Drol Susej Z.

Picazo
BSN 2-A-4
Pharmacology

Week 15

Renovo Mirador

CASE SCENARIO:
Carlo, a 47-year old man, has a wound infection. The culture report states that
the infection is due to Pseudomonas aeroginosa. and Carlo's temperature has
risen to 104 degrees F (40 degrees C ). Amikacin sulfate is to be administered
intravenously in 100 ml of 5% dextrose in water (D5W solution) over 45
minutes every 8 hours. The dosage is 15 mg/kg/day in three divided doses.
Carlo weighs 165 pounds.

1. What is the drug classification of amikacin? How many milligrams of

amikacin should Carlo receive every 8 hours.

 Drug Classification: Aminoglycoside antibiotics

 Order: 15mg/kg/day – Supplied: 100ml – Weight: 165lbs
 Unknown: mg/8hr
165lbs 1 kg 15 mg/day 1000 ml 1 mg 2,475,000 0.333333 day 11,250 mg
x x x x = =11,250 mg/day x
1 2.2 lbs 1 kg 1mg 100 ml 220 8hr 1 day

2. What type of Intravenous infusion should be used? What would be the

IV flow rate?

 Type of IV Infusion that should be used: Dextrose

60 min 100 ml 6000 ml
x = =133.33ml /h r
1 h r 45 min 45
3. When would be the wound culture be obtained to determine the
appropriate antibacterial agent? Explain your answer.

 A wound culture will be taken as soon as the doctor suspects a

pathogenic organism has contaminated the wound. To choose the best
antibacterial agent, you'll need air for development (aerobic), a no-
oxygen or low-oxygen environment (anaerobic or microaerophilic), and
specialized nutrient elements to grow properly (fastidious organisms).
It's critical to take care while handling the samples to support their
growth while also increasing the odds of detection and identification.
Determine which bacteria are present next. Identification has
traditionally been a step-by-step process including many tests and
analyses of the material before it is cultivated or the bacteria detected
growing in the culture. Gram staining and other biochemical assays are
examples of such tests. Finally, antimicrobial susceptibility testing is
essential for many of the pathogens found in wound cultures in order to
guide treatment and identify whether the bacterium strain present is
likely to respond to various drugs. To do so, you'll need a pure culture
(isolate) of the bacterium you've identified. Separating and identifying
each therapeutically important bacterial species in the laboratory may
take longer. Finally, the wound culture, Gram stain, and susceptibility
tests all help the practitioner figure out which pathogen(s) are present
and which antibiotic prescription will stop them from proliferating the
most efficiently.

4. What are the similarities of amikacin to other aminoglycosides such

as gentamycin? Would one aminoglycoside be preferred over another?
Explain your answer.

 The most often used aminoglycoside is gentamicin, but amikacin may

be more efficient against resistant species. There was no association
between the peak serum concentration of gentamicin, the in vitro
minimum inhibitory concentration, and the bacteriologic response to
 treatment in patients treated with gentamicin. There was no direct
evidence of antibiotic-induced toxicity. These findings demonstrate that
in people with urinary tract infections, a reduced amikacin dosage
schedule produced effects that were virtually equal to regular
gentamicin doses. The nurse assesses Carlo for hearing and urinary
function before and during amikacin therapy.
1. Why should a hearing assessment be included?

To detect hearing impairment impacting the human speech frequency range

and hence prevent psychosocial changes associated with communication
problems, patients taking aminoglycosides must be closely monitored.

2. What laboratory test monitors renal function? 

 Urinalysis
A urinalysis examines the urine for the presence of protein and blood.
Protein in your urine can be caused by a variety of factors, not all of which are
related to the disease. Infection raises urine protein levels, but so does a
strenuous workout. If the results are similar after a few weeks, your doctor
may wish to repeat the test.
A 24-hour urine collection sample may also be requested by your
doctor. This can help doctors figure out how quickly a waste product called
creatinine leaves your body. Creatinine is a byproduct of muscle tissue
degradation.
 Serum creatinine test
This blood test determines whether you have a build-up of creatinine in
your blood. Creatinine is normally entirely removed from the blood by the
kidneys. A high creatinine level indicates a renal problem.
A creatinine level of more than 1.2 milligrams/deciliter (mg/dL) for
women and 1.4 mg/dL for males, according to the National Kidney Foundation
(NKF), indicates a kidney problem.
 Blood urea nitrogen (BUN)
The blood urea nitrogen (BUN) test also examines your blood for waste
materials. The amount of nitrogen in the blood is measured by BUN testing.
Protein breakdown produces urea nitrogen.
 Not all elevated BUN readings, however, are caused by renal disease.
Common drugs, such as high dosages of aspirin and certain antibiotics, can
also raise your BUN. Any medications or supplements you take daily should
be disclosed to your doctor. Certain drugs may need to be avoided for a few
days before the test.
BUN levels should be between 7 and 20 mg/dL. A higher score could
indicate a variety of health issues.

 Estimated GFR
This test estimates how well your kidneys are filtering waste. The test
determines the rate by looking at factors, such as:
test results, specifically creatinine levels
-age
-gender
-race
-height
-weight

Any result lower than 60 milliliters/minute/1.73m2 may be a warning sign of

kidney disease.