Nursing Considerations for Aminoglycosides

Superinfections

• Nursing implications: Administer IV only with normal saline (LR has calcium, which can bind with certain drugs and precipitate, leading to problems).
• Give with food or milk to minimize GI upset (PO formulations are less likely to cause issues).
• Monitor BUN and creatinine (nephrotoxic).

Patient Education (General)

• Do not take if allergic to any penicillins.
• Take with food or milk.
• Notify provider of new rash, dyspnea, or watery/malodorous diarrhea.
• Complete the full course of treatment.

Aminoglycosides (e.g., Gentamicin)

Mechanism of Action (M/A)

• Inhibits bacterial protein synthesis, disrupting bacterial function, replication, and cell wall.
• Bactericidal; binds to the bacterial 30S ribosomal subunit, causing faulty protein production and bacterial death.
• Effective against aerobic gram-negative bacteria.

Pharmacokinetics

• Poorly absorbed in the GI tract; administered IM or IV for rapid effect.
• Widely distributed, but concentrates in renal tubules (nephrotoxicity) and inner ear (ototoxicity).

Indications

• Infections caused by aerobic gram-negative bacteria.
• Septicemia.
• Respiratory tract infections.
• Urinary tract infections.
• Intra-abdominal infections.
• Osteomyelitis.
• Often combined with penicillin (penicillin enhances effectiveness by breaking down the cell wall, making aminoglycosides more accessible). Cannot be mixed in the same container.

Contraindications

• Pregnancy (risk of congenital effects, e.g., deafness).
• Caution in:
  • Pediatrics and elderly (developing/degenerating ears/kidneys).
  • Renal impairment.
  • Use with other nephrotoxic drugs.
  • Neuromuscular disorders.

Adverse Effects

• Ototoxicity: Tinnitus, hearing loss, vertigo, dizziness.
• Nephrotoxicity: Diminished urine output, fluid retention (weight gain).
• Peripheral neuropathy: Numbness, tingling.

TMP-SMX (Trimethoprim-Sulfamethoxazole)

Adverse Effects

• GI: Abdominal pain, nausea/vomiting/diarrhea, anorexia, pancreatitis.
• Hematologic: Hyperkalemia, hypoglycemia, anemia, leukopenia, thrombocytopenia.
• Dermatologic: Rash, Stevens-Johnson Syndrome (SJS), urticaria, photosensitivity.
• Hypersensitivity: Dyspnea, shortness of breath.
• Renal: Increased BUN & creatinine, renal failure, interstitial nephritis.
• CNS (Children < 2 months): Kernicterus (brain damage from hyperbilirubinemia, hepatotoxicity).
• Important note: Can cause hyperkalemia, especially in patients with hypoaldosteronism, due to decreased potassium secretion.

Patient Education

• Take with a full glass of water.
• Prevent interstitial nephritis by hydrating (2-3 liters of fluid per day).
• Monitor for superinfections.
• Consider alternative birth control methods.
• Monitor blood sugar if diabetic.
• Use sun protection.

Vancomycin

Mechanism of Action (M/A)

• Inhibits cell wall synthesis.
• Bactericidal.

Indications

• Effective against gram-positive bacteria only.
• MRSA.
• Clostridium difficile infections.

Contraindications

• Vancomycin-resistant enterococci (VRE).
• Renal failure.

Special Considerations

• Toxicity: Nephrotoxic (monitor BUN & creatinine).
• Labs: Monitor serum trough levels (narrow therapeutic index).
• IV administration: Administer over at least 1 hour to prevent Vancomycin flushing syndrome (face, neck, chest).
• IV site: Vesicant, monitor IV site for phlebitis; avoid hand IV insertion.