Cefobid

cefoperazone

Indications

Action

Pharmacokinetics

Time/action profile (blood levels)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• seizures (high doses) (life-threatening)

Gastrointestinal

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

Dermatologic

• rashes
• urticaria

Hematologic

• bleeding
• eosinophilia
• neutropenia

Local

• pain at IM site (most frequent)
• phlebitis at IV site (most frequent)

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)
• superinfection

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
• Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. 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 health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation 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 positive results for Coombs' test.
  • Monitor prothrombin time and assess patient for bleeding (guaiac stools; check for hematuria, bleeding gums, ecchymosis) daily in high-risk patients; may cause hypoprothrombinemia.
  • May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
  • May rarely cause neutropenia and eosinophilia.

Potential Nursing Diagnoses

Implementation

• Intramuscular: Reconstitute IM doses with sterile or bacteriostatic water for injection or 0.9% NaCl for injection. May be diluted with lidocaine to minimize injection discomfort.
  • Inject deep into a well-developed muscle mass; massage well.

• Intravenous Administration

• pH: 4.5–6.5.
• Intravenous: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
  • If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications.
• Intermittent Infusion: Reconstitute each gram with 5 mL of sterile or bacteriostatic water for injection, 0.9% NaCl, or D5W. Shake vigorously and allow to stand for visualization and clarity. Solution may be colorless to straw-colored. Diluent: Further dilute each gram in 50–100 mL of 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.9% NaCl, D5/LR, or lactated Ringer's solution. Solution is stable for 24 hr at room temperature and 5 days if refrigerated.
• Rate: Administer over 15–30 min.
• Y-Site Compatibility: acyclovir, alfentanil, allopurinol, aminophylline, ascorbic acid, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, cefazolin, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, dexamethasone, dexmedetomidine, digoxin, docetaxel, enalaprilat, epinephrine, epoetin alfa, eptifibatide, etoposide, etoposide phosphate, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, glycopyrrolate, granisetron, heparin, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, isoproterenol, ketorolac, lidocaine, linezolid, mannitol, mechlorethamine, melphalan, methotrexate, methylprednisolone, metoclopramide, metoprolol, metronidazole, multivitamins, nafcillin, naloxone, nitroglycerin, nitroprusside, norepinephrine, oxacillin, oxytocin, paclitaxel, penicillin G, pentobarbital, phenobarbital, phenylephrine, phytonadione, potassium chloride, procainamide, propofol, propranolol, ranitidine, rituximab, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, ticarcillin/clavulanate, vasopressin, vincristine
• Y-Site Incompatibility: amifostine, amikacin, amphotericin B cholesteryl, amphotericin B liposome, atracurium, azathioprine, benztropine, calcium chloride, caspofungin, chlorpromazine, cimetidine, cisatracurium, codeine, dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, dopamine, doxacurium, doxorubicin(, doxorubicin liposome, doxycycline, epirubicin, filgrastim, ganciclovir, gemcitabine, gentamicin, haloperidol, hydralazine, hydroxyzine, idarubicin, indomethacin, insulin, labetalol, levofloxacin, meperidine, metaraminol, methoxamine, methyldopate, midazolam, mitoxantrone, nalbuphine, nesiritide, nicardipine, ondansetron, oxaliplatin, pantoprazole, papaverine, pentamidine, pentazocine, perphenazine, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, pyridoxime, quinupristin/dalfopristin, rocuronium, sargramostim, thiamine, tobramycin, tolazoline, trastuzumab, trimetaphan, trimethoprim/sulfamethoxazole, vancomycin, verapamil, vinorelbine

Patient/Family Teaching

• Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
• Caution patients that concurrent use of alcohol with cefoperazone may cause a disulfiram-like reaction (abdominal cramps, nausea, vomiting, headache, hypotension, palpitations, dyspnea, tachycardia, sweating, flushing). Alcohol and alcohol-containing medications should be avoided during and for several days after therapy.
• 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.

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.