{"id":95,"date":"2019-09-22T17:51:13","date_gmt":"2019-09-22T21:51:13","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-6-cephalosporins\/"},"modified":"2023-07-18T14:12:00","modified_gmt":"2023-07-18T18:12:00","slug":"3-6-cephalosporins","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/3-6-cephalosporins\/","title":{"raw":"3.7 Cephalosporins","rendered":"3.7 Cephalosporins"},"content":{"raw":"Cephalosporins are a slightly modified chemical \"twin\" to penicillins due to their beta-lactam chemical structure. (See Figure 3.7 for a comparison of the beta-lactam ring structure, spectrum of activity, and route of administration across different classes of medications.) Because of these similarities, some clients who have allergies to penicillins may experience cross-sensitivity to cephalosporins.<a id=\"fig3.7\"><\/a>[footnote]\"<a href=\"https:\/\/openstax.org\/resources\/875df04f09b347eb5af989aec39c17218e95e976\">OSC Microbio 14 02 BetaLactam.jpg<\/a>\" by <a href=\"https:\/\/cnx.org\/\">CNX Openstax<\/a> is licensed under<a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\"> CC BY 4.0<\/a> Access for free at <a href=\"https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs\">https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs<\/a>[\/footnote]\r\n\r\n&nbsp;\r\n\r\n[caption id=\"\" align=\"alignnone\" width=\"1300\"]<img title=\"&quot;OSC Microbio 14 02 BetaLactam.jpg&quot; by CNX Openstax is licensed under CC BY 4.0 Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/09\/image11-1.png\" alt=\"Illustration and chart detailing Beta-lactam ring structure \" width=\"1300\" height=\"908\" \/> Figure 3.7 Comparison of beta-lactam ring structure across different classes of medications, spectrum of activity and routes of administration. <a href=\"#fig3.7_desc\">[Image Description]<\/a>[\/caption]<strong>Indications for Use:<\/strong> Cephalosporins are used to treat skin and skin-structure infections, bone infections, genitourinary infections, otitis media, and community-acquired respiratory tract infections.\r\n\r\n<strong>Mechanism of Action:<\/strong> Cephalosporins are typically bactericidal and are similar to penicillin in their action within the cell wall. Cephalosporins are sometimes grouped into \"generations\" by their antimicrobial properties. The 1st-generation drugs are effective mainly against gram-positive organisms. Higher generations generally have expanded spectra against aerobic gram-negative bacilli. The 5th-generation cephalosporins are active against methicillin-resistant <a class=\"rId35\" href=\"https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/gram-positive-cocci\/staphylococcal-infections\" rel=\"noopener noreferrer\">Staphylococcus aureus<\/a> (MRSA) or other complicated infections. [footnote]Werth, B.J. (2018, August). <em>Cephalosporins.<\/em> Merck Manual Professional Version. <a href=\"https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-drugs\/cephalosporins\" rel=\"noopener noreferrer\">https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-drugs\/cephalosporins<\/a> [\/footnote]\r\n\r\n<strong>Nursing Considerations Across the Lifespan:<\/strong>\u00a0 Most cephalosporins are considered safe for use in pediatrics. Some dose adjustments are required based on renal dysfunction in older adults. Cephalosporins can be given during pregnancy.\r\n\r\n<strong>Specific Administration Considerations:<\/strong> Clients who are allergic to pencillins may also be allergic to cephalosporins. Clients who consume cephalosporins while drinking alcoholic beverages may experience disulfiram-like reactions including severe headache, flushing, nausea, vomiting, etc.[footnote]Ren, S., Cao, Y., Zhang, X., Jiao, S., Qian, S., &amp; Liu, P. (2014). Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases. <em>International Surgery, 99<\/em>(2), 142\u2013146. <a href=\"https:\/\/www.internationalsurgery.org\/doi\/full\/10.9738\/INTSURG-D-13-00086.1\" rel=\"noopener noreferrer\">https:\/\/www.internationalsurgery.org\/doi\/full\/10.9738\/INTSURG-D-13-00086.1<\/a>[\/footnote]Additionally, like penicillins, cephalosporins may interfere with coagulability and increase a client's risk of bleeding. Cephalosporin dosing may require adjustment for clients experiencing renal impairment. Blood urea nitrogen (BUN) and creatinine should be monitored carefully to identify signs of nephrotoxicity.\r\n\r\n<strong>Client Teaching &amp; Education:<\/strong> Clients who are prescribed cephalosporins should be specifically cautioned about a disulfiram reaction, which can occur when alcohol is ingested while taking the medication.\u00a0 Additionally, individuals should be instructed to monitor for rash and signs of superinfection (such as black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool) and report to the prescribing provider.\r\n\r\nIt is also important to note that cephalosporin can enter breastmilk and may alter bowel flora of the infant. Thus, use during breastfeeding is often discouraged.[footnote]uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n<h1>Cephalosporin Medication Card<\/h1>\r\nNow let's take a closer look at the cephalosporin medication card.[footnote]Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\" rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019.[\/footnote] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">Medication Card 3.7.1: Cephalosporin (Antimicrobial)[footnote]UpToDate (2021). &lt;em&gt;Cefazolin&lt;\/em&gt;. &lt;a href=\"https:\/\/www.uptodate.com\/contents\/search\"&gt;https:\/\/www.uptodate.com\/contents\/search&lt;\/a&gt;[\/footnote]<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<strong>Class:<\/strong> Cephalosporins\r\n\r\n<strong>Prototypes:<\/strong> 1st generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=19307ff0-71de-477b-965d-ea243e5ede3a&amp;audience=consumer\" rel=\"noopener\">cephalexin<\/a> and <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=48656c70-206d-652c-204f-62692d57616e&amp;audience=consumer\" rel=\"noopener\">Cefazolin<\/a>; 2nd generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=97675251-70b8-43bc-93ea-f9ef6bb8cb68\" rel=\"noopener\">cefprozil<\/a>; 3rd generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=4d1ad77f-2c6b-4250-82e5-ab3574444e08\" rel=\"noopener\">ceftriaxone<\/a>; 4th generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=28f1c403-ab91-405e-bf52-ad81b1c66220\" rel=\"noopener\">cefepime<\/a>; 5th generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=70ac1d90-eff3-4f0b-9f46-5846c571b32f\" rel=\"noopener\">ceftolozane<\/a>\r\n<h3>Mechanism<\/h3>\r\nSimilar to penicillins.\u00a0 Bactericidal and bacteriostatic. Well absorbed orally.\r\n<h3>Therapeutic Effects<\/h3>\r\n<ul>\r\n \t<li>Monitor for systemic signs of infection:\r\n<ul>\r\n \t<li>WBC<\/li>\r\n \t<li>Temperature<\/li>\r\n \t<li>Culture results<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Monitor site of infection for improvement<\/li>\r\n<\/ul>\r\n<h3>Administration<\/h3>\r\n<ul>\r\n \t<li>Onset: rapid<\/li>\r\n \t<li>Peak: 1hr<\/li>\r\n \t<li>Duration: 6-12hr<\/li>\r\n \t<li>PO: Administer without regard to food; if GI distress, give with food<\/li>\r\n \t<li>IV: Reconstitute drug with sterile water or normal saline; shake well until dissolved. Inject into large vein or free-flowing IV solution over 3-5 minutes<\/li>\r\n \t<li>Geriatrics: may need dose adjustment d\/t age-related \u2193 in renal function<\/li>\r\n \t<li>OB, Lactating:\u00a0 \u00bd life \u2193 &amp; blood levels lower during pregnancy<\/li>\r\n<\/ul>\r\n<h3>Indications<\/h3>\r\n<ul>\r\n \t<li>UTI<\/li>\r\n \t<li>Respiratory infections<\/li>\r\n<\/ul>\r\nLike penicillin:\r\n<ul>\r\n \t<li>streptococcus<\/li>\r\n \t<li>enterococcus<\/li>\r\n \t<li>staphylococcus<\/li>\r\n \t<li>ear infections<\/li>\r\n \t<li>pneumonia<\/li>\r\n \t<li>UTI<\/li>\r\n \t<li>Prophylaxis pre\u2192post surgery<\/li>\r\n \t<li>STI<\/li>\r\n<\/ul>\r\n<h3>Contraindications<\/h3>\r\n<ul>\r\n \t<li>caution if penicillin allergy<\/li>\r\n \t<li>Lactam drug hypersensitivity: Pts allergic to penicillin \u2191likely to be allergic to cephalosporins<\/li>\r\n \t<li>Hx of GI disease<\/li>\r\n<\/ul>\r\nLike penicillin:\r\n<ul>\r\n \t<li>Other antibiotics = additive, inhibitory effects<\/li>\r\n \t<li>NSAIDs<\/li>\r\n \t<li>Oral birth control<\/li>\r\n \t<li>K+ supplements<\/li>\r\n<\/ul>\r\nDrug interaction with aminoglycosides or oral anti-coagulant drugs (eg warfarin)\r\n<h3>Side Effects<\/h3>\r\n<ul>\r\n \t<li>CNS: Seizures, headaches<\/li>\r\n \t<li>GI: N\/V, diarrhea (Diarrhea can start 4-5 days in)<\/li>\r\n \t<li>Derm: Stevens-Johnson syndrome, rashes<\/li>\r\n \t<li>Local: Pain @ IV site, Phlebitis @ IV site<\/li>\r\n<\/ul>\r\n<strong>SAFETY:<\/strong> If an allergic reaction occurs, antibiotic should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management.\r\n<h3>Nursing Considerations<\/h3>\r\n<ul>\r\n \t<li>Concurrent use of Loop diuretics and Aminoglycosides may \u2191 risk of nephrotoxicity<\/li>\r\n \t<li>alcohol should not be consumed until 72 hrs after stopping med.<\/li>\r\n \t<li>Like penicillin:<\/li>\r\n \t<li>Avoid caffeine, citrus, cola, juices, tomato juice = can inactivate drug<\/li>\r\n \t<li>Monitor skin<\/li>\r\n \t<li>Monitor bowel<\/li>\r\n \t<li>Monitor labs<\/li>\r\n \t<li>Pts should report: diarrhea, flu stx, peeling skin, hearing loss, breathing issues, seizures, bad smelling\/ loose\/bloody stools<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<strong>Note:\u00a0<\/strong>All drug cards are available in the <a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/medication-cards\/\">Medication Cards Chapter<\/a> as editable and printable documents.\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 3.6a<\/header>\r\n<div class=\"textbox__content\">\r\n<h3>Using the above information, consider the following clinical scenario question:<\/h3>\r\nMrs. Jenkins is an 89-year-old client admitted to the medical-surgical floor for treatment of a skin infection. The admitting provider prescribes Cefazolin 1 gram every 8 hours IV.\r\n\r\nMrs. Jenkins' admission laboratory tests include renal laboratory studies reflecting:\r\n<ul>\r\n \t<li><a class=\"rId42\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">Creatinine<\/a>: 120 \u03bcmol\/L (Normal range: 50-110 \u03bcmol\/L[footnote]U.S. National Library of Medicine, Medline Plus. (2020, February 13). <em>Basic metabolic panel.<\/em>\u00a0<a href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/article\/003462.htm<\/a>[\/footnote]<\/li>\r\n \t<li><a class=\"rId43\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">Blood urea nitrogen (BUN)<\/a>: 10.5 mmol\/L (Normal: 2.9-8.2 mmol\/L)<\/li>\r\n \t<li><a class=\"rId44\" href=\"https:\/\/medlineplus.gov\/ency\/article\/007305.htm\">Glomerular Filtration Rate<\/a>: 55 ml\/min (Normal: 90-120 ml\/min)[footnote]U.S. National Library of Medicine, Medline Plus. (2020, February 13). <em>Glomerular filtration rate.<\/em> <a href=\"https:\/\/medlineplus.gov\/ency\/article\/007305.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/article\/007305.htm<\/a>[\/footnote]<\/li>\r\n<\/ul>\r\nOn Day 3 Mrs. Jenkins has renal laboratory studies performed again. The results are:\r\n<ul>\r\n \t<li>Creatinine: 150 \u03bcmol\/L<\/li>\r\n \t<li>Blood urea nitrogen (BUN):\u00a0 16.8 mmol\/L<\/li>\r\n \t<li>Glomerular Filtration Rate: 20 ml\/min<\/li>\r\n<\/ul>\r\nAre Day 3 findings expected or not? What course of action should the nurse take?\r\n\r\nNote: Answers to the activities can be found in the \"<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n<h1>Image Description<\/h1>\r\n<strong><a id=\"fig3.7_desc\"><\/a>Figure 3.7 Comparison of beta-lactam ring structure across different classes of medications, spectrum of activity and routes of administration<\/strong>: Diagrams showing the chemical structures of various medication classes. These medications are:\r\n<ul>\r\n \t<li>Penicillin.<\/li>\r\n \t<li>Cephalosporin.<\/li>\r\n \t<li>Monobactam.<\/li>\r\n \t<li>Carbapenem.<\/li>\r\n<\/ul>\r\nEach of these medications has a becta-lactam ring at the centre.\r\n<table style=\"border-collapse: collapse; width: 100%; height: 129px;\" border=\"0\"><caption>Comparison of different classes of medications, their spectra of activity, routes of administration, and chemistry<\/caption>\r\n<tbody>\r\n<tr style=\"height: 16px;\">\r\n<th style=\"width: 16.6667%; height: 16px;\" scope=\"row\">Drug name<\/th>\r\n<td style=\"width: 16.6667%; height: 16px;\">penicillin G<\/td>\r\n<td style=\"width: 16.6667%; height: 16px;\">penicillin V<\/td>\r\n<td style=\"width: 16.6667%; height: 16px;\">ampicillin<\/td>\r\n<td style=\"width: 16.6667%; height: 16px;\">amoxicillin<\/td>\r\n<td style=\"width: 16.6667%; height: 16px;\">methicillin<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 16.6667%;\" scope=\"row\">R group<\/th>\r\n<td style=\"width: 16.6667%;\">CH<sub>2<\/sub><\/td>\r\n<td style=\"width: 16.6667%;\">CH<sub>2<\/sub> bonded to O<\/td>\r\n<td style=\"width: 16.6667%;\">CH bonded to NH<sub>2<\/sub><\/td>\r\n<td style=\"width: 16.6667%;\">CH bonded to NH<sub>2<\/sub> on one side of the molecule, and OH bonded to the other side<\/td>\r\n<td style=\"width: 16.6667%;\">CH<sub>3<\/sub>O bonded to one side of the molecule, and CH<sub>3<\/sub>O bonded to the other side<\/td>\r\n<\/tr>\r\n<tr style=\"height: 65px;\">\r\n<th style=\"width: 16.6667%; height: 65px;\" scope=\"row\">Spectrum of activity<\/th>\r\n<td style=\"width: 16.6667%; height: 65px;\">G+ and a few G\u2212<\/td>\r\n<td style=\"width: 16.6667%; height: 65px;\">similar to penicillin G<\/td>\r\n<td style=\"width: 16.6667%; height: 65px;\">G+ and more G\u2212 than penicillin<\/td>\r\n<td style=\"width: 16.6667%; height: 65px;\">similar to ampicillin<\/td>\r\n<td style=\"width: 16.6667%; height: 65px;\">G+ only, including \u03b2-lactamase producers<\/td>\r\n<\/tr>\r\n<tr style=\"height: 32px;\">\r\n<th style=\"width: 16.6667%; height: 32px;\" scope=\"row\">Route of administration<\/th>\r\n<td style=\"width: 16.6667%; height: 32px;\">parenteral<\/td>\r\n<td style=\"width: 16.6667%; height: 32px;\">oral<\/td>\r\n<td style=\"width: 16.6667%; height: 32px;\">parenteral and oral<\/td>\r\n<td style=\"width: 16.6667%; height: 32px;\">oral (better than ampicillin)<\/td>\r\n<td style=\"width: 16.6667%; height: 32px;\">parenteral<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<a href=\"#fig3.7\">[Return to Figure 3.7]<\/a>","rendered":"<p>Cephalosporins are a slightly modified chemical &#8220;twin&#8221; to penicillins due to their beta-lactam chemical structure. (See Figure 3.7 for a comparison of the beta-lactam ring structure, spectrum of activity, and route of administration across different classes of medications.) Because of these similarities, some clients who have allergies to penicillins may experience cross-sensitivity to cephalosporins.<a id=\"fig3.7\"><\/a><a class=\"footnote\" title=\"&quot;OSC Microbio 14 02 BetaLactam.jpg&quot; by CNX Openstax is licensed under CC BY 4.0 Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs\" id=\"return-footnote-95-1\" href=\"#footnote-95-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p>&nbsp;<\/p>\n<figure style=\"width: 1300px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;OSC Microbio 14 02 BetaLactam.jpg&quot; by CNX Openstax is licensed under CC BY 4.0 Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/09\/image11-1.png\" alt=\"Illustration and chart detailing Beta-lactam ring structure\" width=\"1300\" height=\"908\" \/><figcaption class=\"wp-caption-text\">Figure 3.7 Comparison of beta-lactam ring structure across different classes of medications, spectrum of activity and routes of administration. <a href=\"#fig3.7_desc\">[Image Description]<\/a><\/figcaption><\/figure>\n<p><strong>Indications for Use:<\/strong> Cephalosporins are used to treat skin and skin-structure infections, bone infections, genitourinary infections, otitis media, and community-acquired respiratory tract infections.<\/p>\n<p><strong>Mechanism of Action:<\/strong> Cephalosporins are typically bactericidal and are similar to penicillin in their action within the cell wall. Cephalosporins are sometimes grouped into &#8220;generations&#8221; by their antimicrobial properties. The 1st-generation drugs are effective mainly against gram-positive organisms. Higher generations generally have expanded spectra against aerobic gram-negative bacilli. The 5th-generation cephalosporins are active against methicillin-resistant <a class=\"rId35\" href=\"https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/gram-positive-cocci\/staphylococcal-infections\" rel=\"noopener noreferrer\">Staphylococcus aureus<\/a> (MRSA) or other complicated infections. <a class=\"footnote\" title=\"Werth, B.J. (2018, August). Cephalosporins. Merck Manual Professional Version. https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-drugs\/cephalosporins\" id=\"return-footnote-95-2\" href=\"#footnote-95-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<p><strong>Nursing Considerations Across the Lifespan:<\/strong>\u00a0 Most cephalosporins are considered safe for use in pediatrics. Some dose adjustments are required based on renal dysfunction in older adults. Cephalosporins can be given during pregnancy.<\/p>\n<p><strong>Specific Administration Considerations:<\/strong> Clients who are allergic to pencillins may also be allergic to cephalosporins. Clients who consume cephalosporins while drinking alcoholic beverages may experience disulfiram-like reactions including severe headache, flushing, nausea, vomiting, etc.<a class=\"footnote\" title=\"Ren, S., Cao, Y., Zhang, X., Jiao, S., Qian, S., &amp; Liu, P. (2014). Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases. International Surgery, 99(2), 142\u2013146. https:\/\/www.internationalsurgery.org\/doi\/full\/10.9738\/INTSURG-D-13-00086.1\" id=\"return-footnote-95-3\" href=\"#footnote-95-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a>Additionally, like penicillins, cephalosporins may interfere with coagulability and increase a client&#8217;s risk of bleeding. Cephalosporin dosing may require adjustment for clients experiencing renal impairment. Blood urea nitrogen (BUN) and creatinine should be monitored carefully to identify signs of nephrotoxicity.<\/p>\n<p><strong>Client Teaching &amp; Education:<\/strong> Clients who are prescribed cephalosporins should be specifically cautioned about a disulfiram reaction, which can occur when alcohol is ingested while taking the medication.\u00a0 Additionally, individuals should be instructed to monitor for rash and signs of superinfection (such as black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stool) and report to the prescribing provider.<\/p>\n<p>It is also important to note that cephalosporin can enter breastmilk and may alter bowel flora of the infant. Thus, use during breastfeeding is often discouraged.<a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-95-4\" href=\"#footnote-95-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<h1>Cephalosporin Medication Card<\/h1>\n<p>Now let&#8217;s take a closer look at the cephalosporin medication card.<a class=\"footnote\" title=\"Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019.\" id=\"return-footnote-95-5\" href=\"#footnote-95-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a> Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\">Medication Card 3.7.1: Cephalosporin (Antimicrobial)<a class=\"footnote\" title=\"UpToDate (2021). &lt;em&gt;Cefazolin&lt;\/em&gt;. &lt;a href=&quot;https:\/\/www.uptodate.com\/contents\/search&quot;&gt;https:\/\/www.uptodate.com\/contents\/search&lt;\/a&gt;\" id=\"return-footnote-95-6\" href=\"#footnote-95-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><strong>Class:<\/strong> Cephalosporins<\/p>\n<p><strong>Prototypes:<\/strong> 1st generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=19307ff0-71de-477b-965d-ea243e5ede3a&amp;audience=consumer\" rel=\"noopener\">cephalexin<\/a> and <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=48656c70-206d-652c-204f-62692d57616e&amp;audience=consumer\" rel=\"noopener\">Cefazolin<\/a>; 2nd generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=97675251-70b8-43bc-93ea-f9ef6bb8cb68\" rel=\"noopener\">cefprozil<\/a>; 3rd generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=4d1ad77f-2c6b-4250-82e5-ab3574444e08\" rel=\"noopener\">ceftriaxone<\/a>; 4th generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=28f1c403-ab91-405e-bf52-ad81b1c66220\" rel=\"noopener\">cefepime<\/a>; 5th generation: <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=70ac1d90-eff3-4f0b-9f46-5846c571b32f\" rel=\"noopener\">ceftolozane<\/a><\/p>\n<h3>Mechanism<\/h3>\n<p>Similar to penicillins.\u00a0 Bactericidal and bacteriostatic. Well absorbed orally.<\/p>\n<h3>Therapeutic Effects<\/h3>\n<ul>\n<li>Monitor for systemic signs of infection:\n<ul>\n<li>WBC<\/li>\n<li>Temperature<\/li>\n<li>Culture results<\/li>\n<\/ul>\n<\/li>\n<li>Monitor site of infection for improvement<\/li>\n<\/ul>\n<h3>Administration<\/h3>\n<ul>\n<li>Onset: rapid<\/li>\n<li>Peak: 1hr<\/li>\n<li>Duration: 6-12hr<\/li>\n<li>PO: Administer without regard to food; if GI distress, give with food<\/li>\n<li>IV: Reconstitute drug with sterile water or normal saline; shake well until dissolved. Inject into large vein or free-flowing IV solution over 3-5 minutes<\/li>\n<li>Geriatrics: may need dose adjustment d\/t age-related \u2193 in renal function<\/li>\n<li>OB, Lactating:\u00a0 \u00bd life \u2193 &amp; blood levels lower during pregnancy<\/li>\n<\/ul>\n<h3>Indications<\/h3>\n<ul>\n<li>UTI<\/li>\n<li>Respiratory infections<\/li>\n<\/ul>\n<p>Like penicillin:<\/p>\n<ul>\n<li>streptococcus<\/li>\n<li>enterococcus<\/li>\n<li>staphylococcus<\/li>\n<li>ear infections<\/li>\n<li>pneumonia<\/li>\n<li>UTI<\/li>\n<li>Prophylaxis pre\u2192post surgery<\/li>\n<li>STI<\/li>\n<\/ul>\n<h3>Contraindications<\/h3>\n<ul>\n<li>caution if penicillin allergy<\/li>\n<li>Lactam drug hypersensitivity: Pts allergic to penicillin \u2191likely to be allergic to cephalosporins<\/li>\n<li>Hx of GI disease<\/li>\n<\/ul>\n<p>Like penicillin:<\/p>\n<ul>\n<li>Other antibiotics = additive, inhibitory effects<\/li>\n<li>NSAIDs<\/li>\n<li>Oral birth control<\/li>\n<li>K+ supplements<\/li>\n<\/ul>\n<p>Drug interaction with aminoglycosides or oral anti-coagulant drugs (eg warfarin)<\/p>\n<h3>Side Effects<\/h3>\n<ul>\n<li>CNS: Seizures, headaches<\/li>\n<li>GI: N\/V, diarrhea (Diarrhea can start 4-5 days in)<\/li>\n<li>Derm: Stevens-Johnson syndrome, rashes<\/li>\n<li>Local: Pain @ IV site, Phlebitis @ IV site<\/li>\n<\/ul>\n<p><strong>SAFETY:<\/strong> If an allergic reaction occurs, antibiotic should be discontinued and appropriate therapy instituted. Serious anaphylactic reactions require emergency treatment with epinephrine and airway management.<\/p>\n<h3>Nursing Considerations<\/h3>\n<ul>\n<li>Concurrent use of Loop diuretics and Aminoglycosides may \u2191 risk of nephrotoxicity<\/li>\n<li>alcohol should not be consumed until 72 hrs after stopping med.<\/li>\n<li>Like penicillin:<\/li>\n<li>Avoid caffeine, citrus, cola, juices, tomato juice = can inactivate drug<\/li>\n<li>Monitor skin<\/li>\n<li>Monitor bowel<\/li>\n<li>Monitor labs<\/li>\n<li>Pts should report: diarrhea, flu stx, peeling skin, hearing loss, breathing issues, seizures, bad smelling\/ loose\/bloody stools<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p><strong>Note:\u00a0<\/strong>All drug cards are available in the <a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/medication-cards\/\">Medication Cards Chapter<\/a> as editable and printable documents.<\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 3.6a<\/header>\n<div class=\"textbox__content\">\n<h3>Using the above information, consider the following clinical scenario question:<\/h3>\n<p>Mrs. Jenkins is an 89-year-old client admitted to the medical-surgical floor for treatment of a skin infection. The admitting provider prescribes Cefazolin 1 gram every 8 hours IV.<\/p>\n<p>Mrs. Jenkins&#8217; admission laboratory tests include renal laboratory studies reflecting:<\/p>\n<ul>\n<li><a class=\"rId42\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">Creatinine<\/a>: 120 \u03bcmol\/L (Normal range: 50-110 \u03bcmol\/L<a class=\"footnote\" title=\"U.S. National Library of Medicine, Medline Plus. (2020, February 13). Basic metabolic panel.\u00a0https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" id=\"return-footnote-95-7\" href=\"#footnote-95-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/li>\n<li><a class=\"rId43\" href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">Blood urea nitrogen (BUN)<\/a>: 10.5 mmol\/L (Normal: 2.9-8.2 mmol\/L)<\/li>\n<li><a class=\"rId44\" href=\"https:\/\/medlineplus.gov\/ency\/article\/007305.htm\">Glomerular Filtration Rate<\/a>: 55 ml\/min (Normal: 90-120 ml\/min)<a class=\"footnote\" title=\"U.S. National Library of Medicine, Medline Plus. (2020, February 13). Glomerular filtration rate. https:\/\/medlineplus.gov\/ency\/article\/007305.htm\" id=\"return-footnote-95-8\" href=\"#footnote-95-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/li>\n<\/ul>\n<p>On Day 3 Mrs. Jenkins has renal laboratory studies performed again. The results are:<\/p>\n<ul>\n<li>Creatinine: 150 \u03bcmol\/L<\/li>\n<li>Blood urea nitrogen (BUN):\u00a0 16.8 mmol\/L<\/li>\n<li>Glomerular Filtration Rate: 20 ml\/min<\/li>\n<\/ul>\n<p>Are Day 3 findings expected or not? What course of action should the nurse take?<\/p>\n<p>Note: Answers to the activities can be found in the &#8220;<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-3\/\">Answer Key<\/a>&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<h1>Image Description<\/h1>\n<p><strong><a id=\"fig3.7_desc\"><\/a>Figure 3.7 Comparison of beta-lactam ring structure across different classes of medications, spectrum of activity and routes of administration<\/strong>: Diagrams showing the chemical structures of various medication classes. These medications are:<\/p>\n<ul>\n<li>Penicillin.<\/li>\n<li>Cephalosporin.<\/li>\n<li>Monobactam.<\/li>\n<li>Carbapenem.<\/li>\n<\/ul>\n<p>Each of these medications has a becta-lactam ring at the centre.<\/p>\n<table style=\"border-collapse: collapse; width: 100%; height: 129px;\">\n<caption>Comparison of different classes of medications, their spectra of activity, routes of administration, and chemistry<\/caption>\n<tbody>\n<tr style=\"height: 16px;\">\n<th style=\"width: 16.6667%; height: 16px;\" scope=\"row\">Drug name<\/th>\n<td style=\"width: 16.6667%; height: 16px;\">penicillin G<\/td>\n<td style=\"width: 16.6667%; height: 16px;\">penicillin V<\/td>\n<td style=\"width: 16.6667%; height: 16px;\">ampicillin<\/td>\n<td style=\"width: 16.6667%; height: 16px;\">amoxicillin<\/td>\n<td style=\"width: 16.6667%; height: 16px;\">methicillin<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 16.6667%;\" scope=\"row\">R group<\/th>\n<td style=\"width: 16.6667%;\">CH<sub>2<\/sub><\/td>\n<td style=\"width: 16.6667%;\">CH<sub>2<\/sub> bonded to O<\/td>\n<td style=\"width: 16.6667%;\">CH bonded to NH<sub>2<\/sub><\/td>\n<td style=\"width: 16.6667%;\">CH bonded to NH<sub>2<\/sub> on one side of the molecule, and OH bonded to the other side<\/td>\n<td style=\"width: 16.6667%;\">CH<sub>3<\/sub>O bonded to one side of the molecule, and CH<sub>3<\/sub>O bonded to the other side<\/td>\n<\/tr>\n<tr style=\"height: 65px;\">\n<th style=\"width: 16.6667%; height: 65px;\" scope=\"row\">Spectrum of activity<\/th>\n<td style=\"width: 16.6667%; height: 65px;\">G+ and a few G\u2212<\/td>\n<td style=\"width: 16.6667%; height: 65px;\">similar to penicillin G<\/td>\n<td style=\"width: 16.6667%; height: 65px;\">G+ and more G\u2212 than penicillin<\/td>\n<td style=\"width: 16.6667%; height: 65px;\">similar to ampicillin<\/td>\n<td style=\"width: 16.6667%; height: 65px;\">G+ only, including \u03b2-lactamase producers<\/td>\n<\/tr>\n<tr style=\"height: 32px;\">\n<th style=\"width: 16.6667%; height: 32px;\" scope=\"row\">Route of administration<\/th>\n<td style=\"width: 16.6667%; height: 32px;\">parenteral<\/td>\n<td style=\"width: 16.6667%; height: 32px;\">oral<\/td>\n<td style=\"width: 16.6667%; height: 32px;\">parenteral and oral<\/td>\n<td style=\"width: 16.6667%; height: 32px;\">oral (better than ampicillin)<\/td>\n<td style=\"width: 16.6667%; height: 32px;\">parenteral<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><a href=\"#fig3.7\">[Return to Figure 3.7]<\/a><\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-95-1\">\"<a href=\"https:\/\/openstax.org\/resources\/875df04f09b347eb5af989aec39c17218e95e976\">OSC Microbio 14 02 BetaLactam.jpg<\/a>\" by <a href=\"https:\/\/cnx.org\/\">CNX Openstax<\/a> is licensed under<a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\"> CC BY 4.0<\/a> Access for free at <a href=\"https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs\">https:\/\/openstax.org\/books\/microbiology\/pages\/14-3-mechanisms-of-antibacterial-drugs<\/a> <a href=\"#return-footnote-95-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-95-2\">Werth, B.J. (2018, August). <em>Cephalosporins.<\/em> Merck Manual Professional Version. <a href=\"https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-drugs\/cephalosporins\" rel=\"noopener noreferrer\">https:\/\/www.merckmanuals.com\/professional\/infectious-diseases\/bacteria-and-antibacterial-drugs\/cephalosporins<\/a>  <a href=\"#return-footnote-95-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-95-3\">Ren, S., Cao, Y., Zhang, X., Jiao, S., Qian, S., &amp; Liu, P. (2014). Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases. <em>International Surgery, 99<\/em>(2), 142\u2013146. <a href=\"https:\/\/www.internationalsurgery.org\/doi\/full\/10.9738\/INTSURG-D-13-00086.1\" rel=\"noopener noreferrer\">https:\/\/www.internationalsurgery.org\/doi\/full\/10.9738\/INTSURG-D-13-00086.1<\/a> <a href=\"#return-footnote-95-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-95-4\">uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a> <a href=\"#return-footnote-95-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-95-5\">Daily Med, <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\" rel=\"noopener noreferrer\">https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019. <a href=\"#return-footnote-95-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-95-6\">UpToDate (2021). &lt;em&gt;Cefazolin&lt;\/em&gt;. &lt;a href=\"https:\/\/www.uptodate.com\/contents\/search\"&gt;https:\/\/www.uptodate.com\/contents\/search&lt;\/a&gt; <a href=\"#return-footnote-95-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-95-7\">U.S. National Library of Medicine, Medline Plus. (2020, February 13). <em>Basic metabolic panel.<\/em>\u00a0<a href=\"https:\/\/medlineplus.gov\/ency\/article\/003462.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/article\/003462.htm<\/a> <a href=\"#return-footnote-95-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-95-8\">U.S. National Library of Medicine, Medline Plus. (2020, February 13). <em>Glomerular filtration rate.<\/em> <a href=\"https:\/\/medlineplus.gov\/ency\/article\/007305.htm\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/ency\/article\/007305.htm<\/a> <a href=\"#return-footnote-95-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":90,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-95","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":70,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/95","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":19,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/95\/revisions"}],"predecessor-version":[{"id":1691,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/95\/revisions\/1691"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/70"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/95\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=95"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=95"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=95"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=95"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}