Med Cards Flashcards
Prednisone
Generic Name: Prednisone
Classification / Schedule: corditosteroid
Indications: Asthma, bell palsy, crohn disease, hepatitis, Immune thrombocytopenia, infantile hemangioma, Kawasaki disease, Lupus nephritis, nephrotic syndrome, ulcerative colitis
Action: Decreases inflammation by supressing the migration of polymorphonuclear leukocytes & reversing increased capillary permeability. It also suppresses the immune system by reducing activity & volume of the lymphatic system.
Pharmacokinetics:
* Absorption: 50% - 90%
* half-life: 2-3 hours
* Time to peak: 2 hours (IR) & 6-6.5 hours (delayed release)
Safe Dose: 1-2 mg/kg/day
Adverse Reactions & Side Effects: shortness of breath, weight gain, swelling of the extremities, bradycardia, tachycardia, bone or joint pain, mood changes, memory problems, confusion, weakness, seizures, stomach pain, black / tarry / bloody stools
Route & Dosage:
* Tabs: 1, 2.5, 5, 10, 20, & 50 mg
* Delayed release tabs: 1, 2, & 5 mg
* Oral solution: 1 mg/mL (120 & 150 mL)
* Concentrated solution (Prednisone Intensol): 5 mg/mL (30 mL)
Precautions:
* Adrenal Suppression: may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children
* Kaposi Sarcoma: prolonged use of corticodsteroids has been associated with the development of Kaposi sarcoma.
Spikes blood sugar; irritates the gut
Contraindications: Hypersensitivity, systemic fungal infections, drug interactions, & administration of live or live attenuated vaccines with immunosuppressive doses of prednisone
Ampicillin
Generic Name: Ampicillin (Principen)
Classification / Schedule: antibiotic (aminopenicillin)
Indications: anthrax treatment, endocarditis, intra-abdominal infection, meningitis, osteoarticular infection, peritonitis, pneumonia, surgical prophylaxis
Action: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.
Pharmacokinetics:
* Absorption (oral): 50%
* Half-Life in Neonates (PNA 2-7 days): 4 hours
* Half-Life in Neonates (PNA 8-14 days): 2.8 hours
* Half-Life in Neonates (PNA 15-30 days): 1.7 hours
* Half-Life in Children & Adults: 1-1.8 hours
Safe Dose:
* IV / IM: 100 - 200 mg/kg/24 hr (4 x day)
- PO: 50 - 100 mg (BID)
- Up to 400 mg/kg/day if septic
Adverse Reactions & Side Effects: fever, chills, sore throat, unexplained bruising or bleeding, feeling weak or tired, mouth irritation or sores, seizures, diarrhea, urticaria, signs of allergic reaction
Route & Dosage:
* Caps: 500 mg
* Injection: 125, 250, & 500 mg; 1, 2, & 10 g (contains 3 mEq Na / 1 g IV drug)
Precautions:Hypersensitivity reactions, rash, & superinfection (prolonged use may result in fungal or bacterial superinfection)
Contraindications: Hypersensitivity (ie. anaphylaxis) to ampicillin, any component of the formula, or other penicillins; infections caused by penicillinase-producing organisms
Unasyn
Generic Name: ampicillin/sulbactam
Classification / Schedule: mixed beta-lactam antimicrobial / beta-lactamase inhibitor
Indications: endocarditis, intra-abdominal infection, meningitis, osteoarticular infection, pelvic inflammatory disease, rhinosinusitis (severe infection requiring hospitalization), skin & soft tissue infection, surgical prophylaxis
Action: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. The addition of sulbactam, a beta-lactamase inhibitor, to ampicillin extends the spectrum of ampicillin to include some beta-lactamase-producing organisms.
Pharmacokinetics: usually extreted via urine within 8 hours
Safe Dose: 100 - 400 mg ampicillin/kg/24 hr (safe dose is based off the ampicillin) — 2:1 ratio (1000 amp / 500 sulbactum = 1500 mg unasyn)
Adverse Reactions & Side Effects: signs of an allergic reaction, rash, diarrhea, pain at the injection site
Route & Dosage:
* 1.5 g Injection = ampicillin 1 g + sulbactam 0.5 g
* 3 g Injection = ampicillin 2 g + sulbactam 1 g
* 15 g Injection = ampicillin 10 g + sulbactam 5 g
Precautions:
* Anaphylactoid / Hypersensitivity
* Hepatic dysfunction
* Rash
* Superinfection
Contraindications: hypersensitivity (ie. anaphylaxis or Stevens-Johnson syndrome) to ampicillin, sublactam, or to other beta-lactam antibacterial drugs (penicillins, cephalosporins, etc.); hx of cholestatic jaundice or hepatic dysfunction associated with ampicllin / sulbactam
Clindamycin
Generic Name: Clindamycin (Cleocin)
Classification / Schedule: lincosamide antibiotic
Indications: Anthrax treatment, community-acquired pneumonia, endocarditis, intra-abdominal infection, opportunistic infections, osteoarticular infections, otitis media, peritonitis, rhinosinusitis, skin & soft tissue infections, Streptococcal infections, surgical prophylaxis
Action: Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis
Pharmacokinetics:
* Half-Life Neonates (PMA < 28 weeks): 2.42 - 12.9 hours
* Half-Life Neonates (PMA > 28-32 weeks): 2.34 - 8.87 hours
* Half-Life Neonates (PMA > 32-40 weeks): 1.3 - 8.83 hours
* Neonates & Infants </= 5 months: 0.94 - 6.44 hours
* Children >/= 2 & Adolescents (Non-Obese): 2.15 - 2.84 hours
* Children >/= 2 & Adolescents (Obese): 2.15 - 3.55 hours
Safe Dose:
* IV: 20 - 40 mg/kg/24 hr
10-30 for PO
Adverse Reactions & Side Effects: signs of allergic reaction including rash, weight gain, jaundice of the skin or eyes, joint pain or swelling, fever / chills / sore throat, unexplained bruising or bleeding, feeling very tired or weak, pain / redness / swelling at the injection site
Route & Dosage:
* Caps: 75, 150, & 300 mg
* Oral Solution: 75 mg / 5 mL (100 mL)
* Injection: 150 mg/mL (2, 4, 6, & 60 mL)
* Premixed Injection in 5% dextrose or NS: 300 mg / 50 mL, 600 mg / 50 mL, 900 mg / 50 mL
Precautions:
* Renal toxicity
* Superinfection
* Liver impairment
* Renal impairment
* Use with caution in patients with hx of GI disease, particularly colitis
Contraindications: Hypersensitivity to clindamycin, lincomycin, or any component of the formulation; oral clindamycin in infants less than 30 days of age
Ceftriaxone / Rocephin
Generic Name: Ceftriaxone (Rocephin)
Classification / Schedule: cephalosporin antibiotic
Indications: endocarditis, epididymitis, gonococcal infections, intra-abdominal infection, lyme disease, bacterial meningitis, meningococcal disease, otitis media, peritonitis, pneumonia (community-acquired), acute bacterial rhinosinusitis, salmonella, STIs (prophylaxis following sexual assault), shingellosis, skin & soft tissue infection, urinary tract infection (UTI)
Action: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting cell wall biosynthesis.
Pharmacokinetics:
* Half-Life of Neonates 1-4 days old: 16 hours
* Half-Life of Neonates 9-30 days old: 9 hours
* Infants & Children: 4 - 6.6 hours
Safe Dose: 50 - 75 mg/kg/24 hr (BID)
Adverse Reactions & Side Effects: back pain, abdominal pain, blood in the urine, palpitations, flushing, dizziness, headache, diarrhea, diaphoresis, rash / signs of allergic reaction
Route & Dosage:
* IV: 50 - 75 mg/kg/day (max dose = 2,000 mg/day)
* Injection: 0.25, 0.5, 1, 2, & 10 g
Precautions:
* Elevated INR
* Superinfection
* Renal or Hepatic Impairment (use with caution in patients with concurrent hepatic dysfunction (impaired biliary excretion) & severe kidney disease)
* Use extreme caution in neonates due to risk of hyperbilirubinemia
Contraindications:
* hypersensitivity to ceftriaxone, any component of the formula, or other cephalosporins
* do NOT use in hyperbilirubinemic neonates
Vancomycin
Generic Name: vancomycin
Classification / Schedule: antibiotic; glycopeptide
Indications: C. difficile, endocarditis, enterocolitis, meningitis, methicillin-resistant staphylococcus aureus (MRSA), peritonitis, pneumonia, skin & skin structure infection, surgical prophylaxis, ventriculitis
Action: Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization through binding tightly to D-alanyl-D-alanine portion of cell wall precursor
Pharmacokinetics (half-life):
* Preterm Neonates (GA: 32-34 Weeks): 5.9 - 9.8 hours
* Term Neonates: 6.7 hours
* Infants: 2.8 hours
* Children < 6 years: 2.4 hours
* Children ≥ 6 years: 2.9 hours
* Adolescents: 3.2 hours
Safe Dose: 45-60 mg/kg/24 hrs (Q6-8)
Adverse Reactions & Side Effects: anaphylaxis, diarrhea, fever, pain or irritation at injection site, nephrotoxicity, vomiting, ototoxocity (troph levels every 3-4 doses & pharmacy will determine the dose)
Route & Dosage:
* Injection: 0.25, 0.5, 0.75, 1, 1.5, 5, & 10 g
* Premixed Injection in D5W or NS: 500 mg / 100 mL, 750 mg/ 100 mL, 1000 mg / 200 mL
* Premixed Injection in water or polyethylene glycol: 500 mg / 100 mL, 1000 mg / 200 mL, 1500 mg / 300 mL, 2000 mg / 400 mL
Precautions:
* Extravasation & Thrombophlebitis: IV vancomycin is an irritant; ensure proper needle or catheter placement prior & during infusion
RED MAN SYNDROME (not allergic rxn), really hot, really red, itching at head & arms — slow down dose & give Benadryl
Contraindications: hypersensitivity to vancomycin or any component of the formulation
Tylenol
Generic Name: acetaminophen
Classification / Schedule: analgesic & antipyretic
Indications: fever & pain management
Action: The analgesic effects are believed to be due to activation of descending serotonergic inhibitory pathways in the CNS. Interactions with other nociceptive systems may be involved as well. Antipyresis is produced from inhibition of the hypothalamic heat-regulating center.
Pharmacokinetics:
* Half-Life: 1-3 hours & 2-5 hours in neonates (metabolized in the liver)
Safe Dose: 10 - 15 mg/kg/dose (max 75 mg/kg/day) adult max = 4,000 mg
Adverse Reactions & Side Effects: upset stomach, vomiting, headache, constipation, signs of an allergic reaction including rash, decreased appetite, dark urine, jaundice of eyes or skin
Route & Dosage:
* Tabs & Caplets: 325, 500, & 650 mg
* Chewable tablets: 80 mg
* Child suspension/syrup, Oral liquid, or Elixir: 160 mg / 5 mL
* Extended-release caplets: 650 mg
* Capsules: 325 & 500 mg
* IV (adolescents ≥ 50 kg): 1,000 mg Q6H or 650 mg Q4H; maximum single dose 1000 mg; maximum daily dose 4,000 mg/day
* Dispersible tabs (Tylenol Children’s Meltaways): 80 & 160 mg
* Suppositories: 80, 120, 325, & 650 mg
* Injection (Ofirmev): 10 mg/mL
* IV: administer undiluted over 15 minutes
Precautions:
* G6PD deficiency
* Hepatic impairment
* Hypovolemia
Contraindications:
* Injection: hypersensitivity to acetaminophen or any component of the formulation; severe hepatic impairment or severe active liver disease
* OTC Labeling: when used for self-medication, do not use with other drug products containing acetaminophen or if allergic to acetaminophen or any of the inactive ingredients
Motrin
Generic Name: ibuprofen
Classification / Schedule: analgesic (non-opioid); anti-inflammatory; antipyretic; Nonsteroidal Anti-Inflammatory Drug (NSAID)
Indications: Pain management, fever, swelling, cystic fibrosis (mild), juvenile idiopathic arthritis
Action: Reversibly inhibits COX-1 & COX-2 enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, & anti-inflammatory properties.
Pharmacokinetics:
* Half-Life IV (infants 3 - < 6 months): 1.3 hours
* Half-Life IV (infants ≥ 6 months to children < 2 years): 1.8 hours
* Half-Life IV (children ≥ 2 years to adolescents ≤ 16 years): about 1.5 hours
* Half-Life Oral (children 3 months - 10 years) 1.6 (+ / - 0.7) hours
Safe Dose: 5 - 10 mg/kg/dose
Adverse Reactions & Side Effects: black, tarry, or bloody stools, fever, stomach pain, constipation or diarrhea, vomiting, dizziness, rash
Route & Dosage:
* Oral suspension: 100 mg / 5 mL (60, 120, & 480 mL)
* Oral drops: 40 mg/mL (15 & 30 mL)
* Chewable: 100 mg
* Caplets: 100 & 200 mg
* Tabs: 200, 400, 600, & 800 mg
* Capsules: 200 mg
* Injection (NeoProfen & generic (lysine salt)): 10 mg iburpofen base / 1 mL (2 mL)
* Injection (Caldolor): 100 mg/mL (4 & 8 mL)
Precautions:
* May cuase drowsiness, dizziness, blurred vision, & other neurologic effects which may impair physical or mental abilities
* Hyperkalemia
* Opthalmic events such as blurred / diminished vision, scotomata, & changes in color vision have been reported
* IV ibuprofen as IV indomethacin for the treatment of patent ductus arteriosus (PDA) in preterm neonates, but is less likely to cause adverse effects on renal function
Contraindications:
* Hypersensitivity to ibuprofen
* Hx of asthma, urticaria, or allergic-type reaction to aspirin or other NSAIDs
* aspirin triad (bronchial asthma, aspirin intolerance, rhinitis)
Lantus
Generic Name: insulin glargine (Lantus)
Classification / Schedule: antidiabetic; long-acting insulin
Indications: Diabetes mellitus (Type 1 & Type 2)
Action: Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, & fats. Target organs for insulin include the liver, skeletal muscle, & adipose tissue. Within the liver, insulin stimulates hepatic glycogen synthesis. Insulin promotes hepatic synthesis of fatty acids, which are released into the circulation as lipoproteins. Skeletal muscle effects of insulin include increased protein synthesis & increased glycogen synthesis. Within adipose tissue, insulin stimulates the processing of circulating lipoproteins to provide free fatty acids, facilitating triglyceride synthesis & storage by adipocytes; also directly inhibits the hydrolysis of triglycerides. In addition, insulin stimulates the cellular uptake of amino acids & increases cellular permeability to several ions including potassium, magnesium, & phhosphate. By activating sodium-potassium ATPases, insulin promotes the intracellular movement of potassium.
Pharmacokinetics:
* Onset: 3-4 hours
* Duration: 10.8 to > 24 hours
Safe Dose: 0.25 - 2 units/kg/day (PATIENT DEPENDENT TO KEEP SUGAR BELOW 250)
Adverse Reactions & Side Effects: redness / pain / swelling at injection site, diarrhea, headache, weight gain, joint pain, signs of low blood sugar (dizziness, blurred vision, slurred speech, seizures, diaphoresis, confusion, tachycardia, headache), signs of low potassium (muscle pain or weakness, muscle cramps, heart palpitations)
Route & Dosage
* Initial total daily insulin: 0.4 - 0.5 units/kg/day in divided doses
* Usual Range: 0.4 - 1 unit/kg/day in divided doses
* Lower doses (0.25 units/kg/day) may be used especially in young children to avoid potential hypoglycemia
- Precautions:
- Glycemic Control: hyper- or hypoglycemia may result from change sin insulin strength, manufacturer, type, and/or administration method. The most common adverse effect of insulin is hypoglycemia.
- Hypersensitivity
- Hypokalemia: insulin (espeically IV insulin) cna cause a shift in potassium from the extracellular to the intracellular space, possibly producing hypokalemia. If left untreated, hypokalemia can result in respiratory paralysis, ventricular arrhythmia, & even death
Contraindications:
* Hypersensitivity to insulin glargine or any component of the formulation
* Use during episodes of hypoglycemia
Humalog
Generic Name: Insulin Lispro
Classification / Schedule: anti-diabetic; rapid-acting insulin
Indications: Diabetes mellitus (Type 1 & 2)
Action: Insulin acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, & fats. Target organs for insulin include the liver, skeletal muscle, and adipose tissue. Insulin lispro differs from human insulin by containing lysine & proline at positions B28 & B29 respectively, in comparison to the proline & lysine found at B28 & B29 in human insluin. Insulin lispro is a rapid-acting insulin analog.
Pharmacokinetics:
* Onset: 31 minutes (T1DM) & 45 minutes (T2DM)
* Duration: 5.7 - 6.6 hours (T1DM) & 6.7 hours (T2DM)
Safe Dose: (PATIENT DEPENDENT TO KEEP SUGAR BELOW 250)
- Initial Dose: 0.4 - 0.5 units/kg/day in divided doses
- Usual Dose: 0.4 - 1 units/kg/day in divided doses
Adverse Reactions & Side Effects: weight gain, flu-like symptoms, cough, headache, upset stomach, stomach pain, diarrhea, feeling tired or weak, redness / swelling / pain / irritation at injection site.
Route & Dosage: Subcutaneous injection
* Initial Dose: 0.4 - 0.5 units/kg/day (divided doses)
* Usual Dose: 0.4 - 1 units/kg/day (divided doses)
* Lower Doses: 0.25 units/kg/day
Precautions:
* Glycemic Control: hyper- or hypoglycemia may result from change sin insulin strength, manufacturer, type, and/or administration method. The most common adverse effect of insulin is hypoglycemia.
* Hypersensitivity
* Hypokalemia: insulin (espeically IV insulin) cna cause a shift in potassium from the extracellular to the intracellular space, possibly producing hypokalemia. If left untreated, hypokalemia can result in respiratory paralysis, ventricular arrhythmia, & even death
Contraindications: Hypersensitivity to insulin lispro or any component of the formulation; during espidoses of hypoglycemia
Morphine
Generic Name: Morphine
Classification / Schedule: Analgesic; Opioid; schedule II narcotic
Indications: severe acute pain, chronic pain, epidural, palliative care, patient-controlled analgesia, procedural pain & sedation, tetralogy of fallot
Action: Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of & response ot pain; produces generalized CNS depression
Pharmacokinetics:
* Onset (Oral): 30 minutes
* Onset (IV): 5-10 minutes
* Duration (immediate release): 3-5 hours
* Duration (extended release): 8-24 hours
* Duration (epidural or intrathecal): up to 24 hours
* Duration (suppository): 3-7 hours
Safe Dose:
* PO: 0.2 - 0.5 mg/kg/dose
* IV: 0.1 - 0.2 mg/kg/dose
Adverse Reactions & Side Effects: feeling dizzy, tired, or weak, dry mouth, constipation, diarrhea, stomach pain, upset stomach, vomiting, decreased appetite, headache, diaphoresis.
Route & Dosage:
* IV Infusion: 0.2 mg/mL, 0.1 mg/mL, 0.5 mg/mL, & 1 mg/mL
Precautions:
* CNS depression
* Hyperalgesia: symptoms may include increased levels of pain upon opioid dosage increase, decreased levels of pain upon opiioid dosage decrease, or pain from ordinarily non-painful stimuli.
* Hypotension
* Phenanthrene Hypersensitivity: use with caution in patients with hypersensitivity reactions to other phenanthrene opioid agonists (codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone)
Contraindications:
* Hypersensitivity to morphine or any component of the formulation; significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; concurrent use of monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days; GI obstruction, including paralytic ileus (known or suspected).
Folic Acid
Generic Name: folate
Classification / Schedule: Vitamin B supplement, water-soluble vitamin
Indications: anemia, parenteral nutrition — sickle cell & pregnant patients
Action: Folic acid is necessary for the formation of a number of coenzymes in many metabolic systems, particularly for purine & pyrimidine synthesis; required for nucleoprotein synthesis & maintenance in erythropoiesis; stimulates WBC & platelet production in folate deficiency anemia.
Pharmacokinetics:
* Absorption: proximal part of small intestine
* Metabolism: Hepatic
* Time to Peak (Oral): 1 hour
Safe Dose: 0.01 - 0.4 mg/24 hr
Adverse Reactions & Side Effects: flushing, malaise, erythema, pruritus, skin rash, hypersensitivity reaction, bronchospasm
Route & Dosage:
* Tabs: 0.4, 0.8, & 1 mg
* Caps (FA-8): 0.8 mg
* Caps (generics): 5 & 20 mg
* Oral solution: 0.05 mg/mL & 1 mg/mL
* Injection: 5 mg/mL (10 mL)
Precautions:
* Anemia (monotherapy): not appropriate for monotherapy with pernicious, aplastic, or normocytic anemias when anemia is present with vitamin B12 deficiency
* Pernicious Anemia: doses > 0.1 mg/day may obscure pernicious anemia with continuing irreversible nerve damage progression
Contraindications:
* Oral: Hypersensitivity to folic acid or any component of the formulation
Hydroxyurea
Generic Name: Hydroxyurea
Classification / Schedule: antineoplastic; antimetabolite DOUBLE GLOVE
Indications: sickle cell anemia
Action:
Pharmacokinetics:
Safe Dose:
- 15 - 35 mg/kg/day
Children ≥ 2 & Adolescents - 20 - 35 mg/kg/day (maximum fixed dose of 2,500 mg/day)
Adverse Reactions & Side Effects:
* Bone marrow suppression
* headache, constipation, diarrhea, upset stomach, decreased appetite, back, joint, arm, or leg pain, weight gain, feeling tired or weak.
Route & Dosage:
* Initial Dose (Oral): 15 - 20 mg/kg/dose QD
* Dose Adjustment (Oral): If blood counts in target range, increase dose by 5 mg/kg/day every 8-12 weeks; maximum dose of 35mg/kg/day
Children ≥ 2 & Adolescents:
* Initial Dose (Oral): 20 mg/kg/dose QD
* Dose Adjustment (Oral): If blood counts in target range, increase dose by 5 mg/kg/day every 8 weeks or sooner if painful crisis occurs; maximum ddaily dose of 35 mg/kg/day (maximum fixed dose 2,500 mg/day)
Precautions: avoid use of live vaccines during hydroxyurea therapy
Contraindications: Hypersensitivity to hydroxyurea or any component of the formulation
Pepcid
Generic Name: famotidine
Classification / Schedule: histamine h2-receptor antagonist (H2-blocker)
Indications: gastroesophageal reflux disease (GERD), heartburn / acid indigestion, peptic ulcer disease, stress ulcer prophylaxis
Action: Competitive inhibition of histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion
Pharmacokinetics:
* Onset: within 1 hour
* Duration (IV, Oral): 10 - 12 hours
Safe Dose: 0.5 - 1 mg/kg/24 hr (BID)
GIVE WITH STEROID
Adverse Reactions & Side Effects: agitation, constipation, diarrhea, headache
Route & Dosage:
* Injection: 10 mg/mL (2, 4, & 20 mL)
* Premixed injection: 20 mg / 50 mL
* Oral suspension: 40 mg / 5 mL (50 mL)
* Tabs: 10, 20, & 40 mg
* Chew tabs (Pepcid complete): 10 mg famotidine with 800 mg calcium carbonate & 165 mg magnesium hydroxide (25 & 50 mg)
Precautions:
* Use of gastric inhibitors, including proton pump inhibitors & H2 blockers, has been associated with an increased risk for development of acute gastroenteritis & community acquired pneumonia in pediatric patients
Contraindications: Serious hypersensitivity to famotidine, other H2 antagonists, or any component of the formulation
Zosyn
Generic Name: Piperacillin and Tazobactam
Classification / Schedule: antibiotic, beta-lactam & beta-lactamase inhibitor combination; penicillin (antipseudamonal)
Indications: Cystic Fibrosis (acute pulmonary exacerbation), endocarditis, intra-abdominal infection, neutropenic fever, pneumonia (nosocomial), skin & soft tissue infection (necrotizing), surgical antimicrobial prophylaxis
Action: Piperacillin inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cellw awlls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing actviity of cell wall autolytic enzymes (autolysins & murein hydrolases) while cell wall assembly is arrested. Piperacillin exhibits time-dependent killing. Tazobactam inhibits many beta-lactamases, including staphylococcal penicillinase & Richmond-Sykes types 2, 3, 4, & 5, including extended spectrum enzymes
Pharmacokinetics:
* Piperacillin Half-Life
* Neonates & Infants < 2 months: 3.5 hours
* Infants 2-5 months: 1.4 ± 0.5 hours
* Infants & Children 6 - 23 months: 0.9 ± 0.3 hours
* Children 2-5 years: 0.7 ± 0.1 hours
* Children 6-12 years) 0.7 ± 0.2 hours
* Adults: 0.7 - 1.2 hours
** Tazobactam Half-Life**
* Infants 2-5 months: 1.6 ± 0.5 hours
* Infants & Children 6 - 23 months: 1 ± 0.4 hours
* Children 2-5 years: 0.8 ± 0.2 hours
* Children 6-12 years: 0.9 ± 0.4 hours
* Adults: 0.7 - 0.9 hours
Safe Dose: 100 mg/kg/dose
* 3.375 g/dose max
* 12.5 mL / hr
Adverse Reactions & Side Effects: seizures, muscle twitching, cramps, stiffness, diarrhea, stomach pain, cramps, headache, nausea, skin rash
Route & Dosage: 8:1 ratio of piperacillin to tazobactam
Injection (powder):
* 2 g piperacillin & 0.25 g tazobactam
* 3 g piperacillin & 0.375 g tazobactam
* 4 g piperacillin & 0.5 g tazobactam
* 12 g piperacillin & 1.5 g tazobactam
* 36 g piperacillin & 4.5 g tazobactam
Injection (premixed in iso-osmotic dextrose):
* 2 g piperacillin & 0.25 g tazobactam in 50 mL
* 3 g piperacillin & 0.375 g tazobactam in 50 mL
* 4 g piperacillin & 0.5 g tazobactam in 100 mL
Precautions:
* Electrolyte Abnormalities: sodium content (2.8 mEq per gram of piperacillin) should be considered in patients requiring sodium restriction. Assess electrolytes periodically in patients with low potassium reserves
* Superinfection
* Renal Impairment: use with caution in patients with renal impairment or in hemodialysis patients
Contraindications: Hypersensitivity to penicillins, cephalosporins, beta-lactamase inhibitors, or any component of the formulation
