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P A R T 2
Chemotherapeutic agents
vomiting, diarrhoea, anorexia, abdominal pain and
flatulence. Pseudomembranous colitis—a potentially
dangerous disorder—has also been reported with some
cephalosporins. A particular drug should be discontin-
ued immediately at any sign of violent, bloody diarrhoea
or abdominal pain.
CNS symptoms include headache, dizziness,
lethargy and paraesthesias. Nephrotoxicity is also asso-
ciated with the use of cephalosporins, most particularly
in people who have a predisposing renal insufficiency.
Other adverse effects include superinfections, which
occur frequently because of the death of protective
bacteria of the normal flora. Monitor people receiving
parenteral cephalosporins for the possibility of phlebitis
with IV administration or local abscess at the site of an
IM injection.
Clinically important drug–drug interactions
Concurrent administration of cephalosporins with
aminoglycosides increases the risk for nephrotoxicity.
Frequently monitor people receiving this combination,
and evaluate serum blood urea nitrogen (BUN) and
creatinine levels.
People who receive oral anticoagulants in addition
to cephalosporins may experience increased bleeding.
Teach these people how to monitor for blood loss (e.g.
bleeding gums, easy bruising) and to be aware that the
dose of the oral anticoagulant may need to be reduced.
Instruct the person receiving cephalosporins to
avoid alcohol for up to 72 hours after discontinua-
tion of the drug to prevent a disulfiram-like reaction,
which results in unpleasant symptoms such as flushing,
throbbing headache, nausea and vomiting, chest pain,
palpitations, dyspnoea, syncope, vertigo, blurred vision
and, in extreme reactions, cardiovascular collapse, con-
vulsions or even death.
Prototype summary: Cefaclor
Indications:
Treatment of respiratory, dermatological,
urinary tract and middle ear infections caused by
susceptible strains of bacteria.
Actions:
Inhibits the synthesis of bacterial cell walls,
causing cell death in susceptible bacteria.
Pharmacokinetics:
Route
Peak
Duration
Oral
30–60 minutes
8–10 hours
T
1/2
:
30 to 60 minutes; excreted unchanged in the
urine.
Adverse effects:
Nausea, vomiting, diarrhoea, rash,
superinfection, bone marrow depression, risk for
pseudomembranous colitis.
Care considerations for
people receiving cephalosporins
Assessment: History and examination
■
■
Assess for
possible contraindications or cautions
:
known allergy to any cephalosporin, penicillin
or any other allergens
because cross-sensitivity
often occurs
(obtain specific information about the
nature and occurrence of the allergic reactions);
history of renal disease,
which could exacerbate
nephrotoxicity related to the cephalosporin
; and
current pregnancy or breastfeeding status.
■
■
Perform physical assessment
to establish baseline
data for assessing the effectiveness of the drug and
the occurrence of any adverse effects associated
with drug therapy.
■
■
Examine the skin for any rash or lesions, examine
injection sites for abscess formation and note
respiratory status—including rate, depth and
adventitious sounds—
to provide a baseline for
determining adverse reactions.
■
■
Perform culture and sensitivity tests at the site of
infection.
■
■
Check renal function test results, including BUN
and creatinine clearance,
to assess the status of
renal functioning and to detect the possible need
to alter dose.
Implementation with rationale
■
■
Check culture and sensitivity reports
to ensure that
this is the drug of choice for this person.
■
■
Monitor renal function test values before and
periodically during therapy
to arrange for
appropriate dose reduction as needed.
■
■
Ensure that person receives the full course of the
cephalosporin as prescribed, divided around the
clock
to increase effectiveness and to decrease the
risk of development of resistant strains.
■
■
Monitor the infection site and presenting signs
and symptoms (e.g. fever, lethargy) throughout
the course of drug therapy.
Failure of these signs
and symptoms to resolve may indicate the need to
reculture the site.
Arrange to continue drug therapy
for at least 2 days after the resolution of all signs
and symptoms
to help prevent the development of
resistant strains of bacteria.
■
■
Provide small, frequent meals as tolerated, frequent
mouth care and ice chips or sugarless lollies to suck
if stomatitis and sore mouth are problems
to relieve
discomfort and provide nutrition
.
■
■
Provide adequate fluids
to replace fluid lost with
diarrhoea
.
■
■
Monitor the person for any signs of superinfection
to arrange for treatment if superinfection occurs.
