{"id":102,"date":"2019-09-22T17:50:18","date_gmt":"2019-09-22T17:50:18","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-5-penicillins\/"},"modified":"2021-12-07T11:06:17","modified_gmt":"2021-12-07T11:06:17","slug":"3-5-penicillins","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-5-penicillins\/","title":{"raw":"3.5 Penicillins","rendered":"3.5 Penicillins"},"content":{"raw":"Now that we have reviewed antimicrobial basics, administration considerations, and the nursing process when administering antimicrobials,\u00a0 we will take a closer look at specific antimicrobial classes and administration considerations, therapeutic effects, adverse effects, and specific teaching needed for each class of antimicrobials. Each of the following sections of this chapter is based on a class or subclass of anti-infective medications.\u00a0 Each section discusses the mechanism of action, specific administration considerations, and common patient teaching for this class\/subclass of medication.\u00a0 Each section is then followed by a medication table with a common generic medication and its specific administration considerations, therapeutic effects, and side effects\/adverse effects for this medication.\n

Penicillins<\/h2>\nPenicillin was the first antibiotic discovered and its detection came as a bit of an accident. In 1928, Alexander Fleming, a professor of bacteriology at St. Mary's Hospital in London, discovered penicillin accidentally growing in a petri dish in his lab. The penicillin was the result of mold juice that had grown there inadvertently. Fleming noted that this \"mold juice\" inhibited the growth of Staphylococcus bacteria that was previously growing in the petri dish. Subsequently, the first antibiotic discovery was made.[footnote]American Chemical Society International Historic Chemical Landmarks. Discovery and development of penicillin.<\/em> http:\/\/www.acs.org\/content\/acs\/en\/education\/whatischemistry\/landmarks\/flemingpenicillin.html<\/a>[\/footnote]<\/sup>\n\n[pb_glossary id=\"2118\"]Indications[\/pb_glossary]:<\/strong> Penicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. Penicillins may be administered orally, IV, or intramuscularly.\n\nMechanism of Action:<\/strong> Penicillins are bactericidal and kill bacteria by interfering with the synthesis of proteins needed in their cellular walls.[footnote]This work is a derivative of Principles of Pharmacology<\/a> by LibreTexts<\/a> licensed under CC BY-NC-SA 4.0<\/a>[\/footnote]\u00a0<\/sup>When the bacterial cell wall is impaired, the cell is rapidly broken down and destroyed.\n\nSpecific Administration Considerations:<\/strong> In addition to general antimicrobial administration considerations, it is important to monitor patients who receive penicillins for signs of superinfections such as C-diff or yeast infections.\u00a0 There is also a cross-sensitivity for patients allergic to cephalosporins.\u00a0 It is important to remember that patients who are prescribed high doses of penicillin may experience significant coagulation abnormalities.[footnote]Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> is licensed under CC BY-NA-SA 4.0<\/a>[\/footnote]<\/sup> Other notable drug interactions include the use of diuretic therapy with penicillin. Penicillin contains a significant amount of potassium. Patients receiving potassium-sparing diuretics or supplementation should be monitored for signs of hyperkalemia. Penicillin is best absorbed on an empty stomach; however, many patients may experience GI upset and subsequently take the medication with food.\n\nPatient Teaching & Education:<\/strong>\u00a0 The patient should notify the health care provider (HCP) if fever or diarrhea develops, especially if the stool contains blood, pus, or mucus.\u00a0 Advise the patient not to treat diarrhea without advice from HCP. If GI upset occurs, the patient may take the medication with meals but should avoid taking with citrus-based products, which can impede absorption.\u00a0 Additionally, patients should be instructed to chew oral chewable tablets thoroughly before swallowing.\u00a0 The patient should report a rash or any signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool).\n\nPatients should be instructed to take medication around the clock and to finish the drug completely as directed.\u00a0 Doses should be spaced evenly to achieve the desired therapeutic effect.\u00a0 Additionally, patients should receive instruction to not share medication and that any sharing of medications may be dangerous.\u00a0 Patients with a history of rheumatic heart disease or valve replacement should receive instruction regarding the importance of using antimicrobial prophylaxis before invasive medical or dental procedures. Female patients taking oral contraceptives should use an alternative form of contraception during therapy with amoxicillin and until next period.\u00a0 Patients should notify their HCP if symptoms do not improve.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the penicillin medication grid in Table 3.5.[footnote]Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> is licensed under CC BY-NA-SA 4.0<\/a>[\/footnote]<\/sup>\u00a0 Medication grids are intended to assist students to learn key points about each medication.\u00a0 Basic information related to a common generic medication in this class is outlined, including administration considerations, therapeutic effects, and side effects\/adverse effects.\u00a0 [pb_glossary id=\"2120\"]Prototype[\/pb_glossary]<\/strong>\/generic medications listed in the medication grid are also hyperlinked directly to a free resource from the United States National Library of Medicine called Daily Med<\/a>. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. \u00a0On the home page of Daily Med, enter the drug name in the search bar to read more about the medication.\n\n \n\nTable 3.5 Penicillin Medication Grid\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype-Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Penicillin<\/th>\npenicillin V<\/a> (PO)\n\npenicillin G <\/a>(IV)\n\namoxicillin<\/a>\n\npiperacillin\/t<\/a>azobactam <\/a>(combination product)<\/td>\nCheck for allergies to penicillin or cephalosporins\n\nObtain culture, if ordered, before first dose\n\nTake w\/ full glass of water; no acidic juice\n\nBest absorbed orally on empty stomach; give with food if stomach upset\n\nIf high doses; monitor INR, platelets, PT<\/td>\nMonitor for systemic signs\u00a0of infection:\n\n-WBCs\n\n-Temp\n\n-Culture results\n\nMonitor actual site of infection for improvement<\/td>\nCommon: nausea, vomiting, epigastric distress, diarrhea, and black hairy tongue\n\nMonitor for C-diff, candidiasis, and hyperkalemia\n\nHypersensitivity: Rash (maculopapular to exfoliative dermatitis), urticaria, laryngeal edema, and anaphylaxis\n\nSAFETY: If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n

Critical Thinking Activity 3.5a<\/strong><\/h2>\nUsing the above grid information, consider the following clinical scenario question:<\/strong>\n\nMr. Jones was admitted to the medical surgical floor with a Pneumococcal respiratory infection and prescribed penicillin V 500 mg PO every 6 hours. You bring the patient his 0800 medications, which include his penicillin. The patient has just finished his breakfast that included orange juice. Would you proceed with the penicillin administration at this time? Why or why not?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.","rendered":"

Now that we have reviewed antimicrobial basics, administration considerations, and the nursing process when administering antimicrobials,\u00a0 we will take a closer look at specific antimicrobial classes and administration considerations, therapeutic effects, adverse effects, and specific teaching needed for each class of antimicrobials. Each of the following sections of this chapter is based on a class or subclass of anti-infective medications.\u00a0 Each section discusses the mechanism of action, specific administration considerations, and common patient teaching for this class\/subclass of medication.\u00a0 Each section is then followed by a medication table with a common generic medication and its specific administration considerations, therapeutic effects, and side effects\/adverse effects for this medication.<\/p>\n

Penicillins<\/h2>\n

Penicillin was the first antibiotic discovered and its detection came as a bit of an accident. In 1928, Alexander Fleming, a professor of bacteriology at St. Mary’s Hospital in London, discovered penicillin accidentally growing in a petri dish in his lab. The penicillin was the result of mold juice that had grown there inadvertently. Fleming noted that this “mold juice” inhibited the growth of Staphylococcus bacteria that was previously growing in the petri dish. Subsequently, the first antibiotic discovery was made.[1]<\/sup><\/a><\/sup><\/p>\n

Indications:<\/strong> Penicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. Penicillins may be administered orally, IV, or intramuscularly.<\/p>\n

Mechanism of Action:<\/strong> Penicillins are bactericidal and kill bacteria by interfering with the synthesis of proteins needed in their cellular walls.[2]<\/sup><\/a>\u00a0<\/sup>When the bacterial cell wall is impaired, the cell is rapidly broken down and destroyed.<\/p>\n

Specific Administration Considerations:<\/strong> In addition to general antimicrobial administration considerations, it is important to monitor patients who receive penicillins for signs of superinfections such as C-diff or yeast infections.\u00a0 There is also a cross-sensitivity for patients allergic to cephalosporins.\u00a0 It is important to remember that patients who are prescribed high doses of penicillin may experience significant coagulation abnormalities.[3]<\/sup><\/a><\/sup> Other notable drug interactions include the use of diuretic therapy with penicillin. Penicillin contains a significant amount of potassium. Patients receiving potassium-sparing diuretics or supplementation should be monitored for signs of hyperkalemia. Penicillin is best absorbed on an empty stomach; however, many patients may experience GI upset and subsequently take the medication with food.<\/p>\n

Patient Teaching & Education:<\/strong>\u00a0 The patient should notify the health care provider (HCP) if fever or diarrhea develops, especially if the stool contains blood, pus, or mucus.\u00a0 Advise the patient not to treat diarrhea without advice from HCP. If GI upset occurs, the patient may take the medication with meals but should avoid taking with citrus-based products, which can impede absorption.\u00a0 Additionally, patients should be instructed to chew oral chewable tablets thoroughly before swallowing.\u00a0 The patient should report a rash or any signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool).<\/p>\n

Patients should be instructed to take medication around the clock and to finish the drug completely as directed.\u00a0 Doses should be spaced evenly to achieve the desired therapeutic effect.\u00a0 Additionally, patients should receive instruction to not share medication and that any sharing of medications may be dangerous.\u00a0 Patients with a history of rheumatic heart disease or valve replacement should receive instruction regarding the importance of using antimicrobial prophylaxis before invasive medical or dental procedures. Female patients taking oral contraceptives should use an alternative form of contraception during therapy with amoxicillin and until next period.\u00a0 Patients should notify their HCP if symptoms do not improve.[4]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the penicillin medication grid in Table 3.5.[5]<\/sup><\/a><\/sup>\u00a0 Medication grids are intended to assist students to learn key points about each medication.\u00a0 Basic information related to a common generic medication in this class is outlined, including administration considerations, therapeutic effects, and side effects\/adverse effects.\u00a0 Prototype<\/strong>\/generic medications listed in the medication grid are also hyperlinked directly to a free resource from the United States National Library of Medicine called Daily Med<\/a>. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. \u00a0On the home page of Daily Med, enter the drug name in the search bar to read more about the medication.<\/p>\n

 <\/p>\n

Table 3.5 Penicillin Medication Grid<\/p>\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype-Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Penicillin<\/th>\npenicillin V<\/a> (PO)<\/p>\n

penicillin G <\/a>(IV)<\/p>\n

amoxicillin<\/a><\/p>\n

piperacillin\/t<\/a>azobactam <\/a>(combination product)<\/td>\n

Check for allergies to penicillin or cephalosporins<\/p>\n

Obtain culture, if ordered, before first dose<\/p>\n

Take w\/ full glass of water; no acidic juice<\/p>\n

Best absorbed orally on empty stomach; give with food if stomach upset<\/p>\n

If high doses; monitor INR, platelets, PT<\/td>\n

Monitor for systemic signs\u00a0of infection:<\/p>\n

-WBCs<\/p>\n

-Temp<\/p>\n

-Culture results<\/p>\n

Monitor actual site of infection for improvement<\/td>\n

Common: nausea, vomiting, epigastric distress, diarrhea, and black hairy tongue<\/p>\n

Monitor for C-diff, candidiasis, and hyperkalemia<\/p>\n

Hypersensitivity: Rash (maculopapular to exfoliative dermatitis), urticaria, laryngeal edema, and anaphylaxis<\/p>\n

SAFETY: If an allergic reaction occurs, penicillin should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Critical Thinking Activity 3.5a<\/strong><\/h2>\n

Using the above grid information, consider the following clinical scenario question:<\/strong><\/p>\n

Mr. Jones was admitted to the medical surgical floor with a Pneumococcal respiratory infection and prescribed penicillin V 500 mg PO every 6 hours. You bring the patient his 0800 medications, which include his penicillin. The patient has just finished his breakfast that included orange juice. Would you proceed with the penicillin administration at this time? Why or why not?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.<\/p>\n

  1. American Chemical Society International Historic Chemical Landmarks. Discovery and development of penicillin.<\/em> http:\/\/www.acs.org\/content\/acs\/en\/education\/whatischemistry\/landmarks\/flemingpenicillin.html<\/a> ↵<\/a><\/li>
  2. This work is a derivative of Principles of Pharmacology<\/a> by LibreTexts<\/a> licensed under CC BY-NC-SA 4.0<\/a> ↵<\/a><\/li>
  3. Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> is licensed under CC BY-NA-SA 4.0<\/a> ↵<\/a><\/li>
  4. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  5. Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> is licensed under CC BY-NA-SA 4.0<\/a> ↵<\/a><\/li><\/ol><\/div>
    definition<\/span>