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Questions and Answers
What should clients with a PCN allergy avoid due to the risk of cross-sensitivity?
What should clients with a PCN allergy avoid due to the risk of cross-sensitivity?
What is the dosing regimen for PCN G in adults?
What is the dosing regimen for PCN G in adults?
Which of the following drug interactions should be avoided when administering PCNs?
Which of the following drug interactions should be avoided when administering PCNs?
Why should PCN G be used with caution in clients on a sodium-restricted diet?
Why should PCN G be used with caution in clients on a sodium-restricted diet?
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Which lab value is crucial to monitor in clients receiving PCNs who are at high risk of toxicity?
Which lab value is crucial to monitor in clients receiving PCNs who are at high risk of toxicity?
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What is the primary mechanism through which penicillin G exerts its bactericidal effect?
What is the primary mechanism through which penicillin G exerts its bactericidal effect?
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Which infections is penicillin G primarily indicated for?
Which infections is penicillin G primarily indicated for?
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What is a common adverse reaction associated with penicillin G administration?
What is a common adverse reaction associated with penicillin G administration?
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Penicillin G is the drug of choice for the treatment of which condition?
Penicillin G is the drug of choice for the treatment of which condition?
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What adverse effect can occur with an accidental injection of penicillin G into a peripheral nerve?
What adverse effect can occur with an accidental injection of penicillin G into a peripheral nerve?
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For which bacteria is penicillin G ineffective?
For which bacteria is penicillin G ineffective?
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What is the role of penicillin G in the context of bacterial endocarditis?
What is the role of penicillin G in the context of bacterial endocarditis?
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Penicillin G is not effective against which type of bacteria?
Penicillin G is not effective against which type of bacteria?
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Study Notes
Penicillin G (PCN G) Overview
- Category: Narrow-spectrum penicillin
- Primary Function: Active against gram-positive bacteria, gram-negative cocci, anaerobes, & spirochetes; first-line treatment for sensitive gram-positive cocci infections.
- Unique Feature: First penicillin available; remains a preferred choice for many infections.
- Mechanism of Action: Weakens bacterial cell walls, causing rupture due to overhydration. Achieved by inhibiting transpeptidases and disinhibiting autolysins, leading to lysis & death. Only effective during bacterial growth & division.
Indications & Therapeutic Uses
- Gram-Positive Cocci: First-choice for infections like Streptococcus pneumoniae (pneumonia), Streptococcus pyogenes (pharyngitis), and Streptococcus viridans (infectious endocarditis).
- Gram-Positive Bacilli: Preferred for gas gangrene, tetanus, and anthrax.
- Meningitis: Treatment for Neisseria meningitidis meningitis.
- Gonorrhea: Treatment for non-penicillinase-producing strains of Neisseria gonorrhoeae; replaced by ceftriaxone for most gonorrhea cases.
- Syphilis: First-line treatment for Treponema pallidum; prophylaxis for exposed partners.
- Rheumatic Fever: Prevention/treatment of recurrent rheumatic fever.
- Bacterial Endocarditis: Prophylaxis for prosthetic heart valves, congenital heart disease, acquired valvular heart disease, mitral valve prolapse, & history of bacterial endocarditis.
Side Effects & Adverse Reactions
- Hypersensitivity: Most concerning; potentially life-threatening allergic reaction.
- Injection Site Reactions: Pain, gangrene (arterial injection), nerve damage (peripheral nerve injection).
- Neurotoxicity: Seizures, confusion, hallucinations with high toxicity.
Precautions & Contraindications
- Penicillin Allergy: Consider all penicillin agents as contraindications.
- Cephalosporin Cross-Sensitivity: Avoid cephalosporins in patients with severe, immediate penicillin allergies due to possible cross-reactivity.
- Sodium Restriction: Use sodium penicillin G cautiously in sodium-restricted diets.
Drug Interactions
- Bacteriostatic Agents: Concurrent use (e.g., tetracyclines) can reduce penicillin's bactericidal effects. Avoid concurrent use.
Dosing, Administration, & Client Teaching
- Dosing: Varies; consult guidelines for individualized dosing based on condition, severity, and response. Available as potassium PCN G, procaine PCN G, benzathine PCN G, & sodium PCN G. Intramuscular (IM) and intravenous (IV) administration.
- Administration: IM or IV, closely monitor for hypersensitivity.
- Client Education: Emphasize completing the full course. Educate clients about side effects, monitoring, and reporting concerns.
Monitoring Labs
- Basic Metabolic Panel (BMP): Monitor renal function (BUN/Creatinine, Creatinine Clearance), as renal impairment significantly increases penicillin half-life, requiring dose adjustments.
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