Hi. Welcome to our video on aminoglycosides,
sulfanomides, and trimethoprim.
These are antibiotics and
we're going to group
them together for you and
kind of walk through
each one of these 3 types of antibiotics.
Okay, so, aminoglycosides.
Some of the names that you'll
likely see are gentamicin,
tobramycin, or amikacin.
Now, they kind of end in that C-I-N,
so one of the tips and strategies
as you're studying
pharmacology is look at that generic name.
Every drug has a generic name
that's usually longer
and sounds more chemically, and
then they have a trade name.
But most hospitals and pharmacies
always use the generic name and, for sure,
that's the name that will be
on your NCLEX exam.
So you want to make sure that
you learn the generic name.
So, these aminoglycosides end mostly in C-I-N.
All right, let's take a look at what they
do. Now, these guys are not
really well-absorbed from the GI tract.
So, unfortunately, we either have
to give them IV, intravenously,
or IM, and nobody likes to
get or give an IM shot,
but sometimes, it's the most convenient
way to give an aminoglycoside.
Now, these guys are killers.
They're bactericidal, that means,
we use them to treat some
really serious infections with aerobic
Now, if you've watched our other videos,
you know that gram-negative bugs
are much harder to kill. Remember, we
compare them to Hannibal Lecter,
that sinister bad guy,
because they're much harder
to kill than gram-positive.
Bactericidal means the antibiotic
actually kills the bacteria.
Bacteriostatic just kind of stops the
reproduction of bacteria,
but they don't actually kill the bug,
but these types of drugs, aminoglycosides,
are bactericidal, so they kill these
aerobic gram-negative bacilli.
Remember, bacilli just talks about
the shape of the bug,
and you can find all that information
when you look at your
culture and sensitivity reports.
So, we're looking at the aminoglycosides.
Remember, their names end in C-I-N,
like gentamicin or amikacin.
They're bactericidal, so they're killers.
And their serum drug levels have to
be monitored with these drugs
because they're pretty intense,
and I'll explain why.
Now, one of the ways I remember,
we call it a peak and a trough.
That's looking at peak is the highest
level of the drug in the bloodstream,
and trough is the lowest level
in the bloodstream.
Now, how I remember that is aminoglycoside
starts with an A,
that kind of looks like a peak. And then
it drops down to the M,
which reminds me about a trough.
So, when I'm thinking about the type
of lab work with aminoglycosides,
I think of peak for the A and
trough for the M.
Now let's talk about how you
monitor that as a nurse
because you'll be the one who's responsible
for timing that lab draw.
So I'm looking for a peak draw,
that means I'll ask the lab
technician to come
and draw a lab sample from their vein.
So they'll take a blood sample
from the patient's vein
30 minutes after I give an IM injection,
or 30 minutes after the IV has infused.
It's completely done. Remember, these
drugs aren't absorbed well
from the GI tract, so we either
have to give them IM or IV.
So, as a nurse, you're going to have
to coordinate with the lab people
to make sure this timing is spot on
because you want to get
an accurate level.
Some hospitals, the nurse
may draw the sample.
You'll just have to check with where
you work and what their policy is.
So the peak, the highest level will be
30 minutes after an IM injection,
or 30 minutes after the IV is
Now, trough levels depend on how often
the healthcare provider has ordered
the medication to be given.
If the medication is given QD --
I want to make sure that makes
sense to you. QD means --
Q means every, D means day.
So QD means every day.
That means they're just
getting it once a day.
So if your patient is receiving
just once a day,
you draw that level, the trough's level,
it's going to be at its lowest level,
about 1 hour before that dose.
So, if the physician or the health
care provider has
ordered an aminoglycoside to be given
every day at 9 AM,
I'm going to set the time with the lab
to draw the trough level at 8 AM.
1 hour before that QDay or every day dose.
Now, what if it's ordered for 9 AM
and 2100, which is 9 PM?
That's -- you see the next line, BID.
That means -- that's our medical
abbreviation for twice a day.
So, you're going to order the trough
level just before the next dose.
So, on the aminoglycosides, we
have to give them IV or IM,
they're killers because they're bactericidal,
and we have some really special lab
work that has to draw within
a peak and a trough.
And it's all based on the timing and how
often and they get that medication.
Now, here's the really bad news
They are ototoxic, that means they can cause
damage to your hearing.
And I put my hand up to my left ear,
naturally, because I am almost partially --
almost completely deaf
in my left ear. So when I
think of ototoxicity,
my mind automatically goes to my left ear.
So, aminoglycosides can cause
irreversible damage to hearing imbalance.
So, you know, I'm going to be really
sensitive if I ever get prescribed
aminoglycoside because I only have
one really good working ear.
The other organ it goes after
are your kidneys.
So, the nephrotoxicity -- Remember,
anytime you see toxicity,
the letters before that tell you
what it hurts or damages.
So, ototoxicity, oto stands for ear,
damaging to the ear.
Nephrotoxicity means toxicity
or damage to the kidneys.
Now this is usually reversible.
So when you're thinking about your patient
getting an aminoglycoside as a drug,
the ear damage will probably
not be reversible.
The kidney damage you want
to keep a close eye on
and we probably can reverse that.
So, with aminoglycosides,
you want to make sure the serum
drug levels are monitored.
Now, that's really important, because not
many medications require serum
And also, we know that the
risk for our patient --
you should see a picture of your ears and
your kidneys there to remind you --
The reason we do serum drug levels
because of this drug can be so toxic,
we want to keep it right at the lowest
possible dose that will be therapeutic.
That peak is drawn 30 minutes after
an IM or completion of an IV.
Trough levels are drawn 1 hour,
if the dose is every day,
or just before the next dose if the
dose is given twice a day.
Okay, so that wraps up our aminoglycosides.
Now, we're going to move on to the next
group of drugs that we're discussing.