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
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
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
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
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
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
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
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
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
10
Q
Carbapenems
Imipenem, Meropenem, Doripenem, Ertapenem
A
- GI distress
- Drug fever
- Seizures with high blood levels
11
Q
Monobactams
Aztreonam
A
- Phlebitis
- Occasional GI upset
- Skin rash
- Rarely abnormal liver function tests
12
Q
Vancomycin
A
- Red man syndrome (histamine release)
- Ototoxicity (usually permanent, additive with other drugs)
- Nephrotoxicity (mild, but additive with other drugs)
- Thrombophlebitis
13
Q
Daptomycin
A
- Hypo or hypertension and edema
- GI upset
- Myalgias and rhabdomyolysis
- Insomnia
- Hypersensitivity
- Eosinophilia
- Life-threatening eosinophilic pneumonia
14
Q
Telavancin
A
- Taste disturbance
- Foamy urine
- QTc interval prolongation
- Interferes with coagulation labs (PT/INR, aPTT, ACT)
- Not recommended in pregnancy
15
Q
Fosfomycin
A
- Nausea, diarrhea
- Vaginitis
- Headache
16
Q
Polymyxins
Polymyxin B, Colistin [Polymyxin E]
A
- Nephrotoxicity
- Neurotoxicity (slurred speech, muscle weakness)
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
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
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
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)
21
Q
Fidaxomicin
A
- Nausea, vomiting, and abdominal pain
- Hypersensitivity including angioderma, dyspnea, and pruritis
- Cross-allergy with macrolides
- Anemia and neutropenia (rarely)
22
Q
Clindamycin
A
- Diarrhea (pseudomembranous colitis)
- Rash
- Fever
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)
24
Q
Quinupristin/Dalfopristin
A
- Venous irritation when administered through a peripheral line
- Hyperbilirubinemia (25%)
- Arthralgia and myalgia
- Inhibits cytochrome P-450
25
Linezolid
- 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]
26
Fluoroquinolones
| Ciprofloxacin, Levofloxacin, Moxifloxacin, Nalidixic acid, Norfloxacin, Ofloxacin
- Nausea, vomiting and diarrhea
- Headache and dizziness
- Peripheral neuropathy
- Glucose dysregulation (hypo or hyperglycemia)
- Phototoxicity
- Tendinitis and tendon rupture
- Prolong QTc interval (especially moxifloxacin)
27
Sulfonamides
| Mafenide, Silver sulfadiazine, Sulfasalazine, Sulfadoxine
- 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
28
Trimethoprim and pyrimethamine
- Megaloblastic anemia (Rx folic acid)
- Leukopenia
- Granulocytopenia
29
Methenamine
- GI distress
| - Albuminuria, hematuria and rashes (at higher doses)
30
Nitrofurantoin
- Hemolytic anemia (G6PD)
- GI distress
- Acute pneumonitis
- Interstitial pulmonary fibrosis (in chronic use)
- Neurologic problems
31
Isoniazid
- 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
32
Rifamycins
| Rifampin, Rifabutin, Rifapentine
- 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
Pyrazinamide
- Hepatitis
| - Hyperuricemia
34
Ethambutol
- Decreased visual acuity and red-green color blindness (optic neuropathy)
- Hyperuricemia
35
Para-aminosalicylic acid (4-Aminosalicylic acid)
- GI intolerance
- Hepatotoxicity
- Hypothyroidism
36
Capreomycin and Viomycin
- Nephrotoxicity
| - Ototoxicity
37
Cycloserine
- CNS toxicity: leading to depression, anxiety, confusion and seizures
- Increased serum creatinine
38
Ethionamide
- GI intolerance
- Hepatotoxicity
- Hypothyroidism
39
Clofazimine
- Pink to brownish-black discoloration of the skin
| - Eosinophilic and other forms of enteritis that may require surgery
40
Dapsone
- Hemolytic anemia (G6PD)
- Methemoglobinemia
- Peripheral neuropathy
41
Bedaquiline
- Prolong QTc interval
42
Polyenes
| Amphotericin B, Nystatin
- 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
Flucytosine
- Reversible neutropenia, thrombocytopenia, and dose-related bone marrow suppression
- Reversible hepatic dysfunction (elevated transaminases and alkaline phosphatase)
- GI distress
- Severe enterocolitis
44
Azoles
| Fluconazole, Itraconazole, Posaconazole, Voriconazole
- Decreased testosterone synthesis (gynecomastia, decreased lipido, and menstrual irregularities)
- Hepatic dysfunction
45
Echinocandins
| Caspofungin, Micafungin, Anidulafungin
- GI upset
| - Histamine-like reaction
46
Squalene epoxidase Inhibitors
| Terbinafine, Natifine, Butenafine, Tolnaftate
- GI upset
- Headaches
- Hepatotoxicity
- Taste disturbance
47
Griseofulvin
- Headache and confusion
| - Teratogenic and carcinogenic
48
Imidazoles (Azole derivatives)
(Butoconazole, Clotrimazole, Econazole, Ketoconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole, Terconazole, Tioconazole)
- Nausea and vomiting
| - Hepatic dysfunction (especially ketoconazole)
49
Ciclopirox
Burning, redness and itching at the site of application
50
Nitroimidazoles
| Metronidazole, Tinidazole, Mebendazole, Ornidazole, Megazol, Azanidazole, Benznidazole, Thiabendazole, Albendazole
- 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
8-Aminoquinolines
| Primaquine, Pamaquine, Tafenoquine, Iodoquinol [halogenated hydroxyquinoline]
- Diarrhea
- Rash
- Dose-related peripheral neuropathy including rare optic neuritis (Iodoquinol)
- Drug induced hemolytic anemia in G6PD (Primaquine)
52
Paromomycin (aminoglycoside)
GI distress and diarrhea
53
4-Aminoquinolines
| Amodiaquine, Chloroquine, Hydroxychloroquine
- GI upset
- Pruritis, headache and blurred vision
- Discoloration of nail beds and mucus membranes (long-term use)
- Prolong QT interval
54
Dehydroemetine
- Pain at site of injection
- Nausea
- Cardiotoxicity (arrhythmias and CHF)
- Neuromuscular weakness and dizziness
- Rash
55
Atovaquone-proguanil
- Nausea, vomiting, abdominal pain, diarrhea, and anorexia
| - Headache and dizziness
56
Mefloquine
- Nausea and vomiting
- Dizziness
- Disorientation, hallucination and depression
- ECG abnormalities and cardiac arrest (with quinine or quinidine)
57
Quinine
- Cinchonism (nausea, vomiting, tinnitus, and vertigo)
| - Hemolytic anemia
58
Artemisinin
- Nausea, vomiting and diarrhea
- Prolong QT interval
- Rash and hypersensitivity reactions
59
Pentamidine
- Serious renal dysfunction (reversible)
- Hyperkalemia, hypotension, hypoglycemia or hyperglycemia and diabetes
- Pancreatitis
60
Suramin
- 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
Melarsoprol
- Reactive encephalopathy (10% fatal)
- Peripheral neuropathy, hypertension, and albuminuria
- Hypersensitivity reactions and fever
- Hemolytic anemia in G6PD
62
Eflornithine
- Anemia
- Seizures
- Temporary hearing loss
63
Nifurtimox
- Hypersensitivity reactions (anaphylaxis, dermatitis)
- GI problems that can cause weight loss
- Peripheral neuropathy
- Headache and dizziness
64
Sodium Stibogluconate
- Injection site pain
- Pancreatitis
- Elevated liver enzymes
- Arthralgias and myalgias
- GI upset
- Cardiac arrhythmias
65
Miltefosine
- Nausea and vomiting
| - Teratogenic
66
Pyrantel Pamoate
Nausea, vomiting and diarrhea
67
Ivermectin
Severe Mazzotti reaction (fever, headache, dizziness, somnolence, and hypotension)
68
Diethylcarbamazine
- Nausea and vomiting
- Arthralgia and headache
- Accelerate blindness and cause severe Mazzotti reaction in patient with onchocerciasis (Contraindicated in those patients)
69
Praziquantel
- Dizziness, malaise and headache
- GI upset
- Contraindicated in Rx of eye cysticercosis cuz it may cause irreversible damage
70
Niclosamide
- Vomiting, diarrhea, abdominal pain
- Perineal itching and unpleasant taste
- Dizziness and rash
71
Neuraminidase Inhibitors
| Oseltamivir, Zanamivir
- GI discomfort and nausea (oseltamivir)
| - Irritation of respiratory tract (zanamivir)
72
Adamantane antivirals
| Amantadine, Rimantadine
- Insomnia, dizziness and ataxia
| - Hallucinations and seizures
73
```
Nucleoside Analogs
Guanosine (Ribavirin, Entecavir, Acyclovir, Ganciclovir, Penciclovir, Famciclovir)
Cytosine (Lamivudine, Cidofovir)
Thymidine (Telbivudine, Trifluridine)
Non-specific (Adefovir, Foscarnet)
```
- 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
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])
- 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](hyperpigmentation of soles and palms, worsening of hepatitis on withdrawal in HBV)
- Abacavir (Hypersensitivity reaction including fever, rash, respiratory distress) HLA-B*5701 used to screen for this possible reaction
75
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
| Nevirapine[NVP], Delavirdine[DLV], Efavirenz[EFV], Etravirine[ETR], Rilpivirine[RPV]
- 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
```
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)
```
- 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
```
Entry Inhibitors
(Enfuvirtide, Maraviroc)
```
Erythema, pain and nodules at site of injection which occur in almost all patients (Enfuvirtide)
78
Integrase Inhibitors
| Raltegravir, Elvitegravir, Dolutegravir
- 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
Interferons
- 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
