Pharmacology - Vancomycin vs. Gentamicin Antibiotics nursing RN PN NCLEX

Summary

In this video, Nurse Mike dives into the toxicity of glycopeptides and aminoglycosides, particularly vancomycin and aminoglycosides like gentamicin. He emphasizes the importance of monitoring blood levels, with a focus on avoiding kidney and ear damage, highlighting key terms like ototoxicity and nephrotoxicity. Nurse Mike explains the proper administration of vancomycin, addressing risks such as red man syndrome and distinguishing it from allergic reactions. The video also covers safe practices, particularly in elderly and at-risk populations, and explains how to recognize and respond to adverse effects, such as muscle cramps and kidney dysfunction.

Takeaways

• 😀 Vancomycin and aminoglycosides are toxic to the kidneys and ears, so monitoring is crucial.
• 😀 Both classes of drugs require careful blood concentration monitoring, with therapeutic ranges between 10 and 20.
• 😀 Peak and trough levels should be checked 15-30 minutes before the next dose to ensure safe drug levels.
• 😀 Ototoxicity signs include vertigo, loss of balance, ataxia, and tinnitus. These should be monitored closely.
• 😀 Nephrotoxicity signs include rising BUN (above 20) and creatinine (above 1.3), as well as decreased urine output (<30 mL/hr).
• 😀 Vancomycin can cause 'Red Man Syndrome' when infused too quickly, which causes hypotension, flushing, and rash.
• 😀 In cases of Red Man Syndrome, slow the infusion rate to over 60 minutes and monitor blood pressure closely.
• 😀 Anaphylaxis is a severe allergic reaction requiring immediate cessation of the drug and administration of epinephrine.
• 😀 Vancomycin does not affect magnesium levels, so there is no need to worry about magnesium-related issues like nausea or DTRs.
• 😀 Aminoglycosides are often used for cystic fibrosis infections and can cause toxicity when combined with vancomycin.
• 😀 Muscle aches and cramping are normal in patients without neuromuscular diseases but are contraindicated in those with such conditions.

Q & A

What are the two primary classes of drugs discussed in the script that are toxic to the kidneys and ears?

The two primary classes of drugs discussed are glycopeptides (e.g., vancomycin) and aminoglycosides (e.g., gentamicin, neomycin). Both are toxic to the kidneys and ears.

What is the importance of monitoring drug levels, specifically peaks and troughs, for glycopeptides and aminoglycosides?

Monitoring peaks and troughs ensures the drug stays within a therapeutic range. If drug levels are too high, they can cause toxicity, particularly nephrotoxicity and ototoxicity. If levels are too low, the infection may not be adequately treated.

What is the therapeutic range for drug concentration of glycopeptides and aminoglycosides?

The therapeutic range for drug concentration is between 10 and 20 µg/mL. Levels higher than 20 µg/mL can lead to toxicity.

What are the early signs of ototoxicity, and why are they significant?

Early signs of ototoxicity include vertigo, loss of balance, ataxia, and tinnitus (ringing in the ears). These are important to monitor as they are early indications of ear damage from the drugs.

How do you monitor nephrotoxicity when using glycopeptides and aminoglycosides?

Nephrotoxicity is monitored by checking for elevated BUN (blood urea nitrogen) and creatinine levels. A creatinine level over 1.3 and BUN over 20 suggest kidney damage. Urine output of less than 30 mL/hr is also a sign of kidney distress.

What is Red Man Syndrome, and how can it be prevented during vancomycin administration?

Red Man Syndrome is a reaction to rapid vancomycin infusion, causing flushing, low blood pressure, and a red rash. It can be prevented by slowing the infusion rate to at least 60 minutes and monitoring blood pressure during the infusion.

How do you differentiate between Red Man Syndrome and anaphylaxis?

Red Man Syndrome is caused by rapid infusion and is not an allergic reaction. In contrast, anaphylaxis is a severe allergic reaction characterized by hives, angioedema (swelling), and wheezing, which requires immediate cessation of the infusion and administration of epinephrine.

What is the significance of magnesium levels in the context of vancomycin administration?

Vancomycin does not affect magnesium levels, so there is no impact on mental status or deep tendon reflexes (DTRs). This distinguishes it from other antibiotics that may influence magnesium levels.

What are the indications for using aminoglycosides, and what are the main concerns regarding their use?

Aminoglycosides are often used to treat infections in patients with cystic fibrosis. However, they are very toxic, especially in combination with vancomycin, leading to nephrotoxicity and ototoxicity. Monitoring renal function and drug levels is crucial.

What is a common distractor in NCLEX questions regarding aminoglycosides, and how should it be approached?

A common distractor is muscle aches and cramping, which can be normal in patients without neuromuscular diseases. These symptoms should not lead to stopping the medication, but the drug should be contraindicated in patients with neuromuscular diseases.