aminoglycosides clinical applications

* aminoglycosides
* tetracyclines

name the 2 antibiotic classes that inhibit 30S

* chloramphenical
* macrolides
* linezolid

name the 3 antibiotic classes that inhibit 50S

aminoglycosides

* neomycin
* tobramycin
* amikacin
* gentamicin
* streptomycin

these are antibiotics that are _________

MOA of aminoglycosides

inhibit protein synthesis by irreversibly binding to 30S . This process is energy and oxygen dependent

false

true or false

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Oxygen is required for aminoglycoside to work, but the process is energy independent (does not require ATP)

bacteriocidal

aminoglycosides are ________

\
A. bacteriocidal

B. bacteriostatic

anaerobes

bacteria that intrinsically resistant to aminoglycosides

gram negative aerobes:

* **pseudomonas**
* Enterobacteria
* acinetobacter

gram positive:

* enterococcus
* streptococcus
* staph. aureus

list coverage range of aminoglycosides

IM or IV

aminoglycosides route of administration

false

true or false

\
aminoglycosides has POOR kidney penetration

amikacin

* empiric therapy with beta-lactam
* for pseudomonas or resistant gram negative organisms severe cases (sepsis, bacteremia, in house pneumonia)

\
the following statements describe the clinical use of _______

tobramycin

for targeted therapy that treat gram negative infection or UTI

\
the following statement describe the clinical use of _________

gentamicin

* for synergistic therapy
* often co-administer with a beta-lactam as co-drug
* treat gram positive infection (enterococcal, strep)

\
the following statements describe the clinical use of ________

low

we treat gram positive infection with _____ dose of aminoglycosides

high

we treat gram negative infection with _____ dose of aminoglycosides

true

true or false

\
aminoglycosides have a unique feature of post-antibiotic effect, which kills bacteria even when the drug plasma level have declined.

traditional or extended interval

we would want to consider ________ dosing for gram negative infection

low dose/synergy

we would want to consider ________ dosing for gram positive infection

* extensive burn patients
* ascites/severe liver disease
* severe renal disease
* cystic fibrosis
* pregnancy

who are contraindicated for extended dosing of aminoglycosides? (5)

false

true or false

\
traditional dosing requires patient to take the medication once daily where extended interval dosing require patients to take the medication multiple tines daily

true

true or false

\
all doses of aminoglycosides must be adjusted for renal function

* low dose
* use with beta-lactam or vancomycin for antibiotic synergy

what are 2 things to consider when dosing AG for gram positive infections?

all of the above are true

which of the following are true regarding aminoglycosides?

\
A. AG are bacteriocidal agents

B. high doses (extended-interval) to target gram negative pathogens (pseudomonas)

C. excreted mainly in the urine

D. all of the above are true

all of the above

PM, 60 year old female, has a blood-stream infection due to streptococcal spp. The medical team starts this patient on Gentamicin 7mg/kg Q24 hour monotherapy

\
What is inappropriate about PM’s therapy?

A. Monotherapy with Gentamicin is inappropriate

B. The dosing regimen of gentamicin for a gram positive infection is inappropriate

C. Gentamicin should be hanged to amikacin

D. All of the above

* ototoxicity
* nephrotoxicity

what are the toxicity of aminoglycosides?

aminoglycosides

nephrotoxicity:

* acute tubular necrosis
* at least 5 days after start of therapy
* rise in BUN and SCr
* reversible

Ototoxicity:

* auditory/cochlear: hearing loss, tinnitus
* vestibular: irreversible, hard to walk or stand alone, NV vertigo, nystagmus

\
the above describes describe the side effects of ________

false

true or false

\
toxicity (nephrotoxicity and ototoxicity) induced by AG are irreversible

amikacin

_________ has the highest risk of inducing nephrotoxicity

gentamicin and tobramycin

_________ has the highest risk of inducing ototoxicity

* no protein synthesis (30s inhibitors)
* __n__egative __o__rganism
* __n__ephrotoxicity and __o__totoxicity
* no anaerobes

what are the 4 “NO” of amiNOglycosides?

protein synthesis inhibitors

what is the mode of action of aminoglycosides?