Aminoglycosides adverse effects

Aminoglycosides Neuromuscular blocking agents Additive adverse effects Avoid... 

Nephrotoxins (N) orototoxins (0) (eg., amphotericin B (N), cisplatin (N/0), cyclosporine (N), furosemide (0), NSAIDs (N), radio contrast (N), vancomycin (N) Additive adverse effects Monitor aminoglycoside SDC and renal function... 

Amphotericin B Azoles Nephrotoxins (e.g, aminoglycosides, cidofovir, cyclosporine, foscarnet, pentamidine) See Chap. 125 in Pharmacotherapy A Pathophysiologic Approach, seventh edition, page 1998. Additive adverse effects Monitor renal function... 

Aztreonam may be used as a substitute for an aminoglycoside in the treatment of infections caused by susceptible gram-negative organisms. Most of the adverse effects of aztreonam are local reactions at the site of injection. Interestingly, aztreonam rarely causes allergic reactions in patients with a history of type I hypersensitivity to other (3-lactam antibiotics. 

Answer Ototoxicity and nephrotoxicity are common adverse effects of aminoglycoside therapy, particularly when administered orally. You immediately arrange to check renal function and fortunately discover that renal function is not significantly impaired in this patient. You inform the patient that the hearing loss is probably permanent and that he should carefully check with pharmacists and physicians in the future to be certain that any prescriptions drugs that he might receive do not further aggravate this condition. 

Adverse effects include skin rash, anaphylaxis, nephrotoxicity, ototoxicity like other aminoglycosides. Other side effects are local pain and phlebitis at the site of injection, fever, eosinophilia and hypotension. 

Adverse effects from aminoglycoside are both time- and concentration-dependent. Toxicity is unlikely to occur until a certain threshold concentration is reached, but once that concentration is achieved the time beyond this threshold becomes critical. This threshold is not precisely defined, but a trough concentration above 2 mcg/mL is predictive of toxicity. At clinically relevant doses, the total time above this threshold is greater with multiple smaller doses of drug than with a single large dose. 

Streptomycin is ototoxic and nephrotoxic. Vertigo and hearing loss are the most common adverse effects and may be permanent. Toxicity is dose-related, and the risk is increased in the elderly. As with all aminoglycosides, the dose must be adjusted according to renal function (see Chapter 45). Toxicity can be reduced by limiting therapy to no more than 6 months whenever possible. 

Cephalexin (Keflex, Panixine DisperDose) [Antibiotic/ Cephalosporin-1st Generation] Uses Skin, bone, upper/lower resp tract, urinary tract Infxns Action lst-gen cephalosporin X- cell wall synth Dose Adults. 250-1000 mg PO qid Feds. 25—100 mg/kg/d PO - qid 4- in renal impair (on empty stomach) Caution [B, +] Contra Cephalosporin allergy Disp Caps, tabs, susp SE D, rash, eosinophilia, T LFTs Interactions T Nephrotox W/aminoglycosides, loop diuretics T effects W/probenecid EMS T Risk of adverse effects w/ loop diuretics monitor for signs of electrolyte disturbances and hypovolemia d/t D monitor pt for super Infxn OD May cause N/V/D, Szs, muscles spasms symptomatic and supportive... 

Aminoglycoside use is limited somewhat by problems with toxicity.66 Nephrotoxicity, as indicated by bloody urine, acute renal tubular necrosis, and so on, is one of the more common and serious adverse effects.49,66 Ototoxicity, as indicated by dizziness and ringing or fullness in the ears, may also occur. This effect can be irreversible in severe cases.67 Toxicity may occur more frequently in certain individuals, such as patients with liver or kidney failure, or in elderly patients. To reduce the risk of toxicity, drug levels in the bloodstream must be periodically monitored so dosages can be adjusted for individual patients. Other adverse effects include hypersensitivity (e.g., skin rashes, itching) in susceptible individuals. 

The primary adverse effect of intravenous cidofovir is a dose-dependent nephrotoxicity. Concurrent administration of other potentially nephrotoxic agents (eg, amphotericin B, aminoglycosides, nonsteroidal anti-inflammatory drugs, pentamidine, foscarnet) should be avoided. Prior administration of foscarnet may increase the risk of nephrotoxicity. Other potential side effects include uveitis, decreased intraocular pressure, and probenecid-related hypersensitivity reactions. Neutropenia and metabolic acidosis are rare. The drug caused mammary adenocarcinomas in rats and is embryotoxic. 

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