释义 |
Azactam ThesaurusNoun | 1. | Azactam - an antibiotic (trade name Azactam) used against severe infections; has minimal side effectsaztreonamantibiotic, antibiotic drug - a chemical substance derivable from a mold or bacterium that can kill microorganisms and cure bacterial infections; "when antibiotics were first discovered they were called wonder drugs"trademark - a formally registered symbol identifying the manufacturer or distributor of a product |
Azactam
aztreonam, aztreonam lysine Azactam, Cayston Pharmacologic class: Monobactam Therapeutic class: Anti-infective Pregnancy risk category B Action Inhibits bacterial cell-wall synthesis during active multiplication by binding with penicillin-binding protein 3, resulting in cell-wall destruction Availability Inhalation solution: 75-mg single-use vial Powder for injection: 500-mg vial, 1-g vial, 2-g vial, 1 g/50-ml I.V. bag, 2 g/50-ml I.V. bag Indications and dosages ➣ Cystic fibrosis in patients with Pseudomonas aeruginosa Adults and children age 7 and older: 75 mg t.i.d. at least 4 hours apart for 28-day course, followed by 28 days off ➣ Infections caused by susceptible gram-negative organisms Adults: For urinary tract infections, 500 mg or 1 g I.M. or I.V. q 8 or 12 hours; for moderately severe systemic infections, 1 or 2 g I.M. or I.V. q 8 or 12 hours; for severe or life-threatening infections, 2 g I.M. or I.V. q 6 or 8 hours. Maximum dosage is 8 g/day. Children: For mild to moderate infections, 30 mg/kg I.M. or I.V. q 8 hours; for moderate to severe infections, 30 mg/kg I.M. or I.V. q 6 or 8 hours. Maximum dosage is 120 mg/kg/day. Dosage adjustment • Severe renal failure Contraindications • Hypersensitivity to drug or its components Precautions Use cautiously in: • renal or hepatic impairment • elderly patients • pregnant or breastfeeding patients. Administration • Flush I.V. tubing with compatible solution before and after giving drug. • Compatible solutions include 0.9% sodium chloride injection, 5% or 10% dextrose injection, Ringer's or lactated Ringer's injection, 5% dextrose and 0.9% sodium chloride injection, and 5% dextrose and 0.45% sodium chloride injection. • After adding diluent to vial or infusion bottle, shake immediately and vigorously. • For I.V. bolus injection, reconstitute powder for injection by adding 6 to 10 ml of sterile water for injection. Inject prescribed dosage into tubing of compatible I.V. solution slowly over 3 to 5 minutes. • For intermittent I.V. infusion, reconstitute powder for injection by adding compatible I.V. solution to yield a concentration not exceeding 20 mg/ml. Administer prescribed dosage over 20 to 60 minutes. See Thaw commercially available frozen drug at room temperature and give by intermittent I.V. infusion only. • For I.M. injection, reconstitute powder for injection by adding 3 ml of sterile water for injection or 0.9% sodium chloride injection. • Give I.M. injection deep into large muscle mass. • Reconstitute inhalation solution with 1 ml sterile diluent supplied and administer only with nebulizer supplied. Don't reconstitute until ready to administer. • Know that patient should use a bronchodilator as prescribed before using inhalation solution. Adverse reactions CNS: dizziness, confusion, seizures CV: phlebitis, thrombophlebitis EENT: diplopia, tinnitus GI: nausea, vomiting, diarrhea (including diarrhea associated with Clostridium difficile), pseudomembranous colitis Hematologic: neutropenia, pancytopenia Hepatic: hepatitis Respiratory: bronchospasm Skin: rash, toxic epidermal necrolysis Other: altered taste, angioedema, anaphylaxis Interactions Drug-drug. Aminoglycosides: increased risk of nephrotoxicity and ototoxicity Beta-lactamase-inducing antibiotics (such as cefoxitin, imipenem): antagonism with aztreonam Furosemide, probenecid: increased aztreonam levels Drug-diagnostic tests. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, eosinophils, platelets, prothrombin time (PT), partial thromboplastin time (PTT): increased values Coombs' test: positive result Neutrophils: decreased count Patient monitoring See Assess patient closely for signs and symptoms of pseudomembranous colitis. See Monitor patient carefully for hypersensitivity reaction, especially if he's allergic to penicillin, carbapenems, or cephalosporins. • Monitor CBC with differential, AST, ALT, PT, PTT, and serum creatinine values. • Monitor renal and hepatic function. Patient teaching • Show patient how to reconstitute inhalation solution using diluent supplied and tell patient not to reconstitute until ready to use. Advise patient to use only the nebulizer supplied and to use a bronchodilator as prescribed before using inhalation solution. See Instruct patient to immediately report severe diarrhea or signs or symptoms of hypersensitivity reaction, such as rash or difficulty breathing. • Tell female patient to notify prescriber if she is pregnant or breastfeeding. • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the tests mentioned above. b aztreonam (az-tree-oh-nam) aztreonam, Azactam (trade name), Cayston (trade name) Classification Therapeutic: anti infectives Pharmacologic: monobactams Pregnancy Category: B
IndicationsTreatment of serious gram-negative infections including:- Skin and skin structure infections,
- Intra-abdominal infections,
- Respiratory tract infections,
- Urinary tract infections.
Useful for treatment of multi-resistant strains of some bacteria including aerobic gram-negative pathogens. Inhalation: To improve respiratory symptoms in cystic fibrosis (CF) patients with Pseudomonas aeruginosa.ActionBinds to the bacterial cell wall membrane, causing cell death.Therapeutic effectsBactericidal action against susceptible bacteria.Displays significant activity against gram-negative aerobic organisms only:- Klebsiella oxytoca or pneumoniae,
Not active against:PharmacokineticsAbsorption: Well absorbed following IM administration. Low absorption follows administration by inhalation.Distribution: Widely distributed. Crosses the placenta and enters breast milk in low concentrations. High concentrations achieved in sputum with inhalation.Protein Binding: 56%Metabolism and Excretion: 60–70% excreted unchanged by the kidneys. 10% of inhaled dose excreted unchanged in urine. Small amounts metabolized by the liver.Half-life: Adults: 1.5–2 hr; Children: 1.7 hr; Neonates: 2.4–9 hr(↑ in renal impairment).Time/action profile (blood levels)ROUTE | ONSET | PEAK | DURATION |
---|
IM | rapid | 60 min | 6–8 hr | IV | rapid | end of infusion | 6–8 hr | Inhaln | rapid | unknown | Several hours |
Contraindications/PrecautionsContraindicated in: Hypersensitivity.Use Cautiously in: Renal impairment (dosage ↓ required if CCr 30 mL/min or less);Cross-sensitivity with penicillins or cephalosporins may occur rarely. Has been used safely in patients with a history of penicillin or cephalosporin allergy;Patients with FEV1 <25% or >75% predicted, or patients colonized with Burkholderia cepacia (safety and effectiveness not established); Obstetric / Lactation: Safety not established; Pediatric: Children <7 yr (inhalation) (safety and effectiveness not established); Geriatric: Consider age-related ↓ in renal function.Adverse Reactions/Side EffectsCentral nervous system- seizures (life-threatening)
Ear, Eye, Nose, Throat- nasal congestion (inhalation) (most frequent)
- nasopharyngeal pain (inhalation) (most frequent)
Cardiovascular- chest discomfort (inhalation)
Gastrointestinal- pseudomembranous colitis (life-threatening)
- abdominal pain (inhalation) (most frequent)
- altered taste
- diarrhea
- nausea
- vomiting
Respiratory- cough (inhalation) (most frequent)
- wheezing (inhalation) (most frequent)
- bronchospasm (inhalation)
DermatologicLocal- pain at IM site
- phlebitis at IV site
Miscellaneous- allergic reactions including anaphylaxis (life-threatening)
- fever (inhalation) (most frequent)
- superinfection
InteractionsDrug-Drug interactionSerum levels may be ↑ by furosemide or probenecid.Route/DosageIntramuscular Intravenous (Adults) Moderately severe infections—1–2 g q 8–12 hr; severe or life-threatening infections (including those due to Pseudomonas aeruginosa)—2 g q 6–8 hr; urinary tract infections—0.5–1 g q 8–12 hr.Intravenous (Children 1 mo–16 yr) Mild to moderate infections infections—30 mg/kg q 8 hr; moderate to severe infections infections—30 mg/kg q 6–8 hr; cystic fibrosis—50 mg/kg q 6–8 hr.Intravenous (Neonates > 2 kg) 30 mg/kg q 6–8 hrIntravenous (Neonates ≤ 2 kg) 30 mg/kg q 8–12 hrInhalation (Adults and Children >7 yr) 75 mg three times daily for 28 days.Renal ImpairmentIntravenous (Adults) CCr 10–30 mL/min—1–2 g initially, then 50% of usual dosage at usual interval; CCr <10 mL/min—500 mg–2 g initially, then 25% of usual dosage at usual interval (1/8 of initial dose should also be given after each hemodialysis session).Availability (generic available)Injection: 500 mg/vial, 1 g/vial, 2 g vial Premixed containers: 1 g/50 mL, 2 g/50 mL Lyphilized powder for use with diluent provided in Altera Nebulizer System only (Cayston): 75 mg/vial with 1 mL ampule of diluent (0.17% sodium chloride) Nursing implicationsNursing assessment- Assess for infection (vital signs; wound appearance, 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 and cephalosporins. Patients allergic to these drugs may exhibit hypersensitivity reactions to aztreonam. However, aztreonam can often be used in these patients.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Assess respiratory status prior to and following inhalation therapy.
- Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify the health care professional immediately if these occur.
- Monitor bowel function. Report diarrhea, abdominal cramping, fever, and bloody stools 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 ↑ in AST, ALT, alkaline phosphatase, LDH, and serum creatinine. May cause ↑ prothrombin and partial thromboplastin times, and positive Coombs’ test.
Potential Nursing DiagnosesRisk for infection (Indications) Ineffective airway clearance (Indications)
Implementation- After adding diluent to vial, shake immediately and vigorously. Not for multidose use; discard unused solution. IV route is recommended if single dose > 1 g or for severe or life-threatening infection.
- Intramuscular: Use 15-mL vial and dilute each gram of aztreonam with at least 3 mL of 0.9% NaCl, or sterile or bacteriostatic water for injection. Stable at room temperature for 48 hr or 7 days if refrigerated.
- Administer into large, well-developed muscle.
Intravenous Administration- Reconstitute 15 mL vial with 6–10 mL of sterile water for injection.
- Rate: Administer slowly over 3–5 min by direct injection or into tubing of a compatible solution.
- Intermittent Infusion: Reconstitute 15 mL vial with at 3 mL of Sterile Water for Injection. Diluent: Dilute further with 0.9% NaCl, Ringer’s or LR, D5W, D10W, D5/0.9% NaCl, D5/0.45% NaCl, D5/0.2% NaCl, D5/LR, or sodium lactate.Concentration: Do not exceed 50 mg/mL. Solution is stable for 48 hr at room temperature and 7 days if refrigerated. Solutions range from colorless to light, straw yellow or may develop a pink tint upon standing; this does not affect potency.
- Rate: Infuse over 20–60 min.
- Y-Site Compatibility: alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amphotericin B lipid complex, anadulafungin, argatroban, ascorbic acid, atracurium, atropine, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, dexamethasone sodium phosphate, dexmedetomidine, digoxin, diltiazem, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin hydrochloride, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, floxuridine, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, midazolam, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pemetrexed, penicillin G, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, propofol, propranolol, protamine, pyridoxime, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: acyclovir, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin B liposome, amsacrine, azathioprine, azithromycin, chlorpromazine, dantrolene, daunorubicin hydrochloride, diazepam, diazoxide, erythromycin, ganciclovir, indomethacin, lorazepam, metronidazole, mitomycin, mitoxantrone, mycophenolate, pantoprazole, papaverine, pentamidine, pentazocine, pentobarbital, phenytoin, prochlorperazine, streptozocin, trastuzumab
- Inhalation: Open glass aztreonam vial by removing metal ring and pulling tab, and removing gray rubber stopper. Twist tip of diluent ampule and squeeze contents into glass aztreonam vial. Replace rubber stopper and swirl gently until contents are completely dissolved. Administer immediately after reconstitution using Altera Nebulizer System. Pour reconstituted solution into handset of nebulizer. Turn unit on. Place mouthpiece into mouth and breathe normally only through mouth. Administration takes 2–3 min. Do not use other nebulizers or mix with other medications. Do not administer IV or IM. Refrigerate azotreonam and diluent; may be stored at room temperature for up to 28 days. Protect from light.
- Administer short-acting bronchodilator between 15 min and 4 hr or long-acting bronchodilator between 30 min and 12 hr prior to treatment. If taking multiple inhaled therapies, administer in the following order: bronchodilator, mucolytic, and lastly, aztreonam.
Patient/Family Teaching- Advise patient to report the signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
- Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
- Advise patient to notify health care professional if new or worsening symptoms or signs of anaphylaxis occur.
- Inhalation: Instruct patient to use aztreonam as directed for the full 28–day course, even if feeling better. If a dose is missed, take all 3 daily doses, as long as doses are at least 4 hrs apart. Skipping doses or not completing full course of therapy may decrease effectiveness and increase likelihood of bacterial resistance not treatable in the future. Inform patient of the importance of using a bronchodilator prior to treatment and in use and cleaning or nebulizer.
Evaluation/Desired Outcomes- Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Improvement in respiratory symptoms in patients with cystic fibrosis.
Azactam (ə-zăk′təm) A trademark for the drug aztreonam.Azactam A brand name for AZTREONAM.Azactam
Synonyms for Azactamnoun an antibiotic (trade name Azactam) used against severe infectionsSynonymsRelated Words- antibiotic
- antibiotic drug
- trademark
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