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12.01 Anti-Infective – Aminoglycosides

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Overview

 

  1. Organisms
    1. Streptomyces
    2. Gram-positive bacteria
  2. Mechanism
    1. Prevents protein synthesis
    2. Plus, bind to ribosomes
    3. Causing cell death – bactericidal
  3. Three most common
    1. Amikacin
    2. Gentamicin
    3. Tobramycin
  4. Aminoglycosides
    1.  Natural
      1. Gentamicin
      2. Kanamycin
      3. Neomycin
      4. Paromomycin
      5. Streptomycin
      6. Tobramycin
    2. Semisynthetic
      1. Amikacin
      2. Netilmicin

Nursing Points

General

  1. Indications
    1. Gram-negative infections
      1. Pseudomonas spp.
      2. Enterobacteriaceae family
    2. Gram-positive cocci
      1. Enterococcus spp.
      2. Staphylococcus aureus
      3. Bacterial endocarditis
  2.  Contraindications
    1. Allergy
    2. Pregnant women
    3. Lactating women

Assessment

  1. Therapeutic drug monitoring
    1. Maximize drug efficacy
    2. Minimize risk for toxicity
    3. Nephrotoxicity
      1. Monitor renal function
      2. Creatinine clearance (2x/weekly)
      3. Decreased urine output
      4. Fluid retention
    4. Ototoxicity
      1. Baseline audiogram
      2. Audiologist
      3. Hearing loss
      4. Tinnitus
  2. Adverse Effects
    1. Nephrotoxicity
      1. Proteinuria
      2. Increased BUN
      3. Increase serum creatinine level
      4. Low urine output
      5. Fluid retention
    2. Ototoxicity
      1. Hearing loss
      2. 8th CN damage
      3. Cochlear / vestibular damage
      4. Dizziness
      5. Tinnitus
      6. Fullness in ear
      7. Vertigo

Therapeutic Management

  1. Antibiotic Dosing
    1. Minimum inhibitory concentration (MIC)
      1. Lowest concentration of drug needed
      2. Crucial for maximum bacterial death
      3. 1- vs 3-day dosing
    2. Time vs concentration killing
      1. Amount of time above MIC
      2. Increased concentration above MIC
    3. Dosing based on concentration kill, not time
    4. Peaks and trough
      1. Peaks = Highest levels of med
      2. Trough = Lowest levels of med
      3. Trough > 2? Toxicity
      4. Trough monitored q3 days
  2. Drug Interactions
    1. Nephrotoxic drugs
    2. Loop diuretics
    3. Intestinal flora
    4. Warfarin

Nursing Concepts

  1. Infection Control
  2. Pharmacology

Patient Education

  1. If you are experiencing any of the following symptoms, you should call your provider as aminoglycosides cause kidney and ear injury and/or damage:
  2. Nephrotoxicity
    1. Protein in urine
    2. Increased BUN
    3. Increase serum creatinine level
    4. Low urine output
    5. Fluid retention
  3. Ototoxicity
    1. Hearing loss
    2. Dizziness
    3. Tinnitus
    4. Fullness in ear
    5. Vertigo

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Video Transcript

Hello and welcome. Today we’re going to discuss aminoglycosides and the must know information regarding these antibiotics.

These are the three most common aminoglycosides (amikacin, gentamicin and tobramycin). Now, let’s look at what we need to monitor for these drugs.

Monitoring aminoglycosides comes in the form of blood work. Common side effects of aminoglycoside use include nephrotoxicity and ototoxicity. These toxicies can cause temporary or permanent damage to patients. This is why monitoring is important. Nephrotoxicity monitoring consists of renal labs and complaints of fluid retention or low urine output. While ototoxicity monitoring consists of baseline audiograms, seeing a audiologist, with complaints of hearing loss or tinnitus.

The understand antibiotic dosing we must first review MIC (minimum inhibitory concentration), what is the measurement of antibiotic efficiency. Basically how well the antibiotics kill bacteria and in what way. Some antibiotics kills based on time while other kill based on their concentration. Aminoglycosides work on their concentration. One great factor about these antibiotics are their post-antibiotic effects. Aminoglycosides continue to suppress bacterial growth for an extended period of time which is why most are dosed daily. A tool used to monitor aminoglycoside efficiency is peak and troughs. Peaks showing highest, while through showing lowest levels. Monitoring will determine if the drug is being proper executed by the body and proper levels are achieved to  max effect.

As mentioned earlier, aminoglycosides come in two forms: natural and semisynthetic. The trend on these drugs being most ending in -MYCIN or -MICIN. When you think on aminoglycosides, think -MYCIN/-MICIN. Amnio = Mycin.

The mechanism of action with aminoglycosides is inhibition of protein synthesis. Protein synthesis crucial for cell proliferation and development. This dysfunction leads of bacterial suppression and to bacteria death.

The indications of aminoglycosides include gram-negative infections (mainly) and gram-positive cocci, in particular. When thinking about indications, used the BEEPS acronym. BEEPS takes the first letter of each infectious groups, see the underlined letters.

Adverse effects in regard to nephrotoxicity revolve around renal dysfunction and include: protein in urine, low urine production, elevated renal labs and fluid retention. Ototoxicity is another adverse effect of aminoglycosides use and includes hearing loss, CN 8 damage, cochlear/vestibular damage, dizziness/vertigo, tinnitus and ear fullness.

Contraindications of aminoglycosides includes allergies, and pregnant or lactating women. These drugs can cause fetal harm, congenital deafness, and can be transferred in breast milk to infants.

Aminoglycosides also have concerns with regard to other medications. Nephrotoxicity risk is increased when used with other nephrotoxic drugs, such as vanco or cyclosporine. Ototoxicity risk is increased when the use of loop diuretics such as lasix. Like most antibiotics, these drugs also kill natural gut flora. The use of aminoglycosides can so increase warfarin toxicity. 

Key nursing concepts for aminoglycosides include pharmacology and infection control.

Let’s recap, these antibiotics inhibit protein synthesis – crucial for bacterial growth. This leads to bacterial suppression and death. Aminoglycosides come in two forms, natural and semisynthetic. The main indication of aminoglycoside use of gram-negative infections. With adverse effects focusing around the kidneys and ears. Due to these possibility permanent adverse effects, proper monitoring is required and dosing in closely monitored using peak and troughs.

You know now the important details regarding aminoglycosides use. Now, go out and be your best self today and as always, Happy Nursing

Read more

  • Question 1 of 7

A nurse is helping a nursing student to understand aminoglycosides and how to identify which drugs belong to this class. The nurse is correct in saying that aminoglycosides tend to have which of the following suffix?

  • Question 2 of 7

A client presents to the emergency room with an abscess that was previously treated but is not responding to penicillin. The nurse knows the next line of antibiotics will be which of the following?

  • Question 3 of 7

A client receiving medication as an anti-infective starts showing signs of nephrotoxicity. The nurse knows that which of the following are signs of nephrotoxicity?

  • Question 4 of 7

A nurse received report on a client who is receiving aminoglycoside. After reviewing orders the nurse sees an order for a trough level. The nurse knows that trough levels are used to ensure adequate clearance of which of the following?

  • Question 5 of 7

The nurse is caring for a client that is receiving aminoglycoside. The nurse knows to assess the client for which of the following adverse effects?

  • Question 6 of 7

The nurse is caring for a client receiving aminoglycoside. The nurse knows that which of the following cranial nerve can be damaged by aminoglycoside use?

  • Question 7 of 7

What two adverse effects are common with aminoglycoside use?

Module 0 – Pharmacology Course Introduction

Module 3 – Disease Specific Medications

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