Aminoglycosides

Aminoglycosides

Drug monograph · NCLEX study reference
Therapeutic class	Antibacterial
Pharmacologic class	Aminoglycoside
Onset / peak / duration	Rapid IV; dosed by level or extended-interval protocols.
Half-life / level	Short; gentamicin peak about 5 to 10 mcg/mL and trough below 2 mcg/mL (traditional dosing).
Routes	IV, IM, Inhaled
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Supportive care.
Pregnancy / lactation	Avoid unless essential (fetal ototoxicity).

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Aminoglycosides — Antibacterial; Aminoglycoside.

Identification

• Therapeutic class: Antibacterial.
• Pharmacologic class: Aminoglycoside.

Pharmacology

• Mechanism of action: Bind the 30S ribosomal subunit to inhibit protein synthesis (bactericidal); used for serious gram-negative infections.
• Onset / peak / duration: Rapid IV; dosed by level or extended-interval protocols.
• Half-life / therapeutic level: Short; gentamicin peak about 5 to 10 mcg/mL and trough below 2 mcg/mL (traditional dosing).

Clinical use

• Indications: Serious gram-negative and synergy infections; neomycin oral for bowel prep and hepatic encephalopathy; tobramycin inhaled for cystic fibrosis.
• Usual dose, route, frequency: IV or IM by weight and level; inhaled (tobramycin).
• Maximum dose / adjustments: Adjust closely by renal function and serum levels.

Safety

• Contraindications: Hypersensitivity; caution with renal impairment, myasthenia gravis, and prior ototoxicity.
• Black box warning: Nephrotoxicity and ototoxicity (hearing and balance), and potential neuromuscular blockade; monitor renal function and drug levels.
• Interactions: Loop diuretics and other nephrotoxic or ototoxic drugs (vancomycin, amphotericin), neuromuscular blockers.
• Pregnancy / lactation: Avoid unless essential (fetal ototoxicity).
• High-alert: No.

Adverse effects

• Common side effects: Few at therapeutic levels; injection-site reactions.
• Serious effects to report: Hearing loss or tinnitus, vertigo, rising creatinine, decreased urine output.
• Antidote / reversal: Supportive care.

Nursing process

• Assessment before administration: Renal function, baseline hearing, drug levels, weight.
• Interventions during therapy: Draw peak and trough as ordered; assess hearing and balance; ensure hydration.
• Monitor: Peak and trough levels, renal function, hearing and balance, infection resolution.
• Evaluation / expected outcome: Resolution of infection without toxicity.

Patient teaching

• Patient teaching: Report ringing in the ears, hearing changes, or dizziness.
• Notify provider if: Hearing changes, ringing, dizziness, decreased urination.
• Administration tips: Timed level draws; monitor renal and auditory function.