This is everything Aminoglycosides.

PHARMACOLOGY STUDY GUIDE: AMINOGLYCOSIDES

Drugs: Amikacin, Gentamicin, Tobramycin, Neomycin, Streptomycin Class: Anti-infective; bactericidal via 30S ribosomal inhibition.

Key Mechanism & Uses

MOA: Inhibits bacterial protein synthesis (30S ribosome) → kills bacteria. Use: Serious gram-negative infections (Pseudomonas, E. coli, Klebsiella, Proteus, Serratia). Often combined with penicillins or other agents for staph, endocarditis, or TB. Special Uses:

• Neomycin: Pre-op bowel prep, hepatic encephalopathy.
• Tobramycin (Inhaled): CF with Pseudomonas. PK: Well absorbed IM, full bioavailability IV. Poor PO absorption (except Neomycin). >90% excreted by kidneys. Half-life: 2–4 hr; prolonged in renal impairment → dose adjust.

Contraindications & Major Interactions

Avoid:

• Hypersensitivity, pregnancy (fetal nephro/ototoxicity), known ototoxicity, severe renal impairment. Deadly Combos:
• Loop diuretics (Furosemide): ↑ ototoxicity
• Nephrotoxic drugs (Vancomycin, NSAIDs): ↑ kidney injury
• Neuromuscular blockers: Respiratory paralysis risk
• Penicillins/Cephalosporins: Inactivation in renal insufficiency
• Warfarin + Neomycin: ↑ anticoagulant effect

Red-Flag Adverse Effects

🚨 Nephrotoxicity — ↓ urine, ↑ BUN/Cr. → Priority: Monitor renal labs + output, ensure hydration (1.5–2L/day).

🚨 Ototoxicity — tinnitus, hearing loss, vertigo. → Priority: Assess hearing pre- and during therapy. Report ringing, dizziness, or balance issues immediately.

🚨 Respiratory Paralysis — esp. w/ rapid IV or neuromuscular blockers. → Priority: Stop infusion, support airway if apnea develops.

Other Common: Headache, ataxia, nausea, vomiting, rash, hypersensitivity.

Nursing Priorities & Monitoring

• Therapeutic Drug Monitoring (TDM):
  • Peak: 30–90 min post-dose.
  • Trough: Just before next dose (most critical to avoid toxicity).
• Maintain hydration, monitor renal & auditory function.
• Avoid in pregnancy unless life-threatening infection.
• Teach patients to report ringing in ears, decreased urine, or dizziness.

Top 5 NCLEX Points

1️⃣ MOA: Bactericidal → inhibits protein synthesis (30S). 2️⃣ Toxicities: Ototoxicity + Nephrotoxicity (dose-related). 3️⃣ Monitor Peaks/Troughs: Narrow therapeutic window—mandatory. 4️⃣ Renal Caution: Half-life ↑ drastically in renal impairment → adjust dose. 5️⃣ Major DDI: Loop diuretics = hearing loss, nephrotoxics = kidney damage.

Rapid Recall: 💊 Gentamicin & friends kill bacteria hard—but kill kidneys & ears faster if you’re not watching. 🩺 Monitor labs, monitor hearing, hydrate, and never skip those trough levels.