Mastering Aminoglycosides

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Questions and Answers

Which of the following is true about aminoglycosides?

They are bacteriostatic

They are primarily effective against gram positive organisms (correct)

They inhibit the 50S portion of the 30S mRNA

They have excellent oral absorption

What is the mechanism of action of aminoglycosides?

Inhibition of protein synthesis (correct)

Inhibition of DNA replication

Inhibition of cell wall synthesis

Inhibition of RNA transcription

Which of the following is NOT a drug within the aminoglycoside class?

Vancomycin (correct)

Gentamicin

Amikacin

Tobramycin

What is the peak concentration over minimum inhibitory concentration (Cp/MIC) the pharmacodynamic parameter for aminoglycosides?

Peak concentration (Cp) Signup and view all the answers

What is the absorption of aminoglycosides when taken orally?

Terrible Signup and view all the answers

Which of the following is true about the distribution of aminoglycosides?

They are primarily distributed to the vasculature Signup and view all the answers

What is the supplemental mode of action of aminoglycosides?

Binding to LPS of gram-negative organisms creating transient holes Signup and view all the answers

Which of the following is NOT a characteristic of aminoglycosides?

High protein binding Signup and view all the answers

How are aminoglycosides generally infused when administered intravenously?

Over 30-60 minutes Signup and view all the answers

What is the spectrum of activity of aminoglycosides?

Primarily gram negative organisms Signup and view all the answers

Which dosing strategy optimizes the pharmacodynamics of the drug by taking advantage of the post-antibiotic effect (PAE) and decreases the risk for toxicity?

Extended interval dosing Signup and view all the answers

When is therapeutic drug monitoring (TDM) always necessary with aminoglycosides (AG)?

During both traditional and extended interval dosing Signup and view all the answers

What is the goal level for the trough concentration (Ctr) of aminoglycosides (AG) during traditional dosing?

Undetectable Signup and view all the answers

What is the recommended timing for peak and trough level monitoring during traditional dosing?

Peak 1 hour after the 2nd or 3rd dose, trough 30 minutes prior to 3rd or 4th dose Signup and view all the answers

What is the maximum creatinine clearance (CrCl) value used in the dosing calculations for aminoglycosides (AG)?

120 mL/min Signup and view all the answers

Which dosing strategy is indicated when patient-specific pharmacokinetic (PK) data is not available?

Traditional dosing Signup and view all the answers

What is the goal level for the peak concentration (Cpk) of aminoglycosides (AG) during traditional dosing?

8-10 times greater than the MIC Signup and view all the answers

Which dosing strategy uses the Hartford Nomogram to adjust the frequency of aminoglycoside (AG) dosing?

Extended interval dosing Signup and view all the answers

What is the recommended timing for random level monitoring during extended interval dosing?

Random 6-14 hours after the start of the infusion Signup and view all the answers

What is the recommended timing for drug infusion times of gentamicin, tobramycin, and amikacin during traditional dosing?

1 hour before administering the next dose Signup and view all the answers

Study Notes

Aminoglycosides

The mechanism of action of aminoglycosides involves inhibiting bacterial protein synthesis by binding to the 30S ribosomal subunit.

Pharmacodynamics

The pharmacodynamic parameter for aminoglycosides is the peak concentration over minimum inhibitory concentration (Cp/MIC).
The post-antibiotic effect (PAE) is a supplemental mode of action of aminoglycosides.

Pharmacokinetics

Aminoglycosides are poorly absorbed when taken orally.
Aminoglycosides are distributed in extracellular fluids, which is important for their antibacterial effect.

Administration

Aminoglycosides are generally infused over 30 minutes to 1 hour when administered intravenously.

Spectrum of Activity

Aminoglycosides have a broad spectrum of activity against aerobic gram-negative bacilli and some gram-positive bacteria.

Dosing Strategies

The extended interval dosing strategy optimizes the pharmacodynamics of aminoglycosides by taking advantage of the post-antibiotic effect (PAE) and decreases the risk for toxicity.
The Hartford Nomogram is used to adjust the frequency of aminoglycoside dosing in the extended interval dosing strategy.

Therapeutic Drug Monitoring (TDM)

TDM is always necessary with aminoglycosides in patients with impaired renal function, those at high risk for toxicity, and those with changing renal function.
The goal level for the trough concentration (Ctr) of aminoglycosides during traditional dosing is < 1-2 mg/L.
The goal level for the peak concentration (Cpk) of aminoglycosides during traditional dosing is 8-10 times the MIC.
Peak and trough levels should be monitored 30 minutes after infusion and just before the next dose, respectively, during traditional dosing.
Random level monitoring is recommended during extended interval dosing.
The maximum creatinine clearance (CrCl) value used in dosing calculations for aminoglycosides is 120 mL/min.

Dosing Calculations

When patient-specific pharmacokinetic (PK) data is not available, a dosing strategy using a standard dose and interval can be used.

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Description

Test your knowledge on aminoglycosides! Explore their spectrum of activity, synergy with gram-positive organisms, and the need for combination with a cell wall active agent. Discover the history of aminoglycosides and learn about specific drugs within this class. Understand their mechanism of action and their alternative name - protein synthesis inhibitors.