Invanz


ertapenem

Invanz

Pharmacologic class: Carbapenem

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Inhibits cell-wall synthesis in bacteria, causing cell death

Availability

Powder for infusion (lyophilized): 1 g/vial

Indications and dosages

➣ Community-acquired pneumonia; skin infections; complicated genitourinary (GU) infections; complicated intra-abdominal infections; acute pelvic infections

Adults and children older than age 13: 1 g I.M. or I.V. daily. Length of treatment varies with type of infection: community-acquired pneumonia, 10 to 14 days; skin and skin structures, 7 to 14 days; GU, 10 to 14 days; intra-abdominal, 5 to 14 days; acute pelvic, 3 to 10 days.

Children age 3 months to 12 years: 15 mg/kg twice daily (not to exceed 1 g/day). May be given by I.V. infusion for up to 14 days or I.M. injection for up to 7 days.

➣ Prophylaxis of surgical site infection in elective colorectal surgery

Adults: 1 g I.V. as single dose given 1 hour before surgical incision

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug, its components, other carbapenems, or beta-lactams

• I.M. injection in patients allergic to lidocaine or other amide local anesthetics

Precautions

Use cautiously in:

• seizure disorder

• pregnant or breastfeeding patients

• children (not recommended in infants younger than age 3 months).

Administration

• Reconstitute for I.V. use by adding to vial 10 ml of sterile or bacteriostatic water or normal saline for injection. Don't use diluents containing dextrose.

• Further dilute reconstituted drug in 50 ml of normal saline solution; infuse over 30 minutes. Don't mix or infuse with other drugs.

• Reconstitute for I.M. use by adding 3.2 ml of 1% lidocaine to vial and shaking well.

• Inject I.M. dose deep into large muscle mass, such as gluteus maximus or lateral thigh.

Adverse reactions

CNS: headache, dizziness, asthenia, fatigue, insomnia, altered mental status, anxiety, seizures

CV: hypotension, hypertension, chest pain, phlebitis, thrombophlebitis, arrhythmias, heart failure

EENT: pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastroesophageal reflux disease, pseudomembranous colitis

GU: vaginitis

Hepatic: hepatotoxicity

Respiratory: crackles, cough, dyspnea, wheezing, respiratory distress

Skin: rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis

Other: fever, pain, induration, and inflammation at I.V. site; edema; hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Probenecid: increased blood level and half-life of ertapenem

Patient monitoring

See Monitor vital signs, ECG, and cardiovascular status closely. Stay alert for arrhythmias, edema, respiratory distress, and other signs and symptoms of heart failure.

See Assess neurologic status, and watch for signs of impending seizure.

See Monitor bowel pattern, and stay alert for signs and symptoms of pseudomembranous colitis.

• Inspect injection site for evidence of thrombophlebitis and induration.

See Watch for indications of erythema multiforme (sore throat, rash, cough, iris lesions, mouth sores, fever). Report early signs before condition progresses to Stevens-Johnson syndrome, and stay alert for other hypersensitivity reactions (including anaphylaxis).

Patient teaching

• Tell patient to notify nurse right away if drug causes pain or swelling at injection site.

• Inform patient that drug can be toxic to many organ systems. Tell him to promptly report significant adverse reactions.

• Tell female patient to inform prescriber of pregnancy or breastfeeding before taking drug.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.

ertapenem

(er-ta-pen-em) ertapenem,

INVanz

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: carbapenems
Pregnancy Category: B

Indications

Moderate to severe:
  • complicated intra-abdominal infections,
  • complicated skin and skin structure infections,
  • community acquired pneumonia,
  • complicated urinary tract infections (including pyelonephritis),
  • acute pelvic infections including postpartum endomyometritis, septic abortion, and postsurgical gynecologic infections.
Prophylaxis of surgical site infection following elective colorectal surgery.

Action

Binds to bacterial cell wall, resulting in cell death. Ertapenem resists the actions of many enzymes that degrade most other penicillins and penicillin-like anti-infectives.

Therapeutic effects

Bactericidal action against susceptible bacteria.Active against the following aerobic gram-positive organisms: Staphylococcus aureus (methicillin-susceptible strains only), Staphylococcus epidermidis, Streptococcus agalactiae, S. pneumoniae (penicillin-susceptible strains only), and S. pyogenes.Also active against the following gram-negative aerobic organisms: Escherichia coli, Haemophilus influenzae (beta-lactamase negative strains), Klebsiella pneumonia, Moraxella catarrhalis, and Providencia rettgeri.Addition anaerobic spectrum includes Bacteroides fragilis, B. distasonis, B. ovatus, B. thetaiotamicron, B. uniformis, B. vulgatis, Clostridium clostrioforme, Eubacterium lentum, Peptostreptococcus, Porphyromonas asaccharolytica, and Prevotella bivia.

Pharmacokinetics

Absorption: 90% after IM administration; IV administration results in complete bioavailability.Distribution: Enters breast milk.Metabolism and Excretion: Mostly excreted by the kidneys.Half-life: 1.8 hr (↑ in renal impairment).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IMrapid2 hr24 hr
IVrapidend of infusion24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Cross-sensitivity may occur with penicillins, cephalosporins, and other carbapenems;Hypersensitivity to lidocaine (may be used as a diluent for IM administration).Use Cautiously in: History of multiple hypersensitivity reactions;Seizure disorders;Renal impairment; Obstetric: Use in pregnancy only if clearly needed; Lactation: Not expected to cause adverse effects in breast-fed infants (NIH); Pediatric: Safety not established; Geriatric: ↑ sensitivity due to age-related ↓ in renal function.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • headache

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea
  • nausea
  • vomiting

Genitourinary

  • vaginitis

Local

  • phlebitis at IV site
  • pain at IM site

Miscellaneous

  • hypersensitivity reaction including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Probenecid ↓ excretion and ↑ blood levels.May ↓ serum valproate levels (↑ risk of seizures).

Route/Dosage

Intravenous Intramuscular (Adults and Children 13 yrs or older) 1 g once daily for up to 14 days (IV) or 7 days (IM).Intravenous Intramuscular (Children 3 mo–12 yrs) 15 mg/kg twice daily (not to exceed 1 g/day) for up to 14 days (IV) or 7 days (IM).

Renal Impairment

Intramuscular Intravenous (Adults) CCr ≤30 mL/min/1.73m2—500 mg once daily.

Availability

Powder for injection: 1 g/vial

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
  • Obtain a history before initiating therapy to determine previous use of and reactions to penicillins, cephalosporins, or carbapenems. 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.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Have epinephrine, an antihistamine, and resuscitative equipment close by in the event of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause ↑ AST, ALT, serum alkaline phosphatase levels.
    • May cause ↑ platelet and eosinophil counts.

Potential Nursing Diagnoses

Risk for infection (Indications, Side Effects)

Implementation

  • Do not confuse Invanz with Avinza.
  • Intramuscular: Reconstitute 1-g vial with 3.2 mL of 1% lidocaine without epinephrine. Shake well to form solution. Immediately withdraw contents and inject deep into large muscle mass. Use reconstituted solution within 1 hr.
  • Intravenous Administration
  • pH: 7.5.
  • Intermittent Infusion: Diluent: Reconstitute 1-g vial with 10 mL of sterile water for injection or 0.9% NaCl and shake well. Further dilute in 50 mL of 0.9% NaCl. Administer within 6 hr of reconstitution.
  • Rate: Infuse over 30 min.
  • Y-Site Compatibility: acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, argatroban, arsenic trioxide, atracurium, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, chloramphenicol, ciprofloxacin, cisatracurium, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, docetaxel, dolasetron, dopamine, doxacurium, doxycycline, enalaprilat, ephedrine, epinephrine, eptifibatide, erythromycin, esmolol, etoposide phosphate, famotidine, fenoldopam, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methyldopate, methylprednisolone sodium succinate, metoclopramide, metronidazole, milrinone, mitomycin, morphine, moxifloxacin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phentolamine, phenylephrine, potassium acetate, potassium chloride, potassium phosphates, procainamide, propranolol, ranitidine, remifentanil, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
  • Y-Site Incompatibility: alemtuzumab, allopurinol, amiodarone, amphotericin B colloidal, anidulafungin, caspofungin, dantrolene, daunorubicin hydrochloride, diazepam, dobutamine, doxorubicin hydrochloride, droperidol, epirubicin, hydralazine, hydroxyzine, idarubicin, midazolam, mitoxantrone, nicardipine, ondansetron, pentamidine, phenytoin, prochlorperazine, promethazine, quinupristin/dalfopristin, thiopental, topotecan, verapamil

Patient/Family Teaching

  • Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) and allergy.
  • 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. Consult health care professional before treating with antidiarrheals.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

Invanz

A brand name for ERTAPENEM.