Clinical Medications WorksheetsGeneric NameImipenem/cilistatin

Trade NamePrimaxin

Classificationanti-infectives, carbapenems

Dose500 mg

RouteIVPB

Time/frequencyQ 12 hr

PeakEnd of infusion

OnsetRapid

Duration6-8 hrs

Normal dosage rangeMild infections--250-500 mg q 6 hr. Moderate infections--500 mg q 6-8 hr or 1 g q 8 hr. Serious infections--500 mg q 6 hr to 1 g q 6-8 hrRate: Administer each 250- or 500-mg dose over 20-30 min and each 1-g dose over 40-60 min.

Why is your patient getting this medicationSkin and skin structure infections

For IV meds, compatibility with IV drips and/or solutionsCompatible diluents include 0.9% NaCl, D5W, D10W, D5/0.2% sodium bicarbonate, D5/0.9% NaCl, D5/0.45% NaCl, D5/0.225% NaCl, or mannitol 2.5%, 5%, or 10%. Solution may range from clear to yellow in color. Do not administer cloudy solutions. Solution is stable for 4 hr at room temperature and 24 hr if refrigerated. Y-Site Incompatibility: allopurinol, amphotericin B, cholesterylsulfate, fluconazole, gemcitabine, lorazepam, meperidine, midazolam, sargramostim, sodium bicarbonate.May be inactivated if administered concurrently with aminoglycosides. If administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.

Mechanism of action and indications(Why med ordered)Imipenem binds to the bacterial cell wall, resulting in cell death. Combination with cilastatin prevents renal inactivation of imipenem, resulting in high urinary concentrations. Imipenem resists the actions of many enzymes that degrade most other penicillins and penicillin-like anti-infectives.

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity, Cross-sensitivity may occur with penicillins and cephalosporins

Common side effectsSEIZURES, PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, rash, ALLERGIC REACTION INCLUDING ANAPHYLAXIS

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)None known for this patient

Lab value alterations caused by medicineBUN, AST, ALT, LDH, serum alkaline phosphatase, bilirubin, and creatinine may be transiently increased. Hemoglobin and hematocrit concentrations may be decreased. May cause positive direct Coombs' test.Be sure to teach the patient the following about this medicationAdvise patient to report the signs of superinfection (black, furry overgrowth on the tongue; loose or foul-smelling stools) and allergy. Consult health care professional before treating with antidiarrheals. Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.

Nursing Process- Assessment(Pre-administration assessment)Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins. 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.

AssessmentWhy would you hold or not give this med?Signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).

EvaluationCheck after givingImprovement of infection