E2 Erdman aminoglycosides

Question 1

what 2 things are reasons why the AMG class is dosed individually for each pt and require serum conc monitoring

Answer 1

• interpatient variability in Vd and Cl
• narrow therapeutic window/index

Question 2

5 AMGs to know for this lecture

Answer 2

gentamicin
tobramycin
amikacin
streptomycin
plazomicin (new)

Question 3

T or F:
AMGs are very polar compounds that are polycationic

Answer 3

true

Question 4

AMG MOA

Answer 4

bind to 30S!!!!
- must bind to and diffuse through outer membrane (passive) and cytoplasmic membrane (energy-dependent) to reach ribosome

Question 5

AMGs are (time/conc) dependent and (cidal/static)

Answer 5

conc, cidal

Question 6

T or F:
AMGs are capable of crossing lipid-containing cellular membranse

Answer 6

false

Question 7

T or F:
AMGs have excellent oral absorption

Answer 7

false

Question 8

T or F:
AMGs penetrate through meninges well

Answer 8

F, they dont

Question 9

T or F:
binding to 30s subunit is reversible

Answer 9

false

Question 10

3 mechs of resistance for AMGs

Answer 10

• altered uptake
• AMG-modifying enzymes
• alteration in ribosomal binding sites (primarily with strepto)

Question 11

AMGs are NEVER USED ALONE for GP aerobes, what are they used with?

Answer 11

low doses of cell-wall active agents to provide synergy - primarily with gent

Question 12

AMG SoA:
GP aerobes

Answer 12

Viridans strep (gent)
enterococcus spp (static, gent or strepto)
Most S. aureus ** (MRSA/MSSA)

Question 13

not very active against GN aerobes.
A. Amikacin
B. Plazomicin
C. Gentamicin
D. Tobramycin
E. Streptomycin

Answer 13

E

Question 14

MOST active against GN aerobes
A. Amikacin
B. Plazomicin
C. Gentamicin
D. Tobramycin
E. Streptomycin

Answer 14

A

Question 15

key GN bacteria AMGs have activity against

Answer 15

Pseudomonas aeruginosa

Question 16

AMG SoA:
anaerobes

Answer 16

not active

Question 17

AMGs display a PAE for most ___ bacteria and S. aerues

Answer 17

GN

Question 18

has activity against ESBLs, AmpCs, KPC/OXA
A. Amikacin
B. Plazomicin
C. Gentamicin
D. Tobramycin
E. Streptomycin

Answer 18

B

Question 19

AMG synergy with cell wall active agents against what key 3 bacterias

Answer 19

Enterococcus
S aureus
P. aeruginosa

Question 20

True/False:
Aminoglycosides can be
used as monotherapy for the
treatment of infections due to
Gram-positive aerobes.

Answer 20

F

Question 21

AMGs:
drug absorption after IM injection may be decreased in patients with hypotension and should not be used in ________ ____ pts

Answer 21

critically ill

Question 22

AMGs are distributed primarily in the ?

Answer 22

extracellular fluid compartment

Question 23

AMGs distribute (well/poorly) into CSF

Answer 23

poorly

Question 24

what body weight should be used for AMGs

Answer 24

IBW (or ADW in obese pts)

Question 25

what must be taken into account to calculate appropriate dose of AMGs

Answer 25

volume status - conc dependent killers so

Question 26

AMGs elimination

Answer 26

85-95% eliminated unchanged in kidney

Question 27

Elimination t1/2 depends on?

Answer 27

renal function

Question 28

T or F: AMGs are removed by hemo

Answer 28

true

Question 29

which of the following DO NOT require serum conc monitoring? A. Amikacin B. Plazomicin C. Gentamicin D. Tobramycin E. Streptomycin

Answer 29

B and E

Question 30

It is imperative to achieve therapeutic AMG concs. within 24 hours in pts with GN _____

Answer 30

sepsis, increased mortality with sub-therapeutic conc

Question 31

are eligible for once-daily dosing A. Amikacin B. Plazomicin C. Gentamicin D. Tobramycin E. Streptomycin

Answer 31

A C D "GTA"

Question 32

True/False: All patients can receive the same aminoglycoside dose since there is little interpatient variability in Vd and Cl.

Answer 32

false no fuckin shit

Question 33

gentamicin/tobramycin. Intra- abdominal infections, urosepsis, skin and soft tissue infections: peak: trough:

Answer 33

peak: 13-20 trough: <0.5

Question 34

amikacin. Intra-abdominal infections, urosepsis, skin and soft tissue infections: peak: trough:

Answer 34

peak: 40-50 trough: <8

Question 35

AMG clinical uses: A/G/T

Answer 35

GN aerobes (usually w/ b-lactams)

Question 36

AMG clinical uses: plazo

Answer 36

complicated UTI due to MDR GN aerobes

Question 37

AMG clinical uses: G/S

Answer 37

GP aerobes (with synergy)

Question 38

tuberculosis: A. Amikacin B. Plazomicin C. Gentamicin D. Tobramycin E. Streptomycin

Answer 38

E

Question 39

AMG AEs: nephrotoxicity

Answer 39

nonoliguric azotemia due to proximal tubular damage

Question 40

AMG AEs: nephrotoxicity risk factors

Answer 40

- prolonged high troughs

Question 41

Irreversible AMG AE (unique to class)

Answer 41

ototoxicity

Question 42

Which of the following antibiotics does NOT have activity against Pseudomonas aeruginosa? A. Cefepime B. Ciprofloxacin C. Tobramycin D. Piperacillin E. Ceftriaxone

Answer 42

E

Question 43

Which of the following antibiotics does NOT cause nephrotoxicity? A. Gentamicin B. Telavancin C. Vancomycin D. Azithromycin E. Nafcillin

Answer 43

D