KEY INFORMATION

❖ Penicillin differs in their

1. Chemical stability in stomach acid
2. Susceptibility to penicillinase (beta lactamase)
destruction
3. Spectrum of action: i.e. Narrow or extended
4. Route of administration
5. Duration of action
6. Site of action
❖ Cephalosporin Generation Characteristics
1. First Generation → exhibit gram-positive and some
gram-negative activity and are generally susceptible
to beta-lactamase inactivation.
2. Second Generation → exhibit a greater spectrum of
gram-negative activity and somewhat less gram
positive activity. Some agents in this group are
resistant to beta lactamases. Generally, drug cost is
grater than first generation cephalosporins.
3. Third Generation → broader spectrum of
gram-negative activity and weaker gram positive
activity. Some agents in this group are resistant to
beta lactamases. Generally, drug cost is greater than
first and second generation drugs.
4. Fourth Generation → broadest action against
gram-negative organisms of the four generations and
minimal action against gram-positive organisms.

SAFE NURSING PRACTICE

❖ CLIENTS RECEIVING PENICILLINS
1. Take a careful medication history before
administering penicillins.
2. Observe the client for indications of allergic reaction,
including rash, fever chills, and anaphylaxis.
3. Oral penicllins should be given -2 hours before or 2-3
hours after meals.
 4. Injection sites must be checked carefully for signs of
local reactions. Do not use the same needle for
withdrawing the solution from the vial and
administering it.
5. Never give procaine penicillin intravenously.
❖ CLIENTS RECEIVING CEPHALOSPORINS
1. Clietns who are allergic to penicillin also may be
allergic to cephalosporins.
2. Administer intramuscular injections into a large
muscle mass to decrease pain.
3. Observe intravenous sites carefully for phlebitis.
4. Avoid administering IV antibiotics greater than 125mL
through a peripheral vascular access because this
can cause phlebitis.
❖ CLIENTS RECEIVING TETRACYCLINES
1. Avoid administering tetracycline simultaneously with
sodium bicarbonate, iron preparations, dairy
products, and drugs containing zinc, aluminum,
calcium or magnesium.
2. Avoid adminisrtation of tetracycline on an empty
stomach.
3. Clients should avoid prolonged exposure to the sun
or use a sunscreen if taking tetracyclines.
4. Super infections may develop. Good oral care is
essnetial. Women prone to the development of vaginal
infections.
5. Because of effects on teeth and bone, tetracyclines
are generally avoided in children under 8 years and
in women during the last two trimesters of pregnancy.
6. Never administer a tetracycline preparation
containing procaine intravenously.
❖ CLIENTS RECEIVING AMINOGLYCOSIDES
1. Obtain an accurate body weight before therapy is
begun.
 2. Observe the client for nephrotoxicity, eight cranial
nerve damage (hearing and balance problems) and
neurotoxicity.
3. When Aminwoglycosides are used for treating urinary
tract infections, avoid urine acidifiers such as
cranberry, plum, and prune juices, as well as Vitamin
C.
4. Monitor peak and trough levels.
❖ CLIENTS RECEIVING VANCOMYCIN
1. If possible infuse through a CVAD such as a PICC.
2. Infuse intravenously over a minimum of 60 minutes.
3. For children and older clients, infuse over 2 hours.
4. Monitor client renal function including intake and
output, BUN and creatinine.
5. Vancomycin is the drug of choice for treatment of
clients with MRSA.
❖ CLIENTS RECEIVING SULFONAMIDES
1. Before beginning therapy with Sulfonamides, the
client must be questioned about allergy to this group
of drugs.
2. Encourage clients receiving Sulfonammides to
consume an adequate fluid intake.
3. Clients should be told that their UTI symptoms may
disappear in a short time but that they must
complete the entire prescription of Sulfonamides.
4. Instruction should be given regarding ways to avoid
recurrences of lower UTI.
❖ CLIENTS RECEIVING ANTIVIRAL AGENTS
1. Amantadine HcI should be taken after meals. Clients
are observed for orthostatic hypotension, depression,
gastrointestinal distress, and urinary retention.
2. Clients receiving vidarabine should have intake and
output monitored and be weighed daily.
3. Parenteral acyclovir is always administered
intravenously as an infusion. Watch for
nephrotoxicity, phlebitis, nausea, and vomiting plus
the development of hypersensitivity reactions.