Menu Icon Search
Close Search

About the ads

  1. If you prefer the SDN Blue style, go to the bottom left of the page and select "SDN Blue"

Ampillicin + Gentamicin = Synergy

Discussion in 'Pharmacy' started by BME103, 03.08.07.

  1. BME103

    BME103 Senior Member

    Joined:
    05.27.03
    Messages:
    165
    SDN 7+ Year Member

    SDN Members don't see this ad. (About Ads)
    I was told that if you add gentamicin to ampillicin then the effect of ampillicin would increase. Does anyone know how or why?
  2. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX
    Yes..I know how and why..but you need to find the answer on your own.
    But I will tell you that Gent and Ampi can't be given together... you will also need to figure out why and how.
  3. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    Hey there!

    How's the new job??? Do you already have an agenda for those rogue dops???

    Did you have a nice few weeks off??? Welcome back....for however long!

    btw....do you think this was a "bait" question???
  4. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX

    Yo SDN!

    Actually...I've been going at it full force... visited 6 hospitals past 2 weeks..meeting DOPs and clinical managers... got a list of agenda..will see if they can implement it. Been using the RV every weekend...realized we need a little fishing boat too!!

    I'm not sure if it's a bait question... but I believe students should be able to find the answers to these simple pharmacology questions on their own instead of asking.
  5. BME103

    BME103 Senior Member

    Joined:
    05.27.03
    Messages:
    165
    SDN 7+ Year Member
    I was under the impression that if you expect of early sepsis, you can add gent to amp and that would give a broad spectrum coverage (G+ and G-). I have a hard time finding the reason. Any hints as to why and how?
  6. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX
    if broad spectrum is what you desire... then why not just use a broad spectrum antibiotic... And if I'm having a septic episode..I sure wouldn't want ampi gent...

    But you still can't give ampi and gent together...
  7. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX
    The mechanism of synergy between Beta Lactam and Aminoglycoside is not really well established except for Enterococci...gram positive strep prevalently resistant to beta lactams such as PCN or AMP..with high MIC and bacteriostatic with reduced susecptibility... but when AG is added to the regimen.. it somehow aids intracelluar uptake of AG.. thereby lowering the MIC of PCN... we call that Synergy.

    This mechanism is not universal to all bugs.

    Do a medline search.. Endocarditis, Aminoglycoside, Penicillin, Synergy.
  8. BME103

    BME103 Senior Member

    Joined:
    05.27.03
    Messages:
    165
    SDN 7+ Year Member
    Thanks for the infor! I will look it up and see if there's more infor.
  9. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    Agree with Zpak - if you need broad spectrum, off the cuff early antibiiotic coverage - use a drug which will give you this - don't cut & paste.

    But...there is the whole pcn (& pcn cogener)-aminoglycoside interaction.

    Its not clearly understood, but we do know that some pcn-like drugs can form complexes with aminoglycosides (look up piperacillin-gentamicin) which not only inactivate the aminoglycoside, but give compounds with unknown toxicities.

    There are also reports which suggest that the two compounds give false readings when you do blood levels. Add to that comorbid factors like renal disease, chf, etc...you now have something you can't make heads or tails out of.

    Why do it??? Choose a broad spectrum drug to start - wait for culture & sensitivity results & change as needed.

    So....zpak - where have you taken the RV??? Do NOT tell me you pull into the parking lot at the hospital you have to consult on with that RV - how awful would THAT look!!!!

    So...a small fishing boat???? How much can you tow??? I'm betting baby Zpak thinks this is all good fun - right? Can you get a life vest that small???

    How is SarahSux doing with cooking in a little oven with a little fridge?? You're not taking up the whole space with you're beer are you????

    Now - final question.......how did Little Miss Sux do on her science project with the - what were they - some fecal bug or such????
  10. BMBiology

    BMBiology on maternity leave (again)

    Joined:
    02.26.03
    Messages:
    4,324
    SDN 10+ Year Member
    I think I will take a stab at it. Amp binds and break down the bacteria cell wall while genti binds ribosome and inhibits protein synthesis. The reason why they are synergic is because amp helps genti get into the bacteria. As a result of resistence (to cell wall or/and ribosome binding), it's harder to kill the bacteria so what amp does is that it barely binds to the bacteria cell wall and makes a small hole and this just allow genti to come in and thus, binds to the ribosome and kill the bacteria. This is why they are synergic (increases the bacterialcidal affect and increases the rate of killing).

    That's my reasoning. Any comments?
  11. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    [​IMG]

    EDIT: Damn, someone responded 3 minutes before I could get this up....
  12. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    WVU - you do not have enough to do!!!

    Where is Mrs WVU????? Why are you spending time drawing these funny pictographs???? (I don't even know how you can do this on a computer!)

    Shouldn't you be studying for the state board or some such nonsense???
  13. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    Sadly, this is true. I played Gears of War for 4 hours tonight, then watched WVU lose it's basketball game, then played on the internet...bringing me to now.

    Playing Elebits on Wii.

    Hey, just trying to help...

    Start---->All Programs---> Accessories---> Paint


    Actually, that's not a bad idea.....
  14. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    You are one funny guy:D !
  15. twester

    twester Senior Member

    Joined:
    08.03.04
    Messages:
    1,389
    Location:
    Denver, CO
    Status:
    Pharmacist
    SDN 7+ Year Member
    Pharm students love this crap (I mean that in the kindest sense). You should consider academia (provided you move beyond Paint). ;) Actually, I really mean that. Some of the best professors I've had are the most unconventional. The point gets across all the quicker.
  16. Farmercyst

    Farmercyst Lowest common denominator Moderator Emeritus

    Joined:
    09.21.06
    Messages:
    7,858
    Location:
    The bottom of a pile of debt.
    Status:
    Pharmacist
    Pharmacist SDN 7+ Year Member
    What do you think, next SDN T-shirt perhaps?
  17. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    The fact that it's made with 1995 technology makes it that much better.
  18. njac

    njac Senior Member

    Joined:
    03.20.05
    Messages:
    8,560
    Location:
    Now headed all the way west!
    Status:
    Pharmacist
    SDN 7+ Year Member
    now as far as the PCN and AG forming that complex - I thought that was only at concentrations achieved if they were in the same bag or something. Can they be run simultaneously, do they need seperate lines or do you stagger the dosing?
  19. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    They definitely require separate lines (always a source of error when both are ordered since you don't KNOW the nurses will use separate lines).

    But, research suggests staggered dosing to allow for tissue distribution out of the intravascular compartment. It really is still unclear exactly what these complexes are in vivo, what their toxicities are & if they have any therapeutic value or if then diminish therapeutic value.
  20. GatorRxGirl

    GatorRxGirl

    Joined:
    09.23.05
    Messages:
    784
    Location:
    Somewhere on the beach.
    Status:
    Pharmacy Student
    SDN 5+ Year Member
    love it!
  21. GatorRxGirl

    GatorRxGirl

    Joined:
    09.23.05
    Messages:
    784
    Location:
    Somewhere on the beach.
    Status:
    Pharmacy Student
    SDN 5+ Year Member
  22. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    I grant SDN the rights to reproduce the picture. As long as I get a t-shirt for free.
  23. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX

    We've been scoping out many beautiful state parks here in Texas...almost every weekend. Haven't parked the RV on the hospital Lot yet..but I am taking notes where I can park it. baby Zpak is happy and content staying in the RV all day and night... and Sarah is loving the cozy kitchen..and the fridge is much larger than the one I had in Pharmacy School... haven't had a beer in 3 months and it's dung beetle...due in April. And the RV can tow about 5000lb..but I won't be towing a boat with the RV.. can you see the big arse RV going into the water to pull the boat out? It'll drown my engine which is in the most rear of the RV!

    How's CA?

    We just reserved a 35ft RV lot at the Tuolumne Meadows Camping ground today...for July for a week!!! Sarah had to get on the phone at 6:55 PST and kept dialing to get through...
  24. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    Aaaah Tuolumne Meadows - beautiful. I haven't been there in years, but I've got fond memories. Its a great place to take the kids. Some nice, easy hikes to falls, Tenaya Lake, evening campfire programs. You can also take your fishing poles, but you might not catch much. Kids don't care - they just like to do it. Are you coming over the Tioga or from the southern entrance? Not much snow this year, so the Tioga will probably be open early.

    CA is good. We've gots lots of changes professionally here. Recently tech check tech for pyxis (thats one thing I gave up when I went part-time:D ) & lots of movement toward expanded practices in the outpt setting. There was a lot of push toward expanding hospital & retail communication, but we've had a number of really bad drug errors in some local hospitals, so they need to get their stuff in order first. Lots more emphasis right now on credentialling in both practice settings.

    MSII is now MSIII & is studying for Step I. She called a bit frantically since she couldn't remember the Type I antiarrhythmics;) . I gave her my old mnemonic (knowing encainide was off the market), but it is hard to remember them when she hasn't seen them in real patients with real ekgs that correlate with physical signs. It will all come soon enough - she's got lots of clinical years ahead.

    Have you ever done the Oregon coast? That's our next trip - if you can believe, we've never done that one!
  25. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX
    We're going up the Tioga.. will load up with Diesel and grocery in Lee Vining. I'll run the generator so I'll need a lot of diesel..and may need a solar panel. We'll cook ...and will have plenty of propane. Won't need to run the AC I don't think...but we'll be there a week and will do some fly fishing.

    I have traveled the Oregon coast every September for the past 7 years. We do a week long golf outing.. Oregon coast is beautiful... went crabbing one year and caught over 300 dungeneous crabs.. kept 36, limit 12 per person.
    Sand dunes are beautiful and the scenery is just awesome.

    We traveled heavily from Bandon up to Florence...because 5 of our buddies live in Coos Bay Oregon. We love it ... but wouldn't want to live there.

    What the heck is an Encainide? j/k
  26. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    No - no need for AC in Yosemite - but on the Lee Vining side - especially if you visit Mono Lake (which you should - it has changed tremendously since you've been there....but needs AC & lots & LOTS of water in July). There also used to be a great burger joint in Lee Vining - if its still there - you'll find it. The whole d*#n town is 1 block long.

    Don't forget the spinning rods for baby Zpack & little Miss Dung Beetle Award Winning Zpak (I know, I know - I'm premature - but, I KNOW these things - I've LIVED these things!). They won't get the hang of fly fishing, but they get great joy out of smaking that spinning rod into the river (go far, far away from the serious fisherman lest they kill you - I'm thinking more Colorado or Wyoming).

    Thanks for the Oregon coast tips - we'll look into them!

    Have a great trip!
  27. MdBrndPhrmcst

    MdBrndPhrmcst Keeping it real....

    Joined:
    05.12.06
    Messages:
    105
    Location:
    Maryland
    Status:
    Pharmacist
    SDN 5+ Year Member
    give us the pneumonic for the anti arrythmics z-pack...
  28. Farmercyst

    Farmercyst Lowest common denominator Moderator Emeritus

    Joined:
    09.21.06
    Messages:
    7,858
    Location:
    The bottom of a pile of debt.
    Status:
    Pharmacist
    Pharmacist SDN 7+ Year Member
    If you ask SDN nicely she may forgive confusing her with Z, she might also give the mnemonic.:rolleyes:
  29. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    Did that guy confuse me with Zpak?:eek: You can tell us apart from a mile away!!!

    I'm the one with the short (albeit not tooo short) skirt, great legs & a white coat - Zpaks that old guy who used to wear scrubs (when he was a dop) - now you can find him in a zipper RV jumpsuit;)

    No worries....I think Zpak is out getting a matching jumpsuit for Sarah for Mother's Day, so I'll give you the mnemonics I used (remember - I'm OLD:rolleyes: !)

    "A Doubtful Quality Product Bought To Preserve Little Money Can Fabricate Enough Problems"

    A = 1A
    D = Disopyriamide
    Q = Quinidine
    P = Procainamide

    B = 1B
    T = Tocainamide
    P = Phenytoin
    L = Lidocaine
    M = Mexiletine

    C = 1C
    F = Flecainamide
    E = Encainamide (now off the market)
    P = Propafenone

    To remember the "P's" - there are 3 of them - they start & end with Pr & the Prs go in alaphebetical order....so...first P is the first alphabetic Pr "procainamide"....second P is "phenytoin" (the only non-Pr - it is surrounded by Pr when it comes to P's) ....the last P is the last alphabetic Pr "propanfenone". (You should have paid attention when your mother told you to watch your Ps & Qs!!!:) ).

    There are others, but you have to know the groups.

    "Quaker Preachers Discuss Sobriety" = Quinidine, Procainamide, Disopyramide, Sodium channel blocade (Class 1A)

    "People Like Salty Mexican Tacos" = Phenytoin, Lidocaine, Sodium channel blockade, Mexilitine, Tocainide (Class 1B)

    "Flea Encrusted People" = Flecainamide, Encainide (off the market), Propafenone (Class 1C) - (not to be taken literally about those with arrhythmias requiring Class 1C drugs!!!!):p

    Anyway, these were the ones I used & worked for me. There are a zillion others & I'm sure Zpak has the "official" USC version - if he remembers..:laugh: :laugh: :laugh:

    Good luck!
  30. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX

    We at USC do not deal with antiarrythmics..we can't spell it..nor does it make that much of a big financial impact..since Cordarone has gone generic!!
  31. ZpackSux

    ZpackSux Retired

    Joined:
    02.25.05
    Messages:
    3,407
    Location:
    Dallas, TX

    We got on some Crappie over the weekend...spring break..some friends and we were at a state park camping..fished off the pier and one of the kids (not mine...Dung Beetle Zpak already got her first fish last year...little large mouth bass and a blue gill) got her first and 2nd fish...
  32. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    Oh - I hope you had cameras!!

    We (well - Dr sdn & the kids) were fishing off a pier at Twin Lakes when they were little. (Twin Lakes is up out of Bridgeport - a bit farther up 395 from Lee Vining - though you can get there thru Ebbits Pass from Lake Alpine)

    Anyway....they were fishing for crappie....MSIII (she was about 6 at the time) had just hooked a fish & in our son's (what should I call him - graphic sdn???) enthusiasm (he was 3) to see the fish - he knocked over dr sdn's tackle box right into the lake.

    It wasn't the "full" tackle box - since a true dad fisherman has a box with those things which he needs & another box with those things which are needed when taking the children (I didn't know that then - silly me:p ) - so not too much was lost. But - he was not of a mind to go down & try to get it & I certainly was not going either.

    A fun memory!!! So - make up an extra tackle box in case baby Zpak takes off & tips it over.
  33. Farmercyst

    Farmercyst Lowest common denominator Moderator Emeritus

    Joined:
    09.21.06
    Messages:
    7,858
    Location:
    The bottom of a pile of debt.
    Status:
    Pharmacist
    Pharmacist SDN 7+ Year Member
    There were 6 of us going out on Lake Oachita in Arkansas. Never let a kid cast in front of you. I was about 7, got hooked by a wayward cast. Luckily just in the finger, but I've been scarred for life. I rarely go fishing. I'll bring myself to do it for the kids, but it won't be the big family past-time.
  34. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

    Joined:
    05.07.05
    Messages:
    22,720
    Location:
    Cube Farm
    Status:
    Pharmacist
    Pharmacist SDN Partner SDN Published Author NCPA Kappa Psi SDN 7+ Year Member
    I once got a fishhook in my finger on a church fishing trip. Some old dude pulled it out, took some chewing "backy" out of his cheek and stuck it on there. Miraculously, it seemed to make it better. *shrugs*

    Gross.
  35. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    Huh. Well...it might have caused some vasoconstriction....
  36. sdn1977

    sdn1977 Senior Member

    Joined:
    07.28.05
    Messages:
    3,553
    SDN 7+ Year Member
    :laugh: :laugh: :laugh:
  37. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

    Joined:
    05.07.05
    Messages:
    22,720
    Location:
    Cube Farm
    Status:
    Pharmacist
    Pharmacist SDN Partner SDN Published Author NCPA Kappa Psi SDN 7+ Year Member
    I know, right? Nasty! I was about 7 at the time and I remember telling people, "He put his 'chaw' on my finger!" :laugh:
  38. Farmercyst

    Farmercyst Lowest common denominator Moderator Emeritus

    Joined:
    09.21.06
    Messages:
    7,858
    Location:
    The bottom of a pile of debt.
    Status:
    Pharmacist
    Pharmacist SDN 7+ Year Member
    As long as you didn't suck on it afterwards.:barf:
  39. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

    Joined:
    05.07.05
    Messages:
    22,720
    Location:
    Cube Farm
    Status:
    Pharmacist
    Pharmacist SDN Partner SDN Published Author NCPA Kappa Psi SDN 7+ Year Member
    EWWWWWWWWWW:laugh:
  40. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    I still haven't gotten my damned free shirt yet.

    What gives?

    ...

    Also, for the mods, have there actually been people nerdy enough to have bought one of these? And if so, where are they from and what do they do? I can't even imagine the type of person that would wear a shirt depicting a cartoon of how antibiotics work...
    Last edited: 05.09.10
  41. njac

    njac Senior Member

    Joined:
    03.20.05
    Messages:
    8,560
    Location:
    Now headed all the way west!
    Status:
    Pharmacist
    SDN 7+ Year Member
    this thread is awesomely classic.

    glad to be home for a bit?
  42. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

    Joined:
    06.23.03
    Messages:
    11,350
    Location:
    Born: Parkersburg, WV | Now: Montgomery TWP, PA
    Status:
    Pharmacist
    Pharmacist SDN 10+ Year Member
    Yes.

    Until the end of the month. Then off to the wonderful land of a Washington DC bedroom community.
  43. Sparda29

    Sparda29 En Taro Adun Gold Donor

    Joined:
    03.25.08
    Messages:
    7,954
    Location:
    New York, New York
    Status:
    Pharmacist
    Pharmacist SDN 5+ Year Member
    I love it.
  44. atticus27

    atticus27

    Joined:
    09.22.08
    Messages:
    1,650
    Status:
    Pharmacy Student
    SDN 2+ Year Member
    Wrong.
  45. StaviZFingerZ

    StaviZFingerZ Retired

    Joined:
    04.12.09
    Messages:
    2,100
    Status:
    Pharmacist

    Nope, not wrong. An AG and b-Lactam can be used in therapy for synergy yet recommended adminstered 2 hours apart.

    Different B-lactams can inactivate different AG.

    Go study some more dummy.
  46. atticus27

    atticus27

    Joined:
    09.22.08
    Messages:
    1,650
    Status:
    Pharmacy Student
    SDN 2+ Year Member
    Mkay. I did not know that. You are right, I am wrong. I thought you were saying they are not used together in practice because broad-spectrums are preferred.

    I have since found that amp+gent has been given right after one another as long as the lines are flushed in between. It seems the recommendation to wait is based mostly on in vitro studies and some hospital policy allows for immediate admin as they report no complications. But yes, never at the same time as you say.
  47. StaviZFingerZ

    StaviZFingerZ Retired

    Joined:
    04.12.09
    Messages:
    2,100
    Status:
    Pharmacist

    In vivo inactivation has been documented also.. but I forgive you.
  48. spacecowgirl

    spacecowgirl brr

    Joined:
    02.27.04
    Messages:
    2,227
    Location:
    in an igloo
    Status:
    Pharmacist
    SDN 10+ Year Member
    I forgot how much I love Mike's drawings. You should submit them to the editors of DiPiro to replace their factually accurate yet boring illustrations.

// Share //

Style: SDN Universal