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pathopharm exam 4

CHAPTER 87

QuestionAnswer
Aminoglycosides CANNOT READILY CROSS MEMBRANE Most commonly used agents, •Gentamicin, tobramycin, amikacin Narrow-spectrum antibiotics Bactericidal Use: Aerobic gram-negative bacilliCan cause serious injury to inner ear and kidney Not absorbed from GI tract Microbial resistance
Adverse effects general anesthetics, and in myasthenia gravis Nephrotoxicity•Ototoxicity (total cumulative and trough levels)•Hypersensitivity reactions•Neuromuscular blockade: Concurrent use with neuromuscular blocking agents,.Treatment of choice: Reversal with IV infusion of a calcium salt (eg, calcium gluconate)
Other adverse effects Hypersensitivity reactions •Blood dyscrasias •Others
Drug interactions CAUTION W/ RENAL IMPAIRMENT SAFE FOR INFANTS, BREST-FEEDINGNOT IN PREGNANY
Serum Levels trough levels must be low enough to minimize toxicity dosing •Single large dose each day or 2 or 3 smaller dosesMonitoring of serum levels is common; the same aminoglycoside dose can produce very different plasma levels in different patientsPeak levels must be high enough to kill bacteria;
Peak Levels? should be taken 30 minutes after giving an IM injection or after completing a 30-minute IV infusion
TROUGH LEVELS? for trough levels depends on the dosing schedule for trough levels depends on the dosing schedule
DOSES? Divided doses: Take sample just before the next dose •Once-daily doses: Draw a single sample 1 hour before the next dose; value should be very low—preferably close to zero
Gentamicin [Garamycin] Used to treat serious infections caused by aerobic gram-negative bacilli •Pseudomonas aeruginosa•Escherichia coli•Klebsiella•Serratia•Proteus mirabilis
Adverse effects Nephrotoxicity•Ototoxicity
Other Aminoglycosides Tobramycin Amikacin Neomycin Kanamycin Streptomycin Paromomycin
he nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? Tinnitus Ototoxicity can result from accumulation of the drug in the inner ear. Early signs that should be reported include tinnitus or headache.
The nurse is reviewing laboratory values from a patient who has been prescribed gentamicin. To prevent ototoxicity, it is most important for the nurse to monitor which value(s)? Trough drug levels of gentamicin The risk of ototoxicity is related primarily to persistently elevated trough drug levels rather than to excessive peak levels.
Before administering gentamycin, it is most important for the nurse to assess the patient for a history of what? B. Myasthenia gravis
The patient is ordered daily divided doses of gentamycin. The patient received an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level? 4:30 PM
Created by: Seka_nurse
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