Antibiotic DRUG ADRs Flashcards
Penicillin Adverse effects. (3)
(Well tolerated).
Diarrhea (much higher w/ clavulin.)
Rarely: seizures. Hyperkalemia (with rapid IV Pen G injection).
Penicillin Interactions.
Caution in renal impairment (accumulation = seizures). No serious interactions.
Cephalosporin Adverse effects.
(Well tolerated).
Diarrhea
Rarely: seizures (in low renal fxn accumulation)
Cephalosporin Interactions.
Caution in renal impairment (accumulation = seizures).
Probenecid decreases elimination.
Antacids decrease absorption.
Carbapenem Adverse effects.
Caution in renal impairment (accumulation = seizures).
Neutropenia.
Carbapenem Interactions.
Cilistatin - decreases renal excretion.
Vancomycin adverse effects.
Red man syndrome: histamine relase = redness, pruritis, hypotension.
Ototoxic, nephrotoxic (dose dependant - not time dependant)
Ciprofloxacin adverse effects.
Dizziness, headache,seizures
Hepatitis, Photosensitivity, GI upset.
Cartilage toxicity,
QT prolongation
Levofloxacin/Moxifloxacin adverse effects.
Dizziness, headache,seizures
Hepatitis, Photosensitivity, GI upset.
Cartilage toxicity,
QT prolongation
Not in Children <18 years
Fluoroquinolone interactions.
Metals/ions/antacids decrease absorption.
NSAIDs increase risk of seizure.
Probenecid/cimetidine inhibit excretion - = increased serum levels.
CIPRO = cyp 3A4 inhib watch warfarin/INR
Aminoglycoside adverse effects.
Reversible nephrotoxicity
Irreversible ototoxicity
parasthesias
Aminoglycoside interactions.
Caution w/ coadminstraiton of other nephrotoxic drugs (vancomycin)
Caution with diuretics - increase risk of renal damage.
SMX-TMP adverse effects.
Nausea, vomiting, rash, photosensitivity,
Bone marrow suppression/ hemolytic anemia.
Nephrotoxic (crystalluria)
SMX-TMP interactions.
Increase INR with warfarin.
Increase bone marrow suppression w/ MTX
Macrolide adverse effects.
QT prolongation (erythro + clarithro)
GI Cramping
(rare) Hepatoxicity(erythromycin estolate) = cholestatic jaundice
(rare) ototoxicity
Macrolide interactions.
Clarithro + erythro = cyp 3A4 inhibs - increase warfarin etc.
Clindamycin adverse effects.
Diarrhea, pseudomembranous colitis (c.dif!)
Thrombophlebitis if IV
Skin Rash
Clindamycin interactions.
(none)
Tetracyline adverse effects.
Nausea, Vomiting, diarrhea, Rash.
Photosensitivity.
Tetracycline interactions.
Cyp 3A4 subtrate - caution w/ phenytoin, carb,
May increase INR w/ warfarin.
Caution w/ dairy (minimal effect)
Caution w/ aluminum, bismuth, iron, mg absorption.
Metronidazole adverse effects.
GI upset
Dark or reddish brown discoloration of urine.
Metallic taste.
Metronidazole interactions.
Disulfiram like reaction w/ alcohol!
Rifampin adverse effects
Rash, orange discoloration of body fluids (stains contact lens), nausea, vomiting, hepatic toxicity, thrombocytopenia.
Rifampin interactions
Potent Cyp inducer - decreases levels of warfarin, CNI’s, phenytoin, COC.
Isoniazid adverse effects
How to offset.
Asymptomatic increase in hepatic ezymes + bilirubin. Hepatitis (wks to months).
Peripheral neuropathy (dose related).
Drug induced lupus
Seizures, drowsiness.
Gynecomastia.
GI Upset
Bone marrow suppression
(Isopropyl - liver toxicity - seizures, drowsiness, - fell and got attacked by dog (lupus) - bled out (bonemarrow suppression) - numbness in leg (peripheral neuropathy.
Prescribe pyridoxine 50mg/day to prevent peripheral neuropathy.
Isoniazid interactions
Increased hepatotoxicity with other hepatotoxic drugs (alcohol, apap, rifampin)
Increased serum levels of CBZ, phenytoin, theophylline (cyp inhibitor)
Pyrazinamide adverse effects
Hepatotoxicity -
Arthralgia/ gout
Drug fever
Rash
Bone marrow suppression
Pyrazinamide sets a fire in your joints, your skin, you liver.
Pyrazinamide interactions
Increases rifampin levels
Ethambutolol adverse effects
Ocular toxicity - red/greeen color blindness -
skin rash - SJS, TEN.
Bone marrow suppression
Neurologic effects: H/A, dizziness, confusion, hallucinations.
Someone pours boiling alcohol into your eye. Scalds your skin. Then you drink it.
Ethambutolol interactions
Binds to mg++ separate doses by at least 4 hours
TB treatments contraindicated in pregnancy (2)
Streptomycin = congenital deafness.
Pyrazinamide - caution - not to be used if can be avoided. (burns fetus?)
Which TB drug to switch out in HIV (1)
Rifampin —> Rifabutin (less enzyme induction = safer with protease inhibitors)
Which TB drugs cause hepatotoxicity. (3)
Rifampin. Isoniazid. Pyrazinamide.
Antibiotics NOT safe in pregnancy.
SMX/TMP - 1st trim = Neural tube defect. 3rd Trim = kernicterus
Tetracyclines - staining of teeth and bone problems
Nitrofurantoin (3rd tim)
Cipro - not in 1st trimester
Macrolides: erythro preferred (just no estolate salt)
Antibiotics NOT safe in lactation.
All except ciprofloxacin, tetracyclines, and metronidazole are OK in breastfeeding.
How does ceftazidime differ from other 3rd generation ceph’s (cefotaxime, ceftriaxone)
Increased gram (-) coverage (covers SPACE bugs + Pseudomonas), decreased gram (+) - to basically nothing.
Chloroquine adverse effects
Non-allergic pruritis in african americans. Vomiting, headache. Bitter taste.
Uncommon: bone marrow suppression, eye problems, hair depigmentation, Rash.
Rare - retinopathy/myopathy.
Chloroquine interactions
NONE. Retinal toxicity with continuous use. Check eyes q 6-12 months.
Mefloquine adverse effects
Common: GI sxs. Nightmares, anxiety, personality changes.
Rare: hair loss, skin rash, seizures, psychosis, thobotic purpura.
Kumar - lost hair, went crazy, dark skin.
Primaquine adverse effects
Hemolysis- G-6-Pd deficiency. Contraindicated in pregnancy (fetus GP6- status is unknown).
Mefloquine is contraindicated in patients with.
Seizures, depression, anixiety disorders.
