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:star:Aminoglycosides:star: (M.O.A. (NARROW spectrum, AEROBIC GRAM…
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Aminoglycosides
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M.O.A.
NARROW
spectrum
AEROBIC
GRAM NEGATIVE BACILLI
Bind to
30S
sub unit, = disruption of protein synthesis+ misreading of genetic coding (bacterial kill)
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STREPTOMYCIN:star:
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GENTAMYCIN:star:
GARAMYCIN
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AMIKACIN:star:
AMKIN
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TOBRAMYCIN:star:
NEBCIN
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NEOMYCIN:star:
MYCIFRADIN
Pharmacokinetics
Distribution
CAN
get to
CSF FOR MENENGITIS
Bind heavily to renal tissuse which could lead to
NEPHROTOXICITY
Limited to
extracellular fluid
Penetrates endolymph and perilymph which can cause
OTOTOXICITY
CAN CROSS PLACENTA= TOXIC TO FETUS
Elimination
RENAL
To decrease toxicity in those with renal impairment,
REDUCE DOSE SIZE OR ADMINISTRATION INTERVALS
Absorption
NOT ABSORBED IN GI TRACT
P.O. IS ONLY FOR PROPHYLACTIC COLORECTAL PTS NEEDING A CLEANSE
suppresses bacterial growth
I.V.
/
I.M.
Systemic infections
INTERDEPENDENT Variation
Patients receiving the same dosage can experience
WIDELY
differing serum levels and effects
% BODY FAT
PATHOPHYSIOLOGY
Edema
RENAL
impairment
DEHYDRATION
Fever
AGE
PEAKS AND TROUGHS
Monitoring depends on the dose schedule
q daily vs dose divided
Q ONCE DAILY
Safer and more effective
NOT
for bbs, pregnancy, and dialysis
Achieve higher peak and kills more, prolonged low dose sub therapeutic
ONLY NEED TO GET PEAK 30 MIN AFTER ADMIN.
Q DIVIDED
Need PEAK AND TROUGH
PEAK 30 MIN AFTER ADMIN
Peak level high enough to
kill
& trough levels low enough to minimize
TOXICITY
MONITOR SERUM LEVELS
for best basis of adjusting
Adverse Effects
Resistance
More than 20 enzymes to inactivate aminos
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AMIKACIN:star:
IS
LEAST SUSEPTIBLE
OTOTOXICITY
Damage to
sensory hairs in COCHLEA
Damage to
VESTIBULAR APPARATTUS
lead to imablance issues
R/T
EXCESSIVE TROUGH LEVELS
cannot diffuse out of inner ear cells
TINNITUS
ringing
PERSITANT HEADACHE
IMBALANCE
Interactions
AMINOS WITH BETA-LACTAMS
WEAKENS
cell wall to help aminos!
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GENTAMYCIN:star:
+
BETA-LACTAMS
= treating
SERIOUS GRAM POSITIVE
COCCI/ENTEROCOCCI/ SOME STREPTOCOCCI
PENICILLINS
Often combined to
ENHANCE
kill
PCN HOWEVER IN HIGH CONCENTRATIONS INACTIVATE AMINOS!!!
NEVER MIX
PCN AND AMINOS IN SAME IV
INACTIVATION OUTSIDE OF BODY, NEVER INSIDE
Preparations
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TOBRAMYCIN:star:
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NEOMYCIN:star:
SKIN & EAR & EYE INFECTIONS
P.O. AND TOPICALLY
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GENTAMYCIN:star:
SERIOUS INFECTIONS
PSEUDOMONAS
E.COLI
KLEBSIELLA
SERRIATIA
PROTEUS MIRABILIS
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STREPTOMYCIN:star:
ACTIVE TB
with other medications
STAPHYLOCOCCAL WHEN PENICILLIN IS CONTRADICTED
Nursing Implications
Encourage
2000-3000 ml
H2O a day to flush
renals out
Monitor
I&O/WEIGHT/B.U.N. /CREATININE + CLEARENCE
NEVER GIVE
PCN AND AMINOS IN SAME LINE
Teach patient
S&S
Separate by
2 HOURS
between
amnio
and
EXTENDED PCN
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PIPERACILLIN:star:
ZOSYN
No more than
10 day use