EXAM 2 AMG Flashcards
aminoglycoside drugs
gentamicin
tobramycin
amikacin
aminoglycoside MOA
bactericidal
irreversibly bind to 30S ribosome
- decrease protein synthesis and misreading of mRNA
aminoglycoside MOR
alteration in AMG uptake
synthesis of AMG-modifying enzymes
- plasmid-mediated; causing poor binding
Alteration in ribosomal binding sites
-primarily with streptomycin
AMG spectrum
MSSA and MRSA (primarily gent, not as monotherapy but w/ cell wall active agent)
Pseudomonas –> A>T>G
post antibiotic effect
Suppression of bacterial growth after serum concentrations have fallen below MIC
T/F: Aminoglycoside can be used as monotherapy for treatment of infections due to gram (+) aerobes
FALSE
will always be with cell wall active antibiotics
AMG pharmacology
interpatient variability exists in Vd and Cl
intermittent IV infusion preferred
AMG distribution
poorly distributed into CSF, Lungs, and adipose
IBW and ADW for dosing patients
volume status must be taken into account –> concentration dependent killers
AMG elimination
85-95% eliminated unchanged in kidney
elimination t 1/2 depends on renal function
AMG monitoring
individualized monitoring and dosing for ALL patients
AMG standard dosing
LD and MD based on VD, IBW, ABW, and desired Cpk
gent/tobra dosing gram (-)
moderate (UTI) –> peak: 4-6, trough: 0.5-1.5
mod-severe (SSTI,bacterimia) –> peak: 6-8, trough: 1-1.5
severe (pneumonia, burn, life-threat) –> peak: 8-10, trough: <2
gent dosing gram (+)
peak: 3-5
trough: 1
extended interval dosing AMG
once daily dosing –> only for gram (-)
gent/tobra: 7mg/kg IBW or ADW
T/F: all patients can receive the same AMG dose since there is little interpatient variability in Vd/Cl
FALSE
AMG dosing should be individualized bc of the variability in Vd and Cl
plazomicin
gram (-)
dosing = 15 mg/kg IV IBW or ADW
trough moniting recommeneded in patients with CrCL 15-90
Adverse effects of AMG
nephrotoxicity
risk factors: prolonged high troughs, long therapy, renal dysfunction
ototoxicity
which of the following antibiotics does not have activity against pseudomonas aeruginosa?
Cefepime
Ciprofloxacin
Tobramycin
Piperacillin
Ceftriaxone
Ceftriaxone
Which of the following antibiotics does not cause nephrotoxicity?
Gentamicin
Telavancin
Vancomycin
Azithromycin
Nafcillin
Azithromycin
