Name /bks_53161_deglins_md_disk/ceftriaxone
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Half-life: 6– 9 hr.
cefTRIAXone (sef-try-ax-one)
ROUTE
ONSET
PEAK
DURATION
IM
IV
rapid
rapid
1–2 hr
end of infusion
12–24 hr
12–24 hr
TIME/ACTION PROFILE
Rocephin
Classification
Therapeutic: anti-infectives
Pharmacologic: third-generation cephalosporins
Pregnancy Category B
Contraindications/Precautions
Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity
Indications
Treatment of: Skin and skin structure infections, Bone and joint infections, Complicated and uncomplicated urinary tract infections, Uncomplicated gynecological infections including gonorrhea, Lower respiratory tract infections, Intra-abdominal infections, Septicemia, Meningitis, Otitis media. Perioperative prophylaxis.
Action
Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of
second-generation cephalosporins, but activity against staphylococci is less, while
activity against gram-negative pathogens is greater, even for organisms resistant to
first- and second-generation agents. Notable is increased action against: Acinetobacter, Enterobacter, Haemophilus influenzae (including ␤-lactamase-producing
strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella pneumoniae,
Morganella morganii, Neisseria, Proteus, Providencia, Serratia, Moraxella catarrhalis. Has some activity against anaerobes, includingBacteroides fragilis. Not active
against methicillin-resistant staphylococci or enterococci.
Pharmacokinetics
Absorption: Well absorbed following IM administration; IV administration results
in complete bioavailability.
Distribution: Widely distributed. CSF penetration better than with first- and second-generation agents. Crosses the placenta; enters breast milk in low concentrations.
Protein Binding: ⱖ90%.
Metabolism and Excretion: 33– 67% excreted in urine as unchanged drug; remainder excreted in feces.
⫽ Canadian drug name.
⫽ Genetic Implication.
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to penicillins; Pedi: Neonates ⱕ28 days (use in hyperbilirubinemic neonates may
lead to kernicterus); Pedi: Neonates ⱕ28 days requiring calcium-containing IV solutions (qrisk of precipitation formation).
Use Cautiously in: Combined severe hepatic and renal impairment (dose reduction/qdosing interval recommended); History of GI disease, especially colitis; OB,
Lactation: Pregnancy and lactation.
Adverse Reactions/Side Effects
CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, cholelithiasis, gallbladder sludging. Derm: rashes, urticaria. Hemat: bleeding, eosinophilia,
hemolytic anemia, leukopenia, thrombocytosis. Local: pain at IM site, phlebitis at IV
site. Misc: allergic reactions including ANAPHYLAXIS, superinfection.
Interactions
Drug-Drug: Should not be administered concomitantly with any calcium-containing solutions.
Route/Dosage
IM, IV (Adults): Most infections— 1– 2 g every 12– 24 hr Gonorrhea— 250 mg
IM (single dose). Meningitis— 2 g every 12 hr. Perioperative prophylaxis— 1 g
0.5– 2 hr before surgery (single dose).
IM, IV (Children): Most infections— 50– 75 mg/kg/day (not to exceed 2 g/day)
divided every 12– 24 hr. Meningitis— 100 mg/kg/day (not to exceed 4 g/day) divided every 12– 24 hr or Uncomplicated gonorrhea— 125 mg IM (single dose).
Acute otitis media— 50 mg/kg (not to exceed 1 g) IM single dose.
NURSING IMPLICATIONS
Assessment
● Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
WBC) at beginning of and throughout therapy.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/ceftriaxone
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● Before initiating therapy, obtain a history to determine previous use of and reac-
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● If aminoglycosides are administered concurrently, administer in separate sites, if
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tions to penicillins or cephalosporins. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
Pedi: Assess newborns for jaundice and hyperbilirubinemia; can increase bilirubinemia and should not be administered to jaundiced neonates, especially premature neonates.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,
laryngeal edema, wheezing). Discontinue the drug and notify health
care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event
of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
Lab Test Considerations: May cause positive results for Coombs’ test.
May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN,
and creatinine.
May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia,
eosinophilia, lymphocytosis, and thrombocytosis.
Potential Nursing Diagnoses
Risk for infection (Indications) (Side Effects)
Diarrhea (Adverse Reactions)
Implementation
● Do not confuse ceftriaxone with cefazolin, cefoxitin, cefotetan, or cefta-
zidime.
● IM: Reconstitute IM doses with sterile water for injection, or 0.9% NaCl for injec-
tion. May be diluted with lidocaine to minimize injection discomfort.
● Inject deep into a well-developed muscle mass; massage well.
IV Administration
● pH: 6.6– 6.7.
● IV: Monitor injection site frequently for phlebitis (pain, redness, swelling).
Change sites every 48– 72 hr to prevent phlebitis.
possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
● Intermittent Infusion: Diluent: Reconstitute each 250-mg vial with 2.4 mL,
each 500-mg vial with 4.8 mL, each 1-g vial with 9.6 mL, and each 2-g vial with
19.2 mL of sterile water for injection, 0.9% NaCl, or D5W for a concentration of
100 mg/mL. Solution should be further diluted in 50– 100 mL of 0.9% NaCl, D5W,
D10W, D5/0.45% NaCl, or D5/0.9% NaCl. Solution may appear light yellow to amber. Solution is stable for 3 days at room temperature . Rate: Infuse over 30 min.
● Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, atracurium, atropine, aztreonam,
benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, carboplatin,
carmustine, cefazolin, cefonocid, cefoperazone, cefotaxime, cefotetan, cefoxitin,
ceftazidime, cefuroxime, cisatracurium, cisplatin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone,
dexmedetomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, doxorubicin liposome, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin alfa,
epitifibitide, erythromycin, esmolol, etoposide, etoposide phosphate, fenoldopam, fentanyl, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide, indomethacin, insulin, isoproterenol, ketorolac,
levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate,
methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam,
milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide,
nitroglycerin, nitroprusside, norepinephrine, octreotide, oxacillin, oxaliplatin,
oxytocin, paclitaxel, palonosetron, pamidronate, pantoprazole, pemetrexed, penicillin G, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium
acetate, potassium chloride, procainamide, propofol, propranolol, pyridoxime,
ranitidine, remifentanil, rituxumab, rocuronium, sargramostim, sodium acetate,
sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trastuzumab, trimethaphan, vasopressin, vecuronium, verapamil, vincristine, voriconazole, warfarin, zidovudine, zoledronic acis.
● Y-Site Incompatibility: alemtuzumab, amphotericin B cholesteryl, amsacrine,
ascorbic acid, azathioprine, azithromycin, calcium chloride, calcium gluconate,
䉷 2015 F.A. Davis Company
CONTINUED
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CONTINUED
cefTRIAXone
caspofungin, chloramphenicol, chlorpromazine, clindamycin, dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, doxorubicin hydrochloride, epirubicin, filgrastim, ganciclovir, haloperidol, hetastarch, hydralazine, hydroxyzine,
idarubicin, imipenem/cilastatin, irinotecan, labetalol, magnesium sulfate, mitoxantrone, mycophenolate, pentamidine, pentazocine, pentobarbital, phenytoin,
prochlorperazine, promethazine, protamine, quinupristin/dalfopristin, tobramycin, trimethoprim/sulfamethoxazole, vinorelbine, Calcium-containing solutions,
including parenteral nutrition, should not be mixed or co-administered, even via
different infusion lines at different sites in patients ⬍28 days old. In older patients,
flush line thoroughly between infusions.
Patient/Family Teaching
● Advise patient to report signs of superinfection (furry overgrowth on the tongue,
vaginal itching or discharge, loose or foul-smelling stools) and allergy.
● Instruct patient to notify health care professional if fever and diarrhea
develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of infection. Length of time for complete res-
olution depends on the organism and site of infection.
● Decreased incidence of infection when used for prophylaxis.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.