{"id":118,"date":"2019-09-22T17:53:30","date_gmt":"2019-09-22T17:53:30","guid":{"rendered":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-12-aminoglycosides\/"},"modified":"2021-12-07T11:06:24","modified_gmt":"2021-12-07T11:06:24","slug":"3-12-aminoglycosides","status":"publish","type":"chapter","link":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/chapter\/3-12-aminoglycosides\/","title":{"raw":"3.12 Aminoglycosides","rendered":"3.12 Aminoglycosides"},"content":{"raw":"Aminoglycosides are a potent broad spectrum of antibiotics that are useful for treating severe infections. Many aminoglycosides are poorly absorbed in the GI tract; therefore, the majority are given IV or IM. Aminoglycosides are potentially nephrotoxic and neurotoxic. They should be administered cautiously. Blood peak and trough levels should be performed to titrate a safe dose for each patient.\n\nIndications:<\/strong> Streptomycin is used for streptococcal endocarditis and a second line treatment for tuberculosis. Neomycin is used in the treatment of hepatic encephalopathy as adjunct therapy to lower ammonia levels and is also used as a bowel prep for colon procedures.\n\nMechanism of Action:<\/strong> Aminoglycosides are bactericidal and bind with the area of the ribosome known as the 30S subunit, inhibiting protein synthesis in the cell wall and resulting in bacterial death (see Figure 3.9).[footnote]This work is a derivative of Microbiology<\/a> by OpenStax<\/a> licensed under CC BY 4.0<\/a>. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a>[\/footnote]<\/sup> Aminoglycosides may be given with beta-lactam medications to facilitate transport of aminoglycoside across the cellular membrane, resulting in a synergistic effect and increasing drug effectiveness.\n\n \n\n[caption id=\"\" align=\"aligncenter\" width=\"816\"]\"Illustration Figure 3.9 Medications that inhibit protein synthesis[\/caption]\n\nSpecial Administration Considerations: <\/strong>Aminoglycosides can result in many adverse effects for the patient and, therefore, the nurse should monitor the patient carefully for signs of emerging concerns. Peak and trough levels are used to titrate this medication to a safe dose. Aminoglycosides can be nephrotoxic (damaging to kidney), neurotoxic (damaging to the nervous system), and ototoxic (damaging to the ear). Nurses should monitor the patient receiving aminoglycosides for signs of decreased renal function such as declining urine output and increasing blood urea nitrogen (BUN), creatinine, and declining glomerular filtration rate (GFR). Indications of damage to the neurological system may be assessed as increasing peripheral numbness or tingling in the extremities. Additionally, the patient should be carefully assessed for hearing loss or hearing changes throughout the course of drug administration.\n\nPatient Teaching & Education: <\/strong>Patients receiving aminoglycosides should be advised to monitor for signs of hypersensitivity and auditory changes.\u00a0 This may include tinnitus and hearing loss.\u00a0 Patients may also experience accompanying vertigo while on the medication.\u00a0 Patients should be advised to drink plenty of fluids while taking the medication.\u00a0 Female patients should notify their provider if pregnancy is planned or if they are actively breastfeeding.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let's take a closer look at the medication grid for streptomycin and gentamycin in Table 3.12.[footnote]Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019[\/footnote]<\/sup>\n\nTable 3.12 Streptomycin and Gentamycin Medication Grid\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Aminoglycosides<\/th>\nstreptomycin<\/a>\n\ngentamicin<\/a><\/td>\nCheck for allergies\n\nObtain culture before administering\n\nIM: Blood sample for peak level should be obtained 1 to 2 hours after IM injection; obtain blood for trough level just before next dose\n\nInject in a large muscle\n\nHandle carefully; use gloves to prepare\n\nMonitor peak and trough levels<\/td>\nMonitor for systemic signs of infection:\n\n- WBCs\n\n- Fever\n\nMonitor actual site of infection\n\nMonitor culture results<\/td>\nGI upset\n\nRash\n\nReport diarrhea immediately\n\nSAFETY:\n\nNephrotoxicity: monitor renal function closely\n\nRisk for severe neurotoxic reactions, especially with renal impairment. Can result in respiratory paralysis if given soon after anesthesia or muscle relaxant\n\nRisk for ototoxicity, especially if administered with a loop diuretic\n\nCan cause harm to fetus and breastfed infants<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n \n

Critical Thinking Activity 3.12a<\/strong><\/h2>\nUsing the above grid information, consider the following clinical scenario question:<\/strong>\n\nA patient is admitted with streptococcal endocarditis and the nurse is preparing the morning dose of streptomycin. The lab has not yet arrived to obtain the trough level, and the drug is now overdue to be given. What is the nurse's next best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key\" sections at the end of the book.","rendered":"

Aminoglycosides are a potent broad spectrum of antibiotics that are useful for treating severe infections. Many aminoglycosides are poorly absorbed in the GI tract; therefore, the majority are given IV or IM. Aminoglycosides are potentially nephrotoxic and neurotoxic. They should be administered cautiously. Blood peak and trough levels should be performed to titrate a safe dose for each patient.<\/p>\n

Indications:<\/strong> Streptomycin is used for streptococcal endocarditis and a second line treatment for tuberculosis. Neomycin is used in the treatment of hepatic encephalopathy as adjunct therapy to lower ammonia levels and is also used as a bowel prep for colon procedures.<\/p>\n

Mechanism of Action:<\/strong> Aminoglycosides are bactericidal and bind with the area of the ribosome known as the 30S subunit, inhibiting protein synthesis in the cell wall and resulting in bacterial death (see Figure 3.9).[1]<\/sup><\/a><\/sup> Aminoglycosides may be given with beta-lactam medications to facilitate transport of aminoglycoside across the cellular membrane, resulting in a synergistic effect and increasing drug effectiveness.<\/p>\n

 <\/p>\n

\"Illustration
Figure 3.9 Medications that inhibit protein synthesis<\/figcaption><\/figure>\n

Special Administration Considerations: <\/strong>Aminoglycosides can result in many adverse effects for the patient and, therefore, the nurse should monitor the patient carefully for signs of emerging concerns. Peak and trough levels are used to titrate this medication to a safe dose. Aminoglycosides can be nephrotoxic (damaging to kidney), neurotoxic (damaging to the nervous system), and ototoxic (damaging to the ear). Nurses should monitor the patient receiving aminoglycosides for signs of decreased renal function such as declining urine output and increasing blood urea nitrogen (BUN), creatinine, and declining glomerular filtration rate (GFR). Indications of damage to the neurological system may be assessed as increasing peripheral numbness or tingling in the extremities. Additionally, the patient should be carefully assessed for hearing loss or hearing changes throughout the course of drug administration.<\/p>\n

Patient Teaching & Education: <\/strong>Patients receiving aminoglycosides should be advised to monitor for signs of hypersensitivity and auditory changes.\u00a0 This may include tinnitus and hearing loss.\u00a0 Patients may also experience accompanying vertigo while on the medication.\u00a0 Patients should be advised to drink plenty of fluids while taking the medication.\u00a0 Female patients should notify their provider if pregnancy is planned or if they are actively breastfeeding.[2]<\/sup><\/a><\/sup><\/p>\n

Now let’s take a closer look at the medication grid for streptomycin and gentamycin in Table 3.12.[3]<\/sup><\/a><\/sup><\/p>\n

Table 3.12 Streptomycin and Gentamycin Medication Grid<\/p>\n\n\n\n\n
\n
Class\/Subclass<\/strong><\/h5>\n<\/th>\n
\n
Prototype\/Generic<\/strong><\/h5>\n<\/th>\n
\n
Administration Considerations<\/strong><\/h5>\n<\/th>\n
\n
Therapeutic Effects<\/strong><\/h5>\n<\/th>\n
\n
Side\/Adverse Effects<\/strong><\/h5>\n<\/th>\n<\/tr>\n
Aminoglycosides<\/th>\nstreptomycin<\/a><\/p>\n

gentamicin<\/a><\/td>\n

Check for allergies<\/p>\n

Obtain culture before administering<\/p>\n

IM: Blood sample for peak level should be obtained 1 to 2 hours after IM injection; obtain blood for trough level just before next dose<\/p>\n

Inject in a large muscle<\/p>\n

Handle carefully; use gloves to prepare<\/p>\n

Monitor peak and trough levels<\/td>\n

Monitor for systemic signs of infection:<\/p>\n

– WBCs<\/p>\n

– Fever<\/p>\n

Monitor actual site of infection<\/p>\n

Monitor culture results<\/td>\n

GI upset<\/p>\n

Rash<\/p>\n

Report diarrhea immediately<\/p>\n

SAFETY:<\/p>\n

Nephrotoxicity: monitor renal function closely<\/p>\n

Risk for severe neurotoxic reactions, especially with renal impairment. Can result in respiratory paralysis if given soon after anesthesia or muscle relaxant<\/p>\n

Risk for ototoxicity, especially if administered with a loop diuretic<\/p>\n

Can cause harm to fetus and breastfed infants<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Critical Thinking Activity 3.12a<\/strong><\/h2>\n

Using the above grid information, consider the following clinical scenario question:<\/strong><\/p>\n

A patient is admitted with streptococcal endocarditis and the nurse is preparing the morning dose of streptomycin. The lab has not yet arrived to obtain the trough level, and the drug is now overdue to be given. What is the nurse’s next best response?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key” sections at the end of the book.<\/p>\n

  1. This work is a derivative of Microbiology<\/a> by OpenStax<\/a> licensed under CC BY 4.0<\/a>. Access for free at https:\/\/openstax.org\/books\/microbiology\/pages\/1-introduction<\/a> ↵<\/a><\/li>
  2. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  3. Daily Med, https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm<\/a>, used for hyperlinked medications in this module. Retrieved June 27, 2019 ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":2,"menu_order":12,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[49],"contributor":[],"license":[53],"class_list":["post-118","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","license-cc-by"],"part":84,"_links":{"self":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/118","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/users\/2"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/118\/revisions"}],"predecessor-version":[{"id":119,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/118\/revisions\/119"}],"part":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/84"}],"metadata":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/118\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=118"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=118"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=118"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.publishdot.com\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=118"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}