Walters - Aminoglycosides

Question 1

____ are amino sugars in glycosidic links to aminocyclitol ring. They are ____ and usually given via IV. They are ___

Answer 1

aminoglycosides; polycations; cidal

Question 2

what is mechanism for aminoglycosides

Answer 2

Enter periplasmic space of G - bacteria through porin channels down electrochemical gradient. In cell:

1. inhibit initiation
2. misreading of mRNA –> faulty proteins
3. premature termination –> postantibiotic effect

Question 3

aminoglycosides are ____ effective vs anaerobes bc they don’t use oxygen and don’t create electrochemical gradient.

Answer 3

not

Question 4

what are aminoglycosides used with for synergism?

Answer 4

beta lactams; increases penetration of amino glycoside

Question 5

where do aminoglycosides attain their highest levels in

Answer 5

1. renal cortex; nephroxicity (reversible)
2. endolymph of inner ear; otoxicity (irreversible)
   - degeneration of auditory nerve leads to permanent hearing loss.
   * oxotoxicity can develop in neonates

Question 6

what are autitory symptoms

Answer 6

1. tinnitus

2. high frequency hearing loss

Question 7

what are vestibular symptoms

Answer 7

1. vertigo
2. ataxia
3. loss of balance

Question 8

What are the IV aminoglycosides

Answer 8

1. Gentamicin
2. Tobramycin
3. amikacin

Question 9

-icin coming from micro mono spora. -mycin come from _____

Answer 9

streptomycins

Question 10

This amino glycoside is given topical for burns, wounds, catheter infections, or ophthalmic for superficial ocular infections

Answer 10

gentamicin

Question 11

This amino glycoside is very similar to gentamicin but may have less ototoxicity than gentamicin

Answer 11

tobramycin

Question 12

this amino glycoside is enemy resistant and is used for ____ infections that resist gentamicin and tobramycin

Answer 12

Amikacin; nocosomial

Question 13

what are the oral aminoglycosides

Answer 13

1. neomycin

2. paromomycin

Question 14

____ is used to prep for bowel surgery and is a topical anti infectant

Answer 14

neomycin

Question 15

____ is used to kill cysts of _____ histolytica; an amebic dystentary

Answer 15

paramomycin; entamoeba

Question 16

aminoglycosides are suppose to be give ____ x a day bc of post antibiotic effect but bc its nephrotic you have to adjust dose for renal function.

Answer 16

1

Question 17

how do you adjust dose for aminoglycosides

Answer 17

max daily dose x estimated CL cr/normal CLcr

Question 18

what is the normal creatanine clearance for a 70 kg male

Answer 18

120-125 ml/min

Question 19

ahminoglycosides are polycations and therefor only distribute in _____ body mass

Answer 19

lean

Question 20

if your giving it 1 x a day monitor _____. if giving 2-3 x a day monitor ____ and troughs.

Answer 20

troughs; peaks

Question 21

what are other side effects of ahminoglycosides

Answer 21

can cause neuromuscular block;–> get a higher rate of respiratory paralysis; becomes a problem post op

Question 22

what is the mechanism of neuromuscular blockage of aminoglycosides

Answer 22

1. block Ca+ uptake into cholinergic nerve terminals thus decreasing Ach release and in turn muscle contraction.
2. block postsynaptic cholinergic receptors.

Question 23

how would you treat the neuromuscular block

Answer 23

give Ca+ via IV or give neostigmine which is a acetylcholinesterase inhibitor that inhibits Ach metabolism thus increasing Ach levels resulting in stimulation of respiratory muscles.

Question 24

You want to avoid aminoglycosides if your patient has ____ ____, because this is autoimmune disease where there is an Ab against the nicotinic receptor at the NMJ creating extreme muscle weakness. Since ahminoglycosides can also block this receptor, they can exacerbate the condition.

Answer 24

mysthenia graves