Exam 2 - Aminoglycosides

Question 1

what is the GP coverage of aminoglycosides

Answer 1

Enterococcus spp. (gent or strepto)
MSSA, MRSA
NEVER USES ALONE

Question 2

what is the GN coverage of aminoglycosides

Answer 2

Pseudomonas Aeruginosa
A,P>T>G

Question 3

what is the aminoglycoside that does not cover pseudomonas aeruginosa

Answer 3

streptomycin

Question 4

Gent and Tobra peak and trough for moderate infections (UTI)

Answer 4

peak: 4-6
trough: 1

Question 5

Gent and tobra peak and trough for moderate to severe infections (soft-tissue, bacteremia)

Answer 5

peak: 6-8
trough: 1

Question 6

gent and tobra peak and trough for severe infections (pneumonia, burns, life threatening)

Answer 6

peak: 8-10
trough: 1

Question 7

gent peak and trough for gram positive

Answer 7

peak: 3-5
trough: 1

Question 8

describe the strategy for extended dosing

Answer 8

use larger doses once daily to obtain high peaks and undetectable troughs. this strategy relies on the PAE

Question 9

what is the extended dose for gent and tobra

Answer 9

5-7 mg/kg as a single daily dose

Question 10

what is the extended dose for amikacin

Answer 10

15-25 mg/kg as a single daily dose

Question 11

what is the cavoite for using extended dosing

Answer 11

Renal function must be good
CrCl > 40-50

Question 12

gent and tobra peak and trough for GN extended dosing

Answer 12

peak: 13-20
trough: < 0.5

Question 13

what are the clinical uses of ami,gent,tobra

Answer 13

serious infections including pseudomonas

Question 14

what are the clinical uses or gent or strepto

Answer 14

serious infections due GP bugs like enterococci, viridans, or staphylococci

Question 15

what is the moa of aminoglycosides

Answer 15

irreversibly bind to the 30S subunit

Question 16

what kind of killers are aminoglycosides

Answer 16

rapidly bactericidal in a concentration dependent manner

Question 17

what is the resistance against aminoglycosides

Answer 17

alteration in uptake
synthesis of aminoglycoside-modifying enzymes
alteration of binding site (only affects streptomycin)

Question 18

what is the most important factor that affects aminoglycoside dosing

Answer 18

volume of distribution and clearance

Question 19

absorption of aminoglycosides

Answer 19

peak within 30-120 min
given IV or IM

Question 20

CI for IM admin of aminoglycosides

Answer 20

hypotension or critically ill

Question 21

how is aminoglycoside distributed

Answer 21

primarily in extracellular fluid compartments

Question 22

where do aminoglycosides distribute POORLY

Answer 22

CSF, sputum, adipose tissue

Question 23

what weight should be used for aminoglycoside dosing

Answer 23

IBW or ABW if obese

Question 24

what is the normal Vd

Answer 24

0.25 L/kg

Question 25

what is the dehydration Vd

Answer 25

0.15-0.2 L/kg

Question 26

what is the edema Vd (ascites, pregnancy, burn, CHF)

Answer 26

0.3-0.35 L/kg

Question 27

what is the Vd for neonates/infants

Answer 27

0.5 L/kg

Question 28

elimination of aminoglycosides

Answer 28

eliminated via the kidney

Question 29

does hemodialysis remove aminoglycosides

Answer 29

yes, give dose after HD

Question 30

when to obtain peaks for aminoglycosides

Answer 30

standard: 30 min after 30 min infusion extended: 60 min after 60 min infusion

Question 31

when to obtain troughs for aminoglycosides

Answer 31

30 min prior to next dose

Question 32

what aminoglycosides have serum conc measuring

Answer 32

Gentamicin Tobramycin Amikacin

Question 33

what are the adverse effects of aminoglycosides

Answer 33

Nephrotoxicity Ototoxicity

Question 34

what AEs of aminoglycosides are reversible and what are irreversible

Answer 34

nephrotoxicity: reversible if caught early ototoxicity: irreversible MUST catch early

Question 35

what is a risk factor for nephrotoxicity

Answer 35

prolonged high trough concentrations prolonger therapy

Question 36

what is a risk factor for ototoxicity

Answer 36

prolonged therapy