AEs

Question 1

Beta-lactams

Answer 1

Hypersensitivity reactions

Seizures (high doses)

Question 2

Natural PCNs

Answer 2

Normal beta-lactam AEs

Question 3

Anti-staphylococcal PCNs

Answer 3

Normal beta-lactam AEs
Interstitial nephritis
Phlebitis

Question 4

Aminopenicillins

Answer 4

Normal beta-lactam AEs

Diarrhea w/PO (more common with ampicillin than amoxicillin b/c amox. is better absorbed)

Question 5

Antipseudomonal PCNs

Answer 5

Normal beta-lactam AEs

Question 6

Beta-lactam/Beta-lactamase inhibitor combinations

Answer 6

Normal beta-lactam AEs

Question 7

1st Generation Cephalosporins

Answer 7

Normal beta-lactam AEs

Question 8

2nd Generation Cephalosporins

Answer 8

Normal beta-lactam AEs

Cefotetan can inhibit Vit K production and prolong bleeding; can also cause disulfuram-like rxn when given with ethanol

Question 9

3rd Generation Cephalosporins

Answer 9

Normal beta-lactam AEs

Ceftriaxone can lead to biliary sludging and hyperbilirubinemia in neonates; best to use cefotaxime instead

Question 10

4th Generation Cephalosporins

Answer 10

Normal beta-lactam AEs

Question 11

Anti-MRSA Cephalosporins

Answer 11

Normal beta-lactam AEs

Question 12

Cephalosporins/Beta-lactamase inhibitors

Answer 12

Normal beta-lactam AEs

Question 13

Carbapenems

Answer 13

Normal beta-lactam AEs
Increased risk of seizures; esp w/imipenem; minimize risk by using appropriate adj. and avoid imipenem in patients with CNS infxns (d/t ability to cross BBB more readily)

Question 14

Monobactams

Answer 14

Normal beta-lactam AEs

Low incidence of hypersensitivity

Question 15

Fluoroquinolones

Answer 15

CNS (dizziness, confusion, hallucinations, peripheral neuropathy, insomnia)
CV (QT prolongation)
Musculoskeletal (arthralgies [common], achilles tendon rupture [BBW: very rare, more likely in the elderly, renal dysfunction, and patients on corticosteroids])
Dermatologic (photosensitivity)
Developmental (contraindicated in pregnancy and children [cartilage lesions seen in juvenile beagle dogs])

Question 16

Macrolides and Ketolides

Answer 16

GI: worst with erythromycin (it is used as a prokinetic agent for patients with impaired GI motility)
Hepatic: rare but serious (recent reports with telithromycin-induced hepatic failure leading to transplantation and death)
CV: Increased QT interval (use with caution in patients with pre-existing heart conditions, those on anti-arrhythmics, or taking interacting drugs)

Question 17

Aminoglycosides

Answer 17

Nephrotoxicity: dose-related, risk higher with higher trough concentrations
Ototoxicity: dose-related, risk higher with high peak concentrations and long-term use (> 2 weeks)
Neuromuscular blockade: can occur, esp. in higher doses in patients who are also receiving paralytic agents

Question 18

Vanc.

Answer 18

Ototoxicity/nephrotoxicity have classically been assigned to vanc.
Nephrotoxicity may occur at high doses. The early formulation was brown ad dubbed “Mississippi mud.” The current formulation is clear and lacks those toxic excipients
“Red-Man Syndrome” (pt feels warm, flushed, and can be hypotensive. Can be prevented by slowing the infusion rate or adding antihistamines prior to infusion. Not a true allergy)

Question 19

Telavancin

Answer 19

Renal toxicity
Taste disturbances
Foamy urine
Red Man syndrome
QT prolongation
AVOID pregnancy

Question 20

Dalbavancin

Answer 20

Infusion reactions
AST elevations
Nausea
H/A
Diarrhea

Question 21

Oritavancin

Answer 21

Increases warfarin exposure
Can falsely prolong aPTT for up to 48 hours and PT/INR for up to 24 hours
Infusion reactions
H/A
N/V/D
Limb and SQ abscessess

Question 22

Cyclic Lipopeptides

Answer 22

Muscle pain or weakness
Possibly rhabdomyolysis
Creatine Kinase concentrations should be checked weekly while on therapy

Question 23

Linezolid

Answer 23

Can cause bone marrow suppression (esp. thrombocytopenia) with long term therapy (> 2 weeks)
Can cause peripheral neuropathy, lactic acidosis with long term therapy d/t toxicity to mitochondria

Question 24

Tedizolid

Answer 24

N/V/D

H/A

Question 25

Streptogramins

Answer 25

Phlebitis; should be administered as a central line, if possible
High incidence of myalgias and arthralgias

Question 26

Tetracyclines and glycylcyclines

Answer 26

GI
Photosensitivity
Esophageal irritation
Discoloration of developing teeth
Contraindicated in pregnant women and children < 8yr

Question 27

Nitroimidazoles

Answer 27

GI: N/V/D, metallic taste is common. Hepatitis and pancreatitis are rare.
Neuro: dose-related, reversible peripheral neuropathy reported occasionally

Question 28

Lincosamides

Answer 28

DIARRHEA!!! Can cause self-limiting diarrhea or can result in more severe diarrhea resulting from superinfection with C. difficile.
C. difficile associated diarrhea and colitis can occur during or after clindamycin therapy and can be life-threatening. Pts with diarrhea need evaluation for C. difficile disease, especially if it is severe, associated with fever, or persists after the end of clindamycin therapy

Question 29

Nitrofurans and Fosfomycin

Answer 29

GI: N/V

Peripheral neuropathy may also occur

Question 30

Nitrofurantoin and pulmonary toxicity

Answer 30

Can cause very rare but serious pulmonary toxicity of forms. First is an acute pneumonitis manifesting as cough, fever, and dyspnea. This form typically revolves soon after drug d/c. A chronic pulmonary fibrosis can occur, most commonly with prolonged therapy duration; recovery of lung function is limited after drug d/c.

Question 31

Folate antagonists

Answer 31

Dermatologic (RASH** most common, life-threatening rxns such as toxic epidermal necrolysis and Stevens-Johnson syndrome have been documented)
Hematologic (dose-dependent bone marrow suppression)
Renal (Can cause true and pseudo-renal failure. Crystalluria and acute interstitial nephritis due to the SMX component can lead to acute renal failure; however, the blockade of creatinine secretion by TMP can cause an increase in serum creatinine w/out a true decline in GFR. TMP can also cause hyperkalemia)

Question 32

Fidaxomicin

Answer 32

GI: N/V/D, abdominal pain, GI hemorrhage, anemia, neutropenia