AEs Flashcards
Beta-lactams
Hypersensitivity reactions
Seizures (high doses)
Natural PCNs
Normal beta-lactam AEs
Anti-staphylococcal PCNs
Normal beta-lactam AEs
Interstitial nephritis
Phlebitis
Aminopenicillins
Normal beta-lactam AEs
Diarrhea w/PO (more common with ampicillin than amoxicillin b/c amox. is better absorbed)
Antipseudomonal PCNs
Normal beta-lactam AEs
Beta-lactam/Beta-lactamase inhibitor combinations
Normal beta-lactam AEs
1st Generation Cephalosporins
Normal beta-lactam AEs
2nd Generation Cephalosporins
Normal beta-lactam AEs
Cefotetan can inhibit Vit K production and prolong bleeding; can also cause disulfuram-like rxn when given with ethanol
3rd Generation Cephalosporins
Normal beta-lactam AEs
Ceftriaxone can lead to biliary sludging and hyperbilirubinemia in neonates; best to use cefotaxime instead
4th Generation Cephalosporins
Normal beta-lactam AEs
Anti-MRSA Cephalosporins
Normal beta-lactam AEs
Cephalosporins/Beta-lactamase inhibitors
Normal beta-lactam AEs
Carbapenems
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)
Monobactams
Normal beta-lactam AEs
Low incidence of hypersensitivity
Fluoroquinolones
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])
Macrolides and Ketolides
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)
Aminoglycosides
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
Vanc.
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)
Telavancin
Renal toxicity Taste disturbances Foamy urine Red Man syndrome QT prolongation AVOID pregnancy
Dalbavancin
Infusion reactions AST elevations Nausea H/A Diarrhea
Oritavancin
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
Cyclic Lipopeptides
Muscle pain or weakness
Possibly rhabdomyolysis
Creatine Kinase concentrations should be checked weekly while on therapy
Linezolid
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
Tedizolid
N/V/D
H/A
Streptogramins
Phlebitis; should be administered as a central line, if possible
High incidence of myalgias and arthralgias
Tetracyclines and glycylcyclines
GI Photosensitivity Esophageal irritation Discoloration of developing teeth Contraindicated in pregnant women and children < 8yr
Nitroimidazoles
GI: N/V/D, metallic taste is common. Hepatitis and pancreatitis are rare.
Neuro: dose-related, reversible peripheral neuropathy reported occasionally
Lincosamides
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
Nitrofurans and Fosfomycin
GI: N/V
Peripheral neuropathy may also occur
Nitrofurantoin and pulmonary toxicity
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.
Folate antagonists
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)
Fidaxomicin
GI: N/V/D, abdominal pain, GI hemorrhage, anemia, neutropenia
