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1 TIME/ACTION PROFILE (peak blood levels)

ROUTE ONSET PEAK DURATION PDF Page #1
amikacin (am-i-kay-sin) IM rapid 0.75–2 hr 12–24 hr
Amikin IV rapid within 30 min of 30 min 12–24 hr
Classification infusion
Therapeutic: anti-infectives
Pharmacologic: aminoglycosides Contraindications/Precautions
Pregnancy Category D Contraindicated in: Hypersensitivity to amikacin, other aminoglycosides, or bi-
sulfites.
Use Cautiously in: Renal or auditory impairment of any kind (dosage adjust-
Indications ments necessary— blood level monitoring useful in preventing ototoxicity and neph-
IM, IV: Treatment of serious infections for which treatment with less toxic anti-infec- rotoxicity); Neuromuscular diseases such as myasthenia gravis or Parkinson’s dis-
tives is contraindicated or known to be ineffective. Unlabeled Use: Part of combi- ease; Patients with burns (may require larger, more frequent doses); OB: May cause
nation treatment of Mycobacterium avium complex infections. IT: With parenteral fetal nephrotoxicity or deafness; Lactation: Safety not established; Pedi: Neonates
amikacin in the management of CNS infections. Inhaln: By aerosol nebulization for have prolonged half-life due to renal immaturity; Geri: Cautious use due to age-re-
the prevention of serious pneumonia in high-risk populations. lated renal impairment; may be difficult to assess vestibular and auditory function in
geriatric or debilitated patients.
Action
Inhibits protein synthesis in bacteria at the level of the 30S ribosome. Resists the ac- Adverse Reactions/Side Effects
tion of enzymes known to inactivate other aminoglycosides. Therapeutic Effects: CNS: vertigo. EENT: ototoxicity (vestibular and cochlear). GU: nephrotoxicity.
Bactericidal action against susceptible bacteria. Spectrum: Notable for activity Neuro: enhanced neuromuscular blockade. Resp: apnea. Misc: hypersensitivity
against: Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Pro- reactions.
teus, Providencia , Enterobacter, Citrobacter freundii, Serratia, Acinetobacter,
Mycobacterium. Amikacin is also active against Staphylococci (including methicil- Interactions
lin-resistant strains). Acts synergistically with beta-lactam anti-infectives against Drug-Drug: Inactivated by extended-spectrum penicillins when coadminis-
gram-negative organisms. In the treatment of enterococcal infections, synergy with a tered to patients with renal insufficiency. May potentiate effects of inhalation anes-
penicillin is required. thetics or neuromuscular blockers.qincidence of ototoxicity with loop diuret-
ics. q incidence of nephrotoxicity with other nephrotoxic drugs, such as
Pharmacokinetics amphotericin, vancomycin, acyclovir, cisplatin, or cephalosporins.
Absorption: Poorly absorbed from the GI tract. Well absorbed after IM administra-
tion; IV administration results in complete bioavailability. Route/Dosage
Distribution: Widely distributed throughout extracellular fluid. Crosses the pla- IM, IV (Adults and Children): 15 mg/kg/day divided q 8– 12 hr (not to exceed 1.5
centa; small amounts enter breast milk. Poor penetration into CSF (qwhen meninges g/day). Mycobacterium avium complex infection: 7.5– 15 mg/kg/day divided q
inflamed). 12– 24 hr.
Metabolism and Excretion: Excretion is mainly (⬎90%) renal; minimal IM, IV (Neonates): Loading dose— 10 mg/kg. Maintenance dose— 7.5 mg/kg q
amounts are metabolized by the liver. 12 hr.
Half-life: Infants ⬎7 days: 4– 5 hr; Children: 1.6– 2.5 hr; Adolescents: 0.5– 2.5 hr; Renal Impairment
Adults: 2– 3 hr (qin renal impairment,pin patients with burns). IM, IV (Adults): Loading dose— 7.5 mg/kg; further dosing based on serum levels.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/amikacin 02/17/2014 01:50PM
2 IV Administration
NURSING IMPLICATIONS
Assessment
● Assess for infection (vital signs; wound appearance; sputum, urine, and stool;
WBCs at beginning and throughout therapy.
● Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
● Evaluate eighth cranial nerve function by audiometry before and throughout ther-
apy. Hearing loss is usually in the high-frequency range. Prompt recognition and
intervention are essential in preventing permanent damage. Also monitor for ves-
tibular dysfunction (vertigo, ataxia, nausea, vomiting). Eighth cranial nerve dys-
function is associated with persistently elevated peak amikacin levels. Amikacin
should be discontinued if tinnitus or subjective hearing loss occurs.
● Monitor intake and output and daily weight to assess hydration status and renal
function.
● Assess for signs of superinfection (fever, upper respiratory infection, vaginal itch-
ing or discharge, increasing malaise, diarrhea).
● Lab Test Considerations: Monitor renal function by urinalysis, specific grav-
ity, BUN, creatinine, and CCr before and during therapy.
● May causeqBUN and creatinine concentrations.
● Toxicity and Overdose: Monitor therapeutic blood levels periodically during
therapy. Timing of blood levels is important in interpreting results. Draw blood for
peak levels 1 hr after IM injection and 30 min after a 30-min IV infusion is com-
pleted. Trough levels should be drawn just before next dose. Peak level range 20–
30 mcg/mL; trough level ⬍10 mcg/mL.
● Unlabeled q 24 h dosing— trough level ⱕ1 mcg/mL.
Potential Nursing Diagnoses
Risk for infection (Indications)
Disturbed sensory perception (auditory) (Side Effects)
Implementation
Keep patient well hydrated (1500– 2000 mL/day) during therapy.
● IV: If aminoglycosides and penicillins or cephalosporins must be administered
concurrently, administer in separate sites, at least 1 hr apart.
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● pH: 3.5– 5.5.
● Intermittent Infusion: Diluent: Dilute with D5W, D10W, 0.9% NaCl, dextrose/ PDF Page #2
saline combinations, or LR. Solution may be pale yellow without decreased po-
tency. Stable for 24 hr at room temperature. Concentration: 10 mg/mL. Rate:
Infuse over 30– 60 min.
● Syringe Incompatibility: heparin.
● Y-Site Compatibility: acyclovir, aldesleukin, alfentanil, amifostine, aminophyl-
line, amiodarone, amsacrine, anidulafungin, ascorbic acid, atracurium, atropine,
aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine,
butorphanol, calcium chloride, calcium gluconate, carboplatin, caspofungin, ce-
fazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefu-
roxime, chloramphenicol, chlorpromazine, cimetidine, cisatracurium, cisplatin,
clindamycin, codeine, cyanocobalamin, cyclophosphamide, cyclosporine, cytar-
abine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin,
diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doripenem, dox-
acurium, doxorubicin hydrochloride, doxycycline, enalaprilat, ephedrine, epi-
nephrine, epirubicin, epoetin alfa, eftifibatide, ertapenem, erythromycin, esmolol,
etoposide, etoposide phosphate, famotidine, fentanyl, filgrastim, fluconazole, flu-
darabine, fluorouracil, foscarnet, furosemide, gemcitabine, gentamicin, glycopyr-
rolate, granisetron, hydrocortisone, hydromorphone, idarubicin, ifosfamide, im-
ipenem/cilastatin, irinotecan, isoproterenol, ketorolac, labetalol, levofloxacin,
lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine,
melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldo-
pate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazo-
lam, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nafcil-
lin, nalbuphine, naloxone, nicardipine, nitroglycerin, nitroprusside,
norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palon-
osetron, pantoprazole, papaverine, pemetrexed, penicillin G, pentazocine, per-
phenazine, phenobarbital, phentolamine, phenylephrine, phytonadione, pipera-
cillin/tazobactam, potassium chloride, procainamide, prochlorperazine,
promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin,
ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate,
sodium bicarbonate, strepotkinase, succinylcholine, sufentanil, tacrolimus, teni-
poside, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tiro-
fiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecuro-
nium, verapamil, vincristine, vinorelbine, voriconazole, warfarin, zidovudine,
zoledronic acid.
䉷 2015 F.A. Davis Company CONTINUED
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PDF Page #3
CONTINUED
amikacin
● Y-Site Incompatibility: allopurinol, amophotericin B cholesteryl, amphotericin
B colloidal, amphotericin B lipid complex, amphotericin B liposome, azathio-
prine, azithromycin, cefoperazone, dantrolene, diazepam, diazoxide, folic acid,
ganciclovir, heparin, hetastarch, indomethacin, pentamidine, pentobarbital, phe-
nytoin, propofol, trastuzumab, trimethoprim/sulfamethoxazole.
● Additive Incompatibility: Manufacturer does not recommend admixing.

Patient/Family Teaching
● Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, muscle weak-
ness/twitching, feeling of fullness in the head, or hearing loss.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of infection. If no response is seen within 3–
5 days, new cultures should be obtained.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.