IV Anti-Infectives Flashcards
Antibiotics treat
bacterial infections
Antifungals treat
fungal infections
Antivirals treat
viral infections
Common indications for anti-infective: bacterial infections
pneumonia, endocarditis, hardware infections, osteomyelitis, skin/soft tissue infections, sepsis, GI infections, UTI
Common indications for anti-infectives: viral infections
influenza, cytomegalovirus (CMV), herpes simplex (HSV), varicella-zoster, meningitis
Common indications for anti-infectives: fungal infections
yeast, mold
Considerations relative to IV formulations
verify allergies, consider diluent in HF/DM, dosing in organ dysfunction, volume in HF, weigth based dosing, rate of administration, conc.-related med errors, compatibility, continuous vs. intermittent vs. bolus, hypersensitivity, extravasation, storage (refrigeration, room temp, protection from light)
IV penicillins
nafcillin
penicillin G
ampicillin/sulbactam (Unasyn)
piperacillin/tazobactam (Zosyn)
Nafcillin
fixed dosing, stable in many diluents, continuous infusion or intermittent dosing, avoid in pcn allergy
Caution: 66mg Na/g Nafcillin, extravasation, neurotoxicity w/ large doses especially in renal/hepatic dysfunction
Penicillin G
fixed dosing (million units, Na+ and K+ salts), stable in many diluents, CI or intermittent dosing avoid in pcn allergy caution: high doses can alter serum Na+ and K+ levels- give at slower rate
Piperacillin/Tazobactam
Zosyn intermittent and extended infusions dose adjust in renal dysfunction avoid in pcn allergy Caution: 54-64mg Na/g piperacillin Incompatible w/ certain aminoglycosides
Ampicillin/Sulbactam
Unasyn Administer ATC Avoid in pcn allergy Caution: 115mg Na/1.5g Unasyn Incompatible w/ aminoglycosides adjust dose in renal dysfunction
Cepalosporins
Cefazolin
Cefepime (Maxipime)
Ceftriaxone (Rocephin)
Cefazolin
1st gen fixed dosing intermittent infusion contains 48mg Na/g cefazolin Use cautiously in pcn allergy (cross sensitivity) Adjust dose in renal dysfunction
Cefepime
Maxipime intermittent and extended infusions Use cautiously in pcn allergy (cross sensitivity) Adjust dose in renal dysfunction Caution: 83mg Na/g Cefepime Caution: neurotoxicity
Ceftriaxone
Rocephin
fixed dosing
intermittent infusion
Renal and hepatic impairment max daily dose shouldn’t exceed 2g
Caution w/ pcn allergy
Incompatible w/ calcium containing soln
Contraindicated in: hyperbilirubinemic neonates, concomittant IV calcium-containing solns/products in neonates (<28 days old)
Aminoglycosides
Intermittent infusions weight based dosing Caution: nephrotoxicity (adjust dose in renal dysfunction), neurotoxicity/ototoxicity Avoid in pregnancy Monitor serum trough and peak conc. Amikacin Gentamycin Tobramycin
Vancomycin
weight based dosing
dose adjust in renal dysfunction
Monitor serum trough conc. to prevent toxicity
Caution: extravasation, avoid rapid infusion (Red Man Syndrome)
Daptomycin
Cubicin or Cubicin RF
incompatible w/ dextrose soln
Verify pt’s weight
Dose adjust in renal dysfunction
Anti-Viral products
Acyclovir (Zovirax)
Ganciclovir (Cytovene)
Cidofovir (Vistide)
Acyclovir
Zovirax
verify pt weight
Use w/ caution in pts w/ underlying neurologic abnormalities, serious hepatic/electrolyte abnormalities or substantial hypoxia
Adjust dose in renal dysfunction
Infuse over 1hr to reduce risk of renal tubular damage and make sure pt is hydrated (crystaluria)
Gancyclovir
Cytovene
Verify pt’s weight
Slow infusion into veins w/ good blood flow
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep
Cidofovir
Vistide
Infuse over 1 hr
Hydrate w/ 1L NS IV over 1-2hrs immediately prior to infusion. A 2nd liter can be given over a 1-3hr period at the start of or immediately following infusion. To reduce risk of renal impairment.
Hazardous agent- dbl glove, protective gown, special ventilated hood for prep
Antifungal products
Eichinocandins
Fluconazole (Diflucan)
Voriconazole (Vfend)
Voriconazole
Vfend Weight based dosing Drug-drug interactions May need to change to oral form in specific stages of renal impairment Dose adjust in hepatic impairment Monitor electrolytes (K+) Monitor serum trough concentrations Hazardous agent- dbl glove, protective gown, special ventilated hood for prep
Fluconazole
Diflucan Don't use if cloudy/precipitated Infuse slowly, don't exceed 200mg/hr Dose adjust in renal impairment Monitor hepatic function Drug-drug interactions (CYP3A4) Monitor K+ and Mg++ Hazardous agent- dbl glove, protective gown, special ventilated hood for prep
Eichinocandins
Micafungin (Mycamine) Caspofungin (Cancidas) Anidulafungin (Eraxis) Infuse slowly -if high doses are used infuse through a central catheter to minimize infusion related reactions
