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CH 86
Amnioglycosides: Bactericidal inhibitors of Protein Synthesis
| Question | Answer |
|---|---|
| What are the 3 Amnioglycosides that we have to know? | GEntamycin, Tobramycin, Amikacin |
| Are Aminoglycosides cidal or static? | cidal |
| what is the mechanism of action of Aminoglycosides? | altered protein synthesis -> cell death |
| What are aminoglycosides used to treat? | serious infections dt aerobic gram negative bacteria |
| What are the adverse effects of aminoglycosides? | ototoxicity, nephrotoxicity, hypersensitivity, neuromuscular blockade |
| in what drug are we really concerned about irreversible ototoxicity and reversible nephrotoxicity? | aminoglycosides |
| If someone acquires ototoxicity related to aminoglycoside use, is it reversible or irreversible? | irreversible |
| if someone acquires nephrotoxicity related to aminoglycoside use, is it reversible or irreversible? | reversible |
| how are Aminoglycosides administered? | IV, topical or parenteral, NOT ABSORBED IN GI TRACT |
| do aminoglycosides cross the BBB? | no |
| is there a problem with resistance with amninoglycosides? why is this? | some have high incidence with resistance. the principle cause of this resistance is the production of enzymes that can inactivate aminoglycosides |
| what are other drugs that might cause ototoxicity that you would want to avoid while taking aminoglycosides? | aspirin in VERY HIGH DOSES and lasix |
| what is the first sign of ototoxicity? how long might this last? what will happen later? | headache, may last 1-2 days. then you'll see n, unsteadiness, dizziness and vertigo |
| what is ototoxicity related to when a pt is on aminoglycosides? | elevated trough levels |
| what are some other nephrotoxic drugs that a pt should avoid when taking aminoglycosides? | NSAIDs, Amphotericin B, Cephalosporins, Vancomycin |
| what is nephrotoxicity when taking aminoglycosides related to? | total cumulative dose |
| what are some s/s of nephrotoxicity? | decreased urinary output (<30 mL/hr), proteinuria, elevated BUN/Creatinine |
| who is at most risk for nephrotoxicity related to aminoglycoside use? | elderly!!!!!! especially those who are diabetic and are taking other nephrotoxic drugs |
| What antibiotic can cause a neuromuscular blockade? | aminoglycosides |
| if a pt experiences the side effect Neuromuscular Blockade while taking aminoglycosides, what should you administer?? | Calcium gluconate |
| what is another drug, besides aminoglycoside, that can cause flacid paralysis? | succinylcholine |
| amninoglycosides and pregnancy: | NO it is toxic |
| Dosing of amninoglycosides are very individualized, so it is important to monitor what? | peak and trough |
| When should the Peak be monitored in a pt on amninoglycosides? should the level be high or low? | 30 minutes after administration. high |
| When should the trough be monitored in a pt on amninoglycosides? should the level be high or low? | right before the next dose. LOW |
| What would a high trough indicate in a pt on amninoglycosides? | a high trough can indicate a lack of excretion, which can lead to ototoxicity/nephrotoxicity. a high trough indicates consistent high levels |
| name the topical aminoglycoside | Neomycin |
| what is the advantage of topical aminoglycosides? | not a high risk for systemic problems unles administered in high doses. |
| Which of the aminoglycosides has less drug resistance? | Amikacin, this is reserved for cases that are very difficult to treat |
| What is the advantage of Gentamycin? | cheaper than other aminoglycosides |
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