Name of the Topical Aminoglycosides Drugs
- Neomycin
Neomycin
| Neomycin |
| Availability Ointment: 0.5% Oral solution: 125 mg/5 ml Tablets: 500 mg |
| Indications and dosages ➣ Preoperative intestinal antisepsis Adults: 1 g P.O. q hour for four doses, then 1 g q 4 hours for 24 hours or 1 g at 19 hours, 18 hours, and 9 hours before surgery ➣ Hepatic encephalopathy Adults: 4 to 12 g/day P.O. in divided doses ➣ Superficial bacterial infections Adults: Apply ointment topically one to five times daily. |
Mechanism of Action
Is transported into bacterial cells, where it competes with messenger RNA to bind with a specific receptor protein on the 30S ribosomal subunit of DNA. This action causes abnormal, nonfunctioning proteins to form. A lack of functional proteins causes bacterial cell death.
Pharmacokinetics
- Half Life: 3 hr
- Peak Plasma Time: oral: 1-4 hr; IM ~2 hr
- Absorption: oral, percutaneous: poor (3%)
- Vd: 0.36 L/kg
- Metabolism: slightly hepatic
- Excretion: Feces: 97% of oral dose as unchanged drug
- Urine: 30-50% of absorbed drug as unchanged drug
Administration
Give preoperative dose before bowel surgery, after cathartic administration, as ordered.
Contraindications
- Hypersensitivity to drug or other aminoglycosides
- Intestinal obstruction
Precautions:
- Renal impairment, neuromuscular diseases (such as myasthenia gravis), hearing impairment
- Obese patients
- Elderly patients
- Pregnant or breastfeeding patients
- Children under age 18 (safety not established).
Adverse reactions
- CNS: neuromuscular blockade
- EENT: ototoxicity (with prolonged, high-dose use)
- GI: nausea, vomiting, diarrhea, malabsorption syndrome
- GU: nephrotoxicity (with prolonged, high-dose use)
- Other: superinfection
Patient monitoring
- Assess for neuromuscular blockade, ototoxicity, and nephrotoxicity.
- Monitor kidney function tests.
Patient teaching
- Instruct patient to drink plenty of water.
- Tell patient to complete full course of therapy.
- Inform patient that drug may cause muscle weakness.
- Instruct patient to report hearing problems and change in urination pattern.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects neuromuscular status.
- Tell patient he’ll undergo frequent blood testing during therapy.
- As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.
Nursing Considerations
- Monitor patient’s BUN and serum creatinine levels to assess renal function before and during neomycin therapy. Expect to decrease dosage or stop drug if nephrotoxicity develops.
- Monitor blood neomycin level, as directed, to assess for therapeutic range of 5 to 10 mcg/ml.
- Watch for evidence of pseudomembranous colitis, such as severe abdominal cramps and severe, watery diarrhea. • Anticipate that neomycin’s curare-like effect may worsen muscle weakness in patients with neuromuscular disorders, such as myasthenia gravis and parkinsonism
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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