Anti-infective Medications Flashcards
Why IV anti-infectives?
- Patient has “orders” for Nothing By Mouth (NPO)
- Critically-ill patient
- Therapeutic drug monitoring
- Pharmacokinetic / pharmacodynamic considerations
Considerations for IV anti-infectives
- verify allergies
- diluent
- dosing; organ dysfunction, weight based
- volume
- rate of administration
- concentration-related medication errors
- compatibility
- continuous versus intermittent versus bolud
- hypersensitivity
- extravasation
- storage
What are the common anti-infectives?
- Penicillins
- Cephalosporins
- Aminoglycosides
- Vancomycin
- Daptomycin
Which drugs are in the Penicillin class?
- Nafcillin
- Penicillin G
- Ampicillin/sulbactam (Unsayn®)
- Piperacillin/sulbactam ( Zosyn®)
Naficillin
- Fixed-dosing
- Stable in an array of diluents
- Administered as continuous (CI) or intermittent dosing
Naficillin cautions
- contains 66mg of Na / 1g of Naficillin
- extravasation
- neurotoxicity with large IV doses, seizures
- can lead to renal / hepatic dysfunction
Penicillin G
- Fixed dosing in million units
- contains Na and K salts
- Stable in an array of diluents
- Administered as CI or intermittent dosing
Penicillin G cautions
- High doses may alter serum Na or K levels
- Avoid altering serum Na and K levels by administering at slower rate
Piperacillin / sulbactam
- Zosyn
- Intermittent and extended-infusions
- Dose adjust in renal dysfunction
Piperacillin / sulbactam cautions
- Contains sodium: 54-64 mg Na/ 1g piperacillin
- Incompatible with certain aminoglycosides
Ampicillin / sulbactam
- Unasyn
- Administer around-the-clock to avoid variations in peak and trough serum levels
- Dose adjustment in renal dysfunction
Ampicillin / sulbactam cautions
- Contains sodium: 115 mg Na/ 1.5g of combination product
- Incompatible with aminoglycosides
Which drugs are in the Cephalosporin class?
- Cefazolin
- Cefepime (Maxipime®)
- Ceftriaxone (Rocephin®)
Cefazolin
- Intermittent and fixed dosing
- Dose adjustment in renal dysfunction
Cefazolin cautions
- Contains sodium: 48 mg Na/ g cefazolin
- Use cautiously in patients with penicillin allergy
Cefepime
- Maxipime®
- Intermittent & extended infusions
- Dose adjustment in renal dysfunction
Cefepime cautions
- Use cautiously in patients with penicillin allergy
- Contains sodium: 83 mg Na/g cefepime
- Caution for Neurotoxicity
- Can lead to renal impairment
Ceftriaxone
- Rocephin®
- In patients with concurrent renal and hepatic impairment, maximum daily dose should not exceed 2 g
Ceftriaxone cautions
Use cautiously in patients with penicillin allergy
Ceftriaxone contraindications
- Incompatible with calcium-containing solutions
- Hyperbilirubinemic neonates
- Concomitant use with IV calcium-containing solutions / products in neonates (≤28 days)
What are the drugs in the aminoglycoside class?
- Amikacin
- Gentamycin
- Tobramycin
Aminoglycosides
- Intermittent infusion
- Weight-based dosing
- Avoid in pregnant women
- Monitor serum trough and peak concentrations
Aminoglycosides cautions
- Nephrotoxicity: Dose adjustment in renal dysfunction
- Neurotoxicity: Ototoxicity
Vancomycin
- Weight-based dosing
- Administer IV
- Dose adjustment in renal dysfunction
- Can monitor serum trough concentration
Vancomycin cautions
- Extravasation
- Avoid rapid infusion -> can lead to “Red Man Syndrome” -> treat w/ Benadryl
Daptomycin
- Cubucin
- Different formulations with varying reconstitution, diluents, preparation, storage, and shelf-life considerations
- Incompatible with dextrose-containing solutions
- Verify patient’s weight
- Dose adjustment in renal dysfunction and pts on dialysis
What are the anti-virals?
- Acyclovir (Zovirax®)
- Ganciclovir (Cytovene®)
- Cidofovir (Vistide®)
Acyclovir
- Zovirax®
- Verify patient’s weight
- Use IV preparation with caution in patients with underlying neurologic abnormalities, serious hepatic or electrolyte abnormalities, or substantial hypoxia
- Dose adjustment in renal dysfunction
- Infuse over 1 hour -> Reduces risk of renal tubular damage
- Ensure patient maintains adequate hydration
- make sure pt is hydrated to decrease crystaluria
Ganciclovir
- Cytovene®
- Verify patient’s weight
- Slow infusion; Administer only into veins with good blood flow
- Hazardous agent
Cidofovir
- Vistide®
- Infuse over 1 hour
- Hydrate with 1 L of NS IV over 1 to 2 hours immediately prior to cidofovir infusion.
- If tolerated, a second liter may be administered over a 1- to 3-hour period at the start of or immediately following cidofovir infusion. –> Reduce risk of renal impairment
- Hazardous agent
What are the antifungals?
- Eichinocandins
- Fluconazole (Diflucan®)
- Voriconazole (Vfend®)
Voriconazole
- Vfend®
- Weight-based dosing
- Drug-drug interactions
- May need to change to oral formulation in patients with specific stages of renal impairment
- Dose adjust in hepatic impairment
- Monitor electrolytes - affects potassium
- For certain instances, may monitor serum trough concentrations
- Hazardous agent
Fluconazole
- Diflucan®
- Do not use if cloudy or precipitated
- Slow infusion; do not exceed 200 mg/hour
- Dose adjust in renal impairment
- Monitor hepatic function (can exacerbate acute liver injury)
- Drug-drug interactions
- Monitor potassium/magnesium
- Hazardous agent
Eichinocandins
- Slow infusion
- Ensure central catheter is placed if high doses used to minimize infusionrelated reactions
What are the drugs in the Eichinocandin class?
- Micafungin (Mycamine®)
- Caspofungin (Cancidas®)
- Anidulafungin (Eraxis®)
