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IVPB & IV push meds
Class Action Indications Side effects Dosage Nursing Implications
33
Nursing
08/25/2011

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Cards

Term
phenytoin sodium (Dilantin)
IV push
Definition
Class: Anticonvulsant

Action: Selectively stabilizes seizure threshold and depresses seizure activity in the motor cortex. May take 15 to 20 minutes to take effect.

Indications: Control of grand mal and psychomotor seizures. Treatment of status epilepticus.

Usual dose: Loading dose 10 to 15 mg/kg. Do not exceed total dose of 1.5 g. Lethal dose estimated at 2 to 5 g. Maintenance doses 100 mg every 6 to 8 hours.

Side effects: Ataxia, confusion, dizziness, drowsiness.

Interactions: Do not add to IV solutions or mix with other meds.

Nursing Implications: Very alkaline; follow with sterile NS to reduce local venous irritation. Best before and after. Adults: 25 to 50 mg or fraction thereof over 1 minute. Do not exceed 50 mg/min.
Term
prochlorperazine edisylate (Compazine)
IV push
Definition
Class: Anti-emetic

Action: As a potent antiemetic acts both centrally at the chemoreceptor trigger zone and peripherally by blocking the vagus nerve in the GI tract. Onset of action is prompt and lasting.

Indications: Control of severe nausea and vomiting.

Usual dose: Single IV dose not to exceed 10 mg. Max daily IV dose should not exceed 40 mg. Normal dose 2.5 to 10 mg; may be repeated one time in 1 to 2 hours if indicated.

Side effects: Extrapyramidal reactions, orthostatic hypotension, blurred vision, constipation, dry mouth, urine retention, mild photosensitivity reactions.

Interactions: Do not use in comatose or severely depressed states or in the presence of large amounts of CNS depressants.

Nursing Implications: Deliver each 5 mg or fraction thereof over 1 minute.
Term
hydromorphone hydrochloride (Dilaudid)
IV push
Definition
Class: Narcotic analgesic

Action: Provides potent analgesia without significant hypnotic effects. Six times more potent than morphine. Onset of action 10 to 15 minutes and lasts 2 to 3 hours.

Indication: Moderate to severe acute or chronic pain, especially in situations in which a hypnotic effect is not desirable, such as postoperatively or in some malignancies.

Usual dose: 0.5 to 1 mg every 3 hours as needed. May increase up to 4 mg every 4 to 6 hours if pain is severe.

Side effects: Constipation, dizziness, dry mouth, dysphoria, euphoria, flushing, light-headedness, nausea, pruritus, sweating, and vomiting.

Nursing Implications: Schedule II narcotic. Administer 2 mg or fraction thereof over 2 to 5 minutes.
Term
digoxin (Lanoxin)
IV push
Definition
Class: Antiarrhythmic

Action: Onset of action within 5 to 30 minutes and lasts 2 to 3 days. Positive inotropic action, increasing the strength of myocardial contraction, Also alters electric behavior of heart muscle through actions on myocardial automaticity, conduction velocity, and refraction.

Indications: CHF, atrial fibrillation, atrial flutter, selected paroxysmal tachycardia or AV junctional rhythm, selected supraventricular tachycardias, cardiogenic shock, and pre/intra/post-op because of stress on the heart.

Usual dose: 0.25 to 0.5 mg (1 to 2 mL) as the initial dose, followed by 0.25 to 0.5 mg (1 to 2 mL) at 4- to 6-hour intervals until digitalized (approx 4 to 6 hours).

Side effects: Seldom lasts more than 3 days after drug is DC'ed. Any form of digoxin may cause partial or AV block and almost any arrhythmia, including paroxysmal tachycardia, atrial tachycardia, fibrillation or standstill.

Nursing Implications: Each single dose over a minimum of 5 minutes.
Term
furosemide (Lasix)
IV push
Definition
Class: Diuretic, antihypertensive

Action: Extremely potent and has rapid onset of action. Effectiveness is noted within 5 minutes and may last for 2 hours. Acts on proximal and distal ends of the tubule and the ascending limb of the loop of Henle to excrete water, sodium, chlorides, and potassium.

Indication: Edema associated with CHF, cirrhosis of liver with ascites, and renal disease including the nephrotic syndrome, acute pulmonary edema, hypercalcemia, hypertension.

Usual dose: 20 to 40 mg. May be repeated in 1 to 2 hours. If necessary, increase dosage by 20-mg increments until desired diuresis is obtained. IV bolus dose should not exceed 1 g/day. If larger dose needed, give as infusion.

Side effects: Usually occur in prolonged therapy, seriously ill patients, or following large doses. Anemia, anorexia, blurring of vision, reversible deafness.

Interactions: Potentiates antihypertensive drugs.

Nursing Implications: Each 40 mg or fraction thereof should be given over 1 to 2 minutes. A 10-g bolus must be given over at least 30 minutes; up to 3 hours is preferred.
Term
morphine sulfate (Astramorph PF, Duramorph PF)
IV push
Definition
Class: Narcotic analgesic

Action: Pain relief effected almost immediately and lasts up to 4 to 5 hours. Induces sleep and inhibits perception of pain by binding to opiate receptors, decreasing sodium permeability, and inhibiting transmission of pain impulses.

Indications: Relief of moderate to severe acute and chronic pain. Analgesic of choice in pain associated with myocardial infarction.

Usual dose: 2.5 to 15 mg. Repeat every 2 to 4 hours as necessary.

Side effects: Anxiety, confusion, constipation, depression of cough reflex.

Interactions: Alcohol, other CNS depressants.

Nursing Implications: Schedule II narcotic. Deliver 15 mg or fraction thereof over 4 to 5 minutes.
Term
diltiazem hydrochloride (Cardizem)
IVPB
Definition
Action: Calcium channel blocker, antiarrhythmic

Action: Directly inhibits the influx of calcium ions through slow channels during membrace depolarization of cardiac and vascular smooth muscle. Slows conduction through the AV node, prolongs the effective refractory period, reduces ventricular rates, and helps to prevent embolic complications.

Indications: Temporary control of rapid ventricular rate in atrial fibrillation or atrial flutter unless associated with an accessory bypass tract, rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm.

Usual dose: 0.25 mg/kg of body weight initially (20 mg for the average patient). Second dose of 0.25 mg/kg may be given in 15 minutes if needed to achieve HR reduction (25 mg for average patient).

Side effects: Arryhthmia, flushing, hypotension, and injection site reactions (burning, itching).

Interactions: Many, including regular insulin, Lasix.

Nursing Implications: Each single dose equally distributed over 2 minutes.
Term
cefazolin sodium (Ancef)
IVPB
Definition
Class: Antibiotic

Action: Semi-synthetic, first-generation, broad-spectrum cephalosporin antibiotic that is bactericidal through inhibition of cell wall synthesis to some gram-positive and gram-negative organisms, including staph and strep.

Indications: Treatment of serious infections of the bone, joints, skin, soft tissue, respiratory tract, biliary tract, and GU tract; septicemia and endocarditis.

Usual dose: 250 mg to 1.5 g every 6 to 8 hours. Up to 6 g is usual, but 12 g in 24 hours has been used, depending on severity of infection. Max recommended dose is 500 mg every 8 hours in the elderly (over 75).

Side effects: Abdominal pain, chills, diaphoresis, none common.

Interactions: If given concurrently with aminoglycosides, administer at separate site.

Nursing Implications: Each 1 g or fraction thereof over 3 to 5 minutes. Extend admin time as indicated by amount of solution and condition of patient.
Term
dopamine hydrochloride (Dopamine)
IVPB
Definition
Class: Inotropic agent, cardiac stimulant, vasopressor

Action: Chemical precursor of norepinephrine, possessing alpha, beta, and dopaminergic receptor-stimulating actions. Increases cardiac output with minimum increase in myocardial oxygen consumption.

Indications: Correct hemodynamic imbalances, drug of choice for hypotension and shock.

Usual dose: 2 to 5 mcg/kg of body weight/min initially in patients likely to respond to minimum treatment 5 to 10 mcg/kg/min may be required initially to correct hypotension in the seriously ill patient. Gradually increase 5 to 10 mcg/kg/min at 10- to 30-minute intervals until optimum response occurs. Average dose 20 mcg/kg/min.

Side effects: Anginal pain, bradycardia, hypertension.

Interactions: Do not add sodium bicarbonate or any other strongly alkaline solution; dopamine is inactivated in alkaline solution.

Nursing Implications: Begin with recommended dose for body weight and seriousness of condition. Gradually increase by 5 to 10 mcg/kg of body weight/min to effect desired response. Use slowest possible rate to maintain adequate or present systolic BP. Use microdrip or infusion pump for accuracy.
Term
dobutamine hydrochloride (Dobutamine)
IVPB
Definition
Class: Inotropic agent, cardiac stimulant

Action: Synthetic catecholamine chemically related to dopamine, direct-acting inotropic agent possessing beta-stimulator activity. Induces short-term increases in cardiac output by improving stroke volume with minimum increases in rate and BP, minimum rhythm disturbances, and decrease peripheral vascular resistance.


Indications: Short-term inotropic support in cardiac decompensation resulting from depressed contractility.

Usual dose: 0.5 to 1 mcg/kg/min initially in patients likely to respond to minimum treatment. Usual effective initial dose ranges from 2.5 to 15 mcg/kg of body weight/min. Gradually adjust rate at 2- to 10-minute intervals to effect desired response.

Side effects: Anginal pain, chest pain, headache, hypertension, hypokalemia.

Interactions: May be ineffective if beta-blocking drugs have been given.

Nursing Implications: Begin with recommended dose for body weight and seriousness of condition, Gradually increase to effect desired response. May take up to 10 minutes to achieve peak effect of a specific dose. Maintain at correct therapeutic level with microdrop (60 gtt/mL) or infusion pump.
Term
metronidazole hydrochloride (Flagyl)
IVPB
Definition
Class: Antibiotic

Action: Bactericidal agent with cytotoxic effects, active against specific anaerobic bacteria and protozoa.

Indications: Treatment of serious intraabdominal, skin and skin structure, gynecologic, bone and joint, CNS, and lower respiratory tract infections, bacterial septicemia, and endocarditis.

Usual dose: Begin with initial loading dose of 15 mg/kg of body weight. Follow with 7.5 mg/kg (up to 1 g/dose) in 6 hours and every 6 hours thereafter for 7 to 10 days or longer if indicated. Do not exceed 4 g in 24 hours. May transfer to oral therapy when condition warrants.

Side effects: Abdominal cramping, anorexia, constipation, cystitis, darkened deep red urine.

Interactions: Avoid alcohol for at least 3 days after therapy completed.

Nursing Implications: Must be given as a slow intermittent or continuous IV infusion, each single dose evenly distributed over 1 hour. Discontinue primary IV during administration.
Term
levofloxacin (Levaquin)
IVPB
Definition
Class: Antibiotic

Action: Synthetic, broad-spectrum, fluoroquinolone antibacterial agent. Bactericidal to a wide range of aerobic gram-negative and gram-positive organisms, as well as some anaerobic organisms through interference with an enzyme needed for synthesis of bacterial DNA.

Indications: Treatment of adults with mild, moderate, and severe infections caused by susceptible strains of microorganisms in conditions including acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and nosocomial pneumonia.

Usual dose: 250 to 750 mg once every 24 hours.

Side effects: Abdominal pain, anorexia, anxiety, constipation.

Interactions: No other drugs should be added to mix or flushed through same line.

Nursing Implications: Each 250- or 500-mg dose must be equally distributed over 60 minutes as an infusion. A 750-mg dose must be equally distributed over 90 minutes as an infusion. Too-rapid infusion may cause hypotension.

Term
naloxone hydrochloride (Narcan)
IV push
Definition
Class: Antidote, narcotic antagonist

Action: Overcomes effects of narcotic overdose including respiratory distress, sedation, and hypotension. Does not have any narcotic effect itself.

Indications: Reversal of narcotic depression.

Usual dose: 0.4 to 2 mg. Repeat in 2 to 3 minutes if indicated. The question of narcotic overdose should be questioned if no response is observed after 10 mg given.

Side effects: Elevated PTT, hypertension, nausea and vomiting, sweating.

Interactions: Solutions with alkaline pH.

Nursing Implications: Each 10 mg or fraction thereof over 3 to 5 minutes. Ineffective against respiratory depression caused by barbituates, anesthetics, other non-narcotic agents, or pathologic conditions.
Term
nalbuphine hydrochloride (Nubain)
IV push
Definition
Class: Narcotic analgesic

Action: Synthetic narcotic agonist-antagonist analgesic. Equals morphine in analgesic effect. Does produce respiratory depression, but this does nto increase markedly with increased dose. Onset of pain relief occurs within 2 to 3 minutes and lasts about 3 to 6 hours.

Indications: Relief of moderate to severe pain. Preoperative and postoperative analgesia.

Usual dose: 10 mg/70 kg. May repeat every 3 to 6 hours. In nontolerant patients, the recommended single maximum dose is 20 mg. Maximum total daily dose is 160 mg.

Side effects: Abdominal pain, agitation, anaphylaxis, anxiety, blurred vision.

Interactions: Potentiated by other CNS depressants.

Nursing Implications: Each 10 mg or fraction thereof over 3 to 5 minutes.
Term
metoclopramide hydrochloride (Reglan)
IV push
Definition
Class: GI stimulant, antiemetic

Action: Dopamine antagonist. Antiemetic properties appear to be the result of antagonism of central and peripheral dopamine receptors. Blocks the stimulation of medullary chemoreceptor trigger zones by dopamine.

Indications: Facilitate small bowel intubation, stimulates gastric and intestinal emptying of barium to permit radiologic examination of the stomach and small intestine.

Usual dose: 10 mg (2 mL) as a single dose.

Side effects: Acute CHF, anxiety, arrhythmias, bowel disturbances, confusion.

Interactions: Chloramphenicol, sodium bicarbonate.

Nursing Implications: Too-rapid IV injection will cause intense anxiety, restlessness, and then drowsiness. 10 mg or fraction thereof over 2 minutes. Reduce rate of injection in peds patients.
Term
hydrocortisone sodium succinate (Solu-Cortef)
IV push
Definition
Class: Hormone, anti-inflammatory, antiemetic

Action: Contains the principal hormone secreted by the adrenal cortex and has both glucocorticoid and mineralocorticoid properties.

Indications: Agents of choice for adrenocortical insufficiency, occassionally used for asthma or shock.

Usual dose: 100 to 500 mg repeated as necessary every 2 to 10 hours.

Side effects: Do occur but are usually reversible: Alteration of glucose metabolism, Cushing's syndrome, electrolyte and calcium imbalance, euphoria or other psychic disturbances, increased BP.

Interactions: Many.

Nursing Implications: Each 500 mg or fraction thereof over 30 seconds to 1 minute. Extend to 10 minutes for larger doses.
Term
methylprednisolone sodium succinate (Solu-Medrol)
IV push
Definition
Class: Hormone, anti-inflammatory

Action: Adrenocortical steroid with potent metabolic, anti-inflammatory actions and innumerable other effects. Has a greater ant-inflammatory potency than prednisolone and less tendency to cause excessive potassium and calcium excretion and sodium and water retention.

Indications: Supplementary therapy for severe hypersensitivity reaction, shock unresponsive to conventional therapy.

Usual dose: 10 to 250 mg initially. May be repeated every 4 to 6 hours as necessary.

Side effects: Do occur but are usually reversible: Cushing's syndrome, electrolyte and calcium imbalance, euphoria, glycosuria, hyperglycemia.

Interactions: Many. Contraindicated in long-term therapy, except in life-threatening situations.

Nursing Implications: Each 500 mg or fraction thereof over 2 to 3 minutes or longer.
Term
methylprednisolone sodium succinate (Solu-Medrol)
IV push
Definition
Class: Hormone, anti-inflammatory

Action: Adrenocortical steroid with potent metabolic, anti-inflammatory actions and innumerable other effects. Has a greater ant-inflammatory potency than prednisolone and less tendency to cause excessive potassium and calcium excretion and sodium and water retention.

Indications: Supplementary therapy for severe hypersensitivity reaction, shock unresponsive to conventional therapy.

Usual dose: 10 to 250 mg initially. May be repeated every 4 to 6 hours as necessary.

Side effects: Do occur but are usually reversible: Cushing's syndrome, electrolyte and calcium imbalance, euphoria, glycosuria, hyperglycemia.

Interactions: Many. Contraindicated in long-term therapy, except in life-threatening situations.

Nursing Implications: Each 500 mg or fraction thereof over 2 to 3 minutes or longer.
Term
ketorolac tromethamine (Toradol)
IV push
Definition
Class: Analgesic (NSAID)

Action: NSAID with peripheral analgesic, anti-inflammatory, and antipyretic actions.

Indications: Short-term management of moderately severe, acute pain (no longer than 5 days).

Usual dose: 30 mg. May be repeated every 6 hours. maximum dose is 120 mg/24 hour.

Side effects: Diarrhea, dizziness, dyspepsia, drowsiness, edema.

Interactions: Additive if used with other NSAIDS. May others. Inhibits platelet aggregation and may prolong bleeding time.

Nursing Implications: A single dose over a minimum of 15 seconds; evenly distributed over 1 to 2 minutes is preferred.
Term
diazepam (Valium)
IV push
Definition
Class: Benzodiazepine, sedative-hypnotic, antianxiety agent, anticonvulsant, amnestic, skeletal muscle relaxant

Action: Depresses the central, autonomic, and peripheral nervous systems in an undetermined manner.

Indications: Management of moderate to severe anxiety disorders or short-term relief of symptoms of anxiety. Acute alcohol withdrawal. Muscle spasm. Status epilepticus. Preoperative medication, including endoscopic procedures. Cardioversion.

Usual dose: Maximum dose in status epilepticus is 30 mg in 8 hours. Usually 2 to 15 mg, varies.

Side effects: Apnea, ataxia, blurred vision, bradycardia, cardiac arrest.

Interactions: Do not mix with any other drug or solution in syringe or solution. Do not use with open-angle glaucoma unless receiving appropriate therapy.

Nursing Implications: 5 mg (1 mL) or fraction thereof over 1 minute.
Term
ondansetron hydrochloride (Zofran)
IV push
Definition
Class: Antiemetic

Action: Selective antagonist of serotonin receptors. Chemotherapeutic agents such as cisplatin increase the release of serotonin from specific cells in the GI tract, causing emesis.

Indications: Prevention of nausea and vomiting.

Usual dose: 4 mg before anaesthesia induction or postoperatively if the patient experiences nausea or vomiting. Although repeat doses are not recommended by the manufacturer, they have been given.

Side effects: Agitation, arrhythmias, chest pain, cold sensations, constipation.

Interactions: phenytoin, carbamazepine, rifampin, many others.

Nursing Implications: A single 4-mg dose over at least 30 seconds; 2 to 5 minutes preferred.
Term
bumetanide (Bumex)
IV push
Definition
Class: Diuretic (loop)

Action: Sulfonamide diuretic, antihypertensive, and antihypercalcemic agent related to the thiazides.

Indications: Edema associated with congestive heart failure, cirrhosis of the liver with ascites, renal diseases including nephrotic syndrome.

Usual dose: 0.5 to 1 mg. May be repeated at 2- to 3-hour intervals. Can be used for patients allergic to furosemide.

Side effects: Usually occur in prolonged therapy, serious ill patients, or following large doses. Abdominal pain, arthritic pain, azotemia, dizziness, headache.

Interactions: Do not use with anuria, causes excessive potassium depletion with corticosteroids, thiazide diuretics.

Nursing Implications: A single dose by IV injection over 1 to 2 minutes.
Term
heparin sodium (Heparin)
IV push
Definition
Class: Anticoagulant

Action: Anticoagulant with immediate and predictable effects on the blood.

Indications: Prevention and/or treatment of all types of thromboses and emoli including DVT, PE, and embolization associated with a-fib.

Usual dose: 10,000 units initially. Dosage is repeated every 4 to 6 hours and adjusted according to coagulation rest results. Usually 5, 000 to 10,000 units.

Side effects: Bruising, epistaxis, hematuria, hemorrhage, tarry stools or any other signs of bleeding.

Interactions: Do not administer others through same IV line. Many contraindications.

Nursing Implications: First 1,000 units or fraction thereof over 1 minute. After this test done, any single injection (5,000 units or fraction thereof) may be given over 1 minute.
Term
fentanyl citrate (Fentanyl)
Definition
Class: Narcotic analgesic

Action: Opium derivative, narcotic analgesic, which is a descending CNS depressant. Approximately 100 times more potent than morphine. Definite respiratory-depressant actions that outlast its analgesic effect.

Indications: Adjunt to general and regional anesthesia. Short-term analgesia during perioperative period.

Usual dose: 50 to 100 mcg (0.05 to 0.1 mg).

Side effects: Bradycardia, diaphoresis, hypersensitivity reactions, hypertension, hypotension.

Interactions: Concurrent use of Valium use with higher doses of fentanyl may produce vasodilation. Many others.

Nursing Implications: Administer over a minimum of 3 to 5 minutes. Rapid administration may result in apnea or respiratory paralysis.
Term
potassium acetate and potassium chloride
IVPB
Definition
Class: Electrolyte replenisher, antihypokalemic

Action: Potassium: Principal cation of intracellular fluid. Participates in carb utilization and protein synthesis. Critical in the regulation of nerve conduction and muscle contraction, particularly in the heart. Chloride: Major extracellular anion. Changes in acid-base balance of the body are reflected by the changes in chloride concentration. Acetate: Alternate source of bicarbonate by metabolic conversion in the liver.

Indications: Prophylaxis or treatment of potassium deficiency.

Usual dose: 40 to 80 mEq/24 hour.

Side effects: Abdominal pain, diarrhea, nausea, vomiting.

Interactions: Potentiated by angiotensin-converting enzyme inhibitors. Others.

Nursing Implications: Maximum of 10 mEq/hr of potassium chloride in any given amount of infusion fluid should not be exceeded. Impaired renal function or adrenal insufficiency can cause potassium intoxication, which can develop rapidly and without symptoms.
Term
ceftriaxone sodium (Rocephin)
IVPB
Definition
Class: Antibiotic

Action: Broad-spectrum, third-generation cephalosporin antibiotic. Bactericidal to selected gram-negative, gram-positive, and anaerobic organisms. Effective against many otherwise resistant organisms. Inhibits bacterial cell wall synthesis.

Indications: Treatment of serious lower respiratory tract, urinary tract, skin and skin structure, bone and joint, and intraabdominal infections.

Usual dose: 1 to 2 g/24 hour at 12- or 24-hour intervals.

Side effects: Allergic pneumonitis, bleeding episodes, burning, discomfort, and pain at injection site, diarrhea, others.

Interactions: Do not use with diluents containing calcium such as Ringer's solution or Hartmann's solution, to reconstitute. Many others.

Nursing Implications: A single dose over 30 minutes.
Term
ranitidine (Zantac)
IVPB
Definition
Class: H2 antagonist, altiulcer agent, gastric acid inhibitor

Action: Histamine H2 antagonist, it inhibits both daytime and nocturnal basal gastric acid secretion. It also inhibits gastric acid secretion stimulated by food, histamine, bentazole, and pentagastric. Not an anticholinergic agent. Does not lower calcium levels. Onset is prompt and effective for 6 to 8 hours. Five to 12 times more potent than cimetidine.

Indications: Short-term treatment of intractable duodenal ulcers and pathologic hypersecretory conditions in the hospitalized patient, treatment of active benign gastric ulcers in those patients unable to take oral medication, others.

Usual dose: 50 mg (2mL) every 6 to 8 hours.

Side effects: Abdominal discomfort, burning and itching at IV site, constipation, diarrhea, headache, and nausea and vomiting are most common.

Interactions: Warfarin, others. No additives into premixed solution.

Nursing Implications: Too-rapid administration has precipitated rare instances of bradycardia, tachycardia, and PVCs. Each 50 mg or fraction thereof at a rate not to exceed 4 mL/min diluted solution (20 mL over 5 min).
Term
gentamicin sulfate (Gentamycin)
IVPB
Definition
Class; Antibiotic

Action: Aminoglycoside antibiotic with neuromuscular blocking action. Bactericidal against specific gram-negative bacilli, including E. Coli, Klebsiella, Proteus, and Pseudomonas. Not effective for fungi or viral infections.

Indications: Treatment of serious infections of the GI, respiratory, and urinary tracts, CNS, skin, bone, soft tissue, septicemia, and bacterial neonatal sepsis.

Usual dose: 3 mg/kg of body weight/24 hour equally divided into 3 or 4 doses (1 mg/kg every 8 hours or 0.75 mg/kg every 6 hours. Up to 5 mg/kg/24 may be given if indicated.

Side effects: Occur more frequently with impaired renal function, higher doses or prolonged administration, in dehydrated or elderly patients, and in patients receiving other ototoxic or nephrotoxic drugs. Anorexia, burning, dizziness, fever, headache, hypertension, hypotension, itching, lethargy, muscle twitching, nausea, numbness, rash, roaring in ears, seizures, tingling sensation, tinnitus, urticaria, vomiting, weight less.

Interactions: Inactivated in solution with penicillins but is synergistic when used in combination with beta-lactam antibiotics.

Nursing Implications: Each single dose, properly diluted, over 30 to 6 minutes, up to 2 hours in peds patients.
Term
piperacillin sodium and tazobactam sodium (Zosyn)
IVPB
Definition
Class; Antibiotic

Action: Antimicrobial agent that combines the extended-spectrum penicillin piperacillin with the potent beta-lactamase inhibitor tazobactam. May be used in suspected polymicrobial infections due to its broad spectrum of activity.

Indications: Treatment of infections caused by piperacillin-resistant, piperacillin/tazobactam-susceptible, beta-lactamase-producing strains of specific microorganisms in the following conditions: intraabdominal, gynecologic, skin and skin structure, pneumonia, others.

Usual dose: Measurement of both drugs is included in the total dose. For every 1 g of piperacillin there is 0.125 g of tazobactam (8:1 ration). 12 g piperacillin/1.5 g tazobactam/ 24 hours given as 3.375 (3 g piperacillin/0.375 g tazobactam) every 6 hours.

Side effects: Hypokalemia, prolonged PTT, and prolonged PT. Abdominal pain, agitation, anxiety, chest pain, constipation, diarrhea, others.

Interactions: Aminoglycosides, others. Do not mix with other drugs in a syringe or infusion bottle.

Nursing Implications: A single dose over 30 minutes as an intermittent infusion. Discontinue primary IV infusion during administration. Slow infusion rate for pain along venipuncture site.
Term
ampicillin sodium and sulbactam sodium (Unasyn)
IVPB
Definition
Class: Antibiotic

Action: Semisynthetic penicillin. The addition of sulbactam improves ampicillin's bactericidal activity against beta-lactamase-producing strains resistant to penicillins and cephalosporins. Broad-spectrum antibiotic and beta-lactamase inhibitor effective against selected gram-positive, gram-negative, and anaerobic organisms.

Indications: Treatment of skin and skin structure and intraabdominal and gynecologic infections due to susceptible strains of specific organisms.

Usual dose: 1.5 to 3 g every 6 hours (1 g ampicillin with 0.5 g sulbactam to 2 g ampicillin with 1 g sulbactam). All commercial preparations in US have 2:1 ratio of ampicillin to sulbactam.

Side effects: Burning discomfort, and pain at injection site, diarrhea, rash, thrombophlebitis most common.

Interactions: May be inactivated in solution with aminoglycosides, gentamicin. Do not mix in same solution. Separate sites required.

Nursing Implications: A single dose over a minimum of 10 to 15 minutes.
Term
pantoprazole sium (Protonix)
IVPB
Definition
Class: Proton pump inhibitor

Action: A proton pump inhibitor that suppresses the final step in gastric acid production. Acts at the secretory surface of the gastric parietal cell. Inhibits both basal and stimulated gastric acid secretion irrespective of the stimulus.

Indications: Short-term treatment (7 to 10 days) of gastroesophageal reflux disease with a history of erosive esophagitis.

Usual dose: 40 mg as an infusion once daily for 7 to 10 days.

Side effects: Abscess, abdominal pain, blurred vision, chest pain, confusion, diarrhea, headache, rash, tinnitus, others.

Interactions: Do not give IM or SC. Many drug interactions including Reyataz.

Nursing Implications: Dedicated line is preferred, but a Y-site may be used. IV line must be flushed before and after. 40 mg/10 mL or 80 mg/20 mL as an injection evenly distributed over at least 2 minutes. Or 40 mg/100 mL or 80mg/100 mL as an infusion evenly distributed over at least 15 minutes.
Term
vancomycin hydrochloride (Vancocin)
IVPB
Definition
Class: Antibiotic

Action: Very potent tricyclic glycopeptide antibiotic bactericidal against gram-positive organisms. Results from inhibition of cell wall synthesis. Also alters bacterial cell-membrane permeability and RNA synthesis.

Indications: Serious gram-positive infections including endocarditis, septicemia, bone, lower respiratory tract, and skin and skin structure infections that do not respond or are resistant to other less resistant staphylococci.

Usual dose: 7.5 mg/kg or 500 mg every 6 hours or 15 mg/kg or 1 g every 1 hours for 7 to 10 days.

Side effects: Chills, dizziness, fever, macular rashes, pain at injection site, pruritis, tinnitus, urticaria.

Interactions: Solutions containing dextrose may be contraindicated in patients with allergies to corn or corn products. Many other incompatibilities including aminoglycosides.

Nursing Implications: Too-rapid injection may cause severe hypotension and cardiac arrest. Single dose properly diluted at a rate not to exceed 10 mg/min or 60 minutes, whichever is longer.
Term
ertapenem (Ivanz)
IVPB
Definition
Class: Antibiotic

Action: Unique, synthetic 1-beta-methyl-carbapenem structurally related to betalactam antibiotics. Effective against gram-positive and gram-negative aerobic and anaerobic bacteria. Does not cover Pseudomonas and Acinetobacter species.

Indications: Treatment of moderate to severe infections caused by susceptible strains or microorganisms in conditions that include complicated intra-abdominal infections, complicated skin and skin structure infections, including diabetic foot infections without osteomyelitis, CAP, complicated urinary tract infections, septic abortion, and post-surgical gynecologic infections.

Usual dose: 1 g daily for up to 7 days. Dose varies with type of infection.

Side effects: Diarrhea, headache, pain at injection site, nausea, phlebitis/thrombophlebitis, vaginitis in females, vomiting.

Interactions: Probenicid, others.

Nursing Implications: Single dose as an infusion equally distributed over 30 minutes.