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Questions and Answers
What is the primary adverse effect associated with TMP-SMX use in patients with hypoaldosteronism?
What is the primary adverse effect associated with TMP-SMX use in patients with hypoaldosteronism?
Which of the following statements about Vancomycin is true?
Which of the following statements about Vancomycin is true?
What is a notable contraindication for using Vancomycin?
What is a notable contraindication for using Vancomycin?
What laboratory monitoring is essential when administering Vancomycin?
What laboratory monitoring is essential when administering Vancomycin?
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Which recommendation is crucial for patient education when using TMP-SMX?
Which recommendation is crucial for patient education when using TMP-SMX?
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What is the primary mechanism of action of aminoglycosides like gentamicin?
What is the primary mechanism of action of aminoglycosides like gentamicin?
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Why should aminoglycosides not be mixed with penicillin in the same container?
Why should aminoglycosides not be mixed with penicillin in the same container?
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What is a significant nursing implication when administering aminoglycosides?
What is a significant nursing implication when administering aminoglycosides?
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What should a patient taking aminoglycosides be educated to report immediately?
What should a patient taking aminoglycosides be educated to report immediately?
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What is a common indication for the use of gentamicin?
What is a common indication for the use of gentamicin?
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Which patient population requires caution when administering aminoglycosides?
Which patient population requires caution when administering aminoglycosides?
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What is one of the main adverse effects associated with aminoglycoside therapy?
What is one of the main adverse effects associated with aminoglycoside therapy?
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What effect do aminoglycosides have on potassium levels in the blood?
What effect do aminoglycosides have on potassium levels in the blood?
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Study Notes
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.
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Description
This quiz focuses on the nursing implications, patient education, and mechanisms of action related to Aminoglycosides such as Gentamicin. Understand the pharmacokinetics and key administration strategies to ensure patient safety and effective treatment. Engage with important details about side effects and monitoring essential for healthcare professionals.
