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Mrs. Smith, a 68-year-old female patient, was admitted to the hospital with a diagnosis of osteomyelitis and placed on intravenous aminoglycosides. Laboratory results are: WBC = 17.3 mm3 Hemoglobin = 10.8 g/dL Hematocrit = 32% Na = 144 mEq/L, Cl = 110, K = 2.9 mEq/L Glucose = 185 ml/dL BUN = 42 mEq/L Creatinine = 0.7 mg/dL 1. What is the MOA of aminoglycosides? a. Interferes with viral DNA replication which reduces viral shedding and prevents the formation of viral lesions. b. Reversibly binds to ribosomes, inhibits protein synthesis and causes bacterial cell death. c. Interferes with enzymes required for the synthesis of bacterial DNA and needed for repliaction. d. Penetrate cell walls and bind irreversibly to structures that synthesize proteins resulting in the bacteria being unable to synthesize proteins needed to function and replicate. 2. Which laboratory value listed above requires pharmacologic intervention? What type of pharmacologic intervention do you anticipate? a. Hematocrit 36%; blood transfusion b. Glucose 146 mEq/dL ; orange juice c. K 2.9 mEq/L; potassium chloride 20 mEq d. Na 142 mEq/L; normal saline bolus 3. The physician orders a peak and trough level with the 3rd dose of the aminoglycoside. Which answer option listed below bests explains the concept of peak and trough? a. Peak represents the lowest concentration of a medication in the blood and is drawn one hour after a medication is administered b. Peak represents the highest concentration of a medication in the blood and is drawn prior to the scheduled dose c. Trough represents the highest concentration of a medication in the blood and is drawn one hour after a medication is administered d. Trough represents the lowest concentration of a medication in the blood and is drawn prior to the scheduled dose 4. What serum laboratory values do you anticipate being ordered to monitor for major adverse effects of aminoglycosides? a. Hemoglobin and Hematocrit b. Amylase and Lipase c. AST and ALT d. BUN and Creatinine 5. What data indicates that the patient is achieving a therapeutic response to the intravenous antibiotic therapy? a. Creatinine 2.4 mg/dL b. Hemoglobin 14 g/dL c. Glucose 105 mg/dL d. WBC 9 mm3
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