Aminoglycosides (Nursing)

00:01 Hi. Welcome to our video on aminoglycosides, sulfanomides, and trimethoprim.

00:07 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.

00:14 Okay, so, aminoglycosides.

00:16 Some of the names that you'll likely see are gentamicin, tobramycin, or amikacin.

00:22 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.

00:30 Every drug has a generic name that's usually longer and sounds more chemically, and then they have a trade name.

00:37 But most hospitals and pharmacies always use the generic name and, for sure, that's the name that will be on your NCLEX exam.

00:44 So you want to make sure that you learn the generic name.

00:48 So, these aminoglycosides end mostly in C-I-N.

00:54 All right, let's take a look at what they do. Now, these guys are not really well-absorbed from the GI tract.

00:59 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.

01:12 Now, these guys are killers.

01:15 They're bactericidal, that means, we use them to treat some really serious infections with aerobic gram-negative bacilli.

01:23 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.

01:37 Bactericidal means the antibiotic actually kills the bacteria.

01:42 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.

01:57 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.

02:05 So, we're looking at the aminoglycosides.

02:08 Remember, their names end in C-I-N, like gentamicin or amikacin.

02:13 They're bactericidal, so they're killers.

02:16 And their serum drug levels have to be monitored with these drugs because they're pretty intense, and I'll explain why.

02:23 Now, one of the ways I remember, we call it a peak and a trough.

02:27 That's looking at peak is the highest level of the drug in the bloodstream, and trough is the lowest level in the bloodstream.

02:36 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.

02:45 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.

02:52 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.

02:59 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.

03:06 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.

03:15 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.

03:21 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.

03:30 Some hospitals, the nurse may draw the sample.

03:32 You'll just have to check with where you work and what their policy is.

03:35 So the peak, the highest level will be 30 minutes after an IM injection, or 30 minutes after the IV is completely infused.

03:44 Now, trough levels depend on how often the healthcare provider has ordered the medication to be given.

03:49 If the medication is given QD -- I want to make sure that makes sense to you. QD means -- Q means every, D means day.

03:59 So QD means every day.

04:01 That means they're just getting it once a day.

04:04 So if your patient is receiving their aminoglycoside 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.

04:15 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.

04:26 1 hour before that QDay or every day dose.

04:31 Now, what if it's ordered for 9 AM and 2100, which is 9 PM? That's -- you see the next line, BID.

04:38 That means -- that's our medical abbreviation for twice a day.

04:42 So, you're going to order the trough level just before the next dose.

04:46 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.

04:58 And it's all based on the timing and how often and they get that medication.

05:02 Now, here's the really bad news about aminoglycosides.

05:05 They are ototoxic, that means they can cause damage to your hearing.

05:11 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.

05:23 So, aminoglycosides can cause irreversible damage to hearing imbalance.

05:28 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.

05:36 The other organ it goes after are your kidneys.

05:39 So, the nephrotoxicity -- Remember, anytime you see toxicity, the letters before that tell you what it hurts or damages.

05:46 So, ototoxicity, oto stands for ear, damaging to the ear.

05:52 Nephrotoxicity means toxicity or damage to the kidneys.

05:56 Now this is usually reversible.

05:58 So when you're thinking about your patient getting an aminoglycoside as a drug, the ear damage will probably not be reversible.

06:05 The kidney damage you want to keep a close eye on and we probably can reverse that.

06:10 So, with aminoglycosides, you want to make sure the serum drug levels are monitored.

06:16 Now, that's really important, because not many medications require serum drug monitoring.

06:23 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.

06:38 That peak is drawn 30 minutes after an IM or completion of an IV.

06:41 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.

06:50 Okay, so that wraps up our aminoglycosides.

06:53 Now, we're going to move on to the next group of drugs that we're discussing.