Generic Name: ampicillin sodium, parenteral
Trade Name: UNASYN

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: The use of UNASYN (ampicillin and sulbactam) is contraindicated in individuals with a history of hypersensitivity reactions to any of the penicillins.
Therapeutic Blood serum level: 40 to 71 mcg/mL
Adverse effects: same as penicillin G
Usual Dose:1-12 g/d IM, IV in divided doses q4-6h.
Nursing Implications:A high percentage of patients with mononucleosis who receive ampicillin develop a skin rash. Thus, ampicillin class antibiotics should not be administered to patients with mononucleosis.
Patient/family teaching: The nurse should tell the patient that diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.

Generic Name: amoxicillin and clavulante potassium
Trade Name: Augmentin

Drug Classification: Penicillin
Therapeutic Use:same as penicillin G
Contraindication: AUGMENTIN is contraindicated in patients with a history of allergic reactions to any penicillin. It is also contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with AUGMENTIN.
Therapeutic Blood Serum Level: 10 to 30 mL/minute
Adverse effects: same as penicillin G
Usual Dose: 250 mg orally q8h or 500 mg orally q12h For severe infections: up to 875 mg q12h
Nursing Implications: should be used cautiously with expectant mothers and a high percentage of patients with mononucleosis who receive ampicillin develop an erythematous skin rash. Thus, ampicillin-class antibiotics should not be administered to patients with mononucleosis.

Generic Name: ampicillin/sulbactam
Trade Name: Unasyn

Drug Classification: Penicillins
Therapeutic Use: same as penicillin G
Contraindication: hypersens. to drug/class/compon.
mononucleosis, caution if EBV, CMV infxn,caution if ALL,caution if non-anaphylactic hypersens. to beta-lactams,caution if renal impairment,caution if hyperuricemia.
Therapeutic Blood serum level: [1.5-3 g IM/IV q6h]
Adverse effects: same as penicillin G
Usual Dose: 1.5 g-3 g q6h IM or IV.
Nursing Implications: Be cautious if you switch from one tablet form to another (regular, chewable, or extended-release tablet), take only the new tablet form and strength prescribed for you. This medicine may not be as effective or could be harmful if you do not use the exact tablet form your doctor has prescribed.
Patient/family teaching: Be aware that oral disintegrating tablets must be used cautiously with patients with phenylktonuria and place the tablet on patient's tongue immediately after opening package. If the patient feels an increased risk of anxiety, confusion, or a tremor, contact a primary care provider.

Generic Name: piperacillin sodium and tazobactam sodium
Trade Name: Zosyn

Drug classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: PIPTAZIN is contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or �-lactamase inhibitors.
Therapeutic Blood serum level: 24 and 34 mcg/mL
Adverse effects: same as penicillin G
Usual Dose:3.375 g-4.5 g q6h IV
Nursing Implications: should be used cautiously with diets consisting of no salt/sodium intake.
Patient/ family teaching: Advise patient to report signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.

Generic Name: piperacillin sodium
Trade Name: Pipracil

Drug Classification: penicillins
Therapeutic Use: same as penicillin G
Contraindication: Hypersensitivity to penicillins or cephalosporins.
Therapeutic Blood serum levels: 125 to 200 mg/kg/day
Adverse effects: same as penicillin G
Usual Dose: 3-4 g q4-6h IV or IM; maximum dosage, 24 g/d.
Nursing Implications: should be used with caution so monitor for hemorrhagic manifestations because high doses may induce coagulation abnormalities.
Patient/family teaching: Advise patient or caregiver to immediately inform health care provider if injection-site pain or redness, skin rash, hives, itching, or shortness of breath occur during treatment. Advise patient or caregiver to report signs of superinfection to health care provider: black "furry" tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.

Generic Name: ticarcillin disodium
Trade Name: Ticar

Drug Classification: Penicillins
Therapeutic Use: same as penicillin G
Contraindication: TIMENTIN is contraindicated in patients with a history of hypersensitivity reactions to any of the penicillins.
Therapeutic Blood serum levels: 100 µg/ml
Adverse effects: same as penicillin G
Usual Dose: 150-300 mg/kg/d IV every 3,4, or 6 hours maximum dosage IM, 2-g injection
Nursing Implications: take cautions with patients with renal impairement for there may be seizures
Patient/family teaching: Nurse to advise patient to decrease sodium intake to reduce the risk of electrolyte imbalance.

Generic Name: ticarcillin and clavulante potassium
Trade Name: Timentin

Drug Classification: Penicillins
Therapeutic Use: same as penicillin G
Contraindication: The molecular weight, degree of protein binding, and pharmacokinetic profile of clavulanic acid together with information from a single patient with renal insufficiency all suggest that this compound may also be removed by hemodialysis or hypersensitivity.
Therapeutic Blood serum level:330 mcg/mL
Adverse effects: same as penicillin G
Usual Dose: up to 3.1 g IV q4-6h or 200-300 mg/kg/d IV in divided doses q4-6h
Nursing Implications: As with any penicillin, an allergic reaction, including anaphylaxis, may occur during administration of TIMENTIN, particularly in a hypersensitive individual.
Patient/ family teaching: The nurse should advise the patient if they have diarrhea that is watery or bloody;blood in your urine, feeling an urgent need to urinate, painful or difficult urination;
easy bruising or bleeding, unusual weakness;dry mouth, increased thirst, confusion, increased urination, muscle pain or weakness, fast heart rate, feeling light-headed, fainting;fever, chills, body aches, flu symptoms;fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;chest pain; or seizure (convulsions) to contact the primary care provider immediately.

Generic Name: carbenicillin indanyl sodium
Trade Name: Geocillin

Drug Classification: Penicillins
Therapeutic Use: UTIs caused by E.coli, Proteus, Enterobacter.
Contraindication: Geocillin (carbenicillin indanyl sodium) is ordinarily contraindicated in patients who have a known penicillin allergy.
Therapeutic Blood serum level: (4-12 mcg/mL)
Adverse effects same as penicillin G
Usual Dose: 382-764 mg orally QID
Nursing Implications:use caution with patients that have a history of or suspected atopy or allergies; history of allergy to cephalosporins or carbapenem; colitis; diabetes mellitus; lactation; impaired renal and hepatic function; patients on sodium restriction; pregnancy.
Patient/family teaching: The nurse should monitor patient for DERM, GI, general body side effects, and signs of superinfection. Report to health care provider if noted and significant. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.

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