Podcast
Questions and Answers
What condition can be exacerbated by the use of TMP-SMX in patients with hypoaldosteronism?
What condition can be exacerbated by the use of TMP-SMX in patients with hypoaldosteronism?
Which of the following is a common gastrointestinal adverse effect of TMP-SMX?
Which of the following is a common gastrointestinal adverse effect of TMP-SMX?
For what type of bacteria is Vancomycin primarily indicated?
For what type of bacteria is Vancomycin primarily indicated?
What must be monitored regularly during Vancomycin treatment due to its nephrotoxic effects?
What must be monitored regularly during Vancomycin treatment due to its nephrotoxic effects?
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What is a key patient education point for individuals taking TMP-SMX?
What is a key patient education point for individuals taking TMP-SMX?
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What is the primary mechanism by which aminoglycosides kill bacteria?
What is the primary mechanism by which aminoglycosides kill bacteria?
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Which of the following is a significant nursing implication when administering aminoglycosides?
Which of the following is a significant nursing implication when administering aminoglycosides?
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What should be done if a patient develops a new rash after starting aminoglycosides?
What should be done if a patient develops a new rash after starting aminoglycosides?
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Which population is at the highest risk for ototoxicity when using aminoglycosides?
Which population is at the highest risk for ototoxicity when using aminoglycosides?
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Why should penicillin not be mixed in the same container as aminoglycosides?
Why should penicillin not be mixed in the same container as aminoglycosides?
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What is a common adverse effect of aminoglycosides related to balance and hearing?
What is a common adverse effect of aminoglycosides related to balance and hearing?
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What is a key patient education point regarding aminoglycosides?
What is a key patient education point regarding aminoglycosides?
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Which of these conditions is an indication for the use of aminoglycosides?
Which of these conditions is an indication for the use of aminoglycosides?
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Study Notes
Superinfections
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Nursing Implications:
- Administer IV only with normal saline (LR contains calcium, which can bind with the drug and precipitate, causing issues)
- Give with food or milk to minimize GI upset (oral formulations won't have this issue)
- Monitor BUN and Creatinine (drug is nephrotoxic)
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Patient Education:
- Do not take if allergic to any penicillins
- Take with food or milk
- Notify provider if breastfeeding
- Report new rash, dyspnea, watery/malodorous diarrhea
- Complete the full course of treatment
Aminoglycosides (e.g., Gentamicin)
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Mechanism of Action (M/A):
- Inhibits bacterial protein synthesis, disrupting function, replication, and cell wall.
- Bactericidal by binding to the bacterial 30S ribosomal subunit, causing faulty protein production and bacterial death.
- Effective against aerobic gram-negative bacteria.
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Pharmacokinetics:
- Poor absorption in the GI tract, so administered rapidly IM or IV.
- Wide distribution, but concentrates in renal tubules (nephrotoxicity) and inner ear (ototoxicity).
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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 gentamicin more accessible)
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Contraindications:
- Pregnancy (risk of congenital effects, e.g., deafness)
- Caution with:
- Pediatrics and elderly (developing/degrading ears/kidneys)
- Renal impairment
- Use with other nephrotoxic drugs
- Neuromuscular disorders
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Adverse Effects:
- Ototoxicity: tinnitus, hearing loss, vertigo, dizziness
- Nephrotoxicity: diminished urine output, fluid retention (weight gain)
- Peripheral neuropathy: numbness, tingling
TMP-SMX (Trimethoprim-Sulfamethoxazole)
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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: kernicterus (brain damage from hyperbilirubinemia, hepatotoxicity) in infants < 2 months.
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Patient Education:
- Take with a full glass of water
- Prevent interstitial nephritis by hydrating (2-3L/day)
- Monitor for superinfection
- Use alternative birth control methods
- If diabetic, monitor for hypoglycemia
- Use sun protection
Vancomycin
-
Mechanism of Action:
- Inhibits cell wall synthesis, leading to bacterial death.
- Effective against gram-positive bacteria.
-
Indications:
- Effective against gram-positive bacteria
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Clostridium difficile infections
-
Contraindications:
- Vancomycin-resistant enterococci (VRE)
- Renal failure
-
Special Considerations:
- Nephrotoxic: monitor BUN and creatinine
- Narrow therapeutic index: monitor serum trough levels
- IV administration: Must occur over at least 1 hour to prevent Vancomycin flushing syndrome (face, neck, chest)
- Vesicant: monitor IV site for phlebitis. Do not use for hand IVs.
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Description
This quiz covers essential nursing implications and patient education related to superinfections and the use of aminoglycosides, such as Gentamicin. It emphasizes safe administration practices, monitoring for adverse effects, and the importance of complete treatment. Test your knowledge about drug interactions, side effects, and nursing responsibilities in patient care.
