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Chemotherapy > Adverse Effects > Flashcards

Adverse Effects Flashcards

1
Q

Natural Penicillins

Penicillin G, Penicillin V

A
  • Hypersensitivity (5%) ranging from rashes to angioderma and anaphylaxis. Cross-allergy is present
  • Diarrhea especially pseudomembranous colitis from C. difficle
  • Neurotoxicity: cause seizures if injected intrathecally or very high blood levels are reached
  • Hematologic toxicities: decreased coagulation, and cytopenias have been associated with therapy greater than 2 weeks
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2
Q

Semi-synthetic Penicillins

Amoxicillin, Ampicillin

A
  • Hypersensitivity (5%) ranging from rashes to angioderma and anaphylaxis. Cross-allergy is present
  • Diarrhea especially pseudomembranous colitis from C. difficle
  • Neurotoxicity: cause seizures if injected intrathecally or very high blood levels are reached
  • Hematologic toxicities: cytopenias have been associated with therapy greater than 2 weeks
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3
Q

Anti-Staphylococcal Penicillins

Methicillin, Nafcillin, Oxacillin, Dicloxacillin

A
  • Hypersensitivity (5%) ranging from rashes to angioderma and anaphylaxis. Cross-allergy is present
  • Diarrhea especially pseudomembranous colitis from C. difficle
  • Neurotoxicity: cause seizures if injected intrathecally or very high blood levels are reached
  • Interstitial nephritis especially methicillin
  • Hematologic toxicities: decreased coagulation, and cytopenias have been associated with therapy greater than 2 weeks
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4
Q

Anti-Pseudomonal Penicillins

Piperacillin, Ticarcillin, Carbenicillin, Mezlocillin

A
  • Hypersensitivity (5%) ranging from rashes to angioderma and anaphylaxis. Cross-allergy is present
  • Diarrhea especially pseudomembranous colitis from C. difficle
  • Neurotoxicity: cause seizures if injected intrathecally or very high blood levels are reached
  • Hematologic toxicities: decreased coagulation, and cytopenias have been associated with therapy greater than 2 weeks
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5
Q

First generation cephalosporins

Cefazolin, Cefadroxil, Cephalexin

A
  • Hypersensitivity (2%): cross-allergy with penicillins is around 5% with the highest rate being with first generation cephalosporins
  • Hemolysis (rarely)
  • Disulfiram-like reaction
  • Vitamin K deficiency
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6
Q

Second generation cephalosporins

Cefuroxime sodium, Cefuroxime axetil, Cefoxitin, Cefotetan, Cefaclor

A
  • Hypersensitivity (2%): cross-allergy with penicillins is around 5% with the highest rate being with first generation cephalosporins
  • Hemolysis (rarely)
  • Disulfiram-like reaction
  • Vitamin K deficiency
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7
Q

Third generation cephalosporins

Cefdinir, Cefixime, Ceftriaxone, Cefotaxime, Ceftazidime, Ceftibuten

A
  • Hypersensitivity (2%): cross-allergy with penicillins is around 5% with the highest rate being with first generation cephalosporins
  • Hemolysis (rarely)
  • Disulfiram-like reaction
  • Vitamin K deficiency
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8
Q

Fourth generation cephalosporins

Cefepime

A
  • Hypersensitivity (2%): cross-allergy with penicillins is around 5% with the highest rate being with first generation cephalosporins
  • Hemolysis (rarely)
  • Disulfiram-like reaction
  • Vitamin K deficiency
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9
Q

Fifth (Advanced) generation cephalosporin

Ceftaroline

A
  • Hypersensitivity (2%): cross-allergy with penicillins is around 5% with the highest rate being with first generation cephalosporins
  • Hemolysis (rarely)
  • Disulfiram-like reaction
  • Vitamin K deficiency
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10
Q

Carbapenems

Imipenem, Meropenem, Doripenem, Ertapenem

A
  • GI distress
  • Drug fever
  • Seizures with high blood levels
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11
Q

Monobactams

Aztreonam

A
  • Phlebitis
  • Occasional GI upset
  • Skin rash
  • Rarely abnormal liver function tests
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12
Q

Vancomycin

A
  • Red man syndrome (histamine release)
  • Ototoxicity (usually permanent, additive with other drugs)
  • Nephrotoxicity (mild, but additive with other drugs)
  • Thrombophlebitis
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13
Q

Daptomycin

A
  • Hypo or hypertension and edema
  • GI upset
  • Myalgias and rhabdomyolysis
  • Insomnia
  • Hypersensitivity
  • Eosinophilia
  • Life-threatening eosinophilic pneumonia
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14
Q

Telavancin

A
  • Taste disturbance
  • Foamy urine
  • QTc interval prolongation
  • Interferes with coagulation labs (PT/INR, aPTT, ACT)
  • Not recommended in pregnancy
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15
Q

Fosfomycin

A
  • Nausea, diarrhea
  • Vaginitis
  • Headache
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16
Q

Polymyxins

Polymyxin B, Colistin [Polymyxin E]

A
  • Nephrotoxicity

- Neurotoxicity (slurred speech, muscle weakness)

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17
Q

Tetracyclines

Tetracycline, Doxycycline, Minocycline, Demeclocycline

A
  • GI distress and esophagitis
  • Deposition in calcified tissues leading to teeth hypoplasia and temporary stunting of growth
  • Photoxicity: severe sun burn (tetracycline and demeclocycline)
  • Vestibular dysfunction: dizziness, vertigo and tinnitus (minocycline and doxycycline)
  • Pseudotumor cerebri: benign intracranial hypertension (headache and blurred vision) reversed by discontinuation
  • Hepatotoxicity: occur with high doses in pregnancy
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18
Q

Glycylcyclines

Tigecycline

A
  • Photosensitivity, pseudotumor cerebri, deposition in calcified tissues
  • Nausea and vomiting
  • Acute pancreatitis which may be fatal
  • Elevated liver and kidney function tests
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19
Q

Aminoglycosides

Amikacin, Gentamicin, Neomycin, Streptomycin, Tobramycin

A
  • Ototoxicity (2%) deafness (irreversible) and vertigo (streptomycin). Enhanced by loop diuretics
  • Nephrotoxicity (7%): includes proteinuria, hypokalemia, acidosis, acute tubular necrosis which enhanced by other nephrotoxic drugs
  • Neuromuscular paralysis: rapid increase in concentrations or concurrent administration with neuromuscular blockers.
  • Allergic reactions: contact dermatitis with topically applied neomycin
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20
Q

Macrolides/Ketolides

Azithromycin, Clarithromycin, Erythromycin, Telithromycin

A
  • GI distress and increased gastric emptying especially with erythromycin
  • Cholestatic jaundice (erythromycin)
  • Ototoxicity (transient deafness with erythromycin and irreversible with azithromycin)
  • Severe hepatotoxicity (telithromycin)
  • Prolong QTc interval
  • Inhibit cytochrome P-450 (except azithromycin)
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21
Q

Fidaxomicin

A
  • Nausea, vomiting, and abdominal pain
  • Hypersensitivity including angioderma, dyspnea, and pruritis
  • Cross-allergy with macrolides
  • Anemia and neutropenia (rarely)
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22
Q

Clindamycin

A
  • Diarrhea (pseudomembranous colitis)
  • Rash
  • Fever
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23
Q

Chloramphenicol

A
  • Anemias: hemolytic anemia (G6PD) or aplastic anemia (dose-independent and can occur after stopping the therapy)
  • Gray baby syndrome (poor feeding, depressed breathing, cardiovascular collapse, cyanosis, and death)
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24
Q

Quinupristin/Dalfopristin

A
  • Venous irritation when administered through a peripheral line
  • Hyperbilirubinemia (25%)
  • Arthralgia and myalgia
  • Inhibits cytochrome P-450
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25
Q

Linezolid

A
  • GI upset
  • Nausea and diarrhea
  • Headache
  • Rash
  • Thromcytopenia (longer than 10 days use)
  • Serotonin syndrome interaction with SSRIs and tyramine-containing food or monoamine oxidase inhibitors
  • Irreversible peripheral neuropathies and optic neuritis (causing blindness) [more than 28 days use]
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26
Q

Fluoroquinolones

Ciprofloxacin, Levofloxacin, Moxifloxacin, Nalidixic acid, Norfloxacin, Ofloxacin

A
  • Nausea, vomiting and diarrhea
  • Headache and dizziness
  • Peripheral neuropathy
  • Glucose dysregulation (hypo or hyperglycemia)
  • Phototoxicity
  • Tendinitis and tendon rupture
  • Prolong QTc interval (especially moxifloxacin)
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27
Q

Sulfonamides

Mafenide, Silver sulfadiazine, Sulfasalazine, Sulfadoxine

A
  • Crystalluria: which may lead to nephrotoxicity
  • Hypersensitivity: rashes, angioderma or Stevens-Johnson syndrome
  • Hemolytic anemia (G6PD), granulocytopenia, thrombocytopenia (also may be agranulocytosis and aplastic anemia)
  • Kernicterus
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28
Q

Trimethoprim and pyrimethamine

A
  • Megaloblastic anemia (Rx folic acid)
  • Leukopenia
  • Granulocytopenia
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29
Q

Methenamine

A
  • GI distress

- Albuminuria, hematuria and rashes (at higher doses)

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30
Q

Nitrofurantoin

A
  • Hemolytic anemia (G6PD)
  • GI distress
  • Acute pneumonitis
  • Interstitial pulmonary fibrosis (in chronic use)
  • Neurologic problems
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31
Q

Isoniazid

A
  • Hepatitis (increased incidence in persons greater than 35 years, taking rifampin, or drink alcohol daily)
  • Peripheral neuropathy (paresthesia of hands and feet) can be treated with pyridoxine
  • CNS adverse effects including seizures
  • Hypersensitivity including rashes and fever
  • Drug induced SLE
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32
Q

Rifamycins

Rifampin, Rifabutin, Rifapentine

A
  • Nausea, vomiting and rash
  • Hepatitis
  • Flu-like syndrome (high doses) fever, chills, and myalgia sometimes extending to acute renal failure, hemolytic anemia and shock
  • Orange discoloration of urine and tears
  • Uveitis, skin hyperpigmentation, and neutropenia (Rifabutin)
33
Q

Pyrazinamide

A
  • Hepatitis

- Hyperuricemia

34
Q

Ethambutol

A
  • Decreased visual acuity and red-green color blindness (optic neuropathy)
  • Hyperuricemia
35
Q

Para-aminosalicylic acid (4-Aminosalicylic acid)

A
  • GI intolerance
  • Hepatotoxicity
  • Hypothyroidism
36
Q

Capreomycin and Viomycin

A
  • Nephrotoxicity

- Ototoxicity

37
Q

Cycloserine

A
  • CNS toxicity: leading to depression, anxiety, confusion and seizures
  • Increased serum creatinine
38
Q

Ethionamide

A
  • GI intolerance
  • Hepatotoxicity
  • Hypothyroidism
39
Q

Clofazimine

A
  • Pink to brownish-black discoloration of the skin

- Eosinophilic and other forms of enteritis that may require surgery

40
Q

Dapsone

A
  • Hemolytic anemia (G6PD)
  • Methemoglobinemia
  • Peripheral neuropathy
41
Q

Bedaquiline

A
  • Prolong QTc interval
42
Q

Polyenes

Amphotericin B, Nystatin

A
  • Fever and chills (1 to 3 hours after starting administration), premedication with corticosteroid or antipyretic prevents this problem
  • Renal impairment
  • Hypotension (shock like) with hypokalemia
  • Thrombophlebitis (adding heparin can alleviate this problem)
43
Q

Flucytosine

A
  • Reversible neutropenia, thrombocytopenia, and dose-related bone marrow suppression
  • Reversible hepatic dysfunction (elevated transaminases and alkaline phosphatase)
  • GI distress
  • Severe enterocolitis
44
Q

Azoles

Fluconazole, Itraconazole, Posaconazole, Voriconazole

A
  • Decreased testosterone synthesis (gynecomastia, decreased lipido, and menstrual irregularities)
  • Hepatic dysfunction
45
Q

Echinocandins

Caspofungin, Micafungin, Anidulafungin

A
  • GI upset

- Histamine-like reaction

46
Q

Squalene epoxidase Inhibitors

Terbinafine, Natifine, Butenafine, Tolnaftate

A
  • GI upset
  • Headaches
  • Hepatotoxicity
  • Taste disturbance
47
Q

Griseofulvin

A
  • Headache and confusion

- Teratogenic and carcinogenic

48
Q

Imidazoles (Azole derivatives)
(Butoconazole, Clotrimazole, Econazole, Ketoconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole, Terconazole, Tioconazole)

A
  • Nausea and vomiting

- Hepatic dysfunction (especially ketoconazole)

49
Q

Ciclopirox

A

Burning, redness and itching at the site of application

50
Q

Nitroimidazoles

Metronidazole, Tinidazole, Mebendazole, Ornidazole, Megazol, Azanidazole, Benznidazole, Thiabendazole, Albendazole

A
  • Nausea, vomiting, epigastric distress and abdominal cramps
  • Metallic taste
  • Oral moniliasis
  • Neurotoxicity (dizziness, vertigo, numbness and paresthesia)
  • Disulfiram-like effect
  • Dermatitis, peripheral neuropathy, insomnia and anorexia (Benznidazole)
51
Q

8-Aminoquinolines

Primaquine, Pamaquine, Tafenoquine, Iodoquinol [halogenated hydroxyquinoline]

A
  • Diarrhea
  • Rash
  • Dose-related peripheral neuropathy including rare optic neuritis (Iodoquinol)
  • Drug induced hemolytic anemia in G6PD (Primaquine)
52
Q

Paromomycin (aminoglycoside)

A

GI distress and diarrhea

53
Q

4-Aminoquinolines

Amodiaquine, Chloroquine, Hydroxychloroquine

A
  • GI upset
  • Pruritis, headache and blurred vision
  • Discoloration of nail beds and mucus membranes (long-term use)
  • Prolong QT interval
54
Q

Dehydroemetine

A
  • Pain at site of injection
  • Nausea
  • Cardiotoxicity (arrhythmias and CHF)
  • Neuromuscular weakness and dizziness
  • Rash
55
Q

Atovaquone-proguanil

A
  • Nausea, vomiting, abdominal pain, diarrhea, and anorexia

- Headache and dizziness

56
Q

Mefloquine

A
  • Nausea and vomiting
  • Dizziness
  • Disorientation, hallucination and depression
  • ECG abnormalities and cardiac arrest (with quinine or quinidine)
57
Q

Quinine

A
  • Cinchonism (nausea, vomiting, tinnitus, and vertigo)

- Hemolytic anemia

58
Q

Artemisinin

A
  • Nausea, vomiting and diarrhea
  • Prolong QT interval
  • Rash and hypersensitivity reactions
59
Q

Pentamidine

A
  • Serious renal dysfunction (reversible)
  • Hyperkalemia, hypotension, hypoglycemia or hyperglycemia and diabetes
  • Pancreatitis
60
Q

Suramin

A
  • Nausea and vomiting
  • Shock and loss of consciousness
  • Acute urticaria and blepharitis
  • Paresthesia, photophobia, hypersensitivity of hands and feet
  • Renal insufficiency
  • Acute hypersensitivity reactions
61
Q

Melarsoprol

A
  • Reactive encephalopathy (10% fatal)
  • Peripheral neuropathy, hypertension, and albuminuria
  • Hypersensitivity reactions and fever
  • Hemolytic anemia in G6PD
62
Q

Eflornithine

A
  • Anemia
  • Seizures
  • Temporary hearing loss
63
Q

Nifurtimox

A
  • Hypersensitivity reactions (anaphylaxis, dermatitis)
  • GI problems that can cause weight loss
  • Peripheral neuropathy
  • Headache and dizziness
64
Q

Sodium Stibogluconate

A
  • Injection site pain
  • Pancreatitis
  • Elevated liver enzymes
  • Arthralgias and myalgias
  • GI upset
  • Cardiac arrhythmias
65
Q

Miltefosine

A
  • Nausea and vomiting

- Teratogenic

66
Q

Pyrantel Pamoate

A

Nausea, vomiting and diarrhea

67
Q

Ivermectin

A

Severe Mazzotti reaction (fever, headache, dizziness, somnolence, and hypotension)

68
Q

Diethylcarbamazine

A
  • Nausea and vomiting
  • Arthralgia and headache
  • Accelerate blindness and cause severe Mazzotti reaction in patient with onchocerciasis (Contraindicated in those patients)
69
Q

Praziquantel

A
  • Dizziness, malaise and headache
  • GI upset
  • Contraindicated in Rx of eye cysticercosis cuz it may cause irreversible damage
70
Q

Niclosamide

A
  • Vomiting, diarrhea, abdominal pain
  • Perineal itching and unpleasant taste
  • Dizziness and rash
71
Q

Neuraminidase Inhibitors

Oseltamivir, Zanamivir

A
  • GI discomfort and nausea (oseltamivir)

- Irritation of respiratory tract (zanamivir)

72
Q

Adamantane antivirals

Amantadine, Rimantadine

A
  • Insomnia, dizziness and ataxia

- Hallucinations and seizures

73
Q 
Nucleoside Analogs 
Guanosine (Ribavirin, Entecavir, Acyclovir, Ganciclovir, Penciclovir, Famciclovir)
Cytosine (Lamivudine, Cidofovir)
Thymidine (Telbivudine, Trifluridine)
Non-specific (Adefovir, Foscarnet)
A
  • Acyclovir, famciclovir, valacyclovir (Obstructive crystalline nephropathy and renal failure if not adequately hydrated)
  • Ganciclovir (Bone marrow suppression, renal toxicity)
  • Foscarnet (Nephrotoxicity, electrolytes imbalance [hypo or hyper calcemia and phosphatemia, hypokalemia, hypomagnesmia] can lead to seizures)
  • Cidofovir (Nephrotoxicity, Rx co-administration with probenecid and IV saline)
74
Q

Nucleoside or Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
Guanosine (Abacavir[ABC])
Cytosine (Emtricitabine[FTC])
Thymidine (Stavudine[d4T])
Adenosine (Tenofovir[TDF])
Non-specific (Zidovudine[AZT], Didanosine[ddl])

A
  • As a general rule dideoxynucleosides like didanosine and stavudin have greater affinity to mitochondrial DNA polymerase and hence more adverse effects
  • Peripheral neuropathy, pancreatitis, lipoatrophy, potentially fatal liver toxicity (with lactic acidosis, hepatomegaly and steatosis)
  • Zidovudine(bone marrow toxicity[anemia,neutropenia])
  • Didanosine (pancreatitis which may be fatal)
  • Emtricitabine fluoro derivative of lamivudine
  • Abacavir (Hypersensitivity reaction including fever, rash, respiratory distress) HLA-B*5701 used to screen for this possible reaction
75
Q

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Nevirapine[NVP], Delavirdine[DLV], Efavirenz[EFV], Etravirine[ETR], Rilpivirine[RPV]

A
  • All rash and hepatotoxicity
  • Nevirapine (Stevens-Johnson syndrome and toxic epidermal necrolysis which mandates a 14-day titration period at half the dose)
  • Efavirenz (Headache, dizziness, vivid dreams, loss of concentration)
  • Rilpivirine (depressive disorders, insomnia)
  • Delavirdine and efavirenz are contraindicated in pregnancy
76
Q 
Protease Inhibitors (PIs)
(Boceprevir/Telaprevir, Ritonavir[RTV], Saquinavir[SQV], Indinavir[IDV], Nelfinavir[NFV], Fosfamprenavir[FPV], Lopinavir[LPV/r], Atazanavir[ATV], Tipranavir[TPV], Darunavir[DRV], Simeprevir)
A
  • Nausea, vomiting and diarrhea
  • Disturbances in glucose and fat metabolism (diabetes, hyperglycemia, hypertriglyceridemia, hypercholesterolemia)
  • Fat redistribution including loss of fat from extremities and accumulation in abdomen, base of the neck (bufallo hump) and breast enlargement
  • Circum-oral paresthesia (Ritonavir)
  • Nephrolithiasis, hyperbilirubinemia and fat redistribution (Indinavir)
  • Hyperbilirubinemia and prolonged PR interval (Atazanavir)
  • Severe and fatal hepatitis and rare intracranial hemorrhage (Tipranavir)
  • Anemia and dysgeusia (Boceprevir)
  • Rash, anemia and anorectal discomfort (Telaprevir)
  • Rash, pruritis and photosensitivity (Simeprevir)
77
Q 
Entry Inhibitors
(Enfuvirtide, Maraviroc)
A

Erythema, pain and nodules at site of injection which occur in almost all patients (Enfuvirtide)

78
Q

Integrase Inhibitors

Raltegravir, Elvitegravir, Dolutegravir

A
  • Elevated creatine kinase, muscle pain, rhabdomyolysis and possible depression with suicidal ideation (Raltegravir)
  • Nausea and elevated serum creatinine (Dolutegravir and Elvitegravir especially when administered with cobicistat [a pharmacokinetic enhancer or booster])
79
Q

Interferons

A
  • Flu-like symptoms
  • Depression, somnolence and behavioral disturbances
  • Bone marrow suppression
  • Severe fatigue, weight loss and myopathy
  • Autoimmune disorders like thyroiditis and rarely heart failure

Chemotherapy (4 decks)

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