Aminoglycosides (6 - 10) - Quiz, Trivia & Questions

2.

Regarding the toxicity of aminoglycosides which statement is accurate?

Gentamicin and tobramycin are the least likely to cause renal damage
Ototoxicity due to amikacin and gentamicin includes vestibular dysfunction, which is often irreversible
Ototoxicity is reduced if loop diuretics are used to facilitate the renal excretion of aminoglycoside antibiotics
Reduced blood creatinine is an early sign of aminoglycoside nephrotoxicity
Skin reactions are very rare following topical use of neomycin

Correct Answer

A. Ototoxicity due to amikacin and gentamicin includes vestibular dysfunction, which is often irreversible

Explanation

Gentamicin and tobramycin are the most nephrotoxic aminoglycosides. The incidence of nephrotoxic effects with gentamicin is 2 to 3 times greater than the incidence of ototoxicity. With traditional dosage regimens, the first indication of potential nephrotoxicity is an increase in trough serum levels of aminoglycosides, which is followed by an increase in blood creatinine. Although aminoglycoside ototoxicity usually involves irreversible effects on vestibular function, hearing loss can also occur. Ototoxicity is enhanced by loop diuretics. Skin reactions are common with topical use of neomycin.

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3.

Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is

Azithromycin
Cefixime
Ceftriaxone
Ciprofloxacin
Doxycycline

Correct Answer

A. Azithromycin

Explanation

All of the listed drugs have been used for the treatment of gonorrhea. Cephalosporins should be avoided in patients with a history of severe hypersensitivity to penicillins, and fluoroquinolones (see Chapter 46) should be avoided in pregnancy. Tetracyclines including doxycycline have been used in the past for gonorrhea, but not as single doses, and they too should be avoided in pregnancy.

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4.

This drug has characteristics almost identical to those of gentamicin but has much weaker activity in combination with penicillin against enterococci.

Amikacin
Erythromycin
Netilmicin
Spectinomycin
Tobramycin

Correct Answer

A. Tobramycin

Explanation

Tobramycin is almost identical to gentamicin in both its pharmacodynamic and pharmacokinetic properties. However, for reasons that are unclear, it is much less active than either gentamicin or streptomycin when used in combination with a penicillin in the treatment of enterococcal endocarditis.
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5.

A 76-year-old man is seen in a hospital emergency department complaining of pain in and behind the right ear. Physical examination shows edema of the external otic canal with purulent exudate and weakness of the muscles on the right side of the face. The patient informs the physician that he is a diabetic. Gram stain of the exudate from the ear shows many polymorphonucleocytes and gram-negative rods, and samples are sent to the microbiology laboratory for culture and drug susceptibility testing. A preliminary diagnosis is made of external otitis. At this point, which of the following is most appropriate?

Amikacin should be injected intramuscularly, and the patient should be sent home
Analgesics should be prescribed, but antibiotics should be withheld pending microbiological results
Oral cefaclor should be prescribed together with analgesics, and the patient should be sent home
The patient should be hospitalized, and treatment started with imipenem-cystatin
The patient should be hospitalized, and treatment started with gentamicin plus ticarcillin

Correct Answer

A. The patient should be hospitalized, and treatment started with gentamicin plus ticarcillin

Explanation

The diabetic patient with external otitis is at special risk because of the danger of spread to the middle ear and possibly the meninges, so hospitalization is advisable, especially in the elderly. Likely pathogens include E coli and Pseudomonas aeruginosa, and coverage must be provided for these and possibly other gram-negative rods. The combination of an aminoglycoside plus a wider spectrum penicillin is most suitable in this case and is synergistic against many pseudomonas strains. Imipenem-cilastatin is also possible, but resistant strains of P aeruginosa have emerged during treatment. Cefaclor lacks antipseudomonal activity.

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Aminoglycosides (6 - 10)

Which statement about “once-daily” dosing with aminoglycosides is not accurate?

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Regarding the toxicity of aminoglycosides which statement is accurate?

Your 23-year-old female patient is pregnant and has gonorrhea. The medical history includes anaphylaxis following exposure to amoxicillin. The most appropriate drug to use is

This drug has characteristics almost identical to those of gentamicin but has much weaker activity in combination with penicillin against enterococci.