Gentamicin Sulfate

Date Ordered: August 11, 2009

Generic Name: Gentamicin Sulfate

Brand Name: Garamycin

Functional Classification: Antibiotic

Chemical Classification: aminoglycoside

Usual Dosage: 40 mg/mL as Gentamicin FOR INTRAVENOUS INFUSION OR

INTRAMUSCULAR INJECTION

Available forms:

Moderate to Severe Infection

Adult: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided
doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in
eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg
preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Acute Pelvic Inflammatory Disease
Adult: IV/IM 2 mg/kg followed by 1.5 mg/kg q8h
Prophylaxis of Bacterial Endocarditis
Adult: IV/IM 1.5 mg/kg 30 min before procedure, may repeat in 8 h
Child: IV/IM < 27 kg, 2 mg/kg 30 min before procedure, may repeat in 8 h

Actual Dosage/Fre/Route: 30mg TIV q12hrs (-) ANST

Action:

o Chemical Effect:

Aminoglycoside; actively transported across the bacterial cell membrane,

binds to a specific receptor protein on the 30 S subunit of bacterial ribosomes,
and interferes with an initiation complex between mRNA (messenger RNA) and
the 30 S subunit, inhibiting protein synthesis. DNA may be misread, thus
producing nonfunctional proteins; polyribosomes are split apart and are unable to
synthesize protein

o Therapeutic Effect:
 Gentamicin, like the other aminoglycosides is not appreciably absorbed after
oral or intrauterine administration, but is absorbed from topical administration
(not skin or urinary bladder) when used in irrigations during surgical procedures.
Patients receiving oral aminoglycosides with hemorrhagic or necrotic
enteritises may absorb appreciable quantities of the drug. After IM
administration to dogs and cats, peak levels occur from 1/2 to 1 hour later.
Subcutaneous injection results in slightly delayed peak levels and with more
variability than after IM injection. Bioavailability from extravascular injection
(IM or SQ) is greater than 90%.

Indications:

Parenteral use restricted to treatment of serious infections of GI,

respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including
burns) when other less toxic antimicrobial agents are ineffective or are
contraindicated. Has been used in combination with other antibiotics. Also used
topically for primary and secondary skin infections and for superficial infections
of external eye and its adnexa.

Contraindication:

History of hypersensitivity to or toxic reaction with any aminoglycoside

antibiotic. Safe use during pregnancy (category C) or lactation is not established

Bacterial and fungal corneal ulcers have developed during treatment with
gentamicin ophthalmic preparations.

The most frequently reported adverse reactions are ocular burning and
irritation upon drug instillation, nonspecific conjunctivitis, conjunctival epithelial
defects, and conjunctival hyperemia.

Other adverse reactions which have occurred rarely are allergic

reactions, thrombocytopenic purpura, and hallucinations.

Side Effects:

• upset stomach
• vomiting
• fatigue
• pale skin

Adverse Reactions:

Special Senses: Ototoxicity (vestibular disturbances, impaired hearing),

optic neuritis. CNS: neuromuscular blockade: skeletal muscle weakness, apnea,
respiratory paralysis (high doses); arachnoiditis (intrathecal use). CV:
hypotension or hypertension. GI: Nausea, vomiting, transient increase in AST,
ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. Hematologic:
Increased or decreased reticulocyte counts; granulocytopenia,
thrombocytopenia (fever, bleeding tendency), thrombocytopenic purpura,
anemia. Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative
dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains,
laryngeal edema, anaphylaxis). Urogenital: Nephrotoxicity: proteinuria, tubular
necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen,
serum creatinine; decreased creatinine clearance. Other: Local irritation and
pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of
hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia).

Drug to drug Interactions:

o Drug Interactions - Aminoglycosides should be used with caution with
other nephrotoxic, ototoxic, and neurotoxic drugs. These include
amphotericin B, other aminoglycosides, acyclovir, bacitracin (parenteral
use), cisplatin, methoxyflurane, polymyxin B, or vancomycin. The
concurrent use of aminoglycosides with cephalosporins is controversial.
Potentially, cephalosporins could cause additive nephrotoxicity when used
with aminoglycosides, but this interaction has only been well documented
with cephaloridine (no longer marketed) and cephalothin. Concurrent use
with loop (furosemide, ethacrynic acid) or osmotic diuretics (mannitol,
urea) may increase the nephrotoxic or ototoxic potential of the
aminoglycosides. Concomitant use with general anesthetics or
neuromuscular blocking agents could potentiate neuromuscular blockade.
Synergism against Pseudomonas aeruginosa and enterococci may occur
with beta-lactam antibiotics and the aminoglycosides. This effect is
apparently not predictable and its clinical usefulness is in question.
o Drug/Laboratory Interactions - Gentamicin serum concentrations may
be falsely decreased if the patient is also receiving beta-lactam
antibiotics and the serum is stored prior analysis. It is recommended
that if assay is delayed, samples be frozen and if possible, drawn at times
when the beta-lactam antibiotic is at a trough.

Nursing Considerations/ Responsibilities:

Assessment & Drug Effects

• Lab tests: Perform C&S and renal function prior to first dose and
periodically during therapy; therapy may begin pending test results.
Determine creatinine clearance and serum drug concentrations at
frequent intervals, particularly for patients with impaired renal function,
infants (renal immaturity), older adults, patients receiving high doses or
therapy beyond 10 d, patients with fever or extensive burns, edema,
obesity.
 • Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.
• Note: Dosages are generally adjusted to maintain peak serum gentamicin
concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL.
Peak concentrations above 12 g/mL and trough concentrations above 2
g/mL are associated with toxicity.
• Draw blood specimens for peak serum gentamicin concentration 30 min–1h
after IM administration, and 30 min after completion of a 30–60 min IV
infusion. Draw blood specimens for trough levels just before the next IM
or IV dose. Use nonheparinized tubes to collect blood.

Rationale:

To reduce the development of drug-resistant bacteria and maintain the

effectiveness of gentamicin and other antibacterial drugs, gentamicin should be
used only to treat or prevent infections that are proven or strongly suspected
to be caused by bacteria.
 Albuterol
Date Ordered: August 10, 2009

Generic Name: Albuterol

Brand Name: Salbutamol, Ventolin, Ventolin Rotocaps, Volmax

Functional Classification: autonomic nervous system agent

Chemical Classification: bronchodilator (respiratory smooth muscle

relaxant), beta-agonists

Usual Dosage: 2 inhalations repeated every 4 to 6 hours

Available forms:
o Solution for inhalation: 0.083%, 0.5%, 0.63 mg/ml, 1.25 mg/3 ml
o Syrup: 2 mg/5 ml
o Tablets: 2 mg, 4 mg
o Tablets (extended-release): 4 mg, 8 mg

Actual Dosage/Fre/Route: neb 1/2 + PNSS 1cc now x 2 doses q20 min
then q6hrs

Action:

o Chemical Effect:

Albuterol may reduce chemical mediator release from pulmonary

mast cells and improve ability of cilia to clear mucus.

o Therapeutic Effect:

Albuterol is a direct-acting agent that relaxes smooth muscle walls

of the bronchi, uterus, and skeletal muscle vascular bed.

Indications:

To relieve bronchospasm associated with acute or chronic asthma,

bronchitis, or other reversible obstructive airway diseases. Also used to
prevent exercise-induced bronchospasm.

Contraindication:
 o Contraindicated in patients hypersensitive to drug or its
ingredients.
o Use cautiously in patients with CV disorders (including coronary
insufficiency and hypertension), hyperthyroidism, or diabetes
mellitus and in those who are unusually responsive to adrenergics.
o Use extended-release tablets cautiously in patients with GI
narrowing.

Side Effects:

Cardiac side effects are not prominent. Muscle tremors are the
dose related side effects.Bad taste,blurred vision,urinary
retension,palpitation and ankle edema can also occur.

Adverse Reactions:

o CNS: tremor, nervousness, dizziness, insomnia, headache,

hyperactivity, weakness, CNS stimulation, malaise.
o CV: tachycardia, palpitations, hypertension.
o EENT: dry and irritated nose and throat with inhaled form, nasal
congestion, epistaxis, hoarseness.
o GI: heartburn, nausea, vomiting, anorexia, altered taste, increased
appetite.
o Metabolic: hypokalemia.
o Musculoskeletal: muscle cramps.
o Respiratory: bronchospasm, cough, wheezing, dyspnea, bronchitis,
increased sputum.
o Other: hypersensitivity reactions.

Drug to drug Interactions:

o Drug Interactions a diuretic (water pill);

• digoxin (digitalis, Lanoxin);

• a beta-blocker such as atenolol (Tenormin), metoprolol
(Lopressor), propranolol (Inderal), and others;
• an antidepressant such as amitriptyline (Elavil, Etrafon),
doxepin (Sinequan), imipramine (Janimine, Tofranil),
nortriptyline (Pamelor), and others;
• a MAO inhibitor such as isocarboxazid (Marplan), phenelzine
(Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or
tranylcypromine (Parnate); or
 • other bronchodilators such as levalbuterol (Xopenex), bitolterol
(Tornalate), pirbuterol (Maxair), terbutaline (Brethine,
Bricanyl), salmeterol (Serevent), isoetherine (Bronkometer),
metaproterenol (Alupent, Metaprel), or isoproterenol (Isuprel
Mistometer).

Nursing Considerations/ Responsibilities:

o Drug may decrease sensitivity of spirometry used for diagnosis of
asthma.
o When switching patient from regular to extended-release tablets,
remember that a regular 2-mg tablet every 6 hours is equivalent to
an extended-release 4-mg tablet every 12 hours.
o Syrup contains no alcohol or sugar and may be taken by children as
young as age 2.
o In children, syrup may rarely cause erythema multiforme or
Stevens-Johnson syndrome.
o The HFA form uses the propellant hydrofluroalkane (HFA) instead
of chlorofluorocarbons.
o Alert: Patient may use tablets and aerosol together. Monitor these
patients closely for signs and symptoms of toxicity.
o Look alike-sound alike: Don't confuse albuterol with atenolol or
Albutein.

Rationale:

Albuterol is a bronchodilator that relaxes muscles in the airways

and increases air flow to the lungs.

Albuterol is used to treat or prevent bronchospasm in people with

reversible obstructive airway disease. Albuterol is also used to prevent
exercise-induced bronchospasm.

Prepared by:

Eduardo L. Alcantara
BSN 3rd Year
Holy Trinity College