Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (399 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(toe-bra-mye′sin)
BETHKIS
Func. class.:
Antiinfective
Chem. class.:
Aminoglycoside
Interferes with protein synthesis in bacterial cell by binding to ribosomal subunits, thereby causing inaccurate peptide sequences to form in protein chain causing bacterial death
Severe systemic infections of CNS, respiratory, GI, urinary tract, bone, skin, soft tissues caused by
Pseudomonas aeruginosa, Escherichia coli, Enterobacter, Providencia, Citrobacter, Staphylococcus, Proteus, Klebsiella, Serratia;
cystic fibrosis (nebulizer) for
Pseudomonas aeruginosa
Hypersensitivity to aminoglycosides
Black Box Warning:
Pregnancy (D), severe renal disease
Precautions:
Breastfeeding, geriatric patients, neonates, mild renal disease, myasthenia gravis, Parkinson’s disease
Black Box Warning:
Hearing deficits, neuromuscular disease
Calculator
• Adult:
IM/IV
3 mg/kg/day in divided doses q8hr; may give up to 6 mg/kg/day in divided doses q8-12hr; once-daily dosing (pulse dosing) (unlabeled)
IV
5-7 mg/kg, dosing intervals determined using nomogram, based on random levels drawn 8-12 hr after 1st dose
• Child:
IM/IV
6-7.5 mg/kg/day in 3-4 equal divided doses
• Child ≥6 yr:
NEB
300 mg bid in repeating cycles of 28 days on/28 days off of product; give
INH
over 10-15 min using a handheld PARI LC PLUS reusable nebulizer with DeVilbiss Pulmo-Aid compressor
• Neonate <1 wk:
IM/IV
≤4 mg/kg/day divided q12hr
pseudomonas aeruginosa
• Adult/adolescent/child:
IV
2.5-3.3 mg/kg q8hr,
neb
300 mg via inhalation bid × 28 days, then 28 days after
• Adult:
IM/IV
1 mg/kg then dose determined by blood levels, may be removed by dialysis
Available forms:
Inj 10, 40 mg/ml; powder for inj 1.2 g; neb sol 300 mg/5 ml
•
After obtaining specimen for C&S; begin treatment before results
•
Product in evenly spaced doses to maintain blood level; separate aminoglycosides and penicillins by ≥1 hr
•
Use only on susceptible organisms to prevent development of product-resistant bacteria
•
IM inj in large muscle mass; rotate inj sites, aspirate
•
Draw peak 1 hr after dose, trough right before next dose; absorption erratic
•
Give as close to q12hr apart as possible; do not use <6 hr apart
•
Do not mix with dornase alfa in nebulizer
•
Have patient inhale while sitting or standing, breathe normally through mouthpiece; may use noseclips; use over 10-15 min
•
The sol for nebulization is for inhalation only
•
Visually inspect sol, do not use if discolored or particulate is present
•
Vantage vials
are for IV only and only for exactly 60 or 80 mg
•
Diluted in 50-100 ml 0.9% NaCl D
5
W (D
10
W, Ringer’s, LR), infuse over 20-60 min, volume for pediatric patients needs and should be sufficient to allow for 20-60 min infusion
Y-site compatibilities:
Acyclovir, aldesleukin, alfentanil, alprostadil, amifostine, aminophylline, amiodarone, amsacrine, anidulafungin, ascorbic acid, atracurium, atropine, aztreonam, bivalirudin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin hydrochloride, DOXOrubicin liposome, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, ifosfamide, imipenem/cilastatin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, miconazole,
midazolam, milrinone, minocycline, mitoXANtrone, morphine, moxalactam, multiple vitamins, nafcillin, nalbuphine, naloxone, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pantoprazole, papaverine, penicillin G, pentazocine, perphenazine, PHENobarbital, phentolamine, phenylephrine, phytonadione, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, riTUXimab, rocuronium, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trastuzumab, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine
CNS:
Confusion, depression, numbness, tremors,
seizures,
muscle twitching,
neurotoxicity,
dizziness, vertigo
CV:
Hypo/hypertension, palpitation
EENT:
Ototoxicity,
deafness, visual disturbances, tinnitus
GI:
Nausea, vomiting, anorexia;
increased ALT, AST, bilirubin, hepatomegaly,
hepatic necrosis,
splenomegaly
GU:
Oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity
HEMA:
Agranulocytosis, thrombocytopenia, leukopenia, eosinophilia,
anemia
INTEG:
Rash
, burning, urticaria, dermatitis, alopecia
Plasma half-life 2-3 hr, prolonged in neonates; not metabolized; excreted unchanged in urine; crosses placental barrier; poor penetration into CSF
IM:
Onset rapid, peak 1 hr, duration 8 hr
IV:
Onset immediate, peak 30 min, duration 8 hr
Increase:
ototoxicity, neurotoxicity, nephrotoxicity—other aminoglycosides, amphotericin B, polymyxin, vancomycin, ethacrynic acid, furosemide, mannitol, methoxyflurane, CISplatin, cephalosporins, bacitracin, acyclovir, penicillins, cidofovir
Increase:
eosinophils, BUN, creatinine, AST, ALT, LDH, alk phos
Decrease:
potassium, calcium, sodium, magnesium, WBC, granulocytes, platelets
•
Weight before treatment; dosage is usually based on ideal body weight but may be calculated on actual body weight
•
I&O ratio, urinalysis daily for proteinuria, cells, casts; report sudden change in urine output
•
VS during inf; watch for hypotension, change in pulse
•
IV site for thrombophlebitis, including pain, redness, swelling q30min; change site if needed; apply warm compresses to discontinued site
•
Serum aminoglycoside conc; serum peak drawn at 30-60 min after IV inf or 60 min after IM inj, trough drawn just before next dose, peak 4-10 mcg/ml, trough 0.5-2 mcg/ml
Black Box Warning:
Renal impairment: CCr, BUN, serum creatinine; lower dosage should be given in renal impairment (CCr <80 ml/min); monitor electrolytes: potassium, sodium, chloride, magnesium monthly if patient receiving long-term therapy
Black Box Warning:
Deafness by audiometric testing; ringing, roaring in ears; vertigo; assess hearing before, during, after treatment
•
Overgrowth of infection:
fever, malaise, redness, pain, swelling, perineal itching, diarrhea, stomatitis, change in cough, sputum
•
Vestibular dysfunction:
nausea, vomiting, dizziness, headache; product should be discontinued if severe
•
Adequate fluids of 2-3 L/day unless contraindicated to prevent irritation of tubules
•
Flush of IV line with NS or D
5
W after inf
•
Supervised ambulation, other safety measures with vestibular dysfunction
•
Therapeutic response: absence of fever, draining wounds, negative C&S after treatment
•
To report headache, dizziness, symptoms of overgrowth of infection, renal impairment
Black Box Warning:
To report loss of hearing; ringing, roaring in ears; feeling of fullness in head
Black Box Warning:
To notify prescriber if pregnancy is planned or suspected; pregnancy (D)
•
To use other therapies first, then tobramycin
Hemodialysis; monitor serum levels of product
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert