ID I: Aminoglycosides Flashcards
aminoglycosides coverage
gram negative (including pseudomonas)
Which AGs are used for synergy when treating gram positive bacteria (such as enterococcal endocarditis)??
gentamicin and streptomycin
in combination with a beta lactam or vancomycin
What are the two dosing strategies?
traditional and extended interval
When you use the lower doses more frequently (Q8H if renal function is normal is which dosing pattern
traditional
When you use higher doses to attain higher peaks less frequently once daily if renal function is normal
extended interval
With which dosing strategy is there less accumulation of drug?
extended; it has been shown to decrease nephrotoxicity and decrease cost
*not clinically superior though
Your patient is underweight (less than ideal weight), what weight do you use for AG?
TOTAL BODY WEIGHT!
If your patient is not obese or underweight, what body weight do you use?
IBW or TBW
If your patient is obese what bodyweight do you use?
ADJUSTED!!! (think 0.4)
What is the dosing for gentamicin and tobramycin for traditional dosing IV
1-2.5mcg/kg/dose
lower doses = gram positive
higher doses = gram negative
When creatine clearance in your patient is >60, what is the interval?
Q8H
40-60 = Q12 20-40 = Q24
Your patient is receiving extended interval IV dosing for gentamicin/tobramycin… what’s the equation?
4-7mch/kg/dose (commonly 7!)
What are the boxed warnings for AG?
nephrotoxicity, ototoxicity
avoid use with other neurotoxic drugs (ampho B, cisplatin, polymyxins, cyclosporin, loops, INSAIDs, contrast dye, tacrolimus, vancomycin) / nephrotoxic drugs
neuromuscular blockade
Your patient is receiving traditional dosing, when do you draw a trough?
right before the FOURTH dose (30 mins before)
Your patient is receiving traditional dosing, when do you draw a peak?
30 minutes AFTER the fourth dose
