Lippincotts Drugs to Know for the NCLEX

tobramycin sulfate
toe-bra-MYE-sinTOBI
Pharmacologic class: Aminoglycoside
INDICATIONS
Serious infection by sensitive strains of Escherichia coli, Proteus, Klebsiella, Enterobacter,
Serratia, Morganella morganii, Staphylococcus aureus, Citrobacter, Pseudomonas, or Providencia
ACTION
Generally bactericidal. Inhibits protein synthesis by binding directly to the 30S ribosomal subunit.
ADVERSE REACTIONS
CNS: seizures, headache, lethargy, confusion, disorientation, fever
EENT: ototoxicity, hoarseness, pharyngitis
GU: nephrotoxicity
Hematologic: leukopenia, thrombocytopenia, agranulocytosis
Respiratory: bronchospasm
NURSING CONSIDERATIONS
Be aware that I.V. loop diuretics such as furosemide may increase ototoxicity.
Obtain specimen for culture and sensitivity tests before giving first dose. Begin therapy while
awaiting results.
Obtain blood for peak level 1 hour after I.M. injection and 30 minutes to 1 hour after I.V. infusion
ends; for trough levels, draw blood just before next dose.
Monitor renal function, including urine output, specific gravity, urinalysis, BUN and creatinine
levels, and creatinine clearance. Report any evidence of declining renal function.
Watch for signs and symptoms of superinfection (especially of upper respiratory tract), such as
continued fever, chills, and increased pulse rate.
Don’t confuse tobramycin with Trobicin.
PATIENT TEACHING
Caution patient not to perform hazardous activities if adverse CNS reactions occur.
Encourage patient to maintain adequate fluid intake.
Teach patient how to use and maintain nebulizer. Tell patient using several inhaled therapies to use
this drug last.
Instruct patient not to use if the inhalation solution is cloudy or contains particles or if it has been