Mosby's 2014 Nursing Drug Reference (399 page)

Black Box Warning:

Hearing deficits, neuromuscular disease

• 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

• 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

• 
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

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

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