Antibiotics

Mechanism of actionInhibit protein synthesis by irreversibly binding to the 30S ribosomal subunit & causing cell membrane damage*concentration-dependent bactericidal effect

Precautions

A. Ototoxicity vestibular toxicity- monitor clinical signs- nausea, vomiting, vertigo, nystagmus, difficulties w gait cochlear toxicity- monitor w tone audiometry testing- noticeable hearing loss, tinnitus, feeling of fullness in ear occurs in 2-4% of treated people, irreversible in 50% (likely that permanent deafness may occur)

B. Neuromuscular changes large doses during surgery have causes transient myasthenic syndrome in people w normal neuromuscular function aminoglycosides increase risk of muscle weakness & respiratory depression hypoglycemia, hypomagnesemia, general anesthesia, large transfusion of citrated blood all increase the risk of neuromuscular adverse effects neuromuscular blockade may result in respiratory depression- can usually be reversed with prompt administration of IV calcium gluconate

C. Nephrotoxicity / Toxicity renal impairment increases risk of toxicity monitor serum creatinine- if low, measure aminoglycoside concentrations daily nephrotoxicity usually reversible & can be anticipated if treatment lasts >7-10d usually presents as gradually worsening non-oliguric renal failure w increasing serum creatinine & proteinuria - but may also present as ATN

Examples:IV1. amikacin2. gentamicin3. streptomycin4. tobramycin

Oral1. neomycin2. paromycin

Aminoglycosides