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Antibiotics - Penicillins: Nursing Pharmacology

Notes

Notes

ANTIBIOTICS: PENICILLINS, PART 1/3
DRUG NAME

penicillin G (Pfizerpen) penicillin V, (Veetids - penicillin VK)

amoxicillin (Amoxil),
ampicillin (Omnipen) 

CLASS
Basic Penicillins
Broad-Spectrum Penicillins (Aminopenicillins)
MECHANISM OF ACTION
Inhibition of the enzyme in cell wall synthesis; bactericidal effect
INDICATIONS
  • Upper respiratory infections
  • otitis media
  • pneumonia
  • rheumatic fever
  • erysipelas
  • skin and soft-tissue infections
  • gonorrhea
  • syphilis
  • Treatment of infections:
    • skin
    • respiratory
    • GI
    • GU
  • Amoxicillin: gonorrhea 
  • Ampicillin: meningitis, endocarditis, septicemia
ROUTE(S) OF ADMINISTRATION
  • Penicillin G: IM, IV 
  • Penicillin G benzathine: IM 
  • Penicillin V: PO 
  • Amoxicillin: PO 
  • Ampicillin: PO, IM, IV 
ANTIBIOTICS: PENICILLINS, PART 2/3
DRUG NAME
dicloxacillin, nafcillin, oxacillin 
piperacillin-tazobactam (Zosyn)
CLASS
Penicillinase-Resistant Penicillins (Antistaphylococcal Penicillins)
Extended-Spectrum Penicillins (Antipseudomonal Penicillins)
MECHANISM OF ACTION
Inhibition of the enzyme in cell wall synthesis; bactericidal effect
INDICATIONS
Infections caused by Penicillin G–resistant Staphylococcus aureus
Infections caused by
Pseudomonas aeruginosa.
ROUTE(S) OF ADMINISTRATION
  • Dicloxacillin: PO 
  • Nafcillin, Oxacillin: IM, IV
  • IV
ANTIBIOTICS: PENICILLINS, PART 3/3
DRUG NAME
(all antibiotics above)
penicillin G (Pfizerpen), penicillin V (Veetids - penicillin VK), amoxicillin (Amoxil)
ampicillin (Omnipen), dicloxacillin, nafcillin, oxacillin, piperacillin-tazobactam (Zosyn)

SIDE EFFECTS
  • Seizures
  • Nausea, vomiting, diarrhea
  • Superinfections (e.g., CDI, candidiasis, vaginitis)
  • Urticaria, pruritus, anaphylaxis, Stevens-Johnson syndrome, erythema multiforme
  • Interstitial nephritis, renal tubular damage
  • Penicillin G: Local pain at injection site, accidental intra-arterial injection or near a major peripheral nerve can cause severe neurovascular damage and tissue necrosis
  • Amoxicillin: Eosinophilia, anemia thrombocytopenia
CONTRAINDICATIONS AND CAUTIONS
Contraindications:
  • Hypersensitivity to penicillins.

Precautions: Hypersensitivity to cephalosporins and carbapenems
  • Pregnancy, breastfeeding
  • Severe renal disease
  • Boxed Warning: Penicillin G benzathine: IV use

Drug interactions:
  • Probenecid increases penicillin effect
  • Tetracyclines decrease the effect of penicillins
  • Penicillins increase effect of methotrexate
  • Penicillins decrease the effect of oral contraceptives
  • Broad-Spectrum Penicillins: Allopurinol increases risk of rash
  • Penicillinase-resistant penicillins:
  • Decrease effect of live virus vaccines, do not use together
  • Food, carbonated drinks, and citrus fruit juices decrease absorption of penicillinase-resistant penicillins
NURSING CONSIDERATIONSAssessment and monitoring
Assessment
  • Vital signs 
  • Current signs and symptoms 
  • Laboratory test results: CBC, renal and hepatic function, VDRL 
  • Diagnostic test results: lumbar puncture

Administration
  • Ensure adequate hydration 
  • Patent IV 
  • Indwelling urinary catheter

Monitoring
  • I&O 
  • Insertion site; rotate regularly 
  • Side effects 
  • Hypersensitivity 
  • Superinfection 
  • Renal damage 
  • Evaluate: resolution of the infection; absence of symptoms 

Client education
  • Purpose of the medication: treats the infection causing their symptoms 
  • Administered intravenously over two weeks 
  • Side effects 
    • Report pain or discomfort at the insertion site 
    • Abdominal pain 
Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Davis's Drug Guide for Nurses"  (2020)
  6. "Neurosyphilis"  (2021)
  7. "Penicillins"  (2020)