{"id":91,"date":"2019-09-22T17:50:18","date_gmt":"2019-09-22T21:50:18","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-5-penicillins\/"},"modified":"2023-03-07T12:37:19","modified_gmt":"2023-03-07T17:37:19","slug":"3-5-penicillins","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-5-penicillins\/","title":{"raw":"3.6 Penicillins","rendered":"3.6 Penicillins"},"content":{"raw":"Now that we have reviewed antimicrobial basics, common bacterial infections and the nursing process when administering antimicrobials, and general administration considerations, 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 client 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.\r\n

Penicillins<\/h1>\r\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]\r\n

Indications for\u00a0 Use<\/h2>\r\nPenicillins are prescribed to treat a variety of infectious processes such as Streptococcal infections, Pneumococcal infections, and Staphylococcal infections. They are considered [pb_glossary id=\"592\"]broad-spectrum[\/pb_glossary] for [pb_glossary id=\"588\"] gram-positive[\/pb_glossary] bacteria, but have little effectiveness for [pb_glossary id=\"800\"]gram-negative[\/pb_glossary] bacteria. Penicillins may be administered orally, IV, or intramuscularly.\r\n

Mechanism of Action<\/h2>\r\nPenicillins are [pb_glossary id=\"595\"]bactericidal [\/pb_glossary] and kill bacteria by interfering with the synthesis of proteins needed in their cellular walls. When the bacterial cell wall is impaired, the cell is rapidly broken down and destroyed.\r\n

Nursing Considerations Across the Lifespan<\/h2>\r\nPenicillins are considered safe for children, with dosages varying based on pediatric clients' weight. No dosage adjustment is required for clients with hepatic or renal impairment. Penicillins can be used during pregnancy.\r\n

Specific Administration Considerations<\/h2>\r\nIn addition to general antimicrobial administration considerations, it is important to monitor clients who receive penicillins for signs of superinfections such as C-diff or yeast infections.\u00a0 There is also a cross-sensitivity for clients allergic to cephalosporins.\u00a0 It is important to remember that clients 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] Other notable drug interactions include the use of diuretic therapy with penicillin. Penicillin contains a significant amount of potassium. Clients receiving potassium-sparing diuretics or supplementation should be monitored for signs of hyperkalemia. Penicillin is best absorbed on an empty stomach; however, many clients may experience GI upset and subsequently take the medication with food.\r\n

Client Teaching & Education<\/h2>\r\nThe client should notify the health care provider (HCP) if fever or diarrhoea develops, especially if the stool contains blood, pus, or mucus.\u00a0 Advise the client not to treat diarrhoea without advice from HCP. If GI upset occurs, the client may take the medication with meals but should avoid taking with citrus-based products, which can impede absorption.\u00a0 Additionally, clients should be instructed to chew oral chewable tablets thoroughly before swallowing.\u00a0 The client should report a rash or any signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool).\r\n\r\nClients 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, clients should receive instruction to not share medication and that any sharing of medications may be dangerous.\u00a0 Clients 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 clients taking oral contraceptives should use an alternative form of contraception during therapy with amoxicillin and until their next period.\u00a0 Clients should notify their HCP if symptoms do not improve.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n

Penecillin Medication Card<\/h2>\r\nNow let's take a closer look at the penicillin medication card.[footnote]Pharmacology Notes: Nursing Implications for Clinical Practice<\/a> by Gloria Velarde<\/a> is licensed under CC BY-NA-SA 4.0<\/a>[\/footnote]\r\n\r\nMedication 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. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. [pb_glossary id=\"722\"]Prototype[\/pb_glossary]\/generic medications listed in the medication card are also hyperlinked directly to a free resource from the United States National Library of Medicine called Daily Med<\/a>. Other resources you can access for free for evidence-based medication information include: OpenMD<\/a> and Merck Manuals<\/a>. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n
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Medication Card 3.6.1: Penicillin (Antimicrobial)[footnote]UpToDate. (2021). Penicillin V Potassium (oral). https:\/\/www.uptodate.com\/contents\/search[\/footnote]<\/h2>\r\n<\/header>\r\n
\r\n\r\nClass:<\/strong> Penicillin\r\n\r\nPrototypes:<\/strong> penicillin V (PO), penicillin G (IV), amoxicillin, piperacillin\/ tazobactam (combination product)\r\n

Therapeutic Effects<\/h3>\r\n