Term
| Aminoglycosides with indications for LE infections |
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Definition
Gentamicin - used the most in podiatry
Tobramycin
Amikacin |
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Term
| Aminoglycosides - adverse reactions |
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Definition
Nephrotoxicity
Ototoxicity
Neuromuscular blockade |
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Term
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Definition
Most feared aminoglycosie side effect
usually begins several days after therapy started
First sign is an increase in serum creatinine - damage may already be done
usually reversible
increased risk when used with Vancomycin |
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Term
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Definition
Most devastating side effect
generally irreversible
Can manifest as auditory toxicity - feeling of fullness in ears, Tinnitus, loss of acuity (high frequency)
Can manifest as vestibular toxicity - dizziness and nausea, poor balance |
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Term
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Definition
Excessive level of antibiotic accumulates at the NMJ which inhibits ACh release and paralysis results
Usually due to rapid administration via IV bolus
For this reason aminoglycosides are always infused over 30 minutes |
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Term
| Aminoglycosides - dosing and administration |
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Definition
All parenteral - not absorbed in stomach
Corellation between dosing and side effects
Pts that need them usually have many medical conditions
Aminoglycosides always require a loading dose
Maintenance dose is calculated based on renal function |
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Term
| Aminoglycosides - peaks and troughs |
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Definition
used to determine blood levels of the drug
usually drawn after 3rd dose
peak drawn immediately after 3rd dose
trough drawn 20-30 minutes before 4th dose
peak is dose dependent
trough is time dependent |
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Definition
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Definition
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Definition
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Definition
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Term
| Aminoglycosides - clinical usage |
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Definition
Severe gram negative infections or sepsis
combination with beta-lactams for synergistic affect
Triple agent combination with beta-lactam and antianaerobic agent for severe diabetic foot infection |
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Term
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Definition
Common cause of post-op fever
usually occurs around day 2
Check UA for presence of leukocytes
check CBC or take urine culture
always check wound |
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Term
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Definition
Wind - pneumonia (1st day)
Water - UTI (2nd day)
Wound - post-op infection (3rd day)
Walk - DVT (4th day)
Wonder - could be drug related? (5th+ day) |
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Term
| Radiographic contrast agents |
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Definition
Increases plasma volume
Osmotic diuresis
Increase in uric acid and oxalate excretion
ARF in 24-48 hr after diuresis in some pts
Creatinine peaks 3-5 days and returns to normal in 10-14 days |
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Term
| Acute Renal Failure (ARF) |
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Definition
Pathology occurs in proximal tubule due to intra-tubular obstruction
Can lead to acute tubular necrosis
Incidence - 0-12%, <2% in healthy pts |
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Term
| Definite contrast induced ARF risk factors |
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Definition
Pre-existing renal insufficiency
Diabetes Mellitus |
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Term
| Probable contrast induced ARF risk factors |
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Definition
Dehydration
Prior contrast induced ARF |
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Term
| Possible contrast induced ARF risk factors |
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Definition
Large contrast load
Advanced age
CHF
Vascular disease
Proteinuria
Hyperuricemia |
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Term
| Incidence of ARF in diabetic patients |
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Definition
Normal renal function : < 1.5 mg/dL - 0%
Moderate renal insufficiency : 1.5-2.0 mg/dL - 50-76%
Severe renal insufficiency > 4.5 mg/dL - 92-100% |
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Term
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Definition
Once ARF has developed, treatment is usually unsuccessful and dialysis is implemented
Emphasis thus should be placed on prevention - hydration! |
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Term
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Definition
Identify patient at risk
Avoid study if feasible
Hydrate - does not really prevent, but may minimize severity
Minimize contrast load
Avoid repeated studies |
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