Aminoglycosides

Question 1

Aminoglycoside MOA

Answer 1

Bind to 30s ribosomal subunit preventing bacterial protein synthesis causing defective cell membrane

Question 2

AMG Coverage

Answer 2

Mainly G-, Pseudomonas
w/ Vanco for G+
Complicated UTI/pyelonephritis (Plazomycin)
Mycobacterium (streptomycin + amikacin)

Question 3

Dosing strategies

Answer 3

Traditional - frequent, low doses

Extended - infrequent, high doses (< nephrotoxicity/cost)

Question 4

Weight-based dosing

Answer 4

Underweight - actual body weight
Ideal Body weight 4 normal dosing
Obese - Adjusted body weight

Question 5

Gentamicin/Tobramycin

Answer 5

IV/IM: 1 - 2.5 mg/kg/dose
lower = G+
higher = G-

Question 6

Amikacin

Answer 6

IV/IM: 5 - 7.5 mg/kg/dose Q8h

Question 7

Renal adjustments

Answer 7

> 60: Q8h
40-60: Q12h
20-40: Q24h
<20: 1 dose then lvl

Question 8

Plazomicin (Zendril)

Answer 8

IV: 15 mg/kg QD

Question 9

BBW

Answer 9

Nephrotoxicity
Ototoxicity
NO neuro/nephrotoxic meds, neuromuscular blockade, respiratory paralysis
Fetal harm

Question 10

Side effects

Answer 10

Nephrotoxicity
hearing loss
vestibular toxicity

Question 11

Monitoring

Answer 11

Drug lvls:
Renal function
Urine output
Hearing test

Question 12

Drug levels

Answer 12

Peak n Trough after 6-14 hrs
Gent G+, Tobramycin: 5-10 mcg/mL, <2 mcg/mL
Gent G-: 3-4 mcg/mL, <1 mcg/mL
Amikacin: 20-30 mcg/mL, <5 mcg/mL
Plazomicin: <3 mcg/mL trough 30mins be4 second dose