Aminoglycoside PK

Question 1

aminoglycs inhibit protein synthesis at ______

Answer 1

30S

Question 2

aminos are _____-dependent to kill bacteria

Answer 2

dose

Question 3

T/F amino with increasing doses shows increased time above MIC

Answer 3

true

Question 4

what is the post antibiotic effect of aminos on gram-neg bacteria?

Answer 4

3-7 hours

Question 5

are aminos bactericidal or bacteriostatic?

Answer 5

bactericidal

Question 6

do aminos treat gram pos or gram neg?

Answer 6

both

Question 7

do aminos exhibit concentration-dpendent or time-dependent killing?

Answer 7

concentration-dependent

Question 8

what is the site of action of aminos?

Answer 8

30S protein synthesis

Question 9

do aminos exhibit persisten effects?

Answer 9

yes “PAE”

Question 10

T/F aminos have good oral bioavailability

Answer 10

false

Question 11

are aminos safe in pregnancy?

Answer 11

no, can cause congenital deafness

Question 12

are aminos safe in breastfeeding?

Answer 12

yes

Question 13

what is the volume of distribution in cystic fibrosis pts for aminos?

Answer 13

0.35 L/kg

Question 14

as renal function declines, the elimination rate constant _____, and the half life ______

Answer 14

decreases, increases

Question 15

as renal function increases, the elimination rate constant _____, and the half life ______

Answer 15

increases, decreases

Question 16

T/F you can predict amino “k” by knowing the creatinine clearance

Answer 16

true

Question 17

half-life is typically _____ in a patient with cystic fibrosis

Answer 17

shorter

Question 18

volume of distribution in ascites would be expected to?

Answer 18

increase

Question 19

what type of toxicity is associated with aminos?

Answer 19

oxotoxicity and nephrotoxicity

Question 20

what concentrations do we aim for for amikacin?

Answer 20

Cmax over 32
Cmin over 8wh

Question 21

why are aminos potentially nephrotoxic?

Answer 21

they are polycationic (+) whereas proximal tubule is anionic (-)

Question 22

how do we monitor for amino induced nephrotoxicity?

Answer 22

rise in SCr, rise in BUN, urinalysis

Question 23

T/F clinical presentation of amino induced renal failure is extensive non-urine output

Answer 23

false

Question 24

what is an important risk factor of pt developing ototoxicity when using aminos?

Answer 24

dialysis

Question 25

what is a rare AE of aminos?

Answer 25

`paralysis

Question 26

all trough values should be drawn within ____ of next dose

Answer 26

30 minutes

Question 27

for extended interval dosing, draw random level _______ after initiation of infusion rather than standard peak/trough

Answer 27

8-10 hours

Question 28

what impact would extending the dose interval (tau) have?

Answer 28

increased efficacy

Question 29

which of the following is true? a. aminos exhibit concentration-dependent killing; however, the upper limit of Cmax is unknown b. aminos have a concentration-dependent post-antibiotic effect. the higher the Cmax the longer the PAE c. aminos exhibit adaptive resistance d. all of the above

Answer 29

d

Question 30

which if the following is true? a. in bacteria, exposure to AG causes down-regulation of uptake (adaptive resistance) which can be overcome by EID b. on the other hand, uptake of AG into renal tubular cells is saturable, therefore if we increase the dose and increase Cmax with EID, then we can maximize efficacy and minimize toxicity c. EID may provide a period of aminoglycosides to leach back into the renal tubular lumen (for renal excretion), thus minimizing toxicity d. all are true

Answer 30

d

Question 31

safety and efficacy parameters for aminos?

Answer 31

safety: 12h tobramycin level nephrotoxicity (kidney fxn tests): BUN, SCr, CLCR, urine output ototoxicity dizziness, imbalance efficacy: WBC resolution of leukocytosis vitals: temp, BP, HR, RR negative cultures pulmonary function