Aminoglycosides

Question 1

What is the MOA of aminoglycosides

Answer 1

Bind to ribosome and interfere with protein synthesis

Question 2

What do ahminoglycosides cover

Answer 2

Gram negative pathogens including pseudomonas

Question 3

How are aminoglycosides used synergistically?

Answer 3

In combination with beta-lactams or vancomycin to treat gram positive infections

Question 4

What are the two dosing strategies of aminoglycosides?

Answer 4

1) Traditional dosing - lower doses more frequently

2) Extended interval dosing - higher doses less frequently

Question 5

List the aminoglycosides

Answer 5

1) Gentamicin
2) Tobramycin
3) Amikacin
4) Streptomycin
5) Plazomicin

Question 6

What disease state is tobramycin inhalation specifically used for?

Answer 6

Cystic fibrosis

Question 7

How should you calculate aminoglycoside dose?

Answer 7

If underweight: Total body weight

If obese: Adjusted body weight

Question 8

What is the traditional IV dosing of gentamicin and tobramycin

Answer 8

1-2.5mg/kg/dose

Question 9

In traditional IV dosing of gentamicin and tobramycin lower doses are used for? Higher doses are used for?

Answer 9

Lower doses: Gram positive infections

Higher doses: Gram negative infections

Question 10

What is the traditional IV dosing of Amikacin

Answer 10

5-7.5mg/kg/dose

Question 11

What is the renal dose adjustment for traditional dosing for aminoglycosides?

Answer 11

CrCl >/ 60 mL/min: Q8h

Question 12

What is the extended interval IV dosing of gentamicin and tobramycin and frequency

Answer 12

4-7mg/kg/dose, frequency is based on nomogram

Question 13

What is the boxed warnings of aminoglycosides?

Answer 13

Nephrotoxicity, ototoxicity, avoid use with other neurotoxic/nephrotoxic drugs; neuromuscular blockades

Question 14

When should caution be used with aminoglycosides

Answer 14

Patients with impaired renal function, elderly, patient taking other nephrotoxic drugs (amphotericin B, Cisplatin, polymyxins, cyclosporine, loop diuretics, NSAIDs, radiocontrast dye, tacrolimus, vancomycin)

Question 15

What should be monitored with aminoglycosides

Answer 15

drug levels and renal functionn

Question 16

With traditional dosing, how are drug levels measured?

Answer 16

Draw a trough level 30 minutes before 4th dose.

Draw a peak level 30 minutes after the end of the 30-minute drug infusion for the 4th dose

Question 17

With extended interval dosing, how are drug levels measured?

Answer 17

Random level is drawn after the first dose, timing depending on Hartford nomogram

Question 18

True or false, amikacin has the broadest spectrum of activity

Answer 18

True

Question 19

If the extended interval random level plots on a line, what should you do?

Answer 19

Round up to the next dosing interval to avoid potential toxicity.

Question 20

What is the goal trough for gentamicin gram-negative infection and tobramycin in traditional dosing

Answer 20

< 2mcg/mL